Jitse P. van Dijk

Self-esteem and resilience: The connection with risky behavior among adolescents

The aim was to explore the association of self-esteem and resilience with smoking and cannabis use among adolescents, separately for gender. A sample of 3694 adolescents (mean age 14.3 years) from elementary schools in Slovakia filled out the Rosenberg Self-esteem scale, the Resiliency scale and answered questions about cigarette and cannabis use. Logistic regression models showed associations between negative self-esteem and risky behavior, but only among boys. Regarding resilience, structured style and family cohesion were associated with a lower probability of smoking and cannabis use among both boys and girls. In contrast, social competence increased the probability of smoking and cannabis use among both groups. Negative self-esteem seems to play an important role regarding smoking and cannabis use among boys. Resilience seems to have mixed effects, some aspects being protective while other aspects increase the likelihood of smoking and use of cannabis. These results imply that the prevention of substance use should target not only specific individual characteristics, but also the possible risk or protective influences of the social environment, i.e. the family and social network.

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.

Social support as a predictor of perceived health status in patients with multiple sclerosis

OBJECTIVE The main aim of this study was to investigate whether different levels of perceived social support are associated with different levels of perceived health status in multiple sclerosis (MS) patients. METHODS Two hundred and seven MS patients (38.4+/-10.6 years, 66.2% female) completed the Short-Form-36 Health Survey (SF-36) as the measure for perceived health status, and the perceived social support scale (PSSS) as the measure for social support. Functional disability was assessed using Kurtzkes expanded disability status scale (EDSS). The contribution of EDSS and PSSS for explaining the variance in SF-36 was investigated with multiple linear regression analysis. RESULTS Demographic variables and EDSS explained 44% of the variance of the physical health summary scale in the SF-36. Demographic variables, EDSS and PSSS from family and friends explained 24% of the variance in mental health summary scale in the SF-36. Results varied according to the multiple linear regression analyses of predictors of variance in the eight dimensions of the SF-36. CONCLUSION PSSS from significant others was positively associated with general health dimension of perceived physical health status, while PSSS from family and friends was positively associated with perceived mental health status in MS patients. PRACTICE IMPLICATIONS The results show the importance of supporting social ties and relationships between MS patients and others.

Prevalence and characteristics of noncompliant behaviour and its risk factors in kidney transplant recipients

Noncompliance with therapy is one possible explanation for the observation that long‐term graft survival is not sufficiently improved by the development in immunosuppression. The aim of the study was to explore the prevalence, characteristics and risk factors of noncompliance with immunosuppression. A total of 161 adult kidney transplant recipients were interviewed about their self‐rated health, social support, education, stress from adverse effects and compliance with the immunosuppression. The prevalence of subclinical noncompliance was 54%. Noncompliant patients declared significantly worse self‐rated health, less satisfaction with social support and higher stress from adverse effects. Male gender (OR 7.5, CI 2.4–23.39), high stress from adverse effects (OR 12.27, CI 2.44–61.88), fair self‐rated health (OR 4.45, CI 1.04–19.55) and fair satisfaction with social support (OR 4.55, CI 1.08–19.24) were predictors of noncompliance. Standardized detection methods should be developed with the aim of identifying patients who are at risk of noncompliance in order to prevent graft loss.

To what extent does socioeconomic status explain differences in health between Roma and non-Roma adolescents in Slovakia?

The Roma make up one of the largest ethnic groups in Europe. The few studies that are available report health among the Roma as considerably worse than that of the majority population, and virtually nothing is known about the health status of Roma adolescents. The purpose of this study was to compare the self-reported health outcomes of Roma adolescents living in Roma settlements with adolescents from the majority population and to assess the impact of socioeconomic status on the results obtained. We conducted a survey among Roma adolescents (N=330, mean age=14.5) and non-Roma adolescents (N=722, mean age=14.9) living in eastern Slovakia. We gathered data on sociodemographic position, self-rated health (using the SF-36), the occurrence of accidents and injuries during the past year, healthcare utilization during the past year, health complaints, mental health and social desirability. Roma adolescents reported poorer self-rated health, more accidents and injuries during the past year and more frequent use of healthcare during the past year, though fewer health complaints. Furthermore, they reported more prosocial behaviour than non-Roma. No differences appeared in total difficulties. Socioeconomic status decreased the association of ethnicity with health outcomes. Adjustment for social desirability had a significant effect on the differences for all outcomes, except for accidents and injuries during the past year.

The impact of the intensity of fear on patient’s delay regarding health care seeking behavior: a systematic review

ObjectivesThis systematic review focuses on the role of the intensity of fear in patient’s delay in cancer and in myocardial infarction.MethodsIn a search of literature published between 1990 and June 2009, 161 articles were found. After the use of inclusion and exclusion criteria, 11 articles in cancer and 4 articles in myocardial infarction remained.ResultsHigh levels of fear are associated with earlier help-seeking in both diseases; for low levels of fear, the picture is unclear.ConclusionThe level of fear is an important factor, which should be taken into account when facilitating help-seeking by patients.

Fatigue in Parkinson's disease is not related to excessive sleepiness or quality of sleep

OBJECTIVES Many patients with Parkinsons disease (PD) suffer from non-motor symptoms like sleep disturbances, excessive daytime sleepiness and fatigue. The aim of our research was to explore whether fatigue is related to sleepiness and sleep problems, depression and functional status, controlled for age, gender and disease duration. METHODS The sample consisted of 78 PD patients from Eastern Slovakia (52% males, mean age 68.8+/-8.7, mean disease duration 7.2+/-6.8). The Multidimensional Fatigue Inventory (5 dimensions), the Epworth Sleepiness Scale, the Pittsburgh Sleep Quality Index, Hospital Anxiety and Depression Scale and the Unified Parkinsons Disease Rating Scale were used. Demographic data were obtained in a structured interview. Multiple linear regression was used to analyse the data. RESULTS Sleepiness did not show significant association with fatigue in any of the fatigue domains; neither did quality of sleep. Depression was significantly associated with all domains of fatigue, the strongest being the relationship with general fatigue (beta .42), reduced motivation (beta .39), mental fatigue (beta .35) (p<.001), and physical fatigue (beta .31) (p<.01), while the relationship with reduced activity was less strong (beta .22) (p<.05). Worse functional status was significantly related to reduced activity (beta .50), general fatigue (beta .35), physical fatigue (beta .35), and mental fatigue (beta .35) (p<.001). CONCLUSION Fatigue is not related to daytime sleepiness or night-time sleep dysfunction. Fatigue is more strongly influenced by the presence of depression and worse functional status.

Psychological and behavioural factors associated with sexual risk behaviour among Slovak students

BackgroundKnowledge about the prevalence of sexual risk behaviour (SRB) in adolescence is needed to prevent unwanted health consequences. Studies on SRB among adolescents in Central Europe are rare and mostly rely on a single indicator for SRB. This study aims to assess the association of behavioural and psychological factors with three types of SRB in adolescents in Central Europe.MethodsWe obtained data on behavioural factors (having been drunk during previous month, smoking during previous week, early sexual initiation), psychological factors (self-esteem, well-being, extroversion, neuroticism, religiousness), and SRB (intercourse under risky conditions, multiple sexual partners, and inconsistent condom use) in 832 Slovak university students (response 94.3%).ResultsAmong those with sexual experience (62%), inconsistent condom use was the most prevalent risk behaviour (81% in females, 72% in males). With the exception of having been drunk in males, no factor was associated with inconsistent condom use. Regarding the other types of SRB, early sexual initiation was most strongly associated. In addition, other, mostly behavioural, factors were associated, in particular having been drunk.ConclusionResults suggest that behavioural factors are more closely related to SRB than psychological factors. Associations differ by type of SRB and gender but offer few clues to target risk groups for inconsistent condom use. Results show a high need for health-promotion programmes in early adolescence that target SRB in conjunction with other health risk behaviours such as alcohol abuse.

Regional socioeconomic indicators and ethnicity as predictors of regional infant mortality rate in Slovakia

ObjectiveExploring the associations of regional differences in infant mortality with selected socioeconomic indicators and ethnicity could offer important clues for designing public health policy measures.MethodsData included perinatal and infant mortality in the 79 districts of the Slovak population in 2004. Linear regression was used to analyse the contribution of education, unemployment, income and proportion of Roma population on regional differences in perinatal and infant mortality rates.ResultsAll the explored socioeconomic indicators and ethnicity individually contributed significantly to both perinatal and infant mortality, with the exception of income. In the model exploring the influence of all these variables together on perinatal and infant mortality, only the effect of the proportion of Roma population remained significant. This model explained 34.9% of the variance for perinatal and 36.4% of the variance for infant mortality.ConclusionsLiving in Roma settlements indicates an accumulation of socioeconomic disadvantage. Health literacy, health-related behaviour and many other factors might contribute to the explanation of the differences in infant mortality, and a better understanding of these processes might help us to design tailored interventions.

Socioeconomic Differences in Psychosocial Factors Contributing to Coronary Heart Disease: A Review

Psychosocial factors have been shown to play an important role in the aetiology of coronary heart disease (CHD). A strong association between CHD and socioeconomic status (lower-level education, poor financial situation) has also been well established. Socioeconomic differences may thus also have an effect on psychosocial risk factors associated with CHD, and socioeconomic disadvantage may negatively affect the later prognosis and quality of life of cardiac patients. The aim of this study was to review the available evidence on socioeconomic differences in psychosocial factors which specifically contribute to CHD. A computer-aided search of the Medline and PsycINFO databases resulted in 301 articles in English published between 1994 and 2007. A comprehensive screening process identified 12 empirical studies which described the socioeconomic differences in CHD risk factors. A review of these studies showed that socioeconomic status (educational grade, occupation or income) was adversely associated with psychosocial factors linked to CHD. This association was evident in the case of hostility and depression. Available studies also showed a similar trend with respect to social support, perception of health and lack of optimism. Less consistent were the results related to anger and perceived stress levels. Socioeconomic disadvantage seems to be an important element influencing the psychosocial factors related to CHD, thus, a more comprehensive clarification of associations between these factors might be useful. More studies are needed, focused not only on well-known risk factors such as depression and hostility, but also on some lesser known psychosocial factors such as Type D and vital exhaustion and their role in CHD.