Kareena McAloney

A scoping review of statistical approaches to the analysis of multiple health-related behaviours.

BACKGROUND Smoking, diet, exercise, and alcohol are leading causes of chronic disease and premature death, many engage in two or more of these behaviours concurrently. The paper identified statistical approaches used to investigate multiple behavioural risk factors. METHOD A scoping review of papers published in English from 2000 to 2011 was conducted; papers are related to concurrent participation in at least two of the behaviours. Statistical approaches were recorded and categorised. RESULTS Across 50 papers, two distinct approaches were identified. Co-occurrence analyses focused on concurrent but independent behaviours, represented by prevalence of behavioural combinations and/or by the summing behaviours into risk indexes. Clustering analyses investigated underlying associations between the concurrent behaviours, with clustering identified by divergences in observed and expected prevalence of combinations or through identification of latent or unobservable clusters. Co-occurrence was more frequently reported, but the use of clustering techniques and, in particular, cluster analytic and latent variable techniques increased across the study period. DISCUSSION The two approaches investigate concurrent participation in multiple health behaviours but differ in conceptualisation and analysis. Despite differences, inconsistency in the terminology describing the study of multiple health behaviours was apparent, with potential to influence understandings of concurrent health behaviours in policy and practice.

Sex, Drugs and STDs: Preliminary Findings from the Belfast Youth Development Study.

Young peoples participation in sexual risk behaviours is commonly linked with participation in a range of other risky behaviours, and in particular with substance use behaviours. This cross-sectional analysis of the sixth sweep of the Belfast Youth Development Study aimed to examine associations between substance use and sexual activity and related risks among 17–19-year olds in Northern Ireland. Being sexual activity and participating in sexual risk behaviours was associated with the use of a range of licit and illicit substances particularly alcohol and ecstasy. Additionally, females were more likely to have been tested for a sexually transmitted disease (STD). The findings add to the existing research body suggesting that substance misuse and sexual risk behaviours tend to co-occur in adolescence and highlight a need to develop appropriate interventions and initiatives for school aged young people.

Assessing the Mental Health Needs of Young People Living in State Care Using the Strengths and Difficulties Questionnaire

Young people living in the state care system are often reported to experience poorer levels of mental health and wellbeing. Government policy encourages a holistic approach to the assessment of all aspects of health and wellbeing of these young people. The Strengths and Difficulties Questionnaire (SDQ), a mental health screener for young people aged four to 16 years, was administered to a number of young people living in state care and a sample not living in state care as part of the Youth Development Study being undertaken at Queens University Belfast. The findings from the study showed that a higher proportion of young people living in state care reported scores on the SDQ that indicated a higher propensity to problem behaviour at both stages of the survey when aged 11/12 years and 14/15 years. The findings show that the SDQ is a tool that may assist professionals to make an informed decision on the health and wellbeing of young people entering the care system and possibly can lead to an empirically assisted decision on intervention planning.

Fruit and vegetable consumption and sports participation among UK Youth

AbstractObjectives UK guidelines for youth recommend daily physical activity and five portions of fruit and vegetables per day. This study examined the prevalence and clustering of meeting recommendations among 10- to 15-year old.Methods Data for 3,914 youth, from the first wave of Understanding Society: the UK Household Longitudinal Study, were analysed. Clustering was assessed using the observed/expected ratio method.ResultsA minority of youth met both recommendations, and these behaviours were clustered. The odds of meeting both recommendations were lower for older youth and for Pakistani and Bangladeshi youth; boys in lower income households were less likely to meet both recommendations.ConclusionsMost youth met neither recommendation and the behaviours clustered with variations by ethnicity and socioeconomic conditions.

Upholding the Convention on the Rights of the Child: A Quandary in Cyberspace

Put in place to protect the rights of the child, the Convention on the Rights of the Child is a set of non-negotiable standards. A core principle underpinning the Convention is the childs right to participate fully in social arenas and to access sources of social support without excessive interference. Juxtaposing this is the right of the child to be shielded from harm, abuse and exploitation. Over the past several decades the Internet has emerged as a fast and easily accessible medium for people to connect and communicate. While the Internet provides children with a source of support through chat rooms, online communities and social networking sites, just as equally it can expose vulnerable children to predatory and deviant individuals exacerbating the potential for harm. Upholding the Convention in cyberspace is a challenge. The Internet is not owned or regulated by any governing body and accountability is difficult to enforce. This article discusses some of the difficulties of upholding the Convention online and provides recommendations for policy-makers to protect children as they participate in cyberspace.

Clustering of sex and substance use behaviors in adolescence.

Background: Adolescents often experiment with substance use and sexual activity, which can impact upon their health and well-being, and establish harmful patterns of behavior which continue into adulthood. While substance use and participation in sexual behaviors often co-occur, few studies have examined whether these behaviors cluster in adolescence. Objective: To investigate clustering of sexual activity and substance use among youth in Northern Ireland. Method: Data from 875 young people (aged 16) who participated in the 2008 Northern Ireland Life and Times Survey were used to investigate clustering using the Odds/Expected ratio method. Gender differences in clustering were explored. Results: Alcohol consumption was the most prevalent risk behavior (75%), followed by cigarette smoking, sexual intercourse, illicit substance use, and solvent use the least prevalent. Over 40% of young people participated in multiple risk behaviors (2 or more). Several behavior combinations were statistically clustered, for most the reported prevalence was lower than expected, however, participation in all five risk behaviors occurred at a much higher rate than expected, particularly for male youth. Conclusions: While experimentation with risky behaviors is often considered developmentally appropriate in adolescence it is important to understand how young people experience these behaviors, and the potential for multiple risk exposures as a result of participation in substance use and sexual behaviors. These findings highlight the clustering of substance use and sexual behaviors, and indicate variations in vulnerability to participation in multiple risk behaviors by gender.

OP13 Diet and Physical Activity Levels Among UK Youth

Background Both physical activity levels and dietary behaviours have consistently been linked with the development of chronic disease, obesity and ill-health in both adult and youth samples. Nationally there are established recommendations of minimum levels of physical activity and fruit and vegetable consumption necessary to promote good health. Developing healthy behaviour is particularly important for young people, as adult behaviours that are detrimental or positive for health and well-being are often established in childhood and adolescence. This paper aims to investigate the prevalence of physical activity and fruit and vegetable consumption and to explore the co-occurrence of these behaviours among young people in the UK, using the newly available Understanding Society study. Methods This study is part of an ongoing secondary analysis of Understanding Society: The UK Household Longitudinal Study. The analysis sample consisted of 4,395 young people aged 10 - 15 living in the UK in 2009/2010 who participated in the first wave of the study. The prevalence of physical activity and fruit and vegetable consumption within the sample, and patterns of co-occurrence across the two behaviours, were explored descriptively. Multinomial regression models were estimated to investigate the social patterning of the health behaviour co-occurrence patterns, using socio-demographic characteristics of the young person and mother. Results 85.2% of young people did not meet the government recommendation for fruit and vegetable consumption, reporting less than 5 portions of fruit and vegetable daily. 70.6% of young people did not meet the recommendation for participation in daily physical activity. A small minority did not consume any fruits and vegetables (5.0%); and 6.4% reported participating in physical activity less often than weekly. On examining the patterns across combinations of the two behaviours, most young people did not meet both recommendations (62%), while only 6.1% of young people met both recommendations. Multinomial regression models indicated that gender, ethnicity and religion and socio-economic status were significantly associated with health behaviour patterns. Conclusion This paper presents an analysis of the most recently available health-risk behaviour data on children from all four countries of the UK. The results indicate that a high proportion of young people do not achieve levels of fruit and vegetable consumption or levels of participation in physical activity considered to be a minimum for good health, and these two behaviours tend to co-occur. The implications of these behaviour patterns and the associations with socio-demographic characteristics are discussed.

Life after prison: the experiences of prison officers serving during the Troubles in Northern Ireland

The men and women employed by the Northern Ireland prison service served through some of the most infamous events in the course of the ‘Troubles’. In 1998 a downsizing initiative was launched which resulted in over 1000 prison personnel accepting early retirement packages. This study aimed to explore the experience of service life in Northern Ireland and investigate how the circumstances of retirement impact upon well‐being. Ninty‐nine retired prison officers participated in the study, 80% of whom were early retirees. Each participant completed several measures of well‐being and a series of open‐ended questions regarding their experiences of service life. Both early retirement from the prison service and the perception of being forced to retire were associated with greater psychological distress and lower self‐esteem. Qualitative analysis revealed a high level of loyalty to the prison service and pride in the role of prison officer. However, participants also expressed feeling of rejection and disappointment in their subsequent treatment by the prison service and the government.

Inter-generational concordance of smoking status between mothers and young people aged 10–15 in the UK

Smoking habits are laid down in adolescence, a habit that will kill half of those who continue to smoke through adulthood. Having a parent, and particularly a mother, who smokes, elevates the risk of adolescent smoking. Both maternal and adolescent smoking statuses are, in turn, related to wider familial factors. Poorer family circumstances increases the risk of adolescent smoking; compared to young people living with both parents, those in lone-mother families are alsomore likely to be smokers. In addition, there aremarked ethnic differences in adolescent smoking; for example in the UK, prevalence is loweramongAsianandAfrican-Caribbeangroups than inwhite groups and in the US, rates are lower among AfricanAmericans than among both Hispanic and white groups. While these familial factors are widely recognized, few studieshave investigatedhowthese familial factorsare related to mother-child concordance in smoking status. The reliance on school-based surveys of young people limits the information that can be collected on family socio-economic

Care and punishment: the need for global perspective on youth victimisation

The United Nations Convention on the Rights of the Child has at its core a consideration for the best interests of the child (Article 3), the right to life, survival and development (Article 6), and nondiscrimination in the application of those rights (Article 2). However, it is an indisputable truth that inherent differences in practices, standards and experiences across and between countries impact upon the application of these rights. This is perhaps clearest when attention is paid to the experiences of those young people exposed to violence and trauma. In this issue of Paediatrics and International Child Health, Atilola and co-authors compare lifetime traumatic exposure of adolescents within Nigeria’s juvenile justice system, with the experiences of youths not in contact with this system. Additionally, the authors distinguish between two types of juvenile justice ‘inmate’ within the Nigerian system: the offenders, youths who have committed an offence; and the victims, youths entered into the system for protection and care purposes. Victimisation has been consistently linked with offending behaviour, both as a consequence of committing an offence, and as a precursor to becoming involved in offending behaviour. In countries where violence is prevalent, youths are particularly vulnerable to victimisation through exposure to violence and trauma. Nigeria is one such country, with high levels of victimisation experienced by the community. Atilola and colleagues report that, amongst their sample of adolescents, exposure to traumatic events was substantially higher in youths within the juvenile justice system compared with young people from a comparison secondary school sample. Research in developed countries has demonstrated that, while the overall prevalence of exposure in juvenile justice inmates is similar to Nigeria, the most common exposures in inmates are those related to indirect and vicarious events, such as witnessing violence, rather than to direct exposure. In developed countries with high levels of violence, victimisation is again primarily indirect and vicarious, with low levels of direct exposure among youths. For example, in Northern Ireland, a post-conflict area transitioning from violence to a more stable, peaceful society, youth samples report high levels of witnessing violence and ‘story-telling’ of historical events, and comparably lower levels of direct violence. While similar patterns are reported for the nonjuvenile-justice, secondary-school sample, the authors of this analysis report the most prevalent traumatic experience among Nigerian inmates to be direct physical victimisation. This highlights an important aspect of violence in developing countries such as Nigeria, and the vulnerability of youths in such societies to exposure to several types of victimisation. Considerations of the nature of violence in Nigeria are further nuanced by the place of children within the society. In addition to identifying higher levels of traumatic victimisation in youths within the juvenile justice system than in secondary school students, the authors also distinguish between two types of juvenile justice inmate. The first are those who are institutionalised as punishment for a criminal offence, while the second are those who have been placed within the system for care and protection. Thus, the juvenile justice system in Nigeria operates as a mechanism for justice and detention, as well as for social welfare, unlike in developed countries where the two systems are distinct and independent. The authors report comparable levels of exposure in these two groups of youths, and similar prevalences in various types of traumatic exposure. Again, direct physical victimisation was among the most prevalent experiences of young people admitted to an institution for protection. Children placed into care services are frequently survivors of maltreatment, neglect and abuse, resulting in high levels of victimisation, and often this is perpetuated by further exposure to violence and trauma as both a victim and as a perpetrator. The comparable experiences of victimisation in both offenders and victims in this analysis highlight the Correspondence to: K McAloney, Department of Psychology and Allied Health Sciences, Glasgow Caledonian University, Cowcaddens Road, Glasgow G4 0BA, UK. Email: kareena.mcaloney@gcu.ac.uk