Patrizia Lemma

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 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.

Decennial trends of social differentials in smoking habits in Italy

AbstractObjective: To present social trends of smoking habits in Italy during the period 1980–1994. Methods: Data from five national health surveys (1980, 1983, 1986–1987, 1990–1991, 1994) were analyzed in order to calculate smoking prevalences. Education attained was used as social class indicator. Main measures: SDPs (prevalence rate standardized on the 1981 Italian population) and PRs (prevalence ratios primary school/degree). Confidence intervals and p-values were calculated as indicators of statistical significance. Results: Among men SDP decreased from 59.5% in 1980 to 37.3% in 1994 and PRs for social classes varied from 1.21 in 1980 to 1.47 in 1994. Corresponding results for women were 17.9% to 20.0% and 0.36 to 0.73. Conclusions: Lower-educated men smoke more than those in higher social categories, and data collected during 1980–1994 in Italy show a tendency to increase such differentials. Among women this pattern was the opposite in 1980, with a tendency to reduce differences over time. Therefore, for both genders data show a progressive disadvantage for the low-educated categories. The greater compliance of better-educated groups with anti-smoking interventions must be taken into account, and should suggest “unequal” interventions that can be more effective among disadvantaged social groups.

Cancer mortality by educational level in Italy

Social differences in health concern both ethics and science. From a public health point-of-view, one must assess actual differences and then try to find explanations. This was made possible for the first time for cancer in Italy via nationwide record-linkage between the 1981 census and the national death index. Over the subsequent six months after census, the study-base included 31,000 deaths for cancer and 18 million person-years at risk. Rate ratios (RR) were estimated through a Poisson regression model adjusted by age and geographic area of residence. Educational level was used as social level indicator. Profound social differences were evident for buccal cavity (RR=3.10 for lowest cf highest educational level), esophagus (RR=3.00), stomach (RR=3.43), and larynx (RR=3.30) among men, and for stomach (RR=2.25) and uterus (RR=1.76) among women. Colon (RR=0.62) and pancreas cancers (RR=0.65) presented an inverse relationship among men, as did colon (RR=0.37), breast (RR=0.56), ovary (RR=0.45), and melanoma (RR=0.62) among women. In conclusion, the Italian population at the beginning of the 1980s had large social differences in the risk of dying from cancer, confirming the patterns commonly found in such other countries as Great Britain, France, and New Zealand. Some dissimilarities, useful for hypothesis generation on the mechanisms of inequality, were evident, such as the generally highest social differences found among northern Italian men and among southern Italian women.

Income inequality and adolescent gambling severity: Findings from a large-scale italian representative survey

Background: Studies have shown that problems related to adult gambling have a geographical and social gradient. For instance, adults experiencing gambling-related harms live in areas of greater deprivation; are unemployed, and have lower income. However, little is known about the impact of socioeconomic inequalities on adolescent problem gambling. The main purpose of the present study was to investigate the contextual influences of income inequality on at-risk or problem gambling (ARPG) in a large-scale nationally representative sample of Italian adolescents. A secondary aim was to analyze the association between perceived social support (from family, peers, teachers, and classmates) and ARPG. Methods: Data from the 2013–2014 Health Behavior in School-aged Children Survey (HBSC) Study was used for cross-sectional analyses of ARPG. A total of 20,791 15-year-old students completed self-administered questionnaires. Region-level data on income inequality (GINI index) and overall wealth (GDP per capita) were retrieved from the National Institute of Statistics (Istat). The data were analyzed using the multi-level logistic regression analysis, with students at the first level and regions at the second level. Results: The study demonstrated a North–South gradient for the prevalence of ARPG, with higher prevalence of ARPG in the Southern/Islands/Central Regions (e.g., 11% in Sicily) than in Northern Italy (e.g., 2% in Aosta Valley). Students in regions of high-income inequality were significantly more likely than those in regions of low-income inequality to be at-risk or problem gamblers (following adjustment for sex, family structure, family affluence, perceived social support, and regionale wealth). Additionally, perceived social support from parents and teachers were negatively related to ARPG. Conclusions: Income inequality may have a contextual influence on ARPG. More specifically, living in regions of highest income inequality appeared to be a potential factor that increases the likelihood of becoming an at-risk or problem gambler. Findings of the study suggest that wealth distribution within societies affected by economic policies may indirectly have an influence adolescent gambling behaviors.

Smoking Habits among Italian Adolescents: What Has Changed in the Last Decade?

Tobacco use, alcohol abuse, overweight and obesity are risk factors for numerous diseases in Italy as elsewhere. However, children and adolescents are not usually included in official national surveys although it is at this stage of life when unhealthy habits are often established. Italian participation in HBSC and GYTS surveys allows our country to implement standardized surveillance systems providing reliable information on tobacco-related behaviors of this population. Data from three HBSC surveys (2002–2010) show that following the drop in the first half of the decade, prevalence of tobacco use stabilized in the second half. The decline was significant for younger age groups, while prevalence of regular tobacco use remained stable among 15-year-olds. Many adolescents reported being exposed to secondhand smoke, to have at least one parent who smokes, and having seen teachers and students smoking at school. Although the sale of tobacco products to minors is prohibited, the vast majority had no trouble in buying cigarettes. Data from GYTS and HBSC surveys provide a wealth of information about attitudes and behaviors of Italian adolescents with respect to smoking. Despite some progress, sizeable gaps remain in meeting standard recommendations for discouraging smoking initiation and motivating adolescent smokers to quit the habit.

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.

Trends in adolescent overweight prevalence in Italy according to socioeconomic position

BACKGROUND The aim of this research is to update the trend in overweight (including obesity) prevalence among Italian adolescents, evaluating possible differences by age and gender, and analyzing their relationships with socioeconomic status, between 2002 and 2014. METHODS The present study is based on data from the Italian HBSC study at four time points (2002, 2006, 2010 and 2014), which involved 15 035 adolescents, aged 11-13-15 (7540 boys and 7495 girls). RESULTS Gender and age were associated with the occurrence of overweight. In all surveys, boys had a higher prevalence of excess weight compared to girls (p < 0.001), but only among girls there was a significant increasing trend (from 11.2% in 2002 to 13.3% in 2014). From 2002 to 2014, the risk of being overweight was inversely associated with the economic level of the family, for both genders and all age groups. CONCLUSIONS Data collected between 2002 and 2014 in Italy showed a low overall increase in prevalence of obesity and overweight and an inverse association between SES and obesity in all age groups and in both genders. These findings suggest that concerted, multi-sectorial, efforts are needed in Italy, in combination with a sound political will, focused on reducing social inequality associate.