Pierre-André Michaud

WHO guidelines on preventing early pregnancy and poor reproductive outcomes among adolescents in developing countries.

Adolescent pregnancy and its consequences represent a major public health concern in many low-middle income countries of the world. The World Health Organization has recently developed evidence-based guidelines addressing six areas: preventing early marriage; preventing early pregnancy through sexuality education, increasing education opportunities and economic and social support programs; increasing the use of contraception; reducing coerced sex; preventing unsafe abortion; and increasing the use of prenatal care childbirth and postpartum care. In each of these areas, World Health Organization recommends directions for future research. The summary concludes with a brief look at global and regional initiatives that provide a window of opportunity for stepping up action in this important area.

Chronic illness, life style and emotional health in adolescence: results of a cross-sectional survey on the health of 15-20-year-olds in Switzerland.

The objective was to evaluate the prevalence of chronic conditions (CC) in adolescents in Switzerland; to describe their behaviour (leisure, sexuality, risk taking behaviour) and to compare them to those in adolescents who do not have CC in order to evaluate the impact of those conditions on their well-being. The data were obtained from the Swiss Multicentre Adolescent Survey on Health, targeting a sample of 9268 in-school adolescents aged 15 to 20 years, who answered a self-administered questionnaire. Some 11.4% of girls and 9.6% of boys declared themselves carriers of a CC. Of girls suffering from a CC, 25% (versus 13% of non carriers; P=0.007) and 38% of boys (versus 25%; P=0.002) proclaimed not to wear a seatbelt whilst driving. Of CC girls, 6.3% (versus 2.7%; P=0.000) reported within the last 12 months to have driven whilst drunk. Of the girls, 43% (versus 36%; P=0.004) and 47% (versus 39%; P=0.001) were cigarette smokers. Over 32% of boys (versus 27%; P=0.02) reported having ever used cannabis and 17% of girls (versus 13%; P=0.013) and 43% of boys (versus 36%; P=0.002) admitted drinking alcohol. The burden of their illness had important psychological consequences: 7.7% of girls (versus 3.4%; P=0.000) and 4.9% of boys (versus 2.0%; P=0.000) had attempted suicide during the previous 12 months. Conclusion: experimental behaviours are not rarer in adolescents with a chronic condition and might be explained by a need to test their limits both in terms of consumption and behaviour. Prevention and specific attention from the health caring team is necessary.

A U-shaped association between intensity of Internet use and adolescent health.

OBJECTIVE: To examine the relationship between different Internet-use intensities and adolescent mental and somatic health. METHODS: Data were drawn from the 2002 Swiss Multicenter Adolescent Survey on Health, a nationally representative survey of adolescents aged 16 to 20 years in post-mandatory school. From a self-administered anonymous questionnaire, 3906 adolescent boys and 3305 girls were categorized into 4 groups according to their intensity of Internet use: heavy Internet users (HIUs; >2 hours/day), regular Internet users (RIUs; several days per week and ≤2 hours/day), occasional users (≤1 hour/week), and non-Internet users (NIUs; no use in the previous month). Health factors examined were perceived health, depression, overweight, headaches and back pain, and insufficient sleep. RESULTS: In controlled multivariate analysis, using RIUs as a reference, HIUs of both genders were more likely to report higher depressive scores, whereas only male users were found at increased risk of overweight and female users at increased risk of insufficient sleep. Male NIUs and female NIUs and occasional users also were found at increased risk of higher depressive scores. Back-pain complaints were found predominantly among male NIUs. CONCLUSIONS: Our study provides evidence of a U-shaped relationship between intensity of Internet use and poorer mental health of adolescents. In addition, HIUs were confirmed at increased risk for somatic health problems. Thus, health professionals should be on the alert when caring for adolescents who report either heavy Internet use or very little/none. Also, they should consider regular Internet use as a normative behavior without major health consequence.

To say or not to say: a qualitative study on the disclosure of their condition by human immunodeficiency virus-positive adolescents.

PURPOSE Human immunodeficiency virus (HIV)-positive adolescents face a number of challenges in dealing with their disease, treatment, and developmental tasks. This qualitative study describes some of the reasons why, and the extent to which, adolescents may or may not disclose their condition to others. METHODS A semistructured interview lasting 40-110 minutes was conducted with each of 29 adolescents 12-20 years old, 22 female and seven male) living in Switzerland. Interviews were tape recorded and transcribed verbatim. The analysis of the content of interviews allowed us to identify salient topics (e.g., disclosure), which were then explored in detail. RESULTS Of 29 participants, eight had not disclosed their condition to anyone outside the family, 19 had disclosed it to good friends, and 16 had disclosed it to some teachers. Four participants had engaged in public disclosure, and six of 10 sexually active teenagers disclosed their status to their partners. The attitudes toward disclosure among younger adolescents were mostly related to those of the parents, particularly the mother. Older adolescents, engaged in their search for autonomy, tended to decide independently what to say and to whom. Although foster/adoptive parents would often encourage disclosure, biological parents, especially HIV-positive mothers, insisted on not disclosing the adolescents status for fear of stigma. CONCLUSION The health care team should systematically address the issue of disclosure with the adolescent and his family (or foster parents), the aim being to balance the right of the adolescent and that adolescents family to maintain privacy against the concerns of sexual partners, as well as the adolescents interest in divulging HIV status to relatives, school staff, and friends.

Are adolescents with chronic conditions particularly at risk for bullying

Objective To compare the prevalence and intensity of victimisation from bullying and the characteristics of the victim of bullying, comparing adolescents with and adolescents without chronic conditions (CC). Design School survey. Setting Postmandatory schools. Participants A total of 7005 students (48% females) aged 16–20 years, distributed into adolescents with CC (728, 50% females) and controls (6277, 48% females). Chronic condition was defined as having a chronic disease and/or a physical disability. Outcome measures Prevalence of bullying—intensity of bullying—and sociodemographic, biopsychosocial, familial, school and violence context characteristics of the victims of bullying. Results The prevalence of bullying in our sample was 13.85%. Adolescents with CC were more likely to be victims of bullying (adjusted OR 1.53), and to be victims of two or three forms of bullying (adjusted OR 1.92). Victims of bullying with CC were more likely than non-victims to be depressed (RR 1.57), to have more physical symptoms (RR 1.61), to have a poorer relationship with their parents (RR 1.33), to have a poorer school climate (RR 1.60) and to have been victims of sexual abuse (RR 1.79) or other forms of violence (RR 1.80). Although these characteristics apply to victims in general, in most cases, they are less pronounced among victims without CC. Conclusions CC seems to be a risk factor for victimisation from bullying. Therefore, as adolescents with CC are increasingly mainstreamed, schools should be encouraged to undertake preventive measures to avoid victimisation of such adolescents.

Disordered Eating Behaviors: What About Boys?

PURPOSE To determine the characteristics specific to boys with disordered eating behaviors (DEB) and the general context in which these DEB occur. METHOD Data were drawn from the SMASH02 database, a survey carried out among post-mandatory school students in Switzerland aged 16-20 years in 2002. Only males (N=3890) were included, and were classified into into one of four groups based on their level of concern about weight/food and on their eating behaviors, as follows: group 1: one concern without behavior (N=862); group 2: more than one concern without behavior (N=361); group 3: at least one behavior (N=798); and a control group (N=1869), according to previously validated items. Groups were compared for personal, family, school, experience of violence, and health-compromising behaviors variables on the bivariate level. All significant variables were included in a multinomial logistic regression using Stata 9 software. RESULTS About one-half of the boys reported either a concern or unhealthy eating behavior. Compared with the control group, boys from the three groups were more likely to be students and to report a history of sexual abuse, delinquency, depression, and feeling fat. In addition, boys from group 3 were more likely to report a history of dieting, early puberty, peer teasing, having experienced violence, frequent inebriation, and being overweight. CONCLUSION DEB concern adolescent males more frequently than thought and seem to be integrated in a general dysfunctional context, in which violence is predominant. Adolescent males also need to be screened for DEB. Moreover, prevention programs should target the increasing social and media pressure regarding boys ideal body shape and raise public consciousness about this phenomenon.

Sexual Dysfunctions Among Young Men: Prevalence and Associated Factors

PURPOSE The purposes of this study are to measure the prevalence of premature ejaculation (PE) and erectile dysfunction (ED) among a population of Swiss young men and to assess which factors are associated with these sexual dysfunctions in this age-group. METHODS For each condition (PE and ED), we performed separate analyses comparing young men suffering from the condition with those who were not. Groups were compared for substance use (tobacco, alcohol, cannabis, other illegal drugs, and medication without a prescription), self-reported body mass index, sexual orientation, physical activity, professional activity, sexual experience (sexual life length and age at first intercourse), depression status, mental health, and physical health in a bivariate analysis. We then used a log-linear analysis to consider all significant variables simultaneously. RESULTS Prevalence rates for PE and ED were 11% and 30%, respectively. Poor mental health was the only variable to have a direct association with both conditions after controlling for potential confounders. In addition, PE was directly associated with tobacco, illegal drugs, professional activity, and physical activity, whereas ED was directly linked with medication without a prescription, length of sexual life, and physical health. CONCLUSIONS In Switzerland, one-third of young men suffer from at least one sexual dysfunction. Multiple health-compromising factors are associated with these dysfunctions. These should act as red flags for health professionals to encourage them to take any opportunity to talk about sexuality with their young male patients.

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.

GPs' role in the detection of psychological problems of young people: a population-based study.

BACKGROUND Among young people, about one in three females and one in five males report experiencing emotional distress but 65-95% of them do not receive help from health professionals. AIM To assess the differences among young people who seek help and those who do not seek help for their psychological problems, considering the frequency of consultations to their GP and their social resources. DESIGN OF STUDY School survey. SETTING Post-mandatory school. METHOD Among a Swiss national representative sample of 7429 students and apprentices (45.6% females) aged 16-20 years, 1931 young people reported needing help for a problem of depression/sadness (26%) and were included in the study. They were divided into those who sought help (n = 256) and those who did not (n = 1675), and differences between them were assessed. RESULTS Only 13% of young people needing help for psychological problems consulted for that reason and this rate was positively associated with the frequency of consultations to the GP. However, 80% of young people who did not consult for psychological problems visited their GP at least once during the previous year. Being older or a student, having a higher depression score, or a history of suicide attempt were linked with a higher rate of help seeking. Moreover, confiding in adults positively influenced the rate of help seeking. CONCLUSION The large majority of young people reporting psychological problems do not seek help, although they regularly consult their GP. While young people have difficulties in tackling issues about mental health, GPs could improve the situation by systematically inquiring about this issue.

A Test of Jessor's Problem Behavior Theory in a Eurasian and a Western European Developmental Context

PURPOSE The current study tested the applicability of Jessors problem behavior theory (PBT) in national probability samples from Georgia and Switzerland. Comparisons focused on (1) the applicability of the problem behavior syndrome (PBS) in both developmental contexts, and (2) on the applicability of employing a set of theory-driven risk and protective factors in the prediction of problem behaviors. METHODS School-based questionnaire data were collected from n = 18,239 adolescents in Georgia (n = 9499) and Switzerland (n = 8740) following the same protocol. Participants rated five measures of problem behaviors (alcohol and drug use, problems because of alcohol and drug use, and deviance), three risk factors (future uncertainty, depression, and stress), and three protective factors (family, peer, and school attachment). Final study samples included n = 9043 Georgian youth (mean age = 15.57; 58.8% females) and n = 8348 Swiss youth (mean age = 17.95; 48.5% females). Data analyses were completed using structural equation modeling, path analyses, and post hoc z-tests for comparisons of regression coefficients. RESULTS Findings indicated that the PBS replicated in both samples, and that theory-driven risk and protective factors accounted for 13% and 10% in Georgian and Swiss samples, respectively in the PBS, net the effects by demographic variables. Follow-up z-tests provided evidence of some differences in the magnitude, but not direction, in five of six individual paths by country. CONCLUSION PBT and the PBS find empirical support in these Eurasian and Western European samples; thus, Jessors theory holds value and promise in understanding the etiology of adolescent problem behaviors outside of the United States.