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This paper describes a quasi-experimental crossover trial of an outdoor adventure program for Year 9 school students in Australia. Previous studies have reported a range of positive outcomes of outdoor camps and adventure programs, but cautious interpretation of some claims may be warranted due to limitations in research methods. This study examines a purpose-designed, seven-day outdoor adventure program intended to promote positive adjustment in young people. A total of 335 participants (aged 14-16 years) were recruited from across two Victorian secondary schools. In year 1 (2015), students from school A were recruited to the outdoor program while students from school B were recruited to a control group. In the second year (2016) the roles of each school were switched (crossed over). Outcome measures assessed on five occasions included a range of self-reported social and emotional health indicators. While quantitative analyses did not find support for positive, universal effects of our program, qualitative information gathered across the course of the study suggested that the outdoor program may have been both impactful and positive for some students. This complex picture suggests that effects of the outdoor adventure experience were quite variable amongst participants. Reasons for this pattern of findings are discussed, including the possibility that our quantitative measures may have been insensitive to some benefits. Future work should examine salient moderators of the beneficial effects of outdoor adventure experiences.

Background: Many emotional and behavioral problems first emerge in primary school and are the forerunners of mental health problems occurring in adolescence. However, the extent that these problems may be associated with academic failure has been explored less. We aimed to quantify the association between emotional and behavioral problems with academic performance. Methods: A stratified random sample of 8- to 9-year-olds (N = 1239) were recruited from schools in Australia. Data linkage was performed with a national assessment of academic performance to assess reading and numeracy. Parent report assessed emotional and behavioral problems with students dichotomized into "borderline/abnormal" and "normal" categories. Results: One in 5 grade 3 students fell in the "borderline/abnormal" category. Boys with total difficulties (ß = -47.8, 95% CI: -62.8 to -32.8), conduct problems, and peer problems scored lower on reading. Numeracy scores were lower in boys with total difficulties (ß = -37.7, 95% CI: -53.9 to -21.5) and emotional symptoms. Children with hyperactivity/inattention scored lower in numeracy. Girls with peer problems scored lower in numeracy. Conclusions: Boys with emotional and behavioral problems in mid-primary school were 12 months behind their peers. Children with emotional and behavioral problems are at high risk for academic failure, and this risk is evident in mid-primary school.

This study examined longitudinal relationships between depressive symptoms and use of alcohol, cigarettes, and illicit substances among adolescents, addressing methodological limitations and potential confounding in the extant literature. The sample comprised adolescents who were surveyed in Grades 6 (n = 916), 9 (n = 804), and 11 (n = 791). Cross-lagged path analyses were used to examine bi-directional relationships between substance use and depressive symptoms. Early adolescent depressive symptoms predicted mid-adolescent cigarette, alcohol, and illicit substance use (the latter among females only). Mid-adolescent depressive symptoms predicted late adolescent illicit substance use (females only). There were no statistically significant pathways from substance use to later depressive symptoms. However, these relationships were reduced to non-significance with the addition of covariates associated with the family environment, school, and individual. The findings suggest that the association between adolescent depressive symptoms and later substance use can be explained by common risk factors that produce vulnerability to both depression and substance use.

Background: Academic difficulties are common in adolescents with mental health problems. Although earlier childhood emotional problems, characterised by heightened anxiety and depressive symptoms are common forerunners to adolescent mental health problems, the degree to which mental health problems in childhood may contribute independently to academic difficulties has been little explored. Methods: Data were drawn from a prospective cohort study of students in Melbourne, Australia (N = 1239). Data were linked with a standardised national assessment of academic performance at baseline (9 years) and wave three (11 years). Depressive and anxiety symptoms were assessed at baseline and wave two (10 years). Regression analyses estimated the association between emotional problems (9 and/or 10 years) and academic performance at 11 years, adjusting for baseline academic performance, sex, age and socioeconomic status, and hyperactivity/inattention symptoms. Results: Students with depressive symptoms at 9 years of age had lost nearly 4 months of numeracy learning two years later after controlling for baseline academic performance and confounders. Results were similar for anxiety symptoms. Regardless of when depressive symptoms occurred there were consistent associations with poorer numeracy performance at 11 years. The association of depressive symptoms with reading performance was weaker than for numeracy if they were present at wave two. Persistent anxiety symptoms across two waves led to nearly a 4 month loss of numeracy learning at 11 years, but the difference was not meaningful for reading. Findings were similar when including hyperactivity/inattention symptoms. Conclusions: Childhood anxiety and depression are not only forerunners of later mental health problems but predict academic achievement. Partnerships between education and health systems have the potential to not only improve childhood emotional problems but also improve learning. [ABSTRACT FROM AUTHOR]

This study examined the extent to which young adolescent alcohol use was related to alcohol-related norms and law enforcement of underage alcohol use, after accounting for known strong parent and peer correlates. Our sample consisted of 7,674 students (X-bar age = 12 years) from 30 Australian communities. Two-level (individuals nested within communities) binary logistic regression was used to examine relationships between recent alcohol use (last 30 days) and perceived community norms about alcohol use, perceived law enforcement of underage alcohol use, parent alcohol use, parent permissiveness of adolescent alcohol use, peer alcohol use, and demographic factors. Results indicated that community norms and perceived law enforcement of alcohol use were associated with alcohol use and this association was independent of parent and peer factors. After accounting for proximal social correlates, community factors were significantly associated with alcohol use among very young adolescents.

The current study documents the changing rates of cannabis use, misuse and cannabis-related social harms among Australian adolescents as they grow into young adulthood. It utilised data from a longitudinal study of young people at ages 15, 16, 17, and 19. The rates of cannabis use were found to increase as participants aged; past year use increased from 7.5% at age 15 to 29.8% at age 19. Further, at ages 17 and 19, cannabis use was more prevalent among males than females. Among those who reported cannabis use, the rates of cannabis-related harms were low to moderate, and did not increase with age in the same manner as rates of cannabis use. The most prevalent self-reported cannabis-related harm was anxiety/depression; affecting between 20-30% of the cannabis users at each age. These findings may assist in understanding the extent of cannabis-related problems among youth, and in planning relevant services. (Contains 4 tables and 2 figures.)

School connectedness is central to the long term well-being of adolescents, and high quality parent-child relationships facilitate school connectedness. This study examined the extent to which family relationship quality is associated with the school connectedness of pre- and early teenagers, and how this association varies with adolescent involvement in peer drinking networks. The sample consisted of 7,372 10-14 year olds recruited from 231 schools in 30 Australian communities. Participants completed the "Communities that Care" youth survey. A multi-level model of school connectedness was used, with a random term for school-level variation. Key independent variables included family relationship quality, peer drinking networks, and school grade. Control variables included child gender, sensation seeking, depression, child alcohol use, parent education, and language spoken at home. For grade 6 students, the association of family relationship quality and school connectedness was lower when peer drinking networks were present, and this effect was nonsignificant for older (grade 8) students. Post hoc analyses indicated that the effect for family relationship quality on school connectedness was nonsignificant when adolescents in grade 6 reported that the majority of friends consumed alcohol. The results point to the importance of family-school partnerships in early intervention and prevention.

Objectives: Childhood sexual abuse (CSA) is associated with both short- and long-term adverse mental and physical health consequences, yet there remains considerable controversy about the prevalence of CSA in the general population. There is also little prospective data on unwanted sexual contact (USC) collected during adolescence. Methods: Data from a 10-year cohort study of a nationally representative sample of students aged 14-15 years in Victoria, Australia from 1992 to 2003 was used. CSA prior to age 16 was assessed retrospectively at age 24 years using a 6-item validated questionnaire. USC was assessed prospectively via questionnaire at 3 time points during adolescence. Multiple imputation was used to handle missing data. Results: One thousand nine hundred forty-three of 2032 eligible adolescents participated in at least one wave of the study. One thousand seven hundred forty-five (812 males and 933 females) provided sufficient information to allow for multiple imputation and inclusion in the main analysis. The prevalence of any CSA was substantially higher among girls [17%, 95% confidence interval (CI): 14-20%] than boys (7%, 95% CI: 3-10%), as was the prevalence of USC reported during adolescence (14%, 95% CI 11-16%, versus 6%, 95% CI: 4-8% respectively). Conclusions: These findings highlight the high prevalence of childhood sexual abuse and unwanted sexual contact among girls as well as boys. Practice implications: In order to accurately inform early recognition, intervention and education programs for individuals with a history of CSA the frequency of sexual abuse must first be precisely quantified. Developing more standardized approaches will be important in order to improve our understanding of the extent of this problem. (Contains 2 tables and 1 figure.)

Purpose: Evidence from the USA/Australia suggests whole-school interventions designed to increase social inclusion/engagement can reduce substance use. Completeness of implementation varies but contextual determinants have not been fully explored. Informed by previous interventions, the paper aims to examine these topics in an English pilot of the Healthy School Ethos intervention. Design/methodology/approach: This intervention, like previous interventions, balanced standardization of inputs/process (external facilitator, manual, needs-survey and staff-training delivered over one year to enable schools to convene action-teams) with local flexibility regarding actions to improve social inclusion. Evaluation was via a pilot trial comprising: baseline/follow-up surveys with year-7 students in two intervention/comparison schools; semi-structured interviews with staff, students and facilitators; and observations. Findings: The intervention was delivered as intended with components implemented as in the USA/Australian studies. The external facilitator enabled schools to convene an action-team involving staff/students. Inputs were feasible and acceptable and enabled similar actions in both schools. Locally determined actions (e.g. peer-mediators) were generally more feasible/acceptable than pre-set actions (e.g. modified pastoral care). Implementation was facilitated where it built on aspects of schools' baseline ethos (e.g. a focus on engaging all students, formalized student participation in decisions) and where senior staff led actions. Student awareness of the intervention was high. Originality/value: Key factors affecting feasibility were: flexibility to allow local innovation, but structure to ensure consistency; intervention aims resonating with at least some aspects of school baseline ethos; and involvement of staff with the capacity to deliver. The intervention should be refined and its health/educational outcomes evaluated. (Contains 3 tables.)

There is considerable evidence that a range of risk factors are associated with adolescent problem gambling. Using a representative sample of 2,788 eighth grade students in Victoria, Australia, the primary aim of this study was to examine the degree to which these risk factors are associated with different levels of adolescent gambling participation, rather than gambling at problematic levels. This study also aimed to obtain prevalence estimates of adolescent gambling and examine the gambling attitudes of adolescents. It was found that there were significant associations between different levels of gambling involvement and a range of risk factors. However, when all predictor variables were considered simultaneously in the prediction of higher involvement in gambling activities, only male gender, drinking alcohol, using marijuana, and few perceived rewards at school were statistically significant predictors. For males, the most important predictors for greater gambling involvement were other antisocial and risk-taking behaviours. In contrast, dissatisfaction with peers and school connectedness was important in predicting greater gambling involvement for females. The study shows the usefulness of a risk and protective factor approach to understanding gambling participation in an adolescent population and that there is much to be gained from understanding the nuances of gendered gambling behaviour in the context of studying gambling participation and attitudes rather than simply in the context of studying disordered or problematic gambling.

This article compares prevalence estimates of substance use and delinquent behavior in Washington State, United States and Victoria, Australia, two states chosen for their different policy environments around problem behavior. Few comparisons of international differences on rates of multiple problem behavior exist, and most are based on methods that are not matched, raising the question of whether findings are based on methodological differences rather than actual rate differences. The International Youth Development Study used standardized methods to recruit and administer an adaptation of the Communities That Care Youth Survey to representative state samples of fifth-, seventh-, and ninth-grade students in each state. Rates of delinquent behavior were generally comparable. However, striking differences in substance use were noted, with Victoria students reporting higher rates of alcohol use, alcohol misuse, smoking, and inhalant use, whereas Washington State students reported higher rates of marijuana use. Implications for conducting international comparisons are discussed. (Contains 4 tables.)

Objective: To ascertain the association between pubertal stage and deliberate self-harm. Method: Cross-sectional survey of 12- to 15-year-olds in 300 secondary schools in the U.S. state of Washington in February-April 2002 and the Australian state of Victoria in June-August 2002. A total of 3,332 students in grades 7 and 9 provided complete data on episodes of deliberate self-harm in the previous 12 months and pubertal stage. Pubertal stage was assessed with the Pubertal Development Scale. Results: The prevalence of deliberate self-harm was 3.7% with a more than twofold higher rate in females. Late puberty was associated with a more than fourfold higher rate of self-harm (odds ratio 4.6, 95% confidence interval 1.5-14) after adjustment for age and school grade level. In contrast age had a protective association (odds ratio 0.7, confidence interval 0.4-1.0). The sharpest rises in prevalence across puberty were for self-laceration and self-poisoning in females. Higher rates of depressive symptoms, frequent alcohol use, and initiation of sexual activity largely accounted for the association between self-harm and pubertal stage in multivariate models. Conclusions: Puberty is associated with changes in the form and frequency of self-harm. For adolescents with a gap between puberty and brain development, risk factors such as early sexual activity and substance abuse may be particularly potent. (Contains 4 tables.)

Background: Bullying occurs in all schools. Measuring bullying in schools is complicated because both definitions of bullying and methods for measuring bullying vary. This study compared a brief 12-item Gatehouse Bullying Scale (GBS) with items drawn from the Peer Relations Questionnaire (PRQ), a well-established bullying questionnaire to measure the concurrent validity of the GBS. Methods: Year 8 secondary school students (14 years of age) in metropolitan and regional Victoria, Australia, completed questionnaires assessing being teased, being deliberately left out, had rumors spread about oneself, and/or being physically threatened or hurt. Results: The prevalence of bullying using GBS and PRQ was 57% and 61%, respectively. Percent agreement between the 2 measures was high. Agreement adjusted for chance was moderate (kappa 0.5). The GBS had good to moderate test-retest reliability (rho 0.65). Conclusions: The GBS is a short, reliable tool measuring the occurrence of bullying in schools. As well as a global estimate of bullying, the GBS provides estimates of 2 covert and 2 overt types of bullying which can be useful for schools to better plan interventions dealing with school bullying.

Background: This study assessed the extent to which women's preconception binge drinking, tobacco use and cannabis use, reported prospectively in adolescence and young adulthood, predicted use of these substances during pregnancy and at 1 year postpartum. Methods: Data were pooled from two intergenerational cohort studies: the Australian Temperament Project Generation 3 Study (395 mothers, 691 pregnancies) and the Victorian Intergenerational Health Cohort Study (398 mothers, 609 pregnancies). Alcohol, tobacco and cannabis use were assessed in adolescence (13–18 years), young adulthood (19–29 years) and at ages 29–35 years for those transitioning to parenthood. Exposures were weekly or more frequent preconception binge drinking (5 + drinks in one session), tobacco use and cannabis use. Outcomes were any alcohol, tobacco and cannabis use prior to awareness of the pregnancy, after awareness of pregnancy (up to and including the third trimester pregnancy) and at 1 year postpartum. Results: Frequent preconception binge drinking, tobacco use and cannabis use across both adolescence and young adulthood were strong predictors of continued use post-conception, before and after awareness of the pregnancy and at 1 year postpartum. Substance use limited to young adulthood also predicted continued use post-conception. Conclusions: Persistent alcohol, tobacco use and cannabis use that starts in adolescence has a strong continuity into parenthood. Reducing substance use in the perinatal period requires action well before pregnancy, commencing in adolescence and continuing into the years before conception and throughout the perinatal period. [ABSTRACT FROM AUTHOR]

There is increasing evidence that the COVID‐19 pandemic has had substantial mental health impacts for adolescents. Yet, few definitive studies have investigated which adolescents were at higher risk of poor mental health and well‐being during the pandemic. Data were drawn from the Childhood to Adolescence Transition Study, a prospective cohort study of students in Australia (N = 1211). Prevalence of mental health outcomes (depressive symptoms, anxiety symptoms, self‐harm and good subjective well‐being) was estimated in school Years 5–12, where Years 11 (2020) and 12 (2021) coincided with the pandemic. The age‐ and sex‐adjusted relative risk of each mental health outcome for each priority group during the pandemic were estimated. During the pandemic, over 50% of study participants reported depressive symptoms, and one quarter reported anxiety symptoms. There was a decrease in good subjective well‐being compared with pre‐pandemic years, while self‐harm prevalence remained similar. History of mental health problems, school disengagement and frequent peer victimisation increased the risk of experiencing mental health problems during the pandemic. Schools play a central role in maintaining the mental health and good subjective well‐being of students, and this is particularly important during periods of social disruption, such as the COVID‐19 pandemic. [ABSTRACT FROM AUTHOR]

This study examined the impact of a school-based preventive intervention on cannabis use in adolescence, using a cluster-randomized trial of a multilevel intervention aimed at improving social relationships within schools by promoting change in school environment. Four waves of data were collected at baseline (1997, Year 8: mean age 13 years) and six, 18, and 30 months later (1999, Year 10: mean age 16 years). Self-reported substance use, school engagement, and sociodemographic data were collected using computer-administered questionnaires. Some 2,678 (74%) Year 8 students participated (wave 1) with minimal attrition (10% by wave 4). Adjusting for baseline use, weak evidence existed for an intervention effect on the prevalence of any use at Year 10 (OR 0.75, 95% CI 0.54, 1.05) and incident weekly use (OR 0.72, 95% CI 0.39, 1.33). These effects were reduced after adjusting for confounders. Moderate evidence suggested an interaction effect between intervention group and tobacco use (p = 0.04), suggesting the intervention was more effective for non-smokers at baseline (Adj. OR 0.50, 95% CI 0.26, 0.98). This study indicates that a multilevel school-based program may provide an innovative direction for sustainable school interventions with the potential to reduce substance use.

Background: The potential for early interventions to reduce the later prevalence of common mental disorders (CMD) first experienced in adolescence is unclear.Aims: To examine the course of CMD and evaluate the extent to which the prevalence of CMD could be reduced by preventing adolescent CMD, or by intervening to change four young adult processes, between the ages of 20 and 29 years, that could be mediating the link between adolescent and adult disorder.Method: This was a prospective cohort study of 1923 Australian participants assessed repeatedly from adolescence (wave 1, mean age 14 years) to adulthood (wave 10, mean age 35 years). Causal mediation analysis was undertaken to evaluate the extent to which the prevalence of CMD at age 35 years in those with adolescent CMD could be reduced by either preventing adolescent CMD, or by intervening on four young adult mediating processes: the occurrence of young adult CMD, frequent cannabis use, parenting a child by age 24 years, and engagement in higher education and employment.Results: At age 35, 19.2% of participants reported CMD; a quarter of these participants experienced CMD during both adolescence and young adulthood. In total, 49% of those with CMD during both adolescence and young adulthood went on to report CMD at age 35 years. Preventing adolescent CMD reduced the population prevalence at age 35 years by 3.9%. Intervening on all four young adult processes among those with adolescent CMD, reduced this prevalence by 1.6%.Conclusions: In this Australian cohort, a large proportion of adolescent CMD resolved by adulthood, and by age 35 years, the largest proportion of CMD emerged among individuals without prior CMD. Time-limited, early intervention in those with earlier adolescent disorder is unlikely to substantially reduce the prevalence of CMD in midlife. [ABSTRACT FROM AUTHOR]

Despite a decline in Australian adolescents reporting to have consumed alcohol, a high proportion of the adolescent population still consumes alcohol. Community-led prevention interventions that systematically and strategically implement evidence-based programs have been shown to be effective in producing population-behaviour change related to youth alcohol and drug use. This study evaluated the post-intervention effects of a multi-component community intervention in Australia. It comprised social marketing targeting adolescents and parents, and a community intervention to reduce underage alcohol sales. Structural equation modelling was used to examine direct and indirect effects of community intervention components on intention and consumption. Self-report surveys (N = 3377) and community sales data (27 communities) were analysed to evaluate the effect of the intervention components on intention and consumption before the age of 18. The intervention reduced alcohol sales to minors (OR =.82). Exposure to the social marketing was significantly associated with household no-alcohol rules (OR = 2.24) and parents not supplying alcohol (OR =.72). The intervention predicted intention not to consume alcohol before age 18; intention was associated with not consuming alcohol (OR = 5.70). Total indirect effects from the intervention through to intention were significant. However, parents setting a rule and not supplying alcohol were the only significant direct effects to intention. Parents setting a rule was directly associated with lower consumption. Overall, the intervention logic was supported by the data modelling. The study extends prior knowledge of community-based interventions to prevent adolescent alcohol use by identifying critical intervention components and effect mechanisms. ClinicalTrials.gov Identifier: ACTRN12612000384853. [ABSTRACT FROM AUTHOR]

Background: Rates of common mental health problems (depression/anxiety) rise sharply in adolescence and peak in young adulthood, often coinciding with the transition to parenthood. Little is known regarding the persistence of common mental health problems from adolescence to the perinatal period in both mothers and fathers. Methods: A total of 393 mothers (686 pregnancies) and 257 fathers (357 pregnancies) from the intergenerational Australian Temperament Project Generation 3 Study completed self-report assessments of depression and anxiety in adolescence (ages 13–14, 15–16, 17–18 years) and young adulthood (ages 19–20, 23–24, 27–28 years). The Edinburgh Postnatal Depression Scale was used to assess depressive symptoms at 32 weeks pregnancy and 12 months postpartum in mothers, and at 12 months postpartum in fathers. Results: Most pregnancies (81%) in which mothers reported perinatal depression were preceded by a history of mental health problems in adolescence or young adulthood. Similarly, most pregnancies (83%) in which fathers reported postnatal depression were preceded by a preconception history of mental health problems. After adjustment for potential confounders, the odds of self-reporting perinatal depression in both women and men were consistently higher in those with a history of persistent mental health problems across adolescence and young adulthood than those without (ORwomen 5.7, 95% CI 2.9–10.9; ORmen 5.5, 95% CI 1.03–29.70). Conclusions: Perinatal depression, for the majority of parents, is a continuation of mental health problems with onsets well before pregnancy. Strategies to promote good perinatal mental health should start before parenthood and include both men and women. [ABSTRACT FROM AUTHOR]

Bullying is a well-established risk factor for common adolescent mental disorders. Yet there has been little published on how patterns of bullying change across late childhood and early adolescence. We estimated the prevalence and patterns of being a victim of bullying across this period including changes with the transition from primary to secondary school. A stratified random sample of 1239 Grade 3 students was recruited from 43 primary schools in Melbourne, Australia. Bullying frequency and form were assessed annually between Grades 3 and 8, and categorized into 5 groups: physical, verbal, spreading rumors, social exclusion, and cyber, together with multiform bullying. Rates of bullying were high across these Grades with 86% of students reporting bullying at least once in the past 4 weeks at any wave, 66% reporting frequent bullying and 37% reporting frequent multiform bullying. The commonest form of bullying was teasing, with cyberbullying the least common. For boys, there were marked falls in bullying with increasing age whereas for girls, bullying persisted at high levels into secondary school, with relational bullying the dominant pattern and cyberbullying increasing sharply in the early teens. Generally, the transition to secondary education brought lower risks for all forms of bullying. We found high rates of bullying across late childhood and early adolescence in both sexes, but more persistent bullying in girls. Declines across primary school and with the transition to secondary school suggest the potential for intervention across these grades to further reduce the prevalence of bullying. [ABSTRACT FROM AUTHOR]

The Australian New Zealand Intergenerational Cohort Consortium (ANZ-ICC) brings together three of the longest running intergenerational cohort studies in Australia and New Zealand to examine the extent to which preconception parental life histories (from infancy to parenthood) predict next generation early health and development. The aims are threefold: (1) to describe pathways of advantage that strengthen emotional health and well-being from one generation to the next, (2) to describe pathways of disadvantage that perpetuate cycles of emotional and behavioural problems across generations, and (3) to identify modifiable factors capable of breaking intergenerational cycles. The Victorian Intergenerational Health Cohort Study has followed 1,943 young Australians from adolescence to adulthood across ten waves since 1992, and 1,030 offspring from pregnancy to early childhood since 2006. The Australian Temperament Project Generation 3 Study has followed 2,443 young Australians from infancy to adulthood across 15 waves since 1983, and 1170 offspring from pregnancy to early childhood since 2012. The Dunedin Multidisciplinary Health and Development Study Parenting Study has followed 1,037 young New Zealanders across 15 waves since 1972, and 730 offspring in early childhood since 1994. Cross-cohort replication analyses will be conducted for common preconception exposures and next generation offspring outcomes, while integrated data analysis of pooled data will be used for rare exposures and outcomes. The ANZ-ICC represents a unique collaboration that bridges the disciplines of lifecourse epidemiology, biostatistics, developmental psychology and psychiatry, to study the role of parental preconception exposures on next generation health and development. [ABSTRACT FROM AUTHOR]

Background: Depression frequently first emerges during adolescence, and one in five young people will experience an episode of depression by the age of 18 years. Despite advances in treatment, there has been limited progress in addressing the burden at a population level. Accordingly, there has been growing interest in prevention approaches as an additional pathway to address depression. Depression can be prevented using evidence-based psychological programmes. However, barriers to implementing and accessing these programmes remain, typically reflecting a requirement for delivery by clinical experts and high associated delivery costs. Digital technologies, specifically smartphones, are now considered a key strategy to overcome the barriers inhibiting access to mental health programmes. The Future Proofing Study is a large-scale school-based trial investigating whether cognitive behaviour therapies (CBT) delivered by smartphone application can prevent depression.Methods: A randomised controlled trial targeting up to 10,000 Year 8 Australian secondary school students will be conducted. In Stage I, schools will be randomised at the cluster level either to receive the CBT intervention app (SPARX) or to a non-active control group comparator. The primary outcome will be symptoms of depression, and secondary outcomes include psychological distress, anxiety and insomnia. At the 12-month follow-up, participants in the intervention arm with elevated depressive symptoms will participate in an individual-level randomised controlled trial (Stage II) and be randomised to receive a second CBT app which targets sleep difficulties (Sleep Ninja) or a control condition. Assessments will occur post intervention (both trial stages) and at 6, 12, 24, 36, 48 and 60 months post baseline. Primary analyses will use an intention-to-treat approach and compare changes in symptoms from baseline to follow-up relative to the control group using mixed-effect models.Discussion: This is the first trial testing the effectiveness of smartphone apps delivered to school students to prevent depression at scale. Results from this trial will provide much-needed insight into the feasibility of this approach. They stand to inform policy and commission decisions concerning if and how such programmes should be deployed in school-based settings in Australia and beyond.Trial Registration: Australian and New Zealand Clinical Trial Registry, ACTRN12619000855123. Registered on 31 May 2019. Clinical Trial Notification Scheme (CTN), CT-2019-CTN-02110-1-v1. Registered on 30 June 2019. [ABSTRACT FROM AUTHOR]

Background: Self-harm in young people is associated with later problems in social and emotional development. However, it is unknown whether self-harm in young women continues to be a marker of vulnerability on becoming a parent. This study prospectively describes the associations between pre-conception self-harm, maternal depressive symptoms and mother–infant bonding problems. Methods: The Victorian Intergenerational Health Cohort Study (VIHCS) is a follow-up to the Victorian Adolescent Health Cohort Study (VAHCS) in Australia. Socio-demographic and health variables were assessed at 10 time-points (waves) from ages 14 to 35, including self-reported self-harm at waves 3–9. VIHCS enrolment began in 2006 (when participants were aged 28–29 years), by contacting VAHCS women every 6 months to identify pregnancies over a 7-year period. Perinatal depressive symptoms were assessed with the Edinburgh Postnatal Depression Scale during the third trimester, and 2 and 12 months postpartum. Mother–infant bonding problems were assessed with the Postpartum Bonding Questionnaire at 2 and 12 months postpartum. Results: Five hundred sixty-four pregnancies from 384 women were included. One in 10 women (9.7%) reported pre-conception self-harm. Women who reported self-harming in young adulthood (ages 20–29) reported higher levels of perinatal depressive symptoms and mother–infant bonding problems at all perinatal time points [perinatal depressive symptoms adjusted β = 5.40, 95% confidence interval (CI) 3.42–7.39; mother–infant bonding problems adjusted β = 7.51, 95% CI 3.09–11.92]. There was no evidence that self-harm in adolescence (ages 15–17) was associated with either perinatal outcome. Conclusions: Self-harm during young adulthood may be an indicator of future vulnerability to perinatal mental health and mother–infant bonding problems. [ABSTRACT FROM AUTHOR]

Objective: Despite known associations between eating disorders and obesity, little is known about the current prevalence of symptoms of eating disorders across the weight spectrum. This study therefore aimed to estimate the population prevalence of eating disorder symptoms in relation to weight status in adolescents. Method: The sample comprised 3,270 participants (14–15 years; 52% boys) drawn from Wave 6 of the Longitudinal Study of Australian Children. Symptoms of anorexia nervosa (AN) and bulimia nervosa (BN) were assessed using self‐report on the Branched Eating Disorder Test. This measure identifies clinically significant symptoms in the past 3 months according to the Diagnostic and Statistical Manual of Mental Disorders, fifth edition. Using study‐derived cross‐sectional population weights, the prevalence of each symptom was estimated for the total population and by sex and weight status. Results: The estimated population prevalence was high (14.3–25.7%) for body image symptoms such as fear of weight gain and overvaluation of body weight but lower (0.5–3.7%) for behavioral symptoms such as binge eating and compensatory behaviors. Symptoms were more prevalent among adolescents with overweight or obesity. Although most symptoms tended to have higher prevalence among girls than boys, boys with obesity had higher prevalence of binge eating and excessive exercise than girls with obesity. The overall estimated population prevalence for AN and BN was 0.20% and 0.10%, respectively. Discussion: The study highlights a need for clinicians to be cognizant of disordered eating behaviors regardless of weight status and has implications for both eating disorder and obesity prevention and intervention. [ABSTRACT FROM AUTHOR]

Background: Alcohol use in adolescence predicts future alcohol misuse. However, the extent to which different patterns of adolescent use present risk remains unclear. Objectives: This study investigated how adolescent trajectories of alcohol consumption during the school years predict alcohol misuse at age 19 years. Methods: Data were drawn from 707 students from Victoria, Australia, longitudinally followed for 7 years. Five alcohol use trajectories were identified based on the frequency of alcohol use from Grade 6 (age 12 years) to Grade 11 (age 17 years). At age 19 years, participants completed measures indicating Heavy Episodic Drinking (HED), dependency - Alcohol Use Disorders Identification Test (AUDIT) and social harms. Results: At 19 years of age, 64% of participants reported HED, 42% high AUDIT scores (8+), and 23% social harms. Participants belonging to a steep escalator trajectory during adolescence had twice the odds at 19 years of age of high AUDIT scores and social harms, and three times greater odds of HED than participants whose alcohol use slowly increased. Stable moderate consumption was also associated with an increased risk of HED compared to slowly increasing use. Abstinence predicted a reduced likelihood of all forms of misuse at 19 years of age compared to slowly increased alcohol use. Conclusions: Trajectories of drinking frequency during adolescence predict alcohol misuse at age 19 years. Although rapid increasing use presents the greatest risk, even slowly increasing drinking predicts increased risk compared to abstinence. The findings indicate that alcohol policies should recommend nonuse and reduced frequency of use during adolescence. [ABSTRACT FROM AUTHOR]

Background: Frequent bullying predicts adolescent mental health problems, particularly depression. This population‐based study with young Australian primary school children aimed to determine the frequency and mental health correlates of bullying, and whether friendship could be protective. Method: Participants were a population‐based sample of 1221 children aged 8–9 years attending 43 primary schools in metropolitan Melbourne, Australia. Children were taking part in the Childhood to Adolescence Transition Study. Children completed online questionnaires at school to measure peer relations and emotional well‐being. Parents reported on their child's mental health in questionnaires sent to the home. Results: One in three children (29.2%) reported experiencing frequent bullying, defined as at least once a week. This included physical bullying alone (13.8%), verbal bullying alone (22.7%) and the combination (7.4%). Children who reported being frequently bullied self‐reported higher internalising symptoms compared with children who did not report frequent bullying (M (SD) 1.6 (0.9) vs. 1.1 (0.8), p < .001). This difference was confirmed by parents' reports of their child's internalising symptoms (M (SD) 2.4 (2.3) vs. 2.1 (2.0), p = .026, respectively). Amongst children who reported frequent bullying, those with a group of friends had better emotional well‐being. Conclusions: A substantial proportion of children report experiencing bullying on a weekly basis early in primary school. Given the prevalence of bullying in primary school and its relationship to children's mental health, we recommend effective school‐wide antibullying programmes. Further research can explore whether intervention to foster a group of friends around bullied children can improve their emotional well‐being. [ABSTRACT FROM AUTHOR]

Abstract: Background and Aims: Studies have linked adolescent alcohol use with adverse consequences in adulthood, yet it is unclear how strong the associations are and to what extent they may be due to confounding. Our aim was to estimate the strength of association between different patterns of adolescent drinking and longer‐term psychosocial harms taking into account individual, family and peer factors. Design: Participant‐level data were integrated from four long‐running longitudinal studies: Australian Temperament Project, Christchurch Health and Development Study, Mater Hospital and University of Queensland Study of Pregnancy and Victorian Adolescent Health Cohort Study. Setting: Australia and New Zealand. Participants: Participants were assessed on multiple occasions between ages 13 and 30 years (from 1991 to 2012). Number of participants varied (up to n = 9453) by analysis. Measurements: Three patterns of alcohol use (frequent, heavy episodic and problem drinking) were assessed prior to age 17. Thirty outcomes were assessed to age 30 spanning substance use and related problems, antisocial behaviour, sexual risk‐taking, accidents, socio‐economic functioning, mental health and partner relationships. Findings: After covariate adjustment, weekly drinking prior to age 17 was associated with a two‐ to threefold increase in the odds of binge drinking [odds ratio (OR) = 2.14; 95% confidence interval (CI) = 1.57–2.90], drink driving (OR = 2.78; 95% CI = 1.84–4.19), alcohol‐related problems (OR = 3.04; 95% CI = 1.90–4.84) and alcohol dependence (OR = 3.30; 95% CI = 1.69–6.47) in adulthood. Frequency of drinking accounted for a greater proportion of the rate of most adverse outcomes than the other measures of alcohol use. Associations between frequent, heavy episodic and problem drinking in adolescence and most non‐alcohol outcomes were largely explained by shared risk factors for adolescent alcohol use and poor psychosocial functioning. Conclusions: Frequency of adolescent drinking predicts substance use problems in adulthood as much as, and possibly more than, heavy episodic and problem drinking independent of individual, family and peer predictors of those outcomes. [ABSTRACT FROM AUTHOR]

Introduction and Aims: There is a need to explain reported trends of reduced alcohol and drug (substance) use in school-aged children in Australia. This study used student survey data collected in the states of Victoria, Western Australia and Queensland to examine trends in substance use and associated influencing factors.Design and Methods: Youth self-reports were examined from 11 cross-sectional surveys completed by 41 328 adolescents (average age 13.5 years, 52.5% female) across 109 Australian communities between 1999 and 2015. Multi-level modelling was used to identify trends in adolescent reports of lifetime alcohol, tobacco and cannabis use, adjusted for age, gender, social disadvantage and minority status. Trends in influencing factors were also examined that included: individual attitudes, and family, school and community environments. Multivariate analyses estimated the main contributors to alcohol use trends.Results: Alcohol, tobacco and cannabis use all fell significantly from 1999 to 2015. Higher levels of use were observed in Victoria compared to Western Australia or Queensland. Multivariate analyses identified reductions in favourable parent attitudes and lower availability of substances as direct contributors to reducing alcohol use trends. Indicators of school and family adjustment did not show similar trend reductions.Discussion and Conclusions: Reductions in adolescent alcohol, tobacco and cannabis use from 1999 to 2015 were associated with similar reductions in parent favourable attitudes and availability of substances. It is plausible that a reduced tendency for parents and other adults to supply adolescent alcohol are implicated in the reductions in adolescent alcohol use observed across Australia. [ABSTRACT FROM AUTHOR]

Keywords: Child health; Adolescence; Health policy; Public health; Social determinants of health EN Child health Adolescence Health policy Public health Social determinants of health 484 485 2 11/07/22 20221101 NES 221101 It is time to reimagine wellbeing and place the future of our children and young people at the centre of public action As we approach World Children's Day and the 2022 United Nations Climate Change Conference (COP27), we are once again reminded of how lack of leadership and coordinated action is threatening the future of humankind and, particularly, that of our children, young people and generations to come.1 Although climate change had already affected how younger generations and their parents imagine a healthy future, the onset of the global coronavirus disease 2019 (COVID-19) pandemic has only served to heighten their concerns.2 Research from around the world indicates that children and young people have been disproportionately burdened by the changes and challenges of the past 3 years. Child health, Adolescence, Health policy, Public health, Social determinants of health. [Extracted from the article]

Background: Suicide is a leading cause of death in Australian males aged 18 to 55. Non-fatal suicidal behaviours and thoughts are indicators of increased risk for future suicide. Suicidal behaviour is complex and multi-determined. Research supports the involvement of stressful life events in suicide and suicidal behaviour, however the evidence regarding suicidal thoughts is less developed. This study investigates stressful life events in relation to suicidal ideation in a large cohort of adult males recruited into Ten to Men, the Australian Longitudinal Study on Male Health.Methods: Baseline data from a national cohort of 13, 884 males aged 18-55 years on suicidal behaviour, psychiatric disorder and life events was used. Multivariable logistic regressions were conducted with current suicidal ideation as the outcome and 12 month life events, 12 month depression, anxiety and harmful/hazardous alcohol use, and socio-demographics as covariates. Further logistic regression models investigated the relative risk of life stress alone, depression/alcohol/anxiety alone and co-occurring life stress and depression/alcohol/anxiety.Results: In multivariable models there was an independent contribution to suicidal ideation for six of 24 life events (ORs 1.27-1.95), 12 month depression (OR 4.49) harmful alcohol use (OR 1.38) and anxiety disorders (OR 1.27). Life events co-occurring with depression (OR 10.3) was higher risk than either alone (depression OR 6.6; life stress OR 2.6). There was a lesser effect for co-occurrence in the anxiety and harmful alcohol use models.Conclusion: Life events appear to be related to suicidal ideation independent of depression, anxiety and harmful alcohol use in adult males, however if life events occur in the context of depression that risk is substantially increased. [ABSTRACT FROM AUTHOR]

Background: The Australian Longitudinal Study on Male Health (Ten to Men) was established in 2011 to build the evidence base on male health to inform policy and program development.Methods: Ten to Men is a national longitudinal study with a stratified multi-stage cluster random sample design and oversampling in rural and regional areas. Household recruitment was conducted from October 2013 to July 2014. Males who were aged 10 to 55 years residing in private dwellings were eligible to participate. Data were collected via self-completion paper questionnaires (participants aged 15 to 55) and by computer-assisted personal interview (boys aged 10 to 14). Household and proxy health data for boys were collected from a parent via a self-completion paper-based questionnaire. Questions covered socio-demographics, health status, mental health and wellbeing, health behaviours, social determinants, and health knowledge and service use.Results: A cohort of 15,988 males aged between 10 and 55 years was recruited representing a response fraction of 35 %.Conclusion: Ten to Men is a unique resource for investigating male health and wellbeing. Wave 1 data are available for approved research projects. [ABSTRACT FROM AUTHOR]

Objective: To provide guidance for the organisation and delivery of clinical services and the clinical management of patients who deliberately self-harm, based on scientific evidence supplemented by expert clinical consensus and expressed as recommendations. Method: Articles and information were sourced from search engines including PubMed, EMBASE, MEDLINE and PsycINFO for several systematic reviews, which were supplemented by literature known to the deliberate self-harm working group, and from published systematic reviews and guidelines for deliberate self-harm. Information was reviewed by members of the deliberate self-harm working group, and findings were then formulated into consensus-based recommendations and clinical guidance. The guidelines were subjected to successive consultation and external review involving expert and clinical advisors, the public, key stakeholders, professional bodies and specialist groups with interest and expertise in deliberate self-harm. Results: The Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for deliberate self-harm provide up-to-date guidance and advice regarding the management of deliberate self-harm patients, which is informed by evidence and clinical experience. The clinical practice guidelines for deliberate self-harm is intended for clinical use and service development by psychiatrists, psychologists, physicians and others with an interest in mental health care. Conclusion: The clinical practice guidelines for deliberate self-harm address self-harm within specific population sub-groups and provide up-to-date recommendations and guidance within an evidence-based framework, supplemented by expert clinical consensus. [ABSTRACT FROM AUTHOR]

Adolescent depressed mood is related to the development of subsequent mental health problems, and family problems have been linked to adolescent depression. Longitudinal research on adolescent depressed mood is needed to establish the unique impact of family problems independent of other potential drivers. This study tested the extent to which family conflict exacerbates depressed mood during adolescence, independent of changes in depressed mood over time, academic performance, bullying victimization, negative cognitive style, and gender. Students (13 years old) participated in a three-wave bi-national study ( n = 961 from the State of Washington, United States, n = 981 from Victoria, Australia; 98 % retention, 51 % female in each sample). The model was cross-lagged and controlled for the autocorrelation of depressed mood, negative cognitive style, academic failure, and bullying victimization. Family conflict partially predicted changes in depressed mood independent of changes in depressed mood over time and the other controls. There was also evidence that family conflict and adolescent depressed mood are reciprocally related over time. The findings were closely replicated across the two samples. The study identifies potential points of intervention to interrupt the progression of depressed mood in early to middle adolescence. [ABSTRACT FROM AUTHOR]

Background: There are limited longitudinal data on the associations between different social contexts of alcohol use and risky adolescent drinking.Methods: Australian prospective longitudinal cohort of 1943 adolescents with 6 assessment waves at ages 14-17 years. Drinkers were asked where and how frequently they drank. Contexts were: at home with family, at home alone, at a party with friends, in a park/car, or at a bar/nightclub. The outcomes were prevalence and incidence of risky drinking (≥5 standard drinks (10g alcohol) on a day, past week) and very risky drinking (>20 standard drinks for males and >11 for females) in early (waves 1-2) and late (waves 3-6) adolescence.Results: Forty-four percent (95 % CI: 41-46 %) reported past-week risky drinking on at least one wave during adolescence (waves 1-6). Drinking at a party was the most common repeated drinking context in early adolescence (28 %, 95 % CI 26-30 %); 15 % reported drinking repeatedly (3+ times) with their family in early adolescence (95 % CI: 14-17 %). For all contexts (including drinking with family), drinking 3+ times in a given context was associated with increased the risk of risky drinking in later adolescence. These effects remained apparent after adjustment for potential confounders (e.g. for drinking with family, adjusted RR 1.9; 95 % CI: 1.5-2.4). Similar patterns were observed for very risky drinking.Conclusions: Our results suggest that consumption with family does not protect against risky drinking. Furthermore, parents who wish to minimise high risk drinking by their adolescent children might also limit their children's opportunities to consume alcohol in unsupervised settings. [ABSTRACT FROM AUTHOR]

Objective The aim of this study was to examine associations between family-based stressors and depressive symptoms in adolescents. Method Participants were 10-14 year olds who participated in a large Australian population study (n = 6,552). Depressive symptoms and pubertal development were assessed using the self-report Short Mood and Feelings Questionnaire and the Pubertal Development Scale. Three indicators of stress exposure were examined-low emotional closeness to parents, residential and school transitions, and family conflict. The effect of gender, stress exposure and the interaction of gender and stress exposure on depressive symptoms was tested using multivariate logistic regression. Results High family conflict, residential instability and low emotional closeness with parents were independently associated with adolescent depressive symptoms. There was a significant gender by emotional closeness interaction; females reporting low emotional closeness to their parents were 2.3 times more likely to report high depressive symptoms than females reporting high emotional connections with parents. Conclusions Female adolescents may be more susceptible to particular types of stresses and particularly the quality of the parent-child relationship. [ABSTRACT FROM AUTHOR]

Background Perinatal depression is a neglected global health priority, affecting 10–15% of women in high-income countries and a greater proportion in low-income countries. Outcomes for children include cognitive, behavioural, and emotional difficulties and, in low-income settings, perinatal depression is associated with stunting and physical illness. In the Victorian Intergenerational Health Cohort Study (VIHCS), we aimed to assess the extent to which women with perinatal depressive symptoms had a history of mental health problems before conception. Methods VIHCS is a follow-up study of participants in the Victorian Adolescent Health Cohort Study (VAHCS), which was initiated in August, 1992, in the state of Victoria, Australia. In VAHCS, participants were assessed for health outcomes at nine timepoints (waves) from age 14 years to age 29 years. Depressive symptoms were measured with the Revised Clinical Interview Schedule and the General Health Questionnaire. Enrolment to VIHCS began in September, 2006, during the ninth wave of VAHCS; depressive symptoms at this timepoint were measured with the Composite International Diagnostic Interview. We contacted women every 6 months (from age 29 years to age 35 years) to identify any pregnancies. We assessed perinatal depressive symptoms with the Edinburgh Postnatal Depression Scale (EPDS) by computer-assisted telephone interview at 32 weeks of gestation, 8 weeks after birth, and 12 months after birth. We defined perinatal depression as an EPDS score of 10 or more. Findings From a stratified random sample of 1000 female participants in VAHCS, we enrolled 384 women with 564 pregnancies. 253 (66%) of these women had a previous history of mental health problems at some point in adolescence or young adulthood. 117 women with a history of mental health problems in both adolescence and young adulthood had 168 pregnancies, and perinatal depressive symptoms were reported for 57 (34%) of these pregnancies, compared with 16 (8%) of 201 pregnancies in 131 women with no preconception history of mental health problems (adjusted odds ratio 8·36, 95% CI 3·34–20·87). Perinatal depressive symptoms were reported at one or more assessment points in 109 pregnancies; a preconception history of mental health problems was reported in 93 (85%) of these pregnancies. Interpretation Perinatal depressive symptoms are mostly preceded by mental health problems that begin before pregnancy, in adolescence or young adulthood. Women with a history of persisting common mental disorders before pregnancy are an identifiable high-risk group, deserving of clinical support throughout the childbearing years. Furthermore, the window for considering preventive intervention for perinatal depression should extend to the time before conception. INSET: Panel: Research in context.. [ABSTRACT FROM AUTHOR]

Introduction and Aims Young offenders are at increased risk of preventable death after release from custody, but risk factors for death in this population are poorly understood. Despite their poor health profiles, no studies have examined mortality outcomes in young people who have served community-based orders. The aims of this study were to describe the causes and identify risk factors for death in a cohort of young offenders in Victoria, Australia. Design and Methods We interviewed young people serving a custodial ( n = 273) or community-based order ( n = 242) in Victoria, Australia in 2002-2003. Measures included demographics and family history, offence history, experience of victimisation, mental illness, self-harm and substance use. Deaths up to 31 December 2011 were identified through a probabilistic linkage with the National Death Index. Results The all-cause crude mortality rate was 4.2 (95% confidence interval 2.7-6.8) per 1000 person years and was not significantly different for those who had served custodial and community-based orders. Most deaths were due to drug overdose, traffic accidents or suicide. Adjusting for age, sex and order type, risk factors for death from the baseline interview included weekly use of opioids, sleeping pills or painkillers, polydrug use and injecting drug use. Discussion and Conclusions Young people who have served community-based and custodial orders are at an increased risk of preventable death. Those engaging in risky substance use, particularly injecting drug use and use of multiple central nervous system depressants, are at greatest risk. There is an urgent need to develop and rigorously evaluate preventive interventions. [Kinner SA, Degenhardt L, Coffey C, Hearps S, Spittal M, Sawyer SM, Patton GC. Substance use and risk of death in young offenders: A prospective data linkage study. Drug Alcohol Rev 2015;34:46-50] [ABSTRACT FROM AUTHOR]

Multiple imputation has entered mainstream practice for the analysis of incomplete data. We have used it extensively in a large Australian longitudinal cohort study, the Victorian Adolescent Health Cohort Study (1992–2008). Although we have endeavored to follow best practices, there is little published advice on this, and we have not previously examined the extent to which variations in our approach might lead to different results. Here, we examined sensitivity of analytical results to imputation decisions, investigating choice of imputation method, inclusion of auxiliary variables, omission of cases with excessive missing data, and approaches for imputing highly skewed continuous distributions that are analyzed as dichotomous variables. Overall, we found that decisions made about imputation approach had a discernible but rarely dramatic impact for some types of estimates. For model-based estimates of association, the choice of imputation method and decisions made to build the imputation model had little effect on results, whereas estimates of overall prevalence and prevalence stratified by subgroup were more sensitive to imputation method and settings. Multiple imputation by chained equations gave more plausible results than multivariate normal imputation for prevalence estimates but appeared to be more susceptible to numerical instability related to a highly skewed variable. [ABSTRACT FROM PUBLISHER]

Introduction and Aims. Despite considerable success in tobacco control, many teenagers in Australia and other industrialised countries still smoke tobacco. There is mixed evidence on the relative influence of proximal social networks (parents/siblings/peers) on pre- and early-teen smoking, and no research has examined how these influences compare after accounting for school- and community-level effects.The aim of this study was to compare the relative influences of parents, siblings and peers, after accounting for school- and community-level variation in smoking. Design and Methods. A cross-sectional fixed and random effects model of smoking prevalence was used, with individuals (n = 7314) nested within schools (n = 231) nested within communities (n = 30). Grade 6 and 8 students (modal ages 11 and 13 years) completed an on-line survey. Key variables included parent/sibling/peer use. Controls included alcohol involvement, sensation seeking, pro-social beliefs, laws/norms about substance use and school commitment. Results. There was significant variation in smoking at both the school and community levels, supporting the need for a multilevel model. Individual-level predictors accounted for much of the variance at higher levels. The strongest effects were for number of friends who smoke, sibling smoking and alcohol involvement. Smaller significant effects were found for parent smoking. At the community level, socioeconomic disadvantage was significant, but community-level variance in pro-social and drug-related laws/norms was not related to smoking. Discussion and Conclusions. Cross-level interactions were generally non-significant. Early teenage smoking was best explained by sibling and peer smoking, and individual risks largely accounted for the substantial variation observed across schools and communities. In terms of future tobacco control, findings point to the utility of targeting families in disadvantaged communities.[Kelly AB, O'Flaherty M, Connor JP, Homel R, Toumbourou JW, Patton GC, Williams J. The influence of parents, siblings and peers on pre- and early-teen smoking: A multilevel model. Drug Alcohol Rev 2011;30:381-387] [ABSTRACT FROM AUTHOR]

Women reporting childhood sexual abuse (CSA) that involved actual or attempted penetration may not identify this as their first sexual intercourse. Data were drawn from a population-based, prospective cohort study spanning adolescence to adulthood. CSA prior to age 16 and age of first sexual intercourse with a male were assessed retrospectively. More than half of women reporting CSA in the form of actual or penetrative abuse reported an age of first sexual intercourse at or beyond 16 years. Direct questioning about CSA is needed to accurately ascertain sexual history. [ABSTRACT FROM AUTHOR]

The article discusses a study that examined age and sex differences in the leading causes of prevalent disability in young Australians, analyzing data from the 2003 Australian Burden of Disease and Injury Study. One of the results revealed that anxiety and depression, along with attention deficit hyperactivity disorder (ADHD) and autism, cause more prevalent years lived with disability (PYLD) in 10-24-year-old males. Another is that anorexia nervosa and bulimia are the second leading cause of mental disability in young females.

CONTEXT: The promotion of optimism has been widely advocated for children and adolescents, but epidemiologic data to support this approach are scant. METHODS: This was a 3-wave longitudinal study of health and social development in younger adolescents from 3 Australian states. The 5634 student participants, initially aged 12 to 14 years, were assessed for optimistic thinking style, emotional problems, substance use, and antisocial behaviors. RESULTS: Cross-sectional associations between optimism and each of the study outcomes were strongly protective but tended to differ according to gender in extent. In prospective analyses of the onset of new cases of each study outcome, protective associations were weaker. Those in the highest optimism quartile had risks for depressive symptoms that were reduced by almost half (odds ratio: 0.54 [95% confidence interval: 0.42- 0.70]) compared with those in the lowest category. No effect was seen in prevention of anxiety symptoms after adjustment for other aspects of psychological style. In predicting the onset of heavy substance use and antisocial behavior, high optimism had modest protective effects. CONCLUSIONS: Optimistic thinking style is somewhat protective against adolescent health risks; the clearest effects are seen against depressive symptoms. Promoting optimism along with other aspects of psychological and emotional style has a role in mental health promotion that is likely to be enhanced if an intervention also addresses risk and protective factors in an adolescent's social context. [ABSTRACT FROM AUTHOR]

Background: Although educational disparity has been linked to single risk behaviours, it has not previously been studied as a predictor of overall lifestyle. We examined if current education, parental education or educational mobility between generations was associated with healthy lifestyles in young Australian adults. Methods: In 2004-06, participant and parental education (high [bachelor degree or higher], intermediate [vocational training], low [secondary school only]) were assessed. Educational mobility was defined as: stable high (participant and parent in high group), stable intermediate (participant and parent in intermediate group), stable low (participant and parent in low group), downwardly (lower group than parent) and upwardly (higher group than parent) mobile. We derived a lifestyle score from 10 healthy behaviours (BMI, non-smoking, alcohol consumption, leisure time physical activity and six components of diet). Scores >4 indicated a high healthy lifestyle score. We estimated the likelihood of having a high healthy lifestyle score by education (participant and parent) and educational mobility. Results: Complete data were available for 1973 participants (53% female, age range 26 to 36 years). Those with lower education were less likely to have healthy lifestyles. Parental education was not associated with having a high healthy lifestyle score after adjustment for participant's education. Those who moved upward or downward were as likely to have a high healthy lifestyle score as those in the group they attained. Conclusions: We found clear disparities in health behaviour by participant education and intergenerational educational mobility. People attaining a higher level of education than their parents appeared protected from developing an unhealthy lifestyle suggesting that population-wide improvements in education may be important for health. [ABSTRACT FROM AUTHOR]

Recognizing there have been few methodologically rigorous cross-national studies of youth alcohol and drug behaviour, state student samples were compared in Australia and the USA. Sampling methods were matched to recruit two independent, state-representative, cross-sectional samples of students in Grades 5, 7 and 9 in Washington State, USA, (n = 2866) and Victoria, Australia (n = 2864) in 2002. Of Washington students in Grade 5 (age 11), 10.3% (95% CI 7.2–14.7) of boys and 5.2% (95% CI 3.4–7.9) of girls reported alcohol use in the past year. Prevalence rates were markedly higher in Victoria (34.2%, 95% CI 28.8–40.1 boys; 21.0%, 95% CI 17.1–25.5 girls). Relative to Washington, the students in Victoria demonstrated a two to three times increased likelihood of reporting substance use (either alcohol, tobacco or illicit drug use), and by Grade 9, experiences of loss-of-control of alcohol use, binge drinking (frequent episodes of five or more alcoholic drinks), and injuries related to alcohol were two to four times higher. The high rates of early age alcohol use in Victoria were associated with frequent, heavy and harmful alcohol use and higher overall exposure to alcohol or other drug use. These findings reveal considerable variation in international rates of both adolescent alcohol misuse and co-occurring drug use and suggest the need for cross-national research to identify policies and practices that contribute to the lower rate of adolescent alcohol and drug use observed in the USA in this study. [ABSTRACT FROM PUBLISHER]