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Self-reported behavioural/emotional problems were studied in 2647 15-18-year-old high school students by Youth Self-Report (YSR), Symptom Checklist (SCL-12) and a Conduct Problem scale. The response rate was 85%. The respondents were from three ethnic groups in northern Norway: indigenous Sami,Kvens (descendants of Finnish-speaking immigrants from northern Finland and Sweden) and Norwegians. Females' mean scores were higher than males' scores for Total Problems [47.2 (SD 19.3) vs. 40.9 (SD 19.4)], Internalising Problems, the Internalising syndrome scales and the Attention Problems scale. Males' mean scores were higher than females' scores for Delinquent Behaviour. There were few differences between the ethnic groups, but Sami had higher scores than Norwegians for the Withdrawn and Social Problems syndromes. Parental status (whether parents were living together) was weakly associated with Total Problems, Internalising and Externalising Problems, while age, socioeconomic status and urban/rural location were not associated with the problem scales. Results for Anxiety-depression (SCL-12) and Conduct Problems were compared with a national representative adolescent sample (n = 4567), showing slight differences between the samples in Anxiety-depression (with north Norwegian adolescents having lower scores) and no significant differences in Conduct Problems. [ABSTRACT FROM AUTHOR]

The influence of parentage and ethnic community context on ethnic self-identification and ethnic attitudes and behaviour were examined in 245 indigenous Sami adolescents in northern Norway. Ethnic identity was strongly related to both parentage and type of ethnic community. Monoethnic adolescents at the coast (with great integration and assimilation) identified themselves mostly as bicultural or Norwegian, but in the highland (with strong ethnic support), they identified strongly as Samis. Adolescents with mixed parentage identified strongly as Norwegian at the coast but mostly as bicultural in the highland. Ethnic behaviour and attitudes were significantly associated with both family and regional context; ethnic self-identification was related to other components of ethnic identity. [ABSTRACT FROM AUTHOR]

Background: This is the first population based study exploring health service use and ethno-cultural factors in indigenous Sami and non-Sami youth in North Norway. The first aim of the present study was to compare the frequency of health service use between Sami adolescents and their non-indigenous peers. The second aim was to explore the relationships between health service use and ethno-cultural factors, such as ethnic context, Sami self-identification, perceived discrimination and Sami language competence. Finally, we wanted to explore the relationship between use of health services and emotional and behavioural problems.Method: The Norwegian Arctic Adolescent Health Study was conducted among 10th graders (15-16 years old) in junior high schools in North Norway. The sample consisted of 4,449 adolescents, of whom 450 (10.1%) were indigenous Sami and 3,999 (89.9%) were non-Sami.Results: Sami and non-Sami youth used all health services with equal frequency. However, several ethno-cultural factors were found to influence health service use. Sami youth in more assimilated ethnic contexts used general practitioners more than non-Sami youth. Youth with Sami self-identification had a higher probability of using the school health service compared with other youth. Ethnic barriers to health service use were also identified. Sami speaking youth with a high degree of perceived discrimination had lower probability of using school health services than non-Sami speaking youth. Sami youth with conduct problems were less likely than non-Sami to use psychologist/psychiatrist. The present study demonstrated a relationship between health need and actual health service use.Conclusion: Culture-specific factors influenced the help-seeking process in indigenous youth; some factors acted as barriers against health service use and other factors increased the probability of health service use. [ABSTRACT FROM AUTHOR]

Introduction: Improving the health of Indigenous adolescents is central to addressing the health inequities faced by Indigenous peoples. To achieve this, it is critical to understand what is needed from the perspectives of Indigenous adolescents themselves. There have been many qualitative studies that capture the perspectives of Indigenous young people, but synthesis of these has been limited to date., Methods and Analysis: This scoping review seeks to understand the specific health needs and priorities of Indigenous adolescents aged 10-24 years captured via qualitative studies conducted across Australia, Aotearoa New Zealand, Canada, the USA, Greenland and Sami populations (Norway and Sweden). A team of Indigenous and non-Indigenous researchers from these nations will systematically search PubMed (including the MEDLINE, PubMed Central and Bookshelf databases), CINAHL, Embase, Scopus, the Informit Indigenous and Health Collections, Google Scholar, Arctic Health, the Circumpolar Health Bibliographic Database, Native Health Database, iPortal and NZresearch.org, as well as specific websites and clearinghouses within each nation for qualitative studies. We will limit our search to articles published in any language during the preceding 5 years given that needs may have changed significantly over time. Two independent reviewers will identify relevant articles using a two-step process, with disagreements resolved by a third reviewer and the wider research group. Data will then be extracted from included articles using a standardised form, with descriptive synthesis focussing on key needs and priorities. This scoping review will be conducted and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines., Ethics and Dissemination: Ethics approval was not required for this review. Findings will be disseminated via a peer-reviewed journal article and will inform a broader international collaboration for Indigenous adolescent health to develop evidence-based actions and solutions., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.)

Nurturing care and protection from parents and community in the early years of life are fundamental for a child's development. The article aims to explore what relations parents see as meaningful in their child's upbringing and how these are shaped, and how these perspectives are reflected in MANU. MANU is a universal parenting programme in Greenland. Ten of 40 interviews with parents were selected for the analysis of this article's objective. Five grandparents were interviewed. Grandparents are the child's closest extended family members and provide support to parents. Parents placed between one to 19 extended family members in their child's network. Eating and being in nature together, along with familial and intergenerational connectedness, were deemed valuable and important aspects in child-rearing. Parents' own experiences in childhood can influence and complicate how parents place their new family within the extended family. The MANU materials address aspects in the role of kin that parents and grandparents described in interviews. The format and delivery of MANU aims to be universal and mostly addresses Western epistemologies, but both Western and Inuit epistemologies coexists in Greenland. This article creates a window into the existing context parents navigate in. It is important that initiatives are built within this context to ensure they are relevant to families.

Background: For young Indigenous people, suicide is one of the leading causes of death, and high rates in Arctic areas indicate serious health and societal concerns. More knowledge is needed, as suicidal behaviour predicts later death by suicide. The aim of this study was to investigate associations between suicidal thoughts and suicide attempts and negative life events, including violence, sexual abuse, and parental substance abuse, in Sami and Greenlandic adolescents, within and between groups and gender., Method: Working samples included 442 Sami and 399 Greenlandic Inuit (15-16-year-olds), in The Norwegian Arctic Adolescent Health Study (NAAHS) and the Well-Being among Youth in Greenland (WBYG) study. Multivariable logistic regression explored associations between suicidal behaviour and violence, sexual abuse, and parental substance abuse., Results: Across Indigenous groups, suicidal thoughts and attempts were significantly associated with violence and sexual abuse. The association between suicidal behaviour; especially suicidal thoughts, and sexual abuse was significant and strong among Sami females. Sami and Inuit adolescents with a history of childhood violence reported significantly more suicide attempts; the strongest association was found among Sami males., Conclusion: To Sami and Greenlandic Inuit, the experiences of negative life events, such as violence or sexual abuse are significant risk factors for suicidal behaviour. Public health programmes and prevention strategies targeting youth mental health and suicide should be culturally sensitive and sensitive to gender differences in the association between negative life events and suicidal behaviour., (© 2023 Ida Pauline Høilo Granheim, Siv Kvernmo, Anne Silviken, Christina Viskum Lytken Larsen, published by Sciendo.)

Background: The transition to parenthood has received increasing attention in research, partly due to evidence pointing out the crucial developmental period of a child's first thousand days. Parenting programmes aim to prepare and support families in their transition and distress. For a programme to be implemented successfully it is important to consider parents' needs and resources. Bringing parents' perspectives and experiences to the forefront of the implementation of the Greenlandic parenting programme MANU 0-1 Year (MANU) is important for determining if the programme can meet its aim of contributing to thriving families. This study aims to investigate how parents' notions and experiences of parenthood are reflected and challenged in MANU., Method: Data were collected in three of Greenland's five municipalities. Qualitative interviews were held with 38 mothers and 12 fathers either individually or as couples: a total of 40 interviews. Additionally, a Sharing Circle with three fathers was held. Interviews were in Greenlandic or Danish. A thematic, inductive analysis was applied., Results: In their transition to parenthood, participants experienced a reprioritisation of their life and changes in their network. It is important to parents that their child experiences security and care, and participants describe this in contrast to their own childhood. Community is the most important value in child-rearing. Conversations and advice from family members and friends are mentioned as a means to prepare for birth and parenthood. Additionally, conversations with midwives and MANU sessions were also used for preparation. Parents appreciated learning from and listening to other parents in MANU sessions. However, accessing MANU depends on the individual parent's interest and ability to attend sessions., Conclusions: Parents' notions and experiences of parenthood are addressed in the programme, but the use of MANU depends on the parents' attendance and how it is organised and locally offered. The study suggests that MANU has the possibility to create a space for parents to reflect and prepare. However, for MANU to be universal as intended and to reach both mother and father the facilitation of sessions could be revisited., (© 2022. The Author(s).)

Background: Teacher reports of child emotional and behavioral problems (EBPs) are sparse in many low- and middle-income countries, especially when compared to reports from parents. Cross-informant information is pivotal to clinicians when dealing with mentally ill children. In this study from Nepal, we examined teacher reports of child EBPs, the agreement between teacher and parent reports, and how this agreement varied by type of EBP and child gender., Methods: This cross-sectional, observational study included 3808 schoolchildren aged 6-18 years from 16 districts of Nepal. Teacher and parent reports of EBPs were measured by the Nepali versions of the Teacher Report Form (TRF) and the Child Behavior Checklist (CBCL), respectively. Linear mixed model analysis was used for group comparisons and intraclass correlations. Agreement between TRF and CBCL scale scores were analyzed using Pearson's correlation coefficient., Results: The prevalence of EBPs according to teacher reports was 15.4%, whereas the previous parent reported prevalence was 19.1%. Also, the mean TRF score was significantly lower than mean CBCL score for the 90 common items. Mean TRF scores for Total Problems, Externalizing Problems, and Internalizing Problems were 26.9 (standard deviation, SD 24.5), 6.1 (SD 7.2), and 7.9 (SD 7.3), respectively. Consistent with parent reports, mean TRF scores for Total Problems and Externalizing Problems were higher among boys than girls, whereas no significant gender differences were found for Internalizing Problems. Teacher-parent agreement was moderate (r = .38), and slightly higher for Externalizing Problems than for Internalizing Problems (r = .37 versus r = .34). Moderate to low correlations were found for all syndrome scales, with coefficients ranging from r = .26 (Social Problems) to r = .37 (Attention Problems). The effect of child gender on the teacher-parent agreement was significant for Internalizing Problems only, with a higher agreement for girls than for boys., Conclusion: Nepali teachers reported fewer child EBPs than parents. Teacher-parent agreement was moderate and varied by type of EBP and child gender. Our findings underscore the importance of obtaining information on child EBPs from both parents and teachers when evaluating and treating children in low- and middle-income countries like Nepal., (© 2022. The Author(s).)

Background: There is a substantial gap in our knowledge about family correlates of child emotional and behavioral problems in low- and middle-income countries (LMIC). The present study contributes to filling this gap by examining such correlates in a larger population study in Nepal., Methods: Our study is a cross-sectional, observational study among 3840 Nepali children aged 6-18 years from 64 schools and 16 districts in the three main geographical regions in the country. We used the Nepali version of the Child Behavior Checklist (CBCL)/6-18 to assess children's internalizing and externalizing problems and an additional background information questionnaire to assess possible family correlates which included parental education, family structure, migrant worker parents, parental mental and physical illness, family conflicts, and child-rearing. The associations between family variables and child internalizing and externalizing problems were analyzed using bivariate correlations and multiple regression., Results: Using bivariate analysis, we found that mental and physical illness in parents, conflict in the family, parental disagreement in child-rearing, and physical punishment of child correlated positively with both Internalizing Problems and Externalizing Problems. The same associations were found by using multiple regression analysis. In addition, parental education, family structure, and migrant worker mothers were associated with Externalizing Problems. However, the effect sizes were small., Conclusion: The results suggest that in Nepal, child mental problems were associated with several family risk factors. Further, the study points to the need of strengthening prevention- and intervention measures to minimize family risk factors of child mental health disorders., Competing Interests: The authors have declared that no competing interests exist.

Background . For young Indigenous people, suicide is one of the leading causes of death, and high rates in Arctic areas indicate serious health- and societal concerns. More knowledge is needed, as suicidal behaviour predictslater death by suicide. Objectives . The objective was to study associations between suicidal thoughts and suicide attempts and socio-demographic, psychosocial, and environmental factors in Sami and Greenlandic adolescents, within and between groups and gender. Methods . Working samples included 442 Sami and 399 Greenlandic Inuit (15-16-year-olds), in "The Norwegian Arctic Adolescent Health Study" (NAAHS) and "Well-being among Youth in Greenland" (WBYG). Multivariable logistic regression explored associations between suicidal behaviour and family , ethnic language , school, friendship, and suicide in close relations. Results . Across Indigenous groups, suicidal behaviour was associated with the female gender, relationships with parents, suicide of friends, and rural living. Sami adolescents in stepparent families reported more suicidal behaviour. Inuit adolescents living outside the family and with poor school performance reported more suicidal thoughts. Inuit adolescents spending less time with friends reported more attempts. Gender differences occurred in both groups. Conclusion . To Sami and Greenlandic Inuit, family and peer relations are important factors of suicidal behaviour. Prevention programmes should be sensitive to gender and bereavement.

In Greenland, the universal parenting programme MANU was developed in 2016. After documenting the initial years of MANU's implementation, this study aimed to identify implementation determinants focusing on i) which context MANU was conceptualised in and how it was developed and ii) how MANU was implemented and initially received in the healthcare system. A qualitative in-depth implementation study was conducted: document analysis, 38 interviews, one focus group discussion, and observations at two trainings for professionals and four parent sessions. Participants included stakeholders from both the health and social sector and from management to practitioner level. MANU was conceptualised based on a political desire to ensure children's well-being by providing parents with the essential parenting skills, and a desire to create a programme for the Greenlandic context. Professionals welcomed the MANU materials, but anticipated or experienced barriers in implementing MANU. The first years of MANU focused on disseminating material and training professionals. Despite political support and financial security enabling implementation, an assessment of the implementation capacity from the very beginning could have prevented some of the implementation challenges identified. Insights on parents' perspectives and local implementation are lacking and need to be brought to the forefront of the implementation process.

Background: As epidemiological data on child mental health in low- and middle-income countries are limited, a large-scale survey was undertaken to estimate the prevalence and amount of child emotional and behavioral problems (EBP) in Nepal as reported by the parents., Methods: 3820 schoolchildren aged 6-18 years were selected from 16 districts of the three geographical regions of Nepal, including rural, semi-urban and urban areas. We used the Nepali version of the Child Behavior Checklist (CBCL)/6-18 years as screening instrument. Comparisons of child problems between genders and between the seven largest castes and ethnic groups were carried out by analysis of variance. Prevalence was computed based on American norms., Results: Adjusted prevalence of Total Problems was 18.3% (boys: 19.1%; girls:17.6%). The prevalence of internalizing problems was higher than externalizing problems. The mean scores of Total, Externalizing, and Internalizing problems were 29.7 (SD 25.6), 7.7 (SD 8.0), and 9.1 (SD 8.1), respectively. The Khas Kaami (Dalit) group scored the highest, and the indigenous Tharu group scored the lowest on all scales. In the Mountains and Middle Hills regions, problem scores were higher in the rural areas, whereas in the Tarai region, they were higher in the urban areas., Conclusion: The prevalence and magnitude of emotional and behavioral problems in Nepali children were found to be high compared to findings in meta-analyses worldwide. Problem scores varied according to gender, castes /ethnic groups, and living areas. Our findings highlight the need for a stronger focus on child mental problems in a low-and middle-income country like Nepal., Competing Interests: The authors have declared that no competing interests exist.

The aim of this study was to examine the associations between self-harm and suicidal behavior in indigenous Sami and non-Sami adolescents and mental health and social outcomes in young adulthood. Data were obtained by linking the Norwegian Patient Registry (2008-2012), the National Insurance Registry (2003-2013), and the Norwegian Arctic Adolescent Health Study, a school-based survey inviting all 10th grade students in North Norway (2003-2005). In total, 3987 (68%) of all 5877 invited participants consented to the registry linkage, of whom 9.2% were indigenous Sami. Multivariable logistic regression was used to explore the associations between self-harm only, suicidal ideation with and without self-harm, and suicide attempts in adolescence (≤16-year-old), and later mental health disorders, long-term medical, social welfare benefit receipt, or long-term unemployment in young adulthood. Self-harm and suicidal behavior in Sami and non-Sami adolescents were associated with increased risk of later mental health disorders, long-term welfare benefit receipt, and long-term unemployment. These associations were attenuated by adolescent psychosocial problems. No major differences between the indigenous Sami participants and their non-Sami peers were found. Young suicide attempters experienced the highest risk, with adolescent suicide attempts being significantly associated with all four adult outcomes after adjustment. Self-harm and suicidal behavior in adolescence are markers of mental health disorders and unfavorable social outcomes in young adulthood, mostly accounted for by adolescent psychosocial problems. In contrast to other indigenous peoples, no indigenous health disparities were found, indicating that the indigenous Sami adolescents were not worse off.

This symposium report provides a brief overview of the six programmes and studies on parental education and maternal health services within the circumpolar region presented in the symposium "parental education" at the 17th International Congress of Circumpolar Health in Copenhagen, Denmark, August 2018.

Objectives: The purpose of the study is to explore the prevalence and predictors of not engaged in education, employment or training (NEET) status in a multicultural young adult population in Northern Norway., Design and Setting: The longitudinal design link a self-reported survey (2003-2005) with an objective registry linkage follow-up 8-10 years later., Participants: Of all 5877 tenth graders (aged 15-16 years) in Northern Norway, 83% of the total age cohort from all 87 municipalities participated in the baseline survey. The follow-up studies consisted of 3987 consent giving adolescents (68%), were 365 (9.2%) reported indigenous Sami ethnicity., Outcome Measures: Youth NEET at the age of 23-25 years., Methods: Explanatory variables were sociodemographic factors (gender, ethnicity, residency, parental education), mental health problems and musculoskeletal pain in adolescence. Outcome variable characterised as NEET-status was defined by no educational engagement, long-term recipient of sickness benefit, medical and non-medical benefit receipt or long-term unemployment., Results: NEET-status in young adulthood was significantly higher among females (20.9%) than among males (16.2%). Ethnic differences occurred as being NEET among Sami males was significantly higher than among non-Sami males, 23.0% and 15.2% respectively. Minority Sami females experienced NEET-status to a lower degree (16.6%) than non-Sami females (20.8%). Among females adolescent peer problems (adjusted OR=1.09) and hyperactivity problems (adjusted OR=1.10) were associated with later NEET-status. Peer problems (adjusted OR=1.23), conduct problems (adjusted OR=1.17) and musculoskeletal problems (adjusted OR=1.15) in male adolescents were associated with later NEET-status, whereas emotional problems among males predicted significantly less later NEET- status (adjusted OR=0.88).We found lower parental education to be significantly associated with being NEET-later in young adults (females: adjusted OR=2.11, males: adjusted OR=3.22)., Conclusions: To address the disengagement of education and work, particular emphasis must be placed on supporting young people struggling with mental and physical health problems., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Little is known about connections between adolescent suicide attempts (SA) and concurrent adversities., Aims: In a cross-sectional study, the authors wanted to investigate prevalences, additive effects of adversities, family and peer relations, gender, divorce and poverty, and ethnic differences between Sami and non-Sami youth., Methods: In an adolescent community population encompassing 4881 adolescents of 15-16 years of age, youth with and without self-reports of attempted suicide the last year were compared on 12 concurrent adversities, on scales assessing family and peer functioning, and on sociodemographic variables., Results: The prevalence of attempted suicide the last year was 5.3%, and more girls (8.8%) than boys (1.8%). All 12 concurrent adversities were strongly related to SA. The suicide attempters reported two and a half times as many adversities as non-attempters. A strong multiple additive relationship was found. Multivariately, among boys, the strongest risk factors were suicide among friends (OR = 9.4), and suicide in the family or in the neighbourhood (OR = 4.8). Among girls, sexual abuse (OR = 5.2) and parent mental problems (OR = 4.6) were strongest related to SA. Suicide attempters reported more divorce and poverty, more conflicts with parents, and less family support and involvement. Totally, Sami youth reported more SA and more concurrent adversities than non-Sami peers., Conclusion: Adolescent suicide attempters are heavily burdened with concurrent adversities. Clinicians should be aware of gender differences in risk factors, and should ask about abuse and suicide or attempts among relatives and peers. A family perspective in clinical work is needed.

Objectives: To examine the association between multisite musculoskeletal pain in adolescence and mental health disorders in young adulthood., Design and Setting: Data were obtained from a linkage between the Norwegian Patient Registry (2008-2012) and the Norwegian Arctic Adolescent Health Study, a school-based survey conducted among 10th grade students in North Norway (2003-2005)., Participants: In total, 3987 (68%) of all 5877 invited participants consented to the registry linkage., Outcome Measures: Mental healthcare use and disorders from age 18-20 to 23-25 years (5 years)., Methods: Musculoskeletal pain was measured by the number of musculoskeletal pain sites. Multivariable logistic regression was used to explore the association with later mental healthcare use and disorders., Results: Multisite adolescent musculoskeletal pain was significantly associated with an increase in mental healthcare use and mental health disorders in young adulthood. The relationship was stronger for anxiety and mood disorders, in both genders. Overall, the association between musculoskeletal pain and later mental health problems was attenuated after controlling for adolescent psychosocial and mental health problems, not by physical or sedentary activity. This could be due to confounding or mediation. However, when examining different mental health disorders, we found musculoskeletal pain to be significantly associated with anxiety disorders, and showing a strong trend in mood disorders, when adjusted for the adolescent factors., Conclusions: Physicians should be aware that multisite adolescent pain is associated with mental health problems in adolescence, and that these adolescents are at increased risk of mental health disorders in young adulthood. As youth troubled by mental health problems commonly present physical symptoms it is important to examine for psychosocial problems in order to offer early interventions., Competing Interests: Conflicts of Interest: None declared., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.)

Purpose: Several studies have confirmed that maltreatment and abuse in childhood are related to conduct problems. Less is known about such relationships with concurrent adversities in adolescence and, also, when compared with other severe adversities and possible multiple additive effects., Methods: The study encompassed a community population of 4881 adolescents 15-16 years of age 50.1 % boys and 49.9 % girls. Youth with and without conduct problem scores within the deviant range on the Strength and Difficulties Questionnaire (SDQ) was compared on 12 concurrent adversities., Results: Based on self-reports, 4.4 % of the adolescents had conduct problem scores within the deviant range and more girls (5.1 %) than boys (3.7 %). In the deviant conduct problem group, 65.1 % had experienced two or more concurrent adversities compared with 26.3 % of youths in the non-deviant group (OR 5.23, 95 % CI 3.91-7.01). Likewise, the deviant conduct problem group was from 1.71 to 8.43 times more at the risk of experiencing the different adversities. Parental mental health problems and experiences of violence were multivariately strongest associated with conduct problem scores within the deviant range on the SDQ. A strong multiple additive relationship with adversities was found., Conclusions: Two-thirds of youth with SDQ conduct problem scores within the deviant range reported two or more concurrent adversities. Clinicians should seek information about kinds and amount of possible traumatic adversities in youth with conduct problems and offer evidence based treatment.

Background: Education is closely associated with health. Non-completion of upper secondary school influences academic achievement, employment, income and personal well-being. The purpose of the study is to explore predictors of non-completion of upper secondary school among female and male young adults in relation to mental health and educational factors in a socio-cultural, Arctic context., Methods: The Norwegian Arctic Adolescent Health Study (NAAHS) is a cross-sectional, school-based survey that was conducted in 2003-2005. Eighty-three percent of the population of 5,877 10th graders participated; 49.1%females, 450 reported indigenous Sami ethnicity, and 304 reported Laestadian affiliation. Data from NAAHS were merged with registry data from the National Education Database (NUDB) Norway for 3,987 adolescents who gave their consent for follow-up studies., Results: Non-completion of upper secondary school was 36.9 % among females and 36.6 % among males. Among females, predictors for non-completion were related to mental health symptoms, and among males, to residency in the northernmost and remote areas and self-reported functional difficulties at school, home and in leisure activities due to mental health problems. There was marginal significance between ethnicity and non-completion of upper secondary school, measured at 41.3 % for Sami and 36.8 % for non-Sami, respectively., Conclusions: The gender differences found in this study emphasize the need for gender-specific interventions in preventing non-completion of upper secondary school. There is a need to recognize and treat extensive pro-social behaviour and social problems in young females. Young males from remote areas and those who in early adolescence struggle with functional impairment due to mental health problems need early interventions in lower secondary school. Enhancing parents' and teachers' ability to detect symptoms and problems as well as low-threshold health services starting in primary school can be effective means. Education, mental health and social inclusion are prominent factors for future employment, income and independent living for young people. Future research should focus more on gender-specific patterns of risk and protective factors for completion of upper secondary school.

Background: To examine demographic and clinical characteristics as potential predictors of change for children and youth with emotional disorders treated at two child and adolescent mental health outpatient services (CAMHS) in Norway., Methods: The study was of naturalistic observational type with "treatment as usual" (TAU). The sample consisted of 84 children and youth with emotional disorders. The Health of the Nation Outcome Scale (HONOSCA), and the Children's Global Assessment Scale (CGAS) were administered at intake (T0), during the assessment (T1) and approximately six months after assessment (T2). Change was analysed by means of the linear mixed models procedure., Results: For the HONOSCA total score, youths with a diagnosis of depression had statistically higher symptom severity levels at baseline and significantly lower change rates as compared to youths with an anxiety disorder., Conclusions: The current study adds to the limited knowledge of predictors of rate of change for children and adolescents with emotional disorders treated within CAMHS. Our results point to a special need to improve clinical care for depressed children and adolescents. Important limitations comprising the external validity of the study concern missing data, a small study sample, and lack of information regarding the content and extent of the service provided.

The objective of the study is to describe the changes in symptomatic and functional impairment for children and youth with emotional disorders treated at child and adolescent mental health outpatient services (CAMHS) in Norway. The study was of naturalistic observational type in which the treatment can be classified as "treatment as usual" (TAU). The Strengths and Difficulties Questionnaire (SDQ), the Health of the Nation Outcome Scale (HONOSCA) and the Children's Global Assessment Scale (CGAS) were used as measures of change. The information from multiple informants allowed the evaluation of change from different perspectives. The sample consisted of 84 children and youth with emotional disorders treated at two CAMHS in the North of Norway. The SDQ, the HONOSCA and the CGAS were administered at intake (T0), during assessment (T1) and approximately, 6 months after T1 (T2). Change was analysed by means of the Linear Mixed Models procedure. The results show that children and youth with emotional disorders experience a statistically significant improvement per month during outpatient treatment according to nearly all the measures of change. For the clinician rated scores, change rates during active assessment/treatment were larger than during the waitlist period. Evaluating change from the perspective of clinical significance showed that only a small proportion of the subjects had change scores that were statistically reliable and clinically significant. Whether an actual change has occurred is uncertain for the majority of patients.

Background: Pain is common in otherwise healthy adolescents. In recent years widespread musculoskeletal pain, in contrast to single site pain, and associating factors has been emphasized. Musculoskeletal pain has not been examined in Arctic indigenous adolescents. The aim of this study was to explore the prevalence of widespread musculoskeletal pain and its association with psychosocial factors, with emphasis on gender- and ethnic differences (Sami vs. non-Sami), and the influence of pain related functional impairment., Methods: This is a cross-sectional study based on The Norwegian Arctic Adolescent Health Study; a school-based survey responded by 4,881 10th grade students (RR: 83%) in North Norway, in 2003-2005. 10% were indigenous Sami. Musculoskeletal pain was based on reported pain in the head, shoulder/neck, back and/or arm/knee/leg, measured by the number of pain sites. Linear multiple regression was used for the multivariable analyses., Results: The prevalence of musculoskeletal pain was high, and significantly higher in females. In total, 22.4% reported 3-4 pain sites. We found a strong association between musculoskeletal pain sites and psychosocial problems, with a higher explained variance in those reporting pain related functional impairment and in females. There were no major differences in the prevalence of musculoskeletal pain in Sami and non-Sami, however the associating factors differed somewhat between the indigenous and non-indigenous group. The final multivariable model, for the total sample, explained 21.2% of the variance of musculoskeletal pain. Anxiety/depression symptoms was the dominant factor associated with musculoskeletal pain followed by negative life events and school-related stress., Conclusions: Anxiety/depression, negative life events, and school-related stress were the most important factors associated with musculoskeletal pain, especially in those reporting pain related functional impairment. The most important sociocultural aspect is the finding that the indigenous Sami are not worse off.

The aim of this literature review was to examine pre-treatment child and adolescent characteristics as predictors and moderators of outcome in psychotherapy treatment trials of anxiety and depressive disorders. A literature search was conducted using several databases and resulted in 45 published studies (32 anxiety studies and 13 depression studies) meeting predefined methodological criteria. Ten client demographic (age, gender, ethnicity, IQ) and clinical factors (duration, type of diagnosis, pre-treatment severity, comorbidity) were examined across studies. The majority of findings showed non-significant associations between demographic factors (gender and age) with treatment outcome for both the anxiety and the depression treatment trials. Some important differences between the results of the anxiety and depression treatment trials were found. The majority of findings for the anxiety studies suggest that there are no demographic or clinical factors that predict or moderate treatment outcome. For the depression studies, however, the findings suggest that baseline symptom severity and comorbid anxiety may impact on treatment response. Overall, existing studies of pre-treatment patient variables as predictors and moderators of anxiety and depression treatment outcome provide little consistent knowledge concerning for what type of patients and under what conditions treatments work. Suggestions for future research are discussed.

We examined the agreement between diagnoses assigned based on the Development and Well Being Assessment (DAWBA) information collected online, and ordinary day-to-day diagnostic assignment by Child and Adolescent Mental Health Service (CAMHS) clinicians. Diagnoses were compared for 286 patients. Raw agreement for diagnostic categories was 74-90%, resulting in kappa values of 0.41-0.49. Multinomial regression models for 'emotional diagnosis' and 'hyperkinetic/conduct diagnosis' were significant (P < 0.001). Age, gender and number of informants significantly contributed to the explanation of agreement and disagreement. Agreement on mental health diagnoses may be sufficient to replace routine clinical assignment of diagnoses with an online clinical assignment, thereby saving time and resources.

Background: Psychotherapy is an effective treatment for mental health disorders, but even with the most efficacious treatment, many patients do not experience improvement. Moderator analysis can identify the conditions under which treatment is effective or whether there are factors that can attenuate the effects of treatment., Methods: In this study, linear mixed model analysis was used to examine whether the Full Scale IQ (FSIQ), Performance IQ (PIQ) and Verbal IQ (VIQ) on the Wechsler Intelligence Scale for Children - Third Edition, moderated outcomes in general functioning and symptom load. A total of 132 patients treated at three outpatient child and adolescent mental health services (CAMHS) were assessed at three different time points. The Children's Global Assessment Scale (CGAS) and the Health of the Nation Outcome Scales for Children and Adolescents (HoNOSCA) were used to measure the severity of impairments in general functioning and symptom load. IQ was assessed at the start of treatment., Results: Moderator analysis revealed that the FSIQ × time interaction predicted changes in CGAS scores (p < .01), and that the PIQ × time interaction predicted changes in HoNOSCA scores (p < .05). The slopes and intercepts in HoNOSCA scores covaried negatively and significantly (p < .05). The same pattern was not detected for the CGAS scores (p = .08)., Conclusions: FISQ and PIQ moderated change in general functioning and symptom load, respectively. This implies that patients with higher IQ scores had a steeper improvement slope than those with lower scores. The patients with the highest initial symptom loads showed the greatest improvement, this pattern was not found in the improvement of general functioning.

Objective: Previous studies indicate that low IQ is a substantial risk factor for developing mental health problems. Based on these results, we hypothesized that IQ may predict some of the variance in clinician-rated severity of children's mental health problems measured with the Children's Global Assessment Scale (CGAS) and Health of the Nation Outcome Scales for Children and Adolescents (HoNOSCA). The other aims of this study were to examine if there was any difference in the predictive ability of the different IQ scores of the Wechsler Intelligence Scale for Children, Third edition (WISC-III) and to examine if parent-rated measure of child mental health problems could predict the scores on CGAS and HoNOSCA after controlling for IQ, age, and gender., Methods: In this study, 132 patients at three outpatient clinics in North Norway were assessed with the parent version of the Strength and Difficulties Questionnaire (SDQ), HoNOSCA, CGAS, and with the WISC-III., Results: Hierarchical regression analyses were conducted with HoNOSCA and CGAS as dependent variables. Demographics, WISC-III IQ scores, and SDQ were entered as independent variables. The model with HoNOSCA as the dependent variable predicted 25% of the total variance. The WISC-III full-scale IQ predicted an additional 6% of the variance. The analyses with CGAS as the dependent variable gave no significant results., Conclusion: When a patient has a high HoNOSCA score, an intelligence test in addition to an evaluation of symptoms on mental health should be considered. Future research ought to examine whether HoNOSCA's ability to detect change might be affected by patients IQ., (©2011 The British Psychological Society.)

Objective: This study examined the agreement between diagnoses and severity ratings assigned by clinicians using a structured web-based interview within a child and adolescent mental health outpatient setting., Method: Information on 100 youths was obtained from multiple informants through a web-based Development and Well-Being Assessment (DAWBA). Based on this information, four experienced clinicians independently diagnosed (according to the International Classification of Diseases Revision 10) and rated the severity of mental health problems according to the Health of the Nation Outcome Scales for Children and Adolescents (HoNOSCA) and the Children's Global Assessment Scale (C-GAS)., Results: Agreement for diagnosis was κ=0.69-0.82. Intra-class correlation for single measures was 0.78 for HoNOSCA and 0.74 for C-GAS, and 0.93 and 0.92, respectively for average measures., Conclusions: Agreement was good to excellent for all diagnostic categories. Agreement for severity was moderate, but improved to substantial when the average of the ratings given by all clinicians was considered. Therefore, we conclude that experienced clinicians can assign reliable diagnoses and assess severity based on DAWBA data collected online.

Background: The use of screening instruments can reduce waiting lists and increase treatment capacity. The aim of this study was to examine the usefulness of the Strengths and Difficulties Questionnaire (SDQ) with the original UK scoring algorithms, when used as a screening instrument to detect mental health disorders among patients in the Norwegian Child and Adolescent Mental Health Services (CAMHS) North Study., Methods: A total of 286 outpatients, aged 5 to 18 years, from the CAMHS North Study were assigned diagnoses based on a Development and Well-Being Assessment (DAWBA). The main diagnostic groups (emotional, hyperactivity, conduct and other disorders) were then compared to the SDQ scoring algorithms using two dichotomisation levels: 'possible' and 'probable' levels. Sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio (ORD) were calculated., Results: Sensitivity for the diagnostic categories included was 0.47-0.85 ('probable' dichotomisation level) and 0.81-1.00 ('possible' dichotomisation level). Specificity was 0.52-0.87 ('probable' level) and 0.24-0.58 ('possible' level). The discriminative ability, as measured by ORD, was in the interval for potentially useful tests for hyperactivity disorders and conduct disorders when dichotomised on the 'possible' level., Conclusions: The usefulness of the SDQ UK-based scoring algorithms in detecting mental health disorders among patients in the CAMHS North Study is only partly supported in the present study. They seem best suited to identify children and adolescents who do not require further psychiatric evaluation, although this as well is problematic from a clinical point of view.

Through differences in family socialization between indigenous and non-indigenous youth, there may be cultural differences in the impact of family factors on mental health outcome. Using structural equation modelling, this population-based study explored the relationship between symptoms of anxiety and depression and family factors in indigenous Sami and non-Sami boys and girls in North Norway. The findings show that family income was to a lesser degree related to internalization symptoms for Sami youth than non-Sami youth. For all groups except for Sami girls, family conflict and moving was associated with increasing symptoms. Sami boys differed from the other three groups with regard to the relationship between family connectedness and symptom level. These interaction effects were discussed in light of traditional Sami values and gender socialization. The present study has indicated that in the family socialization context, culture may be related to internalization symptoms in youth., (Copyright © 2010 The Foundation for Professionals in Services for Adolescents. Published by Elsevier Ltd. All rights reserved.)

Objectives: To examine whether enculturation factors, like cultural activities, ethnic pride and native language competence, are related to decreased internalizing and externalizing symptoms in Indigenous Sami youth from Arctic Norway. The impact of self-efficacy on the relationship between enculturation factors and mental health problems was also examined., Study Design: Population-based, cross-sectional questionnaire study., Methods: The Norwegian Arctic Adolescent Health Study was conducted among 10th graders in junior high schools in north Norway during 2003-2005. The study sample consisted of 450 Indigenous Sami youth, aged 15-16 years. Internalizing symptoms were measured with the Hopkins Symptom Check List-10 (HSCL-10), while externalizing symptoms were measured by two subscales of the Strengths and Difficulties Questionnaire (SDQ)., Results: For boys, self-efficacy and participation in cultural activities were associated with decreased internalizing symptoms. Additionally, self-efficacy interacted with Sami language competence and cultural activities: when self-efficacy increased, these enculturation factors were related to symptom reduction. For girls, self-efficacy had an independent effect on internalizing symptoms and also strengthened the relationship between participation in cultural activities and reduced externalizing symptoms. Sami language competence was related to the reduction of both internalizing and externalizing symptoms in girls., Conclusions: In the present study, several enculturation factors as well as self-efficacy were identified as potential protective factors against mental health problems. In order to develop theoretical models that explain the mechanisms between cultural resilience and mental health, there is a need for both qualitative studies and longitudinal studies.

Background: Clinician-rated measures are used extensively in child and adolescent mental health services (CAMHS). The Health of the Nation Outcome Scales for Children and Adolescents (HoNOSCA) is a short clinician-rated measure developed for ordinary clinical practice, with increasing use internationally. Several studies have investigated its psychometric properties, but there are few data on its correspondence with other methods, rated by other informants. We compared the HoNOSCA with the well-established Achenbach System of Empirically Based Assessment (ASEBA) questionnaires: the Child Behavior Checklist (CBCL), the Teacher's Report Form (TRF), and the Youth Self-Report (YSR)., Methods: Data on 153 patients aged 6-17 years at seven outpatient CAMHS clinics in Norway were analysed. Clinicians completed the HoNOSCA, whereas parents, teachers, and adolescents filled in the ASEBA forms. HoNOSCA total score and nine of its scales were compared with similar ASEBA scales. With a multiple regression model, we investigated how the ASEBA ratings predicted the clinician-rated HoNOSCA and whether the different informants' scores made any unique contribution to the prediction of the HoNOSCA scales., Results: We found moderate correlations between the total problems rated by the clinicians (HoNOSCA) and by the other informants (ASEBA) and good correspondence between eight of the nine HoNOSCA scales and the similar ASEBA scales. The exception was HoNOSCA scale 8 psychosomatic symptoms compared with the ASEBA somatic problems scale. In the regression analyses, the CBCL and TRF total problems scores together explained 27% of the variance in the HoNOSCA total scores (23% for the age group 11-17 years, also including the YSR). The CBCL provided unique information for the prediction of the HoNOSCA total score, HoNOSCA scale 1 aggressive behaviour, HoNOSCA scale 2 overactivity or attention problems, HoNOSCA scale 9 emotional symptoms, and HoNOSCA scale 10 peer problems; the TRF for all these except HoNOSCA scale 9 emotional symptoms; and the YSR for HoNOSCA scale 9 emotional symptoms only., Conclusion: This study supports the concurrent validity of the HoNOSCA. It also demonstrates that parents, teachers and adolescents all contribute unique information in relation to the clinician-rated HoNOSCA, indicating that the HoNOSCA ratings reflect unique perspectives from multiple informants.

Objective: The aim of the present study was to compare symptoms of anxiety and depression among indigenous Sami and non-Sami youth in the Arctic part of Norway, and to examine the influence of perceived discrimination and ethnic identity on these symptoms. The relationship between ethnic self-labeling and native language competence on internalization symptoms was explored for Sami adolescents., Design: The Norwegian Arctic Adolescent Health Study was conducted among 10th graders in junior high schools in North Norway in 2003-2005. The sample consisted of 4449 adolescents, of whom 450 (10%) were indigenous Sami and 3999 (90%) were non-Sami. Anxiety and depressive symptoms were assessed using a short version of the Hopkins Symptom Checklist-10. Participants also completed The Multigroup Ethnic Identity Measure (MEIM) and a measure of perceived discrimination., Results: No differences were found among ethnic groups in internalization symptoms. Sami youth reported more discrimination than the non-Sami. Both MEIM and perceived discrimination were positively associated with internalization symptoms. Moreover, Sami youth who had not learned their native language at home were more vulnerable to experiencing internalization symptoms compared to Sami youth who had learned their native language at home., Conclusion: Culture-specific protective factors were discussed as potential explanations for the similarities between Sami and non-Sami youth. The present study documented a relationship between internalization symptoms and ethnic identity, perceived discrimination, and language loss. These findings could be understood as consequences of the recent colonial history and oppression of the indigenous Sami.

Objectives: To study the prevalence and psychosocial and ethnocultural correlates of self-mutilation and/or suicidal behaviour in Indigenous Sami and majority Norwegian adolescents in north Norway., Study Design: A cross-sectional questionnaire study., Methods: A total of 487 students, aged 13-16 years in 21 junior high schools and 247 parents participated in this school based questionnaire study conducted in 1990 in Finnmark, the county in Norway with the highest suicide rates. Sociodemographics, substance use, thriving at school, ethnocultural factors such as ethnic context, ethnic identity, ethnic language competence and ethnic parentage, self-reported as well as parent-reported behavioural/emotional problems were assessed., Results: Self-mutilation and/or suicidal attempts within the last 6 months were reported by 12.5% of the adolescents and 14.8% reported having suicidal thoughts. In univariate analyses, significant gender differences occurred for both ethnic groups, with more girls reporting self-mutilation and suicidal behaviour. However, in logistic regression analyses adjusting for all other significant variables, the gender difference disappeared. No significant ethnic differences occurred in prevalence. Although factors associated with self-mutilation and suicidal behaviour varied between Sami and Norwegian adolescents, self-reported anxiety/depression was a strong and significant correlate to both self-mutilation/suicide attempts and suicidal thoughts in both ethnic groups. Parents reported less emotional/behavioural problems associated with self-mutilation and/or suicidal behaviour than the adolescents did. Ethnic identification in Sami and ethnic context in Norwegian adolescents occurred in independent analyses as significantly related to self-mutilation and/or suicidal behaviour, but turned insignificant when adjusting for all other significant variables., Conclusions: In contrast to several other Indigenous groups the prevalence of self-mutilation and/or suicidal behaviour did not differ between Sami and Norwegian adolescents. In both ethnic groups, the effect of ethnocultural factors disappeared when controlled for other variables such as anxiety/depression. Across both ethnic groups, anxiety and depression problems occurred as a common and significant correlate for self-mutilation and suicidal behaviour.

The prevalence of suicide attempts and associated risk factors such as sociodemographic conditions, emotional/behavioural problems and parent-child relationships were examined among 591 indigenous Sami and 2100 majority adolescents in Arctic Norway. There were no significant ethnic differences in prevalence of suicide attempts. In both ethnic groups, suicidal ideation, anxious/depressed problems and eating behaviour problems were associated with suicide attempts. Cross-cultural differences in risk factors associated with suicide attempts existed. For Sami adolescents, factors diverging from the traditional cultural norms were associated with suicide attempts, such as alcohol intoxication, single-parent home and paternal overprotection (p

Human health is the result of the interaction of genetic, nutritional, socio-cultural, economic, physical infrastructure and ecosystem factors. All of the individual, social, cultural and socioeconomic factors are influenced by the environment they are embedded in and by changes in this environment. The aim of the paper is to illustrate the influence of environmental change on living conditions and life style and some of the mechanisms through which such changes affect physical and mental health. The interrelationship between environmental and societal change is illustrated by an example from a small community in Greenland, where changing environmental conditions have influenced fishing and employment opportunities to the extent that the size of the population has changed dramatically. The link between social change and health is shown with reference to studies on education, housing and occupation as well as life style changes. The paper further illustrates the relationship between the rapid socio-cultural and economic change and the health of the population. Psychosocial stress is reflected in problems such as alcohol abuse, violence and suicide, and these factors have been shown in studies on migration and transitions in health to be connected to changes in lifestyle and living conditions.

Sami children and adolescents are the indigenous youngsters in Norway, mainly resided in the arctic part of the country. While disadvantaged living conditions, risk behavior and psychososial health problems has been shown for children and youth from many indigenous groups worldwide, the research among Sami youngsters is sparse. However, recent research show that compared to the Norwegian majority group, Sami children and adolescents have just as good mental health as their majority peers. They also show less risk taking behavior as substance and drug use, have less eating problems and have a stronger body satisfaction. However, the smoking rates are high as for their Norwegian counterparts. Intragroup studies show that Sami adolescents grown up in Sami dominated areas, have a strong bicultural identification, are practicing more Sami cultural behavior and have a better mental health compared to Sami peers in marginal Sami areas. Ethnocultural factors have only a slight impact on behavior problems among young Sami and particularly among boys in the marginal Sami areas.

Aims: A study was undertaken to examine predictors of smoking behaviour among indigenous Sami adolescents and non-indigenous peers in North Norway, and to examine for ethnic-specific predictors., Methods: This is a cross-sectional and longitudinal school-based and postal questionnaire study initially including 2,718 10th to 12th grade students (response rate (RR): 85%) in 1994-95 (T1). At the three-year follow-up (T2), in 1997-98, 1,405 were included (RR: 57%). Indigenous Sami contributed 23% (599/324) of the total samples. Logistic regression was used to examine the influence of sociodemographic and psychosocial predictors on smoking behaviour., Results: The proportions of regular smokers were 33% (729) and 35% (401) at T1 and T2, respectively, while 19% (153) had initiated current smoking during the study period. Substance use, externalizing problems, sexual activity and vocational training (p

Objective: To explore the effect of acculturation attitudes and ethnic and national identity on behavior problems in arctic minority adolescents in northern Norway., Method: The Youth Self-Report, the Multigroup Ethnic Identity Measure, and acculturation strategies were completed by 581 indigenous Sami and 291 Kven high school students in 1994-1995, at age 15-18 years. Response rate was 85%. Behavior problems were in addition to ethnic/national identity and acculturation attitudes studied in relation to ethnicity, gender, age, socioeconomic status, parentage, ethnic language, and ethnic context., Results: Although there were no ethnic group differences in behavior problems, the impact of ethnocultural predictors differed between ethnocultural and indigenous adolescents. Acculturation attitudes were most significant for indigenous adolescents' mental health, and identity issues showed the strongest impact on ethnocultural peers. The study revealed significant gender differences regarding the influence of ethnocultural factors, and contextual variation among Sami adolescents with the strongest impact in contexts with low density of Sami people., Conclusions: The significant ethnic group variations emphasize the importance of conducting both between- and within-group analysis on the impact of ethnocultural issues on behavior problems in minority adolescents.

Objective: To explore the relationship between behavior problems and ethnic factors in indigenous minority Sami and Norwegian majority adolescents in northern Norway., Method: The Youth Self-Report (YSR) was completed by 249 Sami and 210 Norwegian students in junior high school, aged 13 to 16 years. Parents completed the Child Behavior Checklist (CBCL). Behavior problems were assessed in relation to ethnicity and ethnic context (geographic region and family context)., Results: Rates of behavior problems (CBCL and YSR) were generally high in both ethnic groups and were highest among girls. Sami adolescents, particularly those living in assimilated ethnic communities, reported more behavior problems than Norwegian adolescents., Conclusion: Ethnic factors have significant impact on behavior problems in indigenous minority adolescents living in a multiethnic context.

The town of Karasjok had during the eighties one of the highest prevalence of suicide among young men with a cluster of deaths in 1987 and 1988. This situation highlighted the life situation of the Sami adolescents in this area and a special suicide prevention program was established. Health and social workers from the primary health care in the town, the psychiatric outpatient clinics, the school, the church among others, worked together in an emergency interventional service for suicidal patients and postventional for the survival relatives and friends. In addition the preventive aspects of health services for the youth were focused. Firmer health services in the primary care in the town were reorganized to recognize and treat children and adolescents with special problems and needs. The school nurses got a central role in the schools available for children and teachers both in treatment, counselling and teaching. A special health service for youth, "the Youth office," was established one evening in the week staffed with a doctor and a nurse. All consultations are free and to make a data is not necessary. Everyone who wants a consultation gets it on the same evening. The Youth office runs evenings with films and discussions on special topics which the youth themselves want to learn more about as contraceptives, AIDS, abortion, friendship, the relationship between a boy and a girl and so on. This offer is very popular, but mostly among girls. The staff also organizes courses for other professionals in cooperation with the youth.(ABSTRACT TRUNCATED AT 250 WORDS)