Tackling smoking among out of school youth in South Africa: An analysis of friendship ties.

BACKGROUND: Friendships during adolescence play a significant role in the initiation and maintenance of tobacco use. Smoking behaviour among adolescent friends has not been explored among out of school youth (OSY) in South Africa. Out of school youth (OSY), described as those between 13 and 20 years old, have not completed their schooling and are not currently enrolled in school, are at greater risk for tobacco use. AIM: The main aim of this study is to examine whether the smoking behaviour of OSY is associated with that of their OSY friends. METHODS: Respondent driven sampling was used to recruit OSY and their OSY friends. A mixed effects logistic regression with a random intercept across school-province combinations was used to analyse survey data. Race and gender were also incorporated into the analyses as effect moderators (n = 391). RESULTS: Results of this study confirm that cigarette smoking was common among OSY and their OSY friends, with 53.5% of the respondents smoking in the past month (SD = 0.44). When OSY friends were either all non-smokers or half their friends were non-smokers, Coloured (mixed race) OSY were less likely to smoke compared to Black African and Other (mostly Asian descent) OSY. CONCLUSION: Cultural norms and values associated with the different race groups may play a role in the smoking behaviour of out of school youth friends. Understanding this relationship is useful for identifying those OSY that are vulnerable to the behaviours that place them at risk of tobacco related morbidity and mortality.

Strength exercises during physical education classes in secondary schools improve body composition: a cluster randomized controlled trial.

BACKGROUND: Metabolic health in people with obesity is determined by body composition. In this study, we examined the influence of a combined strength exercise and motivational programme -embedded in the school curriculum- on adolescents body composition and daily physical activity. METHODS: A total of 695 adolescents (11-15y) from nine Dutch secondary schools participated in a one year cluster randomised controlled trial (RCT). In the intervention schools, physical education teachers were instructed to spend 15-30 min of all physical education lessons (2× per week) on strength exercises. Monthly motivational lessons were given to stimulate students to be more physically active. Control schools followed their usual curriculum. The primary outcome measure was body composition assessed by the deuterium dilution technique. Daily physical activity and sedentary behaviour measured by accelerometry served as a secondary outcome. RESULTS: After 1 year, a 1.6% fat mass difference was found in favour of the intervention group (p = .007). This reflected a 0.9 kg difference in fat free mass (intervention>control; p = .041) and 0.7 kg difference in fat mass (intervention

The Dutch 'Focus on Strength' intervention study protocol: programme design and production, implementation and evaluation plan.

BACKGROUND: Overweight youngsters are better in absolute strength exercises than their normal-weight counterparts; a physiological phenomenon with promising psychological impact. In this paper we describe the study protocol of the Dutch, school-based program 'Focus on Strength' that aims to improve body composition of 11-13 year old students, and with that to ultimately improve their quality of life. METHODS: The development of this intervention is based on the Intervention Mapping (IM) protocol, which starts from a needs assessment, uses theory and empirical research to develop a detailed intervention plan, and anticipates program implementation and evaluation. This novel intervention targets first year students in preparatory secondary vocational education (11-13 years of age). Teachers are the program implementers. One part of the intervention involves a 30 % increase of strength exercises in the physical education lessons. The other part is based on Motivational Interviewing, promoting autonomous motivation of students to become more physically active outside school. Performance and change objectives are described for both teachers and students. The effectiveness of the intervention will be tested in a Randomized Controlled Trial in 9 Dutch high schools. DISCUSSION: Intervention Mapping is a useful framework for program planning a school-based program to improve body composition and motivation to exercise in 11-13 year old adolescents by a "Focus on Strength". TRIAL REGISTRATION: NTR5676 , registered 8 February 2016 (retrospectively registered).

Who's that girl? A qualitative analysis of adolescent girls' views on factors associated with teenage pregnancies in Bolgatanga, Ghana.

BACKGROUND: Adolescent pregnancy remains a public health concern, with diverse serious consequences, including increased health risk for mother and child, lost opportunities for personal development, social exclusion, and low socioeconomic attainments. Especially in Africa, teenage pregnancy rates are high. It is important to find out how girls without pregnancy experience differ in their contraceptive decision-making processes as compared with their previously studied peers with pregnancy experience to address the high rate of teenage pregnancies. METHODS: We conducted semi-structured in-depth interviews with never been pregnant girls (N = 20) in Bolgatanga, Ghana, to explore the psychosocial and environmental factors influencing the sexual decision making of adolescents. Themes such as relationships, sex, pregnancy, family planning and psychosocial determinants (knowledge, attitudes, self-efficacy, norms, risk perceptions) derived from empirical studies and theories related to sexuality behavior guided the development of the interview protocol. RESULTS: Results showed that the girls did talk about sexuality with their mothers at home and did receive some form of sexual and reproductive health education, including the use of condoms discussions in school. Participants reported high awareness of pregnancy risk related to unprotected sex, were positive about using condoms and indicated strong self-efficacy beliefs towards negotiating condom use. The girls also formulated clear future goals, including coping plans such as ways to prevent unwanted pregnancies to reach these targets. On the other hand, their attitudes towards family planning (i.e., contraceptives other than condoms) were negative, and they hold boys responsible for buying condoms. CONCLUSION: An open parental communication on sexuality issues at home, comprehensive sex education in school and attitude, self-efficacy, risk perception towards contraception, alongside with goal-setting, seem to be protective factors in adolescent girls' pregnancy prevention efforts. These factors should be targets in future intervention programs at the individual, interpersonal, and school and community levels.

Sociocognitive predictors of the intention of healthcare workers to receive the influenza vaccine in Belgian, Dutch and German hospital settings.

BACKGROUND: Influenza vaccination of healthcare workers (HCWs) is recommended to prevent the transmission of influenza to vulnerable patients. Nevertheless, vaccination coverage rates of HCWs in European countries have been low. AIM: To investigate the relative and combined strength of sociocognitive variables, from past research, theory and a qualitative study, in explaining the motivation of HCWs to receive the influenza vaccine. METHODS: An anonymous, online questionnaire was distributed among HCWs in hospital settings in Belgium, Germany and the Netherlands between February and April 2013. FINDINGS: Attitude and past vaccination uptake explained a considerable amount of variance in the intention of HCWs to receive the influenza vaccine. Moreover, low perceived social norms, omission bias, low moral norms, being older, having no patient contact, and being Belgian or Dutch (compared with German) increased the probability of having no intention to receive the influenza vaccine compared with being undecided about vaccination. High intention to receive the influenza vaccine was shown to be more likely than being undecided about vaccination when HCWs had high perceived susceptibility of contracting influenza, low naturalistic views, and lower motivation to receive the vaccine solely for self-protection. CONCLUSION: Country-specific interventions and a focus on different sociocognitive variables depending on the intention/lack of intention of HCWs to receive the influenza vaccine may be beneficial to promote vaccination uptake.

Modelling antecedents of blood donation motivation among non-donors of varying age and education.

Understanding blood donation motivation among non-donors is prerequisite to effective recruitment. Two studies explored the psychological antecedents of blood donation motivation and the generalisability of a model of donation motivation across groups differing in age and educational level. An older well-educated population and a younger less well-educated population were sampled. The studies assessed the role of altruism, fear of blood/needles and donation-specific cognitions including attitudes and normative beliefs derived from an extended theory of planned behaviour (TPB). Across both samples, results showed that affective attitude, subjective norm, descriptive norm, and moral norm were the most important correlates of blood donation intentions. Self-efficacy was more important among the younger less well-educated group. Altruism was related to donation motivation but only indirectly through moral norm. Similarly, fear of blood/needles only had an indirect effect on motivation through affective attitude and self-efficacy. Additional analyses with the combined data set found no age or education moderation effects, suggesting that this core model of donation-specific cognitions can be used to inform future practical interventions recruiting new blood donors in the general population.

Identifying blood donors willing to help with recruitment.

BACKGROUND AND OBJECTIVES: Social influence shapes behaviour and donors are ambassadors for blood banks. Donors are role models for family and friends and, therefore, so may be able to help with donor recruitment. MATERIALS AND METHODS: A questionnaire was used to assess donors' willingness to engage in donor recruitment. Measures included willingness to recruit new donors and antecedents of recruitment motivation based on the theory of planned behaviour (TPB). RESULTS: More than half of our participants were willing to try to recruit friends and family (57%). Self-efficacy was the most important correlate of intention to recruit as were cognitive attitude and experience with the blood bank. The findings suggest that the TPB provides a good basis for understanding cognitive antecedents of donors' willingness to recruit other donors. CONCLUSION: Results suggest that using existing donors to recruit new donors could be an efficient and cost-effective way to recruit additional donors. This approach warrants further investigation.

Why don't young people volunteer to give blood? An investigation of the correlates of donation intentions among young nondonors.

BACKGROUND: In the past decade, the number of blood donors has steadily declined in the Netherlands, and young adults are underrepresented among registered donors. An understanding of the correlates of donation intentions among nondonors could facilitate targeting psychological prerequisites of donation decisions in recruitment campaigns. STUDY DESIGN AND METHODS. A cross-sectional study with self-administered questionnaires based on an extension of the Theory of Planned Behavior (TPB; a social cognition model to study the determinants of volitional behavior) was conducted to assess potential cognitive determinants of willingness to donate blood in a student sample. A response rate of 50.5 percent yielded a sample of 311. RESULTS: Just over 7 percent of participants were registered blood donors but most (61.7%) had never seriously considered becoming donors. Self-efficacy (confidence in performing the behavior), attitude (the overall evaluation of the behavior), and personal moral norm (the perceived personal responsibility to perform the behavior) regarding blood donation were the most important correlates of the intention to become a blood donor. In total, 43 percent of the variance in the intentions toward blood donation could be explained by a TPB-based model. CONCLUSION: Among students, determinants of the intention to become a blood donor include self-efficacy, attitude, personal moral norm regarding blood donation, and subjective norm (perceived social support). Future research could establish whether campaigns targeting these psychological prerequisites would be more effective than current strategies.

Determinants of surgery related anxiety in cataract patients.

BACKGROUND/AIMS: Not much is known about the relative importance of different determinants of anxiety in cataract patients. This study analysed the predictive value of factors related to surgery induced anxiety. METHODS: In 128 cataract patients, recruited from two hospitals (Medical Centre Maastricht Annadal (MCMA) and Rotterdam Eye Hospital (REH)), state anxiety was assessed at four different time points using the State-Trait Anxiety Inventory (STAI). The following predictive factors of anxiety were measured: trait anxiety, outcome expectancies, doctor-patient relationship, coping strategy, social support, information supply, sociodemographic variables, and previous cataract surgery. Repeated measures ANOVA, t tests, multiple regression analysis, and correlations were used to analyse data. RESULTS: In general patients reported little anxiety. The level of anxiety (scale 1-4) was the highest before surgery, decreased immediately after surgery, and increased again after the postoperative visit. Patients with higher trait anxiety levels (r = 0.41; p<0.01), and women (r = 0.30; p<0.01) reported more anxiety. The REH patients showed lower anxiety scores than the MCMA patients. CONCLUSION: Women and patients with higher trait anxiety were more likely to experience higher levels of state anxiety. Positive outcome expectancies and social support may decrease anxiety.

Cigarette use among male and female grade 8-10 students of different ethnicity in South African schools.

OBJECTIVES: To provide data on the prevalence of cigarette use by male and female South African students of different ethnic backgrounds in grades 8-10 (ages < or = 11 to > or = 17 years), their age of initiation of cigarette use, as well as their access to cigarettes through underage sales. DESIGN: A nationally representative survey was conducted using self administered questionnaires translated into seven languages. SETTING: School based. PARTICIPANTS: Students in grades 8-10 in all of South Africa's nine provinces. OUTCOME MEASURES: The prevalence data for current users of cigarettes (smoked on one or more days in 30 days preceding the survey), and for the age of initiation (first smoking cigarettes before the age of 10) were analysed. RESULTS: Of the 160 selected schools, 123 schools participated in the survey. The completed survey comprised 6045 of 7074 selected students; 23% of the sample reported being current users of cigarettes. Significantly more males (28.8%) than females (17.5%), and significantly more "Coloured" students than "Black/African" students were classified as current smokers. Sex was the strongest contributor to the prediction of current smoking status. On the issue of age of initiation, 18.5% of students reported having first smoked cigarettes before the age of 10 years with more "Black/African" students than "Coloured" having done so. CONCLUSIONS: In order to tailor tobacco control programmes to the needs of students, historical "racial"/ethnic and sex differences have to be taken into account. Specific determinant studies are needed to understand these differences and to develop appropriate responses.