Secular trends in mental health problems among young people in Norway: a review and meta-analysis.

There is a growing concern that the mental health of recent generations of youth is deteriorating, yet the etiology of these secular changes is not fully understood. We aimed to review the evidence on trends in mental health problems among young people in Norway. Seven large-scale repeated cross-sectional studies were included in this study, comprising 35 cross-sectional data collections between 1992 and 2019, with a total sample of 776,606 young people. Our study found a clear increase in mental health problems among young females in Norway over the past few decades, while the trends were less marked for males. The proportion of individuals scoring above the problematic symptom score threshold increased on average by 11.2% (range 2.2% to 21.9%) for females and 5.2% (range - 0.9% to 11.1%) for males, based on data from the individual studies. The results from a meta-regression analysis showed that across all surveys, mean symptom scores increased by 17% (95% CI 12 to 21%) among females and 5% (95% CI 1 to 9%) among males from 1992 to 2019. Overall, mental health problems have increased continually since the early 1990s among young people, especially among young females. The cause of these secular changes remains unknown but likely reflect the interplay of several factors at the individual and societal level.Protocol registration: Open science framework, November 8, 2021 ( https://osf.io/g7w3v ).

Polysubstance use and its correlation with psychosocial and health risk behaviours among more than 95,000 Norwegian adolescents during the COVID-19 pandemic (January to May 2021): a latent profile analysis.

Background: Polysubstance use represents an adolescent health risk; however, large-scale studies investigating this issue during the COVID-19 pandemic are scarce. We aim to (i) characterise substance use profiles among adolescents and (ii) identify correlates of such substance use profiles. Methods: Norwegian nationwide survey data from 2021 were analysed using latent profile analysis. Participants were 97,429 adolescents aged 13-18. We assessed cigarette, e-cigarette and snus use, alcohol consumption, and cannabis and other illicit drug use. Correlates included psychosocial variables, health risk behaviours, and COVID-19-related problems. Findings: We identified three adolescent profiles; those who use no substances (n = 88,890; 91%); those who use snus and alcohol (n = 6546; 7%); and those who use multiple substances (i.e., polysubstance profile; n = 1993; 2%). Boys, older adolescents, adolescents with lower socio-economic status, and those reporting low levels of parental control, and higher parental alcohol use, mental health problems, pain-related variables, and other health risk behaviours were most likely to be in the polysubstance profile. Adolescents with social and mental health issues related to COVID-19 were more at risk of being in the polysubstance profile. Adolescents who use snus and alcohol showed similar patterns of risk factors, but on a somewhat lower level than those in the polysubstance profile. Interpretation: Adolescents who use multiple substances have an unhealthier lifestyle, are at a higher risk of experiencing psychosocial impairments, and report more problems related to the COVID-19 pandemic. Preventative strategies to reduce polysubstance use might help promote psychosocial well-being in adolescents across various life domains. Funding: This study was funded by two grants from the Research Council of Norway (project #: 288083 and 300816). The Norwegian Directorate of Health has funded the data collection. The Research Council of Norway and the Norwegian Directorate of Health have not had any role in study design, data collection, data analysis, interpretation, and writing of the report.

Temporal stability and responsiveness of a conditioned pain modulation test.

OBJECTIVES: Conditioned pain modulation is a commonly used quantitative sensory test, measuring endogenous pain control. The temporal stability of the test is questioned, and there is a lack of agreement on the effect of different pain conditions on the conditioned pain modulation response. Thus, an investigation of the temporal stability of a conditioned pain modulation test among patients suffering from persistent or recurrent neck pain is warranted. Further, an investigation into the difference between patients experiencing a clinically important improvement in pain and those not experiencing such an improvement will aid the understanding between changes in pain and the stability of the conditioned pain modulation test. METHODS: This study is based on a randomized controlled trial investigating the effect of home stretching exercises and spinal manipulative therapy vs. home stretching exercises alone. As no difference was found between the interventions, all participants were studied as a prospective cohort in this study, investigating the temporal stability of a conditioned pain modulation test. The cohort was also divided into responders with a minimally clinically important improvement in pain and those not experiencing such an improvement. RESULTS: Stable measurements of conditioned pain modulation were observed for all independent variables, with a mean change in individual CPM responses of 0.22 from baseline to one week with a standard deviation of 1.34, and -0.15 from the first to the second week with a standard deviation of 1.23. An Intraclass Correlation Coefficient (ICC3 - single, fixed rater) for CPM across the three time points yielded a coefficient of 0.54 (p<0.001). CONCLUSIONS: Patients with persistent or recurrent neck pain had stable CPM responses over a 2 week course of treatment irrespective of clinical response.

Sexual Victimization in the Digital Age: A Population-Based Study of Physical and Image-Based Sexual Abuse Among Adolescents.

Adolescents increasingly use social media platforms, and these practices open up new forms of sexual victimization, in particular image-based sexual abuse (IBSA). Few studies have examined prevalence rates and correlates of both physical sexual victimization (PSV) and these new forms of victimization in representative samples. We used data from 5,245 adolescent girls (53%) and 4,580 adolescent boys (47%) from the population-based Young in Oslo Study (mean age 17.1 years, SD = 0.9). Of all respondents, 2.9% had experienced IBSA, 4.3% PSV, and 1.7% both IBSA and PSV in the course of the previous 12 months. Multivariate analyses revealed that PSV victims, after control for other variables, had many characteristics described in previous studies of sexual victimization. Girls had higher prevalence rates than boys, many had been victims of other types of violence, and were part of peer groups with much use of alcohol and drugs. PSV victims also reported early intercourse onset and a higher proportion had been commercially sexually exploited. Lesbian, gay, and bisexual adolescents had higher victimization rates. Victims of both PSV and IBSA had a similar but even more pronounced profile. The IBSA victims were different: They lacked many of the traditional risk factors for sexual victimization, there were no significant gender differences in this group, and IBSA victims more often came from high socioeconomic backgrounds. In conclusion, we observe a reconfigured landscape of sexual victimization patterns among Norway adolescents due to their increasing participation on social media and digital platforms.

Psychometric properties of a short self-report measure of rule-breaking behaviour among adolescents: findings from the Ungdata survey.

BACKGROUND: The aim of the present study was to examine the factor structure and reliability of a six-item scale of rule-breaking behaviour, and to test for measurement invariance across gender, age, survey year and geographical location. METHODS: Data were from three yearly cross-sectional and population-based collections of the Ungdata surveys (2017 to 2019) including a total of 297,102 Norwegian adolescents aged approximately 13 to 19 years. Measurements included respondent's rule-breaking behaviour, time, gender, age and geographical location. RESULTS: Confirmatory factor analyses demonstrated that a one-factor solution of the rule-breaking behaviour scale had good fit to data (comparative fit index 0.98; Tucker-Lewis index 0.96; root mean square error of approximation 0.049 (95% confidence interval 0.048, 0.050)), with factor loadings ranging from 0.60 to 0.81 for all items (mean factor loading 0.72). Similar results were found across survey years for both genders. Several multiple group confirmatory factor analyses showed indications of measurement invariance for the scale across gender, age groups, geographical locations and survey years. The ordinal alpha and omega coefficients for internal consistency of the scale were both 0.86. CONCLUSIONS: The six-item scale for self-reported rule-breaking behaviour demonstrated good psychometric properties and appears to constitute a reliable measure of adolescent rule-breaking behaviour for use in population-based surveys in a Norwegian setting.

Are changes in pain associated with changes in heart rate variability in patients treated for recurrent or persistent neck pain?

BACKGROUND: Persistent or recurrent neck pain is associated with perturbations in the autonomic nervous system balance, and nociceptive stimulation has been seen to influence this balance. However, very few prospective studies have addressed the extent to which changes in pain associate with changes in autonomic cardiac regulation. Therefore, we investigated if changes in pain vary with changes in heart rate variability in a cohort of patients treated for persistent or recurrent neck pain. METHOD: This analysis is based on data from a randomized controlled trial in which participants were given home stretching exercises with or without spinal manipulative therapy for two weeks. As the effectiveness of the intervention (home stretching exercises and spinal manipulative therapy) was found to be equal to the control (home stretching exercises alone), all 127 participants were studied as one cohort in this analysis. During the intervention, pain levels were recorded using daily text messages, and heart rate variability was measured in the clinics three times over two weeks. Two approaches were used to classify patients based on changes in pain intensity: 1) Clinically important changes in pain were categorized as either "improved" or "not improved" and, 2) Pain development was measured using pain trajectories, constructed in a data driven approach. The association of pain categories and trajectories with changes in heart rate variability indices over time were then analysed using linear mixed models. RESULTS: Heart rate variability did not differ significantly between improved and not-improved patients, nor were there any associations with the different pain trajectories. CONCLUSIONS: In conclusion, changes in pain after home stretching exercises with or without spinal manipulative therapy over two weeks were not significantly associated with changes in heart rate variability for patients with persistent or recurrent neck pain. Future studies should rely on more frequent measurements of HRV during longer treatment periods. TRIAL REGISTRATION: The trial was registered at ClinicalTrials.gov, registration number: NCT03576846.

Adolescents' psychosocial well-being one year after the outbreak of the COVID-19 pandemic in Norway.

The COVID-19 pandemic has dramatically restricted adolescents' lives. We used nationwide Norwegian survey data from 2014-2021 (N = 227,258; ages 13-18) to examine psychosocial outcomes in adolescents before and during the pandemic. Multilevel models revealed higher depressive symptoms and less optimistic future life expectations during the pandemic, even when accounting for the measures' time trends. Moreover, alcohol and cannabis use decreased, and screen time increased. However, the effect sizes of all observed changes during the pandemic were small. Overall, conduct problems and satisfaction with social relationships remained stable. Girls, younger adolescents and adolescents from low socio-economic backgrounds showed more adverse changes during the pandemic. Estimated changes in psychosocial outcomes varied little with municipality infection rates and restrictions. These findings can inform means and interventions to reduce negative psychological outcomes associated with the pandemic and identify groups that need particular attention during and after the pandemic.

The effect of spinal manipulative therapy and home stretching exercises on heart rate variability in patients with persistent or recurrent neck pain: a randomized controlled trial.

BACKGROUND: Persistent or recurrent neck pain is, together with other chronic conditions, suggested to be associated with disturbances of the Autonomic Nervous System. Acute effects on the Autonomic Nervous System, commonly measured using Heart Rate Variability, have been observed with manual therapy. This study aimed to investigate the effect on Heart Rate Variability in (1) a combination of home stretching exercises and spinal manipulative therapy versus (2) home stretching exercises alone over 2 weeks in participants with persistent or recurrent neck pain. METHODS: A randomized controlled clinical trial was carried out in five multidisciplinary primary care clinics in Stockholm from January 2019 to April 2020. The study sample consisted of 131 participants with a history of persistent or recurrent neck. All participants performed home stretching exercises daily for 2 weeks and were scheduled for four treatments during this period, with the intervention group receiving spinal manipulative therapy in addition to the home exercises. Heart Rate Variability at rest was measured at baseline, after 1 week, and after 2 weeks, with RMSSD (Root mean square of successive RR interval differences) as the primary outcome. Both groups were blinded to the other group intervention. Thus, they were aware of the purpose of the trial but not the details of the "other" intervention. The researchers collecting data were blinded to treatment allocation, as was the statistician performing data analyses. The clinicians provided treatment for participants in both groups and could not be blinded. A linear mixed-effects model with continuous variables and person-specific random intercept was used to investigate the group-time interaction using an intention to treat analysis. RESULTS: Sixty-six participants were randomized to the intervention group and sixty-five to the control group. For RMSSD, a B coefficient of 0.4 (p value: 0.9) was found, indicating a non-significant difference in the regression slope for each time point with the control group as reference. No statistically significant differences were found between groups for any of the Heart Rate Variability indices. CONCLUSION: Adding four treatments of spinal manipulation therapy to a 2-week program of daily stretching exercises gave no significant change in Heart Rate Variability. TRIAL REGISTRATION: The trial was registered 03/07/2018 at ClinicalTrials.gov, registration number: NCT03576846. ( https://pubmed.ncbi.nlm.nih.gov/31606042/ ).

The effect of two weeks of spinal manipulative therapy and home stretching exercises on pain and disability in patients with persistent or recurrent neck pain; a randomized controlled trial.

BACKGROUND: Recurrent or persistent neck pain affects a vast number of people globally, leading to reduced quality of life and high societal costs. Clinically, it is a difficult condition to manage, and treatment effect sizes are often moderate at best. Activity and manual therapy are first-line treatment options in current guidelines. We aimed to investigate the combination of home stretching exercises and spinal manipulative therapy in a multicentre randomized controlled clinical trial, carried out in multidiscipline ary primary care clinics. METHODS: The treatment modalities utilized were spinal manipulative therapy and home stretching exercises compared to home stretching exercises alone. Both groups received 4 treatments for 2 weeks. The primary outcome was pain, where the subjective pain experience was investigated by assessing pain intensity (NRS - 11) and the quality of pain (McGill Pain Questionnaire). Neck disability and health status were secondary outcomes, measured using the Neck Disability Indexthe EQ-5D, respectively. One hundred thirty-one adult subjects were randomized to one of the two treatment groups. All subjects had experienced persistent or recurrent neck pain the previous 6 months and were blinded to the other group intervention. The clinicians provided treatment for subjects in both group and could not be blinded. The researchers collecting data were blinded to treatment allocation, as was the statistician performing data analyses. An intention-to-treat analysis was used. RESULTS: Sixty-six subjects were randomized to the intervention group, and sixty-five to the control group. For NRS - 11, a B-coefficient of - 0,01 was seen, indication a 0,01 improvement for the intervention group in relation to the control group at each time point with a p-value of 0,305. There were no statistically significant differences between groups for any of the outcome measures. CONCLUSION: Based on the current findings, there is no additional treatment effect from adding spinal manipulative therapy to neck stretching exercises over 2 weeks for patients with persistent or recurrent neck pain. TRIAL REGISTRATION: The trial was registered 03/07/2018 at ClinicalTrials.gov , registration number: NCT03576846.

Adolescents' assessments of consequences of the pandemic after one year of COVID-19 restrictions. / Ungdoms opplevelser av konsekvenser av pandemien etter ett år med covid-19-restriksjoner.

BACKGROUND: We have obtained knowledge of how the COVID-19 pandemic affected the lives of adolescents immediately after the pandemic arrived in Norway. However, we know little about adolescents' experiences from the pandemic over time, and whether sociodemographic factors and infection rates at the municipality level play a role. MATERIAL AND METHOD: We used questionnaire data from 106 448 lower and upper secondary school pupils who took part in the Ungdata survey in 167 municipalities in the spring of 2021 (response rate 76 %). The adolescents' responses regarding their experiences during the pandemic were collated with statistics on infection rates at the municipality level. We performed a Chi-square test and multilevel analyses to investigate predictors of adolescents' experiences. RESULTS: A total of 49 % responded that the COVID-19 pandemic affected their lives in a partly or very negative direction. Many reported negative changes in peer relationships, family relationships and mental health, but some also reported positive changes. Girls, older adolescents, those with a low socioeconomic background and those living in municipalities with a higher prevalence of infection reported more negative consequences. INTERPRETATION: Most adolescents reported that the pandemic has had more negative than positive consequences. Girls, older adolescents, those with a low socioeconomic background and those living in municipalities with a higher rate of infection may be especially affected by the negative effects of the pandemic.

Past Year Cannabis Use Among Norwegian Adolescents: Time Trends Based on the Ungdata Surveys 2010-2019.

Aims: To describe trends in cannabis use from 2010 to 2019 among Norwegian adolescents and relate these to individual- and municipal-level variables. Design: Data from nationwide repeated cross-sectional surveys collected in 2010-2013 (T1), 2014-2016 (T2), and 2017-2019 (T3) were used to describe secular trends in proportions of adolescent cannabis use. Setting: Cross-sectional surveys in 410 of the total 428 municipalities of Norway. Participants: A total of 628,678 survey responses from adolescents aged ~13-19 years of age, in which 566,912 survey responses were eligible for analyses, representing data from 340 municipalities. Measurements: Respondent's past year cannabis use, time, gender, school grade, municipality, geographical location, and municipality population. Findings: Boys reported overall higher cannabis use, with ~2:1 gender ratio for any past year cannabis use and a 3:1 gender ratio for frequent cannabis use. Adolescents in Eastern Norway reported higher cannabis use compared with other areas in the country, and adolescents from municipalities with a higher population size reported higher rates of cannabis use than smaller municipalities. A gradual increase in cannabis use from T1 to T3 was found in Eastern Norway and in the largest municipalities. More generally, proportions of past year cannabis use showed a marked increase from T2 to T3 across genders, grade/age groups, geographical location, and municipality population, with few exceptions. Conclusions: Our findings indicate that proportions of past year cannabis use have increased among Norwegian adolescents in recent years. Preventive interventions to hinder initiation of cannabis use, as well as measures to address frequent cannabis use among Norwegian adolescents, are needed.

Neck and shoulder pain in adolescents seldom occur alone: Results from the Norwegian Ungdata Survey.

BACKGROUND: No previous studies have investigated the prevalence of co-occurring neck/shoulder pain, other musculoskeletal pain, headache and depressive symptoms in adolescents. This study aimed to describe the prevalence of isolated neck/shoulder pain and the co-occurrence of neck/shoulder pain with other musculoskeletal pain, headache and depressive symptoms in Norwegian adolescents. METHODS: This is a cross-sectional study using data from the Norwegian Ungdata survey (2017-2019). Adolescents from almost all municipalities in Norway answered a comprehensive questionnaire, including physical complaints. We investigated the prevalence of self-reported neck/shoulder pain in isolation and neck/shoulder pain in combination with other musculoskeletal pain, headache and depressive symptoms. The results were presented with per cent and stratified by school level and sex. RESULTS: In total, 253,968 adolescents (50% girls) participated in the study, of which 56.5% were from lower secondary school. The total prevalence of neck/shoulder pain was 24%, but only 5% reported isolated neck/shoulder pain. Among students reporting neck/shoulder pain, half of them also reported other musculoskeletal pain, and 50% of the boys and 70% of the girls reported co-occurring headache. Depressive symptoms were reported in 28% of the boys and 45% of the girls with neck/shoulder pain. CONCLUSION: Neck/shoulder pain in adolescents is seldom isolated, but seems to co-occur with headache, other musculoskeletal pain and depressive symptoms. Researchers and clinicians should keep a broader health perspective in mind when approaching adolescents with neck/shoulder pain. SIGNIFICANCE: One in five adolescents reported neck/shoulder pain in this large population-based study of Norwegian adolescents. A majority of adolescents reported neck/shoulder pain in co-occurrence with other musculoskeletal pain, headache and depression. Researchers and clinicians should assess these comorbidities when assessing adolescents with neck/shoulder pain.

Lifestyle habits and depressive symptoms in Norwegian adolescents: a national cross-sectional study.

BACKGROUND: This study's purpose was to examine the association between a broad range of lifestyle habits and depressive symptoms in Norwegian adolescents. METHODS: This study was based on national, self-reported, cross-sectional data from the Ungdata Surveys, conducted in 2017-2019. The target group comprised 244,250 adolescents (ages 13-19). Binominal logistic regression was used to analyse the association between lifestyle habits (physical activity, social media use, gaming, dietary habits, smoking, smokeless tobacco, alcohol intoxication) and depressive symptoms. The outcome measure was defined as a high level of depressive symptoms (≥80th percentile). Separate analyses were performed for boys and girls, and all models were adjusted for perceived family economy, parental higher education and age. RESULTS: The odds of having depressive symptoms were significantly lower among those who reported being physically active at least 3 times per week (OR; boys: 0.81, girls: 0.83), used social media ≤3 h per day (OR; boys: 0.65, girls: 0.70), engaged in gaming ≤3 h per day (OR; boys: 0.72, girls: 0.77), were non-smokers (OR; boys: 0.74, girls: 0.72) and had not experienced alcohol intoxication during the previous 12 months (OR; boys: 0.66, girls: 0.67). Furthermore, the results indicated a significant inverse association between depressive symptoms and high consumption of a range of healthy food items and low consumption of unhealthy food and beverages among girls. Similar tendencies were found among boys (OR; 0.77-0.91). Finally, higher adherence to healthy lifestyle habits was associated significantly with lower odds of having depressive symptoms among both genders (OR; boys: 0.40, girls: 0.52). CONCLUSIONS: A healthier lifestyle was associated with lower odds of having depressive symptoms. Additional research is needed to confirm a possible causal relationship.

Recruiting in intervention studies: challenges and solutions.

INTRODUCTION: In order for study results to be relevant for practice, the study participants should represent the source population. A common problem is recruitment of sufficient and representative subjects, threatening the external validity of the study and, ultimately, evidence-based practice. The aim was to highlight common challenges and to present possible solutions to recruitment. METHODS: Using four recent randomised controlled trials as examples, common recruitment challenges were highlighted and solutions were proposed. The four studies represented some common and some specific challenges, but they investigated interventions for the prevention of the two major public health challenges of today: musculoskeletal pain and common mental disorders. RESULTS: Identified challenges and suggested solutions were presented as a checklist to be used for future trials in order to aid recruitment and reporting thereof.

Compliance with infection control rules among adolescents in Oslo during the COVID-19 pandemic. / Smittevern blant Oslo-ungdom under covid-19-pandemien.

BACKGROUND: Effective infection control is crucial for combatting the COVID-19 pandemic. We investigated whether adolescents in Oslo reported compliance with the Norwegian infection control rules during the pandemic and whether compliance with the rules was associated with sociodemographic characteristics, trust in the authorities and acceptance of the infection control rules. MATERIAL AND METHOD: Students in lower and upper secondary schools completed an electronic questionnaire (N = 12 686, 37 % response rate) during a period with strict infection control measures in force. We used self-reporting of compliance with the infection control rules, sociodemographic characteristics, trust in the authorities and people in general, and acceptance of the infection control rules. We used logistic regression analysis. RESULTS: The majority reported that they always or to a large extent complied with the rules for hand washing (n = 9 915, 84 %), refrained from shaking hands/hugging (n = 8 730, 74 %) and avoided large groups (n = 8 565, 73 %). Fewer reported to maintain physical distance (n = 5 859, 50 %). The level of trust in the government (n = 8 742, 80 %) and health authorities (n = 9 962, 92 %) was high. The highest compliance with the rules was among girls, adolescents from immigrant backgrounds, those with a high level of trust in the authorities and people in general, and those who showed acceptance of the infection control rules. INTERPRETATION: A large proportion reported to comply with the infection control rules. Adolescents from immigrant backgrounds and those who were living in the outer eastern suburbs of Oslo also more frequently reported to comply with the rules. Trust and acceptance of the rules were also important factors.

Life satisfaction among adolescents before and during the COVID-19 pandemic. / Livstilfredshet blant ungdom før og under covid-19-pandemien.

BACKGROUND: The COVID-19 pandemic in the spring of 2020 involved closure of schools and strict limitations on social contact. The study examines whether this had an effect on the life satisfaction and subjective well-being among adolescents. MATERIAL AND METHOD: An online survey among students in lower secondary schools in Oslo (N = 8 116, 46 % response rate) was conducted during the period with closed schools and strict infection control measures. The results were compared to equivalent surveys conducted in Oslo in 2018 (N = 13 790, 83 % response rate) and several other counties in 2020 before the COVID-19 restrictions were introduced (N = 19 799, 49 % response rate). Identical measurements were used for life satisfaction, subjective well-being and background factors. We used logistic regression analysis and corrected for sociodemographic differences. RESULTS: Among boys, the proportion reporting high life satisfaction (a score of 6 or higher on a scale from 0 to 10) declined markedly, from 88 % in 2018 and 92 % in 2020 before the COVID-19 restrictions to 71 % during the period of restrictions (p < 0.001). The equivalent figures for girls were 78 %, 81 % and 62 % (p < 0.001). The social inequality in life satisfaction was smaller during the restrictions than in other periods. Concerns about illness and infection were associated with lower life satisfaction. INTERPRETATION: The reduction in life satisfaction and subjective well-being can most likely be explained by the heavy restrictions placed on activities that promote well-being and by concerns about infection. The results also indicate that resourceful adolescents experienced an especially strong reduction in their life satisfaction.

Physical Fighting and Leisure Activities among Norwegian Adolescents-Investigating Co-occurring Changes from 2015 to 2018.

After many years of decline in violent behavior among adolescents in several Western countries, recent official statistics indicate a possible trend change. So far, knowledge on how this change is related to co-occurring changes in leisure time activities is limited. Using two cross-sectional surveys from Oslo, Norway, this study found substantial increases in the prevalence of physical fighting from 2015 (N = 23,381; 51.6% girls) to 2018 (N = 25,287; 50.8% girls) in junior and senior high school. The rise in fighting was related to co-occurring changes in several leisure activities, including increasing time spent unsupervised by adults, rising digital media use, and rising cannabis use. The study emphasizes the importance of considering leisure time activities when addressing adolescent misbehavior.

The effect of spinal manipulative therapy on heart rate variability and pain in patients with chronic neck pain: a randomized controlled trial.

BACKGROUND: Recent experimental research has suggested that spinal manipulative therapy (SMT) may reduce pain through modulation of the ascending pain signals and/or the central pain-regulating mechanisms. People with persistent neck pain (NP) have also been found to have disturbances in autonomic nervous system (ANS) regulation. A common way to study the ANS is to measure heart rate variability (HRV). It is not known whether deviations in HRV are related to changes in pain perception or to the treatment response to SMT. Commonly, an individual in pain will experience pain reduction when exposed to a second pain stimulus, a mechanism known as conditioned pain modulation (CPM). Patients with persistent pain have been found to have a reduced CPM reaction. It is not known whether this is predictive of treatment response to SMT. The aim of the study is to examine the effects of SMT on HRV and pain. Further, a secondary aim is to test whether a CPM test can be used to predict treatment response in a population of patients with recurrent and persistent NP. METHOD/DESIGN: A multicentre randomized controlled clinical trial will be carried out in multidisciplinary primary care clinics. This setting is chosen to minimize bias resulting from patient preference for the treatment modality and provider. The subjects are either self-referred or referred from other health care practitioners locally. The treatment modalities are two well-known interventions for NP; SMT and stretching exercises compared to stretching exercises alone. HRV will be measured using a portable heart monitor. The subjective pain experience will be investigated by assessing pain intensity and the affective quality of pain. CPM will be measured with a standardized cold pressor test. Measurements will be performed three times during a 2-week treatment series. DISCUSSION: The study will utilize normal clinical procedures, which should aid the transferability and external validity of the results. The study will provide knowledge regarding the underlying mechanisms of the effects of SMT. Furthermore, the study will examine whether a CPM test is predictive of treatment outcome in a population of patients with recurrent and persistent NP. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03576846 . Registered on 3 July 2018.

Immigration and the decline in adolescent binge drinking.

BACKGROUND: Adolescent alcohol consumption has fallen in most Western countries over the past two decades, while immigrants and children of immigrants from low-consumption countries constitute a growing proportion of teenagers in many Western nations. We investigate the extent to which immigrants and children of immigrants have contributed to the decline in adolescent heavy episodic drinking in Oslo, the capital of Norway. METHODS: We use repeated cross-sectional survey data on adolescents in grades 9-11 in Oslo (aged around 14-16, N = 54,474) from 1996 to 2018. We use data on heavy episodic drinking/intoxication in the past 12 months (dichotomized), immigrant background, sex and grade. We decompose the trend into components attributable to changes in the demographic composition of the adolescent population (by immigrant background, grade and sex), and to changes in drinking patterns within different groups. Confidence intervals (CIs) are obtained by bootstrap resampling. RESULTS: The proportion of adolescents with immigrant backgrounds increased from 21% to 35% over the time span. The proportion reporting having been intoxicated fell from 42% to 25%. Most of the decline stems from reduced heavy episodic drinking in the majority population, accounting for 70.8% of the reduction (95% CI: 67.5-74.2). The increased proportion of adolescents with an immigrant background accounts for 21.4% of the decline (95% CI: 19.2-23.8). CONCLUSIONS: An increasing proportion of immigrants and children of immigrants with low alcohol consumption explains one-fifth of the decline in the prevalence of adolescent heavy episodic drinking in Oslo.

Anabolic-androgenic steroid use and correlates in Norwegian adolescents.

This paper surveys the prevalence and correlates of anabolic androgenic steroids (AAS) use among Norwegian adolescents, and examines the degree to which sports participation is a mediating or moderating factor to well-known correlations between AAS use and problem behaviour. The data come from the "Ungdata" study, a cross-national youth survey system offered to all municipalities in Norway (response rate: 74%, N = 77,572). The study demonstrates a lifetime prevalence of AAS use of 1.27% and a higher prevalence among boys (1.81%) than girls (0.76%). The analyses show that AAS use is clearly related to problem behaviour such as violence and other substance use. When controlling for problem behaviour, there are no correlations between AAS use and exercising in a sports club or on one's own, whilst there is a weak positive correlation between AAS use and exercising in a gym or engaging in other forms of physical exercise such as dancing or martial arts. These patterns are more or less the same for boys and for girls. We conclude that adolescent AAS use is a low-prevalence phenomenon that primarily takes place in smaller subgroups of individuals who engage in other forms of problem behaviour as well.