Stability of clustering of lifestyle risk factors in the Dutch adult population and the association with mental health.

BACKGROUND: Lifestyle factors often co-occur in clusters. This study examines whether clusters of lifestyle risk factors, such as smoking, alcohol use, physical inactivity, poor diet, sexual risk behaviour, cannabis and other drug use, change over time in a representative sample of Dutch adults. Additionally, the association between mental health and self-reported depression of lifestyle clusters was examined. METHODS: Each year cross-sectional data of approximately 7500 individuals of 18 years and older from the annual Dutch Health Survey of 2014-2019 were used. Clusters were determined by a two-step cluster analysis. Furthermore, regression analyses determined the association between clusters of lifestyle risk factors and mental health. RESULTS: Results show six clusters composed of one, multiple or no lifestyle risk factors. The clusters remained relatively stable over time: in some clusters, the number of people slightly changed between 2014 and 2019. More specifically, clusters that increased in size were the cluster with no lifestyle risk factors and the cluster with multiple lifestyle risk factors. Furthermore, results show that clusters with none to a few lifestyle risk factors were associated with better mental health and a lower prevalence of self-reported depression compared with clusters with multiple lifestyle risk factors. CONCLUSIONS: The clustering of lifestyle risk factors remained stable over time. People with multiple lifestyle risk factors had poorer mental health than those without risk factors. These findings may emphasize the need for intervention strategies targeting this subgroup with multiple lifestyle risk factors.

Lottery incentives for smoking cessation at the workplace: design and protocol of the smoke-free lottery - a cluster randomized trial.

BACKGROUND: Smoking is the leading behavioral risk factor for the loss of healthy life years. Many smokers want to quit, but have trouble doing so. Financial incentives in workplace settings have shown promising results in supporting smokers and their design influences their impact. Lotteries that leverage behavioral economic insights might improve the effectiveness of workplace cessation support. METHODS AND DESIGN: We examine in a cluster randomized trial if a workplace cessation group training paired with lottery deadlines will increase continuous abstinence rates over and above the cessation training alone. Organizations are randomized to either the control arm or lottery arm. The lotteries capitalize regret aversion by always informing winners at the deadline, but withholding prizes if they smoked. In the lottery-arm, winners are drawn out of all participants within a training group, regardless of their smoking status. In weeks 1-13 there are weekly lotteries. Winners are informed about their prize (€50), but can only claim it if they did not smoke that week, validated biochemically. After 26 weeks, there is a long-term lottery where the winners are informed about their prize (vacation voucher worth €400), but can only claim it if they were abstinent between weeks 13 and 26. The primary outcome is continuous abstinence 52 weeks after the quit date. DISCUSSION: There is a quest for incentives to support smoking cessation that are considered fair, affordable and effective across different socioeconomic groups. Previous use of behavioral economics in the design of lotteries have shown promising results in changing health behavior. This cluster randomized trial aims to demonstrate if these lotteries are also effective for supporting smoking cessation. Therefore the study design and protocol are described in detail in this paper. Findings might contribute to the application and development of effective cessation support at the workplace. TRIAL REGISTRATION: Netherlands Trial Register Identifier: NL8463 . Date of registration: 17-03-2020.

[The Lifestyle Monitor: prevalence rates for health policy]. / De Leefstijlmonitor: Cijfers voor gezondheidsbeleid.

The Lifestyle Monitor (LSM) was launched in 2013 on behalf of the Ministry of Health, Welfare and Sports to reorganize the multiple data collections in the field of lifestyle and health in the Netherlands. The reorganization should enhance the efficiency and coherence of the lifestyle and health data collections and should provide unambiguous figures for policymakers. This article describes the background and content (including the lifestyle-themes) of the LSM and the tasks and roles of the collaborating parties involved. The measurement methods used and requirements for data requests are described as well. Finally, some examples of figures and trends over the period 2014-2020 to underpin the health policy are described.

Longitudinal Associations of Substance Use Risk Profiles with the Use of Alternative Tobacco Products and Conventional Smoking among Adolescents.

Although personality is associated with the onset of substance use (i.e., conventional smoking, alcohol use, and cannabis use) during adolescence, it is unclear whether personality traits are also associated with the onset of use of alternative tobacco products (ATPs), i.e., electronic cigarettes, shisha-pens, and water pipes. This study examines whether personality traits are associated with the onset of use of both conventional cigarettes and ATPs. Longitudinal data (baseline and 18-month follow-up) were used. The sample consisted of 1114 non-user adolescents (mean age = 13.36, SD = 0.93, 56% female) at baseline. To measure personality traits, the Substance Use Risk Profile Scale was used with four subscales: anxiety sensitivity, hopelessness, sensation seeking, and impulsivity. Structural equation models were conducted using Mplus 7.3. Results showed that both hopelessness and sensation seeking were associated with the onset of use of e-cigarettes and conventional cigarettes. Further, sensation seeking and impulsivity were associated with the onset of use of shisha-pens and water pipes. In conclusion, to prevent adolescents from using ATPs and/or conventional cigarettes, it is important to take their personality traits into account. More research on other (shared) risk factors and on more advanced stages of ATP use is needed before effective prevention strategies can be developed.

Grumpy or depressed? Disentangling typically developing adolescent mood from prodromal depression using experience sampling methods.

INTRODUCTION: This study aimed at differentiating normative developmental turmoil from prodromal depressive symptoms in adolescence. METHOD: Negative and positive mood (daily) in different contexts (friends, home, school), and (subsequent) depressive symptoms were assessed in Dutch adolescents. RESULTS & CONCLUSION: Mixture modeling on one cross-sectional study, using a newly developed questionnaire (CSEQ; subsample 1a; n = 571; girls 55.9%; Mage = 14.17) and two longitudinal datasets with Experience Sampling Methods data (subsample 1b: n = 241; Mage = 13.81; 62.2% girls, sample 2: n = 286; 59.7% girls; Mage = 14.19) revealed three mood profiles: 18-24% "happy", 43-53% "typically developing", and 27-38% "at-risk". Of the "at-risk" profile between 12.5% and 25% of the adolescents scored above the clinical cut-off for depression. These mood profiles predicted later depressive symptoms, while controlling for earlier symptoms. In subsample 1b, parents were not always aware of the mental health status of their adolescent.

Genetic vulnerability to schizophrenia is associated with cannabis use patterns during adolescence.

BACKGROUND: Previously reported comorbidity between schizophrenia and substance use may be explained by shared underlying risk factors, such as genetic background. The aim of the present longitudinal study was to investigate how a genetic predisposition to schizophrenia was associated with patterns of substance use (cannabis use, smoking, alcohol use) during adolescence (comparing ages 13-16 with 16-20 years). METHOD: Using piecewise latent growth curve modelling in a longitudinal adolescent cohort (RADAR-Y study, N = 372), we analyzed the association of polygenic risk scores for schizophrenia (PRS; p-value thresholds (pt) < 5e-8 to pt < 0.5) with increase in substance use over the years, including stratified analyses for gender. Significance thresholds were set to adjust for multiple testing using Bonferroni at p ≤ 0.001. RESULTS: High schizophrenia vulnerability was associated with a stronger increase in cannabis use at age 16-20 (PRS thresholds pt < 5e-5 and pt < 5e-4; pt < 5e-6 was marginally significant), whereas more lenient PRS thresholds (PRS thresholds pt < 5e-3 to pt < 0.5) showed the reverse association. For smoking and alcohol, no clear relations were found. CONCLUSIONS: In conclusion, our findings support a relation between genetic risk to schizophrenia and prospective cannabis use patterns during adolescence. In contrast, no relation between alcohol and smoking was established.

Development of alcohol expectancies and early alcohol use in children and adolescents: A systematic review.

PURPOSE: Developmental changes in alcohol expectancies (AE) have been proposed to lead to alcohol use initiation and later alcohol use in adolescence. This systematic review aims to provide longitudinal evidence of the development of AE and the relation of AE to alcohol outcomes from childhood to late adolescence (4-18 years old). METHODS: A computer-assisted search of relevant articles identified 1602 studies, of which 43 studies (conducted between 1996 and 2016) were selected. RESULTS: First, negative AE decline and positive AE increase in early adolescence. Moreover, alcohol use (initiation) seems to strongly influence changes in AE. Second, AE predict alcohol use initiation and drinking patterns over time. Third, longitudinal predictors of AE could be divided into individual predictors (i.e., alcohol-related cognitions, psychopathology, and genetics) and environmental predictors (i.e., family, peer, and media influences). Lastly, the results indicated that AE function as mediators of the relations between the various individual and environmental predictors and adolescent's alcohol use. CONCLUSIONS: Alcohol expectancies form an important framework through which drinking behavior can be explained over time. Due to the diverse findings on the predictors of AE, future longitudinal studies should further clarify the factors that are essential in the development of AE and adolescent's later alcohol use.

Impact of an Outdoor Smoking Ban at Secondary Schools on Cigarettes, E-Cigarettes and Water Pipe Use among Adolescents: An 18-Month Follow-Up.

Abstract: The effectiveness of outdoor smoking bans on smoking behavior among adolescents remains inconclusive. This study evaluates the long-term impact of outdoor school ground smoking bans among adolescents at secondary schools on the use of conventional cigarettes, e-cigarettes (with/without nicotine) and water pipes. Outdoor smoking bans at 19 Dutch secondary schools were evaluated using a quasi-experimental design. Data on 7733 adolescents were obtained at baseline, and at 6 and 18-month follow-up. The impact of outdoor smoking bans on 'ever use of conventional cigarettes', 'smoking onset', 'ever use of e-cigarette with nicotine', 'e-cigarette without nicotine', and 'water pipe' was measured. Multilevel logistic regression analysis was used. At schools with a ban, implementation fidelity was checked. At schools where a ban was implemented, at 18-month follow-up more adolescents had started smoking compared to the control condition. No effect of implementation of the ban was found for smoking prevalence, e-cigarettes with/without nicotine, and water pipe use. Implementation fidelity was sufficient. No long-term effects were found of an outdoor smoking ban, except for smoking onset. The ban might cause a reversal effect when schools encounter difficulties with its enforcement or when adolescents still see others smoking. Additional research is required with a longer follow-up than 18 months.

Adolescent Perceptions of Parental Privacy Invasion and Adolescent Secrecy: An Illustration of Simpson's Paradox.

Adolescents' secrecy is intertwined with perception of parents' behaviors as acts of privacy invasion. It is currently untested, however, how this transactional process operates at the within-person level-where these causal processes take place. Dutch adolescents (n = 244, Mage  = 13.84, 38.50% boys) reported three times on perceived parental privacy invasion and secrecy. Cross-lagged panel models (CLPM) confirmed earlier findings. Privacy invasion predicted increased secrecy, but a reverse effect was found from increased secrecy to increased privacy invasion. Controlling for confounding positive group-level associations with a novel random intercept CLPM, negative within-person associations were found. Higher levels of secrecy predicted lower levels of privacy invasive behaviors at the within-person level. These opposing findings within- versus between-persons illustrate a Simpson's paradox.

What parents can do to keep their children from smoking: A systematic review on smoking-specific parenting strategies and smoking onset.

AIM: To provide a systematic overview of longitudinal studies on different smoking-specific parenting practices (i.e., perceived parental norms and influences, smoking-specific monitoring, availability of cigarettes at home, household smoking rules, non-smoking agreements, smoking-specific communication, and parental reactions) as useful tools in the prevention of youth smoking. METHOD: MEDLINE and PsychINFO search identified 986 studies published from 1990 to December 2016. Two independent researchers identified eligible studies. Study quality was assessed using Newcastle Ottawa Scale (NOS). RESULTS: The systematic search resulted in 1 to 14 longitudinal studies per parenting practice. Studies scored between 4 and 9 on the NOS, indicating an overall moderate quality. The results of complete smoking house rules showed a preventive effect on smoking onset. Furthermore, availability of cigarettes, frequency and quality of communication, parental reaction (i.e., conflict engagement) and norms showed significant and non-significant effects. Significant results were in line with expectations: availability of cigarettes and frequent communication about smoking predicted smoking, whereas a high quality of communication, negative reactions or punishments and setting norms by parents showed a preventive effect. No effects were found for non-smoking agreements. The number of studies was too limited to draw conclusions about other parenting strategies. More research on (1) reliable and valid instruments, (2) other stages of smoking in addition to onset, and (3) potential moderators and mediators is warranted. CONCLUSION: While evidence supports the effectiveness of smoking-specific parenting, further research is required.

Engaging parents of children with and without asthma in smoking-specific parenting: results from a 3-year Randomized Controlled Trial evaluation.

The present study evaluated long-term effects of a home-based smoking prevention program targeting smoking-specific parenting in families with children with and without asthma. A total of 1398 non-smoking children (mean age 10.1) participated, of which 197 (14.1%) were diagnosed with asthma. Families were blinded to group assignment. The intervention group (n = 684) received booklets with assignments that actively encouraged parents to engage in smoking-specific parenting strategies. Control families (n = 714) received booklets containing basic information about youth smoking. Latent growth curve modeling was used to calculate intercepts and slopes to examine whether there was change in the different parenting aspects over the study period. Regression analyses were used to examine whether a possible change was different for intervention and control condition families with and without a child with asthma. For those smoking-specific parenting aspects that changed over time, families in the intervention and control condition increased similarly. Families with a child with asthma did not engage in parenting at higher levels due to the intervention program than parents of non-asthmatic children. This prevention program did not affect smoking-specific parenting in the Netherlands. Future prevention research could focus on other risk factors for smoking initiation among adolescents with asthma. TRIAL REGISTRATION: Netherlands Trial Register NTR1465.

What drives developmental change in adolescent disclosure and maternal knowledge? Heterogeneity in within-family processes.

This study aimed to gain a better understanding of the normative declines in adolescent disclosure and maternal knowledge over the course of adolescence, by assessing the underlying monitoring processes. Multilevel structural equation models were applied to 15 assessments among 479 families across 5 years (13 years at T1, 57% boys, 11% low socioeconomic status). Developmental declines in mother-perceived disclosure and knowledge were observed, which were partially explained by processes operating at the level of the family unit. On average, mothers were more knowledgeable in weeks with more disclosure and more solicitation, and adolescent disclosure was higher in weeks with more maternal solicitation and less control. The effect sizes and even the directions of these within-family correlations varied between families, however. This heterogeneity was partially explained by the level of maternal control and adolescent disclosure, and by the families' socioeconomic status. Within-family fluctuations in knowledge and disclosure were also correlated with fluctuations in relationship quality and adolescent and mother mood. Overall, these within-family processes explained up to 14% of the normative developmental decline in disclosure and 19% of the decline in knowledge. This study thus suggests that a wide variety in monitoring processes may drive normative declines in adolescent disclosure and maternal knowledge. (PsycINFO Database Record

Parental Smoking and Smoking Cognitions among Youth: A Systematic Review of the Literature.

AIMS: We summarized and discussed the empirical evidence for an association between parental smoking and smoking-related cognitions among youth and for the mediating role of smoking-related cognitions in the relation between parental and youth smoking behaviour. METHODS: We conducted a systematic review of articles published between 1980 and February 2015 using the databases PsychInfo and PubMed. RESULTS: The systematic search resulted in 41 eligible studies. Only 4 studies investigated smoking-related cognitions as putative mediators in the association between parental and youth smoking. The synthesis of evidence showed a mix of significant and non-significant associations between parental smoking and smoking-related cognitions among youth. A majority of results reported positive associations even when non-significant findings were found. However, studies that report an effect suggest that the effect may be quite modest. CONCLUSION: Empirical evidence does not confirm the commonly applied assertions of social learning theories that parental smoking increases the risk of youth smoking through the development of favourable smoking-related cognitions. Methodological and theoretical aspects that might explain the lack of consistent findings are discussed.

Genome-wide DNA methylation levels and altered cortisol stress reactivity following childhood trauma in humans.

DNA methylation likely plays a role in the regulation of human stress reactivity. Here we show that in a genome-wide analysis of blood DNA methylation in 85 healthy individuals, a locus in the Kit ligand gene (KITLG; cg27512205) showed the strongest association with cortisol stress reactivity (P=5.8 × 10(-6)). Replication was obtained in two independent samples using either blood (N=45, P=0.001) or buccal cells (N=255, P=0.004). KITLG methylation strongly mediates the relationship between childhood trauma and cortisol stress reactivity in the discovery sample (32% mediation). Its genomic location, a CpG island shore within an H3K27ac enhancer mark, and the correlation between methylation in the blood and prefrontal cortex provide further evidence that KITLG methylation is functionally relevant for the programming of stress reactivity in the human brain. Our results extend preclinical evidence for epigenetic regulation of stress reactivity to humans and provide leads to enhance our understanding of the neurobiological pathways underlying stress vulnerability.

Home-based smoking prevention program Smoke-free Kids on smoking-related cognitions: Secondary outcomes from a cluster randomized controlled trial.

OBJECTIVES: The home-based smoking prevention programme 'Smoke-free Kids' did not have an effect on primary outcome smoking initiation. A possible explanation may be that the programme has a delayed effect. The aim of this study was to evaluate the effects on the development of important precursors of smoking: smoking-related cognitions. METHODS: We used a cluster randomised controlled trial in 9- to 11-year-old children and their mothers. The intervention condition received five activity modules, including a communication sheet for mothers, by mail at four-week intervals. The control condition received a fact-based programme. Secondary outcomes were attitudes, self-efficacy and social norms. Latent growth curves analyses were used to calculate the development of cognitions over time. Subsequently, path modelling was used to estimate the programme effects on the initial level and growth of each cognition. RESULTS: Analyses were performed on 1398 never-smoking children at baseline. Results showed that for children in the intervention condition, perceived maternal norms increased less strongly as compared to the control condition (ß = -.10, p = .03). No effects were found for the other cognitions. CONCLUSION: Based on the limited effects, we do not assume that the programme will have a delayed effect on smoking behaviour later during adolescence.

Environmental smoking and smoking onset in adolescence: the role of dopamine-related genes. Findings from two longitudinal studies.

Although environmental smoking (i.e., paternal and maternal smoking, sibling smoking, and peer smoking) is one of the most important factors for explaining adolescent smoking behavior, not all adolescents are similarly affected. The extent to which individuals are vulnerable to smoking in their environment might depend on genetic factors. The aim of this study was to examine the interplay between environmental smoking and genes encoding components of the dopaminergic system (i.e., dopamine receptor D2, D4, and dopamine transporter DAT1) in adolescent smoking onset. Data from two longitudinal studies were used. Study 1 consisted of 991 non-smoking early adolescents (mean age = 12.52, SD = .57) whereas study 2 consisted of 365 non-smoking middle to late adolescents (mean age = 14.16, SD = 1.07) who were followed for 16 and 48 months, respectively. Logistic regression analyses were conducted using Mplus. In study 1, we found positive associations between parents' and friends' smoking at the first measurement and smoking status 16 months later. In study 2 we found a positive association between friends' smoking and smoking onset 48 months later. Neither study demonstrated any interaction effects of the DRD2, DRD4, or DAT1 genotypes. In conclusion, the effects of environmental smoking on smoking onset are similar for adolescent carriers and non-carriers of these specific genes related to the dopaminergic system.

Long-term effects of a home-based smoking prevention program on smoking initiation: a cluster randomized controlled trial.

OBJECTIVE: The aims of the study were to evaluate the long-term effects of a home-based smoking prevention program 'Smoke-free Kids' during preadolescence on smoking initiation during adolescence and to test the potential moderating role of parental smoking, socioeconomic status, and asthma. METHOD: In 2008, 1478 9-11year old children and their mothers were recruited from 418 elementary schools in the Netherlands. An independent statistician randomly allocated schools to one of the two conditions using a 1:1 ratio (single blind): 728 children in the intervention and 750 in the control condition. The intervention condition received five activity modules, including a communication sheet for mothers, by mail at four-week intervals and one booster module one year after baseline. The control condition received a fact-based intervention only. Intention-to-treat analysis was performed on 1398 non-smoking children at baseline. RESULTS: In the intervention 10.8% of the children started smoking compared to 12% in the control condition. This difference was non-significant (odds ratio=0.90, 95% confidence interval=0.63-1.27). No moderating effects were found. CONCLUSION: No effects on smoking initiation after 36months were found. Perhaps, the program was implemented with children that were too young. Programs closer to the age of smoking onset should be tested.

The link between asthma and smoking explained by depressive feelings and self-efficacy.

OBJECTIVE: Adolescents with asthma consistently smoke at higher or similar rates as non-asthmatic peers, although smoking might involve more health risks. This study examined possible mechanisms (i.e. depressive feelings and self-efficacy to refrain from smoking) explaining the association between asthma and smoking initiation. METHODS: An indirect path from asthma to self-efficacy through depressive feelings was examined in two independent samples. Sample 1 consisted of 4531 adolescents (mean age 12.8) and sample 2 consisted of 1289 children (late childhood, mean age 10.1). Data were gathered from maternal and self-report. In the adolescent sample, whether the relationship between depressive feelings at baseline and smoking initiation two years post-baseline runs via self-efficacy was also examined. RESULTS: Higher amounts of depressive feelings decreased adolescents' self-efficacy to refrain from smoking, which subsequently increased the risk to initiate smoking. A diagnosis of asthma was also associated with higher levels of depressive feelings which in turn decreased self-efficacy. A marginal significant indirect effect was found in the childhood sample. CONCLUSION: Smoking prevention efforts should start as early as mid to late childhood. The results indicate that focus should be placed on preventing depressive feelings with the aim of increasing children's self-efficacy to refrain from smoking. This is especially important for children and adolescents with asthma.

Smoking-specific parenting and smoking onset in adolescence: the role of genes from the dopaminergic system (DRD2, DRD4, DAT1 genotypes).

Although only few studies have shown direct links between dopaminergic system genes and smoking onset, this does not rule out the effect of a gene-environment interaction on smoking onset. Therefore, the aim of this study was to examine the associations between smoking-specific parenting (i.e., frequency and quality of communication and house rules) and smoking onset while considering the potential moderating role of dopaminergic system genes (i.e., DRD2, DRD4, and DAT1 genotypes). Data from five annual waves of the 'Family and Health' project were used. At time 1, the sample comprised 365 non-smoking adolescents (200 younger adolescents, mean age = 13.31, SD = .48; 165 older adolescents, mean age = 15.19, SD = .57). Advanced longitudinal analyses were used (i.e., logistic regression analyses, (dual) latent growth curves, and cross-lagged path models). The results showed a direct effect of quality of communication on smoking onset. No direct effects were found for frequency of communication and house rules. Furthermore, no direct and moderating effects of the DRD2, DRD4, or DAT1 genotypes were found. In conclusion, the findings indicated that the effects of smoking-specific parenting on smoking are similar for adolescent carriers and non-carriers of the dopaminergic system genes.

Short-term effects of a home-based smoking prevention program on antismoking socialization and smoking-related cognitions: a cluster randomized controlled trial.

OBJECTIVE: This study aims to evaluate the short-term effects of a home-based smoking prevention program called 'Smoke-free Kids' on antismoking socialization and smoking-related cognitions and the moderating role of parental smoking. PARTICIPANTS AND METHODS: A cluster randomized controlled trial was carried out using one intervention condition compared with a control condition. A total of 1,398 never-smoking children (mean age 10.11 years, SD 0.78) participated. Intention-to-treat and completers-only analyses were performed. Participants in the intervention condition (n=728) received 5 activity modules by mail at 4-week intervals. Modules included communication sheets for their mothers. Participants in the control condition (n=750) received a fact-based intervention only. The main outcomes were the frequency and quality of communication, nonsmoking agreement, house rules, availability of cigarettes, perceived maternal influence, anticipated maternal reactions, attitude, self-efficacy and social norms. RESULTS: Significant effects of the program were found for frequency of communication (B=0.11, p<0.001), nonsmoking agreement (B=0.07, p<0.01), perceived maternal influences (B=0.09, p<0.05), self-efficacy (B=-0.09, p<0.05) and social norms of friends (B=-0.08, p=0.05) and best friends (B=-0.11, p<0.05). Parental smoking had no moderating effect. CONCLUSIONS: The Smoke-free Kids program shows promising short-term effects on antismoking socialization and cognitions. Long-term follow-up on the effects of smoking behavior are needed.