Socio-demographic and lifestyle factors associated with overweight in a representative sample of 11-15 year olds in France: results from the WHO-Collaborative Health Behaviour in School-aged Children (HBSC) cross-sectional study.

BACKGROUND: The prevalence of overweight in children and adolescents is high and overweight is associated with poor health outcomes over short- and long-term. Lifestyle factors can interact to influence overweight. Comprehensive studies linking overweight concomitantly with several demographic and potentially-modifiable lifestyle factors and health-risk behaviours are limited in adolescents--an age-group characterized by changes in lifestyle behaviours and high prevalence of overweight. Thus, the objective of the current study was to examine the association of overweight with several socio-demographic and lifestyle variables simultaneously in a representative sample of adolescents. METHODS: A nationally representative sample of 11-15 year-olds (n = 7154) in France participated as part of the WHO-Collaborative Health Behaviour in School-aged Children (HBSC) study. Students reported data on their age, height, weight, socio-demographic variables, lifestyle factors including nutrition practices, physical activity at two levels of intensity (moderate and vigorous), sedentary behaviours, as well as smoking and alcohol consumption patterns using standardized HBSC protocols. Overweight (including obesity) was defined using the IOTF reference. The multivariate association of overweight with several socio-demographic and lifestyle factors was examined with logistic regression models. RESULTS: The adjusted odds ratios for the association with overweight were: 1.80 (95% CI: 1.37-2.36) for low family affluence; 0.73 (0.60-0.88) for eating breakfast daily; 0.69 (0.56-0.84) for moderate to vigorous physical activity (MVPA); and 0.71 (0.59-0.86) for vigorous physical activity (VPA). Significant interactions between age and gender as well as television (TV) viewing and gender were noted: for boys, overweight was not associated with age or TV viewing; in contrast, for girls overweight correlated negatively with age and positively with TV viewing. Fruit and vegetable intake, computer and video-games use, smoking and alcohol consumption were not associated with overweight. CONCLUSIONS: In multivariate model, family affluence, breakfast consumption and moderate to vigorous as well as vigorous physical activity were negatively associated with overweight. These findings extend previous research to a setting where multiple risk and protective factors were simultaneously examined and highlight the importance of multi-faceted approaches promoting physical activity and healthy food choices such as breakfast consumption for overweight prevention in adolescents.

Improving attitudes towards children with disabilities in a school context: a cluster randomized intervention study.

AIM: although inclusive education of disabled children is now an accepted practice, it is often challenged by negative peer attitudes. We undertook an interventional study aimed at improving students' attitudes towards their disabled peers. METHOD: the participants were students from the 7th grade of twelve paired schools (1509 students from 62 classes; age 12-13y), randomly allocated to an intervention group (205 males, 285 females) or a control group (132 males, 165 females). The intervention consisted of a mandatory comprehensive educational project on disability. The Chedoke-McMaster Attitudes Towards Children with Handicaps Scale (CATCH) was used to assess children's attitudes before (T0) and after (T1) intervention. The hierarchical structure of the data was taken into account by adjusting standard deviations and using linear multilevel models. RESULTS: seven hundred and eighty-four students had at least one score on the three domains (cognitive, affective, behavioural) of the CATCH at T0 and T1. The final scores were higher than baseline scores (total scores, intervention group: baseline score 25.6 (SD=5.4), final score 26.8 (5.9), p<0.001; CONTROL GROUP: baseline 25.2 (5.4), final 26.0 (5.7), p<0.009) with no significant difference between the intervention and control groups. Individual score changes over time were associated with baseline score (p<0.001 for total and all sub-scores). Lower improvement in attitudes was found in students from schools with special units for their peers with cognitive impairment for total (p=0.013), affective (p<0.001), and behavioural (p=0.001) scores, while higher improvement existed for the cognitive domain (p=0.029). INTERPRETATION: although we found no effect of our intervention, we found an improvement in attitudes in the intervention and control groups that could be a result of the nature of the scales and questionnaires the students had to complete before the intervention.

Determinants of students' attitudes towards peers with disabilities.

AIM: To explore factors associated with students' attitudes towards their peers with disabilities. METHOD: All 7th grade students (aged 12-13y) from 12 schools in the Toulouse area were invited to participate (n=1509). Attitudes were measured using the Chedoke-McMaster Attitudes Towards Children with Handicaps (CATCH) questionnaire (affective, behavioural, cognitive, and total scores). Personal characteristics, including KIDSCREEN quality of life scores, were recorded. Data regarding information about disabilities received from parents and the media and acquaintance with people with disabilities constituted the 'disability knowledge' factors. The characteristics of the schools were obtained from the local education authority. Multivariate multilevel linear regression analyses were conducted to explore the associations between CATCH scores and these three groups of factors. RESULTS: Responses from 1135 students (612 females, 523 males; mean age 12y 8mo SD 7mo; age range 10y 8mo-15y) were studied (75.2% of the students approached). Factors independently associated with more positive attitudes were being a female, having a good quality of life, being friends with a child with disabilities, or having received information about disabilities from parents and the media. Presence in the school of a special class for children with cognitive disabilities was independently associated with more negative attitudes. INTERPRETATION: This cross-sectional study identified different personal and environmental factors upon which interventions aimed at improving students' attitudes towards their peers with disabilities could be based.

Measuring children's attitudes towards peers with disabilities: a review of instruments.

This study aimed to identify instruments for measuring children's attitudes towards their peers with disabilities that are suitable for use in epidemiological studies and to report on their psychometric properties. A literature review was conducted to identify instruments measuring at least one of the three components of children's attitudes (affective, behavioural, or cognitive measures) towards peers with disabilities and which are intended for self-completion by children. Criteria used to appraise these instruments were appropriateness, acceptability, validity, reliability, internal consistency, and test-retest reliability. Of the 19 instruments matching the inclusion criteria, 16 measured only one attitude component (affective, n=4; behavioural, n=5; cognitive, n=7); one measured cognitive and behavioural components; and two (Acceptance Scale and Chedoke-McMaster Attitudes Towards Children with Handicaps Scale [CATCH]) measured all three components. The majority of instruments, and those most widely used, were developed in the 1970s and 80s and so do not cover some aspects relevant to current culture, although they are still being used in research. Acceptable levels of validity and reliability were reported. Detailed descriptions of the initial validation process were available for the Acceptance Scale, Adjective Checklist, CATCH, and Peer Attitudes Towards the Handicapped Scale. The Acceptance Scale and CATCH seem to be the most complete instruments among those identified as they include all three attitude components and have appropriate psychometric properties.

Contraceptive use by 15-year-old students at their last sexual intercourse: results from 24 countries.

OBJECTIVES: To identify and report cross-national patterns in contraceptive use among sexually active adolescents. DESIGN: A cross-national cross-sectional survey. SETTING: Data were collected in 2002 by self-report questionnaire from students in school classrooms. PARTICIPANTS: A cluster sample of 33,943 students aged 15 years from 24 countries. MAIN OUTCOME MEASURES: International standardized questions on ever having had sexual intercourse and contraceptive use at last sexual intercourse. RESULTS: The percentages of students reporting having had sexual intercourse ranged from 14.1% in Croatia to 37.6% in England; 82.3% of those who were sexually active reported that they used condoms and/or birth control pills at last intercourse. Condom use only was most frequent and ranged from 52.7% in Sweden to 89.2% in Greece. Dual use of condoms and contraceptive pills was also relatively frequent, ranging from 2.6% in Croatia to 28.8% in Canada. The use of contraceptive pills was most frequent in northern and western Europe. No contraceptive use at last intercourse was reported by 13.2% of students. CONCLUSIONS: A substantial minority of 15-year-olds have engaged in sexual intercourse. Condom use is the most frequent method of contraception reported by the sexually active respondents, followed by the dual use of condoms and contraceptive pills and contraceptive pills only. The proportions of poorly protected and unprotected youth remain high, and attention to international policy and practice determinants of young sexual behavior and contraceptive use is required.

[Schooling of young people with cancer]. / Scolarisation des jeunes porteurs de cancer.

The schooling of young people with cancer poses various problems, similar to those experienced by disabled or chronically ill children. Published data on this subject in the medical literature comes mainly from studies carried out in the USA and the UK. Cancer and its treatment can cause both direct (learning difficulties or other disabilities...) and indirect (discrimination...) problems. Academic failure, and other problems linked to school absenteeism, can affect the future of adolescents with cancer. Sustaining schooling during the illness enables such patients to avoid falling behind academically, and to maintain his or her social status as a student. Due to the organisation of treatment regimes, education is provided in three environments : in hospital (during in-patient stays), at home (generally whilst the patient is convalescing), or at school. Paediatric oncologists have underlined the importance of establishing links between hospital and educational personnel (with parental approval), and suggest that a teachers'illness information manual should be produced. School re-entry is recommended as soon as possible. During the illness, the patient's presence in class is dependent on his or her general health, the progress of the cancer, and the treatment regime being followed. School absenteeism, inevitable during treatment periods and the year following diagnosis, is often associated with academic problems or failure. While many cancer patients worry about their school work and future educational progress, such problems remain rare. In the long term, the educational level of childhood or adolescent cancer survivors remains similar to that of the general population. In order to understand the issues surrounding the schooling of young cancer patients in France, long-term multi-centre studies, focusing on adolescents, must be initiated.

Effects of a large-scale industrial disaster on rates of symptoms consistent with posttraumatic stress disorders among schoolchildren in toulouse.

BACKGROUND: Posttraumatic stress disorder (PTSD) has been studied largely among adults and in the context of intentional, collective experiences such as war and terrorism. Far less is known about PTSD among adolescents and resulting from massive industrial accidents. Such an accident in Toulouse, France, 10 days after the World Trade Center disaster, provided an opportunity to examine its effects among adolescents already sensitized by media coverage of the World Trade Center disaster. OBJECTIVES: (1) To assess the presence of symptoms consistent with PTSD (SCW-PTSD) among adolescents in Toulouse after a massive industrial accident, (2) to determine the "excess" of SCW-PTSD among those directly exposed vs those nondirectly exposed, and (3) to examine dosage effects for exposure and the cumulative effect on PTSD of accident-related experiences. DESIGN, SETTING, AND PARTICIPANTS: A survey containing questions on exposure and SCW-PTSD was administered to students aged 11 years, 13 years, 15 years, and 17 years who were enrolled in randomly selected, grade-stratified classrooms from schools for directly exposed students (n = 577) in Toulouse and nondirectly exposed students (n = 900) in the region.Main Outcome Measure The prevalence of SCW-PTSD among directly exposed and nondirectly exposed students. RESULTS: Nine months after the industrial accident, 44.6% of 11- and 13-year-old directly exposed students and 28.5% of 15- and 17-year-old directly exposed students still showed SCW-PTSD, compared with 22.1% of 11- and 13-year-old nondirectly exposed students and 4.4% of 15-year-old nondirectly exposed students. Among 11- and 13-year-olds, the likelihood of having SCW-PTSD was higher for girls who were enrolled in elementary schools, were personally injured, and had severe damage at home, as opposed to boys who were high-school students without severe damage at home or personal injury. Among the 15- and 17-year-olds, being a girl, 17 years old, and personally injured increased the likelihood of having SCW-PTSD, as opposed to 15-year-old boys who were not injured. The effects of injuries were cumulative: students injured personally and with an injured family member were more likely to have SCW-PTSD than those experiencing either personal or family injury but not both. Excess of SCW-PTSD attributable to direct exposure was 50.5% for 11-year-olds, 49.3% for 13-year-olds, and 73.5% for 15-year-olds. CONCLUSIONS: A substantial proportion of Toulouse adolescents still had SCW-PTSD 9 months after the accident. Directly exposed students were far more likely to show SCW-PTSD than those nondirectly exposed, but both groups had SCW-PTSD at rates that were higher than expected. The symptoms were associated with demographic characteristics and direct experiences of trauma. Higher rates applied to students who were personally injured with injured family members and severe damage at home. Students with these characteristics predictive of SCW-PTSD should be given prompt attention to avoid long-lasting effects.