Selective serotonin re-uptake inhibitors for children and adolescents.

OBJECTIVES: 1) To briefly review the scientific basis for the use of selective serotonin re-uptake inhibitors (SSRIs) in children and adolescents. 2) To review the current data on the efficacy, safety and tolerability in children and adolescents. METHOD: A Medline search back to 1990 was conducted. Review articles and double blind, placebo controlled trials were critically reviewed. Additional hand searches were performed with key journals and in specific areas of interest for this paper. RESULTS: Most of the published papers are from North America. There is an increasing use of SSRIs in child and adolescent psychiatry. The main disorders studied are mood and anxiety disorders. The data supporting efficacy is still limited. The most robust data is in the treatment of OCD and depression. CONCLUSION: Taking the limited data together with clinical experience and with adult studies, there is a valuable role for SSRIs as a component of treatment for various child and adolescent psychiatric disorders.

A qualitative investigation of alcohol drinking among male high school students from three communities in the cape peninsula, South Africa.

This article reports on a qualitative study using focus group discussions about alcohol binge drinking with tenth grade male high-school students. Groups were run separately with binge drinking and non-binge drinking adolescents in three different communities. The Theory of Planned Behaviour with two additional constructs was used to provide a theoretical framework for the semi-structured discussions and for the analysis of the data. Although the findings are complex some clear differences did emerge between binge drinkers and non-binge drinkers and between participants from the three different communities. The binge drinkers perceived positive outcomes from binge drinking, were embedded within a peer group culture of binge drinking, and found few obstacles of obtaining alcohol. The non-binge drinkers were more concerned with longer term life goals and were motivated to comply with family pressures not to drink excessively. The implications of these findings for preventive programs and for future research are discussed.

Alcohol misuse in South african male adolescents: a qualitative investigation.

Previous investigations of risk behaviors among high-school students in the Cape Peninsula, South Africa, revealed a high prevalence of binge drinking among boys. Qualitative methods were used to identify and gain insights into the social context of alcohol misuse in male adolescents. Two focus groups were held with eight adolescent binge drinkers. The content of the discussions were analyzed using the grounded theory method. Three key findings emerged. First, adolescents drink because they derive benefits from the use or misuse of alcohol, such as increased self-confidence and adult status. Factors which facilitate the use of alcohol include the alleviation of boredom, experimentation, peer pressure, and parental influences. Second, participants attributed negative characteristics to teetotallers such as being conservative and immature. Binge drinkers were attributed negative characteristics such as lacking self-control and self-respect. Moderate drinkers were attributed with positive characteristics such as being mature and socially adept. Finally, the influential role of alcohol promoting advertising was highlighted. Although participants minimized the effects of advertising it was clear that it played a role in their perception of themselves and of their peers especially with respect to drinking behaviors. The findings suggest some useful prevention strategies among adolescent males at risk for alcohol misuse.

Risk-taking behaviour of Cape Peninsula high-school students. Part IX. Evidence for a syndrome of adolescent risk behaviour.

OBJECTIVES: To ascertain whether the notion of a syndrome of adolescent risk behaviour (which includes problem drinking, marijuana use, having experienced sexual intercourse, 'general deviance' and cigarette smoking) is valid for this setting; and to investigate whether suicidal behaviour and behaviour that exposes the adolescent to injury should be included in this syndrome. DESIGN: Cross-sectional survey utilising a self-completed questionnaire; for both sexes, relationships between behaviours were documented as odds ratios. SETTING: High schools in the Cape Peninsula, South Africa. SUBJECTS: 7,340 students from 16 schools in the three major education departments. OUTCOME MEASURES: Participation in the following behaviours: alcohol bingeing, cannabis smoking, sexual intercourse, knife-carrying at school, cigarette smoking, attempting suicide, failure to use a seat belt, and walking home at night from beyond the neighbourhood. RESULTS: All the odds ratios were greater than 1. There were statistically significant odds ratios between all the pairs of risk behaviours included in the 'original' syndrome of risk behaviour except for cigarette smoking and having had sexual intercourse in the case of girls. There were statistically significant relationships between all these risk behaviours, suicidal behaviour, and behaviours that exposed the adolescent to risk of physical injury, except for failure to use a seat belt and: (i) suicidal behaviour for both sexes; and (ii) walking home alone at night and having had sexual intercourse in the case of girls. CONCLUSION: The notion of a syndrome of adolescent risk behaviour is valid for this population, and both suicidal behaviour and behaviour that exposes the adolescent to injury should be included in this syndrome.

Risk-taking behaviour of Cape Peninsula high-school students. Part X. Multivariate relationships among behaviours.

OBJECTIVE: To investigate the relationship between adolescent risk behaviours, taking into account their influence upon one another. DESIGN: Cross-sectional survey utilising a self-completed questionnaire; stepwise logistic regression analyses were carried out, stratified for gender. SETTING: High schools in the Cape Peninsula, South Africa SUBJECTS: 7,340 students from 16 schools in the three major education departments. OUTCOME MEASURES: The outcome variables for each regression model were: cigarette smoking, cannabis smoking, alcohol bingeing, sexual intercourse, knife-carrying at school, walking home at night from beyond the neighbourhood, attempting suicide, and failure to use a seat belt. For each model, 26 risk behaviours served as independent variables. RESULTS: For each model, between 3 and 9 variables qualified for inclusion for each gender. There was a substantial association between many forms of substance abuse. In the previous 12 months, suicidal thoughts or statements of suicidal intent were predictors of a suicide attempt. Several variables involving injury were predictors of exposure to danger in getting home at night, and this was a predictor of substance abuse. Cannabis smoking, alcohol bingeing and exposure to danger in getting home at night were predictors of and were predicted by having had sexual intercourse. CONCLUSION: There are significant relationships between many adolescent risk behaviours, even when the influence of other risk behaviours is taken into account. The probability of adverse sequelae of risk behaviours, such as exposure to danger in getting home at night and sexual intercourse, is increased by the presence of selected other risk behaviours.

Risk-taking behaviour of Cape Peninsula high-school students. Part I. Introduction and methods.

In this study, risk-taking behaviour of Cape Peninsula high-school students was investigated. Suicidal behaviour, cigarette smoking, alcohol consumption, drug use, road-related behaviour, violent behaviour and sexual behaviour were included. This article, the first in a series, describes the rationale and methodology of the project. Sixteen schools were selected so as to yield a representative sample of schools in the three major education departments in the Cape Peninsula (administered by the Department of Education and Training and the Houses of Assembly and Representatives). The final sample size was 7,340 school students. A self-administered questionnaire was completed in a normal school period. Estimates for each education department were weighted to produce an overall estimate. The results are presented by standard and home language(s), and gender. Limitations of the study include its cross-sectional nature; the possibility of under- and over-reporting; the exclusion of important groups of adolescents such as absentees and dropouts, and those attending specialised and private schools; and not being able to present the results separately for each education department.

Risk-taking behaviour of Cape Peninsula high-school students. Part II. Suicidal behaviour.

The prevalence of a wide range of risk-taking behaviour among high-school students in the Cape Peninsula, South Africa, was investigated. In this article, the results for suicidal behaviour are presented. Cluster sampling techniques produced a sample of 7,340 students from 16 schools in the three major education departments. A self-administered questionnaire was completed in a normal school period. Estimates for each education department were weighted to produce an overall estimate. During the previous 12 months, 19% of students had seriously thought about harming themselves in a way that might result in their death, 12.4% had told someone that they intended to put an end to their life, and 7.8% had actually tried to put an end to their life. There were different trends according to gender, standard and language(s) spoken at home. Of those who had made a suicide attempt during the previous 12 months, 85.7% indicated that they had seriously thought about doing so, while 57.7% had told someone that they intended putting an end to their life. There is in many cases no continuity from suicidal ideation to communicating suicidal intent to an actual attempt.

Risk-taking behaviour of Cape Peninsula high-school students. Part III. Cigarette smoking.

The prevalence of a wide range of risk-taking behaviour among high-school students in the Cape Peninsula, South Africa, was investigated. In this article, the results for cigarette smoking are presented. Cluster sampling techniques produced a sample of 7,340 students from 16 schools in the three major education departments. A self-administered questionnaire was completed in a normal school period. Estimates for each education department were weighted to produce an overall estimate. Of the students 18.1% indicated that they smoked at least 1 cigarette per day. Of these, 66.9% had tried to stop. Of those who did not smoke at least 1 cigarette per day, 41.2% had smoked previously and 3.6% intended to start smoking. There were different trends according to gender, standard, and language(s) spoken at home. Of note was the small percentage of Xhosa-speaking females who smoked. There is an urgent need for smoking prevention programmes in schools.

Risk-taking behaviour of Cape Peninsula high-school students. Part V. Drug use.

The prevalence of a wide range of risk-taking behaviour among high-school students in the Cape Peninsula, South Africa, was investigated. In this article, the results for drug use are presented. Cluster sampling techniques produced a sample of 7,340 students from 16 schools in the three major education departments. A self-administered questionnaire was completed in a normal school period. Estimates for each education department were weighted to produce an overall estimate. Cannabis was the illicit drug most widely used; 7.5% had smoked cannabis, and 2.4% had done so in the previous 7 days. A small subgroup (1.6%) of students had smoked cannabis and methaqualone (Mandrax) together. Reported lifetime use of injectable drugs was 0.5%, and 10.9% had sniffed solvents, 2.6% having done so in the previous 7 days. There were different trends according to gender, standard, and language(s) spoken at home. Of particular note was the small proportion of Xhosa-speaking females who were involved with drug use. The results suggest that the majority of drug use among school students is experimental. A small number of adolescents abuse drugs and are at risk for its associated problems; intervention is indicated for this group.

Risk-taking behaviour of Cape Peninsula high-school students. Part VII. Violent behaviour.

The prevalence of a wide range of risk-taking behaviour among high-school students in the Cape Peninsula, South Africa, was investigated. In this article, the results for violent behaviour are presented. Cluster sampling techniques produced a sample of 7,340 students from 16 schools in three major education departments. A self-administered questionnaire was completed in a normal school period. Estimates for each education department were weighted to produce an overall estimate. Of the total sample, 12.7%, 9.6% and 13.8% reported that they had been physically injured by another person at school, at home and in other settings, respectively; 11.0% had injured another person during the previous year; 5% had committed an act of vandalism; and 9.8% of males and 1.3% of females had carried knives at school. Other trends according to gender, school standard, and home language were identified. Males were more likely to be the perpetrators and victims of violent behaviour; for both genders the extent of victimization decreased with increasing standard; and fewer Xhosa-speaking students than students in other language groups perpetrated incidents of violent behaviour. The potential for intervention programmes is assessed in a context where much violence is determined by sociopolitical factors.

Risk-taking behaviour of Cape Peninsula high-school students. Part VI. Road-related behaviour.

The prevalence of a wide range of risk-taking behaviour among high-school students in the Cape Peninsula, South Africa, was investigated. In this article, the findings for road-related behaviour are presented. Cluster sampling techniques produced a sample of 7,340 students from 16 schools in the three major education departments. A self-administered questionnaire was completed in a normal school period. Estimates for each education department were weighted to produce an overall estimate. During the previous year, 8.5% of the students had been involved in a motor vehicle accident, and 7.4% had been injured in a pedestrian accident. Of those who had driven a vehicle, 63.2% reported driving without a licence; 16.1% drove an overcrowded vehicle; and 8% reported driving under the influence of alcohol or cannabis. Of those who had been on a motorcycle, 47.9% reported riding without a helmet. Despite the availability of seat belts, 37.3% had failed to wear one on the last occasion they were in the front seat of a vehicle. Variations according to gender, standard, and home language(s) were identified. The prevalence of risk behaviour was higher in males, who also showed a more pronounced increase in such behaviour with age. The need for accident prevention programmes remains urgent.

Risk-taking behaviour of Cape Peninsula high-school students. Part VIII. Sexual behaviour.

The prevalence of a wide range of risk-taking behaviour among high-school students in the Cape Peninsula, South Africa, was investigated. In this article, the results for sexual behaviour are presented. Cluster sampling techniques produced a sample of 7,340 students from 16 schools in the three major education departments, of whom 79.7% answered the section dealing with sexual behaviour. A self-administered questionnaire was completed in a normal school period. Estimates for each education department were weighted to produce an overall estimate. Of the sample, 17.4% indicated a previous episode of heterosexual intercourse. The median age at first intercourse was 15.1 years. The median number of partners in the previous 12 months was 1.0. The median number of weeks since the most recent coital episode was 6.6; on this episode 76.6% had known their partners for more than 7 days, while 60.5% had done something to avoid pregnancy. The most frequently used method of contraception was injectable steroids for Xhosa-speaking students and condoms for the other students. Males and Xhosa-speaking students appear to be particularly at risk for the adverse consequences of sexual activity. The HIV epidemic has increased the urgency of introducing meaningful sexuality education in South African schools.

Risk-taking behaviour of Cape Peninsula high-school students. Part IV. Alcohol use.

The prevalence of a wide range of risk-taking behaviour among high-school students in the Cape Peninsula, South Africa, was investigated. In this article, the results for alcohol use are presented. Cluster sampling techniques produced a sample of 7,340 students from 16 schools in the three major education departments. A self-administered questionnaire was completed in a normal school period. Estimates for each education department were weighted to produce an overall estimate. Of the sample, 53.2% reported ever using alcohol; 26.2% had used it recently and 15.4% reported episodes of binge drinking in the previous 14 days. Drinking patterns varied according to school standard, home language, and gender. Males reported higher rates of alcohol use and for both genders rates increased with age. Overall, the prevalence of drinking was highest among adolescents whose home language was English. The proportion of Xhosa-speaking females who drank was very low. The prevalence of binge drinking in particular was identified as being of concern. The findings indicate a need for preventive action and further local research in this area.