A U-shaped association between intensity of Internet use and adolescent health.

OBJECTIVE: To examine the relationship between different Internet-use intensities and adolescent mental and somatic health. METHODS: Data were drawn from the 2002 Swiss Multicenter Adolescent Survey on Health, a nationally representative survey of adolescents aged 16 to 20 years in post-mandatory school. From a self-administered anonymous questionnaire, 3906 adolescent boys and 3305 girls were categorized into 4 groups according to their intensity of Internet use: heavy Internet users (HIUs; >2 hours/day), regular Internet users (RIUs; several days per week and <= 2 hours/day), occasional users (<= 1 hour/week), and non-Internet users (NIUs; no use in the previous month). Health factors examined were perceived health, depression, overweight, headaches and back pain, and insufficient sleep. RESULTS: In controlled multivariate analysis, using RIUs as a reference, HIUs of both genders were more likely to report higher depressive scores, whereas only male users were found at increased risk of overweight and female users at increased risk of insufficient sleep. Male NIUs and female NIUs and occasional users also were found at increased risk of higher depressive scores. Back-pain complaints were found predominantly among male NIUs. CONCLUSIONS: Our study provides evidence of a U-shaped relationship between intensity of Internet use and poorer mental health of adolescents. In addition, HIUs were confirmed at increased risk for somatic health problems. Thus, health professionals should be on the alert when caring for adolescents who report either heavy Internet use or very little/none. Also, they should consider regular Internet use as a normative behavior without major health consequence. Pediatrics 2011;127:e330-e335

Horizontal innovation in the theory of growth and development

We analyze recent contributions to growth theory based on the model of expanding variety of Romer (1990). In the first part, we present different versions of the benchmark linear model with imperfect competition. These include the labequipment model, labor-for-intermediates and directed technical change . We review applications of the expanding variety framework to the analysis of international technology diffusion, trade, cross-country productivity differences, financial development and fluctuations. In many such applications, a key role is played by complementarities in the process of innovation.

Gender gaps in policy making: Evidence from direct democracy in Switzerland

In spite of increasing representation of women in politics, little is known about their impact onpolicies. Comparing outcomes of parliaments with different shares of female members does not identifytheir causal impact because of possible differences in the underlying electorate. This paper usesa unique data set on voting decisions to sheds new light on gender gaps in policy making. Ouranalysis focuses on Switzerland, where all citizens can directly decide on a broad range of policiesin referendums and initiatives. We show that there are large gender gaps in the areas of health,environmental protection, defense spending and welfare policy which typically persist even conditionalon socio-economic characteristics. We also find that female policy makers have a substantial effect onthe composition of public spending, but a small effect on the overall size of government.

15 years of new growth economics: What have we learnt?

This paper evaluates the empirical and theoretical contributions of theEconomic Growth Literature since the publication of Paul Romer s seminalpaper in 1986.

To use it or not to use it: differences between adolescent males carrying a weapon and those using it in a fight

Purpose Data indicate that 19% of male adolescents living in Switzerland carried a weapon in the last 12 months. The main objective of this research is to compare the characteristics of male adolescents carrying a weapon and having used it in a fight from those who have carried but not used it in the previous 12 months. Methods Data were drawn from the 2002 Swiss Multicenter Adolescent Survey on Health (SMASH02) data base, a survey including 7,548[3,710 males] in-school adolescents aged 16-20 years in Switzerland. Only males declaring having carried a weapon (N = 711; 19.2% of the sample) were included in the analysis. Three groups were created: those not having used a weapon (WO; N = 538 subjects), those having used a weapon in a fight once or twice (W12; N = 127), and those having used a weapon in a fight 3 or more times (W3+; N = 46). Multinomial logistic regression was performed to compare the 3 groups on individual, family, school, and social factors using WO as the reference category. Analyses were performed with STATA9. Results are presented as relative risk ratios (RRR). Results W12 males were significantly more likely to perceive their puberty as advanced compared to their peers (RRR: 2.1), to be foreign born (RRR: 2.6), to live in an urban environment (RRR: 1.9), to be in vocational school (RRR: 4.7), to have a poor school connectedness (RRR: 1.8), to skip classes (RRR: 2.1) and to quarrel while intoxicated (RRR: 5.3). W3+ males were significantly more likely to be foreign born (RRR: 3.6) and to live in an urban environment (RRR: 2.4), to be current users of illegal drugs other than cannabis (RRR: 3.8) and to quarrel while intoxicated (RRR: 4.1). No differences were found between groups for tobacco, alcohol, or cannabis use. Conclusions Within a national sample of Swiss youth aged 16-20 years, almost one fifth of male adolescents have carried a weapon in the previous 12 months. Nevertheless, most of them (75.7%) have never used a weapon in a fight. Whether they carry a weapon for defense purposes or as a manly behavior remains to be elucidated. However, urban foreign-born adolescents who quarrel while intoxicated are the most at risk of using a weapon in a fight, and therefore culturally-sensitive prevention approaches need to be developed to decrease violence in this specific population of youth. Having school problems or using illegal drugs other than cannabis seem to differentiate between those who use it in a fight occasionally (once or twice) and those who do it more often.

Cannabis use as a means of socialization?: new consumption patterns among heavy users

Purpose: After tobacco and alcohol, cannabis is the most used substance among adolescents in Switzerland. Our aim is to assess whether cannabis use has become an ordinary means of socialization. We hypothesize that cannabis consumption has become a normative, although still illegal, behavior. Methods: As part of a larger qualitative study aimed at assessing new ways [patterns] of cannabis consumption, 16 daily cannabis consumers (11 males) and 2 former heavy consumers (both females), aged 15 to 20 years, participated in interviews and focus groups. Data were transcribed verbatim and analyzed using Atlas.ti qualitative analysis software. Results: Most consumers define the beginning of their consumption as a moment when they made new friends. They commonly use cannabis in group settings, which encourages the belief that all adolescents use cannabis. Thus, cannabis is mainly identified as an everyday social act. Joints are smoked like cigarettes: at all times of the day, during or after school or work with peers, often starting at lunch break, and mostly in public places. Friends offer a joint in a group setting, much like beer in a bar, as a means of making contact. Consumption invariably increases while socializing on vacation: "During vacation, we smoke up to 10-15 joints a day; at the end we're just dead." Additionally, in order to obtain cannabis, consumers have to be part of the right networks; they generally have several dealers to assure their supply, buy and sell themselves, or practice group-buying. As a result, all friends or acquaintances of consumers are themselves cannabis users. For instance, 4 boys, who say they are best friends, always smoke together and that, in order to quit, "All four of us should say to ourselves, 'Okay, now, let's all stop smoking'. That would be the only solution. . .but it would be impossible!" The 2 former consumers state that when they started using cannabis, "I found myself little by little in a vicious circle where I saw only people who also smoked". When they quit, they separated from their group of friends: "Either you make new friends who don't smoke or you smoke." Conclusions: Discussions with consumers demonstrate a normative facet of cannabis consumption as part of teenage socialization. Consequently, cannabis consumers develop a significant dependency since a majority of their friends use cannabis and their consumption involves most of their daily social life. Our study highlights the need for clear messages about the harmful aspects of using this substance while also suggesting that cessation efforts should include helping users separate from their consumption milieu. Sources of Support: Dept. of Public Health of the canton of Vaud.

Cannabis use trajectories among Swiss adolescents

Introduction: Swiss data indicate that one fifth of current 16-20 yearold cannabis users do not use tobacco and seem to do better than those smoking both substances. The aim of this research is to assess the substance use trajectories of cannabis users who do not use tobacco and those who use both substances from age 17 to age 23. Methods: Using data from the TREE longitudinal data base, 328 out of 1796 youth 18.3%; 45% females) who smoked cannabis only (Group CAN; N = 46; 36% females) or concurrently with tobacco (Group CANTAB; N = 284; 46% females) at T1 (2001; age 17) were followed at T4 (2004; age 20) and T7 (2007; age 23). Two additional outcome groups were included at T4 and T7: those using only tobacco (Group TOB) and those not using any of these substances (Group NONE). Data were analyzed separately by gender. Results: Females in group CAN at T1 were as likely to be in group TOB (35%) or NONE (35%) at T4 and the percentages increased to 41% and 47%, respectively, at T7. Males in group CAN at T1 were more likely to be in group TOB at T4 (33%) and T7 (61%) than in group NONE (23% and 15%, respectively). Females in group CANTOB at T1 were mainly in group TOB at T4 (52%) and T7 (61%), while males in CANTOB at T1 remained mainly in the same group at T4 (75%) and T7 (61%). Only 10% of females and 5% of males in group CANTOB at T1 were in group NONE at T4 and 15% and 12%, respectively, at T7. Conclusions: Adolescents using only cannabis are globally less likely to continue using cannabis in young adulthood than those using both substances, although a fair percentage (specially males) switch to tobacco use. This result confirms previous research indicating that nicotine dependence and persistent cigarette smoking may be the main public health consequences of cannabis use. A gender difference arises among those using tobacco and cannabis at age 17: while females become mainly tobacco smokers, the majority of males continue to use both substances. Although these results could be explained by a substitution effect, teenagers using both substances seem to have gone beyond the experimentation phase and should be a motive for concern.

Are adolescents with chronic conditions particularly at risk for bullying?

OBJECTIVE: To compare the prevalence and intensity of victimization from bullying, and the characteristics of the victims of bullying, comparing adolescents with and without chronic conditions. DESIGN: School survey. SETTING: Post-mandatory schools. PARTICIPANTS: A total of 7005 students (48% females) aged 16-20 years, distributed into adolescents with chronic conditions (728, 50% females) and controls (6277, 48% females). Chronic condition was defined as having a chronic disease and/or a physical disability.OUTCOME MEASURES: Prevalence of bullying; intensity of bullying; and socio-demographic, bio-psychosocial, familial, school, and violence context characteristics of the victims of bullying. RESULTS: The prevalence of bullying in our sample was 13.85%. Adolescents with chronic conditions were more likely to be victims of bullying (Adjusted Odds Ratio [AOR] 1.53), and to be victims of two or three forms of bullying (AOR 1.92). Victims of bullying with chronic conditions were more likely than non-victims to be depressed (Relative Risk Ratio [RRR] 1.57), to have more physical symptoms (RRR 1.61), to have a poorer relationship with their parents (RRR 1.33), to have a poorer school climate (RRR 1.60), and to have been victims of sexual abuse (RRR 1.79) or other forms of violence (RRR 1.80). Although these characteristics apply to victims in general, in most cases they are less pronounced among victims without chronic conditions. CONCLUSIONS: Chronic conditions seem to be a risk factor for victimization from bullying. Therefore, as adolescents with chronic conditions are increasingly mainstreamed, schools should be encouraged to undertake preventive measures to avoid victimization of such adolescents.

Importance de l'exposition au tabac chez les jeunes consommateurs de cannabis: un cheval de Troie ?

Malgré une récente réduction, le tabagisme reste élevé et préoccupant parmi les jeunes. Les consommations de tabac et de cannabis sont, sur plusieurs aspects, fortement liées. Les preuves scientifiques tendent à démontrer que la dépendance à la nicotine et la consommation persistante de cigarettes seraient les deux principales conséquences néfastes de l'usage de cannabis pendant l'adolescence. Le phénomène du "mulling" (le fait de mélanger du tabac au cannabis pour sa consommation) représente l'une des hypothèses les plus plausibles du risque augmenté qu'ont les jeunes consommateurs de cannabis de devenir des futurs fumeurs de cigarettes. L'objectif principal de cette étude est de déterminer si les niveaux de nicotine retrouvés chez des fumeurs de cannabis sont suffisamment élevés pour prouver une exposition tabagique significative pouvant être expliquée par le phénomène du "mulling" plutôt que par l'environnement.

How adult specialists deal with the principles of a successful transition.

OBJECTIVES: To evaluate whether adult specialists comply with the basic principles for a successful transition of adolescents with chronic disorders, and to determine whether the characteristics of the adult specialists have an influence on applying these principles. METHODS: Out of 299 adult specialists in four French-speaking Swiss cantons, 209 (70%) answered a paper-and-pencil mailed questionnaire between May and July 2007. Only those having received the transfer of at least one adolescent in the previous 2 years (N=102) were included in the analysis. We analyzed four dependent variables: discussing common concerns of adolescent patients, seeing the patient alone, having a transition protocol, and having a previous contact with the pediatric specialist. A logistic regression was performed for each dependent variable controlling for the physicians' characteristics (number of transfers, age, gender, workplace, and perceived experience). RESULTS: Fifty-four percent of the physicians did not spend time alone with their patients, and sensitive issues such as sexuality or substance use were not widely discussed with their young patients. Most respondents (59%) did not have an established protocol, and 54% did not have any contact with the pediatric specialist. In the multivariate analyses, the adult specialists' characteristics had little impact. CONCLUSIONS: For many adolescents with chronic disorders the transition from pediatric to adult healthcare seems to be limited to a simple transfer, often lacking adequate communication between physicians. Applying simple but basic principles such as a good coordination between providers would probably improve the quality of healthcare of adolescents with chronic illness.

Kouluväkivallan uhrien toiminta kiusaamistilanteissa

Summary: Victimized school childrens responses to harassment

Daily smoking as a marker of weight control practices among female adolescents

Purpose: There is evidence indicating that adolescent females smoke as a way to control weight. The aim of our research is to assess whether daily smoking is a marker for weight control practices among adolescent females. Methods: Data were drawn from the 2002 Swiss Multicenter Adolescent Survey on Health (SMASH02) data base, a survey including 7,548 [3,838 females] in-school adolescents aged 16-20 years in Switzerland. Among females self-reporting BMI (N _ 3,761), two groups were drawn: daily smokers (DS, N _ 1,273) included all those smoking at least 1 cigarette/day and never smokers (NS, N _ 1,888) included all those having never smoked. Former (N _ 177) and occasional (N _ 423) smokers were not included. Groups were compared on weight control practices (being on a diet, self-induced vomiting, use of doctor-prescribed or over-the-counter appetite suppressors) controlling for possible confounding variables (age, BMI, feeling fat, body image, use of other substances, depression, sport practice, academic track and perceived advanced puberty). Analyses were performed with STATA 9. Bivariate analyses are presented as point-prevalence and multivariate analysis (using logistic regression) are presented as adjusted odds ratio (AOR) and [95% confidence interval]. Results: In the bivariate analysis, DS females were significantly more likely (p _ 0.001) than NS to be on a diet (DS: 33.2%, NS: 22.2%), to self-induce vomiting (DS: 9.0%, NS: 3.3%), and to use doctor prescribed (DS: 2.3%, NS: 0.9%) or over-the-counter (DS: 3.2%, NS: 1.2%) appetite suppressors. In the multivariate analysis, DS females were more likely than NS to be on a diet (AOR: 1.40 [1.17/1.68]), to self-induce vomiting (AOR: 2.07 [1.45/2.97]), and to use doctor-prescribed appetite suppressors (AOR: 1.99 [1.00/ 3.96]). Conclusions: Weight control practices are more frequent among female daily smokers than among never smokers. This finding seems to confirm cigarette smoking as a way to control weight among adolescent females. Health professionals should inquire adolescent female smokers about weight control practices, and this association must be kept in mind when discussing tobacco cessation options with adolescent females. Sources of Support: The SMASH02 survey was funded by the Swiss Federal Office of Public Health and the participating cantons.

Is cannabis use a significant exposition to nicotine?

Purpose: Young cannabis users are at increased risk for cigarette initiation and later progression to nicotine dependence. The present study assesses to which extent cannabis users are exposed to nicotine through mulling, a widespread process consisting of mixing tobacco to cannabis for its consumption. Methods: Data are issued from an ongoing observational study taking place in Switzerland. A total of 267 eligible participants (mean age 19 years, 46.4% males) completed an anonymous self-administered questionnaire on their tobacco and cannabis intake in the previous 5 days. They also provided a urine sample that was blindly analyzed for cotinine (a key metabolite of nicotine) using liquid-chromatography coupled mass-spectrometry. After the exclusion of cannabis users not having smoked at least one joint/blunt in which tobacco had been mixed (n _ 2), and participants reporting other sources of nicotine exposition than cigarettes or mulling (n _37), four groups were created: cannabis and cigarette abstainers (ABS, n_ 69), cannabis only smokers (CAS; n _ 33), cigarette only smokers (CIS; n _ 62); and cannabis and cigarette smokers (CCS, n _ 64). Cotinine measures of CAS were compared to those of ABS, CIS and CCS. All comparisons were performed using ANCOVA, controlling for age, gender, ethnicity, BMI and environmental exposure to cigarette smoke in the past month (at home, in school/at work, in social settings). The number of mixed joints/blunts smoked in the previous 5 days was additionally taken into account when comparing CAS to CCS. Cotinine values (ng/ml) are reported as means with 95% confidence interval (95% CI). Results: In the previous 5 days, CAS had smoked on average 10 mixed joints/blunts, CIS 30 cigarettes, and CCS 8 mixed joints/ blunts and 41 cigarettes. Cotinine levels of participants considerably differed between groups. The lowest measure was found among ABS (3.2 [0.5-5.9]), followed in growing order by CAS (294.6 [157.1-432.0]), CIS (362.8 [258.4-467.3]), and CCS (649.9 [500.7-799.2]). In the multivariate analysis, cotinine levels of CAS were significantly higher than those of ABS (p _.001), lower than those of CCS (p _ .003), but did not differ from levels of CIS (p _ .384). Conclusions: Our study reveals cannabis users to be significantly exposed to nicotine through mulling, even after controlling for several possible confounders such as environmental exposure to cigarette smoke. Utmost, mixing tobacco to Poster cannabis can result in a substantial nicotine exposition as cotinine levels from cannabis only smokers were as high as those of moderate cigarette smokers. Our findings also suggest that mulling is adding up to the already important nicotine exposition of cigarettes smokers. Because of the addictiveness of nicotine, mulling should be part of a comprehensive assessment of substance use among adolescents and young adults, especially when supporting their cannabis and cigarette quitting attempts. Sources of Support: This study was funded by the Public Health Service of the Canton de Vaud. Dr. BÊlanger's contribution was possible through grants from the Royal College of Physicians and Surgeons of Canada, the CHUQ/CMDP Foundation and the Laval University McLaughlin program, QuÊbec, Canada.