Prevention of unhealthy behaviour by youth health care in The Netherlands.
BACKGROUND
In this study the effect is assessed of (repeated) well-care visits and freely accessible consultation hours at secondary schools on the prevalence of adolescent health-compromising behaviour and later obesity.


METHODS
An ecological case-referent study design was used with data from the Netherlands Bureau of Statistics, the Ministry of Defence, the 1992 High-School Student Study, all youth health care departments in The Netherlands and relevant census. Data from the High-School Student Study included 4,569 students aged 12-18 years, of whom 4,167 had answered all questions on health-compromising behaviour and eating habits. The data from the Ministry of Defence included 1,004 cases with a body mass index greater than 27 of a total of 12 251 male conscripts. The census of 18- and 19-year-old males in the regions of the relevant youth health care departments served as referents.


RESULTS
Except for the use of alcohol, the effect of more well-care visits was in all cases negative, and for the use of tobacco even significantly so [odds ratio (OR) = 1.15, 95 per cent confidence interval (CI) = 1.01-1.33]. The availability of open consultation hours had an adverse effect on use of alcohol (OR = 1.29, 95 per cent CI = 1.11-1.50). The OR for obesity in male conscripts showed an adverse effect of a greater number of well-care visits (OR = 2.46, 95 per cent Cl = 1.74-3.46) and the availability of open consultation hours (OR = 1.97, 95 per cent CI = 1.72-2.25).


CONCLUSIONS
This study does not support the hypothesis that, at a population level, preventive activities of youth health care departments such as (more) frequent well-care visits or offering open consultation hours at secondary schools, have a beneficial effect on prevention of health-compromising behaviour or obesity.
Wiegersma
P A
PA
GGD Groningen, The Netherlands. P.A.Wiegersma@med.rug.nl
Hofman
A
A
Zielhuis
G A
GA
D000293:Adolescent; D000294:Adolescent Behavior; D016497:Adolescent Health Services; D000428:Alcohol Drinking; D015438:Health Behavior; D006293:Health Promotion / Q000706:statistics & numerical data*; D006297:Health Services Accessibility; D006801:Humans; D008019:Life Style; D016015:Logistic Models; D008297:Male; D002189:Marijuana Abuse; D009426:Netherlands / Q000453:epidemiology; D009765:Obesity / Q000453:epidemiology / Q000517:prevention & control*; D015995:Prevalence; D015397:Program Evaluation; D012572:School Health Services / Q000706:statistics & numerical data*; D012907:Smoking; D011795:Surveys and Questionnaires