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PubMed1999

Comparing pupil function with visual function in patients with Leber's hereditary optic neuropathy.

PURPOSE: To compare pupil function with visual function in patients with Leber's hereditary optic neuropathy (LHON) and age-matched normal control subjects. METHODS: Visual function was assessed by measuring the perceptual thresholds at five central locations in the visual field using automated static perimetry. Pupil function was assessed by recording the pupil responses to a standard intensity light stimulus (size equivalent to a Goldmann V target) presented at the same five locations in the visual field. The extent of the pupil afferent defect in LHON patients was quantified by establishing the relationship between stimulus intensity and the size of the pupil response in normal subjects and then interpolating the equivalent luminance deficit in LHON patients from the size of their pupil responses. RESULTS: At all five locations tested, the pupil responses were significantly reduced in amplitude, and the perceptual thresholds were significantly raised in LHON patients compared with normal control subjects. A nonparametric analysis of perceptual and pupil responses to perithreshold stimuli showed that a stimulus that was not perceived was three times more likely to be followed by a pupil response in a LHON patient than in a normal subject (P < 0.001). A quantitative comparison showed that the visual deficits exceeded the pupil deficits by on average 7.5 dB at all tested locations. CONCLUSIONS: Although both visual and pupil function are abnormal in LHON, there appears to be relative sparing of the pupil afferent fibers.

Adult↗
PubMed1978

Pupil cycle time in optic neuritis.

A thin slit-lamp beam illuminating the pupil margin produced clearly visible pupil oscillations. These oscillations were timed with a stopwatch, thus producing a measurement of the "pupil cycle time". The pupil cycle time was remarkably stable in various testing situations and repeatable within +/- 3% over extended periods of time. When the iris muscles were normally innervated and responsive, the pupil cycle time was dependent on the speed of conduction and the number and strength of optic nerve impulses. Pupil cycle time can be measured in most persons with active or inactive optic neuritis. In the few patients whose light reflex is so poor that the pupil cycle time cannot be measured, the inability to induce cycling can itself be taken as a definite abnormality of the light reflex arc. Only 5% of normal persons 12 to 50 years of age are expected to have a pupil cycle time in either eye longer than 954 msec, or a difference in pupil cycle time between the two eyes longer than 70 msec. Pupil cycle time was significantly longer in patients with optic neuritis, with a P-value less than .001. The pupil cycle time is similar to visual evoked response latency time in that it can detect and quantitate subclinical defects in optic nerve conduction time. Pupil cycle time is objective and quantitative for each eye individually. It is a fast, simple, and reliable clinic test of optic nerve function.

Adult↗
PubMed2002

Management of the small pupil for clear corneal cataract surgery.

PURPOSE: To evaluate the benefits of using the Perfect Pupil expansion device (Becton Dickinson Ophthalmic Surgical) for cataract surgery. SETTING: Eye Laser Center, Tucson, Arizona, USA. METHODS: Thirty patients whose pupils failed to dilate beyond 4.0 mm were selected to have the Perfect Pupil used during their cataract surgery. The Perfect Pupil was inserted through an unenlarged 2.8 mm clear corneal incision into the pupillary aperture. The capsulorhexis, hydrodissection, phacoemulsification, and injection of the intraocular lens were performed through the expanded pupil with the device in place. The pupil size before, during, and after surgery was measured. RESULTS: The mean pupil size was 3.2 mm preoperatively, 7.8 mm after insertion of the device, and 4.3 mm after its removal. There were no cases of iris sphincter tear, bleeding, ruptured capsule, or irregular pupil postoperatively. CONCLUSION: The Perfect Pupil was beneficial during small-incision cataract surgery in cases in which the pupil failed to dilate adequately. The device was easy to insert and remove, expanded the pupil to approximately 8.0 mm, protected the iris sphincter during surgery, and allowed the pupil to return to its normal size, shape, and function postoperatively.

Capsulorhexis↗
PubMed1998

Preoperative measurement of scotopic pupil dilation using an office pupillometer.

PURPOSE: To describe a light-amplification pupillometer designed for office evaluation of refractive surgical candidates and compare its usefulness with that of a millimeter ruler and a standard pocket-card pupillary gauge. SETTING: Center for Ophthalmic Surgery, Encino, California, USA. METHOD: The pupil sizes of 100 patients with a mean age of 28 years (range 18 to 50 years) were measured at 2 levels of illumination: 15 and 3 lumens. Pupil size was measured with a Rosenbaum pocket-card pupil gauge, a millimeter ruler, and the pupillometer at approximately 15 lumens. This level of illumination was chosen by 3 technicians as the lowest at which the pupil of a brown eye could be measured with confidence using the Rosenbaum card. Pupil size was then measured using the light-amplification pupillometer at approximately 3 lumens. This illumination level was chosen to simulate that of night-driving conditions. RESULTS: At 15 lumens, mean pupil diameter was 5.1 mm (range 2.5 to 8.0 mm). There was no difference in the measurements taken with the 3 instruments at this illumination level. At 3 lumens, the pupil diameter could not be measured with confidence using the Rosenbaum card or the millimeter ruler. Using the pupillometer, mean pupil size was 6.2 mm (range 3.0 to 9.0 mm). The mean difference in pupil diameter measured at 15 and 3 lumens was 1.1 mm (range 0.0 to 3.0 mm). CONCLUSION: This evaluation suggests that it would be difficult for clinicians to reliably predict the level of pupil dilation at 3 lumens by measuring pupil size at 15 lumens. The light-amplification pupillometer provides a tool for measuring pupil size at an illumination level that simulates night-driving conditions. The use of this device may help surgeons identify refractive surgery candidates who are more likely to be dissatisfied with their postoperative vision at low illumination levels.

Adolescent↗
PubMed1982

Pupil size in insulin-dependent diabetes. Relationship to duration, metabolic control, and long-term manifestations.

The pupil area was measured in complete darkness by infrared TV-videopupillography in 109 insulin-dependent diabetics, aged 25-43 yr, diabetes duration 0-35 yr, and 39 control subjects, aged 26-41 yr. In darkness the pupil was 19.6% +/- 4.2 (SEM) smaller in diabetics than in controls (2 P less than 10(-5). There was an inverse relationship between diabetes duration and pupil area (Kendall's coefficient of correlation, tau = -0.33, 2 P less than 10(-4). There was also an inverse correlation between pupil size and vibratory perception threshold (tau = 0.32, 2 P less than 10(-3). Long-term diabetics (duration greater than or equal to 15 yr) with proliferative retinopathy had a 28.4% +/- 8.1 (SEM) smaller pupil than those without (2 P = less than 10(-3). Likewise, long-term diabetics with nephropathy had a 19.8% +/- 9.1 smaller pupil than those without nephropathy (2 P = 0.035). In the long-term diabetics there was an inverse relationship between the level of blood glucose throughout the years and pupil area (tau = -0.49, 2 P less than 10(-3). Also, high blood glucose levels throughout the years were correlated to severity of retinopathy (tau = 0.43, 2 P less than 10(-3) and nephropathy (tau = 0.30, 2 P = 0.024). There was no correlation between biomicroscopic changes in the iris and the diminished pupil area. Pupil area in light was measured in 85 patients and 31 controls. In continuous light only the long-term diabetics had a smaller pupil size than the controls. Both the absolute and relative change in pupil size from darkness to light was less in the diabetic group. Measuring the pupil size in darkness is a simple, noninvasive and reproducible method that may yield information about autonomic nervous involvement in diabetes.

Adult↗
PubMedDate not supplied

Changes of higher order aberration with various pupil sizes in the myopic eye.

PURPOSE: To investigate the effect of pupil diameter on higher order aberration in myopic eyes. METHODS: One hundred and two eyes of 51 normal subjects were evaluated with the Nidek OPD-Scan. RESULTS: All types of aberration increased significantly with increasing pupil size (P<.001). However, optical aberrations had a less pronounced increase in C3(-1) and C3(+1) , more pronounced increase in C4(0) with pupil area increased (P<.05), 2nd coma (C5(-1) and C6(+1)) and high order astigmatism (C4(-2), C4(+2) C6(-2), C6(+2) with larger pupil diameter. Compared with the aberrations of each high order aberration at 4 mm, the average increase root mean square values were 1.54, 1.59, 1.71, and 1.87 on S3, S4, S5, and S6 respectively, with a 5-mm pupil, whereas increased root mean square values were 1.46, 1.88, 1.51, and 1.60 for a 6-mm-diameter pupil. CONCLUSION: For an equal increase of pupil size, not all Zernike polynomial coefficients induced equivalent increase of values. Coma-like aberrations increased less with pupil dilation. Spherical-like aberration showed only a small increase from 4 mm to 5 mm pupil size, but a larger increase from 5 mm to 6 mm pupil size. Other higher order aberrations (S5 and S6) increased slightly with pupil dilation. Coma-like aberration was larger than spherical aberration, and larger than other higher order aberrations for all pupil sizes.

Adolescent↗
PubMed2002

Pupil location under mesopic, photopic, and pharmacologically dilated conditions.

PURPOSE: To determine whether there are systematic changes in pupil location with changes in the state of pupil size and with other ocular variables. METHODS: High-resolution images of the pupil of the eyes of 70 subjects were taken using an infrared-sensitive camera. Images were obtained under mesopic, photopic, and pharmacologically dilated conditions. From the images, the center and diameter of the corneal limbus and the pupil were computed. In addition, the location of the first Purkinje image was calculated. RESULTS: The pupil center shifted consistently temporally as the pupil dilated. The total motion was relatively small, with a mean distance of 0.133 mm motion between the mesopic and photopic conditions, with the pupil diameter changing from 6.3 to 4.1 mm. Ninety percent of the subjects had a motion of less than 0.3 mm. One patient showed a motion of almost 0.6 mm. The change in location of the pupil center was not significantly related to refractive error, age, or the change of pupil diameter. CONCLUSIONS: Changes in the location of the pupil center with changes in the dilation of the pupil are typically slight, but can be significant in a few subjects, especially in pharmacologically dilated pupils.

Adaptation, Ocular↗
PubMed2006

Attitude and knowledge of high school pupils towards adolescents with special needs (Tourette's syndrome).

OBJECTIVE: To determine high school pupils' attitudes towards adolescents with special needs (for example: TS); to learn what they know about the symptomatology and the exceptional behavior of TS; and what they think about their social future. METHODS: Ninety-nine pupils participated in the study. Their mean age was 16.7 +/- 0.8 years. Forty-eight point five percent were boys, and the rest girls. They completed a questionnaire concerning knowledge and attitudes towards adolescents with special needs (diagnosed as TS). They had participated in lessons and class talks about handicapped children with psycho- behavioral symptoms. RESULTS: The scores for their knowledge were at a level of 68.9%. Half of the pupils knew and responded correctly that TS was of genetic origin; but the most important: they expressed a comprehensive and tolerant attitude towards impaired behavior in TS at a level of 55.3%. The tolerant attitude increased with advancing age and with school grades. The attitudes were more comprehensive in families suffering form their own emotional or other psychiatric difficulties. Forty-three point four percent of pupils understand and consider TS to be an emotional, behavioral and psychiatric entity. Sixty-two point six percent of pupils understand as well and believe that the disruptive behavior and outbursts in TS are involuntary and not under the adolescent's control. On the other hand, a quarter of the pupils see justification for repeated punishment of TS adolescents for their impaired behavior. Fifty-six point six percent of regular pupils were ready to develop friendship with TS classmates in spite of their unexpected and unruly behaviour. Eight-three point eight percent of pupils believe it is better to inform teachers and classmates about the impaired behavior of these TS adolescents. Concerning the future of these disabled adolescents, pupils scored a level of 44% for their optimistic beliefs about success in future life; 52% believe that in spite of all difficulties TS adolescents would be able to live an ordinary life, to raise a family and to work. CONCLUSIONS: It is crucial to improve pupils' attitudes in schools (as well as their teachers') towards adolescents with special needs (including TS). The authors recommend that TS be considered as a neuro-behavioral and psychiatric disorder; it should be considered as a disability, which calls for comprehension, (not punishment). It would also be of value to speak in classes about the handicaps and neurobehavioral limitations for example of these TS adolescents, as well as about other pupils in school with special needs, in order to behave socially correctly towards them. The final aim will be that pupils in school will learn to accept the different child and adolescent as they are.

Adolescent↗
PubMed2004

The influence of school culture on smoking among pupils.

School factors and not solely pupil composition probably cause variation in smoking prevalence amongst schools, but there are no theoretical models to explain why. In this paper we propose a hypothesis to explain schools' influence on pupils' smoking and test this using an existing cross-sectional survey of 23,282 pupils from 166 secondary schools in the West Midlands, UK. We hypothesise that school-level educational achievement scores would not be associated with smoking prevalence, but schools providing value-added education given the social background of pupils (authoritative schools) would provide effective support and control, have a relatively strong influence on pupils' lives and be associated with lower than average smoking prevalence. Schools providing value-denuded education (laissez-faire schools) would have a relatively weak influence on pupils' lives and be associated with higher than average smoking prevalence. The school achievement measures were the proportion of pupils achieving 5A-C General Certificates of Secondary Education (5A-Cs) grades and the proportion of half days lost to truancy. Value-added/denuded terms were created by regressing 5A-Cs and truancy on five markers of the social profile of pupils at the school. Authoritative schools achieved better than expected rates on both measures. Laissez-faire schools achieved worse than expected rates on both measures. All other schools were classed as indeterminate. Multilevel logistic regression was used to relate the risk of regular smoking to school culture in both achievement and authoritative/laissez-faire terms, both with and without adjustment for pupil-level risk factors for smoking. As predicted, schools' achievement measures were unrelated to pupils' smoking. The odds ratios (95% confidence intervals) for smoking in authoritative and laissez-faire schools relative to indeterminate schools were 0.80 (0.70-0.91) and 1.16 (1.07-1.27), respectively. Adjustment for pupil-level smoking risk factors had little effect. School culture is an independent risk factor for adolescent smoking. Schools providing effective support and control might protect pupils from smoking.

Adolescent↗
PubMed1998

Pupil noise is a discriminator between narcoleptics and controls.

The pupil light reflex has a long history of being able to indicate states of mental arousal, ranging from sleepiness to concentrated cognitive effort. Such mental states have usually been inferred from pupil diameter or pupil area movements relative to some reference; sleepiness, for example, is characterized by a smaller than average pupil while mental effort brings on a slightly larger pupil. But all pupil movements and associated states of arousal are accompanied by a persistent random pupil diameter motion which has previously been attributed to neurological noise, the noise apparently arising in the neurological controller of the pupil reflex control system. Our experiments and signal processing methods show that the amplitude of this pupil noise is an indicator of the sleeping disorder narcolepsy. Narcoleptics are found to have diminished pupil noise amplitudes relative to control subjects. Pupil noise is estimated by statistical procedures which yield unbiased noise measures in the form of six-dimensional Gaussian vectors. Each subject is associated with a Gaussian vector which is optimally projected onto a scalar axis so as to maximize the mean square distance between the narcoleptic and control samples. The Kullback-Leibler discrimination function is estimated and then evaluated for each projection as a means of discriminating narcoleptics from controls. The projected noise measures correctly classify 18 out of 20 subjects. The projected values also form the basis for supporting or rejecting a hypothesis of narcoleptic or control class membership. Parametric and nonparametric hypothesis tests suggest that, with probabilities close to one, narcoleptics and controls are distinguishable classes. To emphasize the importance of pupil noise as a diagnostic tool we present evidence from the neurophysiology literature indicating that Alzheimer's disease and narcolepsy have some of the same brainstem nuclei implicated. Further, Alzheimer patients and narcoleptics share some of the same disturbed sleep patterns.

Adult↗
PubMed2000

Pupils' causal attributions for difficult classroom behaviour.

BACKGROUND: Studies of causal attributions within educational contexts have tended to concentrate on academic performance. There have been a smaller number of investigations of teachers' attributions for pupils' behaviour in school. AIMS: The present study examines the causal attribution made by pupils for difficult behaviour in classrooms. It reveals the structure of these attributions and serves as a comparison with the teacher studies. SAMPLE: The participants were 105 pupils (52 males and 53 females) in the first year of secondary schooling, all drawn from the same inner city school. METHOD: Four initial small group interviews were used to identify a wide range of factors that pupils viewed as being causes of difficult classroom behaviour in the 18 primary schools they had previously attended. A questionnaire was then constructed incorporating items from these discussions and administered to the whole of the year group of pupils, but omitting the participants in the initial group discussions. RESULTS: The results of a factor analysis indicated that pupils' attributions for misbehaviour at school were best represented by four factors: (1) 'fairness of teacher's actions', (2) 'pupil vulnerability', (3) 'adverse family circumstances' and (4) 'strictness of classroom regime'. While there were no gender differences, pupils saw the 'fairness of teacher's actions' and 'pupil vulnerability' as more significant contributors to pupil misbehaviour than either 'adverse family circumstances' or 'strictness of classroom regime'. CONCLUSION: The attributions by pupils for difficult classroom behaviour differ markedly from those obtained in studies of teachers. Policy and practice initiatives which do not attend to conflicting attributional styles are unlikely to succeed in improving levels of pupil behaviour in schools.

Child↗
PubMed2006

Pupil findings in a consecutive series of 150 patients with generalised autonomic neuropathy.

AIM: To detect and characterise the pattern and extent of pupil abnormalities in patients with generalised autonomic failure. METHODS: A consecutive series of 150 patients referred for investigation of symptomatic generalised autonomic failure underwent pupil investigations. Infra-red video pupillography was used to measure resting pupil diameters in light and dark, the light reflex response, the miosis associated with an accommodative effort, and responses to topical administration of various pharmacological agents. The results were compared with data recorded under identical conditions from a cohort of 315 age-matched and sex-matched healthy controls. RESULTS: Overall, two thirds of patients had abnormal pupils (66%) with sympathetic deficit occurring twice as often as parasympathetic deficit. However, the prevalence and type of pupil abnormality showed wide variation according to aetiology--for example, almost all patients with amyloidosis had abnormal pupils, two thirds with pure autonomic failure but less than a quarter with multiple system atrophy. In most patients (85%), pupil abnormalities were bilateral and symmetrical, none had a Horner's syndrome in one eye and a tonic pupil in the other. No significant correlation between the type of pupil abnormality and the predominant type of systemic autonomic deficit was seen in most conditions. CONCLUSIONS: The pupils are often affected in autonomic neuropathy, although this is not always apparent either to the patient or to their doctors. Considerable care is needed not only to detect these abnormalities but also to interpret correctly the results of pupil tests in this group of patients.

Adolescent↗
PubMed1997

Pupil dilation to tropicamide is not specific for Alzheimer disease.

BACKGROUND: The extent of pupil dilation after instillation of a dilute tropicamide solution was proposed as a noninvasive neurobiological diagnostic test for Alzheimer disease (AD). Pupils in patients with AD dilated 23% vs only 5% in control subjects. OBJECTIVE: To determine whether pupil dilation in response to tropicamide distinguishes patients with AD from control subjects without dementia. METHODS: There were 50 patients with AD and 51 control subjects; no participant had primarily ocular pathological conditions or took drugs that affected cholinergic tone. All participants received 1 drop of 0.01% tropicamide in 1 eye and 1 drop of 0.9% saline solution in the other eye in random order. Pupil measurements were obtained using a pupil and corneal reflection tracking system (RK-426 PC system, ISCAN Inc, Burlington, Mass) that illuminated the eye with a low-level infrared source and measured pupil diameters, fixation, and light level every 16.7 milliseconds during each 30-second-measurement. Pupil measurements were obtained from each eye at baseline and 5, 10, 15, and 30 minutes after drop instillation. RESULTS: The increase in pupil size after tropicamide instillation was equal between patients with AD and control subjects. The mean (+/- SD) pupil diameter increased from 4.5 +/- 1.1 to 5.5 +/- 1.1 mm after 30 minutes in patients with AD and from 4.7 +/- 0.9 to 5.8 +/- 0.9 mm in control subjects. Anisocoria and the mean rate of dilation did not differ between patients with AD and control subjects. Eye color and corneal moisture did not affect these results. The extent of pupil dilation in patients with AD was not related to clinical estimates of dementia severity. CONCLUSION: Pupil dilation in response to instillation of 0.01% tropicamide is not useful as an antemortem diagnostic test for AD.

Aged↗
PubMedDate not supplied

The pupil is a moving target: centration, repeatability, and registration.

PURPOSE: To evaluate the ability to accurately center and register wavefront data to provide effective custom wavefront application for vision correction. METHODS: Centration images were obtained of 40 undilated pupils at 5 different illumination levels using the Alcon LADARWave aberrometer (Alcon Laboratories Inc, Fort Worth, Tex). Pupil position relative to the limbus was determined for all eyes under all levels of illumination. Variability in centration of the pupil was based on difference in magnitude of offset between pupil center and limbal center. Human operators were compared to a computerized limbus recognition system through repeatability testing using 10 different images of one eye of a single patient. RESULTS: As determined by human operators, the pupil center in undilated pupils shifted a mean of 175 microm between the lowest level and the highest level of illumination (range 34 to 335 microm [standard deviation 84 microm]). Repeatability testing suggests human measurements can accurately position the pupil to within approximately 50 microm using current technology. Computer image processing using limbus recognition software appears equal or superior to manual pupil centration. CONCLUSION: The pupil center can have a significant change in position with changing illumination. Wavefront data must be centered on a fixed eye structure rather than the pupil center to ensure that wavefront data captured in scotopic light are appropriately matched to the pupil in the photopic light used at surgery. The goal is to avoid clinically significant decentration of the wavefront between capture and excimer laser application.

Corneal Topography↗
PubMed1999

An anisocoria produces a small relative afferent pupillary defect in the eye with the smaller pupil.

OBJECTIVES: To determine whether an anisocoria can produce a relative afferent pupillary defect of clinical importance. MATERIAL AND METHODS: Anisocoria and relative afferent pupillary defect were measured with infrared videography in three clinical experiments: 1) every few minutes in eight normal subjects who remained in darkness as one pupil was dilating from mydriatic drops; 2) every 2 hours, for 8 hours in six normal subjects who remained in room light after one pupil was dilated with mydriatic drops; and 3) before and after dilation of one pupil in 24 patients with known afferent defects from optic nerve disease and who remained in room light. RESULTS: In the presence of an anisocoria, the relative afferent pupillary defect was almost always in the eye with the smaller pupil. The results of the three experiments were: 1) In darkness, the induced pupillary defect was found to be related to the ratio of the areas of the two pupils (R = 0.942), and 0.14 log unit of pupillary defect was produced in the eye with the smaller pupil for every millimeter of anisocoria. 2) In room light, the induced pupillary defect was in the eye with the smaller pupil but was less than in Experiment 1 and persisted throughout the 8 hours. This was presumably because the eye with the larger pupil had become more light adapted in the clinic light than the eye with the smaller pupil. 3) In room light, inducing an anisocoria in patients with preexisting afferent pupillary defect tended to shift the pupillary defect toward the eye with the smaller pupil (R = 0.68). CONCLUSIONS: Clinically, approximately 0.1 log unit of relative afferent pupillary defect is produced in the eye with the smaller pupil for every millimeter of anisocoria. Therefore, the anisocoria must be larger than 2 mm in diameter difference to induce a clinically significant relative afferent pupillary defect.

Anisocoria↗
PubMed2026

Identification Matters: How Data Sharing Affects Pupil Honesty and Engagement in Universal School Well-Being Assessments.

PURPOSE: Universal well-being assessments in schools may support early identification of pupils needing mental health support. However, little is known about how privacy and confidentiality concerns influence pupils' acceptability of assessments and willingness to engage authentically. This study examined how hypothetical identification, where responses are linked to pupils and shared with key stakeholders, affects pupils' anticipated honesty and engagement, and whether known help-seeking barriers predict negative responses. METHODS: Cross-sectional data were collected from 12,377 primary (ages 8-10) and secondary pupils (ages 11-17) across 55 schools in England. Pupils reported whether their responses would change if identifiable and shared with school staff, parents/guardians, or external professionals. Responses indicating reduced honesty or likelihood of disengagement were coded as negative. Predictors were examined using mixed-effects logistic regression models, including demographics, school connectedness, and mental well-being. RESULTS: Identification and data sharing influenced pupils' anticipated engagement, particularly in secondary schools. Identification by school staff elicited the highest proportion of negative responses in both phases, whereas external professionals elicited the fewest. Most primary pupils reported they would respond authentically, while a larger proportion of secondary pupils indicated they would respond less honestly or disengage when responses were identifiable and shared. Across primary and secondary samples, low well-being, low school connectedness, and being female were associated with greater likelihood of negative response. DISCUSSION: Pupils' anticipated engagement with well-being assessments is shaped by who accesses their data, with marked developmental differences. Strengthening trust, privacy, and connectedness, and supporting pupils' autonomy, may improve the acceptability and response accuracy.

Humans↗
PubMed2004

A methodological and substantive review of the evidence that schools cause pupils to smoke.

The objectives of this review were to examine whether smoking prevalence varies between schools independently of health promotion programmes and pupil composition, to show which school characteristics are responsible for this variation, and to examine the methodological adequacy of such studies. Searches for published studies were performed on medical, educational and social science databases, relevant articles' reference lists, and citation searches. Any study was included that described inter-school variation in smoking prevalence, or related such variation to school characteristics. A model relating pupil smoking to school, neighbourhood, and pupil characteristics unlikely and likely to be influenced by school was used to examine the adequacy of control of confounding by pupil composition. Data from studies were combined qualitatively considering methodological adequacy to examine the relation of smoking prevalence to school characteristics. Theoretical frameworks underpinning the choice of school characteristics and postulated relationships between these characteristics and smoking prevalence were described. There were large variations in smoking prevalence between ostensibly similar schools. Evidence that pupil composition did not cause this was weak, because all studies had methodological problems, including under control of relevant pupil compositional factors and over control of factors likely to represent the mechanism through which schools influence pupils' smoking. There was little evidence that elements of tobacco control policy other than bans and enforcement deterred smoking. Academic practice and school ethos were related to smoking. Academically selective schools did not influence smoking, once pupil composition was controlled. There was one study on neighbourhood influences, which were unrelated to smoking. Studies frequently offered little or no theoretical justification for associating school characteristics with smoking. Some aspects of school influence pupils' smoking, probably independently of pupil composition. However, under-control and over-control of confounding and lack of theoretical underpinning precludes definitive conclusions on how particular school characteristics influence pupils' smoking.

Adolescent↗
PubMed2004

The sexual health of pupils in years 4 to 6 of primary schools in rural Tanzania.

BACKGROUND/OBJECTIVES: There is an urgent need for effective interventions to improve the sexual and reproductive health of adolescents. Reliable data on the sexual health of adolescents are needed to guide the development of such interventions. The aim was to describe the sexual health of pupils in years 4 to 6 of 121 rural primary schools in north western Tanzania, before the implementation of an innovative sexual health intervention in 58 of the schools. METHODS: A cross sectional survey of primary school pupils in rural Tanzania was carried out. The study population comprised pupils registered in years 4 to 6 of 121 primary schools in 20 rural communities in 1998. Basic demographic information was collected from all pupils seen. Those born before 1 January 1985 (aged approximately 14 years and over) were invited to participate in the survey, and asked about their knowledge and attitudes towards sexual health issues, and their sexual experience. A urine specimen was requested and tested for HIV, Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG) and, for females, pregnancy. RESULTS: 9283 pupils born before 1 January 1985 were enrolled and provided demographic information and a urine sample. Male pupils were significantly older than females (mean age 15.5 years v 14.8 years, p<0.001), but all other demographic characteristics were similar between the sexes. 14 (0.2%) of the enrolled pupils (four male and 10 female) were HIV positive, 83 (0.9%) were positive for CT, and 12 (0.1%) for NG. 32 female pupils (0.8%) were positive by pregnancy test. Sexual experience was reported by one fifth of primary school girls, and by almost half of boys. Only 45/114 (39%) girls with biological markers of sexual activity reported having had sex. CONCLUSIONS: HIV, CT, NG, and pregnancy were present though at relatively low levels among pupils in years 4 to 6 of primary school. A high proportion of pupils with a biological marker of sexual activity denied ever having had sex. Alternative ways of collecting sensitive data about the sexual behaviour of school pupils should be explored.

Adolescent↗