Youth health-risk behavior assessment in Fiji: the reliability of Global School-based Student Health Survey content adapted for ethnic Fijian girls

Gender differences in social environmental factors of psychological distress among Indonesian adolescents: Findings from the 2015 Global School-based Student Health Survey

BACKGROUND

This study aimed to investigate gender differences in social environmental factors of psychological distress among Indonesian adolescents.

METHODS

This was a cross-sectional study using the data from the 2015 Indonesia Global School-based Student Health Survey. Binary logistic regression was used to assess the influences of main independent variables - social environmental factors (i.e., peer support, having close friends, bullying victimisation, physical fight, physical attack, parental supervision, connectedness, bonding), demographic characteristics, and health-related behaviours on the measures of psychological distress (loneliness, anxiety-induced sleep disturbance, and a combination of both measures as psychological distress).

RESULTS

The prevalence of psychological distress measured as loneliness, anxiety-induced sleep disturbance, and combined psychological distress was 6.12%, 4.52%, and 8.04%, respectively. Findings from multivariate analyses indicated that bullying victimisation, physical attack, experience of hunger (a proxy of socioeconomic status), and sedentary behaviour were associated with all measures of psychological distress. Meanwhile, age, gender, drug use, parental connectedness and bonding, and having no close friends were correlates of one or two measures of psychological distress. Based on gender-stratified analyses, experience of hunger, sedentary behaviour, bullying victimisation, and having no close friends were consistently associated with measures of psychological distress among both girls and boys. In addition, the influence of some social environmental factors, such as parental connectedness, peer support, and physical attack, were more salient among girls.

CONCLUSIONS

The findings suggest that social environmental factors, demographic characteristics, and health-related behaviours were associated with psychological distress, and the associations appeared to differ by gender. Interventions that include improving positive social environmental factors (e.g., reducing interpersonal violence, encouraging positive relationships with parents and peers) and promoting healthy behaviours (e.g., less sedentary behaviour, preventing substance use) might help reduce the risk of psychological distress among Indonesian adolescents.

The association between psychosocial factors, protective factors, and its associated triggers with psychological distress among Bolivian adolescents

The purpose of this study is to investigate the association between psychosocial factors, protective factors, and its associated triggers with psychological distress among Bolivian adolescents. This cross-sectional study was conducted by investigating the 2018 Bolivia global school-based student health survey (GSHS). The total number of students who participated in this survey was 7931, and the final sample was 7377. The mean age of the participants was 15.3 years (SD = 1.4). Psychological distress was assessed with a 2-item screener (loneliness and worry induced sleep disturbance). In all 22.3% of participants reported experiencing psychological distress, with 18.1% among adolescent males and 26.2% among adolescent females. In adjusted logistic regression analysis (AOR, 95% CI), there are two significant directions of association. One is the negative association, such as parental involvement as a protective factor. School adolescents who had more parental involvement were less likely to experience psychological distress. Parents understand problems or worries (0.64, 0.54-0.75, p < .001) and parents disregard privacy (0.69, 0.58-0.82, p < .001). On the other hand, many psycho-social factors are significantly positively associated with psychological distress. School adolescents who experience more psychosocial factors are more likely to experience psychological distress. Physical assault in the previous year (1.83, 1.59-2.11, p < .001), being bullied at school (1.27, 1.07-1.52, p < .01), being bullied outside of school (1.36, 1.15-1.61, p < .001), and being cyberbullied (1.60, 1.37-1.88, p < .001), were all significantly associated with psychological distress. Healthy relationships in a family, and interventions to reduce violence and bullying, should be encouraged and promoted.

Combined victimization of face-to-face and cyberbullying and adverse health outcomes among school-age adolescents in Argentina

Face-to-face bullying victimization (FBV) and cyber bullying victimization (CBV) are of global concern, including in Latin America. The aim of this study was to evaluate the associations between combined FBV and CBV relative to single victimization (FBV or CBV) and no victimization with a wide range of adverse health outcomes among school-aged adolescents from Argentina. National cross-sectional school data from 56,981 adolescents that responded to questions on FBV, CBV, and adverse health outcomes were analyzed. The results showed a prevalence of 18.7% FBV alone, 8.1% CBV alone and 13.6% combined FBV and CBV. Combined FBV and CBV had higher odds than single victimization (FBV or CBV) in 18 negative health outcomes, including anxiety, suicidal ideation, loneliness, suicide plan and attempt, smoking, smokeless tobacco use, history of intoxication, alcohol-related problems, current cannabis use, ever use of amphetamine, school truancy, participation in physical fighting, physically attacked, injury, ever sex, multiple sexual partners and sedentary behaviour. In conclusion, combined FBV and CBV had higher odds than single BV or no BV in most adverse health outcomes.

Food insecurity is associated with multiple psychological and behavioural problems among adolescents in five Caribbean countries

The study aimed to assess associations between food insecurity and multiple psychological and behavioural problems among adolescents in five Caribbean countries. Data from national and cross-sectional school health surveys from 9,956 adolescents (15 years, median age) in Trinidad and Tobago, Suriname, Jamaica, Anguilla and the Dominican Republic in 2016-2017 were analyzed in 2016-2017. Results show that the prevalence of moderate (rarely or sometimes) past-month food insecurity was 35.9% and severe (mostly or always) food insecurity was 4.6%. Severe food insecurity among adolescents ranged from 2.9% in Dominican Republic to 11.2% in Suriname. In adjusted logistic regression analyses, the higher severity of food insecurity was associated with negative psychological outcomes (loneliness, suicidal ideation, suicide plan, suicide attempt, anxiety, current tobacco use and any trouble from alcohol use) and negative behavioural outcomes (truancy, bullied, physically attacked, physical injury, and multiple sexual partners). Two out of five adolescents experienced some form of food security. Food interventions, such as school feeding programmes, are warranted to reduce negative psychosocial outcomes.

Worry-related sleep problems and suicidal thoughts and behaviors among adolescents in 88 low-, middle-, and high-income countries: an examination of individual- and country-level factors

A strong association between sleep problems and suicidal thoughts and behaviors (STBs) has been demonstrated in high-income countries. The sleep-STB relationship, however, is minimally understood among youth in low and middle-incomes countries. There also is a limited understanding of how individual- (i.e., age, sex) and country-level (i.e., economic inequality, economic quality) factors may moderate the magnitude of the sleep-STB association among youth. Data were analyzed from the cross-national Global School-based Health Survey 2003-2017, which assessed a range of health behaviors among school-enrolled adolescents aged 11-18 years from 88 low-, lower-middle, upper-middle, and high-income countries. Multilevel models were used to examine the influence of individual- and country-level factors on the association between past-year worry-related sleep problems and past-year suicide ideation, suicide plans, and suicide attempts. Worry-related sleep problems were significantly associated with suicide ideation, plans, and attempts. Adolescent sex, country economic quality (income group designation), and country economic inequality moderated the sleep-STB association, but age did not. The sleep-STB relationship was stronger for males and across macroeconomic indices, the relationship was generally strongest among upper-middle income countries (economic quality) and countries with a big income gap (economic inequality). When examining how individual-level factors differentially affected the sleep-STB relationship within economic quality (income group designation), the effects were driven by older adolescents in high-income countries for suicide ideation and suicide plans. Study findings suggest an important role for global macroeconomic factors, for males, and older adolescents in high-income countries in the sleep-STB relationship. Future directions include expanding worldwide coverage of countries, assessing a wider range of sleep problems, and longitudinal work to understand potential mechanisms in the sleep-STB relationship.

Factors associated with single and multiple suicide attempts in adolescents attending school in Argentina: national cross-sectional survey in 2018

BACKGROUND

Factors associated with single suicide attempts (SSA) and multiple suicide attempts (MSA) may differ.

AIMS

The study aimed to assess the factors associated with MSA in adolescents with a history of suicide attempts during the past 12 months in Argentina.

METHOD

National cross-sectional data from the Global School-based Student Health Survey in Argentina in 2018 were analysed. Students who reported having a history of suicide attempts in the past 12 months were included in the final sample (n = 8507). Students with MSA were compared with students with an SSA through multiple logistic regression.

RESULTS

In a subsample of adolescents attending school (mean age 14.8 years, s.d. = 1.3), 59.4% had an SSA and 40.6% had MSA in the past 12 months. In the final adjusted logistic regression model, compared with participants with SSA, both male and female students with MSA more frequently had no close friends, reported feeling more lonely and had more anxiety-induced sleep disturbances. Furthermore, among female participants, having been physically attacked, having participated in physical fights, low parental support, current tobacco use and lifetime amphetamine use were associated with MSA. Among male students, multiple sexual partners were associated with MSA. Furthermore, among both boys and girls, compared with participants without psychosocial distress, participants with one, two, three or more psychosocial distress factors had higher odds of MSA. Compared with students with one or two social or environmental risk factors, students with seven or eight social or environmental risk factors had higher odds of MSA; compared with students who had zero or one health risk behaviours, students with six or more health risk behaviours had higher odds of MSA.

CONCLUSIONS

Psychosocial distress (anxiety-induced sleep disturbance, having no close friends and loneliness) increased the odds of MSA among both sexes. The odds of MSA were increased by interpersonal violence, low parental support and substance use among girls, and by having multiple sexual partners among boys. This suggests the potential relevance of these variables in identifying multiple suicide attempters among adolescents attending school in Argentina.

Gender inequalities in physical activity among adolescents from 64 Global South countries

PURPOSE

The aims of this study were to (a) describe gender inequalities in physical activity (PA) among adolescents from Global South countries, and (b) investigate the relationship between gender inequalities in PA and contextual factors, such as geographic region, human development index, gender inequality index, and unemployment rates.

METHODS

We analyzed cross-sectional data from the Global School-Based Student Health Survey conducted in Global South countries between 2010 and 2020 among 13- to 17-year-old adolescents. Country-context variables were retrieved from secondary data sources (World Health Organization, World Bank, and Human Development Reports). PA was assessed by a self-administered questionnaire querying the number of days in the past week in which participants were physically active for a total of at least 60 min. PA absolute gender inequalities were evaluated by the differences in the prevalence between boys and girls, 95% confidence intervals (95%CIs) were estimated using the bootstrap method. Relative inequalities were obtained through Poisson regression. Meta-analyses with random effects were used to calculate pooled estimates of absolute and relative inequalities.

RESULTS

Based on 64 Global South countries/surveys, the prevalence of PA was 6.7 percentage points (p.p.) higher in boys than in girls, ranging from 0.5 p.p. in Afghanistan to 15.6 p.p. in Laos (I²= 85.1%). The pooled ratio for all countries showed that boys presented a PA prevalence 1.58 times higher than girls (95%CI: 1.47-1.70) on average. The highest absolute and relative inequalities were observed in high income countries. Countries with higher Human Development Index rankings and lower Gender Inequality Index rankings also presented greater gender differences.

CONCLUSION

Given that girls are overall less active than boys across the globe, the findings of this study reinforce that macro- and micro-level changes should be actively sought if we aim to increase population levels of PA in adolescents and promote equity in PA.

Reliability and validity of using the global school-based student health survey to assess 24 hour movement behaviours in adolescents from Saudi Arabia

This study aimed to examine the reliability and validity of Global School-based Student Health Survey (GSHS) to measure 24-hour movement behaviours (moderate-to-vigorous physical activity - MVPA; sedentary behaviour in the form of recreational screen time - ST; and sleep) in Saudi Arabian youths. A total of 120 (50% female) participants aged 12-15 years old were recruited from eight Saudi public middle schools. Participants completed GSHS survey twice and wore GENEActiv accelerometers for seven consecutive days and completed a diary log. ICC indicated moderate reliability in all 24-hour movement behaviours (ICC = 0.41 - 0.60), whereas ST and sleep were strongly reliable for females only (ICC = 0.61 - 0.80). Kappa agreements for all 24-hr movement behaviours were moderate (k = 0.41 - 0.60), but fair in MVPA and ST for males only (k = 0.21 - 0.40). Spearman's indicated low validity (r = 0.1 - 0.3) in MVPA and sleep between GSHS and GENEActiv. However, kappa test results indicated poor-to-slight agreements (k = <0.00 - 0.2) in MVPA and sleep, but fair in MVPA for males only (k = 0.21 - 0.4). GSHS provided good reliability for single items of 24-hour movement behaviours, and the validity was acceptable and in line with other comparable questionnaires.

Leisure sedentary time and suicide risk among young adolescents: Data from 54 low- and middle-income countries

BACKGROUND

The dose-response association between sedentary time and suicidal ideation and planning among adolescents is unclear. This study examined the association between leisure sedentary time and suicidal ideation, planning and attempts among adolescents in low- and middle-income countries (LMICs).

METHODS

We used the most recent data (2009-2016) from the Global School-based Student Health Survey (GSHS) in 54 LMICs. Leisure sedentary time and suicidal ideation, planning and attempts were assessed using a standardized questionnaire. A total of 146,345 young adolescents aged 12-15 years were included.

RESULTS

Among adolescents in the 54 LMICs, the prevalence of suicidal ideation was 14.8%, planning was 14.5%, and attempts was 13.0%. Compared with those who had less than 1 h/day of sedentary time, those who had 3, 4 h/day sedentary time were at higher odds ratio (OR) of suicidal ideation OR=1.21 (95% confidence interval (CI) =1.14-1.29), planning OR=1.15 (95%CI=1.07-1.22) and attempts OR=1.17 (95%CI=1.09-1.26), and those who had more than 8 h/day sedentary time were at OR=1.58 (95%CI=1.44-1.72), OR=1.44 (95%CI=1.31-1.58) and OR=1.27 (95%CI=1.16-1.40), respectively.

LIMITATIONS

Suicidal behaviors and sedentary time were assessed by a self-reported questionnaire, which might be prone to recall bias.

CONCLUSIONS

Higher amounts of leisure sedentary time are associated with suicidal ideation, planning and attempts among adolescents. Adolescents should spend less than 2 h/day of their sedentary time to reduce the likelihood of suicide.

Participation in Physical Education Classes and Health-Related Behaviours among Adolescents from 67 Countries

The present study sought to examine the associations between participation in physical education (PE) classes and a range of health-related behaviours among adolescents. Secondary analysis of self-reported data from the Global Student Health Survey, collected between 2010 and 2017 from 222,121 adolescents (N = 117,914 girls; 49.0%; aged 13–17 years) from 67 countries and five world regions, was carried out. Participation in PE classes (0, 1–2, ≥3 days/week) was the independent variable. Physical activity (PA); sedentary behaviour (SB); active travel to school; fruit, vegetables, and alcohol consumption; and smoking; as well as adopting ≥5 of these healthy behaviours; were the dependent variables. Complex samples logistic regressions were performed to explore the associations between participation in PE classes and health-related behaviours. The results revealed that 18.2% of adolescents did not take part in PE classes. A total of 56.7% and 25.1% of adolescents reported participating in PE classes on 1–2 and ≥3 days/week, respectively. Only 26.8% of adolescents adopted ≥5 healthy behaviours. Participation in PE classes was positively associated with PA, active travel, fruit consumption, and vegetable consumption (only for ≥3 days/week), but was negatively associated with meeting SB recommendations, and with not smoking (only for girls and ≥3 days/week). Overall, PE participation was positively associated with adopting ≥5 healthy behaviours, with favourable results found for those who attended more PE classes. The findings revealed a positive association between participation in PE classes and a range of health-related behaviours among adolescents. This suggests that, worldwide, quality PE should be delivered at least 3 days per week up to daily to promote healthy lifestyles among adolescents.

The Double Burden of Malnutrition and Associated Factors among South Asian Adolescents: Findings from the Global School-Based Student Health Survey

The health and nutrition of the global adolescent population have been under-researched, in spite of its significant size (1.2 billion). This study investigates the prevalence and associated factors of malnutrition (stunting, thinness and overweight) among adolescents living in South Asia. The sample analysed was 24,053 South Asian schooled adolescents aged 12–15 years that participated in the cross-sectional Global School-Based Student Health Survey (GSHS) between 2009 and 2016. The prevalence of stunting, thinness and overweight was calculated using the World Health Organization (WHO) Child Growth Reference 2007. Associations between the three forms of malnutrition and their possible associated factors were assessed with binary logistic regression analysis using bootstrapping as a resampling method. The overall prevalence of stunting in South Asia was 13%, thinness was 10.8% and overweight was 10.8%. In the logistic regression model of the overall pooled sample, the factors associated with adolescent malnutrition were: age, hygiene behaviours, social support, sedentary behaviour, and tobacco use. A substantial proportion of stunting, thinness and overweight was found among school-going South Asian adolescents, indicating that the double burden of malnutrition is present in this population. Future research should seek to further understand the relationship between all forms of malnutrition and its associated factors in the adolescent population.

Cardiovascular health behaviours of young adolescents: Results from the global school-based student health survey

AIM

Levels of American Heart Association-defined cardiovascular (CV) health behaviours have not been fully reported among young adolescents in low- and middle-income countries (LMICs). We describe poor, intermediate and ideal levels of American Heart Association-defined CV health behaviours among young adolescents in LMICs.

METHODS

We categorised the levels of CV health behaviours (smoking, body mass index, physical activity and diet) as poor, intermediate, or ideal and calculated the prevalence of each level and the cumulative number of ideal CV health behaviours using the latest data from the global school-based health survey during 2009-2015. The weighted prevalence and 95% confidential intervals were calculated for the whole sample and for sub-groups stratified by gender and age. Pooled overall and regional estimates were calculated using a random-effects model. This study included 153 759 young adolescents from 45 countries.

RESULTS

Overall, 86.3% (95% confidence interval, 82.7-89.9), 80.1% (79.8-80.4), 15.4% (13.7-17.2) and 1.7% (1.1-2.2) of respondents reported ideal levels for smoking, body mass index, physical activity and a healthy diet score, respectively. Overall, 0.3% (0.2-0.4) of respondents had 'four' cumulative ideal CV health behaviours. This 'percentage' was lowest in the Americas (0.2%) and highest in Southeast Asia (0.5%).

CONCLUSIONS

Consistently low proportions of young adolescents in LMICs met the ideal levels of physical activity and a healthy diet score or had 'four' ideal CV health behaviours. For this population, physical activity and a healthy dietary pattern should be strongly prioritised.

Loneliness is associated with poor mental health, social-environmental factors, and health risk behaviours among national samples of in-school adolescents in four Caribbean countries

The goal of the study was to estimate associations of loneliness with poor mental health, social-environmental and health risk behaviour indicators among adolescents in the Caribbean. Cross-sectional national 'Global School-Based Student Health Survey (GSHS)' data of four Caribbean countries (N = 9,143 adolescents) in 2016-2017 were analysed. In adjusted logistic regression analysis, loneliness was significantly positively associated with all five poor mental health outcomes (having no close friends, anxiety-induced sleep disturbance, suicidal ideation, suicide plan and suicide attempt). Regarding social-environmental outcomes, loneliness was significantly positively associated with bullying victimization, having been physically attacked, involvement in fighting, frequent experiences of hunger and passive smoking (in particular among boys). In terms of health risk behaviour outcomes, loneliness significantly increased the odds for current tobacco use, ever drunk, trouble from alcohol use, ever amphetamine use, multiple sexual partners, leisure-time sedentary behaviour, injury and frequent soft drink consumption. In addition, among boys, loneliness increased the likelihood for current cannabis use. Loneliness is associated with poorer mental health, social-environmental risk factors and health risk behaviours. Results show the importance of taking loneliness into account in a number of mental, social, and physical health factors.

Prevalence and Correlates of Sexual Risk Behavior among School-Going Adolescents in Four Caribbean Countries

This study aimed to assess the prevalence and correlates of sexual risk behaviors among adolescents in the Caribbean. Nationally representative cross-sectional data were analyzed from 9143 adolescents (15 years = median age) that took part in the 2016 Dominican Republic, 2016 Suriname, 2017 Jamaica, and 2017 Trinidad and Tobago Global School-Based Student Health Survey (GSHS). The results indicate that 41.4% of the students had ever had sex, ranging from 26.4% in Trinidad and Tobago to 48.1% in Jamaica. Among the sexually active, 58.8% had had ≥2 sexual partners; 58.6% had had an early sexual debut (≤14 years); 41.9% had not used birth control the last time they had sex; 28.4% had not used a condom the last time they had sex; and, of the whole sample, 31.9% had engaged in two or more (multiple) sexual risk behaviors, ranging from 16.5% in Trinidad and Tobago to 40.3% in Jamaica. In an adjusted logistic regression analysis, substance use (tobacco, alcohol, and cannabis), psychological distress, frequent soft drink intake, participation in physical fighting, school truancy, older age, and male sex were associated with single and/or multiple sexual risk behaviors. A large number of adolescents in the Caribbean reported sexual risk behaviors, emphasizing the need for intervention.

Prevalence and Associated Factors of Loneliness Among National Samples of In-School Adolescents in Four Caribbean Countries

BACKGROUND

The goal of the study was to estimate the prevalence and correlates of loneliness among adolescent school children in four Caribbean countries.

METHODS

Nationally representative cross-sectional data were analysed from 9,143 adolescents (15 years=median age) that took part in the "2016 Dominican Republic, 2016 Suriname, 2017 Jamaica and 2017 Trinidad and Tobago "Global School-Based Student Health Survey (GSHS)."

RESULTS

The prevalence of loneliness was 15.3% in four Caribbean countries, ranging from 12.1% in Dominican Republic to 18.6% in Jamaica. In adjusted logistic regression analysis, female sex, having no close friends, older age, anxiety induced sleep disturbance, frequent bullying victimization (≥3 days/month), having been physically attacked, parental emotional neglect, having sustained multiple serious injuries (past year) and not eating fruit and vegetables were associated with loneliness. In addition, in sex stratified adjusted logistic regression analysis, among boys, daily exposure to passive smoking, and being from Suriname, and among girls, frequent experience of hunger, low peer support, trouble from drinking alcohol and high leisure-time sedentary behaviour (≥8 hrs/day) were associated with loneliness. Moreover, in addition to above results, in unadjusted analysis, involvement in physical fight, parents never check on homework, parental disrespect of privacy, frequent school truancy (≥3 days/month), current tobacco use, having no physical education and drinking frequently soft drinks (≥3/day) were associated with loneliness.

CONCLUSION

Almost one in six students reported loneliness and several associated factors were identified which can aid intervention strategies.

Health and behavioural outcomes of bullying victimisation among Indonesian adolescent students: findings from the 2015 Global School-based Student Health Survey

Bullying victimisation among adolescents is globally recognised as an important predictor for several adverse health and behavioural outcomes. Due to a paucity of studies in Indonesia, this study aimed to identify the adverse health and behavioural outcomes due to bullying victimisation among school-going adolescents and investigate the possible moderation by age and sex. This was an analysis of the second Global School-based Student Health Survey data of Indonesia conducted in 2015. The eligible samples were 9,601 adolescent students. The main independent variable was bullying victimisation status, while the dependent variables consisted of mental health problems, substance use, and other risk behaviours. Binary logistic regression controlling for some confounders was applied to identify the associations among sex-merged and sex-separated samples. Furthermore, adjusted margin probabilities of having adverse outcomes were calculated by bullying victimisation frequency and age. This study found that nearly 2 out of 10 adolescent students were bullied in the last 30 days. Bullying victimisation was associated with the odds of all adverse health and behavioural outcomes that include loneliness, anxiety, suicidal ideation, smoking cigarettes, alcohol use, truancy, physical fight, and sedentary behaviour. The associations were slightly larger among female than male students for some of the outcomes. The odds of these adverse outcomes increased with the rising frequency of bullying and by age. The findings suggest that bullying victimisation was associated with a number of adverse health and behavioural outcomes among Indonesian adolescent students. Implementation of anti-bullying interventions among students right from a young age is essential to prevent unexpected adverse outcomes and its detrimental consequences.

Suicidal ideation, suicide planning, and suicide attempts among adolescents in 59 low-income and middle-income countries: a population-based study

BACKGROUND

Suicide is a major global health challenge and a leading cause of death among adolescents, but research related to suicide has concentrated on high-income countries. We aimed to estimate the prevalence of suicidal ideation, suicide planning, and suicide attempts in adolescents from 59 low-income and middle-income countries.

METHODS

In this population-based study, we used data from the Global School-based Student Health Survey of schoolchildren aged 13-17 years between 2003 and 2015, in 59 low-income and middle-income countries across six WHO regions. Using a meta-analysis with random effects, we computed the sex-based and age-based estimates of regional and overall prevalence of suicidal ideation, suicide planning, and suicide attempts.

FINDINGS

Our sample consisted of 229 129 adolescents (mean age 14·6 [SD 1·18] years; 111 082 [48%] boys and 118 047 [52%] girls). The overall prevalence of suicidal ideation was 16·9% (95% CI 15·0-18·8), suicide planning was 17·0% (14·8-19·2), and suicide attempts was 17·0% (14·7-19·3) in the 12 months preceding survey completion. The African region had the highest prevalence of suicidal ideation (20·4%, 17·3-23·6) and suicide planning (23·7%, 19·1-28·3), and the western Pacific region had the highest prevalence of suicide attempts (20·5%, 14·3-26·7). Southeast Asia had the lowest prevalence of ideation (8·0%, 4·5-11·5), planning (9·9%, 5·0-14·8), and attempts (9·2%, 5·1-13·3). Girls had higher prevalence than boys for suicidal ideation (18·5%, 16·4-20·6 vs 15·1%, 13·4-16·7), suicide planning (18·2%, 15·8-20·6 vs 15·6%, 13·7-17·6), and suicide attempts (17·4%, 15·0-19·8 vs 16·3%, 14·0-18·6). Adolescents aged 15-17 years had higher prevalence than those aged 13-14 years of suicidal ideation (17·8%, 15·8-19·8 vs 15·9%, 14·1-17·6), suicide planning (17·8%, 15·7-20·0 vs 16·3%, 14·7-17·9), and suicide attempts (17·6%, 15·2-20·0 vs 16·2%, 13·8-18·5).

INTERPRETATION

Suicidal thoughts and behaviours are prevalent among adolescents in low-income and middle-income countries, particularly in the African and the western Pacific regions, and particularly among girls and adolescents aged 15-17 years. Targeted suicide prevention initiatives are needed and should take into account the diverse range of cultural and socioeconomic backgrounds of the countries.

FUNDING

None.

Alcohol Advertisements, Hazard Warnings, Knowledge of Alcohol-Related Harm and Health-Profession Students' Drinking in Inner Mongolia

Background: Consumption of alcohol among adults in Inner Mongolia is high even among health professionals. Little is known of the alcohol consumption patterns of health-profession students. Objectives: To assess the association of knowledge of alcohol-related harm (KAH), and exposure to media-based promotional alcohol sales advertisements (PASA) and alcohol hazard warnings (AHW) with drinking frequency of health-profession university students. Methods: Health-profession students (N = 1277) in the Medical University of Inner Mongolia were interviewed in 2017 regarding their alcohol drinking frequency, KAH, and exposure to PASA and AHW. Multinomial logistic regression was used to evaluate associations between exposure and drinking frequency. Results: Overall, 9% were nondrinkers, 35% occasional drinkers, and 56% frequent drinkers. Females were slightly less commonly drinkers but more commonly frequent drinkers. The prevalence of drinking decreased with age. Mongolians were more commonly frequent drinkers than Han. A majority of students had low KAH. Exposure to PASA was more common among drinkers, and exposure to AHW more common among nondrinkers. The main reason for drinking was social gathering. The relative probability of being an occasional or frequent drinker was lower among older students, those with higher KAH, and those exposed to AHW on television and internet but higher among those exposed to PASA in mini-supermarkets on campus. Conclusions: Students' drinking behavior was associated with low KAH and exposure to alcohol advertisements and warning media messages. Prevalence of frequent drinking might be reduced by wider use of AHW on internet and television and improving the level of knowledge of alcohol-related harm.

Unintentional injuries and socio-psychological correlates among school-going adolescents in four ASEAN countries

Objectives: The study aimed to report the prevalence and socio-psychological correlates of non-fatal injury among school adolescents in four ASEAN countries. Materials and methods: Cross-sectional research data from the 2015 "Global School-based Health Survey (GSHS)" included 29,480 school adolescents (mean age 14.5 years, standard deviation=1.6) that were representative of all students in secondary school. Results: The proportion of participants with one or multiple serious past-year injuries was 36.9% (21.4% once and 15.4% multiple times). The most frequent cause of the reported injury was "I fell" (10.2%) and motor vehicle (5.8%) and the most common form of injury was "a broken bone or dislocated joint" (8.1%) and "cut, puncture or stab wound" (3.4%). In adjusted multinomial logistic regression analysis, male sex, experiencing hunger, substance use (alcohol, tobacco, cannabis, amphetamine and soft drinks), school truancy, participating in physical education classes and psychological distress were associated with one and/or multiple injuries. Parental or guardian support decreased the odds of one annual injury. Compared to students from Indonesia, students from Laos had a lower odd for injury and students from the Philippines and Thailand had higher odds for injury. Conclusion: Several variables, such as male sex, food insecurity, substance use, truancy, physical education and psychological distress, were identified that could be targeted in injury prevention programs in this school population.

Social Norms and Smoking Risk in iTaukei Fijian Adolescent Women

OBJECTIVE

To investigate the association of a variety of social smoking exposures with cigarette smoking among iTaukei adolescent women in Fiji.

METHODS

Self-report data were collected in a representative sample of school-going iTaukei adolescent women (n=523). We fitted logistic regression models of current cigarette smoking with school, peer, media, and other social exposures to smoking as predictors.

RESULTS

Current cigarette smoking was associated with exposure to close friend, peer, and routine social smoking as well as higher prevalence of school peer smoking, but not parent tobacco use and media smoking exposures-in our fully adjusted model.

CONCLUSIONS

Peer and school-based smoking exposures may increase cigarette smoking risk in school-going iTaukei adolescent women and may be strategic interventional targets to augment existing preventive approaches.

Impact of parent-adolescent bonding on school bullying and mental health in Vietnamese cultural setting: evidence from the global school-based health survey

Background

The mental well-being of adolescents is a crucial issue affecting lives of both adults and young people. Bullying and mental health problems are important factors that can have a negative impact on the mental well-being of adolescents. Public awareness of mental health problems among adolescents is rapidly growing in Vietnam. However, current approaches to identifying risk factors influencing mental health problems do not pay attention to potentially protective factors. This study was performed to examine the associations between parent–adolescent bonding and mental health outcomes as protective elements during the adolescent period.

Methods

Data collected from 3331 respondents in grade 8–12 as part of the Vietnam Global School-based Student Health Survey (GSHS) 2013 was used for the analysis. A three-stage cluster sample design was used to produce data representative of students. Multivariate logistic regression analysis was performed to examine the association of demographic characteristics and data regarding parent–adolescent bonding associations with status of mental health problems in adolescents.

Results

Parental understanding, parental monitoring were significantly associated with reduced likelihood of being bullied and mental health problems (P < 0.05). However, parental control was significantly associated with greater likelihoods of being physically attacked (adjusted odd ratio (aOR) = 1.36, 95%CI, 1.06, 1.75) and mental health problems, such as suicidal ideation, and loneliness (aOR = 1.96, 95%CI, 1.49, 2.57, aOR = 2.35, 95%CI, 1.75, 3.15, respectively), after adjusting for potential confounders.

Conclusions

The study indicated the significant associations between parental understanding, monitoring and control in a proxy of parent–adolescent bonding and mental well-being during the period of adolescent rebellion. Thus, parent–adolescent bonding in Southeast Asian cultural context may provide an effective means to promote the mental well-being of adolescents.

Prevalence of underweight and overweight among young adolescents aged 12-15 years in 58 low-income and middle-income countries

BACKGROUND

The co-existence of underweight and overweight is a great challenge for public health in low-income and middle-income countries (LMICs).

OBJECTIVES

The objective of the study is to report the prevalence of underweight, overweight and obesity among young adolescents in 58 LMICs.

METHODS

Data were from the Global School-based Student Health Survey (2007-2013) in 57 LMICs and from the Chinese National Surveys on Students' Constitution and Health (2010). A total of 177 325 young adolescents aged 12-15 years from 58 LMICs were included. Weight status was defined based on both the updated International Obesity Task Force (IOTF) and World Health Organization (WHO) criteria.

RESULTS

Based on the IOTF/WHO criteria, the overall prevalence of weight categories among young adolescents in LMICs was 13.4%/4.7% for underweight, 15.4%/17.3% for overweight and 5.6%/8.6% for obesity. However, the prevalence varied largely across countries and regions. Based on the IOTF criteria, the prevalence of underweight ranged from 0.0% in Niue to 48.8% in Sri Lanka and obesity ranged from 0.1% in Vanuatu to 35.0% in Niue; a prevalence exceeding 10.0% for both underweight and excess weight (overweight and obesity combined) was found in 29.3% of these countries. Underweight was more prevalent in Southeast Asia and Africa, while obesity was more frequent in Central and South Americas. There were no age and sex differences in the prevalence of weight categories for most countries.

CONCLUSIONS

Our data confirm the continued dual burden of underweight and overweight in young adolescents in many LMICs and the need for policy and programmes to address both conditions.

A regional vision of physical activity, sedentary behaviour and physical education in adolescents from Latin America and the Caribbean: results from 26 countries

BACKGROUND

Latin America and the Caribbean (LAC) countries, have been historically under-represented due to the lack of surveillance of physical behaviours in young populations. Therefore, the aim of this study was to describe and compare overall physical activity (PA), active transportation to and from school (i.e. walking or cycling), physical education (PE) participation, and sedentary behaviour (SB) in adolescents from 26 countries in LAC.

METHODS

Data were collected in the Global School-based Student Health Survey (2007-13). Prevalences for each physical behaviour were compared by sex across the region.

RESULTS

In total, 64 034 adolescents provided complete data (age range: 11 to 18 years; 47.7% male). Only about 15% of adolescents in LAC countries were physically active (at least 60 min/day of moderate-to-vigorous PA) with most countries showing sex disparities. Overall, 41.9% reported being active for transportation to and from school at least 3 days per week. In 12 countries, at least 50% of the adolescents reported sitting ≥3 h per day outside school, and a third of adolescents reported participation in PE classes on 3 days or more per week.

CONCLUSIONS

The study sets a challenge for the LAC region, as physical inactivity and SB are highly prevalent across all countries. Gender inequity was shown in most countries, with boys reporting more active behaviours. Regional and national actions for implementing policies to revert this situation are urgent.

Nonfatal Injuries and Psychosocial Correlates among Middle School Students in Cambodia and Vietnam

The aim of the study was to estimate the prevalence and psychosocial correlates of nonfatal injury among middle school students in Cambodia and Vietnam. Cross-sectional data from 7137 school children (mean age 15.5 years, SD = 1.4) who were randomly sampled for participation in nationally representative Global School-based Health Surveys (GSHS) in Cambodia and Vietnam were analyzed. The proportion of school children reporting one or more serious injuries in the past year was 22.6% among boys and 17.5% among girls in Cambodia and 34.3% among boys and 25.1% among girls in Vietnam. The most prevalent cause of the most serious injury in Cambodia was traffic injuries (4.7% among boys and 4.3% among girls) and in Vietnam it was falls (10.0% among boys and 7.0% among girls). In multinomial logistic regression analyses, experiencing hunger (as an indicator for low socioeconomic status) and drug use were associated with having sustained one injury and two or more injuries in the past 12 months in Cambodia. In addition, poor mental health was associated with two or more injuries. In Vietnam, being male, experiencing hunger, current alcohol use, poor mental health and ever having had sex were associated with having sustained one injury and two or more injuries in the past 12 months. Several psychosocial variables were identified which could help in designing injury prevention strategies among middle school children in Cambodia and Vietnam.

Risk and Protective Factors Affecting Sexual Risk Behavior Among School-Aged Adolescents in Fiji, Kiribati, Samoa, and Vanuatu

There are limited studies on the prevalence and correlates of sexual risk behavior among adolescents in Pacific Island countries. In order to inform public sexual and reproductive health interventions, the aim of this study was to assess the prevalence and correlates of various sexual risk behaviors among in-school adolescents in 4 Pacific Island countries using data from the Global School-Based Health Survey. In a cross-sectional study, 6792 school-going adolescents (49.7% boys and 50.3% girls; 13-16 years old) from Fiji, Kiribati, Samoa, and Vanuatu were surveyed with a self-administered questionnaire. Overall, 18.9% of students reported to ever had sex (ranging from 12.9% in Vanuatu to 57.5% in Samoa), and of those sexually active, 38.0% had an early sexual debut (<14 years), 38.1% had 2 or more sexual partners during their lifetime, 39.5% had not used a condom at last sex, 50.9% had not used birth control at last sex, and 77.8% engaged in sexually risky behavior using a composite measure. Multivariate logistic regression found that male sex, older age, tobacco use, alcohol use, mental distress, having no close friends, and truancy were associated with several of 5 or all 5 sexual risk behaviors. Sexual and reproductive health promotion programs are indicated to address the high risk of sexually transmitted infection, HIV, and pregnancy in this adolescent population.

Adolescent suicidal behaviours in 32 low- and middle-income countries

Objective

To estimate prevalence of suicidal ideation and suicidal ideation with a plan in each surveyed country and to examine cross-national differences in associated risk factors.

Methods

We analysed data of students aged 13–17 years who participated in the 2003–2012 Global School-based Health Surveys in 32 countries, of which 29 are low- and middle-income. We used random effects meta-analysis to generate regional and overall pooled estimates. Multivariable logistic regression was used to estimate risk ratios for the associated risk factors. Population attributable fractions were estimated based on adjusted risk ratios and the prevalence of the determinants within each exposure level.

Findings

Across all countries, the pooled 12-month prevalence of suicide ideation were 16.2% (95% confidence interval, CI: 15.6 to 16.7) among females and 12.2% (95% CI: 11.7 to 12.7) among males and ideation with a plan were 8.3% (95% CI: 7.9 to 8.7) among females and 5.8% (95% CI: 5.5 to 6.1) among males. Suicide ideation in the WHO Region of the Americas was higher in females than males, with an estimated prevalence ratio of 1.70 (95% CI: 1.60 to 1.81), while this ratio was 1.04 (95% CI: 0.98 to 1.10) in the WHO African Region. Factors associated with suicidal ideation in most countries included experiences of bullying and physical violence, loneliness, limited parental support and alcohol and tobacco use.

Conclusion

The prevalence of adolescent suicidal behaviours varies across countries, yet a consistent set of risk factors of suicidal behaviours emerged across all regions and most countries.

Nonfatal injury incidence and risk factors among middle school students from four Polynesian countries: The Cook Islands, Niue, Samoa, and Tonga

INTRODUCTION

The burden of injuries in Pacific Island countries is understudied despite the known challenges associated with many residents having limited access to advanced medical and surgical care when they sustain a serious injury. This paper examines nonfatal injuries among early adolescent schoolchildren (those primarily ages 13-15 years) from four Polynesian countries.

METHODS

Self-reported data from the 5507 middle school students who were randomly sampled for participation in the nationwide Global School-based Student Health Surveys (GSHS) in the Cook Islands (in the year 2009), Niue (2010), Samoa (2011), and Tonga (2010) were analysed with various statistical methods including regression models. Injuries were defined by the GSHS questionnaire as serious if they resulted in a full day of missed school or other usual activities or required medical treatment.

RESULTS

The proportion of students reporting a serious injury in the past year was 43.1% in the Cook Islands, 40.8% in Niue, 73.8% in Samoa, and 49.1% in Tonga. In the Cook Islands and Samoa, boys reported more injuries than girls (p<0.01). The most common types of serious injuries reported were cuts and other skin trauma; broken bones and dislocated joints; and concussions, other head injuries, or difficulty breathing. The most common causes of serious injuries reported were falls; motor vehicle accidents; and attacks, fights, or abuse. For both boys and girls, being bullied in the past month, being physically attacked or in a physical fight in the past year, using alcohol and tobacco, skipping school, and having anxiety or loneliness were associated with a higher likelihood of injuries.

CONCLUSIONS

School-based health education programs targeting prevention of intentional and unintentional injuries may benefit from emphasising Polynesian values and promoting personal mental and physical health, healthy behaviours, and healthy family and community relationships.

Leisure Time Physical Inactivity and Sedentary Behaviour and Lifestyle Correlates among Students Aged 13-15 in the Association of Southeast Asian Nations (ASEAN) Member States, 2007-2013

The aim of this study was to examine the relationship between self-reported leisure time physical inactivity frequency and sedentary behaviour and lifestyle correlates among school children in the Association of Southeast Asian Nations (ASEAN) region. The analysis included 30,284 school children aged 13–15 years from seven ASEAN countries that participated in the Global School-based Student Health Survey (GSHS) between 2007 and 2013. The measure asked about overall physical activity, walking or biking to school, and on time spent sitting. Overall, the prevalence of physical inactivity was 80.4%, ranging from 74.8% in Myanmar to 90.7% in Cambodia and sedentary behaviour 33.0%, ranging from 10.5% in Cambodia and Myanmar to 42.7% in Malaysia. In multivariate logistic regression, not walking or biking to school, not attending physical education classes, inadequate vegetable consumption and lack of protective factors (peer and parental or guardian support) were associated with physical inactivity, and older age (14 and 15 years old), coming from an upper middle income country, being overweight or obese, attending physical education classes, alcohol use, loneliness, peer support and lack of parental or guardian supervision were associated with sedentary behaviour. In boys, lower socioeconomic status (in the form of having experienced hunger) and coming from a low income or lower middle income country were additionally associated with physical inactivity, and in girls, higher socioeconomic status, not walking or biking to school and being bullied were additionally associated with sedentary behaviour. In conclusion, a very high prevalence of leisure physical inactivity and sedentary behaviour among school going adolescents in ASEAN was found and several factors identified that may inform physical activity promotion programmes in school-going adolescents in ASEAN.

Health Risk Behaviour among In-School Adolescents in the Philippines: Trends between 2003, 2007 and 2011, A Cross-Sectional Study

Intermittent monitoring of health risk behaviours at the population level is important for the planning and evaluation of national health promotion intervention programmes. The study aimed to provide trend estimates on the prevalence of various health risk behaviours assessed in the Global School-based Health Survey in 2003, 2007 and 2011 in the Philippines. Three waves of cross-sectional data included 18,285 school-going adolescents, 47.4% male and 52.6% female, aged between 11 years or younger and 16 years or older, with a mean age of about 14.7 years (SD = 1.2), and mainly in second to fourth year study Grade. Significant improvements in health risk and risk behaviours (overweight or obese and smokeless tobacco use among boys, being in a physical fight, troubles from alcohol drinking, mental health, oral and hand hygiene among both boys and girls) but also increases in health risk behaviour (bullying victimization, injury and loneliness) among both boys and girls were found in this large study over a period of eight years in the Philippines. High prevalences of health risk behaviours and increases in some of them should call for intensified school health promotion programmes to reduce such risk behaviours.

Unintentional Injuries and Psychosocial Correlates among in-School Adolescents in Malaysia

The study aimed to provide estimates of the prevalence and psychosocial correlates of unintentional injury among school-going adolescents in Malaysia. Cross-sectional data from the Global School-Based Health Survey (GSHS) included 21,699 students (predominantly ≤13 to ≥17 years) that were selected by a two-stage cluster sample design to represent all secondary school students in Forms 1 to 5. The percentage of school children reporting one or more serious injuries in the past year was 34.9%, 42.1% of boys and 27.8% of girls. The two major causes of the most serious injury were “fall” (9.9%) and motor vehicle accident or being hit by a motor vehicle (5.4%), and the most frequent type of injury sustained was cut, puncture, or stab wound (6.2%) and a broken bone or dislocated joint (4.2%). In multivariable logistic regression analysis, sociodemographic factors (being male and low socioeconomic status), substance use (tobacco and cannabis use), frequent soft drink consumption, attending physical education classes three or more times a week, other risky behavior (truancy, ever having had sex, being bullied), psychological distress, and lack of parental or guardian bonding were associated with annual injury prevalence. Several factors were identified, which could be included in injury prevention promotion programs among secondary school children.

Overweight and Obesity and Associated Factors among School-Aged Adolescents in Six Pacific Island Countries in Oceania

The aim of this study was to assess overweight and obesity and associated factors in school-going adolescents in six Pacific Island countries in Oceania. The sample included 10,424 school-going adolescents predominantly 13–16 years old from Fiji, Kiribati, Samoa, Solomon Islands, Tonga, and Vanuatu. Bivariate and multivariable analyses were conducted to assess the relationship between dietary behaviour, substance use, physical activity, psychosocial factors, social-familial influences, and overweight or obesity. The prevalence of overweight and obesity was determined based on self-reported height and weight and the international child body mass index standards. Results indicate a prevalence of overweight or obesity of 24.3% and obesity of 6.1% in the six countries, ranging in terms of overweight or obesity and obesity from 12.0% and 0.4% in Vanuatu to 58.7% and 21.1% in Tonga, respectively. In multivariable regression analysis, being female was associated with overweight, carbonated soft drink use with obesity, sedentary behaviour with overweight or obesity, suicidal ideation with overweight, having close friends and peer support with overweight and obesity, parental or guardian supervision with overweight, and parental or guardian bonding was associated with overweight or obesity. High prevalence rates of overweight and obesity were found and several factors identified which can help guide interventions.

Overweight, obesity, physical activity and sugar-sweetened beverage consumption in adolescents of Pacific islands: results from the Global School-Based Student Health Survey and the Youth Risk Behavior Surveillance System

BACKGROUND

Overweight, obesity and their consequences are challenges to sustainable social and economic development in Pacific island countries and territories (PICTs). Complementing previous analyses for adults, the purpose of this paper is to synthesise available data on overweight, obesity and their risk factors in adolescents in the region. The resulting Pacific perspective for the younger generation will inform both the national and regional public health response to the crisis of noncommunicable diseases.

METHODS

We examined the prevalence of overweight, obesity, physical activity and carbonated sugar-sweetened beverage (SSB) consumption, by using published results of two cross-sectional surveys: the Global School-Based Student Health Survey (GSHS) and the Youth Risk Behavior Surveillance System (YRBSS). GSHS was conducted in ten PICTs between 2010 and 2013 and provided results for 13-15 year olds. YRBSS surveys, conducted repeatedly in five PICTs between 1999 and 2013, provided results for grade 9-12 students (approximately 14-18 years) and enabled examination of trends.

RESULTS

Obesity prevalence ranged from 0 % in female students in Vanuatu to 40 % in males in Niue (GSHS). Among grade 9-12 students (YRBSS), obesity was highest in American Samoa (40 % of males; 37 % of females). Approximately 60 % of students in the Cook Islands, Niue and Tonga (GSHS) and American Samoa (YRBSS), were overweight. In both surveys, less than half of students reported engaging in sixty minutes of physical activity on at least 5 days of the past week. Daily consumption of carbonated SSBs in the past month was reported by over 42 % of students in six PICTs (GSHS), and in the past week by more than 18 % of students in three PICTs (YRBSS). In PICTs conducting YRBSS, obesity prevalence remained high or increased within the period 1999-2013.

CONCLUSION

There is a need for urgent action on overweight, obesity and their risk factors in Pacific youth. The multiple social, economic and physical determinants of this public health crisis must be addressed. This requires all sectors within government and society in PICTs to implement and evaluate policies that will protect and promote the health of their populations across the life course.

Prevalence of behavioural risk factors for cardiovascular disease in adolescents in low-income and middle-income countries: an individual participant data meta-analysis

BACKGROUND

Although overt manifestations of cardiovascular disease (CVD) rarely emerge before adulthood, CVD risk factors are often present in adolescents. However, the prevalence and magnitude of behavioural CVD risk factors in adolescents in low-income and middle-income countries remains unclear. We estimated the magnitude and co-occurrence of behavioural CVD risk factors in adolescents aged 12-15 years for 65 low-income and middle-income countries between 2003 and 2011.

METHODS

We extracted Global School-Based Student Health Surveys (GSHS) datasets from the Centers for Disease Control and Prevention (CDC) website. Pooled prevalence estimates of current tobacco use, alcohol use, low fruit and vegetable intake, low physical activity, obesity and co-occurrence of CVD risk factors for WHO regions and overall, was calculated with random-effects meta-analysis. We explored potential sources of heterogeneity for each CVD risk factor through random-effects meta-regression analysis.

FINDINGS

Between 2003 and 2011, of 169 369 adolescents, 12·1% (95% CI 10·2-14·1) used tobacco, 15·7% (12·3-19·5) used alcohol, 74·3% (71·9 -76·5) had low fruit and vegetable intake, 71·4% (69·5-73·3) reported low physical activity and 7·1% (5·6-8·7) were obese. The pooled regional prevalence of exposure to three or more CVD risk factors was lowest in the southeast Asian region (3·8%, 95% CI 1·2-7·5) and highest in the western Pacific region (18·6%, 12·8-25·3). Substantial heterogeneities within and across regions were not fully explained by major study characteristics.

INTERPRETATION

In low-income and middle-income countries, adolescents carry a substantial burden of behavioural CVD risk factors, which tend to co-occur. Surveillance, prevention, detection, and control initiatives are a global health priority.

FUNDING

None.

The prevalence of underweight, overweight, obesity and associated risk factors among school-going adolescents in seven African countries

Background

The burden caused by the coexistence of obesity and underweight in Low and Middle Income Countries is a challenge to public health. While prevalence of underweight among youth has been well documented in these countries, overweight, obesity and their associated risk factors are not well understood unlike in high income countries.

Methods

Cross-sectional data from the Global School-based Student Health Survey (GSHS) conducted in seven African countries were used for this study. The survey used a clustered design to obtain a representative sample (n = 23496) from randomly selected schools. 53.6% of the sample was male, and participants ranged in age from 11-17 years old. Body Mass Index (BMI) was calculated using age and sex adjusted self-reported heights and weights. Classification of weight status was based on the 2007 World Health Organization growth charts (BMI-for-age and sex). Multivariable Logistic Regression reporting Odds Ratios was used to assess potential risk factors on BMI, adjusting for age, sex, and country. Statistical analyses were performed with Stata with an alpha of 0.05 and reporting 95% confidence intervals.

Results

Unadjusted rates of being underweight varied from 12.6% (Egypt) to 31.9% (Djibouti), while being overweight ranged from 8.7% (Ghana) to 31.4% (Egypt). Obesity rates ranged from 0.6% (Benin) to 9.3% (Egypt). Females had a higher overweight prevalence for every age group in five of the countries, exceptions being Egypt and Malawi. Overall, being overweight was more prevalent among younger (≤12) adolescents and decreased with age. Males had a higher prevalence of being underweight than females for every country. There was a tendency for the prevalence of being underweight to increase starting in the early teens and decrease between ages 15 and 16. Most of the potential risk factors captured by the GSHS were not significantly associated with weight status.

Conclusions

The prevalence of both overweight and underweight was relatively high, demonstrating the existence of the double burden of malnutrition among adolescents in developing countries. Several factors were not associated with weight status suggesting the need to explore other potential risk factors for overweight and underweight, including genetic factors and socioeconomic status.

Challenges in assessing depressive symptoms in Fiji: A psychometric evaluation of the CES-D

BACKGROUND AND AIM

The CES-D is a commonly used self-report assessment for depressive symptomatology. However, its psychometric properties have not been evaluated in Fiji. This study aims to evaluate the reliability and validity of English language and Fijian vernacular versions in ethnic Fijian adolescent schoolgirls.

METHODS

As part of the HEALTHY Fiji study, ethnic Fijian female adolescents (N = 523) completed the CES-D. Participants selected to respond in English or the local vernacular. Reliability (internal consistency, item-total score correlation, and test-retest estimates), validity (associations with other proxies for depression) and factor structure were assessed. Evaluations considered differences between language versions.

RESULTS

In this sample, the CES-D had a Cronbach's α of 0.81 and item-total score correlation coefficients ranged between 0.2 and 0.63. One week test-retest reliability (ICC(2)) was 0.57. CES-D scores were higher among individuals who endorsed feelings of depression and suicidality compared to those who did not. ROC analyses of the CES-D versus binary depression and suicidality variables produced AUCs around 0.70 and did not support a discrete cut-off for significant disturbance. Findings were similar across the two language groups.

CONCLUSIONS

The CES-D has acceptable reliability and validity among ethnic Fijian female adolescents in English and in the Fijian vernacular language. Findings support its utility as a dimensional measure for depressive symptomatology in this study population. Further examination of its clinical utility for case finding for depression in Fijian school-based and community populations is warranted.

Injury and social correlates among in-school adolescents in four Southeast Asian countries

The aim of this study was to determine estimates of the prevalence and social correlates of injury among adolescents in four Southeast Asian countries. Cross-sectional national data from the Global School-based Health Survey (GSHS) included 9,333 students at the ages from 13 to 15 years inclusive from Indonesia, Myanmar, Sri Lanka and Thailand is chosen by a two-stage cluster sample design to represent all students in grades 6, 7, 8, 9, and 10 in each country. The percentage of adolescents reporting one or more serious injuries within the past 12 months was 42.2% for all countries, ranging from 27.0% in Myanmar to 46.8% in Thailand. By major activity, “fall” (14.6%) was the leading external cause of injury, followed by playing or training for a sport (9.9%) and vehicle accident (6.1%). In multivariate regression analysis Thailand and Indonesia, being male, substance use (smoking and drinking alcohol) and psychological distress were associated with annual injury prevalence. Risk factors of substance use and psychological distress should be considered in an integrated approach to injury etiology in planning injury prevention and safety promotion activities among school children.

Breakfast skipping as a risk correlate of overweight and obesity in school-going ethnic Fijian adolescent girls

The prevalence of overweight and obesity has increased globally, and population data suggest that it is also increasing among ethnic Fijian youth. Among numerous behavioural changes contributing to overweight in youth residing in nations undergoing rapid economic and social change, meal skipping has not been examined as a potential risk factor. The study objectives were to assess the prevalence of overweight, obesity, and breakfast skipping and examine their cross-sectional association in a community sample of school-going ethnic Fijian adolescent girls (N=523). We measured height and weight, and assessed dietary patterns, eating pathology, dimensions of acculturation, and other socio-demographic and cultural data by self-report. We observed a high prevalence of both overweight (41%, including 15% who were obese) and breakfast skipping (68%). In addition, in multivariable analyses unadjusted for eating pathology, we found that more frequent breakfast skipping was associated with greater odds of overweight (odds ratio (OR)=1.15, confidence interval (CI)=1.06, 1.26, p<0.01) and obesity (OR=1.18, CI=1.05, 1.33, p<0.01). Regression models adjusting for eating pathology attenuated this relation so that it was non-significant, but demonstrated that greater eating pathology was associated with greater odds of both overweight and obesity. Future research is necessary to clarify the relation among breakfast skipping, eating pathology, and overweight in ethnic Fijian girls, and to identify whether breakfast skipping may be a modifiable risk factor for overweight in this population.