Self-rated health, subjective social status in school and socioeconomic status in adolescents: a cross-sectional study

Predictors for psychosocial consequences of screening for liver diseases: A data-driven approach

BACKGROUND

Medical screening is employed to detect early signs of diseases in asymptomatic populations, potentially improving patient outcomes through early intervention. However, the psychosocial impact of screenings remains a field of discussion. Inconsistent findings from studies, mainly originally from cancer research, are not easily transferable to the context of liver screening. This study aimed to identify predictors of psychosocial consequences in asymptomatic adults screened for early-stage liver cirrhosis, thereby contributing to the current knowledge on screening impact.

METHODS

We analyzed data from 487 participants who underwent a systematic liver disease screening in Germany from January 2018 to February 2021. The screening involved blood tests, advanced diagnostics, and potentially, liver biopsies. We used bootstrapped LASSO regression with 10-fold validation to evaluate the influence of various predictors on psychosocial outcomes measured by the Psychological Consequences of Screening Questionnaire (PCQ).

RESULTS

The results show that severity of comorbidities (beta =  0.44-2.72), subjective social status (beta =  -0.30--0.86), and social support (beta =  -0.33--0.98) were consistent predictors across all psychosocial outcome measures by not covering zero in the confidence intervals. Older age (beta =  -0.03--0.08), the existence of a steady partnership (beta =  -1.08--0.48) and higher health literacy regarding the application of medical information (beta =  0.33-0.48) were associated with less psychosocial dysfunction, indicating their protective roles to prevent psychosocial burden of screening.

CONCLUSION

The study underscores the importance of considering individual patient characteristics in predicting psychosocial consequences of medical screening. Medical practitioners should consider personalized communication strategies taking into account the individual context of patients. The protective role of social support and stable personal relationships suggests that integrating psychosocial support services within screening programs could mitigate negative outcomes. Furthermore, increasing patient health literacy might help to demystify the screening process and can reduce psychosocial burden even if patients come from a segment of lower subjective social status.

The relationship between online communication and mental health and cardiorespiratory fitness from ages 15 to 17: a longitudinal cohort study

BACKGROUND

Adolescence is a critical developmental period marked by significant mental and physical health changes. This longitudinal study examines the relationship between online communication and health from age 15 to 17, focusing on mental health indicators (depression, anxiety, self-esteem, and body image) and cardiorespiratory fitness (CRF). We aimed to assess whether increased time spent in online communication is associated with poorer mental health and lower CRF among adolescents, with consideration of potential moderating effects of sex and socioeconomic status (SES).

METHODS

Data were collected from 315 Icelandic adolescents at age 15 (2015) and age 17 (2017; N = 236). Linear mixed-effects models were used to examine the association between online communication and health outcomes, including depression, anxiety, body image, self-esteem, and CRF. Models accounted for year, sex, and SES, with random intercepts for individual variability.

RESULTS

More online communication was significantly associated with poorer mental health outcomes, including more symptoms of depression (p < 0.001, marginal R² = 0.14), anxiety (p = 0.032, marginal R² = 0.13), lower self-esteem (p = 0.006, marginal R² = 0.07), more negative body image (p = 0.010, marginal R² = 0.13), and lower CRF; p = 0.003, marginal R² = 0.35). These associations did not change between years and were consistent across sex and SES groups. CRF declined from age 15 to 17. Females reported generally worse mental health and lower CRF than males, while higher SES was linked to lower depression scores and higher self-esteem. However, no significant interactions were found between online communication, sex, or SES, suggesting that the impacts of online communication on health were broadly applicable across demographic groups.

CONCLUSIONS

This study underscores the potential negative effects of online communication on mental and physical health among adolescents, regardless of sex or SES. The findings highlight the importance of balancing time spent online communicating with physical activity to support overall adolescent well-being. These insights could inform public health initiatives and preventive strategies to foster healthier digital habits in an increasingly online world, especially during this sensitive developmental period.

School absence policy and healthcare use: a difference-in-difference cohort analysis

BACKGROUND

A national policy in Norway demanding certificates for medical absences in upper secondary school was implemented in 2016, leading to an increase in general practitioner (GP) visits in this age group.

OBJECTIVES

To assess the policy's effect on the use of primary and specialist healthcare.

METHODS

A cohort study following all Norwegian youth aged 14-21 in the years 2010-2019 using a difference-in-differences approach comparing exposed cohorts expected to attend upper secondary school after the policy change in 2016 with previous unexposed cohorts. Data were collected from national registries.

RESULTS

The absence policy led to the increased number of contacts with GPs for exposed cohorts during all exposed years, with estimated incidence rate ratios (IRRs) in the range from 1.14 (95% confidence intervals [CI] 1.11-1.18) to 1.25 (95% CI 1.21-1.30). Consultations for respiratory tract infections increased during exposed years. However, there was no conclusive policy-related difference in mental health consultations with GPs. In specialist healthcare we did not find conclusive evidence of an effect of absence policy on the risk of any contact per school year, but there was a slightly increased risk of contacts with ear-nose-throat specialist services.

CONCLUSIONS

We found an increase in general practice contacts attributable to the school absence policy. Apart from a possible increase in ear-nose-throat contacts, increased GP attention did not increase specialized healthcare.

Associations Between Subjective Social Status and Health Behaviors Among College Students

OBJECTIVE

Examine the associations between subjective social status (SSS), diet, and health outcomes in college students.

METHODS

Cross-sectional study of 841 students enrolled at a large Midwestern university. Subjective social status within the US, as well as within the university, was measured using the MacArthur Scale of SSS. Outcomes included dietary intake (assessed using the Dietary Screening Questionnaire), body mass index, sleep, physical activity, alcohol use, and vaping behavior. Generalized linear models adjusting for students' sociodemographic characteristics were used to assess associations between SSS and outcomes of interest.

RESULTS

Higher SSS-US was associated with 4%, 3%, and 1% higher intake of fruits, whole grains, and fiber, respectively (P < 0.05). Higher SSS-US and SSS-university rankings were both significantly associated with lower body mass index and better sleep duration (P < 0.05). Higher SSS-university rankings were also associated with more days of physical activity and alcohol consumption (P < 0.05).

CONCLUSIONS AND IMPLICATIONS

In this exploratory study, higher SSS, apart from alcohol intake, was associated with more favorable health outcomes. More research is needed to consider additional psychological and biological mediators and dynamic aspects of SSS, examine potential interactions between SSS and racial and ethnic identities, and explore potential mechanisms underlying the observed associations.

Daily Fluctuations in Adolescents' Perceived Friend Dominance and Friendship Clout: Associations with Mood and the Moderating Role of Anxiety

Emerging evidence suggests that whereas occupying high peer status promotes adolescents' well-being, feeling dominated by friends confers psychological costs. However, little is known about day-to-day power dynamics of adolescents' friendships or their acute affective consequences. This 14-day intensive longitudinal study introduced novel daily assessments of friend dominance and friendship clout, examined their associations with mood, and tested anxiety as a moderator. Participants were 195 11th-graders (Mage = 16.48, SDage = 0.35; 66% female). Multilevel models revealed that adolescents experienced worse mood on days they felt dominated by friends and better mood on days they felt powerful and influential among friends. Associations with negative mood were strongest for adolescents higher in anxiety. The findings underscore the dynamic nature of power in adolescents' friendships.

Russian young people's subjective health evaluations, self-care practices, and therapeutic networks

This study investigates the relationship between young people's subjective health evaluations, self-care practices, and therapeutic networks using semi-structured interviews and the computerized qualitative thematic analysis capabilities of the MAXQDA software. In the summer of 2022, 41 Russian youths, ages 16 to 25, took part in this investigation. The major findings demonstrate that young people who had low health evaluations were more likely to conduct self-care with the intention of enhancing their health and to have mothers and other medical experts in their therapeutic networks. Furthermore, individuals who claimed that their health was inadequate engaged in more sports and took care of themselves even when they were ill. There was no association between the objectives of self-care practices, members of the therapeutic network, and self-care activities in terms of the type of health evaluation. Overall, it is possible to suggest that the practices and the structure of therapeutic networks are related to self-evaluated health, but quantitative study is needed to verify the causal relationship.

The Relationship between Self-Rated Health and Physical Fitness in Polish Youth

Self-rated health (SRH) is a tool for assessing a population's health across the lifetime, and seems to be a dynamic assessment of current health status and a strong predictor of cardiovascular disease and mortality, whereas insufficient levels of physical fitness in adolescence are a significant health problem and may contribute to the development of many disorders in adulthood. In this cross-sectional study, we attempted to assess the relationship between SRH and the physical fitness of adolescents. Two hundred and thirty-five adolescents (eighty-five boys and one hundred and fifty girls) aged 16-17 were recruited for this study. The study procedures included a short author questionnaire and physical fitness assessment (Zuchora's Physical Fitness Index). Boys declared better health states and reported less frequent morbidity of seasonal diseases (p < 0.05). No differences were found in physical fitness, the incidence of postural disorders, lower limb malalignments, foot deformities, sleep duration, and perception of physical activity on physical condition and well-being in boys and girls (p > 0.05). The comparison of physical fitness levels in adolescents with different SRH, sleep duration, perceptions of physical activity on physical condition and well-being also showed significant differences (p < 0.05). Positive SRH and perception of physical activity on physical condition and well-being, proper sleep duration (7-8 h/night), and a lack of foot deformities are associated with a better physical fitness in adolescents. Physical fitness seems to be a good predictor of SRH only in Polish boys, but not girls and the entire population. The lack of significance in the entire population could be attributed to the substantial number of girls in the study group. Despite that, it is recommended to encourage adolescents to engage in regular exercises, sleep routines and healthy lifestyles. Further research should be based on a more representative group, with a comparable number of girls and boys in the study group and potential confounders, but also they should be focused on SRH predictors to improve SRH in Polish girls.

Investigating Links between Moderate-to-Vigorous Physical Activity and Self-Rated Health Status in Adolescents: The Mediating Roles of Emotional Intelligence and Psychosocial Stress

Adolescence represents a crucial phase, characterized by rapid physical and mental development and numerous challenges. Physical activity plays a vital role in the mental well-being of adolescents; however, due to the prevailing educational philosophy prioritizing academic performance, adolescent participation in physical activities has yet to reach its full potential. Thus, this study aims to investigate the effects of moderate-to-vigorous physical activity on adolescents' emotional intelligence, psychosocial stress, and self-rated health status. To achieve this objective, a cluster sampling method was employed to collect data from 600 adolescents in 10 schools across five municipal districts of Changsha, China. A total of 426 valid questionnaires were returned and analyzed. Utilizing AMOS v.23, a structural equation model was constructed to validate the hypotheses. The findings reveal that moderate-to-vigorous physical activity significantly impacts adolescents' emotional intelligence and self-rated health status. Conversely, it exerts a significant negative influence on their psychosocial stress. Moreover, emotional intelligence and psychosocial stress mediate the relationship between moderate-to-vigorous physical activity and self-rated health status. In light of these results, education departments, schools, and families must embrace a paradigm shift in educational philosophies and provide robust support for adolescents to engage in moderate-to-vigorous physical activities.

Age at menarche of adolescent girls and the neighbourhood socioeconomic status of their school area

PURPOSE

To assess the association between abnormal timing of menarche among adolescent girls and neighbourhood socioeconomic status of their school area.

MATERIALS AND METHODS

Our analysis included 187,024 girls aged 15-18 years from the Korea Youth Risk Behaviour Web-Based Survey (KYRBS) from 2007 to 2015. Early and late menarche were defined as menarche before 11 years and no menarche by age 14 years, respectively. The deprivation index values for the areas where the schools were located were used as an indicator of neighbourhood socioeconomic status based on the 2005 national census data. We calculated odds ratios (OR) for early and late menarche using a multinomial logistic regression model. Covariates included body mass index, parental education, single or stepparents, siblings, household wealth, year of birth, survey year, and urbanisation.

RESULTS

Mean age at menarche was 12 years. The overall proportions of early and late menarche were 11.3% and 3.3%, respectively. When divided into four quartile groups based on the socioeconomic deprivation index, 11.3% of girls in the most deprived quartile and 10.6% in the least deprived area showed early menarche. The prevalence of late menarche did not differ across the deprivation index quartiles of school area. Attendance at schools located in highly deprived areas was associated with up to 10% higher risk of early menarche. This positive association was not evident for late menarche.

CONCLUSION

Among contemporary Korean girls, socioeconomic deprivation of the school area was associated with earlier puberty. This finding highlights the potential role of the socioeconomic environment of schools in women's lifetime health.

Self-rated physical health, health-risk behaviors, and disparities: A cross-sectional study of youth in the slums of Kampala, Uganda

Self-rated physical health (SRPH) has been extensively used to assess health status. In this study, we examine how youth living in the slums of Kampala perceive their physical health and the psychosocial correlates of poor health. Cross-sectional data from the 2014 Kampala Youth Survey (N = 1,134) of youth ages 12-18 years was used to conduct the analyses. Chi-square tests and logistic regression analyses were conducted to determine associations between SRPH, demographic and psychosocial characteristics. Overall, 72% of youth rated their health as 'excellent' or 'good.' Poor SRPH was associated with older age and lower education, but not with sex. Also, orphans (OR = 2.03; 95%CI:1.51-2.72), those who lived on the streets (OR=3.09; 95%CI:2.30-4.15), who did not have electricity (OR = 2.83;95%CI:2.12-3.78), who initiated alcohol use early (OR = 2.08; 95%CI:1.47-2.94), who frequently get drunk (OR = 5.67; 95%CI:2.69-11.96), who were HIV positive (OR = 2.18; 95%CI:1.47-3.23), who had been injured due to their drinking (OR = 2.09; 95%CI:1.44-3.03), who thought about hurting themselves (OR = 2.09; 95%CI:1.60-2.73), and those who often felt lonely (OR = 2.54; 95%CI:1.61-4.02) had higher odds of poor SRPH compared to their peers without these characteristics. Poor SRPH may serve as a marker for multiple health-risk behaviors and severe health disparities among youth in vulnerable and resource-limited settings.

The impact of school life and family involvement on Western China junior high school students’ wellbeing at multidimensional levels

Background

The focus of students’ health concerns has gradually progressed from the single factor of physical health to comprehensive health factors, and the physical and mental health of students are now generally considered together. This study focuses on exploring the status of junior high school students’ physical health and their subjective health assessment with the major societal factors that affect students’ lives: School Life and Family involvement. In addition, we explore the main factors influencing students’ subjective health.

Methods

A cross-sectional survey was conducted with 190 Tibetan junior high school students in the Maozhuang Township. The intentional sampling was used to choose the research object. The structured questionnaire comprised four parts, namely social and demographic information, family condition, school life, and subjective health quality which was assessed by PROMIS (Chinese version of the Pediatric Patient-Reported Outcomes Measurement Information System).

Result

The average height and weight of boys and girls are statistically different (p-values of 0.026 and 0.044, respectively), but there is no statistically significant difference in BMI (Body Mass Index) between boys and girls (p-value of 0.194). The average values of the five dimensions of depression, anger, anxiety, fatigue, and peer relationships in the PROMIS of the research subjects were 58.9 ± 5.3, 53.3 ± 8.0, 58.1 ± 7.3, 52.8 ± 8.0, 39.3 ± 6.6. In the demographic dimension, the grade was the main factor influencing anger (p < 0.01) and fatigue (p < 0.01), while gender was related to peer relationships (p = 0.02). In the family dimension, the father’s educational level was related to peer relationships (p = 0.05), while the family financial situation was related to depression (p = 0.01). In the school life dimension, relationship with classmates was found to affect anger (p = 0.05), while homework was related to anxiety (p = 0.02) and fatigue (p = 0.05).

Conclusion

the physical health index BMI and subjective health evaluation of students are worse than students of more developed areas in China. Their family environment and school life all have varying degrees of impact on the five subjective health outcomes. There are differences in gender and grade level. The government and society need to pay more attention to the physical and mental health of students in remote and underdeveloped areas and improve their health through a student nutrition plan and the establishment of mental health offices.

Concern of adolescents in conflict with the Law about their oral health

Objective: To assess the self-perception of adolescents in conflict with the law about their concern with oral health, in addition to tracing their relationship with other related variables. Methods: A cross-sectional study involving male institutionalized adolescents in a city in southern Brazil who underwent clinical examination and interviews to understand their concern for their oral health and the relationship between this outcome and associated factors. Concern about oral health was obtained through a validated questionnaire. Two fitted models were performed using Poisson regression (α < 0.05). One of them used the decayed, missing, and filled teeth index (DMF-D), and another considered the components of this index as exploratory variables. Results: Sixty-eight adolescents were included, and a high occurrence (75%) of concern about their oral health was observed. In the final multivariate analysis that included DMFT, this index (prevalence ratio [PR]: 1.033; 95% confidence interval [95%CI]: 1.004 – 1.063) and concern about tooth color (PR: 2.208; 95%CI: 1.028 – 4.740) were significantly associated with oral health concerns. When the various index components were included in the multivariate model, only the number of decayed teeth (PR: 1.073; 95%CI: 1.007 – 1.144) and concerns about tooth color (PR: 2.250; 95%CI: 1.057 – 4.793) were associated with the outcome. Conclusion: Institutionalized adolescents are highly concerned about their oral health, being associated with a DMF index, especially the decayed component, and a concern with the color of their teeth.

Stress Mediates the Association Between Pain and Alcohol Use in College Students

Background

Alcohol use in young adults is highly prevalent and associated with numerous consequences, including academic difficulties and motor vehicle accidents. Pain is one factor that has been increasingly shown to be associated with higher rates of alcohol consumption and riskier patterns of drinking among undergraduate students. Although pain has traditionally been viewed as a lesser concern for young adults, current research demonstrates that pain may be more prevalent in younger populations than originally thought. However, little is known about how common psychosocial factors, such as stress and subjective social status (SSS), influence the association between pain and alcohol consumption in college students.

Objective

The study's goal was to examine the effect of stress and SSS on the relationship between pain and alcohol consumption.

Participants and Methods

Participants (N = 445, 39.3% women, Mage = 22.98) were 18- to 25-year-old college students who completed an online questionnaire.

Results

Pain was significantly associated with total weekly alcohol consumption (r(445) = .22, p < 0.001); this association was significantly mediated by stress (b = 0.15, SE = 0.04, 95% CI = [.07,0.23]). SSS was significantly positively associated with alcohol consumption (r(445) = .22, p < 0.001) but was not found to significantly moderate the relationship between stress and alcohol use.

Conclusion

Results suggest that efforts to reduce college student alcohol use should include assessment of pain and stress given their association with alcohol consumption. Further, findings suggest that future studies are warranted to prospectively examine pain as an antecedent for alcohol use and to examine the utility of incorporating stress management techniques in pain-focused interventions to indirectly target alcohol use.

Sense of Unity and Self-Reported Health Among 15-year-Olds: Findings From the Swedish 2017/18 Health Behavior in School-Aged Children Study

Objectives: Sense of unity refers to the positive feeling of being part of a larger social structure. This study aimed to investigate to what extent adolescents report sense of unity and if this differs across groups, and to assess the associations between sense of unity and self-reported health while taking into account sociodemographic characteristics and tangible social relationships. Methods: Data were obtained from the 2017/18 Swedish Health Behavior in School-aged Children study, using information collected among 15-year-old students (n = 1,392). Linear and binary logistic regression analyses were performed. Results: The participants reported overall high levels of sense of unity. Sense of unity did not differ by gender, but adolescents without an immigrant background and those with higher family affluence reported higher levels. Sense of unity was inversely associated with psychological complaints, somatic complaints, and less than good self-rated health, even when adjusting for sociodemographic characteristics and family, classmate, and teacher relationships. Conclusion: This study suggests that sense of unity may be an important social determinant for adolescent health. More research is needed on the origins and implications of sense of unity.

Family socioeconomic status, subjective social status, and achievement motivation among Chinese college freshmen: A latent growth modeling approach

This study’s objective was to examine direct and indirect relationships among family socioeconomic status, subjective social status, and achievement motivation within the first 3 months after college freshmen enrollment in China. A longitudinal dataset was collected over a 3-month period at four measurement points with 4-week intervals. A cluster sample of 1,983 college freshmen from the eastern, central, and western economic regions of China was surveyed. Latent growth modeling was conducted. The results indicated that achievement motivation decreased over time and was positively related to a decline in subjective social status. Mediation analyses demonstrated that, after controlling for sex and economic region, family socioeconomic status predicted the initial level of achievement motivation directly and indirectly through the initial level of subjective social status, and notably, the directions of these effects were opposite. Further, family socioeconomic status also significantly predicted the rate of change in achievement motivation indirectly through the initial level of subjective social status. These results highlight the longitudinal relationship between family socioeconomic status and achievement motivation via different pathways and have implications for improving college freshmen’s achievement motivation.

The Sequential Mediating Effects of Dietary Behavior and Perceived Stress on the Relationship between Subjective Socioeconomic Status and Multicultural Adolescent Health

Studies have examined the impact of social determinants of health on the health behaviors and health statuses of ethnic minority adolescents. This study examines the subjective health of this population by examining the direct effects of multicultural adolescents’ subjective socioeconomic status (SES) and the sequential mediating effects of their dietary behaviors and perceived stress. We utilized secondary data of 500 middle school students from multicultural families who participated in the 15th Korean Youth Health Behavior Survey, 2019. Information about SES, perceived stress, subjective health status, and dietary behavior (measured by the breakfast intake frequency during the prior week) were utilized. For the relationship between the SES and the subjective health status, we confirmed the sequential mediating effects of breakfast frequency and perceived stress using SPSS 25.0 and PROCESS macro with bootstrapping. The results showed that SES had a direct effect on subjective health status and indirectly influenced subjective health status through the sequential mediating effect of breakfast frequency and perceived stress. However, SES had no direct effects on perceived stress. These findings emphasize that broadening the community-health lens to consider the upstream factor of SES when preparing health promotion interventions is essential to achieving health equity for vulnerable populations.

Playing the complex game of social status in school - a qualitative study

BACKGROUND

Research suggests that social status in school plays an important role in the social lives of adolescents and that their social status is associated with their health. Additional knowledge about adolescents' understanding of social hierarchies could help to explain inequalities in adolescents' health and guide public health interventions.

OBJECTIVE

The study aimed to explore what contributes to subjective social status in school and the strategies used for social positioning.

METHODS

A qualitative research design with think-aloud interviews was used. The study included 57 adolescents in lower (7^th grade) and upper secondary school (12^th grade) in Sweden. Subjective social status was explored using a slightly modified version of the MacArthur Scale of Subjective Social Status in school. Data were analyzed using thematic network analysis.

RESULTS

The participants were highly aware of their social status in school. Elements tied to gender, age, ethnicity and parental economy influenced their preconditions in the positioning. In addition, expectations on how to look, act and interact, influenced the pursue for social desirability. The way these different factors intersected and had to be balanced suggests that social positioning in school is complex and multifaceted.

CONCLUSIONS

Because the norms that guided social positioning left little room for diversity, the possible negative impact of status hierarchies on adolescents' health needs to be considered. In school interventions, we suggest that norms on e.g. gender and ethnicity need to be addressed and problematized from an intersectional approach.

Determinants of self-perceived oral health in adolescents: A cross-sectional study

BACKGROUND

Self-perceived oral health (SPOH) is a summary of multiple determinants related to oral health and has been suggested for use in clinical practice as a health assessment tool.

AIM

To analyse determinants of SPOH among adolescents.

DESIGN

In 2018, we selected 1742 participants from eight high schools in Olinda/PE, Brazil, using a multistage stratified cluster sample. The main survey item of SPOH was 'How would you rate your oral health'. Determinants of were queried with a questionnaire and a clinical examination: socio-demographic variables, exposure to family violence, somatic symptoms, and orofacial and general health factors. Pearson's chi-square test and logistic regressions evaluated associations between determinants and SPOH.

RESULTS

Very poor SPOH had a prevalence of 8.7%. Nearly half (43.5%) rated their oral health as 'fair'. Very poor SPOH was associated with poor self-perceived general health (OR = 2.60), anterior open bite (OR = 2.24), not cohabiting with one or both parents (OR = 2.40), caries experience (OR = 1.93), dental pain (OR = 1.91), and temporomandibular disorders (OR = 1.77).

CONCLUSION

Very poor self-perceived oral health indicates life stress and associates with poor oral conditions. Assessments should be used to explore individual treatment needs and abilities to comply with recommendations.

Secular trends in adolescents' diagnosed health status and healthcare consultation: examinations of Canadian national surveys from 2007 to 2016

OBJECTIVES

The objective of this study was to investigate secular trends in adolescent health status and healthcare consultations.

STUDY DESIGN

The design of this study is cross-sectional comparisons of population survey outcomes.

METHODS

Canadian national population data from 2007 to 2016 (T1 N = 14,223; T2 N = 14,247; T3 N = 13,532; T4 N = 13,184; T5 N = 11,122; Total N = 66,308) were examined to find trends in health diagnosis (chronic illnesses and mental disorders) and healthcare consultation (general health practitioners and mental health professionals). Controlling demographics, Multivariate analysis of covariances (MANCOVAs) and correlations were carried out to compare differences by age group (A1: 12-14 years N = 25,180; A2: 15-17 years N = 25,825; A3: 18-19 years N = 15,303) and gender (girls N = 32,388; boys N = 33,920) across survey years.

RESULTS

Steady increases were found in diagnosed mental disorders and consultations with a mental health professional (MP) for girls, while chronic illnesses remained stable and general practitioner consultations declined for all adolescents over these years. Gender disparity in MP consultations grew with age, much more in recent years, whereas chronic illness diagnoses curved down for all in midadolescence. More integrated relations between health status and healthcare utilization were noted in T5 than in T1.

CONCLUSIONS

Differential secular trends were shown for adolescent physical versus mental health statuses and relevant healthcare consultations. Although girls' and older adolescents' mental health declined over the years, a positive direction was also found for improved awareness of mental health.

Socioeconomic Status and Psychological Well-Being: Revisiting the Role of Subjective Socioeconomic Status

Socioeconomic status (SES) is a complex and multidimensional construct, encompassing both independent objective characteristics (e.g., income or education) and subjective people's ratings of their placement in the socioeconomic spectrum. Within the growing literature on subjective SES belongingness and psychological well-being, subjective indices of SES have tended to center on the use of pictorial rank-related social ladders where individuals place themselves relative to others by simultaneously considering their income, educational level, and occupation. This approach, albeit consistent with the idea of these social ladders as summative or cognitive SES markers, might potentially constrain individuals' conceptions of their SES. This research (N = 368; M age = 39.67, SD = 13.40) is intended to expand prior investigations on SES and psychological well-being by revisiting the role of subjective SES. In particular, it (a) proposes an innovative adaptation of the traditional MacArthur Scale of subjective SES to income, education, and occupation, thus resulting in three separate social ladders; and (b) tests the empirical contribution of such three social ladders to psychological well-being. Overall, our findings showed that the novel education and occupation ladders (excluding the income ladder) are predictive of a significant part of the variance levels of psychological well-being that is not due to canonical objective metrics of SES (i.e., income, education, and occupation), or to the conventional MacArthur Scale of subjective SES. Although preliminary, these results underscore the need to further reconsider (subjective) SES-related conceptualization and measurement strategies to gather a more comprehensive understanding of the SES-psychological well-being link.

Association of Early Menarche with Adolescent Health in the Setting of Rapidly Decreasing Age at Menarche

STUDY OBJECTIVE

This study aimed to investigate the association between age at menarche (AAM) and adverse health indicators in adolescent girls.

DESIGN

A retrospective cohort study.

SETTING

Population-based survey data.

PARTICIPANTS

A total of 319,437 female participants aged 12-18 years from the Korea Youth Risk Behaviour Web-based Survey.

INTERVENTIONS AND MAIN OUTCOME MEASURES

We assessed associations between AAM (categorized as ≤10, 11, and ≥12) and health indicators (poor self-rated health, high psychological stress, unhappiness, sexual initiation, and pregnancy). Covariates were individual-level (bodyweight, living with family, parent's education, household wealth, and presence of parents and siblings) and community-level factors (year of birth, single-sex education and level of school, urbanization level of school area, year of survey, and regional deprivation). Odds ratios (ORs) for each adverse health indicator were examined by each AAM group using multivariable regression analyses. For pregnancy, we calculated relative risks (RRs) using a log-binomial regression model.

RESULTS

Age at menarche was <12 in 42% of our study population. Nearly one-half of the girls born in the early 2000s went through menarche before the age of 12 years, whereas only one-third of girls born in the early 1990s went through menarche before the age of 12 years. Girls who experienced menarche at age ≤10 or age 11 years were more likely to show self-rated poor health (AAM ≤ 10: OR, 1.28; 95% confidence intervals [CI], 1.22-1.34; AAM = 11: OR, 1.16; 95% CI, 1.12-1.21), high stress (OR, 1.19; 95% CI, 1.14-1.23, and OR, 1.10; 95% CI, 1.06-1.14), and sexual initiation (OR, 2.21; 95% CI, 2.05-2.38, and OR, 1.32; 95% CI, 1.23-1.41) compared to those with AAM ≥12 years when data were adjusted for all covariates. AAM ≤10 years was associated with consistently higher odds for poor health than AAM ≥12 years. The ORs of sexual initiation increased with earlier AAM. Risk of pregnancy was similar across AAM groups when individual- and community-level covariates were controlled for.

CONCLUSION

Early menarche, defined as <12 years, can be still a useful indicator in adolescent health interventions to identify high-risk groups in the setting of declining AAM.

The role of mental health, academic stress, academic achievement, and physical activity on self-rated health among adolescents in Iran: A multilevel analysis

BACKGROUND

Health promotion of adolescents requires appropriate evidences of its determinants. The aim of this study was to investigate predictors of self-rated health (SRH) among adolescents in Qazvin, Iran.

MATERIALS AND METHODS

In this descriptive cross-sectional study, with a multistage sampling method, we recruited 1740 adolescents aged 12-19 years from 53 schools in Qazvin, Iran (2018). We used the Strengths and Difficulties Questionnaire and Adolescents' Academic Stress Questionnaire for data collection. The analysis was conducted using a multilevel logistic regression model. Gender, educational period, and socioeconomic status were considered as confounders.

RESULTS

Almost 21% of the adolescents reported their SRH suboptimal. Suboptimal SRH was higher in girls and older adolescents. Mental health disorders and academic stress had a positive association with SRH. However, this association was negative for academic achievement and physical activity. The interaction between mental health disorders and academic stress with SRH had a significant association in a crud regression model.

CONCLUSION

Mental health, academic stress, academic achievement, and physical activity were important predictors for SRH. Interventions that focus on promoting mental health, academic stress, academic achievement, and physical activity such as physical activity for 1 h and each day for 3 days per week can improve SRH in adolescents. Hence, policymakers should pay more attention to this issue in health promotion programs of adolescents.

Health Literacy and Self-Rated Health among Homeless Adults

Poor health literacy reduces the efficacy of behavior change interventions, hampers management of health conditions, and attenuates understanding of the prevention and treatment of diseases. Poor health literacy has also been linked to fair/poor self-rated health in domiciled samples; however, there is a paucity of studies on the relation amongst homeless adults, who bear a disproportionate burden of disease and disability and require high level of care and access to health services. Here, we examined the association between health literacy and self-rated health among a convenience sample of homeless adults. Participants were recruited from six homeless-serving agencies in Oklahoma City (N = 575; 63% men, Mage = 43.6±12.3). Logistic regression was used to assess the association between health literacy (confidence completing medical forms: extremely/quite a bit vs somewhat/little bit/not at all) and self-rated health (poor/fair vs good/very good/excellent) controlling for age, subjective social status, education, race, sex, income, health insurance, employment, social security recipient status, diabetes diagnosis, high blood pressure diagnosis, and high cholesterol diagnosis. In the adjusted model, health literate homeless individuals had greater odds of endorsing good/very good/excellent self-rated health compared to those somewhat/a little bit/not at all confident completing medical forms (AOR = 2.02, [CI95% = 1.35-3.02]). Interventions targeted at adjusting reading level and comprehensibility of health information are needed for homeless individuals with poor/limited health literacy, which may ultimately impact their self-rated health. Shelters and homeless-serving agencies could host classes focused on practical skills for enhancing health literacy and/or provide navigation services.