Frequency of Vigorous physical activity and sleep difficulty in adolescents: A multiply-country cross-sectional study

BACKGROUND

Sleep is an essential health behavior, and sleep difficulties are strongly associated with adolescent health, potentially leading to more severe sleep disorders. The beneficial effects of physical activity (PA) in alleviating sleep difficulties have been well-documented. Numerous investigations reveal influence in moderate to high-intensity physical activity (PA) positively influences sleep quality. Despite these findings, a gap in the literature exists, particularly regarding the association between frequency of vigorous-intensity physical activity (VPA) and sleep difficulties.

AIM

This study aims to bridge the knowledge gap by exploring the link between sleep difficulty and frequency of VPA among adolescents. Insights are derived from analyzing data accumulated from the Health Behavior in School-aged Children (HBSC) project.

METHODS

The analysis in this study utilized cross-sectional data from the HBSC (2017/2018). The study sample comprised a total of 171,233 respondents aged 11, 13, and 15 years, with males representing 51.1% of sample. Measurement instruments included a self-administered questionnaire, providing direct insight into sleep difficulty and frequency of VPA levels. Statistical analysis on the associaiton between frequency of VPA and sleep difficulties was conducted using Generalized Linear Models.

RESULTS

50.0% of adolescents reported no sleep difficulties, while 12.3% experienced sleep issues daily. Additionally, 17.1% of adolescents engaged in frequency of VPA on a daily basis, while 6.4% never participated in such activities. daily VPA was associated with fewer sleep difficulties (OR = 1.07 [1.00, 1.15]), 4-6 times a week (OR = 1.08 [1.01, 1.15]), and 2-3 times a week (OR = 1.08 [1.02, 1.16]). However, no significant association was found between sleep difficulties and frequency of VPA in girls. Furthermore, a negative association was observed between sleep difficulties and all frequencies of VPA (p < 0.05) in 11-year-old adolescents. For 13-year-olds, daily VPA was significantly associated with fewer sleep difficulties (OR = 1.10 [1.02, 1.19]), 4-6 times a week (OR = 1.15 [1.07, 1.24]), 2-3 times a week (OR = 1.19 [1.10, 1.27]), and once a week (OR = 1.13 [1.05, 1.22]). However, no significant association was found between sleep difficulties and frequency of VPA in 15-year-old adolescents.

CONCLUSION

More participations in VPA would be an effective approach to reduce sleep difficulties in adolescents. Insights gleaned from this research illustrate a discernible link between sleep difficulty and frequency of VPA, particularly notable in male and 13-year-old participants. It is also imperative to underscore the variability in the connection between sleep difficulty and frequency of VPA, distinctly influenced by factors such as gender and age. Consequently, tailoring sleep intervention methodologies to align with the specific needs dictated by these variables emerges as a pivotal recommendation.

Intense and problematic social media use and sleep difficulties of adolescents in 40 countries

INTRODUCTION

Social media has become a ubiquitous part of everyday life; however, evidence suggests patterns of social media use can affect sleep health in children and adolescents. This study aimed to examine the associations of intense and problematic social media use (SMU) with sleep-onset difficulties in adolescence.

METHODS

We analysed data from 212,613 adolescents aged 11-15 years (51.1% girls) from 40 European and North American countries that participated in the 2017/2018 Health Behaviour in School-aged Children survey. Intense SMU assessed how often respondents had online contact through social media, and problematic SMU was assessed by symptoms of addiction to social media. Sleep-onset difficulties were assessed using a self-reported item. Multilevel mixed-effects logistic regression was used to obtain the estimates.

RESULTS

Sleep-onset difficulties were more common among girls than boys (27.1% vs 20.8%). Intense SMU was significantly associated with sleep-onset difficulties in boys in 17 countries and in girls in 25 countries, while problematic SMU was significantly associated in most of the participating countries. Overall, exposure to problematic SMU alone was highly associated with sleep-onset difficulties both in girls (OR 2.20, 2.04-2.38) and boys (OR 1.88, 1.73-2.04), while the association estimates for intense SMU were smaller and comparable across gender (Girls: OR 1.27, 1.23-1.31; Boys: OR 1.22, 1.18-1.27). Sensitivity analyses supported the above findings.

CONCLUSIONS

Intense and/or problematic SMU were associated with sleep-onset difficulties across gender with associations being higher for problematic compared to intense SMU. Prospective research with objective measures is needed to understand the causal mechanisms underlying these relationships.

Associations Between Recent Contraceptive Use and First Sex Behaviors of Scottish Adolescents: A Brief Report

Objectives

We examined associations between recent contraceptive use and first-sex behaviors (early initiation, substance use, contraceptive use) among adolescents in Scotland.

Methods

We used data from the Health Behavior in School-aged Children study.

Results

Controlling for early initiation and substance use, girls and boys who used contraceptives at first sex were 7.5 and 12.3 times more likely to use contraceptives at most recent sexual intercourse than adolescents who did not (p < .001). We also present preliminary evidence on contraceptive use of Scottish adolescents in 2022.

Conclusions

Experiences during adolescents' first sex may have lasting implications for later sexual behavior.

Bullying at School, Cyberbullying, and Loneliness: National Representative Study of Adolescents in Denmark

AIMS

The aim was to examine how loneliness was associated with bullying victimization at school and online.

METHODS

We used data from the Danish arm of the international Health Behavior in School-aged Children (HBSC) study from 2022. The study population was a nationally representative sample of 11-15-year-olds who completed the internationally standardized HBSC questionnaire at school, n = 5382. Multilevel logistic regression was applied to study the associations between bullying victimization and loneliness.

RESULTS

The prevalence of reporting loneliness often or very often was 9.0%; 6.3% of the sample experienced habitual bullying victimization at school, and 4.8% incurred cyberbullying. There was a strong and graded association between loneliness and bullying victimization at school and cyberbullying. The associations were significant for boys and girls, and the association between exposure to bullying at school and loneliness was steeper for boys than girls. The gradients were steeper for physical bullying than for cyberbullying. Students exposed to habitual bullying in both contexts had an adjusted OR (95% CI) of 11.21 (6.99-17.98) for loneliness.

CONCLUSION

Exposure to bullying at school and cyberbullying are strongly associated with loneliness. It is important to reduce bullying at school and on the internet and to promote effective interventions to reduce continuing loneliness.

Physical activity of older children and adolescents in Germany - Results of the HBSC study 2022 and trends since 2009/10

Background

Physical activity is central to health, beginning in childhood and adolescence, and regular monitoring provides important information for strategic decisions on promoting physical activity in Germany.

Methods

The current survey cycle of the Health Behaviour in School-aged Children (HBSC) study gives an insight into the prevalence of the indicators daily recommended physical activity, high and low physical activity, and sporting activity among students aged between 11 and 15 for 2022. In addition, the data is compared to the survey cycles of the 2009/10, 2013/14, and 2017/18 school years and analysed over time.

Results

The results of the current survey cycle show that 10.8 % of girls, 20.9 % of boys, and 12.4 % of gender diverse adolescents fulfil the daily physical activity recommendation. There are also major gender-specific differences for the other indicators. The group of gender diverse adolescents needs to be analysed further. The changes over time between 2009/10 and 2022 are relatively small. While girls' physical activity habits decreased slightly for the various indicators between 2009/10 and 2022, boys' prevalence remained relatively stable over the same period.

Conclusions

Overall, in part due to the effects of the various COVID-19 lockdowns, the need for effective and population-based measures to promote physical activity in childhood and adolescence remains high.

Traditional bullying and cyberbullying at schools in Germany: Results of the HBSC study 2022 and trends from 2009/10 to 2022

Background

Bullying is a form of violence that is carried out repeatedly, with the intention of causing harm and with an imbalance of power between those involved. Bullying has serious negative effects on the mental health of adolescents and thus represents a significant health risk in childhood and adolescence.

Methods

Based on data from the Health Behaviour in School-aged Children (HBSC) study from the survey year 2022 in Germany (N = 6,475), the prevalence of school bullying and cyberbullying among 11-, 13- and 15-year-olds in Germany was analysed. In addition, the prevalence of school bullying and cyberbullying was analysed as a trend from 2009/10 to 2022 (bullying) and from 2017/18 to 2022 (cyberbullying).

Results

Around 14 % of the learners surveyed reported direct experience of bullying at school, and around 7 % reported cyberbullying experiences as bullied and/or bullying victims. Adolescents who identified as gender diverse were particularly likely to report bullying experiences. School bullying decreased over time, but remained stable between 2017/18 and 2022. Cyberbullying, on the other hand, increased in 2022 compared to 2017/18.

Conclusions

Experiencing bullying at school and online is an everyday experience for many children and young people, so there is still a need for the broad implementation of effective anti-bullying measures in schools.

Trends in health inequalities in childhood and adolescence in Germany: Results of the HBSC study 2009/10 - 2022

Background

Many studies have identified health inequalities in childhood and adolescence. However, it is unclear how these have developed in recent years, particularly since the COVID-19 pandemic.

Methods

Analyses are based on the German data from the international Health Behaviour in School-aged Children (HBSC) study from 2009/10 (n = 5,005), 2013/14 (n = 5,961), 2017/18 (n = 4,347), and 2022 (n = 6,475). A total of 21,788 students aged approximately between 11 and 15 years were included. Socioeconomic status (SES) was assessed using the Family Affluence Scale (FAS). Several health indicators were analysed stratified by gender using bivariate and multivariate analysis methods.

Results

In 2022, there are clear socioeconomic inequalities in life satisfaction, self-rated health, fruit and vegetable consumption, and physical activity. These inequalities remained largely constant or increased between 2009/10 and 2022. Between 2017/18 and 2022, no significant changes in inequalities were found.

Conclusions

Health inequalities are persistent and reduce the chances of growing up healthy. There is no evidence that inequalities in the analysed outcomes have changed during the pandemic period (between 2017/18 and 2022). Rather, the changes in the health indicators seem to affect all adolescents in a similar way.

A Southern addiction evaluation project: investigating the impact of addiction through a survey HBSC based

Background

Adolescence is a critical phase of development characterized by numerous physical, psychological and social changes. During this stage, individuals may engage in experimentation and risky behavior, leading to increased vulnerability to addiction. This article aims to present the results of a survey based on the HBSC (Health Behavior in School-aged Children) surveillance model in a province of Southern Italy for primary and secondary school students.

Methods

We conducted a prospective study from March 2020 to April 2023 through the administration of a questionnaire to students of the healthcare faculties of the University of Messina and primary and secondary school students, composed of 19 items and based on HBSC surveillance.

Results

We collected a total of 664 questionnaires. We found that smoking habits increase with age: approximately 31% of secondary school students declare they are real smokers compared to 40% of HCP students. At least once, in the three study groups, students experienced alcohol consumption at different rates, with younger students having a greater propensity to drink than older students. Fortunately, in our sample, no middle school students had tried cannabis. At the same time there is a surprising decrease in gambling in all categories compared to national data.

Conclusions

The presence of addictive behaviors in our sample was found to be widespread despite being in line with the national trend. Furthermore, we have observed a reduction in recent years which needs to be investigated to assess the reasons. Primary prevention is probably the main weapon in the hands of politicians and must be applied early in school and community settings to reduce prevalence.

Subjective health and psychosomatic complaints of children and adolescents in Germany: Results of the HBSC study 2009/10 - 2022

Background

Subjective health and well-being are important health indicators in childhood and adolescence. This article shows current results and trends over time between 2009/10 and 2022.

Methods

The Health Behaviour in School-aged Children (HBSC) study examined subjective health, life satisfaction and psychosomatic complaints of N = 21,788 students aged 11 to 15 years in the school years 2009/10, 2013/14, 2017/18 and in the calendar year 2022. Multivariate regression analyses show the associations between sociodemographic characteristics and well-being in 2022, as well as trends since 2009/10.

Results

The majority of children and adolescents indicate a good subjective health and high life satisfaction. About half of the girls and one third of the boys report multiple psychosomatic health complaints, with a clear increase over time. Older adolescents, girls and gender diverse adolescents are at an increased risk of poor well-being. Subjective health and life satisfaction varied between 2009/10 and 2022, with a significant deterioration between 2017/18 and 2022.

Conclusions

The high proportion of children and adolescents with psychosomatic complaints, as well as the observed gender and age differences, underline the need for target group-specific prevention, health promotion and continuous health monitoring.

Concept and methodology of the Health Behaviour in School-aged Children (HBSC) study - Insights into the current 2022 survey and trends in Germany

Background

Health Behaviour in School-aged Children (HBSC) is one of the largest international studies on child and adolescent health and cooperates with the World Health Organization (WHO). In Germany, adolescents aged 11, 13 and 15 are surveyed every four years about their health, health behaviour and social conditions. This article describes the HBSC study and in particular the methodology of the current 2022 survey and prior surveys conducted between 2009/10 and 2017/18.

Method

174 schools with a total of 6,475 students participated in the 2022 survey. The survey was conducted using questionnaires and covered a wide range of topics (including mental health, physical activity, bullying experiences, social determinants of health and experiences related to COVID-19). The 2022 survey was complemented by a school principal survey (N = 160). In addition to the current sample, the samples of the three previous surveys with representative data for Germany are presented: 2009/10 (N = 5,005), 2013/14 (N = 5,961) and 2017/18 (N = 4,347).

Discussion

The health of children and adolescents is of great public health importance. The HBSC study makes a substantial contribution by providing internationally comparable results, analysing trends, and providing stakeholders with comprehensive and representative health monitoring data.

Health literacy of students in Germany - Results of the HBSC study 2022

Background

Health literacy (HL) encompasses knowledge and skills for dealing critically and confidently with health information in individual and social contexts. Current studies show that a high proportion of children and adolescents have limited health literacy, depending on aspects of their social background. Health literacy is considered an important factor influencing health. Little is known about the development of health literacy over time and its connection with psychosomatic complaints in young people.

Methods

Based on the results of the Health Behaviour in School-aged Children (HBSC) study, this article focusses on the level of HL in 11-, 13-, and 15-year-old students (N = 6,475) over time and taking social differences into account. Finally, the relationship between HL and psychosomatic complaints is analysed. Univariate, bivariate, and multivariate analyses were carried out for this purpose.

Results

At 24.4 %, slightly more students have low HL in 2022 than in 2017/18 (21.4 %). There are differences in HL according to gender, age, type of school, and family affluence. Low HL is associated with a high psychosomatic burden.

Conclusions

The results highlight the need for target group-specific measures to promote young people's HL, which address individual and organisational aspects of HL.

Traditional bullying, cyberbullying, and quality of life among adolescents in 35 countries: Do cultural values matter?

RATIONALE

Substantial evidence indicates that involvement in school bullying has been linked to lower quality of life (QoL). Yet there is little information elucidating the link between bullying involvement and QoL in different cultures.

OBJECTIVE

This study investigated the associations between different types of bullying involvement and QoL among adolescents. The moderating roles of cultural values in the relationship between bullying involvement and QoL were examined.

METHODS

This study included representative samples from 35 countries (N = 184,017) using data from the 2017/2018 Health Behavior in School-Aged Children (HBSC) survey and the new 2023 World Cultural Map Scores from the World Values Survey Wave 7 (2017/2021). Multilevel mixed-effects analysis was employed to examine individual-level and country-level effects simultaneously.

RESULTS

All types of bullying involvement were associated with lower QoL, with being a victim having the lowest QoL. Adolescents in societies that prioritize higher self-expression values exhibited a reduced propensity to engage in school bullying. In countries with higher self-expression values, there was a more pronounced negative association between bullying involvement and QoL. Traditional/Secular-rational values had no significant and consistent moderating effect on the association between bullying involvement and QoL. Those results were quite similar for both traditional bullying and cyberbullying.

CONCLUSION

These findings imply that cultural values are closely intertwined with adolescent bullying and quality of life. Therefore, prevention and intervention programs should pay more attention to addressing bullying and promoting the QoL of adolescents according to various cultural values.

Income inequality and socioeconomic differences in bullying perpetration among adolescents in post-communist countries of Europe: Findings from the HBSC study

Background

Adolescent bullying is a major public health concern in post-Communist countries of Europe (PCCE). We studied the impact of income inequality on the prevalence of and socioeconomic differences in bullying perpetration.

Methods

Nationally representative samples of adolescents aged 11-15 years from 14 PCCE participating in the Health Behavior in School-aged Children survey during 2017-18 years were included. Multilevel logistic regression models were fitted.

Results

Overall, 71,119 adolescents participated in the survey. About 27.7 % of country differences in bullying perpetration were attributable to high income inequality. Adolescents with low and high family socioeconomic status (SES) had a 10-15 % greater risk (P < 0.05) of bullying perpetration compared to middle-SES adolescents. In cross-level interaction, the risk of bullying perpetration was the highest among high-SES adolescents from countries with wider income inequality (P-interaction = 0.003). The odds ratios of bullying perpetration comparing high- vs. low-SES adolescents ranged from 0.67 in the least unequal to 1.59 in the most unequal countries.

Conclusions

Our findings suggest that high income inequality might contribute to school bullying among adolescents in PCCE, particularly those from high-SES families. The necessary political and economic interventions should focus on improving the country socioeconomic environment in PCCE. Moving towards less neoliberal policies and creating a strong welfare state that promotes the population's economic and social well-being and reduces income inequality might be a necessary component of macro-level strategies aimed at preventing bullying among adolescents. Targeted public health interventions might be required for high-SES adolescents in countries with wide income inequality.

Exploring the Prevalence and Predictors of Anxiety among Lithuanian Adolescents during Times of Crisis: A Cross-Sectional Study

Recent events in Europe, like the COVID-19 pandemic and the 2022 Russo-Ukrainian War (RUW), might have sparked anxiety among adolescents. This study aimed to compare anxiety levels in Lithuanian adolescents post-COVID-19 peak (Study 1, October 2021) and during the onset of the RUW (Study 2, April-June 2022). Data from 459 participants in Study 1 and 6637 in Study 2, aged 11-17, were collected through HBSC pilot and national surveys in Lithuania. Self-reported questionnaires assessed anxiety, social media use, stress, loneliness, self-efficacy, and peer support factors. Analysis was conducted using multivariable logistic regressions. Notably, anxiety prevalence in Lithuanian adolescents showed no significant difference between Study 1 and Study 2, stabilizing around 24%. In 2021, stress (OR = 5.89, 95% CI 3.11-11.17), problematic social media use (OR = 4.58, 95% CI 1.89-10.58), and female gender (OR = 2.87, 95% CI 1.58-5.22) significantly predicted anxiety. By 2022, stress (OR = 3.68, 95% CI 3.14-4.30), loneliness (OR = 2.85, 95% CI 2.43-3.35), and lower self-efficacy (OR = 1.40, 95% CI 1.20-1.60) emerged as important predictors. This study enhances our understanding of adolescent anxiety during crises, emphasizing the urgency of addressing multiple factors to manage and support vulnerable youth.

Adolescent Toothbrushing and Its Association with Sociodemographic Factors-Time Trends from 1994 to 2018 in Twenty Countries

Regular toothbrushing is the primary self-care method to prevent the most common dental diseases and is considered an important public health indicator. This retrospective observational study aimed to examine cross-national time trends in adolescent toothbrushing behaviour and its association with sociodemographic factors between 1994 and 2018. We studied data from 20 countries that conducted seven surveys of the Health Behaviour in School-aged Children (HBSC) study. Adolescents aged 11, 13 and 15 years responded to questions on their toothbrushing frequency, family affluence and structure. Altogether, reports of 691,559 students were analysed using descriptive statistics and binominal logistic regression. The findings showed an overall positive trend in the prevalence of more-than-once-a-day toothbrushing frequency during the entire study period mainly due to a noticeable increase from 1994 to 2010 (except Denmark and Sweden); this trend continued significantly thereafter in 12 of 20 countries. Across all countries, girls and adolescents from more affluent families were more likely to brush their teeth regularly. These relationships remained unchanged throughout the study period, whereas the age-related difference in toothbrushing prevalence decreased noticeably, and the negative relationship between toothbrushing and living in a non-intact family became evident. While the prevalence of regular toothbrushing among adolescents has increased in recent decades, it is still far behind the recommended level of twice-daily brushing for everyone across all countries. The promotion of toothbrushing needs to start at an early age, with a special focus on boys and adolescents from low-affluence and non-intact families.

The association between self-reported psychosomatic complaints and bullying victimisation and disability among adolescents in Finland and Sweden

AIM

To analyse the associations between bullying victimisation, disability, and self-reported psychosomatic complaints in adolescents, and to investigate the role of support from parents and teachers in such associations.

METHODS

The study was based on Finnish and Swedish data from two waves (2013/2014 and 2017/2018) of the Health Behaviour in School-aged Children survey (n=16,057). Descriptive statistics were produced for four groups of adolescents: (a) bullied with disabilities; (b) not bullied with disabilities; (c) bullied without disabilities; and (d) not bullied without disabilities (reference group). Two multilevel multinomial logistic regression models were performed for the Finnish and Swedish samples separately. The first model analysed associations between psychosomatic complaints and bullying victimisation, controlling for a range of confounders. The second model analysed associations between psychosomatic complaints and social support from parents and teachers.

RESULTS

Across both countries, bullied adolescents with disabilities were more likely to self-report psychosomatic complaints than the reference group, even after adjusting for other potential confounders. Teacher support was identified as a potential protective factor as the odds ratio for psychosomatic complaints decreased when including teacher support as a factor in the model. The association with parent support showed mixed findings in Finland and Sweden.

CONCLUSIONS

Disability in combination with bullying victimisation generated the highest levels of self-reported psychosomatic complaints compared to adolescents that were not bullied nor had disabilities. High teacher support may be a protective factor against psychosomatic complaints for bullied and/or disabled adolescents.

Correlations between weight perception and overt risk-taking among Canadian adolescents

OBJECTIVE

Perceptions of body weight represent an important health issue for Canadian adolescents. While associations between weight perception and mental health concerns like eating disorder symptomatology are well established, there is need for more Canadian evidence about how weight perception is associated with overt risk-taking among adolescents, and further how such associations differ by biological sex.

METHODS

We conducted a national analysis of grade 9-10 students participating in the 2017-2018 cycle of the Health Behaviour in School-aged Children (HBSC) study in Canada. This analysis described contemporary patterns of alternate weight perception and then examined the strength and statistical significance of such associations by biological sex, with tobacco, alcohol, and cannabis use, binge drinking, fighting, and illicit drug use as outcomes. Behaviours were considered both individually and in combination. Analyses were descriptive and analytical, with regression models accounting for the nested and clustered nature of the sampling approach.

RESULTS

Responses from 2135 males and 2519 females were available for a complete case series analysis. A total of 26% and 35% of males and females, respectively, perceived themselves as "too fat" while 20% and 9% identified as "too thin". Females perceiving themselves as "too fat" reported higher likelihoods of engaging in individual and scaled indicators of overt risk-taking. Conversely, among males, alternate weight perception was associated with lower levels of such behaviours.

CONCLUSION

As males and females perceive and react to weight perception differently, clinical and health promotion strategies should be developed and uniquely targeted to groups of adolescents in regards to weight perception and risk-taking.

A latent class analysis of change and continuity in adolescent health and wellbeing in England during the decline in youth alcohol consumption: A repeat cross-sectional study

In England, the proportion of 13-15 year-olds who have ever drunk alcohol fell from 71% in 1999 to 35% in 2019. Despite substantial research literature studying this decline, we know little about connections with concurrent shifts in wider aspects of health and wellbeing. This paper aims to identify how indicators of health and wellbeing cluster within 15-year-olds in England, identify changes in clustering over time, and explore associations with sex and family affluence. We used latent class analysis of cross-sectional data from the Health Behaviours in School-aged Children study (n = 5,942; four waves 2001/02-2013/14). Classes were defined by indicators of substance use, sexual activity, diet, exercise, school-related measures, e-media use, parental relationships, and wellbeing. We identified three classes, which we labelled Overall unhealthy, Substance abstainers with behavioural risk indicators, and Overall healthy. The probability of being in the Overall unhealthy class fell (2001/02: 0.39; 2013/14: 0.18) while the probability of being in the Overall healthy class increased (0.21 to 0.41). The probability of weekly alcohol use fell in all classes (e.g. Overall unhealthy: 0.71 to 0.28). Females (female vs male OR: 1.74 95%CI: 1.30 - 2.34) and those with low family affluence (high vs low family affluence OR: 0.18 95%CI: 0.08 - 0.44) had significantly higher odds of being in the Overall unhealthy class. Overall, adolescents became more likely to have co-occurring indicators of good health and wellbeing, including reduced alcohol consumption, sexual activity and cigarette smoking. However, girls and those from poorer families remained more likely to have poor health and wellbeing.

Gender-specific social and environmental correlates of active travel to school in four European countries: the HBSC Study

Introduction

Despite the health benefits, a large proportion of girls and boys in Europe do not travel to school actively. A better understanding of the correlates associated with this behavior could guide interventions. This study examines perceived social and environmental correlates of active travel to school (ACTS) from the 2017/18 Health Behavior in School-Aged Children (HBSC) survey in four European countries, with a special emphasis on gender differences (n = 22,023).

Methods

Logistic regression was conducted to analyze associations between the perceived importance of each correlate and ACTS behavior for 11-, 13-, and 15-year-old girls and boys from Germany, Czechia, Poland, and Slovakia. All models were adjusted for age, family affluence, and meeting World Health Organization recommendations for moderate-to-vigorous physical activity.

Results

Rates of ACTS significantly differed between girls and boys. In Czechia, 65% of girls and boys traveled to school actively, followed by Slovakia (61.4% girls and 58.4% boys), Poland (57.7% girls and 60.2% boys), and Germany (42.6% girls and 48.6% boys). Girls were less likely to actively travel to school compared to boys (odds ratio [OR]: 0.92, 95% confidence interval [CI]: 0.87-0.97). Increasing age (OR: 0.95, 95% CI: 0.93-0.97) and a greater distance to school index (OR: 0.89, 95% CI: 0.88-0.90) were both negatively associated with ACTS. The perceived importance of living closer to school and of road and neighborhood safety was positively associated with ACTS, with a stronger association in boys than in girls for neighborhood safety. On the contrary, the perceived importance of having people to walk with was negatively associated with ACTS, with a stronger association in girls (OR: 0.74, 95% CI: 0.65-0.84) than in boys (OR: 0.77, 95% CI: 0.66-0.88).

Discussion

This study provides insights into perceived social and environmental correlates associated with ACTS behavior. Future research should include gender-specific perceptions and more in-depth investigations of correlates encouraging ACTS, especially considering social aspects, safety issues, and the structuring of the environment in different cultural settings.

Differences between problematic internet and smartphone use and their psychological risk factors in boys and girls: a network analysis

BACKGROUND

Problematic internet and smartphone use are significant health challenges for contemporary adolescents. However, their mutual relationship is unclear because studies investigating these phenomena are scarce. The present study aimed to investigate the psychological risks and protective factors associated with problematic internet and smartphone use.

METHOD

A representative sample of Slovak adolescents (N = 4070, M_age = 14.38, SD_age = 0.77, 50.5% girls) from the Health Behavior in School-aged Children project was analyzed using network analysis separately for boys and girls.

RESULTS

The results showed weak (for boys) and moderate (for girls) associations between problematic internet use and problematic smartphone use. Risk factors showed stronger associations with problematic internet use than problematic smartphone use, with the exception of fear of missing out, which was strongly associated with problematic smartphone use. The central nodes were externalizing problems for boys and internalizing problems, externalizing problems, and resilience for girls.

CONCLUSION

The study concluded that while problematic internet use and problematic smartphone use are somewhat related, they differ at the psychological level. In addition, the phenomena are rather different between boys and girls.

[Loneliness in childhood and adolescence. On the prevalence of a mental health risk factor among 11- to 15-year-old German students]

BACKGROUND

Loneliness is an increasingly present topic in both public and scientific discourse. There is increasing research on the prevalence of loneliness and health-related correlates in adults. However, there are only a few findings on loneliness in childhood and adolescence in Germany. Therefore, this study aims to present findings on the prevalence of loneliness among 11- to 15-year-old German students and examines associations with socio-demographic characteristics.

METHODS

The Health Behaviour in School-aged Children (HBSC) study is a global research collaboration under the auspices of the World Health Organization (WHO). In the federal state of Brandenburg, Germany, the study collected data from 3819 children and adolescents in grades 5, 7, and 9 (M_age = 13.5, SD = 1.6) at schools for general education. Loneliness was assessed using the University of California, Los Angeles (UCLA) Loneliness Scale and a single item.

RESULTS

Of the respondents, 13.2% reported feeling lonely most of the time and 3.6% always. Loneliness was more prevalent among girls and non-binary students, as well as among older students and children and adolescents of lower socioeconomic status.

DISCUSSION

The findings indicate that loneliness is a widespread phenomenon among children and adolescents. The result that girls, older pupils and children, and adolescents with lower family wealth report feeling lonelier is consistent with findings from other countries and provides starting points for planning prevention measures. Further research is needed in Germany on possible health-related correlates of loneliness.

Adolescent use of social media and associations with sleep patterns across 18 European and North American countries

OBJECTIVE

Over the past decade, concurrent with increasing social media use (SMU), there has been a shift toward poorer sleep among adolescents in many countries. The purpose of this study was to examine the cross-national associations between adolescent SMU and sleep patterns, by comparing 4 different categories of SMU (nonactive, active, intense, and problematic use).

DESIGN, SETTING, AND PARTICIPANTS

Data were from 86,542 adolescents in 18 European and North American countries that participated in the 2017/18 Health Behaviour in School-aged study.

MEASUREMENTS

Mixed-effects linear regression models were used to examine cross-national associations between 4 SMU categories and adolescent sleep duration, bedtime and social jetlag derived from self-reported data.

RESULTS

For all countries combined, nonactive SMU was associated with longer sleep, earlier bedtimes, and less social jetlag, compared to active SMU, although the differences were minor. By comparison, intense and problematic SMU were associated with less sleep and later bedtimes on both school and nonschool days, and greater social jetlag, compared to active SMU. While findings were relatively consistent between countries, some differences were observed, suggesting that the national and cultural context may be important in interpreting results.

CONCLUSIONS

These findings suggest that both intense and problematic SMU are associated with poorer sleep patterns in adolescents across most countries. Further research is needed to identify effective policies, programs, and messaging to promote the healthy use of social media and prevent potential negative impacts on adolescent sleep.

Trends in adolescent psychosomatic complaints: a quantile regression analysis of Swedish HBSC data 1985-2017

BACKGROUND AND AIMS

According to recent criticism, survey-based measures of adolescent psychosomatic complaints have poor content validity insofar as they conflate trivial with severe complaints. It is argued that this means that estimates of prevalence and trends in complaints may reflect trivial complaints that are not indicators of health problems. In this study, two observable implications of this criticism were investigated: (a) that self-reported psychosomatic complaints should have a bimodal distribution; and (b) that the increase in complaints over time should be of approximately equal size throughout the distribution of complaints.

METHODS

Three decades (1985/1986-2017/2018) of repeated cross-sectional data from the Swedish Health Behaviour in School-aged Children survey were used. Psychosomatic complaints were measured using the screening instrument Health Behaviour in School-aged Children symptom checklist. Histograms, bar charts and quantile regression models were used for the analysis.

RESULTS AND CONCLUSIONS

With regard to the first implication, the results showed that the distribution of complaints was not bimodal and that there were no clusters of respondents. This suggests that binary categorisations of students can be reductive and conceal important variations across students. With regard to the second implication, the results showed that the increase in complaints was greatest among students who report frequent and co-occurring complaints. This suggests that reports of increasing complaints in adolescents cannot be explained as being primarily due to a greater inclination to report trivial complaints. It is concluded that any conflation of trivial and more severe complaints in surveys of psychosomatic complaints is not reflected in population-based estimates.

The Correlation between Adolescent Daily Breakfast Consumption and Socio-Demographic: Trends in 23 European Countries Participating in the Health Behaviour in School-Aged Children Study (2002-2018)

Breakfast is often considered the most important meal of the day and can benefit adolescent health in several ways. The aims of the present study were (1) to identify adolescents' socio-demographic (sex, family affluence and family structure) determinants of daily breakfast consumption (DBC) and (2) to describe trends in DBC among adolescents across 23 countries. Cross-sectional surveys of nationally representative samples of adolescents (aged 11, 13, and 15 years) (n = 589,737) participating in the Health Behaviour in School-aged Children (HBSC) survey from 2002 to 2018 were used. Multilevel logistic regression analyses modeled DBC over time, adjusted for family affluence, family structure and year of survey. Four countries showed an increased trend in DBC (the Netherlands, Macedonia, Slovenia, and England). A significant decrease in DBC was observed in 15 countries (Belgium-Fr, France, Germany, Croatia, Portugal, Spain, Hungary, Poland, Russian Federation, Ukraine, Denmark, Finland, Latvia, Lithuania and Sweden). In 4 countries no significant change was observed (Czech Republic, Scotland, Ireland and Norway). In most of the countries (n = 19), DBC was higher among the adolescents from high-affluence homes. In all the countries analysed, the adolescents living in two-parent households report higher DBC use than those in single-parent households. More than half of the countries showed a decrease in DBC. There is a need to implement key interventions by developing different strategies (education, incorporating educational curriculum and counselling programmes) to increase DBC. Comparing DBC patterns across HBSC countries is important for understanding regional and global trends, monitoring strategies, and developing health promotion programmes.

Socioeconomic Differences in the Association Between Bullying Behaviors and Mental Health in Canadian Adolescents

BACKGROUND

Bullying and poverty are each associated with poor health in adolescents. We examined socioeconomic differences in the association of bullying and health.

METHODS

The 2017/2018 Canadian Health Behaviour of School-aged Children study surveyed 21,750 youth (9-18 years). We used linear regression models to investigate interactive effects of bullying involvement (traditional and cyberbullying) and socioeconomic position (SEP) on self-reported life satisfaction, psychological symptoms, and physical symptoms.

RESULTS

Involvement in either form of bullying, as a perpetrator or a target, was associated with worse health and well-being compared to uninvolved youths. Associations of victimization via conventional bullying with low life satisfaction (b = -.33 [-.61, .05]), more psychological symptoms (b = .83 [.27, 1.38]), and more somatic symptoms (b = .56 [.14, .98]) were stronger at lower SEP.

CONCLUSION

Socioeconomic disadvantage intensifies the association between bullying victimization and poor health. The intersections of victimization and poverty pose a significant health risk to adolescents.

Income Inequality and Socioeconomic Disparities in Alcohol Use Among Eastern European Adolescents: A Multilevel Analysis

PURPOSE

In this study, we tested the "golden youth" hypothesis, which suggests that in Eastern Europe, affluent adolescents are at an increased risk of alcohol use. Also, we hypothesized that the relationship between high socioeconomic position (SEP) and more alcohol use is stronger in countries with wider income inequality.

METHODS

In total, 50,421 adolescents aged 13-15 years were included from 16 Eastern European countries participating in the 2013-2014 Health Behaviour in School-aged Children survey. Multilevel logistic regression analyses were performed.

RESULTS

Affluent adolescents had greater odds of weekly alcohol use (OR = 1.32, 95% CI = 1.23-1.41) and binge drinking (OR = 1.24, 95% CI = 1.16-1.32) than their peers from low-SEP families. However, no significant difference was observed between middle- and low-SEP adolescents. In countries with wider income inequality, the relationship between high family-SEP and weekly alcohol use (p interaction = .006), as well as high family-SEP and binge drinking (p interaction = .007), was stronger compared to countries with lower income inequality.

DISCUSSION

Possibly, influenced by the lifestyle choices of their parents, and using alcohol as a status symbol to establish and maintain friendly relationships with peers, Eastern European adolescents from affluent families, particularly in the most unequal settings, are at increased risk of alcohol use, confirming the golden youth hypothesis. Insecure self-image and perceived threat to their high status might be explanatory factors. More research is needed to identify the precise individual and family characteristics responsible for increased alcohol use among wealthy adolescents, especially in Eastern European countries with high income inequality.

Inequalities in health complaints: 20-year trends among adolescents in Scotland, 1998-2018

This study examined trends in inequalities in health complaints among early adolescents in Scotland from 1998 to 2018. We analysed data from the Health Behaviour in School-aged Children (HBSC) survey conducted in Scotland in 1998, 2002, 2006, 2010, 2014 and 2018. A self-report questionnaire was administered in schools to a nationally representative sample of 11-, 13-, and 15-year-olds (n = 29,250). Health complaints were measured using a scale comprising four psychological symptoms (feeling low, feeling nervous, irritability and sleep difficulties) and four somatic symptoms (headache, backache, stomachache and dizziness). Socio-economic status was measured using the Family Affluence Scale. Between 1998 and 2018, there were significant increases in the proportion of girls and boys reporting feeling low, feeling nervous, sleep difficulties and backache. Prevalence of the eight individual health complaints was higher among girls and adolescents from lower affluence families. Socio-economic inequalities increased over time, such that declines in mental health were greatest among low affluence adolescents. The data show worsening trends in health complaints among Scottish adolescents between 1998 and 2018, particularly for girls and adolescents from low affluence families. Increasing inequalities in mental health highlight the need to address the underlying social and structural determinants of adolescent mental health.

Abstainers and Drinkers - Two Sides of the Same Coin?

This commentary discusses a recently published literature review focussing on the growing trend of young people abstaining from drinking alcohol. Despite the recent increase in research on the decline in youth drinking, the review only identified 10 papers that explicitly examined abstainers. The inclusion criteria used thus excluded and overlooked the vast literature available on the decline in youth drinking. This commentary discusses the implications of this and raises the issue of how the adolescent abstainer should be viewed in research; is it a distinct social phenomenon with unique determinants or are abstainers merely the flip side of drinkers?

Assessing policies to reduce adolescent overweight and obesity: Insights from a system dynamics model using data from the Health Behavior in School-Aged Children study

Adolescent overweight and obesity (AdOWOB) in Europe has proven to be a persistent and complex problem, and appropriate systems methods may help in evaluating potential policy options. This paper describes the development of a system dynamics model of AdOWOB as part of the EU-funded CO-CREATE project. The model was developed using literature and data from the Health Behavior in School-Aged Children (HBSC) study across 31 European countries. We identified 10 HBSC variables that were included as direct or indirect drivers of AdOWOB in the dynamic model, seven at the level of the individual, and three related to the social environment. The model was calibrated to 24 separate cases based on four gender and perceived wealth segments for each of the five CO-CREATE countries (The Netherlands, Norway, Poland, Portugal, and the UK) and for Europe overall. Out of 10 possible intervention points tested, exercise, fruit, life dissatisfaction, school pressure, and skipping breakfast were identified as the top five most influential ones across the 24 cases. These model-based priorities can be compared with the policy ideas suggested by the CO-CREATE adolescents.

Associations between adolescent sleep difficulties and active versus passive screen time across 38 countries

BACKGROUND

High screen use has been adversely linked with mental wellbeing; however, little is known about how active versus passive screen time are associated with sleep-onset difficulties among adolescents.

METHODS

We analysed data from 38 European and North American countries that participated in the 2014 Health Behaviour in School-aged Children (HBSC) survey. Difficulties in falling sleep were assessed using a self-reported item with a 5-point Likert scale, and then dichotomised. Participants reported h/day of discretional time spent watching television, electronic gaming, and computer use.

RESULTS

Of the 195,668 participants (M_age 13.59 [1.62] years; 51 % girls), about 25 % of girls reported sleep-onset difficulties, while the rate was 18 % in boys. Adolescents who played electronic games >4 h/day (≤1 h/day as reference) had 30 % higher odds in boys (OR 1.30; 95 % CI: 1.23-1.38) and 38 % higher odds in girls (OR 1.38; 95 % CI: 1.31-1.45) of reporting sleep difficulties. High computer use (>4 h/day) increased the odds of sleep difficulties by 41 % in boys (OR 1.41, 95 % CI: 1.33-1.49) and 61 % in girls (OR 1.61, 95 % CI: 1.53-1.69). Similarly, high television time (>4 h/day) had increased the odds of sleep difficulties by 15 % in boys (OR 1.15, 95 % CI: 1.08-1.22) and 19 % in girls (OR 1.19, 95 % CI: 1.12-1.25).

LIMITATIONS

Cross-sectional analyses cannot establish causality of the associations.

CONCLUSIONS

Higher levels of recreational screen use of any type were associated with sleep-onset difficulties among adolescents with adverse effects being more prevalent in active than passive screen time. Prospective research with objective measures is warranted to understand causality of these relationships.

The Mental Well-Being of Italian Adolescents in the Last Decade through the Lens of the Dual Factor Model

(1) Background: In Italy, the components of adolescents' mental well-being (psychological symptomatology and cognitive perception of life satisfaction) showed different temporal trends, suggesting the adoption of a multidimensional conceptualization. We aimed to assess temporal patterns and provide additional insights into Italian adolescents' mental well-being in the last decade by adopting the Dual Factor Model; (2) Methods: We used nationally representative samples of Italian students (n = 165,000) aged 11, 13, and 15 years across the three more recent Italian Health Behaviour in School-aged Children (HBSC) surveys. Two measures of mental well-being were used: life satisfaction (LS, indicator of positive subjective well-being) and psychological health complaints (PHC, indicator of mental illness); (3) Results: Our study showed that the overall sample has been moving from a Complete Mental Health (Flourishing) to an Incomplete Mental Illness (Struggling) condition. Among 13- and 15-year-old girls, a jump from one to the other mental condition was observed in the 2014-2018 and 2010-2014 time periods, respectively; (4) Conclusions: Our findings suggest that Italian adolescents, especially older girls, have been shifting from Complete Mental Health to Incomplete Mental Illness in the last decade. Further research is needed to investigate this breaking up of the connection between psychological symptomatology and cognitive perception of life satisfaction.

Trends in Adolescent Substance Use: Analysis of HBSC Data for Four Eastern European Countries, 1994-2018

The aim of the study was to analyze the trends of adolescent substance use in four eastern European countries over the time period from 1994 to 2018. The four countries in focus were selected based on their shared historical backgrounds and major economic and social transformations experienced.

METHODS

Two decades (1993/1994-2017/2018) of repeated cross-sectional data from the Estonian, Latvian, Lithuanian, and Polish Health Behaviour in School-aged Children survey were used. Data comprised 42,169 school children 15 years of age (9th grade). The following categories of substance use were included: regular alcohol consumption and drunkenness, tobacco smoking, electronic cigarette smoking, and cannabis use. Trends in substance use over time were tested using Jonckheere's trend test.

RESULTS

Prevalence of substance use among adolescents over time revealed that the Baltic states and Poland have faced relatively different temporal trends. In the Baltic states, there was a general increase during the period of 1994-2002, which was followed by a period of peaking or stability between 2002-2010, and then decreasing trends of these risky behaviors from 2010 onwards. In Poland, the same period had less consistent patterns, with decreasing trends starting much earlier on. The prevalence of cannabis use, which had been measured since 2006, had its own unique pattern with many fluctuations within and between countries.

CONCLUSIONS

The findings on the prevalence of substance use among adolescents from 1994 to 2018 revealed that the Baltic states and Poland have faced relatively different temporal trends. These countries might be facing new public health challenges in a near future, e.g., use of electronic cigarettes and cannabis use among adolescents.

Gender Differences in Bullying Reflect Societal Gender Inequality: A Multilevel Study With Adolescents in 46 Countries

PURPOSE

Social patterns in bullying show consistent gender differences in adolescent perpetration and victimization with large cross-national variations. Previous research shows associations between societal gender inequality and gender differences in some violent behaviors in adolescents. Therefore, there is a need to go beyond individual associations and use a more social ecological perspective when examining gender differences in bullying behaviors. The aim of the present study was twofold: (1) to explore cross-national gender differences in bullying behaviors and (2) to examine whether national-level gender inequality relates to gender differences in adolescent bullying behaviors.

METHODS

Traditional bullying and cyberbullying were measured in 11-year-olds to 15-year-olds in the 2017/18 Health Behaviour in School-aged Children study (n = 200,423). We linked individual data to national gender inequality (Gender Inequality Index, 2018) in 46 countries and tested their association using mixed-effects (multilevel) logistic regression models.

RESULTS

Large cross-national variations were observed in gender differences in bullying. Boys had higher odds of perpetrating both traditional and cyberbullying and victimization by traditional bullying than girls. Greater gender inequality at country level was associated with heightened gender differences in traditional bullying. In contrast, lower gender inequality was associated with larger gender differences for cyber victimization.

DISCUSSION

Societal gender inequality relates to adolescents' involvement in bullying and gendered patterns in bullying. Public health policy should target societal factors that have an impact on young people's behavior.

Vigorous physical activity and self-rated health during adolescence: A cross-sectional survey

Background

Despite the positive relationship between self-rated health and general physical activity, very little research has touched upon the relationship between self-rated health and vigorous physical activity. Such research will help to promote self-rated health among adolescents by addressing the close relationship between self-rated health and the components of physical activity.

Purpose

In this study, the relationship between self-rated health and vigorous physical activity among Chinese adolescents were analyzed.

Methods

The current study was based on a collaborative survey conducted by the WHO in several nations, and the data generated by Health Behavior in School-aged Children every 4 years on health behavior were adopted. The school class was taken as a basic unit for sampling. Cluster sampling was performed systematically, and the possibility was proportional to the population. The sampling was conducted to collect typical cases. The class teachers were informed of the sampling activities, and they were to collect data on the students by distributing the questionnaires.

Results

The research included 116,828 respondents from 36 countries. Among them, 51.82% were girls and 48.18% were boys. A total of 98.54% of the respondents considered their health status as fair or above when completing the questionnaire, while 1.46% believed that their health status was poor. Moreover, more than 86% of the respondents participated in vigorous exercise more than weekly, and better self-health ratings were found among respondents who exercised more than weekly (once a week: OR = 1.95, CI: 1.86-2.04; two or three times a week: OR = 1.69, CIL: 1.63-1.76; four or six times a week: OR = 1.30, CI: 1.25-1.35). Certain respondents reported better results for self-rated health (4-6 h every week: OR = 1.36, CI: 1.30-1.43; 2 or 3 h every week: OR = 1.48, CI: 1.42-1.55; 1 h every week: OR = 1.64, CI: 1.57-1.72).

Conclusion

In this study, empirical evidence is provided for the relationship between self-rated health and vigorous physical activity among adolescents. From the results, it can be observed that there is a positive relationship between self-rated health and vigorous physical activity among adolescents.

Socioeconomic inequalities in adolescent health behaviours across 32 different countries - The role of country-level social mobility

Higher family affluence is associated with healthier behaviours in adolescents, but the strength of this association varies across countries. Differences in social mobility at the country-level, i.e. the extent to which adolescents develop a different socioeconomic status (SES) than their parents, may partially explain why the association between family affluence and adolescent health behaviours is stronger in some countries than in others. Using data from adolescents aged 11-15 years from 32 countries, participating in the 2017/2018 wave of the Health Behaviour in School-aged Children (HBSC) study (N = 185,086), we employed multilevel regression models with cross-level interactions to examine whether country-level social mobility moderates the association between family affluence and adolescent health behaviours (i.e. moderate-to-vigorous physical activity, vigorous physical activity, healthy and unhealthy foods consumption, having breakfast regularly, and weekly smoking). Higher family affluence was more strongly associated with higher levels of adolescent physical activity in countries characterized by high levels of social mobility. No cross-level interactions were found for any of the other health behaviours. Differences in social mobility at the country-level may contribute to cross-national variations in socioeconomic inequalities in adolescent physical activity. Further research can shed light on the mechanisms linking country-level social mobility to inequalities in adolescent physical activity to identify targets for policy and interventions.

Measurement Invariance of the WHO-5 Well-Being Index: Evidence from 15 European Countries

(1) Background: The World Health Organization (WHO)-5 Well-Being Index has been used in many epidemiological studies to assess adolescent mental well-being. However, cross-country comparisons of this instrument among adolescents are scarce and, so far, no good-fitting, common invariant measurement model across countries has been reported. The present study aims to evaluate and establish a version of the WHO-5 Well-Being Index that allows for a valid cross-country comparison of adolescent self-reported mental well-being. (2) Methods: Using data from the 2018 Health Behaviour in School-aged Children study, we evaluated the measurement model and measurement invariance of the five items of the WHO-5 Well-Being Index. We used nationally representative samples of 11-, 13-, and 15-year-old adolescents (N = 74,071) from fifteen countries and regions in Europe. Measurement invariance of the WHO-5 was assessed using a series (country, gender, and age) of multi-group confirmatory factor analyses. In addition, we evaluated the convergent validity of the measure by testing its correlations with psychosomatic complaints, life satisfaction, and self-rated health. (3) Results: We found that WHO-5 does not show good psychometric properties or good measurement invariance fit. However, by excluding the first item of the scale ("I have felt cheerful and in good spirits"), the WHO-4, consisting of the other four original items, had good psychometric properties, and demonstrated good suitability for cross-national comparisons (as well as age and gender) in adolescent mental well-being. (4) Conclusions: The present study introduces the WHO-4-a revised version of the WHO-5-, that allows for a valid comparison of mental well-being across fifteen countries and regions in Europe. The WHO-4 proved to be a reliable and valid instrument to assess mental well-being in the adolescent population.

Problematic Social Media Use and Cyber Aggression in Italian Adolescents: The Remarkable Role of Social Support

The recent increase in electronic and social media use among young people has highlighted the importance of focusing on problematic social media use (PSMU) and the concurrent phenomenon of cyber aggression, as well as the role of social support. As part of the 2018 Health Behavior in School-aged Children study in Italy, this study aims to explore the role of family, peer, and teacher support in the association between cyberbullying and PSMU.

METHODS

Data were collected from 4183 school classes in Italy for a total of 58,976 adolescents aged 11, 13, and 15 years. The prevalence of cyber aggression (both cybervictimization and perpetration) and PSMU was estimated across subgroups of different age, gender, and geographical residence. A set of multivariable logistic regressions was then used to investigate the association between cyberbullying and PSMU, considering the effect of social support.

RESULTS

Cybervictimization was more frequent among girls than in boys. PSMU was higher in 11-year-old boys and 13-year-old girls; 8.3% and 12.7%, respectively. Social support was highest in 11-year-olds, for both sexes, and then decreased with increasing age. The risk of cyberbullying, both suffered and perpetrated, was higher in girls and in the presence of PSMU. Social support showed to be highly protective against PSMU and cyberbullying in all ages and both genders.

CONCLUSION

Although cyber aggression is less represented in Italy than in other European countries, it is likely to increase. PSMU appears to be an important contributor to the risk of cyber aggression; however, social support has been shown to be capable of reducing the risk of both phenomena. Public health policies fostering familiar and school support can help protect adolescents' mental health, reducing the risk of problematic media use and cyberbullying.

Longitudinal associations between different measures of socioeconomic status and health behavior among adolescents. Data from a wealthy Italian region

We investigate the association between socio-economic status and unhealthy behaviors among adolescents. By using different measures of socio-economic status, we capture both subjective aspects, as operationalized by perceived family affluence, and objective aspects, such as parents' educational levels and family affluence scale. We use data from a sample of 11,623 adolescents who participated in the Health Behavior in School-aged Children (HBSC) study in 2007, 2010, and 2014 in the Lombardy region of Italy. Results show that all of our measures of socio-economic status are correlated with unhealthy behaviors among adolescents. In particular, perceiving a family affluence below average is significantly correlated with a higher probability of reporting all of the unhealthy behaviors included in our analysis. Having at least one parent with university education significantly decreases the odds of being obese or overweight, having an unbalance diet, being physically inactive, and reporting sedentary behaviors. However, adolescents with at least one university educated parent are more likely to make use of cannabis. When controlling for all of our SES measures simultaneously, we find that family affluence scale is no longer significant in determining adolescents' behaviors. Our findings suggest that, when focusing on health inequalities among adolescents, self-perceptions and non-material dimensions of SES have more explanatory power than its material dimensions.

Organized Sport Activities of 11 to 15-Year-Old Adolescents: Trends from 2010-2018 and Socioeconomic Context

The aim of this paper was to analyse the trends in the participation of Czech adolescents in organized sport activities in relation to the socioeconomic status (SES) of their families. The sample consisted of 11, 13 and 15-year-old children (N = 4425 (2010), 10,361 (2014) and 13,377 (2018)); the data were collected as part of the HBSC Study in the Czech Republic. The findings suggest that adolescents from affluent families tend to participate more often in organized sports—both team activities and individual activities. Fifteen-year-old adolescents from families with a high SES are 3.01 times more likely to participate in individual organized sports than adolescents from low-SES families. The gap between participation in sport activities increases with the children’s age but does not change significantly during the observed period. The findings suggest that public health policy should be oriented towards children from less-affluent families.

Test-retest reliability of selected HBSC items in Vietnam: well-being, physical and sedentary activities, and eating behaviours

Background

Valid and reliable research tools to assess children’s and adolescent’s health-related behaviour are highly needed across the globe. Rapid economic development, globalization, and associated lifestyle challenges observed in most countries support the need for high-quality evidence in adolescents to target health-promoting policies and interventions. This study aims to examine the test–retest reliability of selected well-being, physical and screen-time related siting activities, and eating behaviour items of the Health Behaviour in School-Aged Children (HBSC) questionnaire in a sample of Vietnamese adolescents.

Methods

Data were collected in autumn 2018 in Vietnam (3-week interval). The sample consisted of 410 adolescents (41.0% of boys; mean age = 12.61; SD = 1.24).Test–retest reliability was evaluated using the single measure Intraclass Correlation Coefficients (ICC) and Cohen’s kappa statistic stratified by sex, grade and place of residence (urban or rural).

Results

The reliability analyses of the well-being items were poor to good ICC values (0.43–0.79) and moderate to large Cohen’s kappa values (0.33–0.77). The physical activity and eating behaviour items were moderate (ICC = 0.54–0.65; Cohen’s kappa = 0.38–0.57). The screen-time related siting activities items were moderate to large (ICC = 0.51–0.72; Cohen’s kappa = 0.42–0.53). There was more item stability among females than males. The social media item was not as stable for 6^th graders (ICC = 0.45) compared with older adolescents (ICC 0.68–0.77).

Conclusions

The findings show that with regards to age, sex and place of residence, self-reported health, life satisfaction, physical and screen-time related siting activities, as well as eating behaviour items of the HBSC questionnaire have a sufficient test–retest reliability to be used in national self-report surveys for Vietnamese adolescents while health complaints items showed borderline reliability.

Associations between the self-reported happy home lives and health of Canadian school-aged children: An exploratory analysis with stratification by level of relative family wealth

BACKGROUND

Connections between home life, level of family wealth, happiness and health are strong, yet these relationships are complex and for Canadian adolescents not well studied. The objective of this investigation was to explore associations between aspects of health and self-reported happy home life among Canadian adolescents aged 10-16 years and to determine if level of self-reported relative family wealth modified associations.

MATERIAL AND METHODS

This was a secondary analysis of Canadian data from the 2018 Health Behaviour in School-aged Children (HBSC) study (n=21,745). Theory drove the selection of 26 health-related HBSC variables. Bivariate analyses and calculation of adjusted odds ratios, considering level of self-reported relative family wealth in a stratified analysis, were undertaken.

RESULTS

Overall, proximal, micro-level factors were most strongly associated with reports of a happy home life, with distal, macro-level factors less strongly associated. Differences existed between the health and home-life associations for adolescents of different levels of self-reported relative family wealth indicating effect modification. Family support and levels of adolescent self-reported overall health and mental health were common factors that were strongly associated with reporting a happy home life.

CONCLUSION

We believe happy home lives are central and critical for thriving youth and families. This was an exploratory analysis. Many of the factors and relationships in this study are potentially modifiable and represent important possible areas of future focus for adolescent and family health improvement.

Socioeconomic inequalities in adolescent health complaints: A multilevel latent class analysis in 45 countries

Our study evaluated the relationship between adolescent health complaints and socioeconomic position in 45 countries. Data are from the 2017/2018 international Health Behaviour in School-aged Children survey which used proportionate sampling among adolescents aged 11 to 15 years old (n=228,979). Multilevel, multinomial regression analysis assessed the association between the multilevel latent classes with socioeconomic status (SES; at the household and country level). Three distinct latent classes were identified: No Complaints, Psychological Complaints, and a Physical and Psychological Complaints class; where, low household SES was highest for the physical and psychological complaints class. The findings suggest that health promotion policies and interventions among adolescents should consider the specific needs of adolescents living with low household SES as they report more subjective health complaints.

Socioeconomic Position Mediates the Relationship between Family Social Benefits and Adolescent Life Satisfaction in 25 countries

The aims of this study were to assess the mediating role of household socioeconomic position (SEP) in the associations between the country-level factors: family social benefits, and public income support to single parent households (SPH), with the individual-level factor adolescent life satisfaction. Our sample consisted of adolescent (11, 13, and 15 years old) participants in the Health Behaviour in School-aged Children study (2013/2014) across Canada and 24 countries in Europe. We used World Bank data on country wealth from OECD data on social benefits for families and public income support to SPH. Multilevel linear regressions assessed mediated (indirect) associations of these country-level predictors, through SEP, with life satisfaction. Family social benefits ranged between 1.1% and 3.7% of country wealth. The direct association showed that family social benefits were associated with lower adolescent life satisfaction (β = -0.244, 95% Confidence Intervals [C.I.] = -0.306, -0.182, p < 0.0001) among all adolescents and for adolescents in SPH (β = -0.118, 95% C.I. = -0.161, -0.074, p < 0.0001). However, the mediated (indirect) association showed that family social benefits were associated with higher life satisfaction which is partially mediated by SEP (β = 0.087, 95% C.I. = 0.065, 0.109, p < 0.0001) among all adolescents and for adolescents in SPH as well (β = 0.041, 95% C.I. = 0.030, 0.052, p < 0.0001). Country policies may support the wellbeing of adolescents by reducing poverty and improving their socioeconomic position in society.

Cross-national validation of the social media disorder scale: findings from adolescents from 44 countries

BACKGROUND AND AIMS

There is currently no cross-national validation of a scale that measures problematic social media use (SMU). The present study investigated and compared the psychometric properties of the social media disorder (SMD) scale among young adolescents from different countries.

DESIGN

Validation study.

SETTING AND PARTICIPANTS

Data came from 222 532 adolescents from 44 countries participating in the health behaviour in school-aged children (HBSC) survey (2017/2018). The HBSC survey was conducted in the European region and Canada. Participants were on average aged 13.54 years (standard deviation = 1.63) and 51.24% were girls.

MEASUREMENT

Problematic SMU was measured using the nine-item SMD scale with dichotomous response options.

FINDINGS

Confirmatory factor analyses (CFA) showed good model fit for a one-factor model across all countries (minimum comparative fit index (CFI) and Tucker-Lewis index (TLI) = 0.963 and 0.951, maximum root mean square error of approximation (RMSEA) and standardized root mean square residual (SRMR) = 0.057 and 0.060), confirming structural validity. The internal consistency of the items was adequate in all countries (minimum alpha = 0.840), indicating that the scale provides reliable scores. Multi-group CFA showed that the factor structure was measurement invariant across countries (ΔCFI = -0.010, ΔRMSEA = 0.003), suggesting that adolescents' level of problematic SMU can be reliably compared cross-nationally. In all countries, gender and socio-economic invariance was established, and age invariance was found in 43 of 44 countries. In line with prior research, in almost all countries, problematic SMU related to poorer mental wellbeing (range β_STDY  = 0.193-0.924, P < 0.05) and higher intensity of online communication (range β_STDY  = 0.163-0.635, P < 0.05), confirming appropriate criterion validity.

CONCLUSIONS

The social media disorder scale appears to be suitable for measuring and comparing problematic social media use among young adolescents across many national contexts.

Is Adolescent Risk Behavior Associated With Cross-Household Family Complexity? An Analysis of Post-separation Families in 42 Countries

We examine whether complex cross-household structures of post-separation families are associated with higher risk-taking behavior in adolescence (substance use, bullying, early sexual onset) and whether the proportion, and thus statistical normality, of complex family types in a certain country is a potential moderator of this association. Drawing on representative data from 42 countries and regions from the Health Behavior in School-aged Children (HBSC) study in 2001, 2006, and 2010 (N = 506,977), we provide detailed analyses on adolescent risk behavior even for very rare family types, thereby accounting for the complex cross-household structure present in many post-separation families. We combine logistic and count regression models to analyze risk incidence and intensity. Controlling for relevant child and family characteristics, our results reveal a gradient along which adolescent risk-taking increases with family complexity: The incidence and intensity of risk-taking among adolescents is lowest in two-biological-parent and highest in two-household families with stepparents in both households. The association decreases with a higher proportion of the respective family type in a country. However, the differences between family types, other than the two-biological parent family, are not as pronounced as expected.

Trends in gender and socioeconomic inequalities in adolescent health over 16 years (2002-2018): findings from the Canadian Health Behaviour in School-aged Children study

INTRODUCTION

Monitoring health inequalities in adolescents informs policy approaches to reducing these inequalities early in the life course. The purpose of this study was to investigate trends in gender and socioeconomic inequalities in six health domains.

METHODS

Data were from five quadrennial survey cycles of the Health Behaviour in School-aged Children (HBSC) study in Canada (pooled n = 94 887 participants). Differences in health between socioeconomic groups (based on material deprivation) and between genders were assessed using slope and relative indices of inequality in six health domains: daily physical activity, excess body weight, frequent physical symptoms, frequent psychological symptoms, low life satisfaction, and fair or poor self-rated health.

RESULTS

Over a 16-year period, adolescents in Canada reported progressively worse health in four health domains, with those at the lowest socioeconomic position showing the steepest declines. Socioeconomic differences increased in excess body weight, physical symptoms, low life satisfaction, and fair or poor health. Gender differences also increased. Females showed poorer health than males in all domains except excess body weight, and gender differences increased over time in physical symptoms, psychological symptoms and low life satisfaction.

CONCLUSION

Socioeconomic and gender inequalities in health are persistent and widening among adolescents in Canada. Policies that address material and social factors that contribute to health disparities in adolescence are warranted.

Time trends in adolescent mental wellbeing in the Czech Republic between 2002 and 2018: gender, age and socioeconomic differences

OBJECTIVES

Recent literature indicates a decline over time in adolescent mental wellbeing but results are inconsistent and rely mainly on data from Western societies. This study investigates time trends in adolescent mental wellbeing (psychological and somatic complaints, life satisfaction) among Czech adolescents and explores the moderating role of gender, age and socioeconomic status.

METHODS

Nationally representative data from 29,376 Czech adolescents (50.8% girls, mean age = 13.43; SD = 1.65) across five Health Behaviour in School-aged Children (HBSC) surveys (2002, 2006, 2010, 2014, 2018) were used. Hierarchical regression models estimated national trends in adolescent mental wellbeing and established the moderating role of gender, age and socioeconomic status.

RESULTS

From 2002 to 2018, an increase in the psychological complaints was observed. Life satisfaction decreased over time up to 2014 only, whereas somatic symptoms increased until 2010, followed by a decline in 2014 and 2018. Girls, older adolescents and those from low family affluence reported poorer mental wellbeing. Gender gap increased over time for psychological complaints and life satisfaction. Socioeconomic inequalities gap remained stable over the investigated timeframe.

CONCLUSIONS

Our findings do not provide evidence for substantial temporal changes in mental wellbeing among adolescents in the Czech Republic. Yet, the increase in psychological complaints has been consistent which is an indicator of a small decline over time in adolescent mental wellbeing. Furthermore, the gender gap in mental wellbeing increased over time, whereas the age and socioeconomic differences remained relatively stable. This calls for the attention of public health professionals and policy makers from the Czech Republic.

Mental Well-Being: 2010-2018 Trends among Italian Adolescents

(1) Aims: To explore temporal trends 2010-2018 of well-being among Italian adolescents and to evaluate potential explanatory factors. (2) Methods: Italian nationality representative samples of students aged 11, 13, and 15 years were recruited in 2010, 2014, and 2018; Health Behaviour in School-aged Children (HBSC), for an overall number of 165,000 teenagers. Multivariable logistic regression models were performed to fit the trends over time of life satisfaction (LS), psychological (PSY-HC) and somatic health complaints (SOM-HC) considering the contextual factors: school work pressure, social support (family, school, peers), socioeconomic status, geographic area, and immigration background; (3) Results: From 2010 to 2018 while LS was steady, health complaints increased, mainly for PSY-HC, in all age and gender groups. Trend of PSY-HC affected mainly 15-years-olds: rates among boys varied from 29.6% to 35.9% (OR: 1.13, 95%CI: 1.02-1.25); among girls from 49.1% to 63.3% (OR: 1.56, 95%CI: 1.42-1.72). High school work pressure and poor social support play a central role in worsening well-being outcomes; (4) Conclusions: Our findings pictured a remarkable worsening trend of teenagers' well-being, especially among 15-year-old girls. Further research will be required to investigate this breaking up of the connection between psychophysical symptomatology and cognitive perception of life satisfaction.

Adolescent screen time: associations with school stress and school satisfaction across 38 countries

This study examined associations of watching television, electronic games, computer uses with school stress, and satisfaction among adolescents. Nationally representative data from 38 European and North American countries that participated in the 2014 Health Behaviour in School-aged Children (HBSC) survey were analysed. School stress and school satisfaction were each assessed using a 4-point self-reported item and then dichotomised. Participants reported discretional time spent on different screen-based activities. Of the 191,786 participants (age 13.6 [1.6] years; 51% girls), 35% reported high levels of school stress, while 30% reported high satisfaction with their school. Multilevel multivariable logistic regression modelling showed that adolescents reporting watching television > 4 h/day (≤ 1 h/day as reference) had 31% higher odds of school stress (OR 1.31; 95% CI: 1.27-1.35) and 36% less odds of school satisfaction (OR 0.64; 95% CI: 0.62-0.67). Prolonged electronic gaming (> 4 h/day) increased the odds of school stress by 26% (OR 1.26; 95% CI: 1.22-1.30) and decreased the odds of school satisfaction by 37% (OR 0.63; 95% CI: 0.61-0.65). Adolescents with prolonged computer use had 46% higher odds of school stress (OR 1.46; 95% CI: 1.42-1.50) and 39% lower odds of school satisfaction (OR 0.61; 95% CI: 0.59-0.63). Association estimates were more evident among younger adolescents than their older counterparts with no apparent gender differences.

CONCLUSION

Prolonged screen use, irrespective of type, was positively associated with school stress and inversely associated with school satisfaction with high computer use showing the highest adverse associations. Prospective research is needed to understand directionality and mechanisms of these relationships.

WHAT IS KNOWN

• Screen-based activities are adversely associated with various health and wellbeing indicators in adolescents.. • The relation between screen time and school-related outcomes is yet to understand fully.

WHAT IS NEW

• Prolonged screen time is associated with increased school stress and decreased school satisfaction in adolescents. • Computer use showed higher adverse associations than watching television or playing electronic games.

Family Support as Smoking Prevention during Transition from Early to Late Adolescence: A Study in 42 Countries

Family support has a beneficial impact on protecting health-risk behaviour in adolescents. This study aimed to explore whether family support is associated with risk of smoking during transition from early (11 years) to late (15 years) adolescence across 42 countries. The data from the cross-national Health Behaviour in School-aged Children (HBSC) study in 2017/2018 were employed (N = 195,966). Family support was measured using the four-item Family dimension of the Multidimensional Scale of Perceived Social Support (sum score 20 or more was categorised as high family support). Smoking was defined as a reported cigarette smoking at least 1-2 days in the last 30 days. The association between smoking and family support was assessed using a prevalence ratio (PR) obtained from the multivariate Poisson regression. Over two thirds of adolescents reported high levels of support from their family. Family support was found to significantly decrease with age in most of the countries, with the boys reported high level of family support more often than girls. The adolescents who reported having low family support also were more likely to smoke compared to their peers who reported having high family support (PR = 1.81; 95% CI: 1.71-1.91 in boys, and PR = 2.19; 95% CI: 2.08-2.31 in girls). The countries with a stronger effect of family support in reducing smoking risk indicated lower rates of adolescent smoking as well as lower increases in the cigarette smoking prevalence during the age period from 11 to 15 years. This study reinforces the need for family support, which is an important asset helping adolescents to overcome the risk of smoking during their transition from early to late adolescence.