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.

Recurrent headache, stomachache, and backpain among adolescents: association with exposure to bullying and parents' socioeconomic status

OBJECTIVES

Recurrent pain is a prevalent and severe public health problem among adolescents and is associated with several negative health outcomes. In a representative sample of adolescents this study examined 1) whether exposure to bullying and low socioeconomic status (SES) were associated with recurrent headache, stomachache and backpain, 2) the combined effect of exposure to bullying and low SES on recurrent pain and 3) whether SES modified the association between bullying and recurrent pain.

METHODS

Data derived from the Danish contribution to the international collaborative study Health Behaviour in School-aged Children (HBSC). The study population was students in three age groups, 11-, 13- and 15-year-olds from nationally representative samples of schools. We pooled participants from the surveys in 2010, 2014 and 2018, n=10,738.

RESULTS

The prevalence of recurrent pain defined as pain 'more than once a week' was high: 11.7 % reported recurrent headache, 6.1 % stomachache, and 12.1 % backpain. The proportion who reported at least one of these pains 'almost every day' was 9.8 %. Pain was significantly associated with exposure to bullying at school and low parental SES. The adjusted odds ratio (AOR, 95 % CI) for recurrent headache when exposed to both bullying and low SES was 2.69 (1.75-4.10). Equivalent estimates for recurrent stomachache were 5.80 (3.69-9.12), for backpain 3.79 (2.58-5.55), and for any recurrent pain 4.81 (3.25-7.11).

CONCLUSIONS

Recurrent pain increased with exposure to bullying in all socioeconomic strata. Students with double exposure, i.e., to bullying and low SES, had the highest OR for recurrent pain. SES did not modify the association between bullying and recurrent pain.

Motor development problems in infancy predict mental disorders in childhood: a longitudinal cohort study

The purpose of this study is to examine whether motor development problems in infancy predicted mental disorders later in childhood, taking a wide array of potential confounding variables into consideration. This longitudinal study included an unselected study population of 33238 newborn children from the Copenhagen area, Denmark. Data on the predictor variable, motor development problems at 8-10 months of age, were obtained from the community health nurses' systematic evaluation of the child's motor development during a home visit and stored in the Child Health Database. Data on outcome, diagnosed mental disorders before the age of 8 years, were obtained from the Danish National Patient Register. Potential confounding variables were obtained from the Child Health Database, the National Birth Register and the Civil Registration System. The prevalence of motor development problems at 8-10 months of age was 19.3%; the incidence of any diagnosed mental disorder from 11 months of age to the 8th birthday was 4.0%. Motor development problems were associated with an increased risk of being diagnosed with a mental disorder before the 8th birthday, adjusted odds ratio (AOR) 1.47 (1.29-1.67). Motor development problems were associated with later neurodevelopmental disorders, AOR 1.77 (1.52-2.06), in particular autism spectrum disorders, AOR 1.63 (1.31-2.03), hyperactivity/attention deficit disorders, AOR 1.29 (1.03-1.61) and disorders of intellectual disability, AOR 3.28 (2.39-4.49).

CONCLUSION

Motor development problems as early at 8-10 months of age were predictive of neurodevelopmental disorders before the 8th birthday. The findings call for clinical attention and more research on preventive potentials in the community child health care.

WHAT IS KNOWN

• Children with ASD, ADHD and ID have high prevalence of early motor development problems.

WHAT IS NEW

• Motor development problems in infancy predicted neurodevelopmental disorders before the 8th birthday. • This observation could improve early identification and prevention of mental health problems in childhood.

Underweight among adolescents in Denmark: prevalence, trends (1998-2018), and association of underweight with socioeconomic status

BACKGROUND

Underweight among adolescents is an important clinical and public health issue. It is associated with adverse health outcomes throughout the life-span and may reflect food poverty, unhealthy eating habits, or some underlying health conditions.

OBJECTIVE

To study prevalence and trends in underweight among adolescents 1998-2018, to examine social inequality in underweight, and whether social inequality changed over time.

METHODS

Data were derived from 6 cross-sectional school surveys from The Health Behaviour in School-aged Children study in Denmark. The study included 11-, 13-, and 15-year-old schoolchildren in random samples of schools in 1998, 2002, 2006, 2010, 2014, and 2018 (n = 22,177). Underweight was determined by body mass index-for-age thinness grade 2-3 (the Cole and Lobstein method). Socioeconomic status was determined using occupational social class (the Danish OSC Measurement).

RESULTS

The overall prevalence of underweight was 3.1% among boys and 5.3% among girls (P < 0.0001) and decreased by age (P < 0.0001) among both boys and girls. The prevalence of underweight was almost stable from 1998 to 2018. There was no observed absolute or relative social inequality in the prevalence of underweight among boys or girls.

CONCLUSION

The prevalence of underweight in 11- to 15-year-olds was significantly higher among girls than boys. The prevalence remained stable from 1998 to 2018. There was no significant association between SES and prevalence of underweight. It is important to elucidate the underlying causes of underweight such as malnutrition, eating disorders, eating problems, loss of appetite, chronic diseases, insufficient knowledge of nutrients effects on bodily functions, and persistent pain.

Lonely, but Not Alone: Qualitative Study among Immigrant and Native-Born Adolescents

This paper explores loneliness as it is understood and experienced by adolescents, with a special focus on the importance of their migration status. We recruited students from five schools following a maximum variation sampling scheme, and we conducted 15 semi-structured, individual interviews with eighth-grade adolescents (aged 14-15 years) that were immigrants, descendants, and with a Danish majority background. A thematic analysis was applied with a special focus on differences and similarities in understanding and experiencing loneliness between adolescents with diverse migration status. The results showed more similarities than differences in loneliness. Generally, loneliness was described as an adverse feeling, varying in intensity and duration, and participants referenced distressing emotions. Feeling lonely was distinguished from being alone and characterized as an invisible social stigma. A variety of perceived social deficiencies were emphasized as causing loneliness, emerging in the interrelation between characteristics of the individual and their social context. The results add to the current literature by highlighting that it is not the presence of specific individual characteristics that causes loneliness; instead, loneliness is dependent on the social contexts the individual is embedded in. Differences across migration status were few and related to variations in the adolescents' individual characteristics. The findings highlight the importance of (1) studying the characteristics of both the individual and the social context in research on the antecedents to adolescents' loneliness, and (2) applying this perspective in other studies on the importance of migration status.

Parental education, parent-child relations and diagnosed mental disorders in childhood: prospective child cohort study

BACKGROUND

Mental disorder in childhood is an important public health issue. We aimed to examine the prospective association between parental education at childbirth and diagnosed mental disorders in young children and explore whether this association was mediated or modified by parent-child relations in infancy.

METHODS

Prospective cohort study of all newborn was from 2002 to 2010 from 16 municipalities in the capital region of Copenhagen, Denmark, with follow-up until their 8th birthday, N = 40 762. Baseline data included information from national population registers and from health visitors' records at child aged 0 to 10 months. Outcome variable: any mental disorder diagnosed at hospital from age 11 months to 8 years.

RESULTS

Low parental education was predictive of diagnosed child mental disorder, adjusted odds ratio (AOR) = 1.83 (95% CI 1.49-2.23). Problematic parent-child relation at age 8-10 months was also predictive of mental disorder, AOR = 2.06 (1.57-2.70) but did not mediate the association between parental education and mental disorder. AOR for mental disorders was 3.24 (2.03-5.16 for the combination vocational training and problematic parent-child relation and 2.49 (1.42-4.38) for the combination primary school and problematic parent-child relation.

CONCLUSIONS

Low parental education and problematic parent-child relation were independent risk factors for diagnosed mental disorders in the age span of 11 months to 8 years.

Social inequality in parent-infant relations: Epidemiological study of community nurse records

Background: Some studies suggest that favourable socioeconomic circumstances are associated with better parent-child relations but the documentation of such an association is limited and inconsistent. Few studies focused on infancy, few studies relied on objective measurement of parent-infant relations, and few studies included more than one measurement of parent-infant relations in the first year of life. Aims: To report the prevalence of objectively measured problems in parent-infant relations during the first year of life and to examine the association between socioeconomic circumstances and parent-infant relations in an unselected community sample of infants. Methods: Cross-sectional study of a community sample of children from birth to 10 months in 15 municipalities in Denmark, n = 11,765. The exposure variables were population register data about socioeconomic circumstances: (a) parents' education, (b) family composition, (c) parents' origin, and (d) parents' occupational status. The outcome variable was the health visitor's concerns about the parent-infant relation assessed at four home visits from birth to 10 months after delivery. Results: The proportion of children with concerns about the parent-infant relation was 10.5%, 7.8% at one home visit and 2.8% at two or more home visits. Logistic regression analyses showed that all four indicators of socioeconomic circumstances were associated with concerns about the parent-infant relation in the first year of life. Conclusions: The risk of problematic parent-infant relations were significantly elevated among, children of immigrant parents, and children of parents with shorter education and not in education or work.

Recurrent abdominal pain among adolescents: trends and social inequality 1991-2018

OBJECTIVES

The association between socioeconomic status and recurrent abdominal pain (RAP) among adolescents is an understudied issue. No study has examined whether such an association changes over time. The aim was to examine trends in RAP among adolescents in Denmark from 1991 to 2018, to examine whether there was social inequality in RAP and whether this inequality varied over time.

METHODS

The study used data from the Danish part of the international Health Behaviour in School-aged Children (HBSC) study of nationally representative samples of 11-, 13- and 15-year-olds. This study pooled data from eight comparable surveys from 1991 to 2018, overall participation rate 88.0%, n=30,048. The definition of RAP was self-reported stomach-ache daily or several days per week during the past six months. We reported absolute inequality as prevalence difference in RAP between low and high socioeconomic status and relative inequality as odds ratio for RAP by socioeconomic status.

RESULTS

In the entire study population, 5.6% reported RAP, 3.1% among boys and 7.8% among girls. There was a significant increase in RAP from 1991 to 2018 among boys and girls, test for trend, p<0.0001. The prevalence of RAP was significantly higher in low than high socioeconomic status, OR=1.63 (95% CI: 1.42-1.87). The absolute social inequality in RAP fluctuated with no consistent increasing or decreasing pattern.

CONCLUSIONS

The prevalence of RAP increased from 1991 to 2018. The prevalence was significantly higher among girls than among boys, and significantly higher in low socioeconomic status families. Professionals should be aware of RAP as common and potentially serious health problems among children and adolescents. In addition to clinical examination it is important to focus on improving the child's quality of life, reduce parents' and children's concerns about the seriousness of the condition, and consider supplements to medicine use.

Trends in social inequality in loneliness among adolescents 1991-2014

BACKGROUND

Loneliness and social inequality in health are important public health concerns. We examined (i) trends in loneliness among adolescents from 1991 to 2014 in Denmark and (ii) trends in social inequality in loneliness.

METHODS

Study population: 11-15-year olds in random samples of schools in 1991, 1994, 1998, 2006 and 2014, n = 19 096. Loneliness was measured by a single item and social background by parents' occupational social class (OSC). We calculated absolute (%) differences in loneliness between high and low OSC and relative differences by odds ratio for loneliness.

RESULTS

Across all surveys, 6.3% reported feeling lonely. The prevalence increased from 4.4% in 1991 to 7.2% in 2014. The prevalence of loneliness in high, middle and low OSC was 5.8, 5.9 and 8.0%. The increase in loneliness was more pronounced in higher than lower OSC, resulting in a decreasing absolute social inequality in loneliness. The statistical interaction between OSC and survey year was significant, P = 0.0176, i.e. the relative social inequality in loneliness also decreased from 1991 to 2014.

CONCLUSION

The prevalence of loneliness increased from 1991 to 2014. The social inequality in loneliness decreased in both absolute and relative terms because of a rising prevalence of loneliness among children from high OSC.

Self-efficacy and social competence reduce socioeconomic inequality in emotional symptoms among schoolchildren

BACKGROUND

Many adolescents experience mental health problems which may have serious consequences for short- and long-term health and wellbeing. This study investigates socioeconomic inequality in emotional symptoms, self-efficacy and social competence. Further, whether self-efficacy and social competence reduce socioeconomic inequalities in emotional symptoms.

METHODS

Data stem from the cross-sectional Danish Health Behaviour in School-aged Children Methodology Development Survey 2012. Data were collected among all schoolchildren in grades 5-9 (11-15-year-olds) in 23 public schools in two municipalities. Participation rate was 76.8% (n = 3969). Analyses of the associations between daily emotional symptoms, occupational social class, self-efficacy and social competence were performed through logistic regression analyses using SAS version 9.3. Multilevel logistic regression analyses were used to study effect modification.

RESULTS

Schoolchildren from lower socioeconomic positions have higher odds for daily emotional symptoms and lower levels of high self-efficacy and high social competence compared to schoolchildren from higher socioeconomic positions. High self-efficacy and high social competence buffer the association between socioeconomic position and emotional symptoms, i.e. they seem to protect children and adolescents from lower socioeconomic strata against the higher risk of daily emotional symptoms.

CONCLUSIONS

High self-efficacy and high social competence buffer the negative effects of low socioeconomic status on emotional symptoms among schoolchildren. Self-efficacy and social competence can be promoted e.g. through school-based initiatives and may be an effective way to improve mental health and reduce socioeconomic inequality in emotional symptoms among children and adolescents.

Loneliness in the lives of Danish adolescents: Associations with health and sleep

Aims: We examined the relationship between loneliness and health among young adolescents. We also investigated the validity of a single-item measure of loneliness by comparing this to a composite score. Methods: The current data come from a nationally representative sample of 11- to 15-year-old adolescents (N=3305; F=52%) from Denmark collected in 2014 as part of the Health Behaviour in School-aged Children (HBSC) collaborative cross-national survey. Results: A series of binary logistic regressions showed that higher loneliness among adolescents, whether measured using the single- or multi-item measurement, was associated with poorer self-rated health, higher frequency of headache, stomach ache, backache, difficulties sleeping, greater sleep disturbance and more instances of feeling tired in the morning. Those associations were relatively consistent across sex and age groups. Conclusions:Loneliness is associated with poorer self-reported health and sleep problems among young adolescents. Those findings are similar across two measures of loneliness, suggesting robust findings. The development of interventions and health-education efforts to fight loneliness in adolescence is important.

Intake of sugar sweetened soft drinks among adolescents: Trends and social inequality in Denmark 2002-2018

BACKGROUND

Intake of sugar sweetened soft drinks (SSSD) has decreased among adolescents, but trends in social inequality in SSSD intake are unknown.

AIM

Examine trends in social inequality in SSSD intake among adolescents in Denmark during 2002-2018.

METHODS

Five Health Behaviour in School-aged Children surveys with data on SSSD intake and parents' occupational social class (OSC) from nationally representative samples of 11, 13 and 15 year olds, n =20,112.

RESULTS

The overall prevalence of daily SSSD intake decreased from 10.1% in 2002 to 6.4% in 2018. The prevalence decreased in both high OSC (from 8% to 5%) and middle OSC (from 10% to 6%) but remained around 12% in low OSC. The odds ratio (OR) estimates of low compared with high OSC increased over the years around an overall OR of 2.01 (1.74-2.34).

CONCLUSIONS

Danish adolescents' SSSD intake decreased during 2002-2018 and was higher the lower the parents' OSC. Thus, social inequality increased during 2002-2018.

Difficulties falling asleep among adolescents: Social inequality and time trends 1991-2018

Sleep problems in adolescence are increasingly common, and associated with adverse health and psychological outcomes. Adolescents' sleep problems may be related to the family's socioeconomic status, but studies are few and no study has examined whether social inequality in sleep problems changes as sleep problems become increasingly common. This study examined trends in difficulties falling asleep among adolescents in Denmark, whether this sleep problem was associated with socioeconomic status, and whether this association changed from 1991 to 2018. The study applied data from eight comparable surveys among 11-15 year olds in Denmark 1991-2018, the Danish arm of the international Health Behaviour in School-aged Children study, N = 30,002. The prevalence of daily difficulties falling asleep increased from 7.0% to 13.4% in 1991-2018 with higher frequencies among girls and younger adolescents. The odds ratio (95% confidence interval) for daily difficulties was 1.14 (1.05-1.24) in middle and 1.52 (1.37-1.69) in low compared with high socioeconomic status. The absolute social inequality in difficulties falling asleep was persistent in 1991-2018 whereas the relative social inequality may have decreased. The increasing prevalence and the social inequality in difficulties falling asleep among adolescents is a serious public health concern that calls for more attention and efforts.

Short report: persistent social inequality in poor self-rated health among adolescents in Denmark 1991-2014

The aim was to examine trends in social inequality in poor self-rated health (SRH) among adolescents in Denmark 1991-2014. The analysis included 18 996 11-15-year-old school children from the cross-sectional Health Behaviour in School-aged Children studies in 1991, 2002, 2006, 2010 and 2014. Across the five surveys, the prevalence of poor SRH was 14.2%, remaining almost unchanged from 1991 to 2014. The proportion with poor SRH was 12.2% in high, 14.3% in middle and 17.6% in low occupational social class. This social inequality in poor SRH was persistent during the entire study period, both in terms of absolute and relative social inequality.

Trends in socioeconomic differences in daily smoking among 15-year-old Danes 1991–2014

Aim: To examine trends in socioeconomic differences in daily smoking among 15-year-old Danes between 1991–2014, using occupational social class as indicator of socioeconomic status. Methods: The study included 15-year-olds participating in seven Danish Health Behaviour in School-aged Children studies between 1991–2014, n = 8,641. The analyses focused on absolute socioeconomic differences (prevalence difference between low and high occupational social class) and relative socioeconomic differences communicated by odds ratio for daily smoking. Results: The prevalence of daily smoking declined from 18.6% in 1991 to 4.5% in 2014. Across all surveys, the prevalence was 8.9% in high, 12.8% in middle and 16.5% in low occupational social classes ( p < 0.0001). The absolute socioeconomic differences increased from 1991 to 2006 and declined thereafter. Across all survey years, the odds ratio (95% confidence interval) for daily smoking was 1.40 (1.19–1.65) in middle and 1.90 (1.56-2.32) in low versus high occupational social classes. The statistical interaction between occupational social class and survey year was significant ( p = 0.0404), suggesting increasing relative socioeconomic differences from 1991 to 2014. Conclusions: There was a substantial decline in daily smoking among 15-year-olds between 1991–2014 in all occupational social class groups. The prevalence of daily smoking was highest in the low occupational social class during the entire period. The absolute socioeconomic differences in daily smoking increased between 1991–2006 and declined thereafter. The relative socioeconomic differences increased over 1991–2014. Studies of change in socioeconomic differences over time should address both absolute and relative socioeconomic differences as they may result in different conclusions and because important improvement in prevalence patterns may be disguised by exclusive focus on changes in relative socioeconomic differences.

[Standardised measuring the health of infants and toddlers in community health services]

Standardised measures are needed in the general child health surveillance. A standardised record with manualised guidelines have been created for use in the existing services of community health nurses, to collect epidemiological data and improve the quality of regional child health surveillance. The record has been used since 2000, and currently one third of the Danish child population is included. Research findings suggest targets of intervention towards risk trajectories of overweight, weight faltering, eating problems and neuro-developmental disorders.

Brief Report: Trends in Social Inequality in Drunkenness Among Danish Adolescents, 1991-2014

OBJECTIVE

This study examined whether social inequality in frequent drunkenness among Danish adolescents changed from 1991 to 2014.

METHOD

We used data from the international Health Behaviour in School-aged Children (HBSC) study, which provided nationally representative samples of 15-year-olds from seven comparable cross-sectional studies in Denmark (N = 8,655). The students provided data about frequency of drunkenness and parents' occupation.

RESULTS

In total, 38.6% reported to have been drunk at least four times, decreasing from 44.2% in 1991 to 21.2% in 2014. Most of the decrease took place in the latter part of the period. This decrease was found in all occupational social classes, but there was no change in absolute social inequality in drunkenness four or more times reported from 1991 to 2014. The sex- and yearadjusted odds ratio for frequent drunkenness was 0.80, 95% CI [0.70, 0.93] in low compared with high occupational social class. The statistical interaction between survey year and occupational social class was insignificant (p = .3601); that is, there was no change in relative social inequality in frequent drunkenness over time.

CONCLUSIONS

Drunkenness was more prevalent among adolescents from the high occupational social class, and this social inequality did not change from 1991 to 2014.

Predictive validity of a service-setting-based measure to identify infancy mental health problems: a population-based cohort study

Measures to identify infancy mental health problems are essential to guide interventions and reduce the risk of developmental psychopathology in early years. We investigated a new service-setting-based measure the Copenhagen Infant Mental Health Screening (CIMHS) within the general child health surveillance by community health nurses (CHN). The study population of 2973 infants was assessed by CIMHS at age 9-10 months. A subsample of 416 children was examined at age 1½ years, using parent interviews including the Child Behavior Checklist (CBCL 1½-5), Check List of Autism and Toddlers (CHAT), Infant-Toddler Symptom Checklist (ITSCL), and the Bayley Scales of Infant and Toddler Development (BSID) and observations of behavior, communication, and interaction. Child mental disorders were diagnosed according to ICD-10 and parent-child relationship disorders according to DC:0-3R. Statistical analyses included logistic regression analyses adjusted and weighted to adjust for sampling and bias. CIMHS problems of sleep, feeding and eating, emotions, attention, communication, and language were associated with an up to fivefold increased risk of child mental disorders across the diagnostic spectrum of ICD-10 diagnoses. Homo-type continuity was seen in problems of sleep and feeding and eating being associated with a threefold increased risk of disorders within the same area, OR 3.0 (95% CI 1.6-5.4) and OR 2.7 (95% CI 1.7-4.2), respectively. The sensitivity at high CIMHS problem scores was 32% and specificity 86%. In summary, CIMHS identify a broad range of infants' mental health problems that are amenable to guide intervention within the general child health surveillance.

Short communication: Persistent socio-economic inequality in frequent headache among Danish adolescents from 1991 to 2014

BACKGROUND

The association between socio-economic status (SES) and headache among adolescents is an understudied issue, and no study has examined whether such an association changes over time. The aim was to examine trends in socio-economic inequality in frequent headache among 11- to 15-year-olds in Denmark from 1991 to 2014, using occupational social class (OSC) as indicator of SES.

METHODS

The study applies data from the Danish part of the international Health Behaviour in School-aged Children (HBSC) study. HBSC includes nationally representative samples of 11-, 13- and 15-year-olds. This study combines data from seven data survey years from 1991 to 2014, participation rate 88.6%, n = 31,102. We report absolute inequality as per cent difference in frequent headache between high and low OSC and relative inequality as odds ratio for frequent headache by OSC.

RESULTS

In the entire study population, 10.4% reported frequent headache. There was a significant increase in frequent headache from 8.0% in 1991 to 12.9% in 2014, test for trend, p < 0.0001. This increasing trend was significant in all OSCs. The prevalence of frequent headache was significantly higher in low than high OSC, OR = 1.50 (95% CI: 1.34-1.67). This socio-economic inequality in frequent headache was persistent from 1991 to 2014.

CONCLUSION

There was a significant and persistent socio-economic inequality, i.e. increasing prevalence of frequent headache with decreasing OSC. The association between socio-economic position and headache did not significantly change over time, i.e. the statistical interaction between OSC and survey year was insignificant.

SIGNIFICANCE

The prevalence of frequent headache among adolescents increases with decreasing SES. This socio-economic inequality has been persistent among adolescents in Denmark from 1991 to 2014. Clinicians should be aware of this social inequality.

Increasing prevalence of emotional symptoms in higher socioeconomic strata: Trend study among Danish schoolchildren 1991–2014

Aims: The aims of this study were: (a) to examine trends in daily emotional symptoms among 11- to 15-year-olds from 1991 to 2014 in Denmark, and (b) to examine trends in social inequality in daily emotional symptoms, that is, whether the differences in prevalence between adolescents with parents of varying occupational social class changed over time. Methods: We combined seven comparable cross-sectional Health Behaviour in School-aged Children surveys ( N=31,169). Daily emotional symptoms were measured by the HBSC Symptom Check List and occupational social class (OSC) by students’ reports about parents’ occupation. We calculated absolute (per cent) differences in emotional symptoms between high and low OSC and relative differences by odds ratio for emotional symptoms by parents’ OSC. Results: Eight per cent reported at least one daily emotional symptoms, with an increasing trend from 1991 to 2014 ( p<0.001). The prevalence in high, middle and low OSC was 6.2%, 7.4% and 10.6% ( p<0.0001). From 1991 to 2014, there was an increase in the prevalence of daily emotional symptoms in high ( p<0.0001) and middle ( p<0.0001) but not low OSC ( p=0.4404). This resulted in a diminishing absolute social inequality in emotional symptoms. The statistical interaction between OSC and survey year was significant ( p=0.0023) and suggests a diminishing relative social inequality in emotional symptoms from 1991 to 2014. Conclusions: There was an increasing prevalence of daily emotional symptoms from 1991 to 2014 and a diminishing social inequality in prevalence of daily emotional symptoms in terms of both absolute and relative social inequality.

Trends in social inequality in physical inactivity among Danish adolescents 1991-2014

The aim of this study was to investigate social inequality in physical inactivity among adolescents from 1991 to 2014 and to describe any changes in inequality during this period. The analyses were based on data from the Danish part of the HBSC study, which consists of seven comparable cross-sectional studies of nationally representative samples of 11–15-year old adolescents. The available data consisted of weekly time (hours) spent on vigorous physical activity and parental occupation from 30,974 participants. In summary, 8.0% of the adolescents reported to be physically inactive, i.e. spend zero hours of vigorous leisure time physical activity per week. The proportion of physically inactive adolescents was 5.4% in high social class and 7.8% and 10.8%, respectively, in middle and low social class. The absolute social inequality measured as prevalence difference between low and high social class did not change systematically across the observation period from 1991 to 2014. Compared to high social class, OR (95% CI) for physical inactivity was 1.48 (1.32–1.65) in middle social class and 2.18 (1.92–2.47) in lower social class. This relative social inequality was similar in the seven data collection waves (p=0.971). Although the gap in physical inactivity between social classes does not seem to be widening in Danish adolescents, there are still considerable differences in the activity levels between high, middle and low social class adolescents. Consequently, there is a need for a targeted physical activity intervention among adolescents from low (and middle) social class.

•

A lower prevalence of physical inactivity with higher family social class

•

a persistent absolute social inequality across the entire observation period from 1991 to 2014

•

a persistent relative social inequality; the magnitude of the social class-difference in physical inactivity did not change with time

Self-reported medicine use among 11- to 15-year-old girls and boys in Denmark 1988 - 1998

Aims: To describe the self-reported medicine use for common health complaints among 11 - 15-year-olds in Denmark during a ten year period, 1988 - 1998. The paper focuses on medicine for headache, stomach ache, cough, cold, nervousness, and difficulties in getting to sleep. Methods: Four cross-sectional surveys of 11 - 15-year-old students in random samples of schools in Denmark, conducted in 1988 (n=1,671), 1991 (n=1,860), 1994 (n=4,046) and 1998 (n=5,205). The surveys were similar with regard to sampling and data collection. Data were collected by self-administered questionnaires in the classroom. Results: A large proportion of 11 - 15-year-olds reported medicine use during the past month. It was most common to take medicines for headache (used by 55% of 15-year-old girls and 36% of 15-year-old boys in 1998) and stomach ache (33% among 15-year-old girls in 1998). Pain reliever use was higher among girls than boys and this sex difference increased with age. There was an upward trend in reported medicine use from 1988 to 1998, in particular regarding medicine for stomach-ache among 13- and 15-year-old girls. A large proportion of girls were frequent users of medicine for headache, stomach-ache, and sleeping difficulties. Conclusion: A high proportion of 11 - 15-year-old girls and boys reported medicine use in relation to common health complaints. The proportion of users increased during the past decade. It is suggested that more information about medicine be built into health education programs in the future.

Development in self-rated health among older people as determinant of social relations

Aim: The purpose of this study was to analyse whether development in self-rated health (SRH) over four years was associated with the structure of and satisfaction with social relations, at four and eight years follow-up, among elderly women and men. Methods: A longitudinal questionnaire-based study was undertaken of non-institutionalized Danes, aged 70 - 95 years, with baseline in 1986. The response rate at baseline was 69%, n=1,231. First follow-up was carried out in 1990, with 91% of eligible individuals participating (n=911). Second follow-up took place in 1994, where 83% of eligible individuals participated (n=542). The association was studied between development in SRH from 1986 to 1990 and social relations in 1990 and in 1994. Results: A sustained poor SRH predicted low contact frequency OR=1.7 (1.1 - 2.6), small contact diversity OR=1.6 (1.0 - 2.6) and low contact satisfaction OR=3.4 (2.3 - 5.2) in the two-point analyses. Furthermore, a deterioration in SRH predicted poor contact satisfaction OR=2.8 (1.7 - 4.5). All analyses were adjusted for age, gender, mental health, functional ability, cohabitation status, and a measure of social relations at baseline. Results for the three-point analyses were similar to those for the two-point analyses. The associations were weaker for contact satisfaction OR=2.8 (1.7 - 4.7), but stronger for contact frequency OR=2.5 (1.4 - 4.4) and diversity OR=2.1 (1.2 - 3.6). Conclusion: Sustained poor SRH and, to some degree, deterioration in SRH were predictors of poor social relations after four and eight years.

Boys and girls smoking within the Danish elementary school classes: a group-level analysis

Aims: To quantify the correlation between male and female smoking prevalence in elementary school classes by group-level analysis. Methods: This study was the Danish contribution to the cross-national study Health Behaviour in School-Aged Children (HBSC) 1998. Ninety school classes at grade nine (1,515 students) from a random sample of schools in Denmark took part. The proportion of male and female "at all '' smokers and daily smokers in the school class was calculated. Results: The mean "at all'' smoking proportion in the school classes is 39% for girls and 32% for boys. The proportion of male and female smokers within school classes does not correlate. There is high variation in male and female smoking behaviour between school classes. Conclusions: The infl uence of social classroom environment on the processes causing smoking behaviour may be different for boys and girls. This paper illustrates that group-level analysis provides valuable new knowledge.

Coping with unemployment: Does educational attainment make any difference?

Aims: The aim of this study was to examine the cross-sectional association between educational attainment and coping strategies with unemployment in a random sample of 37- to 56-year-old Danish men and women in long-term unemployment. Methods: Data were based on a survey among 575 men and 1,064 women who had been unemployed at least 70% of the time during a three-year period (October 1996 to October 1999). The outcome measures were two scales for coping with unemployment, one for problem-solving coping, and one for avoidant coping. Educational attainment was measured by years of vocational training. Results: A significant association was found between low educational attainment and low use of problem-solving coping among both men, OR=1.81 (95% CI 1.19—2.75), and women, OR=1.57 (1.13— 2.18). Adjustment for cohabitation status, self rated health, economic strain, and unemployment status did not change this association substantially. High use of avoidant coping was associated with low educational attainment among men, OR=1.57 (0.98—2.51). For women, medium educational attainment was significantly associated with low use of avoidant coping, OR=0.60 (0.42—0.85). This result was not affected by adjustment for the covariates. Conclusions: Coping strategies are considered a potential modifier of the impact of unemployment on health and well-being. In this study, differences in coping strategies with unemployment were associated with educational attainment.

High and low levels of positive mental health: are there socioeconomic differences among adolescents?

Purpose

– It is important within public health goals to promote adolescents’ mental health and to reduce socioeconomic inequalities in mental health. Among adults there are indications that the socioeconomic pattern of low positive mental health (PMH) differs from the socioeconomic pattern of high PMH. Knowledge regarding the social epidemiology of PMH among young people is lacking. The purpose of this paper is to examine the socioeconomic patterning of aspects of low and high PMH among adolescents.

Design/methodology/approach

– The Health Behaviour in School-aged Children Methodology Development Study 2012 provided data on 3,670 adolescents aged 11-15 in two municipalities in Denmark. Socioeconomic differences in aspects of low and high PMH (self-esteem, social competence and self-efficacy) were investigated by calculating sex-specific prevalence of PMH in socioeconomic groups measured by parents’ occupational social class. Using multi-level logistic regression analyses, odds ratios for low and high PMH compared to moderate PMH were estimated.

Findings

– In age-adjusted analyses there seemed to be a graded relationship with increasing odds for low PMH with decreasing socioeconomic position, but no indication of a socioeconomic patterning of high PMH. The prevalence of high self-esteem and high self-efficacy was higher among boys than girls. High social competence and high self-efficacy increased with age.

Research limitations/implications

– Public health research has primarily focused on risk factors and mental health problems. Research highlighting more detailed aspects of PMH is needed.

Originality/value

– The socioeconomic pattern of high PMH may be different from the socioeconomic pattern of low PMH.

Loneliness and Ethnic Composition of the School Class: A Nationally Random Sample of Adolescents

Loneliness is a public health concern that increases the risk for several health, behavioral and academic problems among adolescents. Some studies have suggested that adolescents with an ethnic minority background have a higher risk for loneliness than adolescents from the majority population. The increasing numbers of migrant youth around the world mean growing numbers of heterogeneous school environments in many countries. Even though adolescents spend a substantial amount of time at school, there is currently very little non-U.S. research that has examined the importance of the ethnic composition of school classes for loneliness in adolescence. The present research aimed to address this gap by exploring the association between loneliness and three dimensions of the ethnic composition in the school class: (1) membership of ethnic majority in the school class, (2) the size of own ethnic group in the school class, and (3) the ethnic diversity of the school class. We used data from the Danish 2014 Health Behaviour in School-aged Children survey: a nationally representative sample of 4383 (51.2 % girls) 11-15-year-olds. Multilevel logistic regression analyses revealed that adolescents who did not belong to the ethnic majority in the school class had increased odds for loneliness compared to adolescents that belonged to the ethnic majority. Furthermore, having more same-ethnic classmates lowered the odds for loneliness. We did not find any statistically significant association between the ethnic diversity of the school classes and loneliness. The study adds novel and important findings to how ethnicity in a school class context, as opposed to ethnicity per se, influences adolescents' loneliness.

Adolescents' medicine use for headache: secular trends in 20 countries from 1986 to 2010

BACKGROUND

This study reports secular trends in medicine use for headache among adolescents in 20 countries from 1986 to 2010.

METHODS

The international Health Behaviour in School-aged Children (HBSC) survey includes self-reported data about medicine use for headaches among nationally representative samples of 11-, 13- and 15-year-olds. We included 20 countries with data from at least three data collection waves, with a total of 380 129 participants.

RESULTS

The prevalence of medicine use for headaches varied from 16.5% among Hungarian boys in 1994 to 62.9% among girls in Wales in 1998. The prevalence was higher among girls than boys in every country and data collection year. The prevalence of medicine use for headaches increased in 12 of 20 countries, most notably in the Czech Republic, Poland, Russia, Sweden and Wales.

CONCLUSION

The prevalence of medicine use for headaches among adolescents is high and increasing in many countries. As some medicines are toxic this may constitute a public health problem.

Trends in Social Inequality in Tooth Brushing among Adolescents: 1991-2014

This study examines whether social inequality in tooth brushing frequency among adolescents changed from 1991 to 2014. The data material was seven comparable cross-sectional studies of nationally representative samples of 11- to 15-year-olds in Denmark with data about frequency of tooth brushing and occupation of parents. The total number of participants was 31,464, of whom 21.7% brushed their teeth less than the recommended 2 times a day. The absolute social inequality measured as prevalence difference between low and high social class increased from 7.7% in 1991 to 14.6% in 2014. The relative social inequality assessed by odds ratios for infrequent tooth brushing also increased from 1991 to 2014.

Main meal frequency measures in the Health Behaviour in School-aged Children study: agreement with 7-day 24-h recalls

OBJECTIVES

To estimate agreement between questionnaire-based frequency measures from the Health Behaviour in School-aged Children study (HBSC) and 7-day 24-h recall measures of breakfast, lunch and evening meals among 11-15-year-olds, and examine whether disagreement between the two methods varied by socio-demographic factors.

METHODS

In one week 11-15-year-old Danish students completed HBSC questionnaires including meal frequency items. The following week they completed daily 24-h recall questionnaire about their meals (response rate 88.4 %, n = 412).

RESULTS

Good to moderate agreement for the breakfast measure: per cent agreement 0.70-0.87, kappa 0.43-0.65. Fair agreement for the lunch measure: per cent agreement 0.53-0.84, kappa 0.26-0.54. High per cent agreement for the evening meal measure (0.83-0.95) but poor kappa agreement (0.14-0.19). Being immigrant predicted disagreement between the two methods for week day breakfast OR (95 % CI) 2.17 (1.16-4.04) and lunch 2.44 (1.33-4.48).

CONCLUSIONS

We found good to moderate agreement between frequency and 7-day 24-h recall measures for breakfast, a fair agreement for lunch and for evening meal the two agreement methods provided different results. Migration status predicted disagreement between the two methods.

Physical activity among adolescents: The role of various kinds of parental support

The objectives of this study were (a) to examine the association between various kinds of parental social support and adolescents' physical activity (PA) and (b) to examine whether various kinds of social support from mothers and fathers were differently associated with boys' and girls' PA. Data came from the Aarhus School Survey that included 2100 schoolchildren at 11, 13, and 15 years of age. Parental social support for PA was measured by items about encouragement to do PA, doing joint PA, parents watching PA, and talking about PA. PA was measured as at least 4 h of vigorous PA per week during leisure time. We used logistic regression analyses to estimate the associations for girls and boys separately, adjusted by age group, parents' occupational social class, family structure, and migration status. There were significant and graded associations between adolescents' PA and all four dimensions of parental support for PA. The association patterns were similar for mothers' and fathers' social support and similar for girls and boys. Social processes in the family are important for adolescents' participation in PA. It is important to continue to explore these social processes in order to understand why some adolescents are physically active and others are not.

Does school social capital modify socioeconomic inequality in mental health? A multi-level analysis in Danish schools

It seems that social capital in the neighbourhood has the potential to reduce socioeconomic differences in mental health among adolescents. Whether school social capital is a buffer in the association between socioeconomic position and mental health among adolescents remains uncertain. The aim of this study is therefore to examine if the association between socioeconomic position and emotional symptoms among adolescents is modified by school social capital. The Health Behaviour in School-aged Children Methodology Development Study 2012 provided data on 3549 adolescents aged 11-15 in two municipalities in Denmark. Trust in the school class was used as an indicator of school social capital. Prevalence of daily emotional symptoms in each socioeconomic group measured by parents' occupational class was calculated for each of the three categories of school classes: school classes with high trust, moderate trust and low trust. Multilevel logistic regression analyses with parents' occupational class as the independent variable and daily emotional symptoms as the dependent variable were conducted stratified by level of trust in the school class. The prevalence of emotional symptoms was higher among students in school classes with low trust (12.9%) compared to school classes with high trust (7.2%) (p < 0.01). In school classes with low level of trust, the odds ratio for daily emotional symptoms was 1.89 (95% CI 1.25-2.86) in the low socioeconomic group compared to the high socioeconomic group. In school classes characterised by high and moderate trust, there were no statistically significant differences in emotional symptoms between high and low socioeconomic groups. Although further studies are needed, this cross-sectional study suggests that school social capital may reduce mental health problems and diminish socioeconomic inequality in mental health among adolescents.

Emotional symptoms among adolescents: epidemiological analysis of individual-, classroom- and school-level factors

BACKGROUND

Large proportions of schoolchildren suffer from emotional symptoms and there are large variations across schools. It is unknown to what degree this variation is due to composition of schoolchildren in each school or to contextual factors. Objectives are to identify factors at individual, classroom and school levels associated with emotional symptoms.

METHOD

Data stem from the Danish contribution to the international Health Behaviour in School-aged Children study 2010 including 4922 schoolchildren aged 11-15-years from a random sample of schools and including data from school leaders. Emotional symptoms are defined as daily presence of at least one of four symptoms: feeling low, irritable or bad tempered, nervous and having difficulties falling asleep. Multilevel multivariable logistic regression analyses are applied to identify and quantify factors at individual, classroom and school level.

RESULTS

Schoolchildren from low (odds ratio (OR) 1.70, 95% CI: 1.33-2.17) and medium (OR 1.50, 95% CI: 1.22-1.85) occupational social class (OSC), girls (OR 1.32, 95% CI: 1.13-1.56) and schoolchildren exposed to bullying (OR 3.82, 95% CI: 2.71-5.40), had increased odds for emotional symptoms. A negative classroom climate was associated with emotional symptoms (OR 1.29, 95% CI: 0.99-1.69) and so was being part of classrooms with a high prevalence of bullying (OR 1.28, 95% CI: 1.0-1.60).

CONCLUSION

Female sex, low OSC, single parent family, exposure to bullying and a high prevalence of bullying within a class are all associated with emotional symptoms. Most variation across schools is explained by individual-level factors but psychosocial aspects of the classroom environment also play a role.

Tooth brushing among 11- to 15-year-olds in Denmark: combined effect of social class and migration status

OBJECTIVE

Regular tooth brushing in adolescence predicts stable tooth brushing habits later in life. Differences in tooth brushing habits by ethnic background and socioeconomic position have been suggested. We investigated migration status and social class in relation to infrequent tooth brushing both separately and combined.

METHODS

The study population was 11-15 year-olds chosen from a clustered random sample of schools. Univariate and multivariate logistic regression analyses estimated the separate and combined effects of migration status and social class on less than twice daily tooth brushing.

RESULTS

10,607 respondents: a response rate of 88.3%. Boys of lower social class had higher odds ratio (OR) of infrequent tooth brushing than girls: 1.98 (95% confidence interval 1.62-2.41) vs 1.80 (1.53-2.24). Immigrants and descendants had higher odds compared to adolescents of Danish origin: immigrant boys OR 1.39 (1.05-1.89), girls OR 1.92 (1.47-2.50); descendant boys OR 2.53 (1.97-3.27), girls OR 2.56 (2.02-3.35). Analyses of the combined effect of social class and migration status showed that the social gradient in tooth brushing habits observed among ethnic Danes cannot be found among groups of immigrants and descendants.

CONCLUSION

The study shows that both non-Danish origin and low social class increases the risk of infrequent tooth brushing among school-aged children. The study calls for in depth analyses of the processes which influence young people's tooth brushing habits. Further, there is a need to strengthen the promotion of appropriate tooth brushing habits of minority and low social class youths.

Adolescent alcohol use: a reflection of national drinking patterns and policy?

AIMS

To analyse how adolescent drunkenness and frequency of drinking were associated with adult drinking patterns and alcohol control policies.

DESIGN, SETTING AND PARTICIPANTS

Cross-sectional survey data on 13- and 15-year-olds in 37 countries who participated in the Health Behaviour in School-Aged Children (HBSC) Study in 2010 (n = 144 788) were linked to national-level indicators on alcohol control policies and adult drinking patterns.

MEASUREMENTS

Outcome measures were self-reported weekly drinking and life-time drunkenness (drunk once or more). Data were analysed using multi-level logistic regression models.

FINDINGS

In the mutually adjusted models, adolescent drunkenness was associated significantly with high adult alcohol consumption [odds ratio (OR) = 3.15 among boys, 95% confidence interval (CI) = 2.13-4.64, OR girls = 2.44, CI = 1.57-3.80] and risky drinking patterns in the adult population (OR boys = 2.02, CI = 1.33-3.05, OR girls = 1.61, CI = 1.18-2.18). The level of abstainers in the adult population was also associated significantly with girls' drunkenness; a 10% increase in the number of abstainers in a country reduced the odds of drunkenness with 21% (OR = 0.79, CI = 0.68-0.90). Weekly drinking was associated significantly with weak restrictions on availability (OR boys = 2.82, CI = 1.74-4.54, OR girls = 2.00, CI = 1.15-3.46) and advertising (OR boys = 1.56, CI = 1.02-2.40, OR girls = 1.79, CI = 1.10-2.94).

CONCLUSIONS

Comparing data cross-nationally, high levels of adult alcohol consumption and limited alcohol control policies are associated with high levels of alcohol use among adolescents.

Self-reported recurrent pain and medicine use behaviours among 15-year olds: results from the international study

BACKGROUND

There is considerable variation in adolescent pain prevalence across epidemiological studies, with limited information on pain-related behaviours among adolescents, including medicine use. The aims of this study were (1) to examine the prevalence of recurrent pain among 15-year-old adolescents internationally; (2) to investigate the association between recurrent pain and medicine use behaviours among boys and girls; and (3) to evaluate the consistency of these associations across countries.

METHODS

The World Health Organization (WHO) collaborative international Health Behaviour in School-aged Children 2009/2010 study collects data about self-reported aches and medicine use from 36,762 15-year-old adolescents from 22 countries/regions in Europe and the United States. Multi-level multivariate logistic regression, stratified by gender, was used to analyse the association between recurrent pain and medicine use for headache, stomachache, nervousness and difficulties in getting to sleep.

RESULTS

More than 30% of adolescents reported recurrent headache, almost 30% recurrent backache and approximately 20% recurrent stomachache. Although pain prevalence and medicine use for aches were much higher for girls, the association between pain and medicine use was similarly strong for both genders. Adolescents with recurrent pain are more likely to use medicines also for non-corresponding pain, nervousness and difficulties in getting to sleep. The association between recurrent pain and medicine use was consistent across countries despite large-country differences in the prevalence of recurrent pain and medicine use.

CONCLUSIONS

Recurrent pain in adolescence is common cross-nationally. Adolescents with recurrent pain are more likely to use medicine in general. Recurrent pain and medicine use should be addressed in adolescent health policies.

Addressing social inequality in aging by the Danish occupational social class measurement

OBJECTIVE

To present the Danish Occupational Social Class (DOSC) measurement as a measure of socioeconomic position (SEP) applicable in a late midlife population, and to analyze associations of this measure with three aging-related outcomes in midlife, adjusting for education.

METHOD

Systematic coding procedures of the DOSC measurement were applied to 7,084 participants from the Copenhagen Aging and Midlife Biobank (CAMB) survey. We examined the association of this measure of SEP with chronic conditions, self-rated health, and mobility in logistic regression analyses, adjusting for school education in the final analysis.

RESULTS

The measure of SEP showed a strong social gradient along the social classes in terms of prevalence of chronic conditions, poor self-rated health, and mobility limitations. Adjusting for school education attenuated the association only to a minor degree.

DISCUSSION

The DOSC measure was associated with aging-related outcomes in a midlife Danish population, and is, thus, well suited for future epidemiological research on social inequalities in health and aging.

Perceived problems with computer gaming and internet use among adolescents: measurement tool for non-clinical survey studies

Background

Existing instruments for measuring problematic computer and console gaming and internet use are often lengthy and often based on a pathological perspective. The objective was to develop and present a new and short non-clinical measurement tool for perceived problems related to computer use and gaming among adolescents and to study the association between screen time and perceived problems.

Methods

Cross-sectional school-survey of 11-, 13-, and 15-year old students in thirteen schools in the City of Aarhus, Denmark, participation rate 89%, n = 2100. The main exposure was time spend on weekdays on computer- and console-gaming and internet use for communication and surfing. The outcome measures were three indexes on perceived problems related to computer and console gaming and internet use.

Results

The three new indexes showed high face validity and acceptable internal consistency. Most schoolchildren with high screen time did not experience problems related to computer use. Still, there was a strong and graded association between time use and perceived problems related to computer gaming, console gaming (only boys) and internet use, odds ratios ranging from 6.90 to 10.23.

Conclusion

The three new measures of perceived problems related to computer and console gaming and internet use among adolescents are appropriate, reliable and valid for use in non-clinical surveys about young people’s everyday life and behaviour. These new measures do not assess Internet Gaming Disorder as it is listed in the DSM and therefore has no parity with DSM criteria. We found an increasing risk of perceived problems with increasing time spent with gaming and internet use. Nevertheless, most schoolchildren who spent much time with gaming and internet use did not experience problems.

Immigrant background and medicine use for aches: national representative study of adolescents

Objectives

The aims of the study were to examine the association between immigrant background and medicine use for headache and stomach-ache among adolescents, and whether symptoms of headache and stomach-ache could explain the differences in medicine use.

Methods

We used data from the Danish contribution to the WHO-affiliated international cross-sectional survey Health Behaviour in School-aged Children (HBSC) in 2006. Among boys, a total of 4170 ethnic Danes, 244 descendants of immigrants, and 224 immigrants participated. Among girls, 4310 ethnic Danes, 264 descendants of immigrants, and 232 immigrants were included. The associations between migrant background and medicine use for headache and stomach-ache by means of multilevel multivariate logistic regression analyses adjusted for age group, symptoms and the clustering effect of school and stratified by sex due to interactions.

Results

Among boys, the risk of medicine use for stomach-ache was higher for immigrants (odds ratio (OR), 1.54; 95% confidence intervals (CI), 0.99-2.44)) and descendants (OR, 1.97 (1.33-2.94)) compared to ethnic Danes. Similar associations were found for use of medicine for stomach-ache for immigrant girls (OR, 1.55 (1.12-2.15) and use of medicine for headache among boys (immigrants (OR, 1.36 (1.02-1.97 and descendants (1.48 (1.12-1.97)). Symptoms of aches were all independently associated with medicine use. After adjusting for these factors the association between immigrant background and medicine use attenuated slightly.

Conclusion

Among adolescents in Denmark, the risk of medicine use for headache and stomach-ache was higher for immigrants and descendants as compared to ethnic Danes, with the exception of medicine use for headache among girls.

Ethnic and migrant differences in the use of anti-asthmatic medication for children: the effect of place of residence

BACKGROUND

Ethnic differences in the use of anti-asthmatic medication have been reported, with ethnic minorities being at a higher risk of suboptimal asthma control. As contextual socioeconomic characteristics may play a role, we analysed whether ethnic differences in the use of anti-asthmatic medication among children residing in the Capital Region of Denmark varied by place of residence.

METHODS

Data were obtained from the Danish Civil Registration System, the Central Taxpayers' Register and the Danish National Prescription Register and were linked at the individual level. Population used was the entire child population in the Capital Region from 0 to 17 years old in 2008 (n = 342,403). Use of anti-asthma medicine was defined as at least one prescription having been filled in 2008. The analyses included multiple multilevel logistic regression models.

RESULTS

Children living in low-income places of residence had lower odds of being prescribed preventive anti-asthmatics compared with children living in higher-income places of residence [odds ratio (OR) = 0.87, 95% confidence interval (CI) 0.84-0.91]. Immigrant children had the lowest OR of being prescribed anti-asthmatics medication, both relief (OR = 0.50, 95% CI 0.20-0.77) and preventive (OR = 0.47, 95% CI 0.24-0.82) compared with ethnic Danes. Similar associations were found among descendants of immigrant children (OR for preventive medication = 0.70, 95% CI 0.62-0.78). Place of residence contributed to but did not account for the ethnic differences in the use of anti-asthmatic medication.

CONCLUSIONS

Ethnic differences in the use of anti-asthmatic medication were documented, and they cannot be explained by socioeconomic characteristics of place of residence. The lower prevalence of anti-asthmatic medication among ethnic minority children suggests poor asthma management control.

Adolescent alcohol use reflects community-level alcohol consumption irrespective of parental drinking

PURPOSE

Risk factors for adolescent alcohol use are typically conceptualized at the individual level, and school- and community-level risk factors have received little attention. Based on the theoretical understanding of youth alcohol consumption as a reflection of community social practice, we analyzed whether adolescent drunkenness was related to community-level adult alcohol use (AAC), when taking individual and school-level risk factors for drunkenness into account. Furthermore, we investigated whether the association between community-level AAC and adolescent drunkenness was attenuated after inclusion of parental drinking.

METHODS

We used data from three sources: data about adolescent drunkenness from the Health Behavior in School-Aged Children 2010 survey (N = 2,911; 13- to 15-year-olds nested in 175 school classes and 51 schools); data about community-level AAC derived from the Danish National Health Survey 2010 (177,639 participants); and data on school-level variables from Health Behavior in School-Aged Children School Leader Survey 2010. We performed multilevel logistic regression analysis with data from students nested within school classes and schools.

RESULTS

Overall, 33.5% of students had been drunk twice or more. High community-level AAC was significantly associated with adolescent drunkenness (odds ratio [95% confidence interval], 1.94 [1.21-3.11]). Parental drinking was strongly related to adolescent drunkenness but did not attenuate the relationship between community-level AAC and adolescent drunkenness. We found no association between adolescent drunkenness and school-level variables (youth friendly environment, alcohol education, and exposure to alcohol outlets).

CONCLUSIONS

Adolescent drunkenness was associated with community-level AAC and was not explained by parental drinking.

Validity of self-reported height and weight among adolescents: the importance of reporting capability

Background

This study proposes a new approach for investigating bias in self-reported data on height and weight among adolescents by studying the relevance of participants’ self-reported response capability. The objectives were 1) to estimate the prevalence of students with high and low self-reported response capability for weight and height in a self-administrated questionnaire survey among 11–15 year old Danish adolescents, 2) to estimate the proportion of missing values on self-reported height and weight in relation to capability for reporting height and weight, and 3) to investigate the extent to which adolescents’ response capability is of importance for the accuracy and precision of self-reported height and weight. Also, the study investigated the impact of students’ response capability on estimating prevalence rates of overweight.

Methods

Data was collected by a school-based cross-sectional questionnaire survey among students aged 11–15 years in 13 schools in Aarhus, Denmark, response rate =89%, n = 2100. Response capability was based on students’ reports of perceived ability to report weight/height and weighing/height measuring history. Direct measures of height and weight were collected by school health nurses.

Results

One third of the students had low response capability for weight and height, respectively, and every second student had low response capability for BMI. The proportion of missing values on self-reported weight and height was significantly higher among students who were not weighed and height measured recently and among students who reported low recall ability. Among both boys and girls the precision of self-reported height and weight tended to be lower than among students with low response capability. Low response capability was related to BMI (z-score) and overweight prevalence among girls. These findings were due to a larger systematic underestimation of weight among girls who were not weighed recently (−1.02 kg, p < 0.0001) and among girls with low recall ability for weight (−0.99 kg, p = 0.0024).

Conclusion

This study indicates that response capability may be relevant for the accuracy of girls’ self-reported measurements of weight and height. Consequently, by integrating items on response capability in survey instruments, participants with low capability can be identified. Similar analyses based on other and less selected populations are recommended.

Meal frequencies in early adolescence predict meal frequencies in late adolescence and early adulthood

Background

Health and risk behaviours tend to be maintained from adolescence into adulthood. There is little knowledge on whether meal frequencies in adolescence are maintained into adulthood. We investigated whether breakfast, lunch and evening meal frequencies in early adolescence predicted meal frequencies in late adolescence and in early adulthood. Further, the modifying effect of gender and adolescent family structure were investigated.

Methods

National representative sample of 15-year-olds in Denmark with 4 and 12 year follow-up studies with measurement of breakfast, lunch and evening meal frequencies. A total of 561 persons completed questionnaires at age 15 years (baseline 1990, n=847, response rate 84.6%), age 19 years (n=729, response rate 73.2%) and age 27 years (n=614, response rate 61.6%).

Results

Low meal frequencies at age 15 years was a significant predictor for having low meal frequencies at age 19 years (odds ratio (OR, 95% CI)) varying between 2.11, 1.33-3.34 and 7.48, 3.64-15.41). Also, low meal frequencies at age 19 years predicted low meal frequencies at age 27 years (OR varying between 2.26, 1.30-3.91 and 4.38, 2.36-8.13). Significant predictions over the full study period were seen for low breakfast frequency and low lunch frequency (OR varying between 1.78, 1.13-2.81 and 2.58, 1.31-5.07). Analyses stratified by gender showed the same patterns (OR varying between 1.88, 1.13-3.14 and 8.30, 2.85-24.16). However, the observed predictions were not statistical significant among men between age 15 and 27 years. Analyses stratified by adolescent family structure revealed different lunch predictions in strata.

Conclusions

Having low meal frequencies in early adolescence predicted low meal frequencies in late adolescence and early adulthood. We propose that promotion of regular meals become a prioritised issue within health education.

Tracking of overweight from mid-adolescence into adulthood: consistent patterns across socio-economic groups

Socially differentiated tracking of health and health behaviours may contribute to health inequalities in adulthood. The modifying effect of socio-economic position on the tracking of overweight from mid-adolescence (age 15 years) into adulthood (age 27 years) was assessed in a randomly sampled Danish cohort (n = 561). The tracking was studied by prediction analyses conducted by logistic regression analyses. Strong tracking patterns were found to be independent of socio-economic background.

Fruit and vegetable intake is associated with frequency of breakfast, lunch and evening meal: cross-sectional study of 11-, 13-, and 15-year-olds

Background

Frequency of eating breakfast, lunch and evening meal as a determinant of fruit and vegetable intake among young people is little studied. We investigated whether irregular meal consumption was associated with fruit and vegetable intake among adolescents. We used separate analyses, and special emphasis was on the potentially modifying effect of sex and age.

Methods

Data were from the Danish contribution to the international collaborative Health Behavior in School-Aged Children Study (HBSC) in 2002. We used a questionnaire-based, cross-sectional design to study schoolchildren aged 11, 13 and 15 years (n = 3913) selected from a random sample of schools in Denmark. Fruit intake and vegetable intake were measured by a food frequency questionnaire and analyses were conducted using multivariate logistic regression.

Results

Overall, statistically significant associations were found between irregular breakfast, lunch and evening meal consumption and low frequency of fruit intake and vegetable intake (breakfast: fruit OR = 1.42, vegetables OR = 1.48; lunch: fruit OR = 1.68, vegetables OR = 1.83; evening meal: vegetables OR = 1.70). No association was found for irregular evening meal consumption and low frequency of fruit intake. Analyses stratified by sex showed that the associations between irregular breakfast consumption and both fruit and vegetable intake remained statistically significant only among girls. When analyses were stratified by both sex and age, different patterns appeared. Overall, skipping meals seemed to be a less serious risk factor for low frequency of fruit and vegetable intake among younger participants compared with those who were older. This was especially evident for skipping breakfast. The same tendency was also seen for skipping lunch and evening meal, although the age pattern varied between boys and girls and between fruit and vegetable intake.

Conclusion

Our results showed that irregular breakfast, lunch and evening meal consumption among adolescents was associated with a low frequency of fruit and vegetable intake and that sex and age may play a modifying role. The different associations observed in different age and sex groups indicate the importance of analysing fruit and vegetable intake and meal types separately. The results highlight the importance of promoting regular meal consumption when trying to increase the intake of fruit and vegetables among adolescents.

Pathways and mechanisms in adolescence contribute to adult health inequalities

AIMS

This paper presents a model that encompasses pathways and mechanisms working over adolescence that contribute to adult health inequalities. We review evidence on the four mechanisms: socially differential exposure, tracking, socially differential tracking, and socially differential vulnerability.

METHODS

We conducted literature searches in English-language peer-reviewed journals using PubMed (from 1966 to May 2009) and PsycINFO, and combined these with hand-searches of reference lists, journals, and authors of particular relevance.

RESULTS

Most health indicators are socially patterned in adolescence and track into adulthood, with higher risks of adverse outcomes among individuals from lower socioeconomic positions. Adolescent health behaviours track into adulthood. Smoking, physical activity, and especially fruit and vegetable intake are socially patterned, while evidence for social patterning of alcohol use is less consistent. Relational dimensions like lone parenthood and bullying are socially patterned and track over time, and there are indications of a socially differential vulnerability to the effects of these types of relational strain. Very little research has investigated the social patterning of the above indicators over time or studied social vulnerability of these indicators from adolescence to adulthood. However, all four mechanisms seem to be active in establishing social differences in adult educational attainment.

CONCLUSIONS

We find the Adolescent Pathway Model useful for providing an overview of what elements and mechanisms in adolescence may be of special importance for adult health inequalities. There is a lack of knowledge of how social patterns of health, health behaviours, and social relations in adolescence transfer into adulthood and to what extent they reflect themselves in adult health.