Behavior In School-aged Children Research Articles

Cross-National Validation of the WHO-5 Well-Being Index Within Adolescent Populations: Findings From 43 Countries.

The five-item World Health Organization Well-Being Index (WHO-5) is among the most frequently used brief standard measures to assess hedonic well-being. Numerous studies have investigated different facets of its psychometric properties in adult populations. However, whether these results apply to adolescents is uncertain, and only few psychometric studies employed adolescent populations. Thus, the current study aimed to conduct an in-depth psychometric item response theory analysis of the WHO-5 among adolescents from 43 countries using the Health Behaviour in School-aged Children (HBSC) 2022 data set and investigated its (a) dimensionality and measurement structure, (b) test information values and marginal reliability, (c) cross-country measurement invariance and differential item/test functioning, and (d) convergent validity with other measures related to mental health and well-being across countries. The WHO-5 showed a unidimensional measurement structure and overall high test information values and marginal reliability. Furthermore, although a large proportion of parameters were flagged as non-invariant, differential test functioning of the WHO-5 was only modest. Moreover, the WHO-5 mainly showed a concurring nomological network with the other measures related to mental health and well-being across countries, although with some differences in effect sizes. The WHO-5 Well-Being Index is a psychometrically sound measure that has shown promise for cross-cultural research among adolescents in the included European, Central Asia, and North American countries. The translated versions of the WHO-5 are available at https://osf.io/pbexq.

Healthier Diet and Diet-Related Behaviors Are Associated with Increased Physical Activity and Reduced Sedentary Behavior Among Adolescents in Greece

Background/Objectives: Healthy diet, regular physical activity (PA), and minimizing sedentary behavior (SB) are crucial in promoting adolescents’ health and well-being. We assessed adherence to PA and SB recommendations among a representative sample of adolescents and explored their relationship with diet and diet-related behaviors. Methods: Data from the Greek arm of the 2017/2018 international Health Behavior in School-Aged Children (HBSC) cross-sectional study were used, including a probability sample of 3357 students (47.6% boys) who were 11, 13, and 15 years old. PA, SB, consumption of food groups/beverages, and diet-related behaviors were self-reported. Multiple logistic regression was used to identify potential associations. Results: Most students failed to meet PA (83.9%) (i.e., ≥1 h of moderate-to-vigorous physical activity/day) and SB (90.2%) (i.e., ≤2 h of screen time/day) recommendations. Daily consumption of fruit and vegetables compared to consumption at ≤1 day/week was associated with increased adherence to PA recommendations (adjusted Odds Ratio (aOR) = 2.26, 95% Confidence Intervals (CI): 1.62–3.17 for fruit; aOR = 1.35, 95%CI: 1.00–1.82 for vegetables). Eating sweets ≤1 day/week vs. every day was associated with higher adherence to SB recommendations (aOR = 2.41, 95%CI: 1.43–4.04). Poor diet quality was related to lower adherence to PA and SB recommendations. Daily breakfast consumption vs. never and abstaining from eating at fast-food restaurants were associated with better adherence to PA and SB recommendations. Rarely eating in front of screens was associated with substantially higher odds of adhering to SB recommendations (aOR = 5.79, 95%CI: 3.67–9.14). Conclusions: Healthier diet/diet-related behaviors were associated with increased PA and reduced SB in this sample of adolescents.

Primary Care Considerations for Youth Martial Arts Athletes.

This review aims to analyze the impact of martial arts on youth, addressing the physical and psychosocial benefits, as well as the injury risks associated with increased participation. Data from the National Federation of State High School Associations indicates a notable increase in youth participation in martial arts, with a rise of over 13,000 participants from 2018 to 2022. In addition to physical benefits, recent studies highlight that martial arts can significantly enhance mindfulness, reduce stress, and improve self-control, thus diminishing bullying behaviors in school-aged children. Additionally, the therapeutic application of martial arts techniques has been effective in managing pain in children with chronic diseases and in alleviating emotional distress in their siblings. However, the popularity of the sport brings concerns over a spectrum of injuries, especially more severe cases in competitive settings. Martial arts provide a dynamic platform for fostering robust physical health and psychological resilience among youth. While the benefits are substantial, they are accompanied by risks that require careful management through informed practices and supervision. This review underscores the importance of understanding the dual nature of martial arts - its capacity to empower and its potential to harm - to maximize its benefits and safeguard young athletes.

Sexual Behavior in Sexual Minority and Non-Minority Youth from Eight European Countries

ABSTRACT Sexual minority youth, compared to their heterosexual peers, have a disproportionate burden of sexual risks, but it remains unclear whether such inequalities exist across cultures and countries. We used data from eight European countries participating in the 2018 Health Behaviour in School-aged Children (HBSC) study to analyze sexual behavior in representative samples of adolescents aged 14.5–16.5 years (N = 10,583). Overall, 19.1% of the participants reported that they had had sexual intercourse. Compared to their non-minority peers (those exclusively attracted to opposite-gender partners), sexual minority youth – attracted to same- or both-gender partners – were significantly more likely to report having had sexual intercourse and sex before age 14. Those attracted to both-gender partners had similar odds of having had sexual intercourse, but higher odds of not using condoms, or neither condoms nor contraceptive pill use at last intercourse. Those not attracted to anyone had similar odds of having had sexual intercourse but were more likely to report early sex and not using protection at last intercourse. Adjusting for gender, country and family affluence did not substantially change the pattern of results. In interpreting the findings, the onset of puberty, sexual abuse, stigma management and experimentation with sexual identity should be considered. We discuss the practical, clinical and research implications of the findings.

Autonomy support, basic needs satisfaction, and involvement in physical education among Norwegian secondary school students

PurposeThis study investigated the relationship between teacher autonomy support, students’ basic psychological needs satisfaction, and involvement in physical education (PE) with gender specific analyses. Additionally, the study examined the validity of a Norwegian version of the Basic Psychological Needs in PE (BPN-PE) scale.MethodSurvey data from the Norwegian 2017/2018 Health Behaviour in School-aged Children study.ResultsA structural equation model showed that perceived autonomy support from teacher predicted students’ basic needs satisfaction of competence, autonomy and relatedness. Furthermore, satisfaction of competence predicted weekly PE participation and physical activity during PE among boys. The analyses revealed mean level differences with boys scoring higher than girls on all the investigated variables. The findings also supported the validity and reliability of the BPN-PE scale across genders.Discussion/conclusionThe study adds knowledge to the understanding of the relationship between autonomy support from teachers, students basic need satisfaction and students’ involvement in PE.

Sleep profiles and their associations with adiposity and cardiorespiratory fitness among adolescents.

This study aimed to identify sleep profiles in a representative sample of Slovak adolescents and investigate their associations with adiposity indicators and cardiorespiratory fitness. Data from the 2022 Health Behaviour in School-aged Children (HBSC) study conducted in Slovakia were analysed. Survey questions on sleep duration and problems from the entire HBSC sample (n = 8906) were used to identify sleep profiles. Associations with adiposity indicators and cardiorespiratory fitness were investigated in a subsample of 924 adolescents (average age 13.3 ± 1.48; 56.2% boys) who completed the HBSC survey, bioimpedance analysis, and 20-metre shuttle run test. Three sleep profiles were identified-optimal sleepers, optimal sleepers with sporadic sleep problems and poor sleepers. Crude models showed that poor sleepers had significantly higher body fat percentage and fat mass index, along with lower cardiorespiratory fitness, compared to optimal sleepers. After adjustment, only the association between sleep profiles and cardiorespiratory fitness remained significant. The observed associations between sleep profiles and cardiorespiratory fitness may help better target future intervention resources towards adolescents with low cardiorespiratory fitness levels.

Exploring mechanisms behind the increasing gender gap in adolescent psychological symptoms, 2002-2022: the role of national-level gender equality.

Internalising problems have increased considerably among adolescents in the last decades, particularly among girls, resulting in widening gender gaps. This study examined whether the gender gap in psychological symptoms increased more in more gender-equal countries in the period 2002-2022, and if so, to what extent this could be explained by changes over time in the experience of stressors (i.e. schoolwork pressure, body dissatisfaction, low classmate support) among boys and girls in these countries. National data on gender inequality (UNDP Gender Inequality Index) were combined with aggregated individual-level data from the Health Behaviour in School-aged Children (HBSC) study (2002-2022) across 43 countries (N = 1,268,220). Absolute and relative gender gaps in psychological symptoms were regressed on survey cycle, GII and their interaction. Next, interactions of survey cycle and either schoolwork pressure, body dissatisfaction or classmate support were added to the model. Increases in the absolute and relative gender gap in psychological symptoms between 2002 and 2022 were stronger in more gender-equal countries, mainly due to larger increases in psychological symptoms among girls in these countries. Also, less favourable time trends for schoolwork pressure and classmate support were found in more gender-equal countries for boys and especially girls. The larger increase in schoolwork pressure among girls in more gender-equal countries partly explained the increased absolute gender gap in psychological symptoms in these countries. While national-level gender equality was positively associated with boys' and girls' mental health in the early 2000s, this association has become negative for girls in more recent years. The benefits of gender equality for girls' mental health may have become overshadowed by the increased experience of stressors, especially schoolwork pressure. Far from advocating that gender equality is a negative situation, these findings suggest that much work remains to achieve full gender equality, where men and women really share the burdens and stressors in everyday life.

The effect of social media use on adolescents’ subjective well-being: Longitudinal evidence from Switzerland

Background and relevanceProblematic social media use and low subjective well-being in adolescents coincide. However, the causal evidence on the effect of (problematic) social media use on subjective well-being is inconclusive. The analysis by Orben et al. (2022: Nature Communications 13: 1649) demonstrates that the effect is moderated by age and gender, giving rise to ‘developmental windows of sensitivity to social media’. In this study, we provide an update of the development of adolescents’ subjective well-being and problematic social media use in Switzerland. Furthermore, we investigate, whether ‘developmental windows of sensitivity to social media’ apply to Switzerland. Data and methodsFor the description of trends, we use data from the survey Health Behaviour in School-aged Children (HBSC; N=59’662, 2002-2022, age: 11-15). We identify the effect of problematic social media use on subjective well-being using HBSC trend data from 2018 to 2022 applying multiple OLS regression. To identify the causal effect of social media use on subjective well-being we exploit panel/cohort data of adolescents from the study Transitions from Education to Employment (TREE; N=19’809, 2016-2022, age: 15-22) applying panel regression models. ResultsWe demonstrate that decreases in subjective well-being coincide with increases in problematic social media use. Causal inference shows that the effect of social media use on subjective well-being only applies to females with low or middle parental educational background until the age of 18 years. Discussion and conclusionOur study enhances the findings of Orben et al. (2022). It reaffirms the importance of health interventions targeted at vulnerable groups.

Three Decades of Adolescent Health: Unveiling Global Trends Across 41 Countries in Psychological and Somatic Complaints (1994-2022).

This study examined (non-)monotonic time trends in psychological and somatic complaints among adolescents, along with gender differences. Repeated cross-sectional Health Behaviour in School-aged Children (HBSC) data from 1994 to 2022 covering 15-year-old adolescents from 41 countries (N = 470,797) were analysed. Three polynomial logistic regression models (linear, quadratic, cubic) were tested for best fit, including separate analyses by gender and health complaints dimension. Time trend patterns varied by gender and health complaints dimension. Increases were found in 82.3% of cases (linear 25%, quadratic U-shaped 28.7%, cubic 28.7%), while 14% showed no clear trend, and 3.7% decreased. Boys typically showed linear increases or no clear trend over time, whereas girls generally showed cubic or U-shaped trends. Psychological complaints often displayed U-shaped or cubic patterns, whereas somatic complaints mostly showed linear increases. Psychological and somatic complaints demonstrated diverse time trend patterns across countries, with non-monotonic patterns (U-shaped and cubic) frequently observed alongside linear increases. These findings highlight the complexity of changes within countries over three decades, suggesting that linear modelling may not effectively capture this heterogeneity.

Late Bedtime from the Perspective of Adolescents: A Qualitative Study.

Later sleep timing is a key determinant of reduced sleep duration and quality in adolescents and is associated with negative mental and physical outcomes. However, little is known about adolescents' views on late bedtime. The study's purpose is to explore adolescents' perspectives on why they go to sleep late during school nights and what would help them to go to bed earlier. We conducted online semi-structured interviews with 24 adolescents aged 14-17 years as a part of the international HBSC (Health Behaviour in School-aged Children) study. The data were collected via individual and group interviews and analyzed using a combination of consensual qualitative research methodology and thematic analysis. School demands and leisure time activities, particularly online socialization with peers, have been identified as one of the main themes related to why adolescents go to sleep late. Adolescents reported difficulties managing these competing activities during the day after school, often postponing them until late at night and prioritizing them to sleep. Adolescents also mentioned bedtime distress as a barrier to falling asleep. However, some adolescents did not perceive late bedtime as a problem, but rather as a habit and personal choice. They reported that better time management, less homework, engagement in physical activity, parent-set bedtime, and less time spent online in the evening would help them to go to bed earlier. Our findings suggest that interventions to improve sleep timing in adolescents should focus on reducing school pressure, building supportive social networks; strengthening adolescents' self-regulation skills; and enhancing parental involvement in establishing sleep and daily routines for their adolescents.

The relationship between habits of television viewing among school-age children and their behaviors: A cross-sectional study

Background: For all children, television serves as a window to the outside world. Watching too much television leads to several health issues in children of all ages. Aim: This study aimed to determine the relationship between school-age children's behavior and their TV-watching habits. Materials and Methods: A quantitative research approach began on October 15, 2022, and ended on April 25, 2023, for conducting cross-sectional studies in primary schools in the province of Babylon. To assess the effect of TV viewing habits among school-age children on their behaviors, a non-probability sample of 150 students was used. After the study questionnaire was distributed to 10 experts, the validity of the tool was determined. All rational and scientific viewpoints put forward by the experts were taken into account. Data analysis was done using both descriptive and inferential statistical methods to conclude. Results: The results of the existing study illustrate that 64.7% of the sample showed a fair attitude toward TV viewing habits, and 73.3% of the sample showed fair behavior. Furthermore, the results show that TV-watching habits have an impact on children's behavior overall, with a p-value of less than 0.05. Conclusions: The current study concludes that more than half of the study sample had fair habits, and more than two-thirds of the sample had fair behaviors toward TV viewing. In addition, the present study indicates that the habit of TV viewing has an influence on the behavior of children.

How Family Structure Can Influence Adolescents' Eating Habits: An Italian Health Behaviour in School-Aged Children (HBSC) 2022 Sample.

Adolescence is an important period of psychophysical development. In this phase of life people acquire greater self-awareness and adopt behaviors that will later shape their lifestyle in adulthood. This study aimed to assess whether family structure can influence adolescents' eating habits. Data were acquired from a survey titled 'Italian Health Behaviour in School-aged Children' (HBSC) given to a representative sample of Tuscan adolescents aged 11, 13, 15 and 17 years of age. Participants (3210) filled out a validated questionnaire answering questions about their eating habits and family structure. After adjusting for covariates, some interesting trends were highlighted in the survey results. Adolescents living in single-mother families reported a lower intake of fruits (OR 0.68, 95% CI = 0.55-0.83) and vegetables (OR 0.66, 95% CI = 0.53-0.81) and a higher intake of sugar-added soft drinks (OR 1.33, 95% CI = 1.08-1.64). Living in a mother and stepfather family was associated with a higher intake of sugar-added soft drinks (OR 1.53, 95% CI = 1.02-2.28), whereas living in a father and stepmother family was associated only with a lower intake of fruits (OR 0.48, 95% CI = 0.26-0.87). Participants living with other family types reported a lower intake of vegetables (OR 0.68, 95% CI = 0.47-0.98). The results of this study show a correlation between family structure and adolescents' eating habits.

Weight status and psychosomatic complaints in Swedish adolescent boys and girls: does family support play a buffering role?

BackgroundPsychosomatic complaints have increased among adolescents in recent decades, as have overweight and obesity rates. Both of these trends are regarded as public health concerns. However, the associations between weight status and psychosomatic complaints are not yet clear, necessitating further research. The aim of the present study was to investigate the associations between weight status and psychosomatic complaints in Swedish adolescent boys and girls, as well as to explore the potential buffering effect of family support.MethodsThe data was obtained from the cross-sectional Swedish Health Behaviour in School-aged Children (HBSC) study conducted in 2017/18, which involved 3,135 students aged 11, 13, and 15 years. Weight status was based on self-reported information on weight and height, which allowed for the calculation of body mass index (BMI) and the categorisation of participants into three groups: non-overweight, overweight, and obese. Psychosomatic complaints were assessed based on information regarding the frequency of eight different complaints, which were summed into an index. Family support was measured using three items describing the level of perceived emotional support, and an index was created, which was dichotomised into low and high family support. Gender stratified linear regression models were run to examine the associations between weight status and psychosomatic complaints. Age and family affluence were included as covariates. Interaction terms were included to evaluate whether family support moderated the main association.ResultsObesity was associated with higher levels of psychosomatic complaints in both boys and girls when compared to being non-overweight (boys: b = 2.56, 95% CI 0.32, 4.79; girls: b = 3.35, 95% CI 0.77, 5.94), while being overweight did not show any statistically significant associations with the outcome (boys: b = 0.21, 95% CI -0.72, 1.15; girls: b = 0.78, 95% CI -0.42, 1.98). In girls, a statistically significant interaction effect between family support and weight status was observed (p = 0.031), indicating that family support buffered against psychosomatic complaints in girls with obesity. No statistically significant interaction was found for boys (p = 0.642).ConclusionsThe findings of this study highlight the importance of public health initiatives aimed at preventing childhood obesity. They also underscore the significant role of family support in reducing psychosomatic complaints among adolescents with obesity. Further research is necessary to gain a deeper understanding of these relationships.

Sleep difficulties as a universal risk factor for injury among adolescents in 46 countries

Abstract Background Poor sleep is common among adolescents and associated with unintentional injuries. The current evidence base is limited by differences in measures of sleep and injury implemented across studies. We examined the potential universality of the relationship between poor sleep and injury cross-nationally using self-reports from 229,589 adolescents in 46 countries that were collected using common procedures and measures. Methods A cross-sectional study was conducted using records from the 2017/18 Health Behaviour in School-aged Children (HBSC): World Health Organization cross-national study. The prevalence of sleep indicators (difficulties in falling asleep, insufficient sleep, social jet lag) and medically treated injuries (overall, multiple) were described across countries and by gender. Multivariable modified Poisson regression analyses were conducted within and across countries to test the consistency of the association between poor adolescent sleep and injuries. Results Overall, indicators of poor sleep were reported by nearly half of adolescents, and varied by gender and across countries. Country-level analyses found consistently positive associations between indicators of poor sleep and injuries. Pooled (multi-country) analyses further demonstrated a universality of these relationships across sleep indicators and injury outcomes. The strength of relationships varied by gender, with more robust associations detected among girls compared to boys. Conclusions Poor sleep is a robust and mainly consistent risk factor for injury among adolescents across countries and regions. Public health officials and policymakers should therefore recognize adolescent sleep as a health priority. The promotion of sleep hygiene may represent a novel target for injury prevention at regional and national levels. Key messages • Poor sleep, in the form of sleep difficulties, insufficient sleep, and social jet lag, were robust and mainly consistent injury risk factors among adolescents across 46 countries. • Public health officials should recognize sleep hygiene as a novel focus for adolescent injury prevention.

Are answers affected by data collection on paper or online? The case of Belgian adolescents

Abstract Background In the early 2000s, the prevalence estimations were compared in relation with the mode of data collection, i.e. paper or online. Following the widely spread routine use of connected devices, especially in adolescents, such a monitoring is of interest. Within the 2022 “Health Behaviour in school-aged children” survey in French-speaking primary and secondary schools of Belgium, those participating could choose between paper and online collection. Our objective was to compare a large set of indicators between the two modes after adjusting for the students’ characteristics. Methods After a two-stage random selection of schools and classes, 11,751 10-to-20-year-old adolescents completed the questionnaire either on paper or online. Descriptive analysis and comparisons were conducted using chi2 and multiple logistic regressions adjusted for the students’ sociodemographic characteristics that may vary according to the questionnaire mode. Results Overall, 54.9% of the questionnaires were completed online. The choice of the collection mode provided to the schools’ headteachers was associated with the adolescents’ characteristics. Those who completed the questionnaire online were more likely to be in secondary schools, in Wallonia, and of a more favourable socioeconomic profile. After adjustments, no difference in the indicators regarding health, well-being, substance use, or sleep duration was observed. Conversely, a difference was observed for screen time (internet ≥2h/weekday: 70.4% on paper vs. 72.3% online; adjusted P-value: 0.02), some food groups (daily vegetables: 51.2% vs. 58.0%; P-value<0.001) and body weight status (overweight including obesity: 16.7% vs. 14.0%; P-value<0.001). Conclusions In some circumstances such as data collection in the school setting, mixed modes are still necessary due to operational issues. While most indicators did not show a difference between online and paper collection, potential implications for others need to be further understood. Key messages • Collecting data through online or paper questionnaires does not lead to major differences in prevalence estimates. • With the rise of online surveys, further assessment is required to understand the potential declaration biases.

Unlocking adolescent dietary behaviours: the causal role of social contexts

Abstract Background Using a causal inference framework, our study aimed to extend previous work in providing a comprehensive understanding of the role various social contexts across different levels can play in predicting adolescent dietary behaviours. Methods Data came from the 2017/18 Health Behaviour in School-aged Children (HBSC) survey in Flanders (Belgium). The sample included representative data from 8,702 adolescents in 165 schools. Social factors at individual-level (family meals, family, peer, student and teacher support) and at contextual-level (school culture of student and teacher support and school-level socioeconomic status [SES]) were considered. Multilevel logistic regression analyses were performed. Results At individual-level, family meals and family and student support were positively associated with fruit and vegetable consumption, family meals with sweet consumption too. Student and teacher support showed positive associations solely with fruit consumption. At contextual-level, adolescents attending schools with a lower school-SES demonstrated lower vegetable consumption. Culture of teacher support was negatively associated with sweets but also vegetable consumption. For culture of student support no associations were found. Conclusions The study mainly provide cues for strengthening family social ties as dietary health promotion initiatives, with some evidence supporting the role of beneficial peer and school social factors. Mixed results for contextual school-level social factors warrant further research to identify additional school-related influences on adolescent dietary behaviours to advance current understandings. Key messages • Family meals and support promote healthy eating in adolescents, emphasising the health promoting role of family social ties in dietary habits. • Mixed findings on school-level social factors call for more research on school health policies.

Risk of eating disorders and body image in adolescents in Belgium: is migration status a modifier?

Abstract Background The risk of eating disorders (ED) has been linked to body image (BI) dissatisfaction in adolescents. In addition, the origin and host country culture may influence BI dissatisfaction. Our objective was to assess the modifying effect of migratory status on the association between BI and risk of ED in Belgium, a setting characterized by a large proportion of migrant adolescents. Methods In the 2022 cross-sectional “Health Behaviour in School-aged Children” (HBSC) study in French-speaking schools, 7,267 adolescents aged 12 to 20 self-completed questionnaires. Risk of ED was determined by an Eating Attitude Test (EAT-7), score ≥5. BI was categorised into 3 groups: “too thin”, “about the right size” and “too fat”. Migratory status was divided into “native”, “2nd generation” and “1st generation” migrants. The association between BI and ED was estimated using logistic regressions adjusted for socioeconomic and psychosocial characteristics. After the inclusion of the “migration*BI” interaction term, migration-stratified logistic regressions were conducted. Results Overall, 13.0% of students were at risk of ED. Percentages of ED were 15.7% among those who perceived themselves as “too fat” (vs. “about the right size”: aOR=1.67 [95%CI: 1.34-2.08]) and 19.4% in the “too thin” group (aOR=3.36 [2.54-4.45]). Despite non-significant interaction terms, perceiving themselves as “too fat” (vs. “about the right size”) was not associated with the risk of ED in 1st generation migrants (aOR: 1.24 [0.67-2.29]). Compared with the overall estimation, it was lower in 2nd generation migrants (aOR: 1.43 [1.00-2.03]) while it was slightly higher in natives (aOR: 1.95 [1.45-2.62]). Conclusions These findings suggest complex interrelations between BI and risk of ED according to migratory status in adolescents with potential underlying mechanisms involving cultural norms. Promoting positive BI as a possible way for preventing the development of eating disorders need to be further investigated. Key messages • This study shows differences of body image dissatisfaction according to the migratory status in adolescents, inducing potential impacts on the risk of eating disorders. • Better understanding differences in body perception related to cultural background could help prevent risk of eating disorders in adolescents, by promoting positive body image for example.

Leveraging epidemiological data for the development of interventions to promote healthy nutrition and physical activity among adolescents from disadvantaged backgrounds

Abstract ePro-Schools is a public health initiative designed to promote healthy nutrition and physical activity among adolescents from socially disadvantaged backgrounds using a targeted e-health intervention to be deployed in the school context. A central theme of ePro-Schools is its robust cross-sectoral collaboration, involving stakeholders from academia, healthcare, education, and local communities. This cooperative approach not only enhances the intervention’s relevance and efficacy but also ensures its cultural, social, and economic adaptability to the needs of the target population. The project embodies a truly interdisciplinary effort, integrating insights from epidemiology, behavioural science, public health, and digital technology to innovate and improve health promotion strategies. This presentation will explore how data from epidemiological studies, such as the Health Behaviour in School-aged Children (HBSC) study, are used to support the development of the ePro-Schools intervention. Utilizing high-quality epidemiological data, the project identifies key determinants of physical activity, dietary habits, and sedentary behaviour amongst adolescents growing up in low-SES contexts, allowing to craft tailored strategies to promote healthier lifestyles within this vulnerable population.

Tobacco and nicotine products use among adolescents in Serbia – Latent class analysis

Abstract Background In parallel with a decline in cigarette smoking in the previous decade, other tobacco and nicotine products (TNPs), that are often used concurrently, have gained popularity among adolescents. The purpose of this study was to identify patterns of tobacco and nicotine product use among Serbian adolescents. Methods Data for this study were obtained from Health Behavior in School-aged Children (HBSC), a WHO collaborative cross-national study of adolescent health and well-being, that was conducted in Serbia in 2022 on a sample of 3713 students 11,13 and 15 years old. Descriptive statistics was used as well as latent class analysis to classify students based on their past-month use of cigarettes, e-cigarettes, heated tobacco products, waterpipes, and oral tobacco/nicotine products. Results Among students 11,13 and 15 years old, 10.2% smoke cigarettes, 13% use e-cigarettes, 11.1% waterpipes, 3.7% oral tobacco/nicotine products, and 4.5% heated tobacco products with differences by age and sex. We found high percentages of dual use of TNPs among cigarette smokers. Among students who smoke cigarettes, 61.6% also use e-cigarettes, 36.2% smoke waterpipes, 30.2% heated tobacco products, and 24.1% oral tobacco/nicotine products. Latent class analysis identified three classes as optimal solution: (1) dual e-cigarette and cigarette users (6.9%); (2) minimal/non-users (83.2%) and (3) poly tobacco and nicotine products users (9.9%). Statistically significant differences between classes were found in age and sex. Conclusions Dual and poly-tobacco and nicotine use is common among Serbian adolescents and presents a challenge for monitoring and public health response. Findings contribute to a better understanding of patterns and heterogeneity of TNPs use among adolescents and might have implications for prevention and cessation interventions for youth. Key messages • Among students 11,13 and 15 years old, tobacco and nicotine products, other than cigarettes is gaining popularity and with the e-cigarettes being the most popular product. • Dual and poly tobacco and nicotine products use is new challenged that should be taken into account in tobacco and nicotine monitoring, cessation and prevention.

Inequities in child health in Luxembourg

Abstract Background In Luxembourg, despite its economic prosperity, 28.6 % of children are estimated to be at the risk of poverty. Research has shown that growing up with socioeconomic disadvantage is associated with worse physical and mental health in childhood. We explore the association of socioeconomic status with health, health behaviours and access to healthcare in Luxembourg for children up to age twelve. Methods We used data from 2014 to 2022 for 11-12 year old children from the Health Behaviour in School-aged Children (HBSC) survey as well as social security data from Luxembourg for a similar time period and children 0 to 12 years old. To assess socioeconomic status, we used information on self-perceived household wealth for the HBSC results and stratified health and health behaviours by well-off, average, or less well-off households. For the social security data, we stratified access to care indicators by equivalized household income quintiles. Results We found that physical activity levels, nutritional quality and daily routines such as eating breakfast and brushing teeth are significantly lower in children from less affluent families. For example, 61% of 11-12-year-old children from well-off families reported eating breakfast every day, but only 41% of children from less well-off families. Only 23% of 11-12 year olds from less affluent families rated their health as excellent, compared to 52% of children from affluent families. There were similarly large differences for multiple health complaints, with 63% of children from less affluent families reporting this indicator for psychosomatic problems, compared to 34% of children from affluent families. We did not find differences in the use of pre- and postnatal care visits. Conclusions Socioeconomic differences in child health, mental health and health behaviours are large, with children from poorer households being in worse physical and mental health and less likely to report positive health behaviours. Key messages • Many children in Luxembourg face socioeconomic challenges that are adversely associated with health and health behaviours. The underlying reasons require further attention to improve child health. • Children from poorer backgrounds are in significantly worse mental health than children from better off families in Luxembourg.