Global School-based Student Health Survey Research Articles (Page 1)

ABSTRACT The study aimed to evaluate school-based hygiene education, protective and psychosocial factors associated with suboptimal (not always) hand hygiene (SHH) and suboptimal (not always) oral hygiene (SOH) among school-aged adolescents in the Philippines. The 2019 national Philippines Global School-based Student Health Survey (GSHS) provided the study’s data. In order to determine the variables associated with SOH, SHH before meals, SHH after toilet use and SHH with soap, the study used bivariate and multivariable logistic regression analysis. The prevalence of SOH was 18.5%, SHH before meals 41.2%, SHH after toilet use 27.9%, and SHH with soap 48.5%. Regression results showed that taught on personal hygiene and taught on healthy eating were protective against SOH, SHH before meals, and SHH after toilet use, and taught on personal hygiene was inversely associated with SHH with soap. Furthermore, high parental and peer support were both negatively associated with SOH, SHH before meals, SHH after toilet use, and SHH with soap. In addition, several psychosocial and sociodemographic factors were found associated with SOH and SHH indicators. The survey showed suboptimal oral and hand hygiene practices. Hygiene education was protective against SOH and SHH after toilet use, SHH before meals, SHH with soap. Further factors associated with SOH and/or SHH included lack of parental and peer support, and several health risk behaviours, which can be targeted in hygiene promotion among adolescents in the Philippines.

Although suicidal ideation is a significant issue among adolescents, previous studies have largely relied on cross-sectional data collected at a single time point or have been limited to individual countries, providing limited insight into temporal trends across diverse populations. Therefore, we aimed to examine temporal trends in suicidal ideation among adolescents across 23 countries. We analyzed data from the Global School-Based Student Health Survey (2003–2021), which included adolescents aged 13–15 years in 23 countries. Each participant participated in multiple surveys, and survey years varied by country. Prior to trend estimation, we compared linear and quadratic fits where more than three surveys were available to identify near-linear patterns. Temporal trend was quantified as the average annual percentage change (AAPC), which was calculated by weighted log-linear regression on the log prevalence rates of the survey years, applied separately to boys and girls. The study analyzed 185,941 school-attending adolescents (46.45% male) across 23 countries. The prevalence of suicidal ideation showed significant upward trends in six countries: Myanmar (AAPC, 32.04%/year; 2007–2016), Guyana (AAPC, 8.88%/year; 2010–2014), Saint Vincent and the Grenadines (AAPC, 3.87%/year; 2007–2018), Mongolia (AAPC, 3.67%/year; 2010–2013), Bolivia (AAPC, 3.02%/year; 2012–2018), and Seychelles (AAPC, 2.54%/year; 2007–2015). Conversely, five countries exhibited significant declines, including Benin (AAPC, -8.60%/year; 2009–2016), Kuwait (AAPC, -6.40%/year; 2011–2015), and the Maldives (AAPC, -4.33%/year; 2009–2014). Sex-specific differences in trends were nominally significant (p < 0.05) in six countries—Benin, Kuwait, Argentina, Saint Vincent and the Grenadines, Thailand, and Guyana—but only two (Saint Vincent and the Grenadines and Thailand) remained statistically significant after Bonferroni correction. In five of these countries (excluding Guyana), girls exhibited more unfavorable patterns, showing either a greater increase or a smaller decrease in suicidal ideation compared to boys. This study highlights divergent trends in adolescent suicidal ideation across 23 countries, with rising prevalence in some regions and notable sex differences. The findings underscore the need for continued surveillance and context-specific mental health interventions.Supplementary InformationThe online version contains supplementary material available at 10.1038/s41598-025-19158-5.

Objective: This study aims to analyze the prevalence of adherence to physical activity, screen time, and sleep recommendations and their association with excess weight in high school adolescents from the state public network of Pernambuco, Brazil. Methods: A cross-sectional study was conducted with 4,203 adolescents aged 14 to 19 years. Data were collected using a translated and validated version of the Global School-Based Student Health Survey (GSHS). The study assessed adherence to recommendations for Moderate to Vigorous Physical Activity (MVPA), screen time (ST), and sleep duration. Logistic regression analysis was used to examine the associations between these behaviors and excess weight, adjusting for age, race, and maternal education. Results: Only 2.68% of adolescents met the combined recommendations for MVPA, ST, and sleep. The total proportion of obese adolescents was 12.3%, with a higher prevalence among girls (13.4%) compared to boys (10.9%). Male adolescents who did not meet the MVPA recommendation had a 1.53 times higher chance of being obese (95% CI: 1.11; 2.12), and those who did not meet the ST recommendation had a 1.60 times higher chance of being obese (95% CI: 1.11; 2.31). Conclusions: Low adherence to physical activity, screen time, and sleep recommendations is associated to higher excess weight rates among adolescents in Pernambuco, Brazil, particularly in boys. Public health strategies promoting these behaviors are essential to combat obesity, with a focus on gender-specific interventions.

IntroductionParent-adolescent relationships play a crucial role in influencing high-risk behaviors among adolescents. In Malaysia, there is limited research exploring the influence of parent-adolescent relationships on adolescent risk behaviors. This study aims to determine the role of parent-adolescent connectedness and parental monitoring against high-risk behaviors among Malaysian adolescents.MethodsThis study utilized data from the National Health and Morbidity Survey (NHMS) 2022: Adolescent Health Survey, a cross-sectional study conducted from June to July 2022 among secondary school students. A two-stage stratified cluster sampling method was applied using a national sampling frame of 2,798 schools to ensure state and national representativeness. The Global School-based Student Health Survey (GSHS) Malaysian version was used to collect data on health risk behavior and protective factors including parent-adolescent connectedness and parental monitoring. Descriptive analysis and multivariable logistic regression were used to analyzed the data.ResultsAmong 33,523 adolescents, a total of 24.2% (95% CI: 23.7–24.7) of adolescents reported parental connectedness, while 33.4% (95% CI: 32.9–33.9) reported parental monitoring. By sociodemographic factors, Indians ethnicity had the highest odds of reporting both parental connectedness (aOR: 1.94, 95% CI: 1.65, 2.28) and parental monitoring (aOR: 2.21, 95% CI: 1.82, 2.70), while adolescents in Labuan Federal Territory (a federally administered island region of Malaysia) had significantly lower odds for both measures. Adolescents with parents married and living together had significantly higher odds of reporting both parental connectedness (aOR: 1.28, 95% CI: 1.18, 1.40) and parental monitoring (aOR: 1.35, 95% CI: 1.26, 1.44). Parental connectedness and monitoring were strong protective factors against all eight high-risk behaviors, including reduced odds of sexual activity (aOR: 0.63 and 0.58), e-cigarette use (aOR: 0.68 and 0.55), smoking, drug use, alcohol use, physical fights, being bullied, and cyberbullying.ConclusionThis study found that parental connectedness and monitoring were significantly associated with lower odds of engaging in high-risk behaviors among Malaysian adolescents, with notable variations by ethnicity, parental marital status, and region. Strengthening parental involvement and addressing disparities in family dynamics are essential strategies for promoting adolescent health and well-being in Malaysia.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12889-025-24598-9.

Violence and non-fatal injuries among Thai adolescents: National prevalence, and sex-stratified risk and protective factors.

High-risk behaviours are those that can have adverse effects on the overall development and well-being of youth, or that might prevent them from future successes and development. A descriptive study conducted with the aim to assess the prevalence and knowledge on high-risk behaviours regarding health among 60 school going adolescents of class X &amp; XII at selected schools of West Bengal with GSHS (Global School Based Student Health Survey) tool and Structured Knowledge questionnaire by convenience sampling technique. Among60 school going adolescents’ maximum were male. Prevalence rate is high among male school going adolescents for feelings of depression and down and among female school going adolescents’ prevalence rate is high at the feelings of nervousness, anxious and could not control worrying of something. High prevalence rate found on dietary module that most of the male and female school going adolescents were taking fat and fried foods many times in a week. Most of the students both male and female school going adolescents were having poor to moderate knowledge on high-risk behaviour regarding health at the mental health and diet. Strong and negative correlation found between the prevalence and knowledge on high-risk behaviour regarding health at mental health module and moderate and positive corelation found between the prevalence and knowledge on high-risk behaviour regarding health at dietary module.

BackgroundSuicide represents a serious global public health challenge and a leading cause of mortality and morbidity in adolescents. This study aimed to investigate the occurrence and some determinants of suicidal ideation, planning, and attempts among school-going adolescents in the Wasit Governorate, Iraq.MethodologyThis was an updated, wide-scale cross-sectional study targeting public governmental middle- and high-school students aged 13 to 18 years. Schools and students were selected using a standardized two-stage cluster sampling design. A pretested Arabic Version of the Iraqi Global School-Based Student Health Survey questionnaire was used in addition to demographic and psychosocial variables, including parental socio-economic status and history of suicidal behaviors among family members and friends. All procedures were performed under ethical standards. The survey data analysis was performed using the primary sampling unit (PSU) and finite population correction (FPC) methods with a baseline univariate analysis and multivariate logistic regression to measure the associated factors.ResultsA total of 1810 students from 42 middle and high schools were included, with a mean age of 15.98 years. Boys formed 50.27% of the study population. The overall 12-month prevalence of suicidal ideation, planning, and attempts was 23.87% (95% CI: 19.65-28.67), 21.90% (95% CI: 18.04-26.32), and 22.37% (95% CI: 18.60-26.65), respectively. In the univariate analysis, suicidal behavior, and thoughts had significant associations with gender, social status, residency, parental conflict, and the presence of suicidal behavior history in family and friends. In the multivariate full-model analysis, the risk factors for suicide attempts were girls (adjusted odds ratio or AOR 1.64; 95% CI; 1.05-2.58), exposure to suicide attempts in family members (AOR 3.36, 95% CI: 1.60-7.06) and friends (AOR 1.99, 95% CI: 1.26-3.15). Suicidal ideation (AOR 11.81, 95% CI: 7.59-18.40) and planning (AOR 8.06, 95% CI: 4.30-15.10) were the most important associated risk factors for suicide attempts.ConclusionSuicidal ideation, planning, and attempts are alarmingly prevalent among school-going adolescents in Wasit, particularly among girls and those with a history of suicide attempts in friends and family members. Suicidal ideation and planning strongly relate to suicide attempts. Multi-level and collaborative efforts toward preventing the onset of ideation, planning, and attempts are crucial.

Background: Harmful use of substances by adolescents is adjudged a global epidemic by the World Health Organization, affecting both the individual and society. This study assessed the prevalence, patterns and predictors of substance abuse among in-school adolescents in Yenagoa Bayelsa State Nigeria Methods: This descriptive cross-sectional study was conducted in year 2022 among 310 secondary school adolescents, selected through a multistage sampling technique. Data were collected using a semi-structured, self-administered questionnaire adapted from the Global School-based Student Health Survey (GSHS) Core Questionnaire, specifically the 2021 version of the Drug Use Module. Data were analysed using SPSS version 25; level of significance was p ≤ 0.05 at 95% Confidence Interval. Chi-square and Fisher's exact tests were used to determine the association between categorical variables. Predictors were determined by binary logistic regression. Result: The mean age of the participants was 15.07 ± 1.573 years. Lifetime substance abuse prevalence was 32.3%, with a 12-month rate of 20.6%, including 13 (4.3%) daily users. The most abused substances were Alcohol 87(90.6%), Marijuana 20(20.5%) and Shisha 18(18.8%) and mean age of initiation was 12.42±2.971 years. Relaxation 23(24.0%) and curiosity 18(18.8%) were the most common reasons provided. Predictors include older adolescents, mother’s educational level, from a polygamous setting, negative influences from family members, easy access to drugs and money, and history of sexual abuse (p&lt;0.05). Conclusion: Substance abuse among in-school adolescents is widespread, with initiation at younger ages. The most abused substances are alcohol, cannabis, and shisha. Prevention should target younger adolescents before they start using these substances.

Food insecurity and adolescents psychosocial health problems globally: observations based on school going adolescents from 59 countries.

Prevalence and associated factors of serious unintentional physical injury, road traffic injury and near drowning experience among a nationally representative sample of school-aged adolescents in the Philippines in 2019.

International Perspectives on the Covariation Among Adolescent Risk Behaviors.

Peer physical violence (PPV) has been shown to be an early marker for development of other health-risk behaviours. This study assessed the prevalence and risk factors of PPV among in-school adolescents in a state in South-east, Nigeria. This was a cross sectional study conducted among 1,296 in-school adolescents using the Global School-based students Health Survey questionnaire. Data on socio-demographic characteristics and factors associated with PPV were obtained and p-value <0.05 was considered significant. The overall mean age (S.D) of participants was 15.0 ± 2.0years and the prevalence of PPV was 43.1%. In multivariate logistic regression, predictors of PPV were gambling (AOR: 1.56; 95%CI:1.13-2.16; p = 0.007), cigarette smoking (AOR: 1.85; 95%CI:1.01-3.40; p = 0.047), serious injury in the past 1year (AOR: 2.29; 95%CI:1.78-2.95; p < 0.001) and bully victims (AOR: 1.70; 95% CI:1.28-2.25; p < 0.001). Older adolescent age (AOR:0.37; 95%CI:0.25-0.53; p < 0.001] and being religious (AOR: 0.70; 95%CI: 0.53-0.92; p = 0.011) were protective. There is high prevalence of PPV in the study population. The risk factors were young adolescence age, bullying, gambling, cigarette smoking, having had a serious injury and not being religious. Stricter regulations on gambling through legislation, especially as it concerns age, and adoption of school policies against bullying and cigarette smoking are recommended.

Adolescence is a critical period marked by significant physical, emotional, and social changes. Concerns for adolescence mental health is an emerging global issue. Second to home, students spend a lot of time in school and amongst peers thus it is important to maintain a school environment conducive to optimal mental and physical health. The study aims to explore mental health concerns and their relationship with physical and cyber violence amongst high-school students in Jeddah, Saudi Arabia. A cross-sectional study using convenience sampling was conducted between April and October 2023 across five international schools in Jeddah. Data were collected using a validated questionnaire adapted from the WHO Global School-based Student Health Survey (GSHS), focusing on the mental health and violence modules. Descriptive statistics were reported, and Chi-square (χ²) tests were used to assess associations between variables. A total of 538 responses, 252 males and 286 female students participated in the study. Male students were significantly more associated with violence-related factors such as bullying whereas female students were more prone to loneliness (p < 0.001) and suicide attempts (p = 0.0016). Moreover, Saudi students were found to be more associated with cyberbullying and in-school bullying (p < 0.001). In conclusion, our analysis of mental challenges and violence risks highlights the need to foster a safer and healthier environment for high-school students. Counselling and surveillance for alarming behaviours with stronger mental health initiatives and policies are suggested to create a more robust school support system.

Association of sedentary time with school bullying among adolescents in 74 countries: A population-based study.

BackgroundStress-related sleep disturbance has emerged as a significant public health concern among adolescents worldwide. The independent and combined effects of substance use on stress-related sleep disturbance remain inconclusive. We aimed to explore the association of the use of substances such as tobacco and alcohol with stress-related sleep disturbance among adolescents in 76 countries.MethodsWe collected data from the global school-based student health survey, which comprised 302 181 adolescents aged 12–17 years from 76 countries. The frequency of tobacco and alcohol use in the past 30 days was categorised as follows: zero, one to two, three to nine, 10–29, and 30 days. Tobacco and alcohol use were classified into four categories: non-use, tobacco use alone, alcohol use alone, and combined use. We used multivariate logistic regression analyses to examine the independent and combined associations of tobacco and alcohol use with stress-related sleep disturbance.ResultsAs the frequency of tobacco use and alcohol use increases, the proportion of stress-related sleep disturbance among adolescents shows an upward trend (for tobacco use 8.3–27.4%, for alcohol use 6.7–28.9%). Compared to non-drinkers, the odds of having stress-related sleep disturbance increased with frequency of drinking from one to two days to 30 days (from odds ratio (OR) = 1.53; 95% confidence interval (CI) = 1.31–1.78 to OR = 3.13; 95% CI = 1.99–4.90), as well as with the frequency of tobacco use (from OR = 1.11; 95% CI = 0.88–1.39 to OR = 1.98; 95% CI = 1.39–2.81) during the past 30 days.ConclusionsWe found both tobacco and alcohol use, as well as their combination, were associated with stress-related sleep disturbance. These findings emphasise the need to strengthen the prevention and control of tobacco and alcohol use among adolescents in order to reduce stress-related sleep disturbance and improve sleep quality.

ABSTRACTAdolescents frequently face emotional and social challenges that make them particularly vulnerable to feelings of loneliness. This study aimed to determine the national prevalence of loneliness among Malaysian secondary school students and to identify the psychosocial and familial factors associated with it. A cross‐sectional study was conducted using a multi‐stage stratified cluster sampling design to ensure the representativeness of all secondary school students from Form 1 to Form 5 in Malaysia. A total of 239 secondary schools were chosen, and 33,523 students participated. The Malaysia Global School‐based Student Health Survey (GSHS) 2012 self‐administered questionnaire was used. The students who responded “most of the time” or “always” to feeling lonely during the past 12 months were categorized as lonely. Multiple logistic regression was used to identify the associated factors. The prevalence of loneliness among secondary school students in Malaysia was 16.2%, with females having the highest prevalence at 20.8%. Multiple logistic regression revealed that students with depression symptoms had a ninefold higher likelihood of feeling lonely. Poor parental or guardian connectedness and bonding were significantly associated with feeling lonely. Furthermore, students whose parents are separated had a 40% higher risk of experiencing loneliness. Loneliness among secondary school students was more evident in those with depression symptoms. Addressing loneliness among secondary school students in Malaysia necessitates a concerted effort to prevent the occurrence of all modifiable factors contributing to this issue.

This study aimed to describe changes over time in the prevalence and associated factors of suicidal behaviours among 13– to 15–year–olds in Southeast Asian countries. It is a secondary analysis of cross-sectional data from the Global School-based Student Health Surveys conducted in Indonesia, Myanmar, the Philippines and Thailand in 2007/2008 and 2015/2016. Each survey included a nationally representative sample of students aged 13–15 years. Data on suicidal thoughts, plans, attempts, and associated factors—including health risk behaviours, experiences of physical violence and bullying, social difficulties, and parental supervision—were collected using self-report questionnaires. The population attributable fraction for each risk factor was calculated using multiple logistic regression. The prevalence of suicidal behaviours ranged from 0.7% (Myanmar) to 17.3% (Philippines) in 2007/2008, and from 8.6% (Indonesia) to 20.9% (Thailand) in 2015/2016. Being physically attacked or bullied and experiencing social difficulties were the most consistent and significant risk factors across countries and time points. Female gender, poverty, alcohol consumption, and drug use also contributed to risk at varying levels. Suicidal behaviours have risen alarmingly in several Southeast Asian countries. These findings suggest the urgent need for coordinated action by policymakers, health professionals, educators, and families to prevent adolescent suicidal behaviours.

Background: In recent years, mental health issues among adolescents have gained significant attention. Like many other nations, Panama is experiencing a growing prevalence of these challenges within its youth. It is crucial to investigate the prevalence of, and the underlying factors associated with, loneliness, anxiety-related sleep disturbances, and suicide ideation to develop effective intervention strategies Objectives: The study aimed to assess the prevalence of loneliness, anxiety-induced sleep disturbance, and suicidal ideation in Panama’s school-going adolescents and to identify the risk factors that make this age group vulnerable to these psychological problems using sex-stratified data. Methods: We used cross-sectional survey data from the Panama Global School-based Student Health Survey 2018 and performed descriptive and inferential statistical analyses. Results: Suicidal ideation was more common (18.5%) than loneliness (16.3%) or anxiety-induced sleep disturbance (10.4%) among adolescents in Panama. Higher odds of loneliness were found among those who had no close friends [AOR =3.553, 95% CI = 2.417 – 5.223], experienced hunger [AOR = 2.606, 95% CI = 1.314 – 5.168], and were bullied on school property [AOR = 1.747, 95% CI = 1.307 – 2.334] than their counterparts (i.e., those who had close friends, did not experienced hunger, and were not bullied on school property. Respondents who had no close friends [AOR = 1.624, 95% CI = 1.016 – 2.598] and suffered bullying both inside [AOR = 1.939, 95% CI = 1.406 – 2.674] and outside [AOR = 1.453, 95% CI = 1.013 – 2.084] of school property were more prone than their counterparts to experience anxiety-induced sleep disturbances. Additionally, adolescents who experienced hunger [AOR = 2.675, 95% CI = 1.396 – 5.126], had no close friends [AOR = 1.605, 95% CI = 1.077 – 2.393], were bullied on school property [AOR = 1.964, 95% CI = 1.499 – 2.571], and consumed alcohol [AOR = 1.425, 95% CI = 1.113 – 1.825] encountered higher odds of suicidal ideation. However, girls were more susceptible to suicidal ideation than boys if they had no close friends, experienced hunger, and were bullied on school property. Conversely, parents’ understanding significantly lowered the odds of suicidal ideation compared to their counterparts. Conclusions: Gender-sensitive and proactive community-based initiatives should be implemented to improve adolescents’ mental health in Panama. Moreover, an inclusive school curriculum is needed to address adolescents’ psychological issues.

Abstract Cyberbullying is a significant concern among adolescents, impacting mental health and behavior. This study aimed to examine the sex-specific prevalence and correlates of cyberbullying victimization among Thai adolescents. Data from the 2021 Thailand Global School-based Student Health Survey, involving 5,657 students in grades 7–12, were analyzed. Cyberbullying victimization was assessed through self-reported experiences in the past 12 months. Twenty-three outcome variables across five domains (lifestyle, mental health, substance use, sexual behaviors, and violence) were examined. Logistic regression models, adjusted for age, assessed the associations between cyberbullying and these outcomes separately for males and females, accounting for the complex survey design and sampling weights. Approximately 17% of male and 13% of female students experienced cyberbullying in the past year. For males, cyberbullying was significantly associated with negative outcomes, including poor mental health (loneliness, insomnia due to anxiety, suicidal thoughts and attempts), increased substance use (cigarettes, alcohol, marijuana), and risky sexual behaviors (multiple sexual partners). Male victims were also more likely to engage in violent behaviors and experience physical attacks. For females, cyberbullying was linked to poor lifestyle choices (sedentary lifestyle, poor oral hygiene, inadequate fruit/vegetable intake), heightened mental health issues (loneliness, insomnia, suicidal thoughts and attempts), and substance use. Female victims were also at higher risk of experiencing violence and traditional bullying. This study documented high cyberbullying rates among Thai adolescents and calls for comprehensive mental‑health support, especially for males with elevated suicidal ideation; healthy‑lifestyle and social‑connectedness programs for females; and universal resilience and digital‑citizenship training for all youth.

Background and Objectives: This study explores gender variations in the associations between lifestyle choices, mental health, and social behaviors among adolescents in the Transylvania region of Romania. The analysis is based on data obtained through the Global School-Based Student Health Survey (GSHS). Materials and Methods: Data on 900 Romanian adolescents aged 11–18 years were obtained via the GSHS. This study evaluated nutritional statuses through BMI Z-scores, employing World Health Organization (WHO) cut-offs applied to self-reported height and weight; furthermore, it assessed well-being and perceived health; worries and sleep anxiety; social connections through having friends, loneliness, peer support, and emotional support; parental bonding relations; experiences of being bullied; safety and protection factors, including distance learning during the COVID-19 pandemic and testing or vaccinations for COVID-19; and social behaviors, including the use of social networks. A multiple logistic regression was used to predict sleep disturbance anxiety, depending on sex, bullying, cyberbullying, loneliness, social network use, and peer support. Results: Results showed that the majority of the adolescents reported having one or more friends (96.8%), with no significant difference between girls and boys (p = 0.071). There were no statistically significant differences in bullying and cyberbullying experiences between sexes (p = 0.063). Notably, gender disparities exist in both health perceptions and risk behaviors, with girls experiencing higher rates of negative health perceptions, sleep anxiety (p < 0.001), and loneliness (p = 0.011) and boys exhibiting more overweight/obesity (p < 0.001) and school truancy (p = 0.027). According to the results, loneliness is significantly associated with a higher likelihood of sleep-disturbing anxiety (p < 0.001). Students who have experienced cyberbullying are more likely to also experience traditional bullying. Students who feel lonely are more likely to be victims of bullying. Conclusions: This study reveals significant gender disparities in adolescent health, particularly in mental health, risk behaviors, and social support. It highlights the need for gender-specific interventions to address these challenges and promote healthy development. Furthermore, this study emphasizes the importance of social connections, family support, and parental involvement in adolescent well-being. Addressing bullying, promoting mental health awareness, and providing accessible support services are crucial for improving adolescent health in Romania.