Health Behaviour In School-aged Children Data Research Articles

Cross-National Study on the Convergent, Discriminant, and Concurrent Validity of the “Body Size Perception” Item in the Health Behaviour in School-aged Children Survey

BackgroundDespite its significant usefulness in adolescent health studies, the single-item “body size perception” question, developed within the Health Behaviour in School-aged Children (HBSC) survey, has yet to undergo multidimensional validation. ObjectivesTo assess the convergent, divergent and concurrent validity of the HBSC body size perception question among adolescents. MethodsThe single-item HBSC body size perception question is as follows: “Do you think your body is…?,” with answers ranging from “much too thin” to “much too fat.” Fifteen-year-old participants included in the analysis were 72,086 from 45 HBSC countries in 2017/18 (concurrent validity), and 595, 127, and 615 in 2021/22 in French-speaking Belgium, Ireland, and Poland, respectively. The convergent, divergent, and concurrent validity was assessed with body dissatisfaction, social desirability, and selfesteem, respectively. The concurrent validity was also examined with body mass index (BMI) from the 2017/18 HBSC data. All analyses were sex-stratified. ResultsCohen’s Kappa values were 0.67 [confidence interval (CI): 95%: 0.62, 0.72] and 0.64 (0.59, 0.69) for boys and girls, respectively, in all 3 countries together. Body size perception was associated with social desirability, selfesteem, and BMI, with a stronger association in girls than that in boys. For instance, girls with higher social desirability were less likely to perceive themselves as “too thin” [Relative Risk Ratio (RRR) = 0.78 (0.69, 0.89)] rather than as the “right size.” Boys with higher selfesteem were less likely to perceive themselves as “too fat” [0.93 (0.90, 0.97)] rather than the “right size.” Girls with underweight were less likely to perceive themselves as “too fat” [0.38 (0.34, 043)] rather than “right size” and girls with overweight/obesity were more likely to perceive themselves as such [8.19 (7.49, 8.95)]. ConclusionsThe single-item HBSC body size perception question demonstrated good convergent, divergent, and concurrent validity. It reflects adolescents’ own perception of body size, possibly influenced by societal norms and ideals.

Mental health and BMI in children and adolescents during one year in obesity treatment

BackgroundMental health plays a major role in children and adolescents with obesity. The aim of this study was (1) to compare mental health in children with obesity with the background population and (2) to investigate if mental health changed during one year in an obesity treatment program.MethodsData on self-reported mental health was collected in 107 children and adolescents (mean age 13.2 years) with obesity at first visit in an obesity treatment program and at one year follow-up (n = 47). Mental health was assessed by eight questions from the Danish Health Behaviour in School-aged Children (HBSC) questionnaire: (1) self-rated health (2) life satisfaction (3) feeling low (4) body-image (5) loneliness (6) self-esteem (7) self-efficacy and (8) social competence. Data was compared to a reference population based on HBSC data. BMI-SDS was based on Danish reference values.ResultsChildren and adolescents with obesity had significantly higher odds of reporting negative body image and feeling low and lower odds of reporting high self-rated health and high self-esteem compared to a reference population. There was no difference between the groups regarding life-satisfaction, social competence, self-efficacy or feeling lonely. There were no significant changes in mental health from first visit to one-year follow-up.ConclusionOur findings highlight the mental health difficulties in children and adolescents with obesity, and the importance of addressing these issues in obesity treatment. The results also indicate that children with obesity have psychosocial resources that should be exploited in treatment protocols.

Who Stays, Who Moves on and the Host Population: A Picture of Adolescents' Perceived Well-Being and Risk Behaviours.

The study aims to evaluate the health profile of first- and second-generation Romanian immigrants living in Italy compared to their adolescent peers in the country of origin (Romania) and the host population (Italian-borns). Analyses were performed on the 2013/2014 Health Behaviour in School-aged Children (HBSC) survey data. Romanian natives showed lower levels of health complaints and higher life satisfaction than Romanian migrants, who were similar to the host population, especially the second-generation ones. A comparable prevalence of being bullied was registered among Romanians, both native and immigrant, with significantly lower levels among Italian natives. Bullying others showed the second-generation migrants share a similar prevalence with the host population. The prevalence of liking school a lot was three times higher among the Romanian natives than among their peers living in Italy. Thanks to the HBSC data, this study is the first to examine the health of adolescent migrants from both the perspective of the host country and the population of origin. The results highlight the need for a more nuanced approach to studying immigrant populations, taking into account both the host country's perspective and the health patterns of the population of origin.

Mental health and cannabis use among Canadian youth: Integrated findings from cross-sectional and longitudinal analyses.

Using data from two methodologically independent youth research studies in Canada, the Health Behaviour in School-aged Children (HBSC) study and the Cannabis, Obesity, Mental health, Physical activity, Alcohol, Smoking, and Sedentary behaviour (COMPASS) study, the objective of this study was to compare associations between youth's mental health and cannabis use across samples. Using similar indicators in both studies, our goal was to affirm the potential for nationally representative cross-sectional analyses (HBSC) to replicate findings found in a longitudinal non-representative data source (COMPASS), enhancing opportunity for causal inferences. Data were collected from grade 9 and 10 Canadian students participating in the 2017/18 HBSC (n=8462) and 2017/18 to 2018/19 waves of COMPASS (n=32,023). Using multivariable Poisson regression models, the strength and statistical significance of the effects of mental health indicators on cannabis use outcomes were estimated within both studies and compared for consistency. Using a 2-year linked sample of students participating in COMPASS, models examining the impact of mental health indicators on cannabis use initiation and maintenance over time were similarly fit using Poisson regression to estimate relative risk. Similar associations between mental health problems and cannabis use were observed in both data sources. The direction, magnitude, and precision of the estimates for restless sleep, loneliness, poor wellbeing, and cannabis use were highly comparable across both studies. Worse mental health was consistently associated with current and lifetime cannabis use among youth. Cross-sectional and longitudinal findings from two large methodologically diverse studies in Canada demonstrate a replicable association between indicators of mental health and youth cannabis use. Similarities were identified and two generalizations may be concluded: 1) potentially causal etiological relationships inferred from HBSC data were supported in longitudinal findings based on COMPASS, and 2) longitudinal COMPASS data aligns with nationally representative data from HBSC.

Baltic Adolescents' Health Behaviour: An International Comparison.

The aim of the study is to assess the time trends in Baltic adolescents’ physical activity, dietary habits and BMI and compare the results with the average of the Health Behaviour in School-aged Children (HBSC) study. The research used HBSC data from 2006 to 2018. The total number of respondents was 17,458 in Estonia, 18,416 in Latvia and 20,466 in Lithuania. A logistic regression analysis was applied to estimate time trends in health behaviour indicators. The results demonstrated that Baltic adolescents’ physical activity has declined over the study years, except for Lithuanian girls. The prevalence of overweight adolescents has significantly increased since 2006. Dietary habits improved in all three Baltic countries, as consumption of vegetables increased, and soft drink consumption decreased during this time period. This research shows that a nationwide, highly representative study with health behaviour indicators enables us to assess regional differences compared to the HBSC average. The prevalence of overweight and obese adolescents in the Baltic countries has increased and moved closer to the HBSC average. Although Baltic adolescents’ daily vegetable consumption has increased over the last decade, it is still lower than the HBSC average.

Is policy ‘liberalization’ associated with higher odds of adolescent cannabis use? A re-analysis of data from 38 countries

Background: Policy makers worldwide face the choice of whether to reform cannabis policy from the ‘full prohibition’ model. A paper by Shi, Lenzi and An (2015) suggested that such ‘liberalization’ is significantly associated with higher odds of adolescent cannabis use. Aim: To test the validity and reliability of Shi et al’s conclusion that the HBSC data show an association between policy ‘liberalization’ and increased likelihood of adolescent cannabis use. Methods: Replication and re-analysis of the same pooled data from three waves of the Health Behaviour in School-aged Children (HBSC) survey (2001/2, 2005/6 and 2009/10). This replicates – as far as possible – the coding and analytical strategy of the Shi et al article. The re-analysis makes some improvements by: excluding a variable (‘number of siblings’) for which many cases have missing data; including available data from the theoretically relevant case of Sweden for the latter two waves of the HBSC survey, which Shi et al omit; and including random slopes for gender between countries as well as random intercepts for countries in the mixed effects model, as the predictive effect of gender on cannabis use varies across countries. Results: Shi et al’s verbal summary of their findings is not supported by detailed interpretation of their own numerical results. Without making the suggested amendments, it is possible to find a statistically significant association between policy ‘liberalization’ and higher odds of some measures of adolescent cannabis use. But when these improvements are made, this association becomes statistically non-significant. Conclusion: Using a larger and more theoretically relevant sample of the HBSC respondents and an improved statistical model shows that the HBSC data do not reveal a statistically significant association between policy ‘liberalization’ and higher odds of adolescent cannabis use.

Improving Adolescent Health: Translating Health Behaviour in School-aged Children Evidence Into Policy

The Health Behaviour in School-aged Children (HBSC) study has informed the development and implementation of policy for children and adolescents for over three decades. The growing recognition that adolescence is a critical period for later health and well-being has highlighted the need for, and importance of timely and accurate data. Every 4 years, the HBSC study provides evidence on health behaviors, health outcomes, and social environments of boys and girls across Europe and North America. To maximize the impact of evidence, the HBSC study has a working Policy Development Group that cultivates relationships with key stakeholders, disseminates widely HBSC research, and facilitates discussion and cross-fertilization of ideas and priorities. To date, HBSC data have been central to health promotion efforts and developments in practice, policy, and legislation at both national and international levels.

Alcohol use and misuse: a profile of adolescents from 2018 Italian HBSC data.

Alcohol remains the most commonly substance used by adolescents.The aim of the study was to draw a comprehensive picture of the behavioural patterns that characterize alcohol use and abuse among 15-year-olds. The study sample included 18,918 15-year-olds participating in the 2018 Italian Health Behaviour in School-aged Children (HBSC) survey. A Bayesian approach was adopted for selecting the manifest variables associated with alcohol consumption; a latent class regression model was employed to identify health-related risk patterns associated with alcohol use. 21% of our sample represented the cluster of heavy drinkers who shared other risk behaviours: heavy smoking habits (29%), cannabis (68%), gambling (52%) and drunkenness (76%) experience, binge drinking (96%) and sexual intercourse (51%). Our results confirm multiple risk-taking behaviours among adolescents tending to cluster in behavioural patterns. This has implications for public health policies and must be considered when planning interventions and prevention strategies.

Using data from the HBSC study for evidence-based suicide prevention in Luxembourg

Abstract Issue As suicide is the second leading cause of death for young people, WHO aims to reduce the suicide rate with 10% by 2020 worldwide. In Luxembourg, organization D’Ligue coordinates suicide prevention. Since suicide research has been carried out in the country for a few years only, data on adolescent suicidal ideation is lacking. Therefore, D’Ligue has contacted the Luxembourg team of the international Health Behaviour in School-aged Children (HBSC) study, to identify risk factors for suicide behaviour and derive recommendations from them. Description of the problem First, our practice partner wanted us to provide them with basic data on the suicidal ideation of adolescents: How many adolescents are suicidal and what are risk factors? Second, recommendations for practice should be derived from the results. To this end, the HBSC data (2014) of 5262 pupils aged 12-18 were analysed. Results 15.1% of adolescents thought about suicide last year and 7% attempted suicide. Of the 24 risk factors examined, 12 were found to be significant, with three being particularly important: multiple health complaints (OR: 1.3 for each health complaint, p < 0.001, CI: 1.18 - 1.33), lower life satisfaction (OR: 1.3 for the loss of each life satisfaction point, p < 0.001, CI: 1.17 - 1.33) and frequent physical fighting (OR: 2.4, p < 0.001, CI: 1.57 - 3.74). Lessons Risk factors for suicide behaviour known from research have been confirmed for Luxembourg. What is new is that the number of health complaints is the most important risk factor for Luxembourgish adolescents. Therefore, a list of 8 health complaints was validated as a screening tool for suicidal thoughts. In a further step, this tool could be used, for example, by school nurses. The HBSC data can be used to update the national suicide prevention plan. Main messages HBSC data are used to: update the Luxembourgish national plan for suicide prevention.investigate a screening tool for adolescents at risk for suicide.

Using HBSC data as part of Ireland’s key policy documents: the example of wellbeing

Abstract This paper examines the importance of understanding wellbeing in childhood and adolescence, and will present Ireland’s efforts to develop a set of national indicators of wellbeing that are published every two year in the State of the Nation’s Children Report. One of the main source of population based indicators of wellbeing in Ireland is the Irish Health Behaviour in School-Aged Children (HBSC). The HBSC Study in Ireland collects data from 10-18 year olds children since 1998, using a self-completion questionnaire. Data are collected every four years using standardised procedures for sampling and data collection. The same procedures are used since the initiation of the study in Ireland allowing for both cross-country comparison and time trend analysis. As part of the efforts to develop the Irish set of indicators of wellbeing, the HBSC group used a participatory research with children to identify what makes children happy, and the indicators identified by children are now routinely collected. The paper will present these indicators and how they were developed. Most recently, the HBSC study group was asked to develop indicators to the new National Policy framework for children and young people, Better Outcomes Brighter Future, to fill in the gaps in existing knowledge. This further expands the role that the HBSC study in Ireland has in informing policy and in providing data for assessing its success. The paper will present the indicators that are currently used for both national documents, as well as how these were developed.

Tények és tévhitek a hátrányos helyzetről egy új kutatás tükrében

Feltáró jellegű kutatásunkat Hajdú-Bihar megye 11 hátrányos helyzetű településén/térségében végeztük olyan állami fenntartású általános iskolákban, ahol magas (12-80%) a hátrányos helyzetű tanulók aránya. Vizsgáltuk a tanulók közérzetét és motivációját, ezek kapcsolatát egymással és a szocioökonómiai háttérrel az egyének és az iskolák szintjén. A közérzetet a hangulat, a stressz skáláival, valamint az iskolához való érzelmi viszonyulás, a tanulással és a közösséggel szembeni attitűdökkel határoztuk meg. A motivációt 9 dimenzió által kirajzolt mintázatok alapján vizsgáltuk. Jelen munkánkban 771 tanuló online válaszait értékeltük ki. Eredmények. A HBSC 2014 adataihoz képest a megkérdezett diákok kevésbé szeretik az iskolájukat, jobban nyomasztják őket az iskolai feladatok, és kevésbé érzik a tanárok odafordulását; viszont sokkal kedvezőbben élik meg osztályuk közösségét. Klíma: A felső tagozatosok közül az ötödikesek és a jobb tanulók élik meg pozitívabban az iskolai klímát. A Tanulási klíma és az Iskolához való érzelmi viszonyulás korrelációja viszonylag magas (r=0,426, p<0,001). Motiváció: A lányok és a jobb tanulók kevésbé versengőek és inkább szociálisan motiváltak. A szociális háttér alig differenciálja a motivációs profilt. A közérzet változói alapján klaszteranalízissel nyert három csoport – Iskolabarátok, Rosszul alkalmazkodók, Túlélők – motivációs mintázatában markáns különbségek mutatkoznak. Adataink megerősítik, hogy a motiváció tekintetében meghatározóbbak az iskolához kapcsolható attitűdök, mint a szociális háttér. Az iskolák szociális összetételének hatása: Az általunk vizsgált változók az iskolák szintjén nem mutattak szabályszerűséget a hátrányos helyzetű tanulók arányának függvényében. Fontos eredménynek tekintjük, hogy az iskolák rendkívül változatosak a tanulóik iskolához/tanuláshoz való viszonyuk, alapattitűdjük tekintetében; a hátrányos helyzetű tanulók aránya e tekintetben nem döntő faktor.

Is policy ‘liberalization’ associated with higher odds of adolescent cannabis use? A re-analysis of data from 38 countries

BackgroundPolicy makers worldwide face the choice of whether to reform cannabis policy from the ‘full prohibition’ model. A paper by Shi et al. (2015) suggested that such ‘liberalization’ is significantly associated with higher odds of adolescent cannabis use. AimTo test the validity and reliability of Shi et al’s conclusion that the HBSC data show an association between policy ‘liberalization’ and increased likelihood of adolescent cannabis use. MethodsReplication and re-analysis of the same pooled data from three waves of the Health Behaviour in School-aged Children (HBSC) survey (2001/2, 2005/6 and 2009/10). This replicates – as far as possible – the coding and analytical strategy of the Shi et al article. The re-analysis makes some improvements by: excluding a variable (‘number of siblings’) for which many cases have missing data; including available data from the theoretically relevant case of Sweden for the latter two waves of the HBSC survey, which Shi et al omit; and including random slopes for gender between countries as well as random intercepts for countries in the mixed effects model, as the predictive effect of gender on cannabis use varies across countries. ResultsShi et al’s verbal summary of their findings is not supported by detailed interpretation of their own numerical results. Without making the suggested amendments, it is possible to find a statistically significant association between policy ‘liberalization’ and higher odds of some measures of adolescent cannabis use. But when these improvements are made, this association becomes statistically non-significant. ConclusionUsing a larger and more theoretically relevant sample of the HBSC respondents and an improved statistical model shows that the HBSC data do not reveal a statistically significant association between policy ‘liberalization’ and higher odds of adolescent cannabis use.

A trend analysis of sexual health behaviours of a national sample of Canadian adolescents using HBSC data from 2002–2014

Regular monitoring of trends in sexual health behaviours of adolescents is required to guide evidence-based intervention programs and health policies. The purpose of this study was to examine national trends in sexual behaviours of Canadian adolescents from 2002 to 2014. Method: A secondary analysis of data was conducted using the Canadian Health Behaviour in School-Aged Children (HBSC) survey of Grade 9 and 10 students over four survey cycles. Sexual behaviours of interest were ever having sexual intercourse, early onset of sexual intercourse, and oral contraceptive, condom, and dual method use at last intercourse. Disaggregated by gender and survey cycle, data were analyzed using cross-tab analyses and aged-adjusted logistic regressions. From 2002 to 2014, boys had decreasing trends in early onset of sexual intercourse [AOR = 0.55, 95% CI = (0.36–0.85), p = 0.008], and increasing trends in oral contraceptive use [AOR = 1.94, 95% CI = (1.24–3.04), p = 0.004]. During this time, girls had decreasing trends in condom use [AOR = 0.64, 95% CI = (0.41–1.00), p = 0.052], but increasing trends in oral contraceptive use [girls: AOR = 1.47, 95% CI = (0.98–2.19), p = 0.061] approaching statistical significance. No significant trends were noted in ever having sexual intercourse and dual method use for both genders. In sum, boys showed improvements in sexual behaviours over time. The inverse trends of condom use and oral contraceptive use suggested girls’ increasing reliance on oral contraceptive pills instead of condoms. Health services interventions and policies should consider implementing new strategies that better promote dual method use.

Cross-country comparisons of trends in adolescent psychosomatic symptoms \u2013 a Rasch analysis of HBSC data from four Nordic countries

BackgroundTo analyse the psychometric properties of the HBSC Symptom Checklist (HBSC-SCL) on psychosomatic symptoms with a focus on the operating characteristics of the items, and on the impacts of measurement distortions on the comparisons of person measures across time and between countries.MethodsData were collected in 1993/94, 1997/98, 2001/02, 2005/06, 2008/09, 2013/14 in Denmark, Finland, Norway and Sweden as part of the Health Behaviour in School-aged Children (HBSC) study. Data comprised 116,531 students 11, 13 and 15 years old. Rasch analysis was conducted of the HBSC-SCL consisting of eight items with a focus on Differential Item Functioning (DIF) and item threshold ordering. The impacts of DIF and threshold disordering on trend analyses were analysed in a subsample consisting of 15 years old students.ResultsOne item shows evidence of severe DIF and the categorisation of some items does not seem to work as intended. Analyses of changes based on proportions of psychosomatic symptoms show that bad item functioning affects some comparisons between countries across time: A four percentage point difference between 15 years old girls in Finland and Sweden concerning the rate of increase of psychosomatic symptoms from 1994 to 2014 disappears when the problems with DIF and disordered item thresholds are taken into account. Although the proportions of students with psychosomatic symptoms are clearly higher 2014 than 1994 in all four countries the shape of most trends is nonlinear.ConclusionsSome of the cross-country comparisons were distorted because of DIF and problems related to disordering of the item thresholds. The comparisons among girls between Finland and Sweden were affected by the problems pertaining to the original measure of psychosomatic symptoms, while the trend patterns among boys were not much affected. In addition to confirming increasing rates of adolescent mental health problems in the Nordic countries, the substantive analyses in the current study show that Finland is joining Sweden in having the sharpest increase among older adolescents, in particular among girls.To improve the functioning of the scale the DIF item could be removed or replaced and response categories collapsed in post hoc analyses.

Sexual Health questions included in the Health Behaviour in School-aged Children (HBSC) Study: an international methodological pilot investigation.

BackgroundThis paper describes the methodological developments of the sexual health items included in the Health Behaviour in School-aged Children (HBSC) study since their mandatory inclusion in the study in 2002. The current methodological, ethical and pedagogical challenges in measuring young people’s sexual health behaviours are discussed along with the issues associated with the sexual health items introduced to the HBSC study in 2002. The development and piloting of new cross-national items for use in the 2013/14 HBSC data collection are presented and discussed.MethodsAn international pilot study was undertaken to determine the impact of these proposed changes. Questionnaires and classroom discussion groups were conducted in five pilot countries in 2012/2013 (France, Hungary, Ireland, Portugal and Romania) with a total of 612 school-aged children (age M = 15.55 years, SD = 0.95).ResultsThe majority of participants in each country provided positive feedback about the appropriateness of the questions. Some small cross-national differences were found in the self-reported quantitative data relating to the appropriateness of the questions (χ2 = 22.831, df = 9, p = .007, V = .117). Qualitative feedback suggests that for the vast majority of students the phrasing and age-targeting of the questions were considered appropriate. With the exception of a small number of respondents who commented on the clarity and/or personal nature of the content, no specific issues with the questions were identified.ConclusionsThese findings provide guidance on the answerability (including the extent of missing and inconsistent data), understandability, acceptability (including in different cultures) and relevance of questions to potential participants. The findings from the pilot study suggest that in general, the questions are understandable, acceptable, and of a high priority to the target population, and that the simplification has significantly reduced the proportion of missing data. The new developments thus enhance the capacity of the questions to measure cross-nationally, sensitive aspects of young people’s sexual behaviour. These questions were included in the 2013/2014 round of the HBSC survey and will continue to be used to monitor trends in adolescent sexual health and behaviours, and to inform and influence health services and health education policy and practice at local, national and international levels.

Obesogenic behaviours in South Asian adolescents in England: a literature review and quantitative investigation

BackgroundWHO has stated that childhood obesity is one of the most serious challenges facing public health in the 21st century, with obese children and adolescents facing a plethora of health complications and increased risk of many chronic diseases. Using a literature review and quantitative analysis of the WHO Health Behaviour in School-Aged Children (HBSC) data, we aimed to better understand obesogenic behaviours in South Asian adolescents in England. MethodsWe searched electronic databases (Embase, Scopus, Medline, Web of Science) from inception of the database to April 10, 2016, and the references of relevant papers. Grey literature including reports and non-peer reviewed sources were also included. Inclusion criteria were: adolescents aged 11–18 years of age, articles in English language, and studies based in England. Quantitative analysis of HBSC data from 2010 examined variables such as physical activity, dietary behaviours, and mental health indicators. We compared adolescents from Bangladeshi, Indian, and Pakistani groups for each variable, by sex, with white British adolescents. Pearson's χ2 test was carried out to compare all groups against each other. Ethics approval was given by the University of Hertfordshire Ethics committee for Health and Human Sciences (HSK/SF/UH/00007). Ethical sensitivity was also enhanced through the work of reference groups with young people, which informed the conduct of the study within schools. FindingsThe HSBC 2010 sample consisted of 51 Bangladeshi, 96 Indian, 111 Pakistani, and 3476 white British adolescents. Two (8·7%) of 23 Bangladeshi girls undertook 5 or more days' physical activity, compared with 744 (44·1%) of 1688 white British girls, 13 (27·7%) of 47 Indian girls, and 16 (33·3%) of 48 Pakistani girls. South Asian adolescents had significantly worse outcomes in terms of number of times physical activity was undertaken per week (p=0·023) or any physical activity in the previous 7 days (p=0·002). 11 (20·0%) of 55 Pakistani girls never ate vegetables or ate them less than once a week, compared with 94 (5·3%) of 1771 white British girls (consumption of vegetables, p<0·0005). InterpretationKey findings from the literature review and HBSC 2010 data were that South Asian adolescents have lower physical activity levels compared with their white peers, have worse dietary behaviours, and have barriers to engaging in healthier lifestyles, compared with their white British counterparts. These negative lifestyle behaviours will need careful consideration of upstream policy and local health service provision and interventions in South Asian adolescents in England. Taking this evidence into action will be crucial to address the obesity epidemic and reduce existing health inequalities. FundingNone.

Trend analyses in the health behaviour in school-aged children study: methodological considerations and recommendations.

This article presents the scope and development of the Health Behaviour in School-aged Children (HBSC) study, reviews trend papers published on international HBSC data up to 2012 and discusses the efforts made to produce reliable trend analyses. The major goal of this article is to present the statistical procedures and analytical strategies for upholding high data quality, as well as reflections from the authors of this article on how to produce reliable trends based on an international study of the magnitude of the HBSC study. HBSC is an international cross-sectional study collecting data from adolescents aged 11-15 years, on a broad variety of health determinants and health behaviours. A number of methodological challenges have stemmed from the growth of the HBSC-study, in particular given that the study has a focus on monitoring trends. Some of those challenges are considered. When analysing trends, researchers must be able to assess whether a change in prevalence is an expression of an actual change in the observed outcome, whether it is a result of methodological artefacts, or whether it is due to changes in the conceptualization of the outcome by the respondents. The article present recommendations to take a number of the considerations into account. The considerations imply methodological challenges, which are core issues in undertaking trend analyses.

Conceptualizing and contextualizing food insecurity among Greenlandic children

ObjectiveTo review the context of food insecurity in Greenlandic children, to review and compare the outcomes related to food insecurity in Greenlandic children, in other Arctic child populations and in other western societies, and to explore the measure used by the Health Behaviour in School-aged Children (HBSC) study.DesignThe study includes literature reviews, focus group interviews with children and analyses of data from the HBSC study. HBSC is an international cross-national school-based survey on child and adolescent health and health behaviour in the age groups 11, 13 and 15 years and performed in more than 40 countries. The item on food insecurity is “Some young people go to school or to bed hungry because there is not enough food in the home. How often does this happen to you?” (with the response options: “Always”, “Often”, “Sometimes”, or “Never”).ResultsThe context to food security among Inuit in Arctic regions was found to be very similar and connected to a westernization of the diet and contamination of the traditional diet. The major challenges are contamination, economic access to healthy food and socio-demographic differences in having a healthy diet. The literature on outcomes related to food insecurity in children in Western societies was reviewed and grouped based on 8 domains. Using data from the Greenlandic HBSC data from 2010, the item on food security showed negative associations on central items in all these domains. Focus group interviews with children revealed face and content validity of the HBSC item.ConclusionTriangulation of the above-mentioned findings indicates that the HBSC measure of food shortage is a reliable indicator of food insecurity in Greenlandic schoolchildren. However, more research is needed, especially on explanatory and mediating factors.

Veränderungen im Tabak-, Alkohol- und Cannabiskonsum von Jugendlichen im Zeitraum von 2002 bis 2010 in Deutschland

So far, little is known about long-term trends in the use of psychoactive substances by adolescents in Germany. However, these results are urgently required for a target-orientated prevention. The aim of the present study is to analyse age- and gender-specific prevalences and trends in tobacco, alcohol und cannabis use among young people in Germany from 2002 to 2010.Data were obtained from the German part of the WHO collaborative study "Health Behaviour in School-aged Children (HBSC)" conducted in 2002, 2006, and 2010. The analysis is based on 11 917 students aged 13 and 15 years. Age- and gender-specific trend analyses were done using log binomial regression models.The prevalences of regular tobacco and alcohol use among 13- and 15-year-olds decreased from 2002 to 2010, independent of gender. A similar effect was found for repeated drunkenness and for the 12-month prevalence of cannabis use. In 2010 about 15% of the 15-year-olds consumed tobacco and alcohol at least once a week, 30% reported 2 or more episodes of drunkenness and 11% used cannabis in the last 12 months. The corresponding values for 13-year-olds with a prevalence of 3-5% on average are considerably lower.Following an increase over the 1990s the HBSC data shows a strong decrease in the use of psychoactive substances over the last 8 years which can be interpreted as a success of recent preventive efforts. However, noticeable is a clear flattening of the decrease from 2006 to 2010. This underlines that preventive actions must continue play a central role in health policy and practice.

Measuring the health and health behaviours of adolescents through cross-national survey research: recent developments in the Health Behaviour in School-aged Children (HBSC) study

Cross-national surveys have the potential to make a significant contribution to the study of adolescent health. The Health Behaviour in School-aged Children (HBSC) study was among the first international studies established in three countries in 1983 and growing to more than 40 countries for the seventh wave of fieldwork in 2005/06. The original aim of the study has remained largely the same since its inception, to increase understanding of adolescent health behaviours, health and well being in their social context and to collect high quality comparable data to achieve this. The challenges to producing valid and reliable data from cross-national, school-based research were recognised from the outset and reflected in the methodo- logical development of the study. The paper sets out how these challenges were addressed, examining key aspects of the methodology, including study design, questionnaire content, data collection and file preparation. These methods are still in place, but HBSC has had to recognise the social and political change of recent years. The challenges that were recognised 20 years ago are magnified today, with the study embracing a variety of cultures across Europe and North America. As demand for HBSC data has grown from the scientific and policy communities, greater attention has been paid to scrutiny of the data produced, matched by a sharper focus on continuous improvement in data quality. Key developments of recent years are summarised in the paper, focusing on study organisation, review of the international Research Protocol, strengthening support for sampling, greater attention to translation and improvements in data processing and documentation. It is concluded that the HBSC study has evolved over the last 20 years and continues to do so, recognising the importance of data quality, but also the constraints of cross-national survey research. Looking to the future, some outstanding issues for consideration are touched upon, including the opportunities and challenges for expanding our knowledge on the possibilities for gathering cross-national and cross-cultural data, with the HBSC study being used to build capacity in understanding the health needs of young people in other regions of the world.