Health Behaviour In School-aged Children Study Research Articles

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

Physical activity is central to health, beginning in childhood and adolescence, and regular monitoring provides important information for strategic decisions on promoting physical activity in Germany. The current survey cycle of the Health Behaviour in School-aged Children (HBSC) study gives an insight into the prevalence of the indicators daily recommended physical activity, high and low physical activity, and sporting activity among students aged between 11 and 15 for 2022. In addition, the data is compared to the survey cycles of the 2009/10, 2013/14, and 2017/18 school years and analysed over time. The results of the current survey cycle show that 10.8 % of girls, 20.9 % of boys, and 12.4 % of gender diverse adolescents fulfil the daily physical activity recommendation. There are also major gender-specific differences for the other indicators. The group of gender diverse adolescents needs to be analysed further. The changes over time between 2009/10 and 2022 are relatively small. While girls' physical activity habits decreased slightly for the various indicators between 2009/10 and 2022, boys' prevalence remained relatively stable over the same period. Overall, in part due to the effects of the various COVID-19 lockdowns, the need for effective and population-based measures to promote physical activity in childhood and adolescence remains high.

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

Bullying is a form of violence that is carried out repeatedly, with the intention of causing harm and with an imbalance of power between those involved. Bullying has serious negative effects on the mental health of adolescents and thus represents a significant health risk in childhood and adolescence. Based on data from the Health Behaviour in School-aged Children (HBSC) study from the survey year 2022 in Germany (N = 6,475), the prevalence of school bullying and cyberbullying among 11-, 13- and 15-year-olds in Germany was analysed. In addition, the prevalence of school bullying and cyberbullying was analysed as a trend from 2009/10 to 2022 (bullying) and from 2017/18 to 2022 (cyberbullying). Around 14 % of the learners surveyed reported direct experience of bullying at school, and around 7 % reported cyberbullying experiences as bullied and/or bullying victims. Adolescents who identified as gender diverse were particularly likely to report bullying experiences. School bullying decreased over time, but remained stable between 2017/18 and 2022. Cyberbullying, on the other hand, increased in 2022 compared to 2017/18. Experiencing bullying at school and online is an everyday experience for many children and young people, so there is still a need for the broad implementation of effective anti-bullying measures in schools.

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

Many studies have identified health inequalities in childhood and adolescence. However, it is unclear how these have developed in recent years, particularly since the COVID-19 pandemic. Analyses are based on the German data from the international Health Behaviour in School-aged Children (HBSC) study from 2009/10 (n = 5,005), 2013/14 (n = 5,961), 2017/18 (n = 4,347), and 2022 (n = 6,475). A total of 21,788 students aged approximately between 11 and 15 years were included. Socioeconomic status (SES) was assessed using the Family Affluence Scale (FAS). Several health indicators were analysed stratified by gender using bivariate and multivariate analysis methods. In 2022, there are clear socioeconomic inequalities in life satisfaction, self-rated health, fruit and vegetable consumption, and physical activity. These inequalities remained largely constant or increased between 2009/10 and 2022. Between 2017/18 and 2022, no significant changes in inequalities were found. Health inequalities are persistent and reduce the chances of growing up healthy. There is no evidence that inequalities in the analysed outcomes have changed during the pandemic period (between 2017/18 and 2022). Rather, the changes in the health indicators seem to affect all adolescents in a similar way.

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

Subjective health and well-being are important health indicators in childhood and adolescence. This article shows current results and trends over time between 2009/10 and 2022. The Health Behaviour in School-aged Children (HBSC) study examined subjective health, life satisfaction and psychosomatic complaints of N = 21,788 students aged 11 to 15 years in the school years 2009/10, 2013/14, 2017/18 and in the calendar year 2022. Multivariate regression analyses show the associations between sociodemographic characteristics and well-being in 2022, as well as trends since 2009/10. The majority of children and adolescents indicate a good subjective health and high life satisfaction. About half of the girls and one third of the boys report multiple psychosomatic health complaints, with a clear increase over time. Older adolescents, girls and gender diverse adolescents are at an increased risk of poor well-being. Subjective health and life satisfaction varied between 2009/10 and 2022, with a significant deterioration between 2017/18 and 2022. The high proportion of children and adolescents with psychosomatic complaints, as well as the observed gender and age differences, underline the need for target group-specific prevention, health promotion and continuous health monitoring.

The international Family Affluence Scale (FAS): Charting 25 years of indicator development, evidence produced, and policy impact on adolescent health inequalities

In the absence of suitable indicators of adolescent socioeconomic status, the Family Affluence Scale (FAS) was first developed in Scotland 25 years ago. Since then, it has been adapted for use in the Health Behaviour in School-Aged Children (HBSC) Study to research inequalities in adolescent health in Europe and North America. FAS has also been used as an indicator of adolescent socioeconomic status in research studies outside of HBSC, worldwide. There has been a need for FAS to evolve and change its component items over time in order to take into account social and technological changes influencing the families of adolescents. This paper uniquely charts the development of FAS describing the methodological work carried out to validate the measure internationally and over time. It also presents an overview of the body of evidence on adolescent health inequalities produced over years from the HBSC Study and other research studies. Interviews conducted with policy stakeholders reveal that the evidence from FAS-related HBSC work has influenced their strategic work to raise awareness of inequalities and make the case for action to address these. Finally, the future of FAS is discussed with respect to its continual evolution in the context of technological, environmental and social change.

Changes in the prevalence of obesity in Czech adolescents between 2018 and 2022 and its current non-genetic correlates – HBSC study

BackgroundThe main aim of the study is to examine changes in the prevalence of obesity in Czech adolescents between 2018 and 2022 and its current non-genetic correlates with respect to the adolescents’ families’socioeconomic status (SES) in 2022.MethodsThe sample of 24,535 adolescents (n = 11,629/12,9062018/2022; boys: 50.4/50.6%2018/2022) aged 10.5–16.5 years that was analysed was drawn from two nationally representative cohorts of Czech youngsters from the last two cycles of the Health Behaviour in School-aged Children (HBSC) online questionnaire survey from 2018 to 2022. Obesity is represented by the > 97th percentile interval on the World Health Organization Body Mass Index percentile chart, with distinctions by sex and the age of adolescents. The differences in the prevalence of obesity between boys and girls from all SES family categories in 2018 and 2022 were tested using a chi-square test (χ2). Multiple logistic regression analysis with repeated measures was used to analyse correlates of obesity in 2022.ResultsBetween 2018 and 2022, there was no significant difference in the prevalence of obesity in girls or boys in any of the SES categories of families. Adolescents from low-SES families have the highest prevalence of obesity, 11% for boys and 5.8% for girls, significantly higher (p < .001) than its prevalence among adolescents from high-SES families, by + 4.8% points for boys and + 3.9% points for girls. Among adolescents from low-SES families, individuals who engaged in moderate-to-vigorous physical activity (PA) daily (p < .005) or vigorous PA three times per week (p < .05) were significantly less likely to be obese than their less active peers. Skipping breakfast significantly (p < .05) increased the odds of obesity, but only among adolescents from low-SES families. Shorter screen time (ST) significantly (p < .05) reduced the odds of obesity for all categories of adolescent SES.ConclusionsObesity is most pronounced in adolescents from low-SES families as a result of a long-term positive energy balance mediated by unbalanced behaviour. Significantly lower odds of obesity in adolescents from low-SES families were confirmed to be associated with regular practice of the recommended PA, shorter ST, and not skipping breakfast.

Increases in Sleep Difficulties and Psychological Symptoms are Associated With the Increase of Chronic Back Pain in Adolescents: The HBSC Study 2002 to 2018

Cross-national research using data from the Health Behavior in School-aged Children (HBSC) survey showed an increase in the prevalence of chronic back pain from 2002 to 2014. However, it is unknown if this trend has persisted beyond 2014. The aims of this study were to 1) determine if the prevalence of chronic back pain in girls and boys aged 11, 13, and 15 continued to increase from 2014 to 2018 and if this was the case, 2) examine whether this increase in the prevalence of chronic back pain between 2002 and 2018 was explained indirectly by increases in sleep difficulties and psychological symptoms. Data from 7,89,596 adolescents retrieved from 5 waves of the HBSC survey conducted in 2002, 2006, 2010, 2014, and 2018 in 32 countries/regions were used. Logistic regressions and path analyses were conducted. Results showed an overall increase of .5% in the prevalence of chronic back pain between 2014 and 2018, ranging from .4% for 15-year-old girls to 1.3% for 11-year-old boys, indicating a continued overall increase in chronic back pain in adolescents beyond 2014. For 13-year-old girls and for 15-year-old girls and boys, the increase in the prevalence of chronic back pain between 2002 and 2018 was partially mediated by increases in sleep difficulties, which in turn were associated with increases in psychological symptoms. The findings provide important information that may aid stakeholders in enhancing public health initiatives to prevent or reduce the increasing trend in the prevalence of chronic back pain in adolescents. PerspectiveThis study shows that chronic back pain prevalence continues to increase among adolescents, with sleep difficulties and psychological symptoms contributing significantly to this trend. The findings provide insights that may inform strategies to prevent or reduce the increasing trend of chronic back pain in adolescents.

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

Despite the health benefits, a large proportion of girls and boys in Europe do not travel to school actively. A better understanding of the correlates associated with this behavior could guide interventions. This study examines perceived social and environmental correlates of active travel to school (ACTS) from the 2017/18 Health Behavior in School-Aged Children (HBSC) survey in four European countries, with a special emphasis on gender differences (n = 22,023). Logistic regression was conducted to analyze associations between the perceived importance of each correlate and ACTS behavior for 11-, 13-, and 15-year-old girls and boys from Germany, Czechia, Poland, and Slovakia. All models were adjusted for age, family affluence, and meeting World Health Organization recommendations for moderate-to-vigorous physical activity. Rates of ACTS significantly differed between girls and boys. In Czechia, 65% of girls and boys traveled to school actively, followed by Slovakia (61.4% girls and 58.4% boys), Poland (57.7% girls and 60.2% boys), and Germany (42.6% girls and 48.6% boys). Girls were less likely to actively travel to school compared to boys (odds ratio [OR]: 0.92, 95% confidence interval [CI]: 0.87-0.97). Increasing age (OR: 0.95, 95% CI: 0.93-0.97) and a greater distance to school index (OR: 0.89, 95% CI: 0.88-0.90) were both negatively associated with ACTS. The perceived importance of living closer to school and of road and neighborhood safety was positively associated with ACTS, with a stronger association in boys than in girls for neighborhood safety. On the contrary, the perceived importance of having people to walk with was negatively associated with ACTS, with a stronger association in girls (OR: 0.74, 95% CI: 0.65-0.84) than in boys (OR: 0.77, 95% CI: 0.66-0.88). This study provides insights into perceived social and environmental correlates associated with ACTS behavior. Future research should include gender-specific perceptions and more in-depth investigations of correlates encouraging ACTS, especially considering social aspects, safety issues, and the structuring of the environment in different cultural settings.

Epidemiologie seelischen Wohlbefindens von Kindern und Jugendlichen in Deutschland. Ergebnisse aus 3 Studien vor und während der COVID-19-Pandemie

ZusammenfassungHintergrundEin kontinuierliches bundesweites Gesundheitsmonitoring ist wichtig, um das Wohlbefinden von Kindern und Jugendlichen im Blick zu behalten und Entwicklungsverläufe abzubilden. Anhand der Ergebnisse von 3 ausgewählten epidemiologischen Studien werden Entwicklungen zum kindlichen Wohlbefinden der letzten 20 Jahre vorgestellt.MethodikDatengrundlage bilden (1.) die bevölkerungsbezogene BEfragung zum seeLischen WohLbefinden und VerhAlten (BELLA-Studie, 2003–2017, N = 1500–3000), die ein Modul der KiGGS-Studie ist, (2.) die COrona und PSYche Studie (COPSY, 2020–2022, N = 1600–1700), die auf der BELLA-Studie aufbaut, und (3.) die internationale Health-Behaviour in School-aged Children Studie (HBSC, 2002–2018, N = 4300–7300). Das Wohlbefinden wurde bei 7‑ bis 17-Jährigen mittels der Indikatoren gesundheitsbezogene Lebensqualität (KIDSCREEN-10), Lebenszufriedenheit (Cantril Ladder) und psychische Auffälligkeiten (Strenghts and Difficulties Questionnaire (SDQ), Screen for Child Anxiety Related Emotional Disorders (SCARED) und Center for Epidemiological Studies Depression Scale for Children (CES-DC)) erfasst.ErgebnisseInsgesamt zeigen Kinder und Jugendliche präpandemisch (2002–2018) eine konstant hohe gesundheitsbezogene Lebensqualität und eine hohe allgemeine Lebenszufriedenheit, die sich mit Beginn der COVID-19-Pandemie 2020 zunächst verschlechterte. 2 Jahre später zeigen sich Verbesserungen, die jedoch noch nicht das Ausgangsniveau erreichen. Psychische Auffälligkeiten, ängstliche und depressive Symptome nahmen mit Pandemiebeginn um bis zu 12 Prozentpunkte zu und zeigen auch 2 Jahre nach Pandemiebeginn noch höhere Werte als präpandemische Studien.DiskussionDie Epidemiologie kindlichen Wohlbefindens bietet eine notwendige Datengrundlage, um den Unterstützungsbedarf von Kindern und Jugendlichen zu erfassen und auf dieser Basis Maßnahmen der Gesundheitsförderung, Prävention und Intervention zu entwickeln.

How ‘outdoors time’ transforms the social relationships of children in Iceland

This study explores the relationship between the time children spend outdoors with critical social and health factors. We use questionnaire data from the 2017–2018 Health Behaviour in School-aged Children (HBSC) study in Iceland, focused on children in the 6th, 8th, and 10th grades. All Icelandic schools with pupils in these classes were invited to participate. The HBSC study is based on a research collaboration dating back to 1983 and is in cooperation with the WHO Regional Office for Europe (Inchley et al., 2020). Every four years the study is conducted in more than 50 countries and regions across Europe and North America. Data is collected on children’s health and well-being, social environments and health behaviours. The purpose of this paper is to better understand the social and health factors that impact children in Iceland, paying attention to the diversity of this social group, and how these factors relate to their outdoor behaviour. Our analysis focuses on children’s time spent outdoors on weekdays in relation to their parents, general health, leisure, and friendship. The findings reveal a complex picture of children’s outdoor lives. The results show that a great majority of children spend time outside mostly with friends and that children with poor relationships with other children spend considerably less time outside. Children’s outdoor lives emerge as a social activity that strongly relates to physical and mental health. Interventions to increase time spent outside might focus on this social dimension rather than simply on the extent of outside time.

Quality of life in 13-year-olds depending on health status, residential neighbourhood deprivation and social capital - results from the Polish HBSC Study 2010-2018.

Health-related quality of life (HRQL) should be used more extensively in monitoring the health of school-aged children. The presented study aimed to evaluate trends in KIDSCREEN-10 indices, considering mean scores and the level of social inequalities. 3,937 children aged 13 participated in three Health Behavior in School-aged Children (HBSC) cross-sectional surveys conducted in Poland between 2010-2018. Subgroups were distinguished according to gender, health status, and three social factors (family affluence, neighbourhood social capital, and local deprivation). The average KIDSCREEN-10 index value was equal to: 22.36±4.54; 25.41±6.75; and 24.74±6.53 in 2010, 2014, and 2018,respectively. However, in 2018 no deterioration was recorded in boys, in poorer families or in regions with high social capital. The improvement in HRQL in 2014 was accompanied by an increase in disparities in health status and family wealth, as well as a decrease in disparities in local deprivation. An especially high increase in Glass index values was recorded for neighbourhood social capital (increasing from 0.542 in 2010 to 0.938 in 2018). The multivariate general linear model revealed the main effect of the year of the study, gender, chronic disease status, and the three social factors, as well as six significant 2-way interactions. Changes in the well-being of adolescents should be tracked over time using HRQL indices with proven psychometric properties. The level of social inequalities faced by young people should be included in policies and when designing interventions. The relevant initiatives should be targeted at different populations in order to properly address the needs of different groups of children and adolescents.

Psychosocial School Conditions and Mental Wellbeing Among Mid-adolescents: Findings From the 2017/18 Swedish HBSC Study.

Objectives: To investigate mid-adolescent boys' and girls' experiences of school demands, teacher support, and classmate support, and explore the associations of these factors with mental wellbeing. Methods: Data were derived from the Swedish Health Behaviour in School-aged Children (HBSC) study of 2017/18, with information collected among 1,418 students in grade 9 (∼15-16years). School demands, teacher support, and classmate support were measured by indices based on three items each. Mental wellbeing was measured by the Short Warwick-Edinburgh Mental Wellbeing Scale (SWEMWBS). Linear regression analyses were performed. Results: Higher demands were associated with lower mental wellbeing. Conversely, mental wellbeing increased with greater teacher support and classmate support. Interactions between demands and the support variables showed that at the lowest levels of teacher and of classmate support, mental wellbeing was low and not associated with school demands. With increasing levels of teacher and classmate support, the overall level of mental wellbeing increased and revealed an inverse association between school demands and mental wellbeing. Conclusion: The study contributes with knowledge about how psychosocial conditions in school may hinder or enhance wellbeing among students.

Family Structure through the Adolescent Eyes: A Comparative Study of Current Status and Time Trends over Three Decades of HBSC Study

This study aimed to investigate how family structure varies and identify its time trends in European and North American countries using data from seven surveys conducted between 1994 and 2018 according to the Health Behaviour in School-aged Children (HBSC) study. The current family structure in 44 countries was described and time trend analysis of 28 countries was performed. Adolescents were asked whom they lived with in their home to describe family structures. Family structures showed distinct patterns and dynamics between countries. In 2018, in all countries, 73% of adolescents lived with both their mother and father; 14% and 5% of adolescents lived in a single-parent family and stepfamily, respectively; and around 9% of adolescents lived in another family type. In the period 1994–2018, the proportion of young people living in intact families decreased from 79.6% to 70.0%, on average about 10 percentage points. There were no significant changes in the prevalence of single-parent families and stepfamilies, but a significant increase in the number of adolescents living without either parent was revealed. The findings have implications for cross-national adjustment of adolescent health, well-being, and behaviours, and for critical analysis of socioeconomic family resources.

Bulling and Cyberbullying: Problem of the Modern Teenager

Background. Russia is one of the top ten European countries with high level of bullying and ranks second in cyberbullying among adolescents. Involvement in bullying and virtual aggression has immediate and long-term consequences for all parties to the conflict, including witnesses. Immediate consequences can be manifested as violation in adaptation and socialization of children and adolescents; long-term consequences can be mental disorders in emotionally labile schoolchildren. School bullying is always distinguished by its cruelty and intransigence.Objective. The aim of the study is to estimate the prevalence of bullying and cyberbullying among boys and girls aged 11, 13 and 15 years studying in educational organizations in Yekaterinburg and to create the complex of preventive guidelines.Methods. Sociological cross-sectional study was carried out using the questionnaire with questions from the international questionnaire Health Behaviour in School-Aged Children (HBSC). Analysis of the results was carried out for different age and gender groups, the results of comparative analysis with the data of the international HBSC study are also presented.Results. The main characteristics of bullying are presented: prevalence, age and social features. High involvement of adolescents in bullying (11.7%) and cyberbullying (18.2%) was revealed. The ratio of adolescents who have repeatedly been the victims of physical, psychological and virtual aggression was significantly higher (21.7 and 31.8%, respectively). Boys are more likely to be aggressors and victims of abusive behaviour (physical and psychological aggression) than girls. Moreover, number of schoolchildren who became victims of bullying decreases with age, this indicator is more significant among boys, while the number of cyberbullying victims increases among older adolescents.Conclusion. The high prevalence of bullying in adolescents has negative impact on both, victims and aggressors. Bullying affects the physical and mental health of children and adolescents, leads to psychological and social maladaptation, as well as the development of sustainable models of problematic and most often aggressive behavior. Educational organizations have to become the basis for implementation of future programs on bullying and cyberbullying prevention. They should not only provide safe environment but also help children to establish open and friendly relationship with peers and adults and to clearly understand their actions and their consequences.

Long-term research impact: the case of adolescents having ‘good places to spend free time’ in Ireland

Abstract Background Demonstrating long-term impacts of research can be fraught with methodological challenges, especially when approached retrospectively. Potential accusations of bias or over-interpretation, and a lack of clear and specific causal data, can be real obstacles. This paper presents a case study of research impact, including enablers and context to aid interpretation. To develop a national set of child wellbeing indicators in line with UNCRC commitments, a participative study of children's understandings of wellbeing was undertaken to accompany a Delphi study with experts. The children contributed a number of unique indicators, including having ‘good places to spend free time'. Methods Public actions which aimed to meet Irish commitments to child wellbeing were documented. Collected evidence comprised the development of, and reporting on, a national set of wellbeing indictors for children, the development and implementation of two national policies and cyclical monitoring data, collected through the nationally representative data sets of the Health Behaviour in School-aged Children (HBSC) study in Ireland, 2002-2018. Results Measurement of stakeholder-informed indicators helped stimulate national policies on play (2004) and recreation (2007). Partnership-based policy implementation led to increases in spaces for play and recreation. Trends data from the HBSC study revealed significant and meaningful increases in ‘good places to go spend free time' for children aged 10-17 from 45.1% in 2002 to 63.5% in 2018, and for all socio-demographic sub-groups. Temporal analyses showed that increases followed policy implementation. Conclusions This impact case study links an original participative study, though policy development and implementation, to long-term improvements in Irish children reporting having ‘good places to spend free time'. An understanding of the decision-making context at key points is important to aid interpretation of the evidence under investigation. Key messages Commitment to child participation influenced national indicator adoption, policy development and implementation, with subsequent improvements to children’s health-related environments. The quality and specificity of data needed to demonstrate long-term research impact is challenging and interpretation requires contextualisation to avoid leaps of faith.

Prevalence and Social Inequality in Youth Loneliness in the UK.

Using data from the English arm of the Health Behaviour in School-aged Children (HBSC) study, we examined the prevalence of loneliness for school-aged adolescents and how it is linked to social inequalities. The HBSC study collects data from 11-, 13-, and 15-year-olds, and is repeated every four years, allowing the exploration of prevalence rates of loneliness pre COVID-19 pandemic for comparison. We also explored whether loneliness was associated with socio-economic status (SES) and linked to academic attainment and health complaints. The total sample was 14,077 from 156 schools in England. Findings revealed a stable prevalence rate of 8.2% for loneliness from 2006 to 2014. We also found, across all survey years, (1) those aged 15 years were significantly lonelier than younger peers, (2) those who reported lower SES were lonelier than their more well-off peers, and (3) higher loneliness was associated with being ‘”below average” academically and reporting more health complaints. Conclusions: These prevalence data enable researchers, policymakers, and others to make comparisons with prevalence rates during the COVID-19 pandemic to explore whether there have been increases in loneliness among school-aged adolescents. Loneliness was consistently related to social inequalities, suggesting that targeted interventions that include whole systems changes are needed.

Cross-National Trends of Chronic Back Pain in Adolescents: Results From the HBSC Study, 2001-2014

Chronic back pain is a common problem that negatively impacts the wellbeing of many adolescents. Prior research suggests that the prevalence of chronic back pain has increased over the last decades, but research on this issue is scarce, single country-based, and has yielded inconsistent results. This study aimed to examine trends in the prevalence of chronic back pain over time in adolescents aged 11, 13 and 15, using data from the Health Behavior in School-aged Children (HBSC) survey. We conducted a secondary analysis of data from 650,851 adolescents, retrieved from four waves (2001/02, 2005/06, 2009/10 and 2013/14) of HBSC data from 33 countries or regions. The prevalence of back pain was higher (1) in each successive survey over time (18.3% in 2001/02, 19.3% in 2005/06, 20.4% in 2009/10 and 21.6% in 2013/14), (2) in girls (21.9%) compared to boys (17.8%), and (3) in older adolescents compared to younger ones (14.5% in 11-year-olds, 19.6% in 13-year-olds and 25.5% in 15-year-olds). The increase in prevalence from 2001/02 to 2013/14 was more marked in older girls compared to younger girls, and in older boys compared to younger boys, and it ranged between 1% for 11-year-old boys and 7% for 15-year-old girls. More resources should be allocated to the prevention and treatment of chronic back pain in adolescents, especially for older girls. PerspectiveThe prevalence of chronic back pain in adolescents has increased from 2001-2002 to 2013-2014, especially in older adolescent girls. These findings underline the need of further research to understand the reason behind the increasing trend, and what programs are better suited to prevent chronic back pain among adolescents.

Energy Drinks Consumption Associated with Emotional and Behavioural Problems via Lack of Sleep and Skipped Breakfast among Adolescents.

The aim of our study was to explore whether energy drink consumption is associated with both emotional and behavioural problems and whether this association might be mediated by amount of sleep and breakfast consumption among adolescents. The nationally representative Health Behaviour in School-aged Children (HBSC) study, realised in 2018 in Slovakia in schools, was used to acquire needed data, with the research sample of 8405 adolescents from 11 to 15 years old (mean age = 13.43; 50.9% boys) who completed the questionnaires on their own in a presence of researchers and research assistants. Emotional and behavioural problems were assessed by a Strengths and Difficulties Questionnaire, while energy drinks consumption, breakfast consumption and sleep duration was assessed by questions in line with the HBSC study protocol. Linear regression models assessed the associations between energy drinks consumption and emotional and behavioural problems. Mediation by sleep duration and breakfast consumption was assessed with parallel mediation models. Energy drink consumption was significantly associated with emotional (p < 0.001) and behavioural problems (p < 0.001), with higher consumption of energy drinks leading to more emotional and behavioural problems. Results from a parallel mediation analysis indicated that energy drink consumption is indirectly related to both emotional and behavioural problems through its relationship with the amount of sleep and breakfast consumption. Parents and professionals working with adolescents should be aware that unhealthy dietary habits and lack of sleep might be related to emotional and behavioural problems.

Social cohesion, psycho-physical well-being and self-efficacy of school-aged children in Lombardy: Results from HBSC study.

Within the literature on health inequalities and social determinants of health, there is a growing interest in studying how the context of residence is able to influence health conditions and health-related outcomes, over and above individual characteristics. Life context affects people's well-being in a material way, through the availability of services and resources, but also through social, cultural and relational resources, to the extent to which people within the same context share norms, values and behaviours affecting their health conditions. In this study, we analysed the association between social cohesion in the context of residence and two health-related outcomes, psycho-physical well-being and self-efficacy, in school-aged children in Lombardy, using data from the Health Behaviour in School-aged Children (HBSC) study for 2014. The results show a positive association between the variables, indicating that social cohesion matters for young people's health and well-being and suggesting new areas of intervention in policies aiming at promoting health and reducing inequalities.

Traditional bullying and cyberbullying among children and adolescents in Germany - Cross-sectional results of the 2017/18 HBSC study and trends.

Bullying is a specific form of violence that can potentially lead to numerous and long-term negative health implications. Despite consistent coverage in the media, particularly on cyberbullying, as of yet there are only few representative findings on the frequency of (cyber)bullying in Germany. This article analyses how widespread bullying and cyberbullying were at schools in Germany in 2018, what differences exist between girls and boys, age groups and various types of schools, and changes in bullying trends between 2002 and 2018. Our findings are based on an analysis of the data provided by the 2017/18 cycle (N=4,347 students, 53.0% female) and previous cycles of the German Health Behaviour in School-aged Children (HBSC) study. In the 2018 cycle, boys reported having bullied other children more frequently than girls, but were bullied just as often. 15-year-olds reported having bullied other children more frequently than 11- to- 13-year-olds but reported being bullied less frequently. Students at grammar schools (Gymnasium) least frequently reported any involvement in bullying. Only few children and adolescents reported cases of cyberbullying. Compared to all previous survey years, 2018 saw the lowest number of children that reported having bullied others. However, reports of having been bullied have remained almost stable. The findings highlight the need for evidence-based prevention and intervention anti-bullying programmes and measures across all types of general education schools and age groups.