Health Behaviour In School-aged Children Research Articles

Have performance-based educational reforms increased adolescent school-pressure in Sweden? A synthetic control approach

Increased levels of stress and other mental health problems have been reported amongst adolescents in high-income countries. In particular, rates of school-pressure have increased significantly. Despite such increases, little is known about the underlying determinants of increased adolescent stress, making this an emerging public health concern. The educational stressors hypothesis contends that increased rates of stress result from pronounced performance pressures placed on adolescents resulting from educational policy initiatives which emphasizes academic goal attainment. The present study tests this hypothesis using a synthetic control method and panel data techniques to analyse data from the Health Behavior in School-aged children (HBSC) survey, including more than 150,000 adolescents per survey wave in 25 European countries over 16 years, to assess if the Swedish Educational reforms implemented in the 2011–13 period were associated with increased self-reported school-pressure. These reforms implemented increased summative assessments, new grading systems and increased eligibility criteria in accessing further education. Results demonstrate that following the reforms, Swedish adolescents experienced greater levels of school-pressure and led to a greater gender difference in experienced school-pressure where girls were relatively more affected. We conclude that, consistent with the educational stressors hypothesis, the educational reforms have likely contributed to increasing levels of school-pressure for Swedish adolescents.

The development and cross-national validation of the short health literacy for school-aged children (HLSAC-5) instrument

Health literacy is an asset for and indicator of adolescents’ health and wellbeing, and should therefore be monitored and addressed across countries. This study aimed to develop and validate a shorter version of the original 10-item health literacy for school-aged children instrument in a cross-national context, using data from the health behaviour in school-aged children 2017/18 survey. The data were obtained from 25 425 adolescents (aged 13 and 15 years) from seven European countries. Determination was made of the best item combination to form a shorter version of the health literacy instrument. Thereafter, the structural validity, reliability, measurement invariance, and criterion validity of the new 5-item instrument were examined. Confirmatory factor analysis showed a good model fit to the data across countries and in the total sample, confirming the structural validity (CFI = 0.995, TLI = 0.989, SRMR = 0.011, RMSEA = 0.031). The internal consistency of the instrument was at a good level across countries (α = 0.87–0.98), indicating that the instrument provided reliable scores. Configural and metric invariance was established across genders, ages, and countries. Scalar invariance was achieved for age and gender groups, but not between countries. This indicated that the factor structure of the scale was similar, but that there were differences between the countries in health literacy levels. Regarding criterion validity, structural equation modelling showed a positive association between health literacy and self-rated health in all the participating countries. The new instrument was found to be valid and reliable for the purposes of measuring health literacy among adolescents in a cross-national context.

Association between meeting the 24-h movement guidelines and psychosocial health in children: A cross-sectional study.

Emerging evidence suggests that meeting the 24-h movement guidelines is associated with optimal mental health. However, there remains some uncertainty regarding this association in children. Therefore, this study aimed to examine the association between meeting the 24-h movement guidelines and psychosocial health in children. A cross-sectional study design was employed to investigate 2005 children aged 9-12 years from four districts of Shanghai, China. The 24-h movement behaviours were assessed using selected items from the Health Behaviour in School-aged Children (HBSC) survey questionnaire. Children's self-rated psychosocial health was evaluated using the Strengths or Difficulties Questionnaire (SDQ). Generalised Linear Models with the ordinal logistic module were employed to analyse the association between meeting the 24-h movement guidelines and psychosocial health. The overall prevalence of meeting all three 24-h movement recommendations was 10.2%. Among children, 7.9% of them exhibited abnormal total difficulties, with a notable difference between sex (boys: 11.2%, girls: 7.0%, p = 0.001). Meeting all three 24-h movement behaviour recommendations was associated with reduced total difficulties, emotional symptoms, conduct problems, hyperactivity and peer problems. Furthermore, a dose-response association was observed, indicating that meeting a greater number of 24-h movement behaviour recommendations was associated with enhanced psychosocial health, particularly in boys. The findings of this study highlight the positive association between meeting the 24-h movement guidelines and psychosocial health in children. Notably, meeting more of these recommendations was associated with a lower likelihood of experiencing psychosocial problems, with greater benefits observed in boys compared with girls.

PHYSICAL ACTIVITY AND HEALTH PROBLEMS OF STUDENTS IN SOUTHERN SERBIA DURING THE STATE OF EMERGENCY

The COVID-19 pandemic affected practically every country in the world and changed how people lead their daily lives. The purpose of research was to ascertain the relationship between physical activity levels and the incidence of health issues among pupils. This research was conducted using an anonymous online survey that contained selected questions from the World Health Organization's health behaviour in schoolchildren (HBSC questionnaire). The sample of participants consisted of 500 elementary and high school students from the territory of southern Serbia. It was observed that less than 1% of students reported having poor health, while 6% of participants said that they were dissatisfied with their health overall, compared to 94% of students who reported being satisfied with their health. Additionally, a total of 88% of students evaluated their lives with the highest marks, out of which 28% considered their lives to be the greatest they could possibly be. 90% of participants from this sample of students in southern Serbia reported engaging in physical activity three or more times per week, whereas only 3% of students reported engaging in physical activity only once a week or not at all. The key finding of this study proved that students who engaged in greater physical activity had fewer health issues than students who engaged in the least amount of physical activity. There are numerous benefits to being physically active, including how it influences the maintenance of human health and helps children grow and develop properly. Therefore, the importance of this work is reflected in the possibility of gaining knowledge about physical activity during the state of emergency and the connection between physical activity and health problems that emerged among students in southern Serbia during the COVID-19 pandemic.

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.

Trends in adolescent mental health problems and the role of lifestyle factors

Abstract Background Adolescent mental health problems are on the rise globally, including in Sweden. One indicator is an increase in psychosomatic symptoms (PSS) over time. Lifestyle factors such as physical activity (PA), diet, smoking, and alcohol consumption may influence the trends in PSS. However, we found limited research on such associations. Methods This study is based on data collected every four years from nationally representative samples of 15-year-old boys and girls in Sweden (N = 9,196, 50.5% girls), as part of the Health Behavior in School-aged Children (HBSC) study. PSS was measured using a scale developed from the HBSC symptom checklist. We analyzed the trends in PSS from 2002 to 2018 and fitted models to investigate the associations between the trends and lifestyle factors. We included interaction terms between time and each lifestyle factor and fitted separate models for the high and low socioeconomic status (SES) groups. Results In general, the mean scores for PSS increased from 2.26 in 2002 to 2.49 in 2018 (p&amp;lt;.001). Compared to the average mean scores during preceding years, the changes in PSS mean scores at each survey year were also significant in all years except 2010. More frequent breakfast intake, daily consumption of fruits and vegetables, and higher PA were associated with lower PSS mean scores while smoking and alcohol consumption had the opposite association. The only significant interaction (B = .050; CI: .015, ¬ .085; p&amp;lt;.01) was observed in the high SES group, indicating that the increasing trend in PSS was stronger among those who had been drunk once or more in a lifetime, compared to those who had never been drunk. Conclusions The results indicate increasing trends in mental health problems among young people in Sweden. Furthermore, the study revealed that alcohol drunkenness was associated with a more substantial rise in PSS over time among those in the high SES group. Further research is needed to understand the reasons behind these findings. Key messages • Psychosomatic complaints have increased among Swedish adolescents in recent decades. • Although alcohol drunkenness has significantly declined among Swedish adolescents, it was not sufficient to influence trends in psychosomatic symptoms among those in the high socioeconomic group.

Body dissatisfaction in the classroom context and adolescent psychological complaints

Abstract Background Body dissatisfaction, which refers to negative feelings towards one's own body shape, size, weight, or appearance, has been indicated to be a risk factor for a range of adverse health-related outcomes among youth. Although previous research has investigated the link between adolescents’ own body image and psychological outcomes, the contextual effect of body dissatisfaction on individual health has not been explored. The purpose of this study was to examine if the concentration of students with a negative body image in the classroom was associated with individual students’ psychological complaints. Methods Data was obtained from the 2017/18 Swedish Health Behaviour in School-aged Children (HBSC) study, a cross-sectional survey among 13- and 15-year-olds (n = 2,619 in 145 school classes). Body image was captured by one question on perceived body size and one question on weight change attitude/behaviour. Psychological complaints were measured by self-reports on the frequency of feeling low, irritable, nervous, and having difficulties falling asleep, which were summed to an index. Gender, school grade, socioeconomic status, and immigration background were included as covariates. Two-level random intercept linear regression models were performed. Results The proportion of students in the classroom with a negative body image was associated with higher levels of psychological complaints (dissatisfaction with perceived body size b = 0.02, p &amp;lt; 0.05; desire/attempts to change weight b = 0.02, p &amp;lt; 0.01), even when adjusting for the corresponding measures at the student level. These associations were driven by the class-level dissatisfaction related to perceiving oneself as too fat or wanting to lose weight. Conclusions The study found that body dissatisfaction among classmates was associated with psychological complaints in individual students. Reducing body dissatisfaction among adolescents could improve the well-being not only of the individual but also of their peers. Key messages • The study found that the proportion of classmates who reported body dissatisfaction was associated with individual-level psychological complaints. • Interventions aimed at reducing body dissatisfaction among adolescents have the potential to improve the well-being of both the individual and their peers.

Dual Factor Model: exploring different social sources and loneliness of adolescents in Luxembourg

Abstract Background The Dual Factor Model (DFM) of mental health incorporates both subjective well-being (SWB) and psychopathology symptoms, proposing a more comprehensive approach to mental health. As such, four groups can be distinguished in accordance with the level of SWB and psychopathology symptoms: 1. complete mental health; 2. incomplete mental health; 3. incomplete mental illness; 4. complete mental illness. Social support and loneliness are known to influence both SWB and psychopathology symptoms. The aim of this study is to explore the odds of different sources of support and loneliness in the different mental health groups, as proposed by the DFM, in adolescents in Luxembourg. Methods A total of 7201 adolescents aged 11 to 18-years old participated in the 2022 Health Behaviour in School-Aged Children in Luxembourg. In order to categorize the DFM mental health groups, SWB was measured using the WHO-5 Index and anxiety symptomatology (GAD-2) was used for psychopathology symptoms. Social support (from family, peers, teacher and classmates) and loneliness were analyses using a multinomial logistic regression, adjusting for age, gender, family affluence and family composition. Results Adolescents who perceive a low (in comparison to good) classmate support and teacher support and feel lonely have an increasing chance of being in the Incomplete Mental Health, Incomplete Mental Illness and Complete Mental Illness (e.g. classmate support: OR = 1.69, OR = 2.19 and OR = 2.79, respectively). Discussion The lack of support from the school sources and feeling loneliness are the most important factors increasing the probability to be part of the Complete Mental Illness group. Prevention strategies should focus on improving the school setting conditions. School is a privileged place for health promotion, offering a comprehensive, sustained and effective means of intervention for the target population. Key messages • In Luxembourg, the four groups of the Dual Factor Model of mental health vary according to the source and level of support and loneliness. • Low classmate and teacher support as well as feeling of loneliness contributes to Complete Mental Illness (low SWB and moderate to high symptomology of anxiety) in adolescents, in Luxembourg.

Risk and Resiliency Factors Associated with School Bullying and Cyberbullying Among Adolescents in Mediterranean Countries

ABSTRACT School bullying and cyberbullying are serious public health problems that negatively affect the lives of school-aged children. We examined the correlation between risk behaviors and lack of resiliency factors with bullying and cyberbullying across seven Mediterranean countries. The sample consisted of 33,399 adolescents (51.1% girls) aged 11, 13, and 15 years who participated in the Health Behavior in School-aged Children (HBSC) survey in 2018 in Greece, Israel, Italy, Macedonia, Malta, Portugal, and Spain. Bivariate logistic regressions were conducted to test the relationship between risk behaviors, resilience, and bullying. All risk behaviors and lack of resiliency factors examined were related to involvement in bullying as a victim, perpetrator, or bully-victim, both in school and cyberbullying. Moreover, the odds of involvement in school bullying and cyberbullying increased as the number of risk behaviors and the lack of resiliency factors grew. Our results may contribute to the development and implementation of anti-bullying programs.

"Are You a Boy or a Girl?"-A Missing Response Analysis.

Many adolescent health surveys ask if respondents are male or female. Non-response may be due to fear of de-anonymisation or being a gender-nonconforming youth. The present study investigates the frequency of non-response and its potential reasons. To this end, data from 54,833 adolescents aged 11-18 from six countries, participating in the 2018 Health Behaviour in School-aged Children (HBSC) study, were analysed. Respondents were divided into three groups: (1) "Responders" who answered both questions on age and gender, (2) "Age non-responders" who did not answer the question on age, and (3) "Gender non-responders" who answered the question on age but not the one on gender. These groups were compared regarding their non-response to other questions and regarding their health. Overall, 98.0% were responders, 1.6% were age non-responders and 0.4% were gender non-responders. On average, age non-responders skipped more questions (4.2 out or 64) than gender non-responders (3.2) and responders (2.1). Gender non-responders reported more psychosomatic complaints, more frequent substance use and lower family support than responders. This study shows that age and gender non-responders differ in their response styles, suggesting different reasons for skipping the gender question. The health disparities found between the groups suggest that further research should use a more nuanced approach, informed by LGBT+ youth's insights, to measure sex assigned at birth and gender identity.

Less Computer Access: Is It a Risk or a Protective Factor for Cyberbullying and Face-to-Face Bullying Victimization among Adolescents in the United States?

The present study investigates whether less computer access is associated with an increase or decrease in cyberbullying and face-to-face bullying victimization. Data were derived from the 2009-2010 Health Behavior in School-Aged Children U.S. Study, consisting of 12,642 adolescents aged 11, 13, and 15 years (Mage = 12.95). We found that less computer usage was negatively associated with cyberbullying victimization and face-to-face bullying victimization. The findings from the study have implications for research and practice.

Associations between marijuana and tobacco use among Croatian pupils in 2022 Health Behaviour in School-aged Children (HBSC) survey

Associations between marijuana and tobacco use among Croatian pupils in 2022 Health Behaviour in School-aged Children (HBSC) survey

Healthy Social Network Use and Well-Being during Adolescence: A Biopsychosocial Approach.

Screen time and the use of social networks is the most frequent form of leisure time occupation and socializing for adolescents. The present study is aimed at understanding and characterizing, from an ecological perspective, what distinguishes healthy and less healthy or even dependent use of social media in young people and the influence on adolescents' well-being. This paper is based on the Health Behaviour in School-aged Children (HBSC) from 2022, a survey carried out every 4 years, in collaboration with the World Health Organisation (WHO), following an international protocol. A total of 7643 students from the 6th, 8th, 10th, and 12th school grades responded, of which 53.9% were female, with an average age of 15.05 (SD = 2.36). The sample is representative of the school grades under study. The results allow us to study and identify similarities and differences between three groups related to the level of healthiness in the use of social networks and its relations to well-being from an ecological perspective. What distinguishes adolescents with less healthy use of social networks is that they are more often female, older, have more self-injurious behaviour, higher alcohol consumption, and a worse relationship with teachers. The adolescents with the highest level of dependence on social networks are those who have a higher perception of lack of safety at school and in their area of residence, as well as a higher use of screen time as a leisure activity. The well-being of adolescents using social media in a healthy way is explained by fewer psychological symptoms, better stress management strategies, better body awareness, more physical activity, less time online with friends, and better relationships with family and teachers. Technologies and social networks are important for the well-being of adolescents; it is essential to promote a healthy, critical and balanced use with other "screen-free" activities and to promote socio-emotional skills, a lack of which seems to be one of the biggest risk factors associated with the healthy use of technologies.

Association of breakfast, total diet quality, and mental health in adolescents: a cross-sectional study of HBSC in Greece.

The emerging field of nutritional psychiatry offers proof that diet quality can be changed to reduce one's risk of developing mental illness. What you eat has a big impact on teenage mental health, and the quality and frequency of breakfast, as well as the different food groups, can affect adolescent mental health. In this study, regression models were employed to analyze four indicators (self-rated health, body satisfaction, life satisfaction, and eight symptoms) of mental health problems as well as demographic factors (gender, age, body mass index, affluence class, physical activity), with forest plots displaying the regression connections. This study, a descriptive cross-sectional survey of 3480 adolescents aged 11 to 15years, chosen data from the 2018 Greek Health Behaviour in School-aged Children (HBSC) International Study for secondary analysis. The data revealed that high levels of four indicators of mental health (self-rated health, body satisfaction, life satisfaction, and eight symptoms) were significantly related to breakfast quality, total dietary patterns. Students reporting poor total food quality, for example, were more predictive of self-assessment when unhealthy (2.286 95% CI 1.851-2.824), and the largest connections with eating a "bad" breakfast were discovered when the eight symptoms of mental status were the worst (- 0.869 95% CI: - 1.300, - 0.439); physical activity may enhance the positive relationship of diet quality on mental health, while obesity weakens this positive relationship; and age patterns varied by gender, with girls and older individuals showing a higher risk of diet quality and mental health. Conclusions: The findings revealed that each of the four indices of general mental health was correlated with teenage breakfast and overall diet quality. Physical activity and weight were shown to be moderating factors, and obesity had the biggest impact on psychological risk. Gender, age, and family economic inequality were potential explanations for the rise in psychological symptoms. Researchers are urged to focus more on nutritional psychiatry research and look into psychological perception disparities in the future. What is Known: •There is a potential correlation between adolescent dietary patterns or quality and mental health. •Factors such as age, gender, socio-economic status, body weight and physical activity all have an impact on diet and mental health outcomes. What is New: •There have been no studies of the ability to simultaneously predict breakfast quality and overall diet quality for broadly defined mental health complaints [positive (life satisfaction), neutral (body satisfaction, self-rated health) and negative (eight symptoms: depressed mood, irritability, nervousness, difficulty sleeping, dizziness, headache, stomachache and backache)]. •Differences in overall diet quality trends between demographic subgroups remain unclear.

Body-related concerns and participation in physical education among adolescent students: the mediating role of motivation.

There is a need to understand better factors influencing participation in physical education (PE) and the mechanisms involved. The adolescent years are characterised by increasing levels of body-related concerns. In PE, the body is judged for its physical abilities and subject to social comparisons and body judgements. Grounded in the Self-Determination Theory, this study aimed to explore whether body-related factors were associated with adolescents' involvement in PE and whether types of motivation mediated this relationship. The study involved 2,140 (54.5% girls) secondary students (15-16-year-olds) from Norway participating in the nationally representative "Health Behaviour in School-aged Children (HBSC) study: a WHO collaborative cross-national study." Body-related factors included Body Mass Index (BMI), health complaints, body perception and dietary behaviours. Gender, age, and socioeconomic status (family affluence) were control variables. Motivation for PE was assessed with the Perceived Locus of Causality (PLOCQ) scale measuring three distinct factors: autonomous motivation, controlled motivation and amotivation. PE involvement was self-reported as weekly participation in PE classes and time spent in moderate-to-vigorous physical activity (MVPA) during PE. Gender (girl), family affluence, health complaints, not being on a diet but wanting to lose weight, and body perception (too fat) were negatively associated with weekly PE participation when adjusting for other variables. This association was largely explained by students' autonomous motivation in the case of health complaints and partly in the case of dietary behaviour and body perception. Similar results were observed for MVPA during PE lessons. Additionally, gender was associated with MVPA through amotivation. The study adds new knowledge to the understanding of the relationship between body-related factors and PE, supporting that autonomous motivation is a central mechanism and an avenue for further research. The results should be considered in planning high-quality PE classes and suggest that an autonomous supportive learning climate sensitive to body-related concerns should be a priority to increase adolescent involvement in PE.

O.4.3-9 Perceived COVID-19 impact and its relationship with Physical Activity in youths in Luxembourg: Health Behaviour in School-aged Children 2022 survey

Abstract Purpose The prevention measures undertaken due to the COVID-19 pandemic, such as lockdown and social distancing may have caused changes in the population’s lifestyle, including physical activity (PA). The current study aimed to investigate the PA level according to the perceived COVID-19 impact in youth in Luxembourg. Methods This representative cross-sectional study was based on the Health Behaviour in School-aged Children (HBSC) Luxembourg 2022 survey. The population includes 8018 participants aged 11 to 18 years old. The PA was measured on how many days per week they practice 60 or more minutes of moderate-vigorous (MVPA) and vigorous PA (VPA). The perceived COVID-19 impact on PA was measured by the question “What impact did the Covid-19 measures have on your PA?”, with 5 answers categories ranging from very negative to very positive. A chi-square test was performed to observe the association between the perceived COVID-19 impact on PA and gender. In addition, a linear regression was performed to analyse the relation between MVPA and VPA and the perceived COVID-19 impact, adjusted by age, splited by gender. Results An association was found between gender and the perceived COVID-19 impact on PA. 28.2% of boys perceived a very positive impacted of COVID-19 on PA, compared to 15.5% of girls. There was a relationship between MVPA, and the perceived COVID-19 impact on PA, in both genders. Participants who perceived a positive impact of the COVID-19 on PA practiced MVPA and VPA more frequently than the others, for both boys (β = 0.491, p &amp;lt; 0.001 and β = 0.491, p &amp;lt; 0.001, respectively) and girls (β = 0.543, p &amp;lt; 0.001 and β = 0.733, p &amp;lt; 0.001, respectively). Conclusions Findings suggest a rather positive impact of the COVID-19 on PA, especially for boys. In addition, those who perceived a positive impact practiced significantly more days of MVPA and VPA, in both gender. This study highlights adolescent’s perception of COVID-19 impacts on their PA and draw attention to the positive impact perceived and its relation to an increased PA practice. Future studies should further investigate the reasons behind the perception of a positive impact, in order to mimic the contextual factors favouring the increased practice of PA.

Problematic social media use and overweight/obesity: explanatory pathway analysis of 124 667 in-school adolescents in 39 high-income countries.

The relationship between adolescent problematic social media use (PSMU) and overweight/obesity and the potential explanatory pathways for this association are unclear. This study (1) examined the relationship between PSMU and overweight/obesity and (2) evaluated potential explanatory pathways for this association. The data used in this study came from the 2018 Health Behaviour in School-aged Children (HBSC) survey. A sample of 124 667 in-school adolescents from 39 high-income countries was analysed. Sequential logistic regressions were used to estimate the association between PSMU and overweight/obesity. Pathway analysis using a non-parametric bootstrapping technique tested the hypothesized mediating roles. The multivariable logistic regressions indicated that higher problematic social media users were 1.11 times more likely to be overweight/obese compared with those who reported low PSMU (AOR = 1.11; 95% CI = 1.05-1.18). Our bootstrapping mediation analyses showed that PSMU indirectly influenced overweight/obesity through breakfast skipping, life satisfaction, family communication, self-rated health, and physical activity, accounting for 19.8% (β = 0.0068, Boots 95% CI = 0.0056-0.0074), 15.1% (β = 0.0050, Boots 95% CI = 0.0046-0.0056), 9.2% (β = 0.0031, Boots 95% CI = 0.0024-0.0038), 7.8% (β = 0.0024, Boots 95% CI = 0.001-0.004), and 5.2% (β = 0.0017, Boots 95% CI = 0.0014-0.0023), respectively, of the total effect. To the best of our knowledge, this is the first study that used nationally representative data from multiple countries in high-income countries to examine the association between PSMU and overweight/obesity and potential explanatory pathways among school-going adolescents. This finding has important implications for public health interventions to reduce overweight/obesity rates among young people.

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.

Encouraging greater empowerment for adolescents in consent procedures in social science research and policy projects.

The United Nations Convention on the Rights of the Child emphasizes the importance of allowing children and adolescents to influence decisions that are important to them following their age and maturity. This paper explores the principles, practices, and implications around using parental versus child/adolescent consent when participating in social science research and policy development. Experiences from two studies are presented: The Confronting Obesity: Co-creating policy with youth (CO-CREATE) and the Health Behaviour in School-aged Children (HBSC) study, a World Health Organization (WHO) Collaborative Cross-National study. Although parental consent may be an important gatekeeper for protecting children and adolescents from potentially harmful research participation, it may also be considered an obstacle to the empowerment of children and adolescents in case they want to share their views and experiences directly. This paper argues that evaluation of possible harm should be left to ethics committees and that, if no harm related to the research participation processes is identified and the project has a clear perspective on collaborating with the target group, adolescents from the age of 12 years should be granted the legal capacity to give consent to participate in the research project. Collaboration with adolescents in the development of the research project is encouraged.

Sixteen-year trends in fruit consumption and related socioeconomic inequalities among adolescents in Western European countries.

To investigate time trends in daily fruit consumption among Western European adolescents and in related socioeconomic inequalities. We used nationally representative data from 18 countries participating in five rounds (2002 to 2018) of the cross-sectional "Health Behaviour in School-aged Children" (HBSC) survey (n = 458,973). The questionnaire, standardised across countries and rounds, was self-administered at school by 11-, 13- and 15-year-old adolescents. Daily fruit consumption was assessed using a short food frequency questionnaire (sFFQ). Socioeconomic inequalities were measured using the Family Affluence Scale (FAS). Multilevel logistic regressions were applied to study linear time trends in daily fruit consumption, overall, by country and by FAS. Between 2002 and 2018, daily fruit consumption increased in 10 countries (OR range, 1.04 to 1.13, p < 0.05) and decreased in 3 (OR range 0.96 to 0.98, p < 0.05). In all survey years combined, prevalence of daily fruit consumption was significantly higher among high FAS groups (42.6%) compared to medium (36.1%) and low FAS groups (31.7%; all countries: p < 0.001). Between 2002 and 2018, socioeconomic inequalities in fruit consumption increased in Austria, Germany, Italy, Netherlands, Scotland, Sweden, and Switzerland. Only in Norway FAS inequalities decreased while the prevalence increased. The prevalence of daily fruit consumption generally increased among adolescents between 2002 and 2018 in Western European countries, yet socioeconomic inequalities increased in some countries. Public health interventions should continue to promote fruit consumption with special attention to lower socioeconomic groups.