Health Behaviour In School-aged Children Research Articles

Adolescents' problematic internet and smartphone use in (cyber)bullying experiences: A network analysis.

This study investigates both offline and online bullying perpetration and victimization in association with problematic internet use (PIU) and problematic smartphone use (PSU), while also considering the related psychosocial difficulties. A total of 3939 adolescents (49.4% boys, aged 13-15 years) from a representative sample of schools in Slovakia was obtained from the Health Behavior in School-aged Children (HBSC) project in 2018. Due to the lack of similar complex research and the expected mutual associations among the constructs, we compared exploratory network models that provided separate estimates for boys and girls. The constructs formed similarly clustered networks for both genders, with a few notable differences. Unlike PIU, PSU was not associated with bullying experiences in boys or girls; however, PSU and PIU were partially related in girls. Bullying experiences formed a strong cluster in both networks. Two strong bridges were identified, and they are potential candidates for intervention in both boys and girls: first, traditional bullying victimization connected the cluster of bullying experiences to psychosocial difficulties; and, second, frequently missing sleep or meals due to internet use (behavioral salience) that is connected to the bullying cluster with PIU. The findings offer an indication for the preventive and interventive work of practitioners who deal with adolescents, as well as complex gender comparisons for the mutual relations of problematic internet and smartphone use, bullying experiences, and the psychosocial difficulties of youth. This study provides evidence that problematic digital media can play a role in bullying experiences irrespective of whether bullying happens offline or online.

Body Size and Well-being in Adolescents: The Roles of Bullying Victimization and Body Image

This research investigates the association between body size and key indicators of well-being for adolescents (i.e., self-rated health, mental health, and life satisfaction), and simultaneously tests two social mechanisms that may explain these relationships: stigma enacted as bullying victimization and body image, representing the “outside” and “inside” views of the body, respectively. This study tested these relationships using the United States Health Behaviors in School-aged Children (HBSC) 2009/2010 data set ( N = 12,210). Results demonstrated that larger body size is associated with reduced well-being on all the indicators studied as well as higher levels of bullying victimization and worse body image. However, body image predominantly mediates the relationship between body size and well-being. The study broadens the empirical base on whether body size is linked to well-being for adolescents, clarifies the role of two important social mechanisms, and indicates that body image is critical to understanding the effects of body size.

Antisocial behavior of Spanish adolescents: Prevalence and relationship with their perceived global health

Engagement in antisocial behavior during adolescence is a controversial issue causing social concern and with implications for the adolescents. This research is based on data from the 2014 Health Behavior in School-aged Children (HBSC) study and aims to determine the prevalence rate of antisocial behavior in 11-16-year-old adolescents and examine the relationship between antisocial behavior and perceived global health. The sample is composed of 9775 adolescents enrolled in school in Spain (50.95% girls). Results show a similar prevalence for boys and girls in all categories except in destruction, which is more prevalent in boys. However, discrepancies were found in the prevalence of engaging in antisocial behavior according to age, with a higher prevalence in older age groups. It was found that lesser antisocial acts are associated with a worse health score at all ages regardless of sex, justifying the need to carry out preventive interventions and tackle the circumstances that promote antisocial behavior.

Early physical maturation and subjective health complaints in adolescent girls: a pooled cross-sectional analysis

BackgroundAlthough adolescents are generally healthy, subjective health complaints (SHC) are common in this age group, especially in adolescent girls. We explored the association between early menarche and the frequency of...

Geographical variations in the prevalence of traditional and cyberbullying and its additive role in psychological and somatic health complaints among adolescents in 38 European countries

ObjectivesTo explore geographical variations in the prevalence of traditional and cyberbullying and their individual and additive role on psychological and somatic health issues of adolescents. MethodsWe used cross-sectional data from 188,003 adolescents (50.9% females; mean age 13.6 years) from the nationally representative Health Behaviour in School-aged Children 2014 survey in 38 European countries. Multivariable linear regression analyses were conducted to explore the role of bullying on health outcomes whilst meta-analyses were conducted to generate pooled regression coefficients. ResultsOverall, the prevalence of traditional bullying was 26.9%, ranges from 8.8% in Armenia to 49.7% in Latvia, and cyberbullying was 15.8%, ranges from 5.8% in Greece to 38.3% in Greenland. 1 in 10 (8.4%) adolescents reported experiencing both forms of bullying, with the prevalence ranging from 2.5% (Greece) to 21.0% (Greenland). Meta-analytic estimates suggest a significant role of both traditional and cyberbullying in poor somatic and psychological health issues. The additive effect of both forms of bullying was more prominent on psychological health issues (β 0.70, 95% CI 0.66–0.74) than on somatic health issues (β 0.50, 95% CI 0.47–0.53). These associations varied across countries. ConclusionThe prevalence of traditional and cyberbullying varied significantly across European countries while their individual and additive links with an increased risk of poor psychological and somatic health issues remain common in majority countries. To ensure both forms of bullying are prevented, a multifaceted approach and particular attention to mental health issues in bullying victims are needed in countries with high prevalence of bullying.

Adolescents' Nutrition: The Role of Health Literacy, Family and Socio-Demographic Variables.

Adolescent obesity rates are increasing on an epidemic level and food intake is one of the most important causes of this condition. From an ecological perspective, food intake is, in turn, influenced by many factors that need to be considered. This study aims to evaluate the associations between socio-demographic factors (gender, family origin, socio-economic status, parent's education level), which consist of social stratifiers, health literacy and family context, as independent variables, and food intake (consumption of fruits, vegetables, soft drinks and sweets and breakfast frequency) and outcomes (Body Mass Index category), as dependent variables. Data were retrieved from 2145 students (13 and 15 years old) from the Lombardy region (Italy) who participated in the 2018 edition of Health Behaviour in School-Aged Children (HBSC). Six multiple binary logistic regression models were used in this study. Fruit, vegetable and soft drinks consumption models were related to all three-factor levels. Breakfast consumption frequency was associated with socio-demographic variables. BMI category was associated with socio-demographic and family variables. The results confirmed the existence of social inequalities, the importance of health literacy in predicting healthy behaviours and the relevance of the family context. The study confirms the importance of the ecological approach to understanding food intake and overweight/obesity status in adolescents.

Assessing policies to reduce adolescent overweight and obesity: Insights from a system dynamics model using data from the Health Behavior in School-Aged Children study.

Adolescent overweight and obesity (AdOWOB) in Europe has proven to be a persistent and complex problem, and appropriate systems methods may help in evaluating potential policy options. This paper describes the development of a system dynamics model of AdOWOB as part of the EU-funded CO-CREATE project. The model was developed using literature and data from the Health Behavior in School-Aged Children (HBSC) study across 31 European countries. We identified 10 HBSC variables that were included as direct or indirect drivers of AdOWOB in the dynamic model, seven at the level of the individual, and three related to the social environment. The model was calibrated to 24 separate cases based on four gender and perceived wealth segments for each of the five CO-CREATE countries (The Netherlands, Norway, Poland, Portugal, and the UK) and for Europe overall. Out of 10 possible intervention points tested, exercise, fruit, life dissatisfaction, school pressure, and skipping breakfast were identified as the top five most influential ones across the 24 cases. These model-based priorities can be compared with the policy ideas suggested by the CO-CREATE adolescents.

Perceived Discrimination Among Adolescents in Ireland.

Adolescents belonging to minority or marginalized groups often experience discrimination, which may negatively affect their mental and physical health. Using the dataset of the 2018 Health Behaviour in School-Aged Children (HBSC) study, we analyzed perceived discrimination based on various grounds in four minority groups of schoolchildren in Ireland: sexual minority youth, youth living with a disability or chronic condition, immigrant youth, and youth belonging to the Traveller community. To minimize the potential confounding effect of psycho-social contextual factors, we used a case-control matching approach, comparing minority groups with their non-minority peers matched by gender, age group, and social class. Minority groups were significantly more likely than their matched non-minority counterparts to report discrimination, not only on the basis of their minority status but also on other grounds. These associations varied in their effect size. We discuss educational and policy implications of the findings for reducing discrimination and structural stigma in school settings.

An Investigation of the Implementation of Obligatory Physical Activity Classes for 5th-7th Grade in Norway.

In 2009, all Norwegian 5th-7th graders were allocated 76 h of obligatory physical activity (PA) classes in addition to physical education (PE). The study explores how schools implemented these classes and the relationship with school physical activity guidelines. The sample consisted of 134 schools participating in the WHO collaborative Health Behaviour in School-Aged Children (HBSC) survey in 2014 (n = 69) and 2018 (n = 65). Ten questions concerning PA were asked in 2014, and four of these were included in the 2018 survey. Chi-squared tests were used to investigate differences between groups. In 2014, 51% reported that PE teachers led the classes; this had reduced to 30% in 2018. A combination of teacher- and student-driven activities was most common. More student-led activities were observed when nonpedagogical personnel were responsible for the classes. Most schools reported no professional staff development related to the implementation of obligatory PA. In 2018, schools with written guidelines on physical activity had to a greater extent implemented staff development measures and increased the use of PE teachers compared to 2014. A considerable variation regarding teaching competence, teaching forms, group sizes, and facilities makes the outcome of the PA scheme uncertain. A potential effect of having established written school policies on the implementation of physical activity classes was however found.

Are adolescents' physical activity and body-related factors associated with medically attended injuries?

Injuries are the major cause of disability and death during adolescence, representing a significant public health burden among youth. Body-related factors such as body composition and cardiovascular fitness (CVF) may affect adolescents' vulnerability to injuries. As evidence is lacking, we aimed to explore the associations of medically attended injuries with adolescents' physical activity (PA) and body-related factors, and whether these associations are modified by age, gender and family affluence. We used data on 888 11- to 15-year-old adolescents (mean age = 13.5, 56% boys) from the Health Behaviour in School-aged Children study conducted in 2018 in Slovakia. We used binary logistic regression analysis to assess the association of medically attended injuries with adolescents' PA and body-related factors (body composition, CVF), considering age, gender and family affluence. Adolescents were more likely to report medically attended injuries if they were physically very active (odds ratio/confidence interval OR/CI:2.76/1.83-4.15) or active (OR/CI:1.91/1.27-2.87) rather than inactive. Body-related factors were not associated with medically attended injuries among adolescents. Moreover, age, gender and family affluence did not modify the association of medically attended injuries with adolescents' PA and body-related factors. The only exception was the modifying effect of gender: the association of medically attended injuries with being very active was stronger in boys (OR/CI: 3.04/1.32-6.99). Very physically active adolescent boys are the most vulnerable group of adolescents in terms of injuries. PA promotion programmes should further consider gender-specific strategies aimed at preventing injuries.

Meeting 24-hour movement guidelines: Their relationships with overweight and obesity among Chinese children with autism spectrum disorder

BackgroundCanada's and Australia's 24-hour movement guidelines for children and youth provide daily recommendations for physical activity (PA), screen time (ST), and sleep for optimal health. Previous studies have examined the associations between meeting these 24-hour movement guidelines and overweight and obesity among children without disabilities. Less is known about potential associations between the 24-hour movement behaviors and the weight status of children with disabilities.Therefore, the purpose of this study was to examine whether meeting movement behavior recommendations (i.e. ≥ 60 min of Moderate-to-vigorous activity [MVPA] per day, ≤ 2 h of recreational ST per day, and 9–11 h of sleep for those aged 5–13 years [or 8–10 h for children aged 14–17 years]), and combinations of these recommendations, are associated with overweight and obesity in Chinese children with ASD. MethodParticipants were 99 children with autism spectrum disorder (ASD) 7–17 years old recruited from one Chinese special school. MVPA and nightly sleep duration were measured using 24-hour wrist-worn accelerometer. ST was reported by parents by using reliable and valid items derived from the Health Behavior in School-aged Children (Chinese version). A series of binary logical regression analyses were performed for analysis. ResultsOnly 16.2% met all the three movement behavior recommendations. The proportions of children with ASD who met the recommendation for PA, ST, and sleep were 32.3%, 52.5%, and 65.7%, respectively. The children with ASD who met the MVPA (OR = 0.37, 95% CI: 0.15–0.94), MVPA + Sleep (OR = 0.27, 95% CI: 0.09–0.81), and all three 24-hour movement guidelines (OR = 0.14, 95% CI: 0.03–0.77), had significantly lower odds ratios for overweight/obesity than those who did not meet the respective recommendations. ConclusionsMeeting the MVPA, MVPA + Sleep, and all three of the guidelines was associated with lower odds ratios for overweight and obesity in children with ASD, and MVPA was the single most important activity for weight control among this population. Therefore, meeting the 24-hour movement guidelines, especially the MVPA guideline should be considered an effective intervention and can inform the design of strategies and policies for the prevention of overweight and obesity in children with ASD.

Vigorous physical activity and self-rated health during adolescence: A cross-sectional survey.

Despite the positive relationship between self-rated health and general physical activity, very little research has touched upon the relationship between self-rated health and vigorous physical activity. Such research will help to promote self-rated health among adolescents by addressing the close relationship between self-rated health and the components of physical activity. In this study, the relationship between self-rated health and vigorous physical activity among Chinese adolescents were analyzed. The current study was based on a collaborative survey conducted by the WHO in several nations, and the data generated by Health Behavior in School-aged Children every 4 years on health behavior were adopted. The school class was taken as a basic unit for sampling. Cluster sampling was performed systematically, and the possibility was proportional to the population. The sampling was conducted to collect typical cases. The class teachers were informed of the sampling activities, and they were to collect data on the students by distributing the questionnaires. The research included 116,828 respondents from 36 countries. Among them, 51.82% were girls and 48.18% were boys. A total of 98.54% of the respondents considered their health status as fair or above when completing the questionnaire, while 1.46% believed that their health status was poor. Moreover, more than 86% of the respondents participated in vigorous exercise more than weekly, and better self-health ratings were found among respondents who exercised more than weekly (once a week: OR = 1.95, CI: 1.86-2.04; two or three times a week: OR = 1.69, CIL: 1.63-1.76; four or six times a week: OR = 1.30, CI: 1.25-1.35). Certain respondents reported better results for self-rated health (4-6 h every week: OR = 1.36, CI: 1.30-1.43; 2 or 3 h every week: OR = 1.48, CI: 1.42-1.55; 1 h every week: OR = 1.64, CI: 1.57-1.72). In this study, empirical evidence is provided for the relationship between self-rated health and vigorous physical activity among adolescents. From the results, it can be observed that there is a positive relationship between self-rated health and vigorous physical activity among adolescents.

Health literacy among adolescents: summary of some key findings from ten European countries

Abstract Introduction In research on disparities, the concept of health literacy (HL) as a set of competencies to promote and sustain health may help in understanding the disparities better and in addressing avoidable and unfair health disparities. The presentation will present some key findings on adolescents’ HL levels in ten European countries, and how HL mediates and moderates between various background factors and health outcomes. Methods Data consisted of cross-sectional data from Health Behaviour in School-aged Children (HBSC) study from year 2017/18 of ten European countries (Austria, Belgium (Fl), Czechia, England, Estonia, Finland, Germany, Macedonia, Poland, and Slovakia). Data (n = 14,590 - 22,291) of 13- and 15-year-old pupils were used. Indicators include background variables (e.g. age, gender), Health literacy, Health indicators (e.g. self-rated health (SRH) and problematic social media use (PSMU)). Analysis include (1) Mediator analysis (with Mplus): pearson correlation coefficients, path models (Mplus 7.3 and Maximum Likelihood estimator) and (2) random effects models and moderator analyses (with R-sofware). Findings HL is an independent factor explaining disparities in health (e.g. SRH), and a mediator as well as a moderator between health outcomes and background factors. Based on the national analyses HL had significant main effects in every country, but group level differences emerged only in some countries. For instance, in Finland and Belgium, among girls HL lowered the likelihood to problematic social media use, but not among boys. Discussion HL is of use in understanding and tackling health disparities among adolescents. Results confirm the need to adopt the principles of proportionate universalism when promoting HL among adolescents to avoid widening the disparities within population groups. Also, country-specific health literacy interventions are needed to secure equity in opportunities of different population groups to benefit from the HL interventions.

Risk behaviors among migrant adolescents in Italy

Abstract Background Over the last decade, the student population migrated to Italy has quadrupled, but studies on their potentially harmful behaviors such as substance use are still scarce. The aim of this research is to monitor risk behaviors among migrant adolescents in Italy and provide appropriate indications for the definition of targeted policies and interventions. Methods A representative sample of 15 year-old adolescents was drawn from the 2018 Italian Health Behavior in School-aged Children (HBSC) survey data. Smoking habits, alcohol consumption and drunkenness were investigated and differences with Italian peers were assessed. Findings Results were based on more than 18,500 students, of which 16% were migrants: 32.7% from Western countries (We), 32.5% from Eastern European countries (Ee), and 34.8% from non-Western/non-European countries (nW). Compared with natives, students from nW countries showed a lower risk of smoking habits (OR: 0.72, 95%CI: 0.58-0.89) and weekly alcohol consumption (OR:0.57, 95%CI:0.43-0.75), whereas drunkenness was more prevalent among Ee migrants (OR: 1.42, 95%CI: 1.10-1.83). Overall, both migrant and Italian girls showed a lower risk of unhealthy behaviors than boys. Conclusions Compared to the native counterparts, migrant adolescents showed differences in substance use according to their ethnic background. We observed two different immigration patterns: the Western immigrants, who came from countries with higher affluence and share similar risk behaviors with native peers, and non-Western immigrants, who came from less affluent countries and seemed to maintain the risk behaviors of their culture of origin. Key messages

It matters what we do: Relationships between forms of media use and life satisfaction of adolescents

Abstract Background Electronic media communication is firmly anchored in the leisure time of adolescents. Adolescents use electronic devices (ED) as a means of interpersonal communication with friends, such as text messaging, for entertainment in the form of receptive communication, such as watching movies, in the form of interactive communication, such as playing computer games, and for other purposes, such as homework. We aimed to identify how these communication forms are related to and interact on life satisfaction (LS) of girls and boys. Methods We conducted multivariable linear regression analysis with the dataset of 5,961 adolescents aged 11, 13 and 15 years, obtained from the German Health Behaviour in School-aged Children (HBSC) survey of 2013/2014. Separate statistical analyses were performed for girls and boys, including statistical interactions. We controlled for age, family affluence and family structure. Results Interpersonal communication with friends has a positive relationship with LS in boys (β = 0.12, t = 3.19, p = 0.001), but no effect in girls. Whereas other communication forms have a negative main effect on life satisfaction in girls (entertainment β = -0.1, t = -3.79, p < 0.001; gaming β = -0.09, t = -4.12, p < 0.001; using the ED for other purposes β = -0.04, t = -2.26, p = 0.024), we found no association of entertainment with LS for boys. The negative effect of gaming in boys is conditional on the level of using the ED for other purposes: the results show a reinforcing statistical interaction (β = 0.02, t = 3.24, p = 0.001). Conclusions The results demonstrate the relevance of considering the differences in associations between single forms of communication and LS for boys and girls separately. This confirms our theoretical focus on a communication-centred approach. Moreover, it is of high relevance to identify potentially enabling and harmful media communication and to understand adolescents’ perspectives on these forms of communication. Key messages • When examining associations between media use and life satisfaction among adolescents, form of communication and gender should be taken into account. • Investigating interactions of different forms of communication can help to better understand their influence on adolescents’ life satisfaction.

Country-level social mobility and inequalities in adolescent health behaviours in 32 countries

Abstract Background Higher family affluence is associated with healthier behaviours in adolescents, but the strength of this association varies across countries. Differences in social mobility at the country-level, i.e. the extent to which adolescents develop a different socioeconomic status (SES) than their parents, may partially explain why the association between family affluence and adolescent health behaviours is stronger in some countries than in others. Methods Using data from adolescents aged 11-15 years from 32 different countries, participating in the 2017/2018 wave of the Health Behaviour in School-aged Children (HBSC) study (N = 185,086), we employed multilevel regression models with cross-level interactions to examine whether country-level social mobility moderates the association between family affluence and adolescent health behaviours (i.e. moderate-to-vigorous physical activity, vigorous physical activity, healthy foods consumed, unhealthy foods consumed, having breakfast regularly, weekly smoking). Results Higher family affluence was more strongly associated with higher levels of physical activity in countries characterized by high levels of social mobility (cross-level interaction linear regression coefficient 0.34; 95% CI 0.08 to 0.60; p = 0.009 for moderate-to-vigorous physical activity, and 0.31; 0.11 to 0.50; p = 0.002 for vigorous physical activity). No cross-level interactions were found for any of the other health behaviours. Conclusions Our findings suggest that differences in social mobility at the country-level may contribute to cross-national variations in socioeconomic inequalities in adolescent physical activity. Further research can shed light on the mechanisms linking country-level social mobility to inequalities in adolescent physical activity to identify targets for policy and interventions. Key messages • This is one of the first studies to investigate country-level social mobility in relation to health equity. Inequalities in adolescent physical activity were steeper in socially mobile countries. • Stronger efforts to engage adolescents from low-affluent families in physical activity may be necessary in countries characterized by high levels of social mobility.

The Role of School Connectedness and Friend Contact in Adolescent Loneliness, and Implications for Physical Health.

The current study investigated how adolescents' loneliness relates to school connectedness, classmate support, teacher support, and offline and online communication with friends. We also examined the association between loneliness, physical health, and sleep. Data came from the Scottish Health Behavior in School-aged Children (HBSC). The total sample was 2983 adolescents (F = 1479 [49.6%]) aged 14-17years (M = 15.66, SD = 0.39) from 117 secondary schools in Scotland. Results showed that (1) higher teacher support, classmate support, and offline contact with friends predicted lower levels of loneliness, (2) online friendship engagement predicted higher levels of loneliness, and (3) poor health and sleep were positively associated with loneliness. The study offers new findings, highlighting the role played by classmates/peers and teachers in reducing loneliness. Supporting previous research, we also found associations between loneliness, poor sleep, and worse physical health.

Association between vigorous physical activity and life satisfaction in adolescents.

PurposeThe association between overall physical activity (PA) and life satisfaction has been confirmed in adolescents. However, the associations between different forms of PA at various intensities and life satisfaction are under-studied. This study aimed to explore the association between vigorous PA (VPA) and life satisfaction, and whether the associations vary by gender and age.MethodsUsing data from the Health Behavior in School-aged Children (HSBC) investigation, the research samples of 11- to 15-year-old adolescents were included for further. The information on VPA was collected via two self-reported questions, including frequency per week and hours per week. Life satisfaction was assessed by a ladder of 0–10 scores, with being higher indicating better life satisfaction. Logistic models were carried out to analyse the association between VPA and life satisfaction among adolescents, and results were presented with odd ratio (OR) and associated 95% confidence interval.ResultsAmong the 214,080 (49.2% male) adolescents studied, both boy and girl participants reporting higher frequency of VPA per week were more likely to be associated with higher life satisfaction (e.g., in boys, VPA for every day: OR = 1.054; in girls: VPA for every day: OR = 1.047). More hours of VPA was also associated with better life satisfaction in adolescents (in overall sample, 7 h or more: OR = 1.178).ConclusionsIn conclusion, this research provided evidence on the roles of VPA on life satisfaction among adolescents aged 11–15. Considering life satisfaction is regarded as an indicator of adolescents' psychological health development, our study supports and extends the evidence for the importance of VPA in adolescence.

Adolescents' online communication and well-being: Findings from the 2018 health behavior in school-aged children (HBSC) study.

BackgroundDigital transformation has influenced all areas of adolescents’ lives, including the ways adolescents maintain friendships. Interpersonal communication is one of the most common activities while online. Online communication may provide adolescents with opportunities to expand their social contacts, but these encounters can be risky, especially when the communication is with unknown people on the internet. This study examined the associations between different forms of online communication behavior and well-being.Materials and methodsData were collected from Finnish adolescents as part of the Health Behavior in School-Aged Children (HBSC) study in 2018. The participants were 3,140 Finnish adolescents aged 11–15 years. Descriptive analyses were used to examine the frequency of different forms of online communication behaviors. The associations between online communications and individual factors were analyzed using the X2 test and 95% confidence intervals. Structural equation modeling (SEM) was used to analyze the extent to which adolescents’ online communication behavior explained the variance in adolescents’ well-being indicators.ResultsOverall, 60% of the adolescents reported communicating intensively with close friends, with higher rates of intensive communication reported by girls, higher age groups, and the high health literacy group. 22% of adolescents reported intensive communication with friends they got to know through the internet (online friends), while intensive online communication with unknown people was reported by 13% of adolescents. Overall, around one-fourth of adolescents preferred sharing personal matters online rather than in face-to-face encounters, and 10% of adolescents reported using the internet daily to get to know new people, and to look for like-minded company. The SEM analysis showed that keeping online contact with offline friends was linked to a positive outcome in all the measured well-being indicators; however, intensive communication with people contacted only online (online friends and unknown people) was negatively associated with well-being indicators (lower self-rated health, lower life satisfaction, higher loneliness, and problematic social media use).ConclusionBoth positive and negative associations were observed between online communication and well-being, depending on the target and content of the communication. The results indicate that online communication has benefits for adolescents who have more offline social life. Overall, one should ensure that the impact of interventions is proportionately greater for adolescents at the bottom end of the health gradient.

Measuring Health Literacy in Childhood and Adolescence with the Scale Health Literacy in School-Aged Children – German Version

Abstract. Health literacy can help explain health inequalities in childhood and adolescence. However, suitable instruments for assessing health literacy in this age group are rare, especially in the German-speaking countries. One economical measure is the 10-item Health Literacy in School-Aged Children (HLSAC) scale, developed and reviewed as part of the WHO Child and Adolescent Health Study (HBSC, Health Behavior in School-Aged Children). In the present study, we tested dimensionality, measurement invariance, and associations with health-related measures of the German version of the scale (HLSAC–German), using data from the 2018 national German HBSC study ( N = 4,347 students aged 11, 13, and 15 years). We also tested HLSAC–German with 11-year-olds, representing an expansion of the original scale. Exploratory and confirmatory factor analyses consistently demonstrated the unidimensionality of the scale (α = .88). Complete scalar measurement invariance was found for sex and partial scalar measurement invariance for age groups and school type, allowing for the comparison of means. Associations with indicators of health and health behavior further demonstrate the construct validity of the scale. The analyses show that the scale is suitable for the economic measurement of a general factor of health literacy in 11- as well as in 13- and 15-year-olds.