National Student Health Survey Research Articles

Determinants of Inequalities in the Exposure to and Adoption of Multiple Health Risk Behaviors among Brazilian Adolescents, 2009-2019.

The occurrence of multiple risk behaviors among adolescents imposes challenges in the context of public policies of health, particularly in low- and middle-income countries. Evidence on the conditions leading to the exposure to and adoption of multiple risk behaviors allows the identification of vulnerable groups of adolescents, and may support the proposition of targeted strategies directed to individuals at risk. Therefore, the aim of this study was to perform a quantitative analysis to identify recent trends in the exposure to and adoption of multiple health risk behaviors among Brazilian adolescents, highlighting individual-, household-, and school-level characteristics linked to inequalities among social groups. The analysis was based on cross-sectional data from the National Student Health Survey (PeNSE), conducted by the Brazilian Institute for Geography and Statistics in 2009, 2012, 2015, and 2019. The trends in the occurrence of multiple risk behaviors among adolescents were estimated according to social strata, allowing the calculation of concentration indexes and their disaggregation into major determinants of inequalities in the exposure and adoption of risk behaviors. The analyses were conducted using a complex survey design to allow representativeness at the population level. The results showed a rise in the incidence of multiple risk behaviors among youngsters in Brazil from 2009 to 2019. Factors influencing inequalities in the exposure to multiple risk behaviors were socioeconomic status and the characteristics of the household and school environments, whilst the adoption of multiple risk behaviors was also influenced by early exposure to multiple risk behaviors. Furthermore, trends in inequalities in the exposure to and adoption of multiple risk behaviors showed an intensification from 2009 to 2019, being initially concentrated among wealthier adolescents, followed by a transition to higher incidence in the lower socioeconomic strata in 2012 and 2015, respectively. The findings underscore the role of support systems for adolescents at risk within the familial and school contexts, whereas strategies of public policies of health based on the strengthening of community ties may require improvements to tackle socioeconomic inequalities in the occurrence of risk behaviors among youngsters.

Changes in tobacco use and associated factors among Brazilian adolescents: National Student Health Survey.

This cross-sectional study used data from Brazil's National Student Health Survey (PeNSE), from 2015 and 2019, to compare consumption of tobacco products among adolescent students in Brazil and identify associated factors. The study variables were current cigarette smoking, use of other tobacco products and use of any tobacco product. Pearson's Chi-square test was used to ascertain associations between the variables; bivariate and multivariate analyses were performed using logistic regression. Cigarette smoking remained stable between 2015 (6.6%) and 2019 (6.8%), but use of any tobacco product increased (from 10.6% in 2015 to 14.8% in 2019), involving particularly hookahs (7.8%) and e-cigarettes (2.8%). Cigarette smoking was greater among adolescents aged 16 and 17, whose skin colour was black or brown, who missed classes without permission, who reported having no friends, displayed other risk factors, such as drinking alcoholic beverages, or who were passive smokers. The prevalence of smoking has increased over the years and is associated with sociodemographic aspects and other health risk behaviour, highlighting the need for lifelong health promotion actions.

Mudanças no uso do tabaco entre adolescentes brasileiros e fatores associados: Pesquisa Nacional de Saúde do Escolar

Abstract This cross-sectional study used data from Brazil’s National Student Health Survey (PeNSE), from 2015 and 2019, to compare consumption of tobacco products among adolescent students in Brazil and identify associated factors. The study variables were current cigarette smoking, use of other tobacco products and use of any tobacco product. Pearson’s Chi-square test was used to ascertain associations between the variables; bivariate and multivariate analyses were performed using logistic regression. Cigarette smoking remained stable between 2015 (6.6%) and 2019 (6.8%), but use of any tobacco product increased (from 10.6% in 2015 to 14.8% in 2019), involving particularly hookahs (7.8%) and e-cigarettes (2.8%). Cigarette smoking was greater among adolescents aged 16 and 17, whose skin colour was black or brown, who missed classes without permission, who reported having no friends, displayed other risk factors, such as drinking alcoholic beverages, or who were passive smokers. The prevalence of smoking has increased over the years and is associated with sociodemographic aspects and other health risk behaviour, highlighting the need for lifelong health promotion actions.

Cyberbullying among Brazilian schoolchildren: data from the National Student Health Survey, 2019.

This cross-sectional study assessed data from Brazil's 2019 National Student Health Survey to investigate associations between cyberbullying and sociodemographic, family, mental health, and behavioural factors among Brazilian schoolchildren. Multivariate analysis by Poisson regression found 13.2% prevalence of cyberbullying, which was higher among adolescents who felt nobody cared about them (PR=1.47; 1.36-1.59); felt sad (PR=1.5; 1.4-1.7); reported that life was not worth living (PR=1.71; 1.59-1.84); had no friends (PR=1.68; 1.50-1.87); suffered parental aggression (PR=1.54; 1.45-1.65); missed classes without permission (PR=1.13; 1.06-1.20); used tobacco (PR=1.19; 1.10-1.30); alcoholic beverages (PR=1.16; 1.08-1.25); or illicit drugs (PR=1.14; 1.04-1.25); or had sexual intercourse (PR=1.23; 1.14-1.33). Prevalence was lower among boys (PR=0.85; 0.80-0.91); those 16-17 years old (PR=0.88; 0.82-0.95); and who reported having parental supervision in their free time (PR=0.78; 0.73-0.83). Cyberbullying has a high prevalence, highlighting the importance of monitoring this practice and establishing prevention measures in schools.

Cyberbullying entre escolares brasileiros: dados da Pesquisa Nacional de Saúde do Escolar, 2019

Abstract This cross-sectional study assessed data from Brazil’s 2019 National Student Health Survey to investigate associations between cyberbullying and sociodemographic, family, mental health, and behavioural factors among Brazilian schoolchildren. Multivariate analysis by Poisson regression found 13.2% prevalence of cyberbullying, which was higher among adolescents who felt nobody cared about them (PR=1.47; 1.36-1.59); felt sad (PR=1.5; 1.4-1.7); reported that life was not worth living (PR=1.71; 1.59-1.84); had no friends (PR=1.68; 1.50-1.87); suffered parental aggression (PR=1.54; 1.45-1.65); missed classes without permission (PR=1.13; 1.06-1.20); used tobacco (PR=1.19; 1.10-1.30); alcoholic beverages (PR=1.16; 1.08-1.25); or illicit drugs (PR=1.14; 1.04-1.25); or had sexual intercourse (PR=1.23; 1.14-1.33). Prevalence was lower among boys (PR=0.85; 0.80-0.91); those 16-17 years old (PR=0.88; 0.82-0.95); and who reported having parental supervision in their free time (PR=0.78; 0.73-0.83). Cyberbullying has a high prevalence, highlighting the importance of monitoring this practice and establishing prevention measures in schools.

Lack of awareness of the HPV vaccination campaign among Brazilian students: a multilevel analysis

The scope of this article is to analyze the association between lack of awareness of the HPV vaccination campaign among Brazilian adolescents and individual and contextual factors. It involved a cross-sectional study with data from the National Student Health Survey (2015). Bivariate analysis was performed and Prevalence Ratios were calculated, in a multilevel Poisson Regression (95%CI) to verify the effect of variables on the outcome. The outcome was significantly associated with being 15-19 years old (PR=1.36), studying during the afternoon/night shift (PR=1.05), having already had sexual intercourse (PR=1.10), with self-perceived poor or very poor health status (PR=1.23), dissatisfied (PR=1.14) or indifferent (PR=1.15) regarding their body image, playing truant from classes without parental consent (PR=1.10) and studying at a public school (PR=1.24). There was less prevalence of the outcome among females (PR=0.24) and in states with greater income inequality (PR=0.80). The lack of awareness about the HPV vaccination campaign among adolescents was associated with individual characteristics, the context of the school and the unit of the federation. These findings indicate the importance of enhancing health promotion for vulnerable young people.

Association between excessive TV viewing time and body mass index among Brazilian adolescents: quantile regression analysis of the National Student Health Survey (PeNSE), 2015

The study aimed to investigate whether excessive TV viewing time is associated with body mass index (BMI), irrespective of physical activity (PA) and interaction with consumption of ultra-processed foods (UPFs), among Brazilian adolescents. It is a cross-sectional study with data on 13-17-year-old adolescents from the 2015 National Student Health Survey. BMI was the outcome (direct measurement of height and body mass) and exposure was excessive TV viewing time (>2 h/day), daily consumption of UPFs and PA. Quantile regression was used to test associations and interactions. Excessive screen time was associated with higher BMI values (e.g., 25th percentile =0.060 kg/m² versus 95th percentile =0.891 kg/m², p<0.001). After adjusting for PA, the association remained, however, attenuated. The inclusion of UPFs in the model potentiated the association (e.g., 25th percentile =0.062 kg/m² versus 95th percentile =0.956 kg/m², p<0.001). Excessive screen time was associated with BMI percentiles, irrespective of PA - the absence of PA and the presence of UPF consumption affect the upper BMI percentiles more. Actions to reduce excessive TV viewing time, consumption of UPFs and promoting PA are essential to positively impact BMI and its reflexes on the health of Brazilian adolescents.

ANÁLISE DO IMPACTO DO PROGRAMA SAÚDE NA ESCOLA SOBRE A VIOLÊNCIA E O CONSUMO DE SUBSTÂNCIAS ILÍCITAS DOS JOVENS NAS ESCOLAS BRASILEIRAS

O estudo analisa o impacto do Programa Saúde na Escola (PSE) na prevençãoda violência e no uso de álcool, tabaco e outras drogas. Com base nas informaçõesda Pesquisa Nacional de Saúde do Escolar, Pense 2015, estima-se o efeito médio dotratamento (escolas que aderiram ao PSE) através do propensity score matching e dométodo de Lewbel (2012), que se baseia na construção de instrumentos internamentepara lidar com o possível viés das características não observáveis que influenciam otratamento. Também é estimado o efeito do tratamento quantílico. Os resultados indicamque o PSE contribui para a prevenção do consumo de drogas, cigarros e de brigas.No caso do álcool e do bullying, não foram observados resultados significativos.

Only the lonely: A study of loneliness among university students in Norway

Loneliness is a major public health concern among college and university students, the evidence is inconsistent regarding whether there is an increasing trend or not. Furthermore, knowledge of the demographic determinants for loneliness are limited. The present study assesses recent trends of loneliness from 2014 to 2018, and explores demographic risk indicators of loneliness among students. Data was drawn from two waves of a national student health survey from 2014 and 2018 for higher education in Norway (the SHoT-study). In 2018, all 162,512 fulltime students in Norway were invited to participate and 50,054 students (69.1% women) aged 18-35 years were included (response rate = 30.8%). Loneliness was measured by "The Three-Item Loneliness Scale" (T-ILS) and one item from the Hopkins Symptom Checklist-25 (HSCL-25). Age showed a curvilinear association with loneliness, with the youngest and oldest students reporting the highest level of loneliness across all measures. Other significant demographic determinants of loneliness were being female, single and living alone. There was a considerable increase in loneliness from 2014 (16.5%) to 2018 (23.6%, p < .001), and the increase was particularly strong for males, for whom the proportion of feeling "extremely" lonely had more than doubled. The high rate of loneliness and the increasing trends indicate the need for preventive interventions in the student population.

Eating habits, physical activity and sedentary behavior among Brazilian schoolchildren: National Student Health Survey, 2015.

Urbanization and industrialization have contributed to changes in eating patterns, as well as the emergence of sedentary behaviors and reduced physical activity. To identify and describe the prevalence of eating habits, physical activity and sedentary behavior in Brazilian schoolchildren, and to analyze their association with sociodemographic characteristics. Data from the National Student Health Survey (PeNSE) of 2015 were used. Prevalence rates, prevalence ratios, and 95% confidence intervals (95%CI) were calculated. The analyses were adjusted for age and maternal schooling. The majority of adolescents: consumed beans (65.1%) and snacks (52.3%); had more than three days of physical education at school (50.7%); practiced physical activity out of school for more than three days (55.4%); had a sedentary behavior (73.3%); and, had physical activity during 60min/day for less than four days a week (72.7%). In general, girls were more exposed to unhealthy eating habits and sedentary behavior, and a higher socioeconomic level was associated with higher prevalence of the indicators studied. High consumption of unhealthy foods, increased sedentary behavior and reduction in the practice of physical activity. An association of unhealthy attitudes with sociodemographic characteristics was observed among schoolchildren. Strategies that focus on reducing these behaviors will contribute to health promotion actions in the school and family environments.

Potential Confounders in the Analysis of Brazilian Adolescent's Health: A Combination of Machine Learning and Graph Theory.

The prevalence of health problems during childhood and adolescence is high in developing countries such as Brazil. Social inequality, violence, and malnutrition have strong impact on youth health. To better understand these issues we propose to combine machine-learning methods and graph analysis to build predictive networks applied to the Brazilian National Student Health Survey (PenSE 2015) data, a large dataset that consists of questionnaires filled by the students. By using a combination of gradient boosting machines and centrality hub metric, it was possible to identify potential confounders to be considered when conducting association analyses among variables. The variables were ranked according to their hub centrality to predict the other variables from a directed weighted-graph perspective. The top five ranked confounder variables were “gender”, “oral health care”, “intended education level”, and two variables associated with nutrition habits—“eat while watching TV” and “never eat fast-food”. In conclusion, although causal effects cannot be inferred from the data, we believe that the proposed approach might be a useful tool to obtain novel insights on the association between variables and to identify general factors related to health conditions.

Higher Education Students’ Mental Health Problems: Results from the Norwegian SHOT study

Abstract Highly educated people have better health than those without education. The number of young adults pursuing higher education is increasing; In 2015 almost half the Norwegian adult population had completed higher education (1). Studies have investigated horizontal stratification (i.e. differentiation within higher education) effects on labor market outcomes, but few have studied health returns from education (2). Data stem from a recent national student health survey from 2018 for higher education in Norway (the SHoT2018-study; N = 50 054, response rate = 30.8%). We examined the associations between level of ongoing education (One-year program, Bachelor, Master, longer professional education) and mental health problems measured with Hopkins Symptoms Checklist (HSCL-25; 3. There was a pattern of decreasing symptoms of mental health problems with level of study program, F (5,49782) = 103,34, p &amp;lt; .001. The results formed a monotonic relationship; each level of increased education was associated with significantly less mental health problems. There was no difference between the Masters and professional programs. We found evidence of horizontal stratification of mental health problems in this large sample of Norwegian college and university students. The observed association may have three explanations; causality may run from schooling to health (4), it may run from health to schooling (5), or both may be determined third factors. Further studies should investigate mechanisms such as stigma and social status in relation to the observed associations (6,7). 1 OECD. (OECD Publishing, 2015), 2 Conti, G. et al. Am. Econ. Rev. 100, 234-238 (2010), 3 Derogatis, L. et al. Behavioral science 19, 1-15 (1974), 4 Grossman, Michael et al. in Handbook of the Economics of Education (eds. Eric A Hanushek &amp; F. Welch) 1, (Elsevier, 2006), 5 Currie, J. J Econ Lit 47, 87-122 (2009), 6 Marmot, M. (Bloomsbury, 2004), 7 Hagquist, C. E. I. Eur J Public Health 17, 21-26 (2007) Key messages Increasing numbers of young adults pursue higher education, it is therefore important to investigate educational inequalities within higher education. College students pursuing higher education (masters or professional programs) have fewer mental health problems relative to college students enrolled in higher education, but at lower levels.

Physical exercise and body-mass index in young adults: a national survey of Norwegian university students

BackgroundPhysical inactivity and obesity pose a major public health challenge. The aim of this study was to describe the level of physical exercise and body-mass index in college and university students, as well as to examine potential changes from 2010 to 2018.MethodsData stem from the SHoT study, a national student health survey for higher education in Norway, conducted at 4-year intervals. The SHOT studies conducted so far in 2010, 2014 and 2018, included 6053, 13,525 and 50,054 fulltime students (aged 18–35), respectively. Exercise frequency (average number of times exercising each week) was assessed in all three waves, and was used for the trend analysis. The last wave in 2018 also assessed the average intensity and duration of the exercise.ResultsOverall, students exercised less in 2018 compared to 2014, but comparable to level in 2010. The prevalence of overweight increased substantially from 2010 to 2018, but especially in the last 4 years and among older female students. Less than one of four male, and one of five female students, met the recommended criteria for both exercise frequency, intensity and duration. As expected, the associations between exercise and overweight/obesity were in a dose-response manner, and strong across all three waves.ConclusionsOur findings show that the large majority of young adults fail to meet international recommendations on exercise, and that the proportion of overweight is increasing in both genders and across all age groups. We conclude that there is an urgent need for a broad approach to achieve a paradigm shift in supporting our college and university students to become more active.

Sexual harassment and assault among university students in Norway: a cross-sectional prevalence study

ObjectiveThe aim of the current study was to provide estimates of both overall and specific forms of sexual harassment among male and female college and university students.Design and settingData stem...

Cohort profile: the SHoT-study, a national health and well-being survey of Norwegian university students

PurposeThe SHoT study was set up as a national student health survey for higher education in Norway, conducted at 4-year intervals. The dataset comprises a wide range of self-reported data...

Sleep patterns and insomnia in young adults: A national survey of Norwegian university students.

The aim of this study was to describe sleep patterns and rate of insomnia according to diagnostic criteria in college and university students, as well as to examine potential changes in sleep problems from 2010 to 2018. Data stemmed from a national student health survey from 2018 for higher education in Norway (the SHoT study), which invited all 162,512 fulltime students in Norway. A total of 50,054 students (69.1% women) aged 18-35years were included, yielding a response rate of 30.8%. Sleep parameters, reported separately for weekdays and weekends, included calculations of bedtime, rise time, sleep duration, sleep-onset latency, wake after sleep onset, sleep need and sleep deficit. Insomnia was defined according to the Diagnostic and Statistical Manual of Mental Disorders (5th edn) criteria. For the trend analysis, we used one item measuring difficulties initiating and/or maintaining sleep, over three time points (2010, 2014 and 2018). The results from 2018 showed large weekday-weekend differences across most sleep parameters. Both male and female students obtained a mean sleep duration in the lower end of the normal range on weekdays (7:24 hr), but met their own sleep need and sleep recommendations at weekends (8:25 hr). The overall prevalence of insomnia was 34.2% in women and 22.2% in men. There was a substantial increase in sleep problems from 2010 (22.6%) to 2018 (30.5%), which was especially pronounced in women. We conclude that sleep problems are both prevalent and increasing among students. This warrants attention as a public health problem in this population.

Relationship between perceived body weight and body mass index based on self- reported height and weight among university students: a cross-sectional study in seven European countries.

BackgroundDespite low rates of obesity, many university students perceive themselves as overweight, especially women. This is of concern, because inappropriate weight perceptions can lead to unhealthy behaviours including eating disorders.MethodsWe used the database from the Cross National Student Health Survey (CNSHS), consisting of 5,900 records of university students from Bulgaria, Denmark, Germany, Lithuania, Poland, Spain and Turkey to analyse differences in perceived weight status based on the question: "Do you consider yourself much too thin, a little too thin, just right, a little too fat or much too fat?". The association between perceived weight and body mass index (BMI) calculated from self-reported weight and height was assessed with generalized non-parametric regression in R library gam.ResultsAlthough the majority of students reported a normal BMI (72-84% of males, 65-83% of females), only 32% to 68% of students considered their weight "just right". Around 20% of females with BMI of 20 kg/m2 considered themselves "a little too fat" or "too fat", and the percentages increased to 60% for a BMI of 22.5 kg/m2. Male students rarely felt "a little too fat" or "too fat" below BMI of 22.5 kg/m2, but most felt too thin with a BMI of 20 kg/m2.ConclusionsWeight ideals are rather uniform across the European countries, with female students being more likely to perceive themselves as "too fat" at a normal BMI, while male students being more likely to perceive themselves as "too thin". Programs to prevent unhealthy behaviours to achieve ill-advised weight ideals may benefit students.

Anemia in Mexican students

The objective of the study was to describe the prevalence and distribution of anemia in Mexican students from Elementary and Secondary Public Schools. Information was gathered from 55,034 students from the National Student Health Survey, 2008 (ENSE, 2008). A portable photometer was used to determine hemoglobin concentration by the capillary puncture method. The cut values used to classify anemia are those designated by WHO. Results showed that female students aged 12 years and over, had lower concentrations of hemoglobin (14.00 ± 1.50 in comparison with male students 14.21 ± 1.54 mg/dL; P &lt;0.001). However, male students aged 12 years and over, had a higher prevalence of anemia (20.99 vs.11.72%; P&lt;0.001), than female students. Once disaggregated by educational level, elementary school students showed a higher prevalence of anemia, than secondary school students (21.2 vs.14.4%; P&lt;0.001). In a logistic regression model, the highest risk of anemia was associated with being a man (OR 1.26, CI95% 1.17, 1.36) and belong to secondary school (OR 1.15, CI95% 1.01, 1.30) and the probability of having anemia decreases as age increases (OR 0.87, CI95% 0.86, 0.89). Prevalence of anemia is still of high magnitude in Mexican students, so big efforts have to be done to undertake measures for prevention and control.Supported by the Rio Aronte Foundation, and Fondo de Apoyo al Programa Intersectorial de Educacion Saludable.