School-aged Children Research Articles

Impact of the COVID-19 pandemic on lifestyle’s behaviours of school-aged children in Portugal

Abstract Background COVID-19 pandemic impacted children’s daily routines. Based on this, WHO Collaborating Centre for Nutrition and Childhood Obesity in collaboration with WHO Regional Office for Europe coordinated the study about the impact of COVID-19 on lifestyle’s behaviours of school-age children in Europe, where 17 Member States participated, including Portugal. Methods Cross-sectional study was conducted within the sixth round of COSI Portugal, following a WHO common methodological protocol, during 2021-2022 school year. A national representative sample of families with children 6-8 years old were included and asked to report on variables comparing two periods: pre and during the COVID-19 pandemic. Results 5139 families participated. 11.4% reported a worsening of their perceived wealth and the percentage of fathers and mothers working full- or part-time decreased (74.6% to 68.7% and 70.6% to 59.6%, respectively) during pandemic. Children’s consumption of sweets (19.4%), savoury snacks (13.8%), fruit (11.9%) and vegetables (7.1%) increased, and sugary soft drinks (13.8%) decreased during pandemic. Family behaviours with the highest increases during pandemic were “eating together as a family” (35.4%), “cooking meals together with your child” (33.6%), “buying food in large quantities” (33.6%) and “eating home-cooked meals” (29.1%). Approximately, one in four parents reported children’s physical activity decreased and almost one in two reported an increase in recreational screen time. Parents who perceived their child as overweight during pandemic doubled (f7.9% to 14.6%). Children’s well-being behaviours that worsened more during pandemic were “having fun with friends” (44.3%), “got on well at school” (27.9%), “feel full of energy” (23.8%) and “feel fit and well” (22.2%). Conclusions These observations underscore the need to “build back better” post-pandemic with a focus on preventing and controlling childhood obesity and its determinants. Key messages • Portuguese children experienced negative impacts of the pandemic in their lifestyle behaviours, particularly on their physical health and well-being, with a report of a poorer socioeconomic situation. • This study and its findings give us a first-of-its-kind view into the physical and mental outcomes of the pandemic on school-aged children with a focus on the long-term, high-risk disease of obesity

Preventing unintentional injuries due to home and leisure time accidents in children: the parents’ beliefs matters (CHILD Vigilance project - CHIVI)

Abstract Background The CHILD Vigilance project is a European study supported by the Injury Prevention section of the European Public Health Association and aims at contributing to the epidemiological knowledge of injuries and accidents in Greece, Portugal and Lithuania, through increasing knowledge on parents’ and caregivers’ safety perceptions. Methods A descriptive, observational, cross-sectional study was developed in these countries between February and April 2023, under the CHILD Vigilance project. Information was collected online via a questionnaire exploring parents’ and/or caregivers’ knowledge, attitudes and risk perception towards prevention of unintentional injuries in children and adolescents. Results A total of 916 valid responses were obtained, involving 1229 children (51.4% male; mean age 7.8 years). Falls were perceived as the most common type of unintentional injuries in pre-schoolers and school-age children (47,8% in Greece; 63,5% in Portugal; 74,8% in Lithuania). Country differences were observed in terms of the most commonly perceived types of injury in adolescents, which were road traffic crashes in Greece and Portugal (41.2% and 39.5% respectively) vs poisonings in Lithuania (38.1%). Some differences were also observed between these countries as to the most common causes of death. In Greece and Lithuania diseases were reported as the main cause of death in pre-schoolers (62.5%; 35.1%) and in children attending primary education (55.1%; 29.7%), while injuries were identified as a cause only in the oldest group of children. In Portugal on the other hand, injuries were identified as the most frequent cause of death in all groups, pre-schoolers (40.5%), children attending primary education (47.1%) and in the oldest (55.1%). Conclusions The study emphasizes the need to address misperceptions, improve safety attitudes and invest more efforts in managing harmonised injury outcomes across global initiatives.

Public health prevention programmes for mental illness in school-age children and adolescents

Abstract Background Psychiatrists, psychotherapists and other mental health professionals have long stated the importance of adequate social groups and early intervention for the prevention of severe mental diseases. With psychiatric illness incidence increasing most in the adolescent and young adult populations, we propose the use of school-age directed public mental health initiatives to combat remaining social stigma and promote mental wellbeing, as well as educate children and adolescents in how to recognise symptoms and ask for help. Methods We conducted a systematic review on PubMed as well as government and NGO websites to identify public health initiatives in the prevention and early identification of mental illness among young individuals. Results Preliminary results show that, while certain countries have delineated guidelines on how to support students’ mental health, very few have implemented nation-wide, or even region-wide programmes that directly target prevention and education. A particular note should be made regarding substance abuse and addiction, one of the few illnesses for which many countries have already enacted in-school programmes, that however often overlook the medical aspect of such diseases. Of further note are certain local programmes aimed at offering quality and accessible care to adolescents struggling with mental diseases. Conclusions With psychiatric diseases projected to become one of the greatest contributors to the global burden of disease by 2030, and the importance of early intervention in preventing severe psychiatric illness, we advocated for European public health initiatives implemented in schools, which could be crucial in curbing the spread of mental illness. Key messages • Adolescent and young adults are those most affected by the rising prevalence of mental illness. Consequently, we advocate for in-school programmes to aid in early identification and intervention. • Early identification of mental diseases is crucial in the prevention of severe psychiatric illness, but little has been done so far in terms of public health interventions to tackle such problems.

Digital interventions to prevent smoking habit among children. Is there evidence?

Abstract Smoking remains one of the foremost preventable causes of death and disease on a global scale, with its roots often traced back to early childhood. The habit typically begins at a young age, setting a pattern that becomes increasingly difficult to break over time. This enduring issue highlights the critical need for effective preventive measures. Traditional approaches to curbing smoking among the youth-such as public health campaigns, school-based education, and legislative measures like age restrictions on tobacco purchases-have had limited success. In this context, digital interventions (DIs) have begun to emerge as a promising new frontier for tobacco prevention. Leveraging the pervasive influence of technology in young people’s lives, these interventions include gamified educational programs, which transform learning about the dangers of smoking into interactive and engaging activities; social media campaigns, which can spread powerful anti-smoking messages quickly and broadly; and virtual reality experiences, which immerse users in scenarios that vividly illustrate the impact of smoking on health. These digital strategies not only offer fresh avenues for conveying important health information but also engage young audiences in a medium they find relatable and compelling. In this context, the presentation will discuss results of a systematic review aims to assess the efficacy of DI in preventing smoking, and improving knowledge and awareness about smoking damages, among children. This review is part of the PRIN project, titled: “Leo&Giulia standing for public health”, whose goal is to evaluate the effectiveness of a DI aimed at school-aged children, intended to increase knowledge about the negative effects of smoking and prevent its use. Grasping the impact of DI in smoking prevention can greatly benefit public health by offering practical alternatives.

Effect of body mass index on quadriceps angle and tibial torsion in school-aged children

BackgroundThe prevalence of excessive body mass (BMI) is increasing in pediatric population. Accordingly, the number of musculoskeletal problems in this population is also likely to increase. The quadriceps angle (Q-angle) is a clinical measure used to measure knee alignment in relation to the hip, femur, and tibia, as well as evaluating alignment of the patella. Tibial torsion (T.T) is an important morphological feature of human tibia. The aim of that study was to study the relationship between the Q-angle and TT in children 8 to 12 years old, the effect of BMI on Q-angle and T.T, and the difference in Q-angle and TT between dominant and non-dominant side.Results“Seventy-five children from primary schools” were enrolled in the study and allocated into 3 groups (25 subjects in each group), according to BMI: group I (normal weight = 25), group II (overweight = 25), and group III (obese = 25). The mean value of age of groups I, II, and III was 10.35 ± 1, 10.74 ± 1.2, and 10.17 ± 1.18 years respectively; the mean value of weight was 29.88 ± 3.94, 43.68 ± 6.55, and 50.06 ± 10.44 kg respectively; the mean value of height was 135.28 ± 7.63, 143.2 ± 8.85, and 140.72 ± 9.3 cm respectively; and the mean value of BMI was 16.22 ± 1, 21.18 ± 1.4, and 25.17 ± 2.67 kg/m2. The number (%) of boys in groups I, II, and III was 15 (60%), 18 (72%), and 17 (68%) respectively and of girls was 10 (40%), 7 (28%), and 8 (32%) respectively.The significant values were Q-angle and TT. Data were expressed as mean ± SD. ANOVA was used to compare between subjects’ characteristics of the groups. Kolmogorov-Smirnov test was used for testing normality of data distribution. One-way MANOVA was used to compare parametric variables (Q-angle and TT) between the two groups. Compared with normal weight children, there was statistically significant increase in Q-angle and TT angle in overweight and obese children.ConclusionAny change in BMI would eventually lead to change in both Q-angle and TT angle. The greater the BMI values, the greater the values of Q-angle and TT angle.

A comprehensive evaluation of an artificial intelligence based digital pathology to monitor large-scale deworming programs against soil-transmitted helminths: A study protocol.

Manual screening of a Kato-Katz (KK) thick stool smear remains the current standard to monitor the impact of large-scale deworming programs against soil-transmitted helminths (STHs). To improve this diagnostic standard, we recently designed an artificial intelligence based digital pathology system (AI-DP) for digital image capture and analysis of KK thick smears. Preliminary results of its diagnostic performance are encouraging, and a comprehensive evaluation of this technology as a cost-efficient end-to-end diagnostic to inform STH control programs against the target product profiles (TPP) of the World Health Organisation (WHO) is the next step for validation. Here, we describe the study protocol for a comprehensive evaluation of the AI-DP based on its (i) diagnostic performance, (ii) repeatability/reproducibility, (iii) time-to-result, (iv) cost-efficiency to inform large-scale deworming programs, and (v) usability in both laboratory and field settings. For each of these five attributes, we designed separate experiments with sufficient power to verify the non-inferiority of the AI-DP (KK2.0) over the manual screening of the KK stool thick smears (KK1.0). These experiments will be conducted in two STH endemic countries with national deworming programs (Ethiopia and Uganda), focussing on school-age children only. This comprehensive study will provide the necessary data to make an evidence-based decision on whether the technology is indeed performant and a cost-efficient end-to-end diagnostic to inform large-scale deworming programs against STHs. Following the protocolized collection of high-quality data we will seek approval by WHO. Through the dissemination of our methodology and statistics, we hope to support additional developments in AI-DP technologies for other neglected tropical diseases in resource-limited settings. The trial was registered on September 29, 2023 Clinicaltrials.gov (ID: NCT06055530).

Preventing unintentional injuries in children: the parents’ beliefs matters (CHILD Vigilance)

Abstract The CHILD Vigilance project is a European study supported by the Injury Prevention & Safety Promotion Section of the European Public Health Association (EUPHA INJ) and aims at assessing parenting knowledge and attitudes that are relevant to supervision and risk taking in children. For children the majority of these injuries occur in or around the home when their safety is the responsibility of a parent or other caregiver. The study aims contribute to the epidemiological knowledge of injuries through the study of the perceptions of parents and caregivers of children and adolescents. A descriptive, observational, cross-sectional study was developed under the CHILD Vigilance project, developed at European level within the scope of the Injury Prevention & Safety Promotion Section of the European Public Health Association. The information was collected by survey, from parents’ associations and schools in the EU countries represented in the EUPHA INJ Section. A total of 916 valid responses were obtained, involving 1229 children (51,4% male; mean age 7,8 years). Falls were perceived as the most common type of unintentional injuries in pre-schoolers and school-age children (47,8% in Greece; 63,5% in Portugal; 74,8% in Lithuania). However it was found differences in these countries as to the most common type of injury in adolescents, pointing out road traffic crashes (41.2% in Greece vs 39.5% in Portugal) and poisonings in Lithuania (38,1%). Some differences were also observed between these countries as to the most common causes of death. In Greece and Lithuania diseases were reported the main cause in the pre-schoolers (62,5%; 35,1%) and in primary education (55,1%; 29,7%), being injuries pointed as the most frequent cause only in the oldest. The study emphasizes the need to invest in the identification of appropriate determinants of child unintentional injuries and harmonised injury outcomes across global initiatives. Key messages • The lack of data regarding to parents’ knowledge on injury prevention involving children highlight the need to conduct this type of studies. • The need for adequate epidemiological data on the burden of child injuries and validated tools to accurately measure injuries.

Sleep difficulties as a universal risk factor for injury among adolescents in 46 countries

Abstract Background Poor sleep is common among adolescents and associated with unintentional injuries. The current evidence base is limited by differences in measures of sleep and injury implemented across studies. We examined the potential universality of the relationship between poor sleep and injury cross-nationally using self-reports from 229,589 adolescents in 46 countries that were collected using common procedures and measures. Methods A cross-sectional study was conducted using records from the 2017/18 Health Behaviour in School-aged Children (HBSC): World Health Organization cross-national study. The prevalence of sleep indicators (difficulties in falling asleep, insufficient sleep, social jet lag) and medically treated injuries (overall, multiple) were described across countries and by gender. Multivariable modified Poisson regression analyses were conducted within and across countries to test the consistency of the association between poor adolescent sleep and injuries. Results Overall, indicators of poor sleep were reported by nearly half of adolescents, and varied by gender and across countries. Country-level analyses found consistently positive associations between indicators of poor sleep and injuries. Pooled (multi-country) analyses further demonstrated a universality of these relationships across sleep indicators and injury outcomes. The strength of relationships varied by gender, with more robust associations detected among girls compared to boys. Conclusions Poor sleep is a robust and mainly consistent risk factor for injury among adolescents across countries and regions. Public health officials and policymakers should therefore recognize adolescent sleep as a health priority. The promotion of sleep hygiene may represent a novel target for injury prevention at regional and national levels. Key messages • Poor sleep, in the form of sleep difficulties, insufficient sleep, and social jet lag, were robust and mainly consistent injury risk factors among adolescents across 46 countries. • Public health officials should recognize sleep hygiene as a novel focus for adolescent injury prevention.

Unlocking adolescent dietary behaviours: the causal role of social contexts

Abstract Background Using a causal inference framework, our study aimed to extend previous work in providing a comprehensive understanding of the role various social contexts across different levels can play in predicting adolescent dietary behaviours. Methods Data came from the 2017/18 Health Behaviour in School-aged Children (HBSC) survey in Flanders (Belgium). The sample included representative data from 8,702 adolescents in 165 schools. Social factors at individual-level (family meals, family, peer, student and teacher support) and at contextual-level (school culture of student and teacher support and school-level socioeconomic status [SES]) were considered. Multilevel logistic regression analyses were performed. Results At individual-level, family meals and family and student support were positively associated with fruit and vegetable consumption, family meals with sweet consumption too. Student and teacher support showed positive associations solely with fruit consumption. At contextual-level, adolescents attending schools with a lower school-SES demonstrated lower vegetable consumption. Culture of teacher support was negatively associated with sweets but also vegetable consumption. For culture of student support no associations were found. Conclusions The study mainly provide cues for strengthening family social ties as dietary health promotion initiatives, with some evidence supporting the role of beneficial peer and school social factors. Mixed results for contextual school-level social factors warrant further research to identify additional school-related influences on adolescent dietary behaviours to advance current understandings. Key messages • Family meals and support promote healthy eating in adolescents, emphasising the health promoting role of family social ties in dietary habits. • Mixed findings on school-level social factors call for more research on school health policies.

Risk of eating disorders and body image in adolescents in Belgium: is migration status a modifier?

Abstract Background The risk of eating disorders (ED) has been linked to body image (BI) dissatisfaction in adolescents. In addition, the origin and host country culture may influence BI dissatisfaction. Our objective was to assess the modifying effect of migratory status on the association between BI and risk of ED in Belgium, a setting characterized by a large proportion of migrant adolescents. Methods In the 2022 cross-sectional “Health Behaviour in School-aged Children” (HBSC) study in French-speaking schools, 7,267 adolescents aged 12 to 20 self-completed questionnaires. Risk of ED was determined by an Eating Attitude Test (EAT-7), score ≥5. BI was categorised into 3 groups: “too thin”, “about the right size” and “too fat”. Migratory status was divided into “native”, “2nd generation” and “1st generation” migrants. The association between BI and ED was estimated using logistic regressions adjusted for socioeconomic and psychosocial characteristics. After the inclusion of the “migration*BI” interaction term, migration-stratified logistic regressions were conducted. Results Overall, 13.0% of students were at risk of ED. Percentages of ED were 15.7% among those who perceived themselves as “too fat” (vs. “about the right size”: aOR=1.67 [95%CI: 1.34-2.08]) and 19.4% in the “too thin” group (aOR=3.36 [2.54-4.45]). Despite non-significant interaction terms, perceiving themselves as “too fat” (vs. “about the right size”) was not associated with the risk of ED in 1st generation migrants (aOR: 1.24 [0.67-2.29]). Compared with the overall estimation, it was lower in 2nd generation migrants (aOR: 1.43 [1.00-2.03]) while it was slightly higher in natives (aOR: 1.95 [1.45-2.62]). Conclusions These findings suggest complex interrelations between BI and risk of ED according to migratory status in adolescents with potential underlying mechanisms involving cultural norms. Promoting positive BI as a possible way for preventing the development of eating disorders need to be further investigated. Key messages • This study shows differences of body image dissatisfaction according to the migratory status in adolescents, inducing potential impacts on the risk of eating disorders. • Better understanding differences in body perception related to cultural background could help prevent risk of eating disorders in adolescents, by promoting positive body image for example.

Leveraging epidemiological data for the development of interventions to promote healthy nutrition and physical activity among adolescents from disadvantaged backgrounds

Abstract ePro-Schools is a public health initiative designed to promote healthy nutrition and physical activity among adolescents from socially disadvantaged backgrounds using a targeted e-health intervention to be deployed in the school context. A central theme of ePro-Schools is its robust cross-sectoral collaboration, involving stakeholders from academia, healthcare, education, and local communities. This cooperative approach not only enhances the intervention’s relevance and efficacy but also ensures its cultural, social, and economic adaptability to the needs of the target population. The project embodies a truly interdisciplinary effort, integrating insights from epidemiology, behavioural science, public health, and digital technology to innovate and improve health promotion strategies. This presentation will explore how data from epidemiological studies, such as the Health Behaviour in School-aged Children (HBSC) study, are used to support the development of the ePro-Schools intervention. Utilizing high-quality epidemiological data, the project identifies key determinants of physical activity, dietary habits, and sedentary behaviour amongst adolescents growing up in low-SES contexts, allowing to craft tailored strategies to promote healthier lifestyles within this vulnerable population.

Tobacco and nicotine products use among adolescents in Serbia – Latent class analysis

Abstract Background In parallel with a decline in cigarette smoking in the previous decade, other tobacco and nicotine products (TNPs), that are often used concurrently, have gained popularity among adolescents. The purpose of this study was to identify patterns of tobacco and nicotine product use among Serbian adolescents. Methods Data for this study were obtained from Health Behavior in School-aged Children (HBSC), a WHO collaborative cross-national study of adolescent health and well-being, that was conducted in Serbia in 2022 on a sample of 3713 students 11,13 and 15 years old. Descriptive statistics was used as well as latent class analysis to classify students based on their past-month use of cigarettes, e-cigarettes, heated tobacco products, waterpipes, and oral tobacco/nicotine products. Results Among students 11,13 and 15 years old, 10.2% smoke cigarettes, 13% use e-cigarettes, 11.1% waterpipes, 3.7% oral tobacco/nicotine products, and 4.5% heated tobacco products with differences by age and sex. We found high percentages of dual use of TNPs among cigarette smokers. Among students who smoke cigarettes, 61.6% also use e-cigarettes, 36.2% smoke waterpipes, 30.2% heated tobacco products, and 24.1% oral tobacco/nicotine products. Latent class analysis identified three classes as optimal solution: (1) dual e-cigarette and cigarette users (6.9%); (2) minimal/non-users (83.2%) and (3) poly tobacco and nicotine products users (9.9%). Statistically significant differences between classes were found in age and sex. Conclusions Dual and poly-tobacco and nicotine use is common among Serbian adolescents and presents a challenge for monitoring and public health response. Findings contribute to a better understanding of patterns and heterogeneity of TNPs use among adolescents and might have implications for prevention and cessation interventions for youth. Key messages • Among students 11,13 and 15 years old, tobacco and nicotine products, other than cigarettes is gaining popularity and with the e-cigarettes being the most popular product. • Dual and poly tobacco and nicotine products use is new challenged that should be taken into account in tobacco and nicotine monitoring, cessation and prevention.

Impact of loneliness and social support on leisure physical activity in adolescents in Luxembourg

Abstract Background Healthy lifestyle includes a regular practice of vigorous physical activity in adolescents’ leisure time. Engaging in physical activity (PA) depends on individual, social and environmental factors. Previous literature has showed that social support and loneliness can influence the practice of PA. The study aims to analyse the relation between PA during leisure time and social support and loneliness among adolescents in Luxembourg. Methods The study includes 7049 adolescents from the Health Behaviours in School-aged Children (HBSC) Luxembourg 2022 survey. PA in leisure time was categorised according to WHO recommendations for vigorous physical activity. Perceived social support (friends, family, teacher, and classmate) was dichotomised in high support and in low/medium and loneliness in feel often lonely and not feel often lonely. It was executed a binomial logistic regression to analyse the PA levels in leisure time by loneliness and social support, controlling by age, migration background, perceived wealth, and family structure, split by gender. Results In Luxembourg, boys who perceived high support from most of the sources and didn’t feel often lonely had higher chances to reach WHO recommendations for PA during leisure time (e.g. loneliness: OR = 1.38, CI95%[1.11-1.74]; family support: OR = 1.31, CI 95%[1.10-1.56]), except for teacher support (OR = 0.79, CI95%[0.67-0.93]). In contrast, girls who only perceived high support from classmates (OR = 1.21, CI95%[1.05-1.4]) and teachers (OR = 1.19, CI95%[1.01-1.38]) had higher chances to be physically active. Conclusions This is the first study to investigate the impact of social support and loneliness among adolescents in Luxembourg. Future research should investigate social-related barriers and facilitators of PA during leisure time. Key messages • Understanding adolescents social support can guide towards effective strategies that promote physical activity during leisure time. • Boys benefit from several social support sources, while girls thrive with encouragement from classmates and teachers to stay physically active in leisure time.

Inequities in child health in Luxembourg

Abstract Background In Luxembourg, despite its economic prosperity, 28.6 % of children are estimated to be at the risk of poverty. Research has shown that growing up with socioeconomic disadvantage is associated with worse physical and mental health in childhood. We explore the association of socioeconomic status with health, health behaviours and access to healthcare in Luxembourg for children up to age twelve. Methods We used data from 2014 to 2022 for 11-12 year old children from the Health Behaviour in School-aged Children (HBSC) survey as well as social security data from Luxembourg for a similar time period and children 0 to 12 years old. To assess socioeconomic status, we used information on self-perceived household wealth for the HBSC results and stratified health and health behaviours by well-off, average, or less well-off households. For the social security data, we stratified access to care indicators by equivalized household income quintiles. Results We found that physical activity levels, nutritional quality and daily routines such as eating breakfast and brushing teeth are significantly lower in children from less affluent families. For example, 61% of 11-12-year-old children from well-off families reported eating breakfast every day, but only 41% of children from less well-off families. Only 23% of 11-12 year olds from less affluent families rated their health as excellent, compared to 52% of children from affluent families. There were similarly large differences for multiple health complaints, with 63% of children from less affluent families reporting this indicator for psychosomatic problems, compared to 34% of children from affluent families. We did not find differences in the use of pre- and postnatal care visits. Conclusions Socioeconomic differences in child health, mental health and health behaviours are large, with children from poorer households being in worse physical and mental health and less likely to report positive health behaviours. Key messages • Many children in Luxembourg face socioeconomic challenges that are adversely associated with health and health behaviours. The underlying reasons require further attention to improve child health. • Children from poorer backgrounds are in significantly worse mental health than children from better off families in Luxembourg.

7.N. Round table: Social media & smartphones: Threats to child & adolescent health and public health solutions

Abstract The daily lives of children and adolescents in 2024 are heavily influenced by social media and smartphones, which is unprecedented in previous generations. While this technology offers undoubted benefits, there is strong evidence on the negative effects of social and cognitive development of infants and primary school aged children, and mental health impacts in adolescents including depression, anxiety, sleep disruption, addictive behaviours and self-harm. Internet companies are financially incentivised to maximise screen time of users to generate advertising revenue, and more time spent by young people on these devices in a largely unregulated online domain increases risk of consequences like bullying and harassment, body dysmorphia, gambling addiction, porn addiction, sexual predation and suicide. Comprehensive solutions are urgently needed to regulate the activities of social media and tech companies and support young people to protect themselves from serious harms. Governments have been slow to introduce policies such as smartphone bans or enhanced privacy laws, perhaps because they are perceived as unpopular infringements on the rights of adult users and/or due to a potential detrimental effect on commercial interests. Guidance can be disseminated to young people, schools, families and institutions on how to reduce screen time and smartphone addiction, and improve coping and self-regulation to mitigate these risks. Information campaigns with positive health messages in this area, to compete with the advertising dominance of social media companies, are another opportunity to improve behaviours and reduce adverse health effects. The objectives of this round table workshop are to share examples of strategies, guidance and policies from across Europe, and discuss with the audience how the public health community can collaborate to tackle this problem. Members of the EUPHA Child and Adolescent Public Health (CAPH) section will outline the latest available evidence on the negative impacts of social media and screens, present examples of innovative public health responses and strategies to protect children, and engage conference participants for their input and discussion. Five panellists will present. First, John will start with a quiz of the audience which will include presentation of current data and trends relating to social media and smartphone usage. The second presentation by Cecilia will highlight in detail evidence of both benefits and adverse effects of these technologies in the lives of young people. The third speaker Karin will discuss examples of effective policies to reduce this impact, with a focus on the role of schools. The fourth speaker Jean will give further examples of public health actions, and share recommendations directly from children and young people. The fifth panellist Silja will re-quiz the audience, to gauge the reaction and support of solutions that were covered, and this will lead into the interactive discussion. Key messages • Popularity of smartphones and social media has increased dramatically in recent years, particularly among minors, with significant impacts on mental and physical health. • Public health solutions are urgently needed, and this workshop will share examples of effective innovative responses in European contexts, followed by an interactive audience discussion.

Electromagnetic fields exposure and neuropsychological effects in young people

Abstract Background In recent years, there has been a large increase in the use of communication/connected devices and technologies. This raises a question about radiofrequency electromagnetic fields (RF-EMF) exposure levels and neuropsychological effects of RF-EMF in young people. The aim of this study was to assess the pattern of use of communication/connected devices and technologies and its impact on cognition and mental health of early school age children in Poland. Methods The study population consists of 293 children from Polish Mother and Child Cohort (REPRO_PL). The study was based on questionnaire data covering type and duration of usage of communication/connected devices and technologies by mothers during pregnancy and children at age of 7 years. The environmental exposure to RF-EMF was also taken into account. Based on such data RF-EMF exposure was assessed. Child emotional and behavioral assessment was done by Strengths and Difficulties Questionnaire whereas IQ and psychomotor development of children was performed by psychologist using Intelligence and Development Scales. Results About 75% of young people used smartphones (2% for voice calls and 7% for Internet browsing at least one hour per day). Tablet or laptop use was declared by 59% and 56% of respondents, respectively. More than 10% declared that they use these devices at least one hour a day. The main factors determining the use of new technology devices were parental age and education (p < 0.05) and the age at which youth started school education (p = 0.06). In multivariable regression model higher level of RF-EMF was associated with total difficulties and emotional problems (p < 0.05). Conclusions This study presents the pattern of use of new technology devices by early school age children in Poland and the association between the exposure to RF-EMF and child mental health. Key messages • The use of communication/connected devices and technologies is common among young people in Poland. • The exposure to RF-EMF can increase mental health problems among young people.

Are early emotional and behavioral problems related to subsequent asthma in preschool children?

Abstract Background The most common mental health problems in preschool children are emotional and behavioral problems, and one of the most common chronic inflammatory diseases in children is asthma. Most research on the relationship between emotional and behavioral problems and asthma includes school-aged children. The current study aimed to explore the association between emotional and behavioral problems during preschool years and the risk of asthma in a Swedish context. Methods The study was a longitudinal cohort study, with 6954 children aged 3-5 years for which data on emotional and behavioral problems through the Strengths and Difficulties Questionnaire were collected in Uppsala Region, Sweden, between 2013 and 2017. The cohort was followed with data from the National Patient Register from 2013 to 2022. Asthma was defined as having at least three diagnoses (ICD-10 codes: J45-J46) during follow-up. Unadjusted and adjusted cox regression models were used to analyze data. Results A total of 269 children (3.9%) had diagnosed asthma during follow-up. Preliminary results show that children with emotional symptoms, rated separately by mothers (HR: 1.62, 95% CI: 1.20-2.20), fathers (HR: 1.49, 95% CI: 1.10-2.03), and preschool teachers (HR: 1.53, 95% CI: 1.08-2.16) had increased risk of being diagnosed with asthma according to unadjusted cox-regression models. In addition, children with total emotional and behavioural problems, rated by fathers (HR: 1.51 95% CI: 1.10-2.07) were also at higher risk of being diagnosed with asthma. These associations remained significant when adjusting for background and sociodemographic factors. Conclusions Our findings point to the significance of a clinical awareness of the relation between emotional and behavioral problems and asthma in young children. Our findings highlight the importance of also considering somatic problems, including asthma, in children with early signs of emotional and behavioral problems. Key messages • Emotional and behavioral problems in preschool children is related to being diagnosed with asthma. • Somatic problems, as asthma, needs to be considered in children with emotional and behavioral problems.

Overcoming barriers in implementing healthy school nutrition policies: insights from Ukraine

Abstract The general mortality rate from NCDs in Ukraine exceeds that in European Union countries, (Yurochko et al., 2023) exacerbated by the ongoing war. Healthy nutrition plays a pivotal role in enhancing the overall quality of life and curbing the prevalence of non-communicable diseases (NCDs). Despite its significance, ensuring healthy eating habits, particularly during the early stages of life at the period of setting lifelong habits (Jackson et al., 2020; Riley et al., 2018), remains a challenge. Besides, school-based settings represent an ideal environment for effective intervention because they offer a shared common physical, academic, and social space (Tapia-Fonllem et al., 2020). Through a series of semi-structured interviews with key stakeholders, this study identifies barriers and facilitators to policy implementation, with a focus on educational institutions. Qualitative analysis reveals barriers such as inadequate human resources, funding constraints, resistance from the food industry, and ineffective communication strategies at the family level. Moreover, there exists a disjointed understanding of nutrition standards. However, collaborative efforts with civil society, empowerment of nursing roles, strategic utilization of grants and fundraising, engagement with the food industry, and the adoption of a family-oriented approach emerge as crucial enablers for successful policy implementation. These findings offer theoretical foundations for fostering healthier nutrition environments within schools. This research serves as a roadmap for policymakers and educators striving to create sustainable and effective strategies for promoting healthy eating among early school-age children in Ukraine and beyond. Study finds human resource shortages, funding constraints, and food industry resistance as major barriers to school nutrition policy. Recommendations include collaborative approaches, nurse involvement, and aligned standards for effective school nutrition policy. Key messages • Healthy nutrition plays a pivotal role in enhancing the overall quality of life and curbing the prevalence of non-communicable diseases. • Through a series of semi-structured interviews with key stakeholders, this study identifies barriers and facilitators to policy implementation, with a focus on educational institutions.

Optimal child-led goal setting practices for school-aged children with a disability or delay: an international Delphi consensus study

Aim To achieve expert consensus on optimal child-led goal setting and evaluation practices for school-aged children (5 ≤ 17 years) who have a disability or delay. Method A three-round, eDelphi consensus design was used. In Round 1, expert allied health professionals identified factors important during child-led goal setting for: (i) planning, (ii) process steps and tools, and (iii) support strategies. Factors were collated into items for Rounds 2 and 3. Participants rated item agreement on a 7-point Likert scale. Consensus was determined as ≥75% of participants in agreement or disagreement. Results Sixty professionals from nine countries and six disciplines participated. Of 323 unique items generated, 159 (50%) reached consensus. Strong agreement was reached for goal setting and evaluation “process steps” and “support strategies” to engage children. It was strongly recommended that allied health professionals should tailor their processes to each child’s individual needs, provide ability-specific strategies and resources, and empower children to share their perspectives. Fewer items reached consensus for “planning” and “tools” to guide child-led goal setting. Interpretation Professional experts agree that children can be actively involved in goal setting and evaluation. Future research should focus on tools and technologies to support child-led goal setting for children with diverse abilities.

Enhance physical, mental and academic wellbeing of pupils in Germany through digital health literacy

Abstract Background Digital health literacy (DHL) involves the ability to find, understand, appraise, and apply health information from digital sources. It serves as the foundation for informed decision-making about one’s health and well-being using digital technology and online health information sources and services. Despite its significance, the role of DHL in relation to schoolchildren’s wellbeing remains underexplored. Therefore, this study aims to investigate how schoolchildren’s DHL influences their physical, mental, and academic well-being. Methods The cross-sectional survey comprised a representative sample of N = 1448 school-aged children (9-18 years) living in Germany. DHL was assessed via a translated and adapted version of the DHL instrument. The assessment of physical, mental, and academic well-being relied on the KINDL questionnaire. Linear regression analyses were conducted, with the scale score of physical, mental, and academic well-being serving as dependent variables and DHL as predictor. Additionally, potential confounding variables such as sex, age, migration background, subjective family wealth, chronic illness, and subjective health status were included in the analyses. Results All three regression models were significant (physical: F(9,1325) = 34.99, p < .001; R2 = 0.19; mental: F(9,1320) = 27.43, p < .001; R2 = 0.16; academic: F(9,1336) = 15.19, p < .001; R2 = 0.09). DHL significantly predicted physical (B=.08, p=.01), mental (B=.17, p<.001), and academic (B=.21, p<.001) wellbeing. Conclusions This study provides the first evidence of the predictive power of DHL for schoolchildren’s physical, mental, and academic well-being. It emphasizes the importance of promoting DHL in schoolchildren to empower them to find, understand, appraise, and apply digital health information effectively. Key messages • Digital health literacy significantly predicts schoolchildren’s physical, mental, and academic well-being. • Promoting digital health literacy can empower schoolchildren to make informed decisions about their well-being.