School-based Data Research Articles

Condom non-use among adolescents: Prevalence and associated factors among school-going adolescents from 58 countries

ObjectivesStudies in several resource-limited settings have investigated the prevalence and potential factors associated with condom non-use among adolescents, showing inconsistent and varied findings, owing to methodological inconsistencies. Thus, this study aimed to investigate the prevalence and associated factors of condom non-use among a global sample of adolescents and their differences based on sex and region. MethodsWe conducted a cross-sectional study using the 2009–2018 Global School-based Health Survey data from 58 countries which included 183,100 adolescents aged 12–15 years. Random-effects meta-analysis was used to estimate the overall and regional pooled prevalence of condom non-use. Multilevel mixed-effect logistic regressions were used to investigate the correlates of condom non-use. ResultsOverall, 26.2% of the total sample reported being sexually active and of these, 27.6% did not use condoms during last intercourse, with boys reporting higher than girls (27.9% vs. 25.6%). The prevalence of condom non-use was the highest in the African region (29.2%) and the lowest in the South-East Asia region (21.1%). There were variations in prevalence across countries, regions, and sex. Female gender, older age, loneliness, suicidal ideation, being bullied, parental support and supervision, truancy, smoking, illicit drug use, early sexual initiation, and having multiple sex partners were associated with condom non-use. There was evidence of heterogeneity of correlates across regions and sex. ConclusionsIn this analysis, we found variations in the prevalence and associated factors of condom non-use among adolescents by sex and region. These findings can shape effective sexual health initiatives and improve resource distribution across regions.

Risk and protective factors associated with substance use among Puerto Rican youths after Hurricane María: a cross-sectional study

BackgroundIdentifying factors associated with post-disaster youth substance use is a crucial element of developing evidence-based prevention and intervention efforts. Hurricane María struck Puerto Rico in September of 2017 and the wide-spread impact from this disaster, including exposure to trauma, displacement, and disrupted social supports had the potential to negatively impact levels of substance use among youth across the archipelago. However, post-disaster substance use remains under-investigated in this context. The current study sought to identify risk and protective factors associated with substance use among Puerto Rican youth in the aftermath of Hurricane Maria.MethodsCross-sectional, secondary data analyses were conducted using school-based survey data collected at all schools in Puerto Rico between February 1 and June 29, 2018 (5–9 months after Hurricane María). Social supports, substance use, and trauma symptoms were assessed. An ordinal regression analysis was conducted to identify student factors associated with greater likelihood of post-disaster substance use.ResultsA total of 36,485 participants (50.7% female, grades 7–12), were included in an ordinal regression analysis that compared the likelihood of respondents endorsing high, low, or no substance use after Hurricane María based on reported adult social support, counselor/teacher social support, peer social support, ptsd symptomatology, and gender. Findings showed that, when compared to students that endorsed low or no substance use, those who reported having adult social support demonstrated a 58% reduction in odds (OR = 0.42, 95% CI: 0.34-0.53) of reporting high substance use after Hurricane María, while students who reported having teacher/counselor social support demonstrated a 21% reduction in odds (OR = 0.79, 95% CI: 0.69-0.89) of reporting high substance use. Additionally, those that reported having peer social support demonstrated a 31% increase in odds (OR = 1.31, 95% CI: 1.10 to 1.58) of reporting higher substance use, compared to those that reported low or no substance use.ConclusionsWhile social support was generally protective, prevention efforts to build positive family and community connections may be indicated. Evidence-based school screenings of substance use and trauma may help direct intervention to those most at risk for co-occurring issues.

The Normal Weight Obesity (NWO) Problem-Prevalence and Time Changes in Children and Adolescents From Kraków (Poland).

Normal weight obesity can be associated with an increased risk of metabolic abnormalities, systemic inflammation and mortality. The main aim of the study was to analyze the changes in the prevalence of normal weight obesity in 8-18-year-olds from Kraków (Poland) between 2010 and 2020. The study was based on two sets of cross-sectional, school-based data obtained in 2010 and 2020. Body height, weight, and fat percentage were obtained. Body mass index was calculated, and only normal-weight individuals were included. Normal weight obesity was defined as normal BMI with adiposity >85 percentile for age and sex. The prevalence of normal weight obesity among Polish children and adolescents has been alarming for at least the last 10 years. Depending on the sex and age, normal weight obesity was present in more than 10% up to even more than 20% of the examined population. Alarming numbers of Polish children and adolescents suffer from NWO and this problem seems to be present for at least the last decade. A need for a maximally universal definition and cut-offs to diagnose normal weight obesity should also be stressed, as it will be helpful in providing the best prophylaxis and help to persons already suffering from normal weight obesity.

Estimated timing of the first menstrual period and dietary and nutritional correlates of menarche among urban school-going adolescents in four sub-Saharan African sites.

Characterizing the timing of menarche and the factors that are associated with it is important for understanding a population's reproductive health needs and long-term health trajectories. We estimated the age at the menstrual onset among adolescent girls and the association between dietary and nutritional factors and menarche in four sub-Saharan African urban sites. We used cross-sectional school-based data from 2307 female adolescents aged 10-14 years collected by the Africa Research, Implementation Science, and Education (ARISE) Network in Ouagadougou, Burkina Faso; Addis Ababa, Ethiopia; Khartoum, Sudan; and Dar es Salaam, Tanzania. Logit models were used to estimate the median age at menarche at each site. Associations between menarche and BMI-for-age, stunting, dietary qualityand food insecurity across settings were assessed using Poisson regression models adjusted for country and school levels. The estimated median age at menarche was 13.1 years (95% confidence interval: 12.7, 13.5) in Ouagadougou; 12.9 (12.6, 13.2) in Addis Ababa; 13.3 (12.7, 13.6) in Khartoum; and 13.2 (12.3, 14.0) in Dar es Salaam. Between 18% and 49% of the girls in each setting had already menstruated. Based on the pooled multivariable models, underweight participants were 42% less likely (adjusted prevalence ratio [PR]0.58 [0.44, 0.77]) to have experienced menarche in comparison to normal-weight individuals. The likelihood of experiencing menarche increased for overweight [PR 1.47 (1.30,1.66)] and obese [PR 1.57 (1.35,1.82)] in comparison to normal-weight girls. Those stunted were 47% less likely to have experienced menarche [PR 0.53 (0.41, 0.69)] than their nonstunted counterparts. A lower likelihood of menarche among those experiencing moderate/severe hunger when compared to those with no/little hunger was also observed (PR 0.78 [0.63,0.96]). No evidence of association with dietary quality was found. Further research is needed to strengthen the body of evidence and inform evidence-based initiatives in low- and middle-income settings.

Association of the COVID-19 lockdown with health risk behaviors in South Korean adolescents.

Since there is no certainty about when the coronavirus disease 2019 (COVID-19) lockdown will be affected by health risk behaviors, so we investigate the effect of COVID-19-related health risk behavior changes using school-based self-reported data from a nationally representative South Korean adolescent population. We analyzed web-based self-reported data from the Korea Youth Risk Behavior Web-based Survey in 111,878 participants (57,069 in COVID-19 prepandemic); 54,809 in during the COVID-19 pandemic. This study included 12 to 18-year-olds. Self-report questionnaires were used to assess socioeconomic status, health risk behaviors, and psychological factors. Health risk behaviors such as alcohol consumption, substance use, and sexual experience significantly decreased in COVID-19 pandemic than in COVID-19 prepandemic. Psychosomatic changes such as stress levels, violence experience, depression, suicidal ideation, suicidal plans, and suicide attempts were significantly lower in COVID-19 pandemic compared to COVID-19 prepandemic (P < .001). After adjusting for multiple confounding variables, less alcohol consumption (odds ratio [OR] = 0.98; 95% confidence interval [CI] = 0.88-0.93), less exercise (OR = 0.92; 95% CI = 0.89-0.94), less sexual experience (OR = 0.82; 95% CI = 0.77-0.86), less violence experience (OR = 0.61; 95% CI = 0.55-0.67), less stress (OR = 0.86; 95% CI = 0.84-0.88), less depression (OR = 0.85; 95% CI = 0.83-0.88), less suicidal ideation (OR = 0.93; 95% CI = 0.89-0.97), plans (OR = 0.82; 95% CI = 0.76-0.88), attempts (OR = 0.78; 95% CI = 0.71-0.85) were significantly associated with the COVID-19 pandemic compared to COVID-19 prepandemic. The COVID-19 pandemic was associated with changes in health risk behaviors among Korean adolescents, resulting in alcohol drinking, sexual experience, drug use, violence experience, and suicidal behaviors (idea, plan, and attempts) being decreased during the lockdown period.

COVID-19-Related Emotional Impact and Personal Experiences, Family Income, and Sleep Hygiene of Early Appalachian Adolescents

Objectives: The coronavirus disease 2019 (COVID-19) pandemic has negatively impacted the lifestyles and routines of adolescents, making it difficult to prioritize sleep. This has raised concerns regarding the sleep hygiene of young individuals, as good sleep is important for healthy youth development. Therefore, understanding how the pandemic has disproportionally affected the sleep of specific youth subgroups is essential for developing interventions to alleviate poor sleep and its adverse consequences. Methods: School-based survey data from the Young Mountaineer Health Study (YMHS) was used to create generalized estimating equation models to predict daytime sleepiness and the amount of sleep among early adolescents on weekday and weekend nights. The study included data from 2,322 students collected over three waves ~6 months apart. COVID-19-related emotional impact (scale range: 5–25) was considered the independent variable. Results: The average age of the participants in wave 1 was 11.50 (male, 44.1%). COVID-19-related emotional impact was positively associated with daytime sleepiness (estimate=0.25, &lt;i&gt;p&lt;/i&gt;&lt;0.001) and increased the odds of receiving less than the recommended average amount of sleep on weekdays (odds ratio [OR]=1.05, &lt;i&gt;p&lt;/i&gt;&lt;0.001) and weekends (OR=1.04, &lt;i&gt;p&lt;/i&gt;&lt;0.001). Conclusions: Thus, we recommend targeting proper sleep interventions for individuals deeply affected by the pandemic and young individuals from lower-income families. Moreover, despite a decrease in the emotional impact of COVID-19 over time, its potential negative effects on sleep persisted. Therefore, efforts should focus on educating young individuals regarding the health benefits of proper sleep, with an emphasis on integrating this information into the health curricula of secondary schools in the Appalachian region.

Childhood Adversity and Adolescent Smartphone Use Across Sexual Orientation and Gender Expression

Nonheterosexual and gender-nonconforming (GNC) individuals tend to report adverse childhood experiences (ACEs) more frequently compared with heterosexual and gender-conforming individuals, and individuals who have experienced ACEs, identify as nonheterosexual, or exhibit moderate to high levels of GNC are more prone to engaging in problematic smartphone use (PSU). However, there is limited school-based data among adolescents regarding this matter. To explore the associations between ACEs and PSU among adolescents across different sexual orientation and gender expression groups. Using data from the 2021 School-Based Chinese Adolescents Health Survey, this cross-sectional study includes participants from 288 public high schools across 8 provinces in China. Statistical analysis was performed from October 2023 to February 2024. Data on ACEs, sexual orientations, and gender expressions (high, moderate, and low GNC) were collected. PSU was assessed using the 10-item Smartphone Addiction Scale-Short Version (SAS-SV). Weighted linear, logistic, or Poisson regression models were used. Among the 85 064 adolescents included (mean [SD] age, 14.92 [1.77] years), 42 632 (50.1%) were female, 70 157 (83.2%) identified as Han Chinese, and 14 208 (16.8) identified as other ethnicities (Miao, Hui, Yi, Dai, and other ethnic groups). The prevalence of PSU among participants was 35.4%. Weighted Poisson regression models indicated that the interaction between GNC and ACE was significant (adjusted prevalence ratio [APR], 0.98; 95% CI, 0.97-0.99). Further stratified analysis demonstrated homosexual adolescents who experienced 4 or more ACEs showed a significantly increased prevalence of PSU (APR, 1.79; 95% CI, 1.64-1.96). Similarly, a markedly higher prevalence of PSU was observed among bisexual individuals with 4 or more ACEs (APR, 1.60; 95% CI, 1.41-1.80). Regarding gender expression categories, a significantly higher prevalence of PSU was noted among high GNC adolescents with 4 or more ACEs (APR, 1.78; 95% CI, 1.60-1.98) compared with low GNC adolescents without ACEs. Furthermore, experiencing any 3 ACE categories (abuse, neglect, and household dysfunction) was associated with an increased prevalence of PSU across different sexual orientation and gender expression subgroups. In this cross-sectional study, the amalgamation of elevated ACE scores with nonheterosexual orientations or GNC identities was significantly associated with increased PSU prevalence. These findings underscore that preventing ACEs may be beneficial in mitigating PSU among adolescents, particularly for nonheterosexual adolescents and those with high levels of GNC.

Academic and behavior combined support: A single-case practice-based replication study

The purpose of this research was to conduct a practice-based replication of Academic and Behavior Combined Support (ABC Support), a previously developed and experimentally evaluated supplemental intervention that merges a combined focus on reading fluency and academic engagement. In the present study, a school-based interventionist and data collector had access to implementation resources online and participated in virtual training and coaching. Four Grade 2 students received the ABC Support intervention for 6 weeks in their school. Students' oral fluency on training and non-training reading passages, as well as occurrence of engagement and disruptive behaviors during universal reading instruction, were measured repeatedly across baseline, intervention, and follow-up phases in a multiple-baseline design. In concert with prior empirical findings on ABC Support, analyses revealed improvement from baseline to intervention for both reading and behavior outcomes, as well as from baseline to follow-up assessments. Empirical contributions of the study are offered within the context of replication research and an implementation science perspective. We also emphasize the importance of telecommunication for practice-based research evaluation of interventions.

Parenting and other potential protective factors associated with polysubstance use among public school students in Lagos, Nigeria.

Substance use is a growing problem in Nigeria. The present study extended recent work documenting the importance of parenting as protective against substance use in Nigerian youth by testing a model linking parenting, additional protective factors and polysubstance use. Public school students (N = 1607; 56% female; M age = 14.88; SD = .44 years) living in the greater Lagos region participated in school-based data collection. Lifetime polysubstance use, defined as use of two or more substances including alcohol or illicit drugs, or misuse of over-the-counter medications, was reported by 5.2% of the sample. Structural equation modelling that accounted for adolescent age and sex on all constructs revealed good model fit. Positive parenting (support and solicitation) was significantly associated with higher perceived harmfulness of substance use, religiosity and positive relationships at school. Positive school relationships were associated with a decreased likelihood of polysubstance use. Multiple group analysis revealed no overall sex differences in the model paths. Strengthening parent-adolescent relationships may have a cascading effect on protective factors and subsequent substance use, and should be included in youth substance use prevention programmes.

Dental decay in children and the link to weight status: A cross-sectional analysis of national school health data

Recent national reports have indicated an increasing trend of dental decay among school-aged children. National school-based data are required to guide decision-making to ensure effective public health efforts to manage dental decay. This study aimed to assess the prevalence of dental decay among school-age children in Saudi Arabia and explore the possible link between dental decay and weight status. This was a cross-sectional analysis of a national sample including 1,134,317 Saudi children in the 1st, 4th, 7th, and 10th grades who participated in a national school screening program. Data for weight, height, body mass index (BMI), dental decay prevalence, and decayed, missing, and filled teeth (DMFT) index were analysed. An independent t-test, one-way analysis of variance, and chi-square test were used to compare the means, while Pearson’s r correlation and multiple linear regression were used to examine the relationships between the study variables. The prevalence of dental decay was 24.20%, and dental decay was the highest among female students (26.5%), students in primary school (25.9%), students living in the eastern region (35.2%), in the administrative capital (27.6%), and in rural areas (23.4%). Dental decay was the highest among students who were underweight. Female sex and living in rural areas significantly predicted higher DMFT while being overweight/obese significantly predicted lower DMFT. Dental decay is highly prevalent among underweight students, female students, and students living in rural areas and the eastern regions of Saudi Arabia. To reduce the prevalence of dental decay and related health disparities, dental health screening programs should be designed to detect dental decay early among children at high risk due to abnormal BMIs and sociodemographic factors. In addition, dental health screening and management programs should utilize standardized dental decay assessment methods and ethnically representative growth charts.

Previous Infection and Effectiveness of COVID-19 Vaccination in Middle- and High-School Students.

Understanding the real-world impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) mitigation measures, particularly vaccination, in children and adolescents in congregate settings remains important. We evaluated protection against SARS-CoV-2 infection using school-based testing data. Using data from Utah middle- and high-school students participating in school-wide antigen testing in January 2022 during omicron (BA.1) variant predominance, log binomial models were fit to estimate the protection of previous SARS-CoV-2 infection and coronavirus disease 2019 vaccination against SARS-CoV-2 infection. Among 17 910 students, median age was 16 years (range: 12-19), 16.7% had documented previous SARS-CoV-2 infection; 55.6% received 2 vaccine doses with 211 median days since the second dose; and 8.6% of students aged 16 to 19 years received 3 vaccine doses with 21 median days since the third dose. Protection from previous infection alone was 35.9% (95% confidence interval [CI]: 12.9%-52.8%) and 23.8% (95% CI: 2.1%-40.7%) for students aged 12 to 15 and 16 to 19 years, respectively. Protection from 2-dose hybrid immunity (previous SARS-CoV-2 infection and vaccination) with <180 days since the second dose was 58.7% (95% CI: 33.2%-74.4%) for students aged 12 to 15 and 54.7% (95% CI: 31.0%-70.3%) for students aged 16 to 19 years. Protection was highest (70.0%, 95% CI: 42.3%-84.5%) among students with 3-dose hybrid immunity, although confidence intervals overlap with 2-dose vaccination. The estimated protection against infection was strongest for those with hybrid immunity from previous infection and recent vaccination with a third dose.

Association between COVID-19 lockdown and sleep behaviors in Korean adolescents.

To find the effect of coronavirus disease 2019 (COVID-19)-related sleep behavior changes using school-based self-reported data from a nationally representative Korean adolescent population. We analyzed web-based self-reported data from the Korean Youth Risk Behavior Web-based Survey in 98,126 participants (51,651 in 2019 [before the COVID-19 pandemic]; 46,475 in 2020 [during COVID-19 pandemic] 12 through 18 years old were included in this study. Self-report questionnaires were used to assess socioeconomic status, health behaviors, psychological factors, and sleep patterns. During the COVID-19 pandemic, Korean adolescents had a later weekend bedtime (≥1:00 am: 68.2% vs 71.5%, P < .001) and late weekend wake time (≤7:00 am: 13.3% vs 10.7%, P < .001) compared to before COVID-19 pandemic. Average sleep duration (434.7 ± 102.6 vs 428.2 ± 100.4 minutes; P < .001) was significantly lower during the COVID-19 pandemic and weekend catch-up sleep >2 hours (42.1% vs 43.7%; P < .001), late chronotype (17.1% vs 22.9%, P < .001) were significantly higher during COVID-19 pandemic. After adjusting for multiple confounding variables, short sleep duration (≦5 hours, odds ratio [OR] 1.14; 95% confidence interval [CI] 1.10-1.19), 6 hours, OR 1.07; 95% CI 1.03-1.12), long weekend catch-up sleep (OR, 1.08; 95% CI, 1.06-1.11) and late chronotype (OR, 1.43; 95% CI, 1.38-1.47) were significantly associated with COVID-19 pandemic. The COVID-19 pandemic was associated with changes in sleep behavior among Korean adolescents, resulting in later bed and wake-up times, increased weekend catch-up sleep, and a shift of chronotype toward eveningness.

Analysis of Missing Data in Progressed Learners: The Use of Multiple Imputation Methods

The issue of missing data raises concerns in all statistical and educational research. In this study, we focus on missing data in school-based assessment data generated by progressed high school learners (those who did not meet the promotional requirements for their current grades but were allowed to move to the next grade because of policy stipulations). There are a number of approaches available for handling missing data in statistical literature. Multiple imputation is an approach statisticians often recommend for dealing with missing data. We analysed a longitudinal dataset composed of progressed high school learners with missing data points, imputing the missing values with multiple imputation by chained equations and Amelia II. The missing data points in our dataset were due to learners not submitting their tasks, which then impacted negatively on their results. We found a higher proportion of missing values in mathematics/mathematical literacy, science and accounting. Our results showed that progressed learners struggle more with these subjects where knowledge develops cumulatively, and that their gaps in prior knowledge probably hinder them in understanding new concepts. Thus, the policy on progression of learners brings challenges to the already strained educational system and requires a more specialised system of support.

Overestimation of school-based deworming coverage resulting from school-based reporting.

Soil Transmitted Helminths (STH) infect over 1.5 billion people globally and are associated with anemia and stunting, resulting in an annual toll of 1.9 million Disability-Adjusted Life Years (DALYs). School-based deworming (SBD), via mass drug administration (MDA) campaigns with albendazole or mebendazole, has been recommended by the World Health Organization to reduce levels of morbidity due to STH in endemic areas. DeWorm3 is a cluster-randomized trial, conducted in three study sites in Benin, India, and Malawi, designed to assess the feasibility of interrupting STH transmission with community-wide MDA as a potential strategy to replace SBD. This analysis examines data from the DeWorm3 trial to quantify discrepancies between school-level reporting of SBD and gold standard individual-level survey reporting of SBD. Population-weighted averages of school-level SBD calculated at the cluster level were compared to aggregated individual-level SBD estimates to produce a Mean Squared Error (MSE) estimate for each study site. In order to estimate individual-level SBD coverage, these MSE values were applied to SBD estimates from the control arm of the DeWorm3 trial, where only school-level reporting of SBD coverage had been collected. In each study site, SBD coverage in the school-level datasets was substantially higher than that obtained from individual-level datasets, indicating possible overestimation of school-level SBD coverage. When applying observed MSE to project expected coverages in the control arm, SBD coverage dropped from 89.1% to 70.5% (p-value < 0.001) in Benin, from 97.7% to 84.5% (p-value < 0.001) in India, and from 41.5% to 37.5% (p-value < 0.001) in Malawi. These estimates indicate that school-level SBD reporting is likely to significantly overestimate program coverage. These findings suggest that current SBD coverage estimates derived from school-based program data may substantially overestimate true pediatric deworming coverage within targeted communities. NCT03014167.

Bullying Victimization and Suicidal Behavior among adolescents in 28 Countries and Territories: A Moderated Mediation Model

BackgroundPrevious studies have increasingly shown the adverse effects of being bullied on suicidal behavior among young people, but the mechanisms underlying this association remain unclear. We examined the association between bullying and suicidal behavior among in-school adolescents. We further tested whether loneliness mediated the link between bullying and suicidal behavior and explored the moderated role of parental involvement in this association. MethodsWe used cross-sectional school-based data from the Global School-based Student Health Survey among 28 countries and territories. Adjusted, modified Poisson regressions with robust variance relative risks and moderation analyses were used to examine associations among bullying, suicidal behavior, and parental involvement. The mediating effect of loneliness on the bullying-suicidal behavior link was assessed using the generalized decomposition method. ResultsA total of 78,558 school-going adolescents participated in this study. Bullying was associated with a 44% increased risk of suicidal behavior after adjusting for potential confounders (relative risk = 1.44; 95% confidence interval = 1.39–1.48). Loneliness partially mediated the association between bullying and suicidal behavior, and parental involvement moderated the association. DiscussionThe findings suggest the need to recognize the dual burden of bullying and loneliness when addressing suicidal behavior and the importance of parental support in adolescents' mental health and well-being.

Trends and Disparities in Suicidality Among Heterosexual and Sexual Minority/Two-Spirit Indigenous Adolescents in Canada

PurposeTo explore trends in sexual orientation group differences in suicidality among Indigenous adolescents and evaluate whether gaps between heterosexual and sexual minority/Two-Spirit adolescents have changed over time. MethodsLeveraging pooled school-based population data from five waves of the British Columbia Adolescent Health Survey (1998–2018), we used age-adjusted logistic regression models, separately for boys and girls, to examine 20-year trends and disparities in past year suicidal ideation and suicide attempts among heterosexual and sexual minority/Two-Spirit Indigenous adolescents (N = 13,788). ResultsSuicidal ideation increased among all sexual orientation groups in 2018 compared to previous survey waves. Suicide attempts spiked for heterosexual girls in 2003, remained stable for heterosexual boys, and decreased for sexual minority/Two-Spirit boys and girls over time. Compared to their heterosexual peers, sexual minority/Two-Spirit boys had higher odds of suicidal ideation since 1998, whereas sexual minority/Two-Spirit girls had higher odds of suicidal ideation since 2003. Sexual minority/Two-Spirit (vs. heterosexual) boys were approximately 4–7 times more likely to attempt suicide since 2008, whereas sexual-minority/Two-Spirit (vs. heterosexual) girls were approximately 3–4 times more likely to attempt suicide since 2003. These gaps in suicidality were persistent across time. DiscussionSexual minority/Two-Spirit Indigenous adolescents are at an elevated risk for suicidality compared to their heterosexual Indigenous peers. While trends of suicidal ideation worsened for all Indigenous adolescents, suicide attempts either lessened or remained stable over time. Greater efforts are needed to help reduce suicidality among Indigenous adolescents in Canada, especially among sexual minority/Two-Spirit young people.

Underachievement at school relative to potential: links between reasoning, phonological decoding, short-term memory, and complex grammar

Around 6% of U.K. children are underachieving at school relative to their potential (URP). We explored whether difficulties with phonological decoding, short-term memory (STM), and complex grammar may be responsible. We compared school-based reading test data or formal SATs, and verbal reasoning in 2462 children (150 URP and 2312 non-URP children) and administered a 7-min follow-up test to a matched subgroup of 106 URP and 106 non-URP children. Thirty-three of our original 150 URP children (22%) scored in the top 10% nationally for verbal reasoning, compared with 46 of our 2312 non-URP children (2%). Phonological decoding, STM, and complex grammar acquisition made independent URP contributions in children aged 7–9; in ages 10–12, only phonological decoding contributed. URP children were more likely to show multiple difficulties. The 7-min test enables school staff to quickly identify areas for targeted support. Some URP children not previously detected as capable may be encouraged to take up and succeed in further education.

Psychological distress and unhealthy dietary behaviours among adolescents aged 12-15 years in nine South-East Asian countries: a secondary analysis of the Global School-Based Health Survey data.

It is unclear whether there is any association between psychological distress and unhealthy dietary habits among adolescents in low- and middle-income countries. We aimed to estimate the prevalence of these factors in South-East Asia region and investigate their associations. We used data from the Global School-based Health Survey for nine South-East Asian countries. Psychological distress was defined by presence of ≥ 2 factors from loneliness, anxiety, suicide ideation, suicide planning and suicide attempt. We assessed inadequate fruit intake, inadequate vegetable intake, daily soft drink and weekly fast-food consumption. We used random-effects meta-analysis to estimate pooled prevalence. Logistic regressions were used to estimate OR of unhealthy dietary behaviours for psychological distress. Among 30013 adolescents (56 % girls) aged 12-15 years, the prevalence of psychological distress was 11·0 %, with girls reporting slightly higher than boys (11·8 % v. 10·1 %). The prevalence of inadequate fruit intake, inadequate vegetable intake, daily soft drink consumption and weekly fast-food consumption was 42 %, 26 %, 40 % and 57 %, respectively. Psychological distress was associated with inadequate fruit intake (pooled OR = 1·20, 95 % CI 1·03, 1·40), inadequate vegetable intake (pooled OR = 1·17, 1·05, 1·31) and daily soft drink consumption (pooled OR = 1·14, 1·03, 1·26); but not with weekly fast-food consumption (pooled OR = 1·13, 0·96, 1·31). We observed substantial cross-country variations in prevalence and OR estimates. In conclusion, South-East Asian adolescents have significant burden of psychological distress and unhealthy dietary behaviours, with those having psychological distress are more likely to have unhealthy dietary behaviours. Our findings will guide preventative interventions and inform relevant policies around adolescent nutrition in the region.

The Effects of School Climate, Parent-Child Closeness, and Peer Relations on the Problematic Internet Use of Chinese Adolescents: Testing the Mediating Role of Self-Esteem and Depression.

Although previous research has investigated the associations among family factors, school factors, peer factors, and problematic Internet use, its causal direction has not been verified, particularly in the Chinese context. Using school-based data, this study aims to explore the possible causal direction among school climate, parent–child closeness, peer relations, and the problematic Internet use of Chinese adolescents. Nine hundred and sixty students in junior and senior high schools participated in a questionnaire survey. The results showed that parent–child closeness, school climate, and peer relations had a significantly direct effect on the problematic Internet use of Chinese adolescents. Meanwhile, the effects of parent–child closeness, school climate, and peer relations on problematic Internet use were mediated by self-esteem and depression. Implications are also discussed to prevent the problematic Internet use of adolescents.

Rate of diagnosed seasonal influenza in children with influenza-like illness: A cross-sectional study

IntroductionAlthough influenza surveillance systems have been used to monitor influenza epidemics, these systems generally evaluate diagnostic information obtained from medical institutions and they do not include patients who have not been examined. In contrast, community based epidemiological studies target people with influenza-like illness (ILI) that self-reported influenza-like symptoms whether they have medical examinations or not. Because the criteria for influenza surveillance systems and ILI differ, there is a gap between them. The purpose of this study was to clarify this gap using school-based survey data.MethodsQuestionnaires about both ILI and the influenza diagnosis history during the 2018/19 season were administered to the guardians of 11,684 elementary schoolchildren in a single city in Japan. Based on their responses, a Bayesian model was constructed to estimate the probability of infection, ILI onset, and diagnosis at medical institutions.ResultsResponses were obtained from guardians of 10,309 children (88.2%). Of these, 3,380 children (32.8%) had experienced ILI, with 2,380 (23.1%) diagnosed as influenza at a medical institution. Bayesian estimation showed that the probability of influenza cases being diagnosed among ILI symptomatic children was 70% (95% credible interval, 69–71%). Of the infected children, 5% were without ILI symptoms, with 11% of these patients diagnosed with influenza.ConclusionsThis epidemiological study clarified the proportion gap between ILI and influenza diagnosis among schoolchildren. These results may help to establish epidemic control measures and secure sufficient medical resources.