School-based Survey Research Articles

Background Academic stress has emerged as a significant risk factor for mental health development during adolescence. Schools have a considerable influence on adolescents’ development, but increasing academic pressures and social expectations have caused students to experience higher levels of stress, impacting their mental health and overall development. Objective To assess academic stress levels and the factors associated with it among students aged 13–15 years in Belagavi district, Karnataka. Methods A school-based survey was conducted among 1,426 students from four CBSE schools using universal sampling. Data were collected from July to September 2023. The Educational Stress Scale for Adolescents (ESSA) was used to measure academic stress. Statistical analysis involved Chi-square tests, Fisher’s exact test, and independent t -tests. Results Among the 1,426 students, 74% reported high levels of academic stress, with 17% reporting medium levels. Academic stress levels were significantly associated with age ( p = 0.027), area ( p = 0.000), father’s education ( p = 0.023), and gender ( p = 0.001). Male students experienced significantly higher stress levels in study pressure, grade-related anxiety, self-expectation, and self-despondency ( p < 0.05). Female students experienced slightly higher stress related to workload, though this was not statistically significant. Conclusion Academic stress is prevalent among students and is significantly influenced by various sociodemographic variables.

Background: This study examined the clustering of unhealthy lifestyle behaviours and their determinants among adolescents across Europe, Central Asia, and North America. Methods: The study included 210,713 adolescents aged 11 to 15 years from 45 countries who participated in the 2018 Health Behaviour in School-aged Children (HBSC) study. Lifestyle behaviours, including physical inactivity, inadequate fruit and vegetable consumption, frequent soft drink consumption, alcohol use, and smoking, were used to examine the clustering of unhealthy behaviours. Multilevel mixed-effects logistic regression was employed to assess the associations between unhealthy behaviour clustering (≥3 unhealthy behaviours) and contextual factors at the individual, family, and school levels. Results: A high prevalence of clustered unhealthy behaviours was observed among adolescents, with 51.5% engaging in three or more unhealthy lifestyle behaviours. The odds increased with age (AOR: 1.79, 95% CI: 1.75, 1.84 for those aged ≥ 15 years), among males (AOR: 1.26, 95% CI: 123, 1.28), and among those experiencing higher academic pressure (AOR: 1.13, 95% CI: 1.09, 1.17 for very high academic pressure). In contrast, the odds were lower among adolescents from a higher family affluence background (AOR: 0.62 95% CI: 0.60, 0.65 for high), among adolescents living with both parents (AOR: 0.83, 95 CI: 0.81, 0.85), those reporting higher family support (AOR: 0.62, 95% CI: 0.60, 0.63 for high), higher peer support at school (AOR: 0.87, 95% CI: 0.84, 0.89 for high), and those reporting higher school satisfaction (AOR: 0.50, 95% CI: 0.48, 0.52 for very high). Conclusions: The study reveals that one in two adolescents engages in three or more unhealthy lifestyle behaviours. It emphasises the need to tackle this public health challenge through multisectoral interventions targeting individual-level and contextual factors at the family and school levels.

BackgroundThis study focused on the importance of long-lasting insecticide treated nets (LLINs) in malaria control in a study area where socio-economic disparities are widening. The objective was to assess the effectiveness of LLIN ownership when nets were available for no more than two people, controlling for differences in socio-economic status (SES). It was hypothesized that LLIN effectiveness would differ by SES and that LLIN effectiveness should be analysed with adjustment for differences in SES.MethodsA household level survey was conducted in an area in the Lake Victoria region in Suba North Sub-County, Homa Bay County, Western Kenya between June and September 2021. Through the household survey, the number of people living in the home, the number of LLINs, and demographic data were recorded. The ratio of the number of people reporting sleeping in the house to the total number of LLINs in the home was calculated. Through a school-based malaria survey, researchers administered blood-spot, PCR tests for Plasmodium infection. Community workers linked individual malaria tests to homes that were involved in the household survey through names and geographic identifiers. A generalized linear model (GLM) tested the associations between household parasitaemia risk in children and the ratio of people to LLINs, stratifying on asset-based household level SES measures.ResultsThe association between sufficient LLIN ownership and household malaria infection status was analysed across SES groups. In middle SES households, sufficient LLIN ownership was significantly associated with lower malaria infection status compared with insufficient LLIN ownership (OR 0.32, 95% CI 0.12–0.92). In the low SES group, a similar trend was observed, although it was not statistically significant (OR 0.59, 95% CI 0.15–2.91). When middle and low SES groups were combined, sufficient LLIN ownership remained significantly associated with lower incidence (OR 0.37, 95% CI 0.17–0.87).ConclusionsThe results suggest that promoting the use of one LLIN by no more than two people, as recommended by WHO, can reduce the risk of malaria. Efforts to promote LLINs as an effective means of preventing malaria in children might encourage LLIN compliance and maintain community level control targets. If households have been excluded from LLIN distribution, LLINs should be distributed immediately along with information about their effectiveness. The effectiveness of LLINs varies by region, but strategies to sustain LLIN use should be recognized as contributing to benefits for the entire community.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12936-025-05528-x.

ABSTRACT The study aimed to evaluate school-based hygiene education, protective and psychosocial factors associated with suboptimal (not always) hand hygiene (SHH) and suboptimal (not always) oral hygiene (SOH) among school-aged adolescents in the Philippines. The 2019 national Philippines Global School-based Student Health Survey (GSHS) provided the study’s data. In order to determine the variables associated with SOH, SHH before meals, SHH after toilet use and SHH with soap, the study used bivariate and multivariable logistic regression analysis. The prevalence of SOH was 18.5%, SHH before meals 41.2%, SHH after toilet use 27.9%, and SHH with soap 48.5%. Regression results showed that taught on personal hygiene and taught on healthy eating were protective against SOH, SHH before meals, and SHH after toilet use, and taught on personal hygiene was inversely associated with SHH with soap. Furthermore, high parental and peer support were both negatively associated with SOH, SHH before meals, SHH after toilet use, and SHH with soap. In addition, several psychosocial and sociodemographic factors were found associated with SOH and SHH indicators. The survey showed suboptimal oral and hand hygiene practices. Hygiene education was protective against SOH and SHH after toilet use, SHH before meals, SHH with soap. Further factors associated with SOH and/or SHH included lack of parental and peer support, and several health risk behaviours, which can be targeted in hygiene promotion among adolescents in the Philippines.

Inadequate eating habits in adolescence are an important risk factor for obesity and other chronic non-communicable diseases in adulthood. The school environment can have a relevant impact on adolescent behaviour, since many habits acquired in this phase affect the individual throughout life, with visible effects on health. In this study, we aimed to evaluate the association between food sales at Brazilian schools and ultra-processed food consumption among adolescents. The Study of Cardiovascular Risk Factors in Adolescents (ERICA) was a nationwide, school-based survey conducted from 2013 to 2014, including public and private schools in 121 Brazilian cities. Dietary intake was assessed via a 24-hour recall, and foods were divided according to the Nova Classification based on the degree of processing. Unadjusted and adjusted linear regression models were used to assess the association between exposure to school food sales and intake of ultra-processed food. The prevalence of exposure to food sales was 55.2% and the mean diet share of ultra-processed foods was 34.5%. Exposure to food sales in schools was associated with higher consumption of ultra-processed food (β=0.11; p=0.002). The results were similar when the analyses were stratified according to sex, usual intake of school meals, and public-school attendance (β=0.11; p=0.002). The association between exposure to food sales in schools and higher consumption of ultra-processed food suggests that school sales can influence adolescents' food choices.

Sedentary behavior and risk of depressive symptoms among adolescents in Tianjin: A cross-sectional and longitudinal analysis of a school-based study.

Although suicidal ideation is a significant issue among adolescents, previous studies have largely relied on cross-sectional data collected at a single time point or have been limited to individual countries, providing limited insight into temporal trends across diverse populations. Therefore, we aimed to examine temporal trends in suicidal ideation among adolescents across 23 countries. We analyzed data from the Global School-Based Student Health Survey (2003–2021), which included adolescents aged 13–15 years in 23 countries. Each participant participated in multiple surveys, and survey years varied by country. Prior to trend estimation, we compared linear and quadratic fits where more than three surveys were available to identify near-linear patterns. Temporal trend was quantified as the average annual percentage change (AAPC), which was calculated by weighted log-linear regression on the log prevalence rates of the survey years, applied separately to boys and girls. The study analyzed 185,941 school-attending adolescents (46.45% male) across 23 countries. The prevalence of suicidal ideation showed significant upward trends in six countries: Myanmar (AAPC, 32.04%/year; 2007–2016), Guyana (AAPC, 8.88%/year; 2010–2014), Saint Vincent and the Grenadines (AAPC, 3.87%/year; 2007–2018), Mongolia (AAPC, 3.67%/year; 2010–2013), Bolivia (AAPC, 3.02%/year; 2012–2018), and Seychelles (AAPC, 2.54%/year; 2007–2015). Conversely, five countries exhibited significant declines, including Benin (AAPC, -8.60%/year; 2009–2016), Kuwait (AAPC, -6.40%/year; 2011–2015), and the Maldives (AAPC, -4.33%/year; 2009–2014). Sex-specific differences in trends were nominally significant (p < 0.05) in six countries—Benin, Kuwait, Argentina, Saint Vincent and the Grenadines, Thailand, and Guyana—but only two (Saint Vincent and the Grenadines and Thailand) remained statistically significant after Bonferroni correction. In five of these countries (excluding Guyana), girls exhibited more unfavorable patterns, showing either a greater increase or a smaller decrease in suicidal ideation compared to boys. This study highlights divergent trends in adolescent suicidal ideation across 23 countries, with rising prevalence in some regions and notable sex differences. The findings underscore the need for continued surveillance and context-specific mental health interventions.Supplementary InformationThe online version contains supplementary material available at 10.1038/s41598-025-19158-5.

Objective: This study aims to analyze the prevalence of adherence to physical activity, screen time, and sleep recommendations and their association with excess weight in high school adolescents from the state public network of Pernambuco, Brazil. Methods: A cross-sectional study was conducted with 4,203 adolescents aged 14 to 19 years. Data were collected using a translated and validated version of the Global School-Based Student Health Survey (GSHS). The study assessed adherence to recommendations for Moderate to Vigorous Physical Activity (MVPA), screen time (ST), and sleep duration. Logistic regression analysis was used to examine the associations between these behaviors and excess weight, adjusting for age, race, and maternal education. Results: Only 2.68% of adolescents met the combined recommendations for MVPA, ST, and sleep. The total proportion of obese adolescents was 12.3%, with a higher prevalence among girls (13.4%) compared to boys (10.9%). Male adolescents who did not meet the MVPA recommendation had a 1.53 times higher chance of being obese (95% CI: 1.11; 2.12), and those who did not meet the ST recommendation had a 1.60 times higher chance of being obese (95% CI: 1.11; 2.31). Conclusions: Low adherence to physical activity, screen time, and sleep recommendations is associated to higher excess weight rates among adolescents in Pernambuco, Brazil, particularly in boys. Public health strategies promoting these behaviors are essential to combat obesity, with a focus on gender-specific interventions.

IntroductionParent-adolescent relationships play a crucial role in influencing high-risk behaviors among adolescents. In Malaysia, there is limited research exploring the influence of parent-adolescent relationships on adolescent risk behaviors. This study aims to determine the role of parent-adolescent connectedness and parental monitoring against high-risk behaviors among Malaysian adolescents.MethodsThis study utilized data from the National Health and Morbidity Survey (NHMS) 2022: Adolescent Health Survey, a cross-sectional study conducted from June to July 2022 among secondary school students. A two-stage stratified cluster sampling method was applied using a national sampling frame of 2,798 schools to ensure state and national representativeness. The Global School-based Student Health Survey (GSHS) Malaysian version was used to collect data on health risk behavior and protective factors including parent-adolescent connectedness and parental monitoring. Descriptive analysis and multivariable logistic regression were used to analyzed the data.ResultsAmong 33,523 adolescents, a total of 24.2% (95% CI: 23.7–24.7) of adolescents reported parental connectedness, while 33.4% (95% CI: 32.9–33.9) reported parental monitoring. By sociodemographic factors, Indians ethnicity had the highest odds of reporting both parental connectedness (aOR: 1.94, 95% CI: 1.65, 2.28) and parental monitoring (aOR: 2.21, 95% CI: 1.82, 2.70), while adolescents in Labuan Federal Territory (a federally administered island region of Malaysia) had significantly lower odds for both measures. Adolescents with parents married and living together had significantly higher odds of reporting both parental connectedness (aOR: 1.28, 95% CI: 1.18, 1.40) and parental monitoring (aOR: 1.35, 95% CI: 1.26, 1.44). Parental connectedness and monitoring were strong protective factors against all eight high-risk behaviors, including reduced odds of sexual activity (aOR: 0.63 and 0.58), e-cigarette use (aOR: 0.68 and 0.55), smoking, drug use, alcohol use, physical fights, being bullied, and cyberbullying.ConclusionThis study found that parental connectedness and monitoring were significantly associated with lower odds of engaging in high-risk behaviors among Malaysian adolescents, with notable variations by ethnicity, parental marital status, and region. Strengthening parental involvement and addressing disparities in family dynamics are essential strategies for promoting adolescent health and well-being in Malaysia.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12889-025-24598-9.

Better mental health and better academic performance: A longitudinal study of high school freshmen in China.

While research has demonstrated the importance of K-12 environments for adolescent well-being, there have been numerous challenges to measuring and addressing this social environment. The School as a Protective Factor (SPF)-Framework and Brief instrument were established to meet this gap. This study investigates SPF in an academic-community partnership with a small, rural public school district. A school-based survey of middle and high school students was implemented to track key risk and protective factors (including SPF) and a variety of health outcomes, including depression and suicidal ideation, from 2022 to 2025. SPF data were shared annually with school employees to focus on practical ways to improve the school environment. Analyses show SPF was significantly associated with depression and suicidal ideation. Over 3 years, depression rates at the population level decreased from 66% to 24%. Findings support (1) the use of SPF-Framework and Brief instrument as meaningful tools in school-based efforts to address youth mental health, and (2) the utility of academic-school partnerships to support robust data collection, analysis, and translation into meaningful action. Schools, researchers, and other partners may benefit from the SPF tools to create a shared understanding, provide clear direction for action, and act as a means of tracking and measuring progress over time.

Alcohol consumption among adolescents is a critical public health concern, leading to numerous adverse health, social, and economic consequences, which underscores the need for effective prevention strategies. This study aimed to conduct a situational analysis and produce a knowledge synthesis in the initial phase of the Prev.Action study, a multicomponent co-produced community intervention aimed at reducing alcohol use among Brazilian adolescents. This mixed-methods study conducted a comprehensive situational analysis to assess adolescent alcohol use in a Brazilian municipality, corresponding to Phase 1 of the Implementation Research Cycle. We employed three types of triangulation: data source, methodological, and investigator. Data were collected from five sources: a school-based survey (1,210 adolescents), focus groups (144 adolescents), semi-structured interviews with stakeholders (26 participants), a community web-based survey (516 participants), and stakeholder workshops (20 participants). Quantitative data were analyzed using descriptive statistics, whereas qualitative data underwent thematic analysis, ensuring a thorough understanding of community needs and intervention barriers. Key findings revealed that 54% of middle school and 73% of high school students had experimented alcohol. In addition, 13% of students reported binge drinking in the last 30 days. The primary methods of alcohol acquisition were self-purchase (30%) or receipt from parents (40%). Priority issues identified by the community, such as easy access to alcohol, cultural acceptance, and inadequate law enforcement, were key in designing a three-arm multicomponent intervention: school-based programs, family programs, and environmental strategies. The Prev.Action study underscores the importance of community involvement and tailored strategies to reduce adolescent alcohol consumption effectively.

Prevalence of and factors associated with anxiety among school going adolescents analysis from 59 countries.

Exploring why adolescents of disadvantaged family socio-economic status were more depressed than others: Serial mediations via personal psychological resources, loneliness, and school refusal functions.

With the development of technology, easier access to the internet and its excessive use have led to problematic internet use (PIU). The prevalence of PIU and its association with lifestyle behaviors in adolescents have become subjects of increasing academic interest. This study aimed to determine the prevalence of PIU among Turkish high school students and to investigate its association with sleep, physical activity and dietary habits. This cross-sectional study was conducted on high school students between October 2019 and March 2020. Participants completed a questionnaire regarding demographic characteristics, internet use, lifestyle habits and the "Young Internet Addiction Test-Short Form (YIAT-SF)". Among the total 951 participants, the mean age was 15.3±1.0 years, 42.3% were female, and the prevalence of PIU was determined as 12.1%. It was shown that having daily internet usage time ≥2 hours on weekdays, having at least one type of sleep problem, having breakfast less than 3 days per week, eating salty snacks ≥3 days per week, consuming sugary-carbonated drinks ≥3 days per week were associated with PIU. PIU is a widespread public health problem that is negatively associated with the daily health habits of adolescents. There is a need for nationwide school screening programs for this problem and rehabilitation of adolescents diagnosed with PIU.

BackgroundPrevious studies showed that nonrestorative sleep (NRS) was associated with various adverse outcomes. This study aimed to explore whether NRS was associated with self-injury behavior, suicidal ideation, and suicide attempts.MethodsAdolescents attending Grades 7–12 in Nanjing, China, were invited to participate in this longitudinal school-based survey from January 11 to 23, 2024 (T1) and from May 16 to 26, 2024 (T2). The Nonrestorative Sleep Scale (NRSS), Perceived Stress Scale, Center for Epidemiologic Studies Depression-10, and Family APGAR Index were employed to assess NRS, stress, depression, and family function at T1, respectively. The self-injury behavior, suicidal ideation, and suicide attempts during the last four months were measured at T2. Multivariable logistic regressions were applied to investigate the associations of NRS with self-injury behavior, suicidal ideation, and suicide attempts. Stratified analyses were conducted to explore gender-specific effects, and the area under curve was calculated to explore the predictive ability of NRS.ResultsTotally, 322 adolescents (57.1% male, mean age 15.4 ± 1.86 years) completed the two-wave surveys. The prevalence of self-injury behavior, suicidal ideation, and suicide attempts in adolescents was 9.3%, 12.7%, and 5.9%, respectively. Reduced NRS symptoms (higher scores of NRSS) were associated with a decreased likelihood of self-injury (odds ratio, OR = 0.89, P < 0.001), suicidal ideation (OR = 0.90, P < 0.001), and suicide attempts (OR = 0.93, P = 0.015). After accounting for sociodemographics, stress, depression, and family function, reduced NRS symptoms significantly decreased the odds of self-injury behavior (adjusted odds ratio, AOR = 0.88, P = 0.002) and suicidal ideation (AOR = 0.92, P = 0.009) but not suicide attempts (AOR = 0.93, P = 0.082). Subgroup analysis showed that the associations of NRS symptoms reached statistical significance exclusively in female participants. The optimal risk-screening threshold of NRSS was 36.5.ConclusionsReduced NRS symptoms might decrease the risk of self-injury and suicidal ideation. Relieving NRS symptoms with appropriate interventions would be advantageous for adolescents’ health.

Mindsets of Negative Emotions Mediate the Impact of Self-Compassion on Youth Mental Health: Evidence from a Three-Annual Wave Study

Background: Harmful use of substances by adolescents is adjudged a global epidemic by the World Health Organization, affecting both the individual and society. This study assessed the prevalence, patterns and predictors of substance abuse among in-school adolescents in Yenagoa Bayelsa State Nigeria Methods: This descriptive cross-sectional study was conducted in year 2022 among 310 secondary school adolescents, selected through a multistage sampling technique. Data were collected using a semi-structured, self-administered questionnaire adapted from the Global School-based Student Health Survey (GSHS) Core Questionnaire, specifically the 2021 version of the Drug Use Module. Data were analysed using SPSS version 25; level of significance was p ≤ 0.05 at 95% Confidence Interval. Chi-square and Fisher's exact tests were used to determine the association between categorical variables. Predictors were determined by binary logistic regression. Result: The mean age of the participants was 15.07 ± 1.573 years. Lifetime substance abuse prevalence was 32.3%, with a 12-month rate of 20.6%, including 13 (4.3%) daily users. The most abused substances were Alcohol 87(90.6%), Marijuana 20(20.5%) and Shisha 18(18.8%) and mean age of initiation was 12.42±2.971 years. Relaxation 23(24.0%) and curiosity 18(18.8%) were the most common reasons provided. Predictors include older adolescents, mother’s educational level, from a polygamous setting, negative influences from family members, easy access to drugs and money, and history of sexual abuse (p&lt;0.05). Conclusion: Substance abuse among in-school adolescents is widespread, with initiation at younger ages. The most abused substances are alcohol, cannabis, and shisha. Prevention should target younger adolescents before they start using these substances.

Adolescent e-cigarette use is of public health interest in England, yet the influence of household environmental factors remains poorly understood. This cross-sectional study examined the association between secondhand tobacco smoke exposure in the home and regular e-cigarette use among adolescents. We analysed data from 12297 adolescents aged 11-15 years who participated in the 2023 wave of the Smoking, Drinking and Drug Use among Young People in England (SDD) survey. The primary exposure was self-reported frequency of secondhand smoke exposure in the home or someone else's home, categorized into five levels. The outcome was regular e-cigarette use, defined as vaping at least once per week. Logistic regression models estimated crude and adjusted associations, controlling for age, gender identity, ethnicity, family affluence, and household or peer smoking. Regular e-cigarette use was reported by 5.8% (n = 716) of the sample. Compared to those never exposed, adolescents exposed to secondhand smoke 'daily or most days' had significantly higher odds of regular e-cigarette use [adjusted odds ratio (aOR) = 7.25; 95% confidence interval (CI): 5.62-9.34; P < .001]. A clear dose-response relationship was observed across exposure categories (P for trend <.001), with increasing exposure linked to progressively higher odds of vaping. Among adolescents who had never smoked cigarettes, daily or near‑daily exposure to household secondhand smoke was still strongly associated with regular e‑cigarette use (aOR = 5.04; 95% CI: 3.64-6.99; P < .001). Frequent secondhand tobacco smoke exposure in the home is a strong and independent correlate of regular e-cigarette use among adolescents in England.

Little is known about the associations between unintentional injuries from the perspective of parents and their children's bullying victimization. This study aimed to examine the links between parent-reported unintentional injury subtypes and student-reported experiences of bullying victimization from a school-based large-scale survey. A total of 30,386 students from 35 primary schools, 27 middle schools, and 6 high schools with available data on unintentional injuries, school bullying victimization, and covariates were included in this study. Multivariable and multinomial logistic regression analyses were used to scrutinize the association of 12 types of unintentional injuries with any type of school bullying victimization, as well as multiple types of bullying experienced concurrently. 10 out of 12 types of unintentional injuries were found to be associated with elevated risks of bullying victimization, with children and adolescents whose parents reported being struck by thrown, projected, or falling objects demonstrating the greatest vulnerability to school bullying victimization, followed by accidental drowning and submersion, contact with sharp instrument, etc. And there was also a positive association between the number of unintentional injuries and bullying victimization. The associations varied among children and adolescents who reported the presence of multiple bullying. Certain types and cumulative circumstances of unintentional injuries of children and adolescents necessitate vigilant attention from parents due to the potential indication of bullying. Subsequent research should delve into the underlying mechanisms linking unintentional injuries to school bullying victimization, focusing on specific injury types to provide more targeted guidance for identifying bullying.