School-aged Children Study Research Articles

Autonomy support in toddlerhood: Similarities and contrasts between mothers and fathers.

Infant exploration often hinges on parental autonomy support (i.e., parental behaviors that support children’s goals, interests, and choices), a construct that is widely applied in family studies of school-age children and adolescents but less studied in infants and toddlers. Notable gaps concern the equivalence, similarities, and contrasts between mothers’ and fathers’ autonomy support and the correlates of individual differences in autonomy support. To address these underresearched topics, we conducted parallel home-based structured play observations of 195 infants (Mage = 14.42 months, SD = .59) in dyadic interaction with mothers and fathers. Confirmatory factor analyses demonstrated measurement invariance across parent gender, enabling comparisons that revealed significantly moderately higher levels of autonomy support in mothers than in fathers. Individual differences in autonomy support were unrelated to either parental personality or child temperament, highlighting the potential importance of dyadic characteristics. Consistent with this view, whereas maternal autonomy support did not differ by child gender, fathers with sons displayed less autonomy support than did fathers with daughters.

Pharmacokinetics of a Pediatric Tribendimidine Dose-Finding Study To Treat Hookworm Infection in African Children.

Tribendimidine is a broad-spectrum anthelminthic available in China, which is currently being pursued for U.S. Food and Drug Administration approval for soil-transmitted helminth infections. Pharmacokinetic (PK) studies with tribendimidine in children, the main target group for treatment programs, have not been conducted to date. In the framework of a dose-ranging study in hookworm-infected school-aged children in Côte d'Ivoire, children were treated with either 100, 200, or 400 mg tribendimidine. Dried blood spot samples were collected up to 22 h after treatment. The active metabolite, deacetylated amidantel (dADT) and its metabolite acylated dADT (adADT) were quantified using liquid chromatography tandem mass spectrometry. PK parameters were calculated using a noncompartmental model, and univariate logistic regression was applied using maximal blood concentrations (Cmax) and area under the blood concentration-time curve for 0 to 22 h (AUC0-22) as predictors of drug efficacy. Dried blood spot samples of 101 children were analyzed. We observed a less than proportional and proportional exposure in dADT's median Cmax and AUC0-22, respectively, following administration of 100 mg (Cmax = 853 ng/ml; AUC0-22 = 3,019 h · ng/ml) and 400 mg (Cmax = 2,275 ng/ml; AUC0-22 = 12,530 h · ng/ml) tribendimidine. There were large, dose-independent variations in the time to Cmax (Tmax) and ratios of dADT to adADT. We did not detect an influence of Cmax or AUC0-22 of dADT or adADT on drug efficacy or adverse events. Since our study population was bearing hookworm infection of mainly low intensity, additional studies with heavy intensity infections might be required to confirm this observation.

Changes in the amount of sleep and daytime sleepiness: A follow-up study of schoolchildren from ages 10 to 15 years.

This study examines the amount of sleep and daytime sleepiness, and how these change in a follow-up cohort study of school-aged children. A total of 1351 schoolchildren (aged 10) and their parents were invited to participate in the study and were studied again at ages 12 and 15years. A survey put forth by the Health Behaviour of Schoolchildren research network was used. The amount of sleep during weekdays dropped significantly from age 10 to 15. At weekends, the amount of sleep increased significantly. During weekdays, the proportion of children reporting having slept enough dropped from 71% at age 10 to 19% at age 15. Frequent daytime sleepiness occurred in 13% of children at age 10 and increased to 24% at the age of 15. It is essential to promote adequate amount of sleep and prevent daytime sleepiness in children growing from age 10 to 15years. Nurses and other health care professionals should systematically assess and promote healthy sleeping habits while caring for children between these ages.

School Start Time and the Healthy Weight of Adolescents

PurposeStudies have found that an early school start time is detrimental to the sleep, health, and well-being of youth, but its association with body weight remains unclear. We examined this association in Canadian adolescents. MethodsWe collected information on start times from 362 schools that participated in the 2013/2014 Canadian Health Behaviour in School-aged Children Study (n = 29,635 students; ages 10–18). We estimated body mass indices (BMIs) and BMI z-scores, and identified overweight and obesity using international growth references. Multilevel regression models tested the associations between school start times and our outcomes, adjusted for grade, family affluence, school rurality, latitude, and province. ResultsThe average BMI was 21.2 (standard deviation 4.9) and BMI z-score was .48 (standard deviation 1.23). Every 10-minute delay in school start time corresponded with a .02 (95% confidence interval .00, .04) smaller BMI z-score. This association translated to BMIs in the 70th and 64th percentiles when comparing students from schools that started at 8:00 a.m. and 9:30 a.m., respectively. School start time was not significantly related to overweight or obesity. ConclusionsLater school start time was linked to lower BMI in Canadian adolescents. Delaying school start time may be an additional strategy to support the healthy weight of adolescents. Future intervention and impact studies are recommended to confirm these findings.

The Problem with Low-Prevalence of Bullying.

This paper tests the hypothesis of whether being bullied in an environment where bullying is infrequent decreases adolescents’ life satisfaction. Analyses were based on the international standard questionnaire from the 2005/2006 Health Behaviour in School-aged Children study (HBSC). The sample included answers from 183,736 children in 35 Western, industrialized countries. Our results show that the negative effects of being bullied on the life satisfaction of individuals are stronger in schools and countries where bullying is less frequent. We therefore conclude that the prevalence of bullying in the students’ surroundings may act as a mediating variable explaining the relationship between bullying and life satisfaction.

Activity Involvement and Spiritual Health in Children with ADHD and Learning Disabilities

ABSTRACTAttention-deficit/hyperactivity disorder (ADHD) and learning disabilities (LDs) represent two of the most prevalent disabilities experienced by adolescents. Despite the benefits of spiritual health in relation to happiness and overall well-being, there has been limited examination of spiritual health among adolescents with disabilities. Sports and other activities can act as protective factors that mediate the relationship between low spiritual health and negative outcomes. Therefore, the purpose of this study was threefold: to explore the differences in spiritual health (a) among adolescents with ADHD, LDs, or without disabilities; (b) by activity type; and (c) after taking into account the interaction between disabilities and activities. Adolescents included in the 2014 (Canadian cycle 7) Health Behaviour in School-aged Children study (n = 17,407, Mage = 14.08 years, SD = 1.46 years) reported their disability status and involvement in organized activities and completed a shortened version of Fisher's Spiritual Well-being scale. Overall spiritual health (analysis of covariance) and its dimensions (multivariate analysis of covariance) were compared by disabilities and activities with gender, age, and family affluence as covariates. Lower levels of engagement in both sports and nonsport activities were associated with diagnoses of ADHD (38.4%) and LDs (50.5%) compared with peers without disabilities (53.8%). Involvement in either sports or nonsport activities was associated with positive spiritual health outcomes (F = 228.7, p < .001), with the highest levels of spiritual health reported by children involved in both types of activities (F = 7.8, p < .001). The protective effect of activity involvement was stronger for children with ADHD or LDs than for children without disabilities. Diversity of activities including both sports and nonsport activities among adolescents with ADHD or LDs mitigates overall spiritual health when compared with peers without disabilities.

Attachment security buffers the HPA axis of toddlers growing up in poverty or near poverty: Assessment during pediatric well-child exams with inoculations

Poverty is associated with poor physical and emotional development. Activation of the hypothalamic-pituitary-adrenocortical (HPA) axis is argued to be one of the pathways through which poverty acts on these outcomes. While studies of school-aged children have found some evidence for this, there is little evidence for this hypothesis early in development. This may be, in part, because for very young children, the security of their attachment relationships with parents moderates the impact of poverty on HPA axis functioning. The current study investigated the relations between family income as a percentage of the federal poverty limit (FPL), salivary cortisol and attachment (Attachment Q-sort) during well-child checkups with inoculations in 177 toddlers between 12- and 22-months of age. Approximately half of the toddlers were in families living below 150% FPL, with 47% of these classified as securely attached, compared to 72% of toddlers in families living above 150% FPL. Cortisol levels increased in response to the inoculation and this did not differ by poverty or attachment security. Overall, however, beginning at clinic arrival toddlers in families living below 150% FPL who had an insecure attachment had significantly higher cortisol compared to toddlers living in poverty or near poverty with secure attachments. This finding held when we removed toddlers with high levels of negative life events in their families and primary caregivers who exceeded the screening cutoff for depressive symptoms. Thus, attachment was a significant moderator of the association between poverty and HPA axis activity, with significant implications for screening and referral of caregiving dyads at risk.

Children's Speech Perception in Noise: Evidence for Dissociation From Language and Working Memory

We examined the association between speech perception in noise (SPIN), language abilities, and working memory (WM) capacity in school-age children. Existing studies supporting the Ease of Language Understanding (ELU) model suggest that WM capacity plays a significant role in adverse listening situations. Eighty-three children between the ages of 7 to 11 years participated. The sample represented a continuum of individual differences in attention, memory, and language abilities. All children had normal-range hearing and normal-range nonverbal IQ. Children completed the Bamford-Kowal-Bench Speech-in-Noise Test (BKB-SIN; Etymotic Research, 2005), a selective auditory attention task, and multiple measures of language and WM. Partial correlations (controlling for age) showed significant positive associations among attention, memory, and language measures. However, BKB-SIN did not correlate significantly with any of the other measures. Principal component analysis revealed a distinct WM factor and a distinct language factor. BKB-SIN loaded robustly as a distinct 3rd factor with minimal secondary loading from sentence recall and short-term memory. Nonverbal IQ loaded as a 4th factor. Results did not support an association between SPIN and WM capacity in children. However, in this study, a single SPIN measure was used. Future studies using multiple SPIN measures are warranted. Evidence from the current study supports the use of BKB-SIN as clinical measure of speech perception ability because it was not influenced by variation in children's language and memory abilities. More large-scale studies in school-age children are needed to replicate the proposed role played by WM in adverse listening situations.

Association Between Early Menarche and School Bullying

PurposeEarly pubertal onset may relate to more involvement in bullying in adolescent girls, both as a target and as a perpetrator. However, the few studies of the association between early menarche and school bullying have shown mixed findings. The present study examined whether early menarche is associated with bullying victimization and perpetration. MethodsWe obtained survey data on adolescent girls from the 2001–2002, 2005–2006, and 2009–2010 cycles of the Health Behaviour in School-aged Children study in 35 European and North American countries. We identified school bullying in the past 2 months using the Revised Olweus Bully/Victim Questionnaire. We defined early menarche as a reported onset of menarche before 11 years and tested the associations between early menarche and bullying victimization and perpetration using three-level logistic regression models. ResultsThe sample included 227,443 adolescent girls with a mean age of 13.64 (standard deviation [SD] 1.63) years, of which 10,172 (4.47%) were early matured; 62,528 (28.33%) and 56,582 (25.67%) were occasional victims and perpetrators, respectively; and 21,985 (9.96%) and 14,115 (6.40%) were frequent victims and perpetrators, respectively. Early menarche related to occasional victimization (adjusted odds ratio [OR] [95% confidence interval [CI] = 1.21 [1.12–1.31]) and perpetration (aOR [95% CI] = 1.19 [1.11–1.27]) and to frequent victimization (aOR [95% CI] = 1.35 [1.22–1.50]) and perpetration (aOR [95% CI] = 1.46 [1.31–1.63]). ConclusionsEarly menarche in European and North American adolescent girls positively relates to bullying victimization and perpetration. Early-maturing girls should not be neglected in antibullying programs.

Vagus nerve stimulation for 6- to 12-year-old children with refractory epilepsy: Impact on seizure frequency and parenting stress index

ObjectivesRefractory epilepsy (RE) is frequently associated with neuropsychological impairment in children and may disrupt their social development. Vagus nerve stimulation (VNS) had been reported to have beneficial effects on behavioral outcomes. The aim of this study was to compare Parenting Stress Index (PSI) scores before and after VNS device implantation in children with RE, especially those who experienced seizure frequency reduction. MethodsWe conducted a one-group pretest–posttest study in school age children with RE. Seizure frequency and PSI were recorded at 12months after VNS device implantation. ResultsTreatment with VNS was significantly associated with reduced seizure frequency and parental stress as measured by PSI. Factors contributing to seizure frequency included idiopathic/cryptogenic etiology and neurobehavioral comorbidities. In children with reduced seizure frequency, statistically significant improvements in the child domain of the PSI on the subscales of mood and reinforces parent were found. In the parent domain, the scores for social isolation were reduced. ConclusionsTreatment with VNS was significantly associated with reduced seizure frequency and improved PSI scores, especially within the child domain on the mood and reinforces parent subscales. These findings suggest that VNS reduced not only seizure frequency but also the psychological burden on children with RE.

Child neglect and its relation to emotional and behavioral problems: A cross-sectional study of primary school-aged children in Tanzania.

Child maltreatment is known to engender negative emotional and behavioral consequences. Although neglect is the most frequent form of maltreatment, it has thus far only received little attention, especially when looking at low-resource countries. The current study investigated possible associations between neglect and internalizing and externalizing problems. As neglect and abuse often co-occur, the latter was controlled for. In total, 409 Tanzanian primary school students (52% boys, M = 10.5 years, range = 6-15) participated in the cross-sectional study. Structured clinical interviews were conducted assessing maltreatment, internalizing problems, and externalizing problems. Overall, 31% (n = 128) of the children reported at least one type of physical neglect and 31% (n = 127) of emotional neglect. Using structural equation modeling, we found a significant association between neglect and internalizing (β = 0.59, p &lt; .01) and externalizing problems (β = 0.35, p &lt; .05). However, these associations could only be detected in younger children (ages 6-9), whereas in older children (ages 10-15), mental health problems were significantly related to violence and abuse. Our findings suggest that the current age may influence the association between maltreatment type and the development of internalizing and/or externalizing problems.

Do public expenditures on health and families relate to alcohol abstaining in adolescents? Multilevel study of adolescents in 24 countries.

Several European countries have observed an increase in the proportion of adolescents that abstain from drinking alcohol in the last decade. The reasons for this trend remain underexplored. We hypothesised that more generous government expenditures on health services and benefits to families with children relate to a positive trend in abstainers. We used data on 15-year-olds in four successive cycles of the World Health Organization Health Behaviour in School-aged Children study (2002 to 2014) in 24 North American and European countries (pooled n = 175 331). Generalised linear mixed-effects models were tested to analyse trends in alcohol abstinence and to investigate whether cross-country differences in these trends relate to public expenditures on health and families with children (in proportion to gross domestic product). Overall, we observed an increase in the proportion of abstainers from 21% in 2002 to 35% in 2014. An exception was Greece where abstaining had decreased from 20% to 15%. Similar results were found in boys and girls. The upward trend in abstinence related to larger government expenditures on health and families. More generous expenditures on health services and family benefits relate to more adolescents abstaining from alcohol.

Relative deprivation and disordered gambling in youths

BackgroundPrevious research has found that area-level income inequality and individual-level relative deprivation both contribute to disordered gambling in adults. However, the socioeconomic factors that contribute to disordered gambling in youths...

Social Inequality in Adolescent Life Satisfaction: Comparison of Measure Approaches and Correlation with Macro-level Indices in 41 Countries

Family affluence plays a crucial role in adolescent well-being and is potential source of health inequalities. There are scarce research findings in this area from a cross-national perspective. This study introduces several methods for measuring family affluence inequality in adolescent life satisfaction (LS) and assesses its relationship with macro-level indices. The data (N = 192,718) were collected in 2013/2014 in 39 European countries, Canada, and Israel, according to the methodology of the cross-national Health Behavior in School-aged Children study. The 11-, 13- and 15-year olds were surveyed by means of self-report anonymous questionnaires. Fifteen methods controlling for confounders were tested to measure social inequality in adolescent LS. In each country, all measures indicated that adolescent from more affluent families showed higher satisfaction with their life than did those from less affluent families. According to the Poisson regression estimations, for instance, the lowest inequality in LS was found among adolescents in Malta, while the highest inequality in LS was found among adolescents in Hungary. The ratio between the mean values of LS score at the extreme highest and lowest family affluence levels (Relative Index of Inequality) derived from the regression-based models distinguished for its positive correlation with the Gini index, and negative correlation with Gross National Income, Human Development Index and the mean Overall Life Satisfaction score. The measure allows in-depth exploration of the interplay between individual and macro-socioeconomic factors affecting adolescent well-being from a cross-national perspective.

Family wealth and parent–child relationships

This study examined associations between self-reported family wealth and parent–child relationships, by contrasting three theoretical perspectives on the shape of the association. The study utilized data from the Norwegian part of the “Health behaviour in school-aged children study (HBSC) 2013/2014”, with a sample of 3383 children aged 11–15 years old. The shape of associations between family wealth and parent–child communication were tested using regression spline models with knots at 1 SD below mean family wealth and at 1 SD above mean family wealth. The regression spline models showed that increasing family wealth was associated with easier family communication, clearer family communication, and higher family support. Results revealed that for boys, the association between family wealth and outcomes was stronger for the lower segment of family wealth, than in medium and high segments of family wealth. For girls, the gradient across level of wealth was monotone, with higher parent–child communication and higher family support at higher family wealth. To conclude, the results from this study suggest a nonlinear pattern of inequality in parent–child relationships across the range of family wealth.

Urinary Cotinine Level in Indonesian Children Exposed to Domestic Cigarette Smoke.

Background:Cotinine is a major metabolite of nicotine, and its urinary level is an indicator of exposure to cigarette smoke. The present study was aimed at identifying the urinary cotinine level in Indonesian children who were exposed and not exposed to domestic cigarette smoke.Methods:The study was a cross-sectional study in elementary school-aged children who had not smoked. The subjects were categorized into an exposed group and unexposed group based on their exposure status. Data were obtained from a questionnaire and random urinary samples measured using enzyme-linked immunosorbent assay.Results:There were a total of 128 subjects, including 64 children in the exposed group and 64 children in the unexposed group. The median level of cotinine in all subjects was 17.95 ng/ml (with a range of 0.1–158.3 ng/ml). The urinary cotinine level in the exposed group was higher than the unexposed group (median: 30.1 ng/ml vs. 8.45 ng/ml; P < 0.000). There was a correlation between urinary cotinine levels in children exposed to cigarette smoke and the number of cigarettes smoked by the smokers at home (P < 0.05). The optimal cut-off points of urinary cotinine levels in children, which was utilized to evaluate cigarette smoke exposure, was 17.95 ng/ml (81% sensitivity; 81% specificity; P < 0.000).Conclusion:The urinary cotinine level in children exposed to cigarette smoke is higher than children who are not exposed to domestic cigarette smoke. The urinary cotinine level can be used as a noninvasive marker to evaluate cigarette smoke exposure in children.

Subjective health literacy among school-aged children

PurposeThe purpose of this paper is to explore Finnish adolescents’ subjective health literacy (HL) in association to school achievement, learning difficulties, educational aspirations, and family affluence.Design/methodology/approachNationally representative data were collected in Finland as a part of the international Health Behaviour in School-aged Children study. The respondents consisted in total of 3,833 adolescents (7th and 9th graders) from 359 schools. The Health Literacy for School-aged Children instrument was applied to measure adolescents’ subjective HL, while the Family Affluence Scale was used to measure adolescents’ socioeconomic status. Information was gathered on school achievement, learning difficulties, and educational aspirations.FindingsApproximately one-third of the adolescents manifested a high level of HL, around 60 per cent had a moderate level of HL, and about one-tenth had low HL. The HL level was lower for boys than for girls, and lower for 7th graders than for 9th graders. In the total sample, the strongest explanatory variables for HL were school achievement in the first language, and educational aspirations.Originality/valueThis study provides the first nationally representative examination of adolescents’ subjective HL levels, and how these vary across age and gender groups. In drawing conclusions and presenting suggestions for HL interventions, it is important to verify the nature of the HL examined in any given study, and how it was researched.

The Family Affluence Scale as an Indicator for Socioeconomic Status: Validation on Regional Income Differences in the Czech Republic.

The Health Behaviour in School-Aged Children study (HBSC) uses the Family Affluence Scale (FAS) as a tool to identify the socioeconomic status of children and adolescents. Even though it is now widely applied in research studies, the external criterion validation of FAS has not been verified in terms of objective economic indicators in Central Europe. The aim of this study is to validate FAS in terms of disposable income per capita in 14 Czech administrative regions. Regional differences in the FAS score were analyzed using Pearson correlation and linear regression to measure the dependency of the aggregated mean of the FAS index at the regional level on data from the Czech HSBC survey carried out from April to June 2014 (n = 10,361). The data analysis has shown an overall positive correlation between the FAS index and regional disposable income (R = 0.77, p < 0.01). The regional disposable income per person could explain 59.7% of the variance in the FAS index (p < 0.01). By validating individual items, the authors identified three items with a significant correlation (p < 0.01): number of computers, dishwasher at home, and number of holidays. FAS seems to be a valid instrument to measure adolescents’ socioeconomic status.

Spoken sentence production in college students with dyslexia: working memory and vocabulary effects.

Individuals with dyslexia demonstrate syntactic difficulties on tasks of language comprehension, yet little is known about spoken language production in this population. To investigate whether spoken sentence production in college students with dyslexia is less proficient than in typical readers, and to determine whether group differences can be attributable to cognitive differences between groups. Fifty-one college students with and without dyslexia were asked to produce sentences from stimuli comprising a verb and two nouns. Verb types varied in argument structure and morphological form and nouns varied in animacy. Outcome measures were precision (measured by fluency, grammaticality and completeness) and efficiency (measured by response times). Vocabulary and working memory tests were also administered and used as predictors of sentence production performance. Relative to non-dyslexic peers, students with dyslexia responded significantly slower and produced sentences that were significantly less precise in terms of fluency, grammaticality and completeness. The primary predictors of precision and efficiency were working memory, which differed between groups, and vocabulary, which did not. College students with dyslexia were significantly less facile and flexible on this spoken sentence-production task than typical readers, which is consistent with previous studies of school-age children with dyslexia. Group differences in performance were traced primarily to limited working memory, and were somewhat mitigated by strong vocabulary.

Alcohol consumption among first- and second-generation immigrant and native adolescents in 23 countries: Testing the importance of origin and receiving country alcohol prevalence rates.

This internationally comparative study examines differences in alcohol consumption between first- and second-generation immigrant and native adolescents. We also investigate to what extent origin and receiving country alcohol per capita consumption (APCC) rates and proportions of heavy episodic drinkers (HED) are associated with immigrant adolescents' alcohol consumption. We used cross-sectional survey data from the 2013/2014 Health Behaviour in School-aged Children study. Applying multilevel regression analyses, we investigated the lifetime frequency of alcohol use and drunkenness in 69 842 13- to 15-year-olds in 23 receiving countries, with immigrants from over 130 origin countries (82% natives, 6% first-generation immigrants and 12% second-generation immigrants). The lifetime frequency of alcohol use was higher among natives than among first- and second-generation immigrants, while no differences were found between the latter two. Lifetime drunkenness was more frequent among first-generation immigrants than among natives and second-generation immigrants. Higher origin country APCC and HED were associated with more frequent lifetime alcohol use and drunkenness among immigrant adolescents. Cross-level interactions revealed that for lifetime frequency of alcohol use, the origin country HED effects were stronger for first- than for second-generation immigrant adolescents. Further, especially for first-generation immigrants, a higher receiving country HED was related to lower lifetime frequencies of alcohol use and drunkenness. Our results suggest differences in lifetime frequencies of alcohol use and drunkenness between natives and first- and second-generation immigrant adolescents. Origin country APCC and HED seem to affect immigrant adolescents' alcohol consumption differently than receiving country APCC and HED.