Symptoms of distress among young Danes during the national lockdown in May 2020.

Objectives of this study were to assess (1) prevalence of worries and symptoms of distress, and (2) perceived change in symptoms of distress by sociodemographic factors and preexisting vulnerabilities, among young Danes under the first COVID-19 related lockdown. Data were derived from online surveys, collected 7th-18th of May 2020. The study population included 11,245 young people (15-20 years of age), of which 1807 had participated in The Danish National Youth Study 2019 (DNYS19). Descriptive statistics and linear regressions analyses, including robust standard errors, were performed. All analyses were based on cross-sectional data, except analyses of preexisting vulnerabilities among responders from DNYS19. Few young people were very worried to get infected with coronavirus. Females reported a higher frequency of symptoms of distress than males. Perceived change in symptoms of distress, did not vary systematically based on age, cohabitation, nor physical health conditions. Individuals working, perceived a lower increase in symptoms of distress, than those studying etc. Females with symptoms of anxiety pre-pandemic, mental health disorders, and in families with economic hardship had a marginal higher perceived increase in symptoms of distress, than females without these difficulties. The tendencies were similar but nonsignificant among males, and for symptoms of depression pre-pandemic. In conclusion, during the lockdown, young females reported a higher frequency of symptoms of distress than males, and individuals with symptoms of anxiety pre-pandemic, mental health disorders, and in families with economic hardship were more likely to perceive the lockdown to be associated with an increase in symptoms of distress, than individuals without these difficulties.

The Danish National Youth Study 2019: study design and participant characteristics.

AIM: To present the study design, study population and questionnaire content of the Danish National Youth Study 2019, and to describe the differences between participants and non-participants regarding demographic and socioeconomic characteristics. METHOD: The Danish National Youth Study 2019 is a nationwide web-survey among high school students in Denmark. Data was collected from January to April 2019 through a self-administered questionnaire in the classroom. The questionnaire included 120 questions on, for example, physical and mental health, health behaviour and well-being. Data collection took place at 50 general high schools, 32 preparatory high schools, 15 commercial high school and 19 technical high schools. RESULTS: A total of 29,086 students participated (20,287 general high school students, 2,113 preparatory higher school students, 4027 commercial high school students and 2659 technical high school students) corresponding to 66% of the students in the 88 participating schools (31% of invited schools). Among students, 55% were female and the mean age was 17.8 years. Participants were more likely to be female, to be younger, to be of Danish origin, and have family disposable income in the highest quartile compared to non-participants. CONCLUSIONS: The Danish National Youth Study 2019 contributes to knowledge on high school students' health, health behaviour and well-being that can support health planning and prioritizing, through identification of specific risk groups at both local and national level. The study also offers great opportunities for future research as it provides possibility of linkage to various Danish national registers.

Are emotional symptoms and depression among young people with parental alcohol problems modified by socioeconomic position?

The aim was to test the hypothesis that parental alcohol problems and low socioeconomic position would be associated with higher odds ratio of emotional symptoms and depression as compared to high socioeconomic position and parental alcohol problems. Data came from Danish National Youth Study 2014, a web-based national survey with 75,853 high school and vocational school students participating, merged with register-data on family socioeconomic position. Multi-level logistic regression models (nesting participants within schools) were used to assess the association between perceived parental alcohol problems and frequent emotional symptoms and depression and effect modification by financial strains in the family, family income, or parental educational level. All analyses were adjusted for age, sex, education, immigration status, and cohabitation with parents. Young people with parental alcohol problems had higher odds ratio of experiencing frequent emotional symptoms (OR = 1.56 [1.46-1.66]) and depression (OR = 2.07 [1.88-2.28]), compared to young people without parental alcohol problems. There was no effect modification between severity of parental alcohol problems and the measures of socioeconomic position on the odds ratio of frequent emotional symptoms and depression. This study found that young people with parental alcohol problems in all social strata had higher odds ratios of frequent emotional symptoms and depression compared to young people without parental alcohol problems; the more severely they had been affected by parent's alcohol problems, the higher the odds ratios of frequent emotional symptoms and depression.

School and class-level variations and patterns of physical activity: a multilevel analysis of Danish high school students.

BACKGROUND: There is limited knowledge of physical activity (PA) patterns among high school students. High schools plays an important role as context for the students, but it is uncertain to what extent schools influence student participation in PA during leisure time. The purpose of this study is to describe patterns of PA and assess variations between schools and classes in PA, in a large cohort of Danish high school students. METHODS: Self-reported cross-sectional data came from The Danish National Youth Study, comprising a total of 70,674 students attending 119 different schools and 3213 classes. Multilevel logistic regressions were applied to evaluate the association between socio-demographic variables and patterns of PA, and to assess the impact of schools and classes on PA measures. RESULTS: Students whose parents have achieved a lower level of education, older students and girls of perceived ethnic minority generally participated less in several forms of PA during leisure time. Substantial variations between schools were observed in terms of participation in PA at school during leisure time and in terms of use of active transportation to and from school. The school-level accounted for 9% (intra-class correlation coefficient (ICC) = 0.09 (95% CI: 0.06-0.11)) and 8% (ICC = 0.08 (95% CI: 0.07-0.11)) of the variation for participation in PA during leisure time and active transportation. CONCLUSION: Overall, students whose parents achieved a lower level of education, older students and girls of perceived ethnic minority represent vulnerable groups in relation to participation in several forms of PA during leisure time. The ICCs indicate that schools, in particular, have the potential to influence participation in PA at school during leisure time and active transportation to and from school. Thus, high schools should encourage and facilitate activities aimed at engaging students in PA during leisure time as well as encourage active transportation.

Perceived parental alcohol problems and later dropout and grade point average in high school: A register-based follow-up study.

INTRODUCTION: The aim of the study was to test the hypothesis that young people with perceived parental alcohol problems have higher dropout rates in high school and lower grade point average (GPA) at graduation compared to young people without perceived parental alcohol problems. METHODS: Data come from Danish National Youth Study 2014 (n = 62,171), merged with register-data on later dropout of high school and GPA. Multilevel Poisson regression models of incidence rates of dropout and multilevel linear models of GPA were used to assess the association with perceived parental alcohol problems. RESULTS: A total of 6.6% of the students perceived their parent(s) to have alcohol problems. Young people with perceived parental alcohol problems had higher dropout rate (girls incidence rate ratio 1.83; 95% confidence interval [1.62-2.06]); boys (incidence rate ratio 1.38; 95% confidence interval [1.17-1.64]) and lower grades (GPA: -0.24; 95% confidence interval [-0.32; -0.17]) compared to those without. There was no statistically significant difference between mother's and fathers' alcohol problems in the associations with dropout and GPA. DISCUSSION AND CONCLUSIONS: Perceived parental alcohol problems were associated with higher incidence rate ratio of dropout and lower grades within all categories of the socioeconomic factors. Our results show that young people with perceived parental alcohol problems have higher high school dropout rates and lower grades compared to those without perceived parental alcohol problems across gender and socioeconomic position. The results call for evidence-based interventions to support young people with parental alcohol problems in the educational system.

Study protocol for a cluster randomised controlled trial testing the effectiveness of the 'High schools High on life' intervention on reducing excessive drinking in Danish high schools.

INTRODUCTION: This paper describes the evaluation design of the 'High schools High on life' intervention; a school-based intervention to reduce excessive drinking among high school students in Denmark. The intervention includes a school environmental component to limit access to alcohol at school, a school-educational component to change social norms around alcohol among first year students and a parental component addressing parents' knowledge and attitudes towards alcohol. METHODS AND DESIGN: The study will employ a cluster randomised controlled study design and will include a random sample of 16 high schools randomly allocated 1:1 to either intervention or control group. Target group: first year high school students. Timeline: baseline survey: January to March 2019, collected as part of the Danish National Youth Study 2019. Delivery of intervention: April 2019 to March 2020. Follow-up survey: April to May 2020. PRIMARY OUTCOME MEASURE: 30% reduction in mean number of binge-drinking episodes (five or more alcoholic drinks on one occasion) within the last 30 days. SECONDARY OUTCOME MEASURES: proportion of students who drink alcohol, mean weekly alcohol consumption, alcohol intake at last school party, alcohol intake at the school during last school party, proportion of students who agree to be able to have fun at a party without drinking and the proportion of students who think alcohol plays a too dominant part at the school. Implementation will be monitored through process evaluation. ETHICS AND DISSEMINATION: The Scientific Ethics Committees for the Capital Region of Denmark has declared that the trial is not subject to notification (jnr. 19021957). The study is registered at the Research an Innovation Office at University of Southern Denmark (ref: 10.314) allowing collection of personal data. Results will be published in peer-reviewed journals. TRIAL REGISTRATION NUMBER: NCT03906500.

'High schools High on life': Development of an Intervention to Reduce Excessive Drinking in Danish High Schools.

Background: Clear documentation of the understanding of the problem, process of development, and content of interventions is essential to enable other researchers to understand why interventions succeed or fail and to enable researcher to build on previous evidence and replicate and adapt findings in other contexts. In this paper we describe the rationale, intervention development, and final design of the 'High schools High on life' intervention; a high school-based, multi-component intervention to reduce excessive drinking among Danish high school students. Methods: The development of the intervention 'High schools High on life' was guided by the planning steps of the Intervention Mapping protocol (IM) in combination with the behavior change wheel and the behavior change techniques, theory, evidence, practice, and new empirical studies of contextual factors in the Danish high school setting. Results: The development process resulted in a multi-component intervention with the following intervention elements: a school environmental component targeting school alcohol policies and norms, a school educational component addressing students' social norms around alcohol, and a parental component encouraging parent-child communication around alcohol. Discussion: Not all steps of IM were followed rigidly. However, IM proved useful as a planning tool in combination with the behavior change wheel and the behavior change techniques, as it provided a systematic approach to the intervention development process. IM forced the research group to be explicit about decisions and choices throughout the planning process. The transparency of the developmental process and theoretical, empirical and practical/contextual foundation of the 'High schools High on life' intervention may enable future intervention studies to build on our findings and accumulate knowledge to reduce excessive drinking among young people. Trial registration: The trial was registered at clinicaltrials.gov (Trial registration number NCT03906500) prior to randomization.

Socioeconomic position and alcohol-related harm in Danish adolescents.

BACKGROUND: In adults, it has consistently been observed that with equal alcohol consumption levels, alcohol harms individuals with low socioeconomic position (SEP) more than individuals with high SEP. It is unknown if this so-called alcohol harm paradox is also present in adolescents. We aim to test the hypothesis that low SEP is associated with more alcohol-related harm as compared with higher SEP in Danish adolescents. METHODS: We used survey data from the Danish National Youth Study 2014 including 70 566 students from 119 high schools. Alcohol-related harm was measured by self-report as having been in a fight, involved in an accident, had problems with parents or friends, had sex that was regretted afterwards and done drugs that was regretted afterwards, because of alcohol. Further, a combined measure was constructed defined as having experienced any harm more than once within the last year. SEP was measured as parents' educational level, family income, parents' employment status and experiencing financial strain in the family. Analyses were adjusted by age, sex, perceived ethnicity, class type and binge drinking. RESULTS: Lower SEP was associated with higher odds of experiencing alcohol-related harm more than once as compared with highest SEP, and lower SEP was associated with higher odds of having been in a fight, problems with parents or friends, sex and regretting afterwards or drugs and regretting afterwards, as compared with highest SEP. These associations were statistically significant. Adjustment for the frequency of binge drinking did not change results. CONCLUSION: The alcohol harm paradox exists in Danish adolescents, and this should be addressed in future prevention strategies to reduce the risk of alcohol-related harm among adolescents.