Associations between dietary behaviours and the mental and physical well-being of Swedish adolescents.

AIMS: This study aims to investigate the association between dietary behaviours, overweight/obesity, and mental health and well-being among Swedish adolescents. METHODS: Data from the 2017/2018 Health Behaviour in School-aged Children (HBSC) survey of 3692 adolescents aged ≈11, ≈13, and ≈15 years was analysed. We evaluated the prevalence and association of dietary behaviours, characterised by daily intake of fruits and vegetables, consumption of sugar-sweetened beverages (SSBs) and sweets once per week, and daily consumption of family meals and breakfast, with socioeconomic and demographic factors. Multivariate logistic regression models (adjusted and unadjusted) were then used to examine the relationship between dietary behaviours, overweight/obesity, and mental health and well-being including psychosomatic complaints, life satisfaction, and school-related pressure. RESULTS: Boys were more likely to eat breakfast and have meals together with their family than girls, but their fruit and vegetable intake was lower compared to girls. Adolescents with lower socioeconomic status (low family affluence, families perceived 'not well-off' and two unemployed parents), single-parent households and twoforeign born parents were more likely to engage in poorer dietary behaviours. Daily breakfast, family meals, fruit and vegetable intake were positively associated with mental health and well-being. Specifically, daily family meals were linked to higher life satisfaction, fewer psychosomatic complaints, and reduced school-related pressure. Breakfast emerged as a beneficial dietary habit, associated with higher life satisfaction, and a lower likelihood of psychosomatic complaints, school-related pressure, and overweight/obesity. Fruit and vegetable consumption was consistently associated with better mental health and well-being while associations between SSBs and sweets were mixed. CONCLUSIONS: Improving mental health and well-being, along with tackling the rising rates of mental illness and challenges related to overweight/obesity in adolescents constitute key public health priorities. Implementing policies that promote the intake of fruits and vegetables, reducing the consumption of SSBs and sweets, and emphasizing the value of having breakfast and sharing family meals could offer a cost-effective public health intervention.

Impact of poverty and adversity on perceived family support in adolescence: findings from the UK Millennium Cohort Study.

Emotional support from family members may have an important effect on adolescent health outcomes, and has been identified as a target for policy to protect against the impacts of poverty and other early life adversities. However, few studies have assessed the extent to which poverty and adversity themselves influence the nature of emotional support that parents can provide to adolescents. We, therefore, aimed to investigate the impact of trajectories of income poverty and family adversities, including parental mental ill health, alcohol misuse and domestic violence across childhood developmental stages on young people's relationships with their families and perceived emotional support received. We analysed longitudinal data on 10,976 children from the nationally representative UK Millennium Cohort study. Exposure trajectories of poverty and family adversities were characterised using group-based multi-trajectory models (age 9 months-14 years). The outcomes were perceived emotional support and quality of family relationships, measured by the three-item Short Social Provisions Scale (SPS-3) and levels of parent-adolescent closeness and conflict, measured at age 14. ORs and 95% CIs were estimated using multivariable logistic regression models, adjusting for potential confounding factors. At age 14, the overall prevalence of low perceived emotional support was 13% (95% CI: 12, 14). Children of mothers with lower socioeconomic status (SES) were more likely to report low emotional support, with a clear social gradient (education-degree plus: 10.3% vs. no qualifications: 15.4%). Compared with children exposed to low levels of poverty and adversity, children in the persistent adversity trajectory groups experienced higher odds of low emotional support and low-quality parent-adolescent relationship; those exposed to both persistent poverty and poor parental mental health were particularly at increased risk of experiencing poor family relationships and low perceived emotional support (adjusted odds ratio 2·2; 95% CI 1·7-2·9). Low perceived emotional support and poor family relationships in adolescence are more prevalent among socially disadvantaged children and adolescents and those experiencing social adversity. Policies to improve levels of family support for UK adolescents should focus on improving modifiable determinants such as child poverty and family mental health.

The clustering of multiple health and lifestyle behaviors among Swedish adolescents: a person-oriented analysis.

Background: Knowledge of the distribution, prevalence, and clustering of multiple health and lifestyle related behaviors (HLBs) among adolescents can inform the development of effective health-promoting policies and interventions. We assessed the clustering of multiple HLBs among 11, 13 and 15-year-old Swedish adolescents and examined the socioeconomic and demographic correlates for the identified clusters. Methods: We used data from the 2017/2018 Swedish Health Behaviour in School-aged children (HBSC) study to conduct sex and age-stratified latent class analysis (LCA). The LCA was based on five HLBs: eating behavior and habits (EBH), physical activity (PA), tobacco usage (TU), alcohol consumption (AC) and sleeping habits and patterns (SHPs). Multinomial logistic regression models were used to assess the associations between the identified clusters and the socioeconomic and demographic characteristics of adolescents and their parents. Results: Health behaviors varied by sex and age. Four distinct clusters were identified based on sex: cluster 1 (Mixed eating behaviors and habits, physical activity and low alcohol consumption), cluster 2 (Healthy lifestyle behaviors), cluster 3 (Unhealthy lifestyle behaviors), and cluster 4 (Breakfast, low alcohol consumption and tobacco usage). In the age-stratified analyzes, three clusters were identified: cluster 1 (Unhealthy lifestyle behaviors), cluster 2 (Moderately healthy lifestyle behaviors) and cluster 3 (Healthy lifestyle behaviors). The multinomial analysis showed that sex, age, family situation and perceived family wealth were strong predictors of health behaviors. Unhealthy behaviors were most commonly associated with socioeconomic disadvantage, having a migrant background, and living in reconstructed families or single-parent households. Conclusion: Health behaviors vary significantly based on socioeconomic and demographic circumstances. Targeted policies and intervention programs are necessary to improve HLBs among vulnerable and at-risk adolescents.

Changes in parents' mental health related to child out-of-home care placements: A Swedish national register study.

BACKGROUND: Literature on outcomes of children in out-of-home care (OHC) is extensive. However, less is known regarding associations of such placements with parental mental health disorders (MHD). OBJECTIVE: This study investigated changes in hospitalization rates due to MHD among parents, four years before and after placement of their child in OHC. PARTICIPANTS AND SETTING: We used data on 4067 members (Generation 1) of the RELINK53 cohort (individuals born and living in Sweden in 1953) and their 5373 children (Generation 2) in OHC. METHODS: Using random effects regression models, associations between OHC and MHD were examined separately for fathers and mothers. Nested models were tested exploring associations with parent and child/placement-related factors. Marginal effects were computed to assess mean rates of hospitalization annually. RESULTS: Overall, mothers had higher mean hospitalization rates than fathers. Compared to the year of placement, hospitalization rates were significantly lower in the four years before placement for mothers (9.9 %, 9.5 %, 10.5 %, 12.1 %, respectively) and fathers (5.9 %, 7.6 %, 8 %, 9.8 %, respectively). Mothers showed highest hospitalization rates at the year of placement (26.6 %), while fathers, one year after placement (13.4 %). Hospitalization rates declined significantly directly after placement among mothers, but an unclear and non-significant pattern of results was found among fathers. CONCLUSIONS: Most parents have higher hospitalization rates at and directly after placement. Potential hypotheses underlying these findings are discussed, including psychosocial gender differences and opportunities to seek care as means of reunification. There is an urgency to develop strategies to better support these parents throughout the process.

Socioeconomic inequalities in overweight and obesity among 6- to 9-year-old children in 24 countries from the World Health Organization European region.

Childhood overweight and obesity have significant short- and long-term negative impacts on children's health and well-being. These challenges are unequally distributed according to socioeconomic status (SES); however, previous studies have often lacked standardized and objectively measured data across national contexts to assess these differences. This study provides a cross-sectional picture of the association between SES and childhood overweight and obesity, based on data from 123,487 children aged 6-9 years in 24 countries in the World Health Organization (WHO) European region. Overall, associations were found between overweight/obesity and the three SES indicators used (parental education, parental employment status, and family-perceived wealth). Our results showed an inverse relationship between the prevalence of childhood overweight/obesity and parental education in high-income countries, whereas the opposite relationship was observed in most of the middle-income countries. The same applied to family-perceived wealth, although parental employment status appeared to be less associated with overweight and obesity or not associated at all. This paper highlights the need for close attention to context when designing interventions, as the association between SES and childhood overweight and obesity varies by country economic development. Population-based interventions have an important role to play, but policies that target specific SES groups are also needed to address inequalities.

Determinants and impact of role-related time use allocation on self-reported health among married men and women: a cross-national comparative study.

BACKGROUND: Research on the effects of marriage on health maintains that there is a gender-specific gradient, with men deriving far greater benefits than women. One reason provided for this difference is the disproportionate amount of time spent by women on housework and childcare. However, this hypothesis has yet to be explicitly tested for these role-related time use activities. This study provides empirical evidence on the association between role-related time use activities (i.e. housework, childcare and paid work) and self-reported health among married men and women. METHODS: Data from the Multinational Time Use Study (MTUS) on 32,881 men and 26,915 women from Germany, Italy, Spain, the UK and the US were analyzed. Seemingly unrelated regression (SUR) models and multivariable logistic regression were used to estimate the association between role-related time use activities and self-reported health among married men and women. RESULTS: The findings showed that education, occupation and number of children under 18 years old in the household were the most consistent predictors of time allocation among married men and women. Significant gender differences were also found in time allocation, with women sacrificing paid working time or reducing time devoted to housework for childcare. Men, in contrast, were less likely to reduce paid working hours to increase time spent on childcare, but instead reduced time allocation to housework. Allocating more time to paid work and childcare was associated with good health, whereas time spent on housework was associated with poor health, especially among women. CONCLUSIONS: Time allocation to role-related activities have differential associations on health, and the effects vary by gender and across countries. To reduce the gender health gap among married men and women, public policies need to take social and gender roles into account.

Social Capital, Deprivation and Psychological Well-Being among Young Adolescents: A Multilevel Study from England and Wales.

Examining the mechanisms influencing mental health and life satisfaction simultaneously allows for a better understanding of adolescents psychological well-being. Six indicators of neighbourhood social capital (NSC), neighbourhood socioeconomic deprivation (SecD) and their association with psychological well-being among young adolescents aged 10-15 from England and Wales were investigated. Using a random sample of 5201 adolescents (7253 observations) from the UK Household Longitudinal Study merged to aggregated local area census measures, we fitted a series of multilevel models. The findings showed that not being worried about crime and friendship networks mitigated the negative effects of deprivation on adolescent's psychological well-being. These findings suggest that some forms of NSC may have a buffering and protective function, with the strongest effects in deprived neighbourhoods. We further found that psychological well-being of adolescents is dependent on both individual vulnerabilities and neighbourhood context. However caution is required if, and when public health policies are formulated to address this issue, given significant variations (27-36%) in the inter- and intra-individual psychological well-being were found among this group over time. Thus, policies designed to improve psychological well-being among adolescents should take into account the role of social processes in transmitting deprivation's effects, as well as the various forms of social capital.

Time spent on work-related activities, social activities and time pressure as intermediary determinants of health disparities among elderly women and men in 5 European countries: a structural equation model.

BACKGROUND: Psychosocial factors shape the health of older adults through complex inter-relating pathways. Besides socioeconomic factors, time use activities may explain gender inequality in self-reported health. This study investigated the role of work-related and social time use activities as determinants of health in old age. Specifically, we analysed whether the impact of stress in terms of time pressure on health mediated the relationship between work-related time use activities (i.e. housework and paid work) on self-reported health. METHODS: We applied structural equation models and a maximum-likelihood function to estimate the direct and indirect effects of psychosocial factors on health using pooled data from the Multinational Time Use Study on 11,168 men and 14,295 women aged 65+ from Italy, Spain, UK, France and the Netherlands. RESULTS: The fit indices for the conceptual model indicated an acceptable fit for both men and women. The results showed that socioeconomic status (SES), demographic factors, stress and work-related time use activities after retirement had a significant direct influence on self-reported health among the elderly, but the magnitude of the effects varied by gender. Social activities had a positive impact on self-reported health but had no significant impact on stress among older men and women. The indirect standardized effects of work-related activities on self-reported health was statistically significant for housework (ß = - 0.006; P < 0.001 among men and ß = - 0.008; P < 0.001 among women) and paid work (ß = 0.012; P < 0.01 among men and ß = 0.000; P > 0.05 among women), which implied that the paths from paid work and housework on self-reported health via stress (mediator) was very weak because their indirect effects were close to zero. CONCLUSIONS: Our findings suggest that although stress in terms of time pressure has a direct negative effect on health, it does not indirectly influence the positive effects of work-related time use activities on self-reported health among elderly men and women. The results support the time availability hypothesis that the elderly may not have the same time pressure as younger adults after retirement.

Ethnic variations in mental health among 10-15-year-olds living in England and Wales: The impact of neighbourhood characteristics and parental behaviour.

Several studies indicate that young people from certain ethnic minority groups in Britain have significant mental health advantages over their White majority counterparts, but the reasons for these differences have not been adequately explored. This work analyses the impact of neighbourhood characteristics, measured by socioeconomic deprivation; crime; living conditions; ethnic density and parenting behaviour on the mental health of young people. To determine the impact of these factors on mental health among young people, geocoded data from waves 1, 3 and 5 of the UK Household Longitudinal Study (UKHLS) are merged with small area statistics from the 2011 census, and multilevel linear regression models are fitted to the sample of 5513 (7302 observations) 10-15-year-olds of varying ethnicity residing in England and Wales. We find that mental health is generally poorer for White British youths, even after accounting for individual/family-level predictors, neighbourhood characteristics and parental behaviour than it is for minority youths. In keeping with results from studies of adult populations, neighbourhoods with high levels of deprivation are associated with poorer mental health. However, some aspects of parenting behaviour appear to have a more significant impact on the mental health of young people from ethnic minority backgrounds than on White British youths. Further research into factors that influence inter-ethnic disparities in mental health among young people is warranted, given that clear differences remain after the models in this study are fully adjusted.

Does the ethno-religious diversity of a neighbourhood affect the perceived health of its residents?

Concerns about the diversification of Britain, and its impact on social capital and health are widely debated. The literature has however produced a fuzzy discourse, full of assumptions and claims that are rarely tested. We attempt to disentangle some of these assumptions by providing empirical evidence on the mediating and moderating influence of inter-ethnic conflict and contact, and examine whether they underlie the erosion of health among minorities and white British respondents residing in diverse local areas. Analyses were conducted using multilevel models that relied on geocoded data from a random stratified sample of adults 16-75 years collected in the 2009-2011 Citizenship Survey merged to small area aggregated statistics from the 2011 UK census. The final sample comprised of minorities (n = 13,236) and white British (n = 15,021) residing in England. We find that local area deprivation matters much more for the health of minorities and whites than diversity. Yet, residing in diverse areas can be problematic for whites if it is accompanied by high levels of social distance measured by negative attitudes towards immigrants. Greater contact among minorities and whites, residing in more diverse areas appears to have no significant effect on health. Overall, the findings supported our hypothesis that residing in areas of greater diversity has a differential impact on minorities when compared to whites. In particular, diversity appear to be more beneficial for minorities, especially newly arriving migrants. The effect of contact as measured by social capital is dwarfed in comparison to the effect of deprivation, underlying the importance for policy makers to tackle structural inequalities.