Life satisfaction in the context of the COVID-19 pandemic among middle school adolescents in France: findings from a repeated cross-sectional survey (EnCLASS, 2012-2021).

Background and aims: Since the COVID-19 pandemic, several studies have reported a decrease in adolescents' well-being. We aim to describe life satisfaction over the last decade and examine the factors associated with its variations between 2020 and 2021 among French students in their last year of middle school (around 14-15 years old). Methods: Data were drawn from a repeated biennial cross-sectional national survey conducted in French schools over the last decade (EnCLASS study), using a self-administered questionnaire. After describing life satisfaction trends between 2012 and 2021 using the Cantril ladder, we examined individual changes in life satisfaction between 2020 and 2021 and their associations with housing and studying conditions during the COVID-19 lockdown, using multinomial logistic regression analysis (decrease, increase, no change as reference). Results: Among the 17,686 survey respondents, an overall slight decrease in the prevalence of adolescents reporting high life satisfaction (i.e., Cantril score ≥6) was observed since 2012 with the lowest proportion reported in 2021 (77.4%). Between 2020 and 2021, 16.3% of French adolescents experienced an improvement in life satisfaction, while 17.7% experienced the opposite. Decrease in life satisfaction between 2020 and 2021 was more likely experienced by adolescents living in reconstructed families [aOR 2.09 (95%CI, 1.58-2.77)], those who did not have their own room [aOR 1.58 (1.16-2.15)], nor access to the Internet to interact with their friends during the lockdown [aOR 1.47 (1.09-1.98)]. Interestingly, more girls than boys were represented in both those reporting increase and decrease in life satisfaction [aOR 1.82 (1.40-2.37) and 1.43 (1.14-1.79), respectively]. Conclusions: This study shows that the way adolescents experienced the first 2020 lockdown in France was not uniform, and that one must consider sex as well as housing and studying conditions when interpreting adolescents' life satisfaction decrease during the COVID-19 pandemic.

Chronic health conditions and school experience in school-aged children in 19 European countries.

This study investigates chronic conditions (CC) prevalence among children in mainstream schools, their school experience and life satisfaction in Europe. Data were collected from the 2017/2018 HBSC survey, a cross-national study using self-reported questionnaires administered in classrooms. Nationally representative samples of children aged 11, 13, and 15 years in mainstream schools from 19 European countries (n = 104,812) were used. School experience was assessed using four variables: low school satisfaction, schoolwork pressure, low teacher support, and peer-victimization, which were related to life satisfaction. Latent class analysis (LCA) was conducted to identify patterns of school experience among students with CC. The prevalence of CC varied from 8.4 (Armenia) to 28.2% (Finland). Children with CC (n = 17,514) rated their school experience and life satisfaction lower than children without CC. LCA identified three school experience patterns: "negative on all items" (37%), "negative on all items, except school pressure" (40%) and "overall positive" (23%). The distribution of subgroups varied across countries-in countries with a higher proportion of children with CC in mainstream schools, children reported more negative school experiences. Compared to the "overall positive" group, low life satisfaction was highest for students classified as "negative on all items" (relative risk (RR) = 2.9; 95% CI 2.2-3.8) with a lesser effect for "negative on all items, except school pressure" (RR) = 1.8; 95% CI 1.4-2.4). These findings provide cross-national data documenting the diversity in inclusive educational practices regarding school placement and school experiences, and suggest that efforts are still needed to allow a fully inclusive environment.

Shedding Light on the Lifestyle and Participation of Portuguese Adolescents with Chronic Conditions-Data from the HBSC 2018 Study.

Variables associated with lifestyle can constitute either risk or protective factors for the development and progression of chronic conditions (CC). This study intends to explore the differences between adolescents with and without CC and between adolescents whose school participation is affected/not affected by the existing CC with regard to variables related to lifestyle (i.e., sleep, physical activity, BMI, and leisure). In addition, it also intends to analyze the influence of these variables (i.e., CC and lifestyle) regarding the adolescents' quality of life (QoL). This work is part of the Portuguese HBSC 2018 study. A total of 8215 adolescents participated (52.7% female), with an average age of 14.36 years (SD = 2.28). The results showed that the adolescents with CC and whose school attendance and participation are affected by their CC exhibit more sleep difficulties (i.e., they experience lower sleep quality and have a higher degree of sleepiness), higher BMI levels (i.e., higher values of overweight and obesity), less participation in leisure activities, and a lower perception of QoL. A higher perception of QoL is associated with school participation unaffected by the existing CC, sleeping well, a low level of sleepiness, a more frequent practice of physical activity, a lower BMI, and a greater involvement in leisure activities. Adolescent health and well-being are a prominent issue in terms of public policies, with behavior and lifestyle playing a significant role in this domain. This message needs to be reinforced in regard to families, educators, healthcare professionals, and public sector policies, particularly concerning students with CC.

Chronic Conditions and School Participation of First-Year University Students-HOUSE ULisbon Study.

Students with chronic conditions (CC) tend to experience several barriers in terms of their school participation and performance. Therefore, the present study aims to explore the factors related to the time of diagnosis of CC (recent/non-recent), the barriers to participation and academic success (health condition, people's attitude towards CC and school physical environment), the physical and mental health (physical/psychological symptoms and concerns) and school-related variables (relationship with teachers and peers), regarding the school participation of first-year students with CC. This work is part of the HOUSE-Colégio F3 Project, University of Lisbon, which includes 1143 first-year university students from 17 Faculties and Institutes of the University of Lisbon. In this specific study, only the subsample of 207 students with CC was considered, 72.4% of which were female, aged between 18 and 54 years (M = 20.00; SD = 4.83). The results showed that students with a recent diagnosis of CC and students with school participation affected by the CC were those who presented more negative indicators regarding barriers to school participation, physical and mental health, and school-related variables. A greater impact of CC in terms of school participation was associated with having a recent diagnosis, with people's attitude towards CC and with the health condition as barriers, with more psychological symptoms and worse relationships with teachers and peers. This is a relevant message for the organization of health services for students with CC at the beginning of their university studies, especially since they are often displaced from home and managing their health conditions alone (in many cases, for the first time).

Smoking Behavior among Adolescents: The Lebanese Experience with Cigarette Smoking and Waterpipe Use.

(1) Background: The study aims to assess cigarette smoking and waterpipe experimentation among Lebanese adolescent school students with respect to their gender, region, age, and socioeconomic status. (2) Methods: This is a cross-sectional study, where students between 11 to 18 years of age were included from all over Lebanon. (3) Results: A total of 1133 students were interviewed. The total proportion of adolescents who ever experimented with cigarette smoking was 24.5%. Males experimented with cigarette smoking more commonly than females (31.9% vs. 19.1%; p < 0.001). Cigarette smoking experimentation was higher among students from the Beirut area (33.6%; p < 0.001) in comparison to other regions, and among those with poor health perception (29.1% vs. 19.8%; p < 0.001) compared to students with excellent health perception. The total proportion of adolescents who ever used a waterpipe was 33.9%. Waterpipes were significantly more experimented with among males than females (40.3% vs. 29.8%; p < 0.001), and among students with bad perception about their health (39.4% vs. 28.9%; p < 0.001). Adolescents who experimented with both cigarettes and waterpipes constitute 22.2% of the studied sample. (4) Conclusions: The rate of tobacco product use is alarming and constitutes a major public health issue for adolescents that urgently needs intervention. The findings raise important policy implications for the development of cigarette smoking prevention programs for youth.

Changes in tooth brushing frequency and its associated factors from 2006 to 2014 among French adolescents: Results from three repeated cross sectional HBSC studies.

OBJECTIVES: This study aimed to evaluate in the changes in the percentage of adolescents who brush their teeth twice a day and the association with socio-economic status and health behaviors between 2006, 2010 and 2014 among adolescents from the French cross-sectional studies of the Health Behavior in School-aged Children (HBSC) survey. METHODS: Our sample included 18727 adolescents aged 11, 13 or 15 years old (y/o). The relationship between toothbrushing frequency (TBF) and eating habits, health and socio-economic status markers, family status, school perception, substance use, sedentary lifestyle and physical activity, together with their evolution over the 3 studies, were investigated using multivariate logistic regression. RESULTS: The proportion of adolescents brushing twice a day increased from 68.8% in 2006 to 70.8% in 2010 and 78.8% in 2014 (p<0.0001). Notable associated factors (p<0.0001) were: being a girl (adjusted Odds Ratio = 1.5) and, even more, an older girl (aOR 1.5 for 15 y/o vs 11 y/o girls), having breakfast (aOR 1.4) and eating fruits daily (aOR 1.6), excellent perceived health (aOR 1.2), obesity or overweight (aOR 0.6), being bullied at school (aOR 0.8), and perceived family wealth (aOR 1.4 for High vs Low). No impact from any associated factor changed over the 3 studies. CONCLUSIONS: Among French adolescents, TBF improved from 2006 to 2014. TBF was significantly associated with other health behaviors. These associations stayed similar in 2006, 2010 and 2010. This increase in TBF may be linked with global prevention programs developed during this time period. These programs should be maintained and associated with more specific ones targeting and adapted to disadvantaged populations, in order to reduce inequalities in oral hygiene and oral health.

[Substance use among young people: From medicine to illicit substances]. / Consommation de substances chez les jeunes : du médicament aux substances illicites.

This paper aims to present the main information presented at the 9th meeting about addictovigilance in 2016 by three healthcare professionals and addiction experts on the issue of substance use in young people. The results of surveys conducted in general population and of specific addictovigilance investigations, bring information on consumption data and use patterns in this population of 11-25years of age. The provision of care, mainly constituted by the Young consumers' consultations, has to adapt to diversified practices, ranging from experiment to substance use disorders, which vary over time and often hidden.

Self-Reported Health and Patterns of Romantic Love in Adolescents from Eight European Countries and Regions.

Purpose: Sexual minority youth (SMY) are at increased risk of poor health, but it remains unclear whether this phenomenon is universal. In this study, nationally representative samples of 15-year olds from eight European countries and regions were investigated to test if adolescents who have been in love with same- or both-gender partners report poorer health than those exclusively in love with opposite-gender partners or who have never been in love. Methods: A subsample of 13,674 adolescents participating in the 2014 Health Behaviour in School-aged Children (HBSC) study was used. We conducted binary logistic regression, adjusted for gender, region, and relative family affluence, to analyze associations between self-reported romantic love, multiple psychosomatic symptoms, and poor self-rated health. Results: Adolescents reporting same-gender love (adjusted odds ratio [aOR] = 1.50, 95% confidence interval [CI]: 1.11-2.02) and both-gender love (aOR = 3.57, 95% CI: 2.65-4.83) had significantly higher odds for multiple psychosomatic symptoms than those who reported opposite-gender love. Similarly, both SMY groups had higher odds of poor self-rated health (aOR = 2.95, 95% CI: 1.64-5.31 and aOR = 3.08, 95% CI: 1.79-5.31, respectively). Those who reported that they have never been in love had significantly lower odds for multiple symptoms. Adjustment for sociodemographic variables and stratifying by gender did not substantially change the odds ratios. Conclusion: Adolescents in love with same- and both-gender partners reported poorer subjective health outcomes than those in love with opposite-gender partners or who reported never being in love, suggesting that SMY health inequalities are found across various European countries and regions.

Negative feelings about the timing of first sexual intercourse: findings from the Health Behaviour in School-aged Children study.

OBJECTIVES: This study investigates the association between negative feelings about the first intercourse timing and sociodemographic and contextual factors. We hypothesized that girls and adolescents with an older first sexual partner will be more likely to report negative feelings and that prevalence of those feelings will vary across countries. METHODS: Adolescents (N = 6073, mean age = 15.6 ± 0.34), from Bulgaria, France, Ireland, and Scotland, taking part in the 2013/2014 HBSC study, were asked about sexual initiation, their age and partner's age at first intercourse, and their feeling about the timing of first intercourse. RESULTS: One-fifth of the 1321 adolescents who had had sexual intercourse reported negative feelings about the first intercourse timing. Girls, adolescents from low affluent families, and those with an older first partner were more likely to report negative feelings. However, after adjustment for covariates, only girls and those from less affluent families had significantly higher odds of reporting negative feelings. CONCLUSIONS: Sexual education programmes need to explicitly address decision-making around timing of first intercourse in order to reduce negative feelings, with a special attention to gender and social inequalities.

Sleep in adolescence: sex matters?

OBJECTIVE: Sleep is of upmost importance for everybody and especially for adolescents who face life and leisure challenges that may impair their sleep. This study aimed to verify if girls are at a higher risk to present sleep problems and if associations of a sleep perception are different between sexes even when accounting for biological maturation. METHODS: Data is from the HBSC Portuguese survey 2014, all variables were self-reported. Participants were 3869 adolescents (2057 girls), mean age 14.8 years. Participants' socio-demographic characteristics included sex, age, school grade, father and mother education; besides participants were inquired about sleep duration and characteristics of their sleep quality. RESULTS: Sleep deprivation was reported by 13.1% of the adolescents (girls 14.3%, boys 11.7%, p<0.05). The most prevalent characteristics of poor sleep quality were waking up tired (50.8%) and difficulties falling asleep (19.5%), for both girls presented higher prevalence than boys. Overall, girls presented a poorer sleep health with low quality and quantity of sleep. Furthermore, associations of an enough and good sleep were different between boys and girls, even when controlling for the impact of delayed pubertal maturity. DISCUSSION: Together with screen time, substance use, poorer nutrition, sedentary behaviours and abuse of screen time, sleep is an issue that must be addressed by professionals, families and public policies with impact in family life and family routines. Modelling a health education in schools should include the sleep topic. In addition, yes, sex matters and must be included on board.

Love and Dating Patterns for Same- and Both-Gender Attracted Adolescents Across Europe.

Sexual orientation is a multidimensional phenomenon, which includes identity, behavior, and attraction. The attraction component, however, is less studied than the other two. In this article, we present the development of a two-item measure to identify adolescents who prefer same- and both-gender partners for love and dating. The questions were administered to nationally representative samples of 15-year-old adolescents in eight European countries and regions participating in the Health Behaviour in School-aged Children (HBSC) cross-national study. The distribution of attraction, as operationalized by preference for the gender of love and dating partners, was similar across countries. These questions offer an alternative or supplementary approach to identify same- and both-gender attracted youth, without administering questions related to sexual identity.

Revisiting Factors Associated With Screen Time Media Use: A Structural Study Among School-Aged Adolescents.

BACKGROUND: Screen-based media overuse has been related to harmful consequences especially among children and adolescents. Given their complex interrelationships, predictors of screen time (ST) should be analyzed simultaneously rather than individually to avoid incomplete conclusions. METHODS: Structural equation models were conducted to examine associations between media ST (television, video games, and computers) along with harmful consequences in adolescents' well-being, such as underweight and overweight, depression, and school failure. Predictors included individual (gender, age, and physical activity), family (structure and socioeconomic background), and substance use variables. We used the Health Behaviour in School-aged Children survey organized in 2014, including eighth- and ninth-grade students living in France (N = 3720). RESULTS: Students reported spending 3 hours per day in front of each media. Spending more than 2 hours behind each of those 3 media was associated with lower life satisfaction, less physical activity, active school bullying, and grade repetition. Socioeconomic status was the most important predictor of ST, whereas regular substance uses showed modest associations. CONCLUSION: The main implication of our findings is to sensitize parents and stakeholders about the limitation of ST, including their own use that adolescents are likely to mimic. Alternative measures such as off-line time should be encouraged.

Socioeconomic and behavioral determinants of tooth brushing frequency: results from the representative French 2010 HBSC cross-sectional study.

OBJECTIVES: To describe tooth brushing frequency and its association with a wide range of socioeconomic and behavioral characteristics, using a nationally representative sample of school-aged children in France. METHODS: Our sample included 11,337 students aged from 10 to 16 years, who answered the HBSC questionnaire. Some variables were grouped into composite variables, thus generating scores for: eating habits, health and body, relationships with parents, socioeconomic status (SES) of family, and school life. Multivariate logistic regression analyses were used to study the relationship between these variables and tooth brushing frequency. RESULTS: Girls were more likely to brush twice a day than boys [adjusted Odds Ratio: aOR 2.47, 95 percent confidence interval CI95% (1.97; 3.11), aOR 1.89, CI95% (1.56; 2.29), aOR 1.45, CI95% (1.25; 1.68) for low, mid, and high school life score, respectively]. Students were more likely to brush twice a day when they had high (versus low) scores for healthy eating habits [aOR = 1.60; 95 percent CI: (1.40; 1.83)], well-being concerning health and body [aOR = 1.61; 95 percent CI: (1.40; 1.86)] and SES [aOR = 1.25; 95 percent CI: (1.09; 1.43)]. CONCLUSIONS: We believe that preventive health campaigns should target school and family environments more specifically to reach the most disadvantaged sections of the population and include promotion of whole health. The messages should be designed to efficiently reach adolescents, e.g., by appealing to their maturity, self-esteem, and emotional factors. Through the incorporation of qualitative research elements, identifying the reasons for not brushing twice a day would also help to develop new prevention programs.

Relative deprivation and episodes of drunkenness among French and Canadian adolescents.

INTRODUCTION AND AIMS: Studies link socio-economic deprivation to alcohol consumption in adolescents, but the role of relative deprivation has been understudied and may be equally important. This study investigates the association between relative deprivation and episodes of drunkenness among adolescents in France and Canada. DESIGN AND METHODS: We used data from the 2014 Health Behaviours in School-aged Children study collected from 15-year-olds in Canada (n = 4276) and France (n = 1625). Students reported the number of times they had ever been drunk. The degree of relative deprivation was quantified through the student's rank in the deprivation distribution, measured through the Family Affluence Scale, within school and the extent of the inequality. Random intercept logistic regression models were used to examine the association between relative deprivation and drunkenness. RESULTS: Canadian adolescents were more likely to have experienced drunkenness more than once in their lifetime compared with French adolescents (21.6% vs. 16.2%). Adolescents with high relative deprivation were not more likely to report episodes of drunkenness in Canada and were less likely to report episodes of drunkenness in France compared with those with low relative deprivation. DISCUSSION AND CONCLUSIONS: Our findings do not support the hypothesis that adolescents who experienced greater relative deprivation are more likely to report drunkenness. They suggest that policies and interventions on alcohol use should target adolescents across all levels of deprivation in Canada and particularly those that are relatively more affluent in France. The context of countries appears to matter to the socio-economic distribution of drinking behaviour in youth. [Sentenac M, Ehlinger V, Napoletano A, Spilka S, Gariepy G, Godeau E, Elgar FJ. Relative deprivation and episodes of drunkenness among French and Canadian adolescents.

Alcohol, tobacco and cannabis use: Do students with mild-intellectual disability mimic students in the general population?

Education policies encourage inclusion of students with mild-intellectual disability (mild-ID) in community/school life. However, such policies potentially increase exposure to substance use. This article examines tobacco, alcohol and cannabis use among French students enrolled in special units for students with disabilities (ULIS) at mainstream junior high schools compared to those of general population of the equivalent age; and explores factors associated with substance use among ULIS students, known to present mostly mild-ID. In 2014, a questionnaire adapted from the international HBSC/WHO study was administered to 700 ULIS students (mean-age 14.2). Comparative data were gathered from 7023 junior high-school students (mean-age 13.6) in the general population. Among students <14 years-old, tobacco and alcohol use rates were similar between ULIS and general population. For students ≥14, alcohol use remained comparable, while tobacco and cannabis use were higher in general population. Among ULIS students, low perceived health/life satisfaction, divorced/separated parents and high perceived academic demands were associated with tobacco use. Bullying, not liking school very much and attending schools outside a deprived area were associated with alcohol use. Having had sexual intercourse and not perceiving one's health as excellent were associated with cannabis use. Having dated was associated with using all three substances.

Sexual Health questions included in the Health Behaviour in School-aged Children (HBSC) Study: an international methodological pilot investigation.

BACKGROUND: This paper describes the methodological developments of the sexual health items included in the Health Behaviour in School-aged Children (HBSC) study since their mandatory inclusion in the study in 2002. The current methodological, ethical and pedagogical challenges in measuring young people's sexual health behaviours are discussed along with the issues associated with the sexual health items introduced to the HBSC study in 2002. The development and piloting of new cross-national items for use in the 2013/14 HBSC data collection are presented and discussed. METHODS: An international pilot study was undertaken to determine the impact of these proposed changes. Questionnaires and classroom discussion groups were conducted in five pilot countries in 2012/2013 (France, Hungary, Ireland, Portugal and Romania) with a total of 612 school-aged children (age M = 15.55 years, SD = 0.95). RESULTS: The majority of participants in each country provided positive feedback about the appropriateness of the questions. Some small cross-national differences were found in the self-reported quantitative data relating to the appropriateness of the questions (χ2 = 22.831, df = 9, p = .007, V = .117). Qualitative feedback suggests that for the vast majority of students the phrasing and age-targeting of the questions were considered appropriate. With the exception of a small number of respondents who commented on the clarity and/or personal nature of the content, no specific issues with the questions were identified. CONCLUSIONS: These findings provide guidance on the answerability (including the extent of missing and inconsistent data), understandability, acceptability (including in different cultures) and relevance of questions to potential participants. The findings from the pilot study suggest that in general, the questions are understandable, acceptable, and of a high priority to the target population, and that the simplification has significantly reduced the proportion of missing data. The new developments thus enhance the capacity of the questions to measure cross-nationally, sensitive aspects of young people's sexual behaviour. These questions were included in the 2013/2014 round of the HBSC survey and will continue to be used to monitor trends in adolescent sexual health and behaviours, and to inform and influence health services and health education policy and practice at local, national and international levels.

Gendered trends in early and very early sex and condom use in 20 European countries from 2002 to 2010.

BACKGROUND: Sexual activity is often initiated during the adolescent period, and previous research suggests that the age of first sexual intercourse and condom use are crucial determinants of later sexual health. This study examined trends in adolescent sexual behaviours from 2002 to 2010 in 20 countries across four geographical regions of Europe. METHODS: Data were collected by self-report questionnaires from 15-year-olds in classrooms during 2002, 2006 and 2010. Linear time trends were determined through logistic regression models, stratified for gender. RESULTS: No linear trend over time was documented for most countries for sexual intercourse at the age of 13 or younger. Increased initiation among girls in Eastern Europe and decreased very early initiation among girls in Northern Europe emerged, along with a general increase in condom use in boys and most notably in girls. CONCLUSION: Overall prevalence of early and very early sexual intercourse initiation was quite stable in Europe between 2002 and 2010, while condom use increased. More detailed research and policy attention to the antecedents of non-condom use among young people is warranted; and further study of the relationships between age of sexual initiation and condom or pill use would be particularly valuable.

Decreases in adolescent weekly alcohol use in Europe and North America: evidence from 28 countries from 2002 to 2010.

BACKGROUND: This study examined trends in adolescent weekly alcohol use between 2002 and 2010 in 28 European and North American countries. METHODS: Analyses were based on data from 11-, 13- and 15-year-old adolescents who participated in the Health Behaviour in School-Aged Children (HBSC) study in 2002, 2006 and 2010. RESULTS: Weekly alcohol use declined in 20 of 28 countries and in all geographic regions, from 12.1 to 6.1% in Anglo-Saxon countries, 11.4 to 7.8% in Western Europe, 9.3 to 4.1% in Northern Europe and 16.3 to 9.9% in Southern Europe. Even in Eastern Europe, where a stable trend was observed between 2002 and 2006, weekly alcohol use declined between 2006 and 2010 from 12.3 to 10.1%. The decline was evident in all gender and age subgroups. CONCLUSIONS: These consistent trends may be attributable to increased awareness of the harmful effects of alcohol for adolescent development and the implementation of associated prevention efforts, or changes in social norms and conditions. Although the declining trend was remarkably similar across countries, prevalence rates still differed considerably across countries.

Adolescents' medicine use for headache: secular trends in 20 countries from 1986 to 2010.

BACKGROUND: This study reports secular trends in medicine use for headache among adolescents in 20 countries from 1986 to 2010. METHODS: The international Health Behaviour in School-aged Children (HBSC) survey includes self-reported data about medicine use for headaches among nationally representative samples of 11-, 13- and 15-year-olds. We included 20 countries with data from at least three data collection waves, with a total of 380 129 participants. RESULTS: The prevalence of medicine use for headaches varied from 16.5% among Hungarian boys in 1994 to 62.9% among girls in Wales in 1998. The prevalence was higher among girls than boys in every country and data collection year. The prevalence of medicine use for headaches increased in 12 of 20 countries, most notably in the Czech Republic, Poland, Russia, Sweden and Wales. CONCLUSION: The prevalence of medicine use for headaches among adolescents is high and increasing in many countries. As some medicines are toxic this may constitute a public health problem.