Adolescents with emotional and behavioural problems are at higher risk to become excessive or addicted Internet users: is this association moderated by gender?

BACKGROUND: The Internet offers many opportunities for adolescents to facilitate their lives. However, its everyday use may lead to excessive behaviour, including addiction. Our aim was to assess the association between emotional and behavioural problems (EBP) and level of internet use, and whether gender moderates this association. METHODS: We used data from a representative sample of 5,433 Slovak adolescents (mean age: 13.51, 48.8% boys) from the Health Behaviour in School-aged Children-study conducted in 2018, collected through online self-report questionnaires. EBP was measured by the Strengths and Difficulties Questionnaire and excessive internet use (EIU) and internet addiction (IA) by the Excessive internet use scale. We analysed using multinomial logistic regression. RESULTS: More than 25% of the adolescents reported EIU; almost 4% reported being addicted to Internet. EIU was more prevalent in girls, but IA was more prevalent in boys. Adolescents with borderline or increased levels of EBP were more likely to report EIU (odds ratio, OR/95% confidence interval, CI: 1.85/1.60-2.14; 3.16/2.67-3.75, respectively) and IA (OR/95% CI: 2.23/1.57-3.18; 4.89/3.41-7.03, respectively). Adjustment for gender, age or perceived family wealth hardly changed the findings. Moreover, gender did not modify the associations between EBP with EIU. CONCLUSION: Adolescents with higher levels of EBP are more likely to become excessive Internet users or Internet addicts. This shows a need of early identification of adolescents with EBP as they seem to be relatively vulnerable to develop EIU or IA.

"I could do almost nothing without digital technology": a qualitative exploration of adolescents' perception of the risks and challenges of digital technology.

Background: The fast development of digital technology and of its use at even younger ages is significantly shaping the current generation of adolescents. This is leading to an almost unlimited accessibility that provides a large number of opportunities, but also to many challenges that adolescents have to face. The aim of our study was to explore the perceptions adolescents have of the risks of digital technology. Methods: We conducted online semi-structured interviews as a part of the international Health Behaviour in School-aged Children study. The sample consisted of 15 Slovak adolescents (mean age: 15.33; 20% boys). To analyse our data, we used consensual qualitative research and thematic analysis. Findings: Our findings confirmed that adolescents are aware of the risks associated with the use of digital technology. Regarding their specific types of the perceived risks, we identified four main themes: 1. dependence on the functionality of technology; 2. problematic control; 3. vulnerability in the virtual environment; 4. health risks. Adolescents thus want technology that is functional, safe and does not endanger their health. Conclusion: Despite the fact that adolescents know of the risks they may experience due the digital technology, they still use it. Preventive strategies should focus on functionality, safety and healthiness; furthermore, they should support the constant development of adolescents' digital awareness and raising their awareness about effective and non-threating use of technology.

Technology supports me: Perceptions of the benefits of digital technology in adolescents.

Background: Technology plays a significant role in the lives of adolescents. Our knowledge is predominantly based on research exploring the risks associated with it, but adolescents also feel that technology supports their lives. This has received less consideration. Therefore, we aim to examine how adolescents perceive the benefits of digital technology. Methods: We used qualitative data collected as part of the international Health Behaviour in School-Aged Children study. We conducted online, semi-structured interviews with 15 Slovak adolescents who came from three different types of secondary schools based on their graduation systems (mean age: 15.33; 20% boys). The data were analyzed using consensual qualitative research and thematic analysis. Results: We identified five main themes based on the comments of adolescents: 1. I know (source of information, formal and non-formal education); 2. I can (smart device, helpful tool); 3. I am connected/included (social interactions); 4. I have my comfortable place (leisure time, creating my alternative world); and 5. I work on my future (self-development). Conclusion: Adolescents perceived digital technology as mostly supportive and a helpful tool in their lives. The potential benefits of digital technology should be better reflected in public perception and policy, as the societal debate is mostly dominated by perceived disadvantages and risks.

Selected Behavioural Factors Affecting Oral Health in Schoolchildren: Results from the Health Behaviour in School-Aged Children (HBSC) Slovak Study.

Oral diseases, particularly dental caries, affect as much as nine in 10 persons globally. Its development starts during childhood. Behavioural factors play an important role in its aetiology. The aim of the research was to analyse the prevalence of selected behavioural factors associated with dental caries in Slovak adolescents. Selected factors, such as toothbrushing less than once a day, consumption of sweets and sweetened soft drinks daily and their combination, were analysed using data from Health Behaviour in School-Aged Children surveys carried out in 2005/2006, 2009/2010, 2013/2014 and 2017/2018 in Slovakia. The target group consisted of 11- to 13-year-old schoolchildren. The results were analysed by sex and socioeconomic status. The consumption of sweets and sweetened soft drinks, despite declining, remains widespread (41.3% of boys and 39.6% of girls in 2017/2018). The absence of daily toothbrushing, similarly as a co-occurrence of factors, were more frequent in boys (10.6% and 5.0% in 2017/2018, respectively) than in girls (5.1% and 2.3% in 2017/2018, respectively). The absence of daily toothbrushing was associated with a lower socioeconomic situation. In conclusion, behavioural risk factors affecting oral health are widespread in Slovak adolescents. Despite the positive development of the epidemiological situation, effective interventions, as well as the improvement of oral hygiene in lower socioeconomic groups, are needed.

Adolescents exposed to discrimination: are they more prone to excessive internet use?

BACKGROUND: The Internet may serve as a suitable environment for discriminated adolescents as they may consider the online space as the place where they have possibility to build social ties they are missing in their offline life or manage their self-presentation. Therefore, our aim was to explore the association between different types of discrimination by peers (because of gender, physical appearance, culture/skin color/language, unfavorable family situation) and excessive Internet use (EIU), and whether gender moderates this association. METHODS: We used data from a representative sample of 6,462 Slovak adolescents (mean age: 13.00, 49.6% boys) from the HBSC study conducted in 2018. Data were collected through online self-reported questionnaires. We assessed the association between various types of discrimination by peers and EIU using linear regression, and the role of gender as potential moderator. RESULTS: Discrimination because of physical appearance was most prevalent (18.0%). Adolescents exposed to discrimination by peers reported higher levels of EIU. We found an interaction of gender on the association of discrimination because unfavorable family situation with EIU. Boys who experienced this type of discrimination were at higher risk of EIU compared to girls. CONCLUSION: Discriminated adolescents are more likely to use the Internet excessively, with some associations being stronger for boys than for girls. Prevention strategies focused on raising adolescent awareness of the risks and benefits of the Internet should target discriminated adolescents, especially boys, as they seem to be the vulnerable group.

Does Life Satisfaction Mediate the Association between Socioeconomic Status and Excessive Internet Use?

Excessive Internet use is becoming a rapidly increasing problem in today's society. Our aim was to assess the association between socioeconomic status (SES) of the family and excessive Internet use (EIU), and whether life satisfaction mediates this association. We analyzed data from a representative sample of 2844 Slovak adolescents (mean age 14.34, 50.5% boys) from the 2014 Health Behavior in School aged Children (HBSC) study, based on self-report questionnaires. We assessed the association of SES, measured by several indicators, such as perceived family wealth, parental education, and (un)employment, and adolescent EIU using linear regression, adding life satisfaction as a mediator. Adolescents whose father was unemployed and whose perceived family wealth was low tended to score higher on EIU. Neither gender nor age affected this relationship. Life satisfaction mediated a part of the association between SES and EIU in the case of low perceived family wealth and father's (un)employment. Adolescents with a low SES are more likely to become excessive Internet users, and life satisfaction mediates this association. Prevention of EIU among adolescents should be targeted at those with low SES, with life satisfaction being the topic to address.

What Protects Adolescents with Youth Subculture Affiliation from Excessive Internet Use?

Youth subculture affiliation (SA) appears to be an important risk factor with regard to adolescents' problem behavior. Excessive Internet use (EIU) has emerged as a new type of problem behavior; however, it has not yet been studied in adolescents affiliated with youth subcultures. Thus, the aim of this study was to assess the association between SA and EIU and to explore the role of selected protective factors. We used data from the Health Behaviour in School-aged Children (HBSC) study conducted in 2014 in Slovakia. The final sample for this study comprised 532 adolescents (mean age: 15.4; 49.6% boys). Hierarchical linear regression analysis was conducted to examine the associations of EIU with SA. Adolescents with SA were more likely to report EIU. Adjustment for protective factors decreased the association between EIU and SA. From all tested interactions, only the interaction of SA with family support was found to be significant. The relationship between family support and EIU was mediated via Monitoring by the mother only in adolescents without SA. Our findings imply that the risk of EIU is higher in adolescents with SA. There was a difference in how protective factors worked in adolescents with and without SA.

Test-retest reliability of selected HBSC items measuring problem behaviour among Slovak and Czech adolescents.

OBJECTIVES: The purpose of this study was to assess the test-retest reliability of selected items based on self-reports, measuring problem behaviour in the Slovak and Czech version of the HBSC survey questionnaire. METHODS: The data from test-retest study, based on an international Health Behaviour in School-aged Children (HBSC) study and consistent with its methodology, were analysed. A sample of 580 primary school pupils (51.2% of boys), grades five and nine participated in a test and retest with a four-week interval. Six items concerning problem behaviour were evaluated overall and stratified by gender and age. RESULTS: Analyses of test-retest reliability indicated modest (0.30 to 0.49), moderate (0.50 to 0.69), or high (0.70 to 1.00) reliability across nearly all questions, with some reliability differences in analyses by gender and age. In general, findings of present study suggest the moderate reliability of measures of smoking, drunkenness, fighting and negative relationship to school, modest reliability of measures of bullying behaviour, and low reliability of measure of truancy. CONCLUSIONS: The overall findings of this study suggest that most of selected indicators in the HBSC survey questionnaire have satisfactory test-retest reliability. Further test-retest studies in a large and diverse sample, as well as validity studies, should be considered for the future HBSC study.

Unhealthy eating habits and participation in organized leisure-time activities in Czech adolescents.

A healthy lifestyle habits in adolescents consist of healthy eating patterns and active ways of spending leisure time. This study aimed to examine the relationship between organized leisure-time activities (OLTA) and eating habits in adolescence. Data from the 2013/2014 Health Behaviour in School-aged Children (HBSC) study on 10,494 Czech adolescents aged 11-15 years was used. The associations of participation in OLTA with ten specific eating habits were analyzed using logistic regression. Involvement in any type of OLTA was associated with higher consumption of daily breakfast, fruit, and vegetables and a lower intake of soft drinks. Participants in non-sport and sport and other activity reported lower rates of unhealthy eating habits (e.g., lower rates of eating crisps and eating in front of the TV or computer). Participation only in sport was related to more frequent eating at fast food restaurants but less frequent snacking in front of the computer and intake of crisps. CONCLUSION: Participation in OLTA was associated with healthier eating habits (e.g., consumption of fruit and vegetables) and a lower occurrence of unhealthy eating habits (e.g., consumption of soft drinks). Alternatively, our findings indicate that non-participation in OLTA can serve as an indicator of an unhealthy lifestyle in adolescence. What is Known • Unhealthy eating habits in youth tend to persist into adulthood and are related to adverse health consequences later in life. • The type of the leisure-time activity (participation in sport, non-sport, sport, and other activities) affects the strength of developmental outcomes in adolescents. What is New • Youth participating in non-sport activity and sport and other activity concurrently reported lower rates of unhealthy eating habits (e.g., eating junk food, eating in front of the TV/computer). • Non-participation in OLTA could be viewed as a potential risk factor for an unhealthy lifestyle in adolescents.

Body-image Dissatisfaction and Weight-control Behaviour in Slovak Adolescents.

OBJECTIVES: The aim of the study was to examine body-image dissatisfaction in adolescents aged 13-15 years reporting to be on a diet and to assess gender and age differences in weight-reduction behaviour in Slovak adolescents. METHODS: Data on a representative sample of 2,765 adolescents (mean age 14.37 years) from the Slovak part of Health Behaviour in School Aged Children Study carried out in 2014 were analysed. Self-reported body-image dissatisfaction and engagement in weight-reduction behaviour of 13 to 15-year-old adolescents was assessed using multiple logistic regression models. RESULTS: More that 20% of boys and 35% of girls perceived themselves to be too fat. Girls reported being on a diet more frequently than boys (28.8% vs. 14.9%). The most frequent weight-reduction behaviours were drinking more water (67.7%), eating more fruits and vegetables (67.1%), and consuming fewer sweets (60.5%) and soft drinks (51.7%). Girls prevailed above boys in the use of these dietary methods. Age differences were not apparent, except for smoking, believed to help in weight reduction and used upmost by 15-year-olds (8.9%) followed by 14 and 13-year-olds, 6.0% and 4.1%, respectively. CONCLUSIONS: Body-image dissatisfaction and weight-control behaviour are issues particularly in girls, however, they did not necessarily correspond with actual obesity. The most commonly used weight-reduction behaviours are in the same way important aspects of a healthy lifestyle. There is room to improve obesity control, particularly within primary health care.

Is Spiritual Well-Being Among Adolescents Associated with a Lower Level of Bullying Behaviour? The Mediating Effect of Perceived Bullying Behaviour of Peers.

The aim of this study was to explore the association between spiritual well-being and bullying among Slovak adolescents, and whether perceived bullying behaviour of peers mediated this relationship. Data from the Health Behaviour in School-aged Children study conducted in 2014 in Slovakia were used. Data were obtained from 9250 adolescents with a mean age of 13.48 years. The final sample consisted of 762 adolescents aged 15 years old (52.2% boys). We used logistic regression models and the Sobel test. Adolescents who reported a higher level of spiritual well-being were at lower risk of reporting that some or more schoolmates bully others or that they themselves bully others. These relationships were partially mediated by perceived norms about the bullying behaviour of schoolmates. Spiritual well-being was found to be negatively associated with bullying; in addition, a mediating role of perceived bullying behaviour of peers in this relationship was confirmed.

Regular energy drink consumption is associated with the risk of health and behavioural problems in adolescents.

Consumption of energy drinks has become popular and frequent among adolescents across Europe. Previous research showed that regular consumption of these drinks was associated with several health and behavioural problems. The aim of the present study was to determine the socio-demographic groups at risk for regular energy drink consumption and to explore the association of regular energy drinks consumption with health and behavioural problems and negative school experiences in adolescents. Data from the Health Behaviour in School-aged Children Study conducted in 2014 in Slovakia were analysed. We assessed socio-demographic characteristics, energy drink consumption, health and behavioural problems and negative school experiences based on self-reports from 8977 adolescents aged 11-15 years (mean age/standard deviation 13/1.33; 50.0% boys). The prevalence of regular energy drink consumption in the present sample was 20.6% (95%CI: 20%-21%). Regular energy drink consumption was more frequent among boys and older adolescents. Adolescents with a medium-level family affluence were less likely to drink energy drinks regularly. Adolescents who consumed energy drinks regularly had more health and behavioural problems and negative school experiences. CONCLUSION: Adolescents drinking energy drinks are at risk of a wide range of negative outcomes and should be specifically addressed by preventive interventions. What is Known • Energy drink consumption has become popular and frequent among adolescents across Europe. • There is growing evidence that energy drink consumption is related to negative social, emotional and health outcomes, but only a few studies have explored this relationship in adolescents. What is New • Regular energy drink consumption was more frequent among boys and adolescents reporting low family affluence and increased with age. • Adolescents reporting regular energy drink consumption were in higher risk to suffer from health and behavioural problems and negative school experiences.

Is risk-taking behaviour more prevalent among adolescents with learning disabilities?

Background: Reports from schools indicate that adolescents with learning disabilities (LD) frequently show risk-taking behaviour (RTB), but evidence is lacking. The aim of the study was to assess the associations between LD status and RTBs among Slovak adolescents and to explore whether family affluence and family composition have a moderating or mediating role in these associations. Data from the Slovak national HBSC study 2014 were analyzed. The sample comprised 1549 15-year-old adolescents (mean age: 15.4; 52.5% boys). RTBs were defined as early sexual experience, truancy, fighting, bullying, early smoking initiation and drunkenness. The associations between LD status and RTBs were assessed using binary logistic regression; the mediating as well as moderating role of family affluence and family composition was explored as well. Adolescents with LD are two times more likely to be engaged in early sexual experiences (OR 2.39; 95% CI 1.45-3.95), fighting (OR 1.72; 95% CI 1.01-2.95) and bullying (OR 2.08; 95% CI 1.26-3.44), but not in early smoking initiation, drunkenness or truancy. Family affluence and family composition did not moderate or mediate these associations. Adolescents with LD are at high risk of early sexual experiences, fighting and bullying but not of smoking initiation, drunkenness or truancy. Non-intact and poor families do not increase the risks associated with LD status of adolescents; however, in these families adolescents with LD are more prevalent.

Young adolescents who combine alcohol and energy drinks have a higher risk of reporting negative behavioural outcomes.

OBJECTIVES: To explore whether young adolescents consuming alcohol and energy drinks combined were more likely to report negative behavioural outcomes than their peers who drink only one type of these beverages or are abstinent. METHODS: We analysed data on a representative sample of Slovak adolescents 8502 adolescents (mean age 13.21, 49.4 % boys) from the 2014 Health Behaviour in School-aged Children cross-sectional study. We assessed the associations of alcohol and energy drinks consumption with negative outcomes and their potential synergy, as measured by the synergy index (SI). RESULTS: Adolescents consuming both alcohol and energy drinks were at higher risk of negative behavioural outcomes than their peers who drank only alcohol or energy drinks or were non-consumers. Consumers of alcohol and energy drinks were highly prone to be involved in fighting-the joint association of alcohol and energy drinks consumption was greater than sum of its associations separately in relation to fighting (SI 1.49; 95 % confidence interval 1.03-2.16). CONCLUSIONS: Preventive strategies should aim at increasing awareness of negative behavioural outcomes-especially aggressive behaviour associated with alcohol and energy drinks consumption among young adolescents.

Lack of parental rule-setting on eating is associated with a wide range of adolescent unhealthy eating behaviour both for boys and girls.

BACKGROUND: Unhealthy eating habits in adolescence lead to a wide variety of health problems and disorders. The aim of this study was to assess the prevalence of absence of parental rules on eating and unhealthy eating behaviour and to explore the relationships between parental rules on eating and a wide range of unhealthy eating habits of boys and girls. We also explored the association of sociodemographic characteristics such as gender, family affluence or parental education with eating related parental rules and eating habits of adolescents. METHODS: The data on 2765 adolescents aged 13-15 years (mean age: 14.4; 50.7 % boys) from the Slovak part of the Health Behaviour in School-Aged Children (HBSC) study 2014 were assessed. The associations between eating-related parental rules and unhealthy eating patterns using logistic regression were assessed using logistic regression. RESULTS: Unhealthy eating habits occurred frequently among adolescents (range: 18.0 % reported skipping breakfast during weekends vs. 75.8 % for low vegetables intake). Of all adolescents, 20.5 % reported a lack of any parental rules on eating (breakfast not mandatory, meal in front of TV allowed, no rules about sweets and soft drinks). These adolescents were more likely to eat unhealthily, i.e. to skip breakfast on weekdays (odds ratio/95 % confidence interval: 5.33/4.15-6.84) and on weekends (2.66/2.12-3.34), to report low consumption of fruits (1.63/1.30-2.04) and vegetables (1.32/1.04-1.68), and the frequent consumption of sweets (1.59/1.30-1.94), soft drinks (1.93/1.56-2.38) and energy drinks (2.15/1.72-2.70). CONCLUSIONS: Parental rule-setting on eating is associated with eating behaviours of adolescents. Further research is needed to disentangle causality in this relationship. If causal, parents may be targeted to modify the eating habits of adolescents.

The mediating effect of daily nervousness and irritability on the relationship between soft drink consumption and aggressive behaviour among adolescents.

OBJECTIVES: This study investigated whether soft drink consumption is related to fighting and bullying behaviour among school-aged children and whether nervousness and irritation mediated this relationship. METHODS: The data on 7583 adolescents aged 11-15 years from the Slovak part of the Health Behaviour in School-Aged Children (HBSC) study 2010 were analysed. Self-reported soft drink intake, bullying, fighting, nervousness, irritability and confounding variables were analysed using logistic regressions. To assess the potential mediation of daily nervousness and irritability on the association between soft drink consumption and aggressive behaviour, we used Sobel tests. RESULTS: Adolescents' daily soft drink consumption was associated with bullying and fighting, and these relationships were partially mediated by nervousness and irritability. Adjustment of the analyses on gender, age and family affluence did not change the estimates. CONCLUSIONS: Adolescents' daily soft drink consumption was associated with negative mood deviations such as nervousness and irritability and with aggressive behaviour in the form of bullying and fighting. Our findings provide new evidence about soft drink consumption-related risks and thus can contribute to the preventive actions aimed at reducing them.

Is subjective perception of negative body image among adolescents associated with bullying?

UNLABELLED: Adolescents' body image dissatisfaction has an adverse effect on peer relationships. It may lead to changes in behaviour (aggressive or passive) and consequently to bullying behaviour. Our aim was to assess the association between body image dissatisfaction and involvement in bullying and whether this differs by gender. We used data from the Slovak part of the 2010 Health Behaviour in School-aged Children study. The final sample comprised 8050 adolescents aged 11 to 15 years old (mean age 13.57), less than half of whom were boys. The association between self-reported body image and involvement in bullying was determined using multinomial logistic regression. We found a significant association between body dissatisfaction and involvement in bullying. Adolescents dissatisfied with their bodies because due to feeling overweight were more likely to become passive or reactive victims. Self-reported thinness was found to be significantly associated with bully-victims only in boys. CONCLUSION: Adolescent body dissatisfaction is strongly associated with bullying behaviour. Our findings point out the importance of incorporating at schools different types of intervention programmes supporting positive self-perceptions of adolescents and reducing bullying behaviour.