Establishing spirituality as an intermediary determinant of health among 42,843 children from eight countries.

The World Health Organization (WHO) Commission on the Social Determinants of Health (CSDH) conceptual framework identifies socio-economic position as a structural determinant of health. Recognized intermediary determinants include biological, behavioural, and psychosocial factors. We examined whether connections afforded by a healthy spirituality potentially act as unrecognized intermediary determinants in adolescent populations, contributing to inequities in mental health. Reports from 42,843 children (21,007 boys, 21,836 girls) from eight countries who participated in the 2017-2018 Health Behaviour in School-aged Children (HBSC) study were used to describe correlations between family affluence and positive levels of mental health, using a cross-sectional design. Based on the CSDH conceptual framework and multivariable regression analyses, we then examined whether these associations were mediated by spiritual health. Connections afforded by a high level of spiritual health were universally correlated with positive mental health status. In three Western European nations (England, Scotland, and Wales) and Canada affluence was correlated with better mental health and this was partially mediated by spiritual health. Among the four Eastern European countries (Latvia, Lithuania, Moldova, Poland), our findings did not support aspects of the CSDH framework that focus on affluence as a direct determinant of health. Spiritual health potentially is an intermediary determinant of children's health in some Western countries, but not in Eastern countries. The universality of social determinants of health models and the measures used in their evaluation require careful assessment across cultures, political contexts, and health outcomes.

Similarities and Differences between Psychosocial Determinants of Bullying and Cyberbullying Perpetration among Polish Adolescents.

Despite the extensive literature on the psychosocial determinants of bullying and cyberbullying among adolescents, there is not sufficient comprehensive analysis of the differences between perpetrators. This study aims to assess the psychosocial similarities and differences between bullies and cyberbullies. Data of 3650 students from two grades, K9 and K11 (47% females, mean age = 16.53), were used from a survey conducted in Poland in 2018 as part of the Health Behaviour in School-aged Children study. Perpetration was measured by questions adapted from the Olweus Bully/Victim Questionnaire. The following predictors were analyzed: demographic, socioeconomic status measured with the Family Affluence Scale-III (FAS), and individual and social factors. Multiple binary logistic regression was applied. The random sampling design was based on stratification according to the local deprivation index of the region where the school was located. Male gender, younger age, and non-intact family were associated with a higher risk of bullying and cyberbullying. Family support, empathy, school performance, and school attachment had a protective effect against both aggressive behaviors. Life dissatisfaction and high FAS were revealed as determinants of cyberbullying and local deprivation of bullying only. Bullying and cyberbullying school prevention programs should take into account these psychosocial differences and consider the economic deprivation of the region.

Access to medical care and its association with physical injury in adolescents: a cross-national analysis.

BACKGROUND: Strong variations in injury rates have been documented cross-nationally. Historically, these have been attributed to contextual determinants, both social and physical. We explored an alternative, yet understudied, explanation for variations in adolescent injury reporting-that varying access to medical care is, in part, responsible for cross-national differences. METHODS: Age-specific and gender-specific rates of medically treated injury (any, serious, by type) were estimated by country using the 2013/2014 Health Behaviour in School-aged Children study (n=209 223). Available indicators of access to medical care included: (1) the Healthcare Access and Quality Index (HAQ; 39 countries); (2) the Universal Health Service Coverage Index (UHC; 37 countries) and (3) hospitals per 100 000 (30 countries) then physicians per 100 000 (36 countries). Ecological analyses were used to relate injury rates and indicators of access to medical care, and the proportion of between-country variation in reported injuries attributable to each indicator. RESULTS: Adolescent injury risks were substantial and varied by country and sociodemographically. There was little correlation observed between national level injury rates and the HAQ and UHC indices, but modest associations between serious injury and physicians and hospitals per 100 000. Individual indicators explained up to 9.1% of the total intercountry variation in medically treated injuries and 24.6% of the variation in serious injuries. CONCLUSIONS: Cross-national variations in reported adolescent serious injury may, in part, be attributable to national differences in access to healthcare services. Interpretation of cross-national patterns of injury and their potential aetiology should therefore consider access to medical care as a plausible explanation.

Do Neighbors Have More Peaceful Students? Youth Violence Profiles among Adolescents in the Czech Republic, Hungary, Poland, and Slovakia.

(1) Background: Co-occurrence or overlaps of different forms or involvement in peer violence among adolescents have been broadly studied. The study aimed to assess adolescents' violence profiles related to bullying, cyberbullying, and fighting in the Czech Republic, Hungary, Poland, and Slovakia. The study was to investigate the pattern of bullying, cyberbullying, and fighting involvement among adolescents in these four countries to test the stability of previously identified profiles. (2) Methods: We analyzed the data from the 2017/2018 international Health Behaviour in School-aged Children survey, which used proportionate sampling among adolescents aged 11-15 years old (n = 24,501). A Latent Class Analysis (LCA) was performed to determine violence profiles in each country. (3) Results: In Slovakia, three distinct latent classes were identified, primarily cyber victims, school bullies, and those involved in multiple forms, and in the Czech Republic, Hungary and Poland bully victims was the fourth class. (4) Conclusions: The findings suggest that peer violence prevention programs in adolescents should consider violence profiles and multiple involvements.

Gender Differences in Bullying Reflect Societal Gender Inequality: A Multilevel Study With Adolescents in 46 Countries.

PURPOSE: Social patterns in bullying show consistent gender differences in adolescent perpetration and victimization with large cross-national variations. Previous research shows associations between societal gender inequality and gender differences in some violent behaviors in adolescents. Therefore, there is a need to go beyond individual associations and use a more social ecological perspective when examining gender differences in bullying behaviors. The aim of the present study was twofold: (1) to explore cross-national gender differences in bullying behaviors and (2) to examine whether national-level gender inequality relates to gender differences in adolescent bullying behaviors. METHODS: Traditional bullying and cyberbullying were measured in 11-year-olds to 15-year-olds in the 2017/18 Health Behaviour in School-aged Children study (n = 200,423). We linked individual data to national gender inequality (Gender Inequality Index, 2018) in 46 countries and tested their association using mixed-effects (multilevel) logistic regression models. RESULTS: Large cross-national variations were observed in gender differences in bullying. Boys had higher odds of perpetrating both traditional and cyberbullying and victimization by traditional bullying than girls. Greater gender inequality at country level was associated with heightened gender differences in traditional bullying. In contrast, lower gender inequality was associated with larger gender differences for cyber victimization. DISCUSSION: Societal gender inequality relates to adolescents' involvement in bullying and gendered patterns in bullying. Public health policy should target societal factors that have an impact on young people's behavior.

Socioeconomic inequalities in adolescent health complaints: A multilevel latent class analysis in 45 countries.

Our study evaluated the relationship between adolescent health complaints and socioeconomic position in 45 countries. Data are from the 2017/2018 international Health Behaviour in School-aged Children survey which used proportionate sampling among adolescents aged 11 to 15 years old (n=228,979). Multilevel, multinomial regression analysis assessed the association between the multilevel latent classes with socioeconomic status (SES; at the household and country level). Three distinct latent classes were identified: No Complaints, Psychological Complaints, and a Physical and Psychological Complaints class; where, low household SES was highest for the physical and psychological complaints class. The findings suggest that health promotion policies and interventions among adolescents should consider the specific needs of adolescents living with low household SES as they report more subjective health complaints.

Psychosocial Determinants of Adolescents' Cyberbullying Involvement-The Role of Body Satisfaction.

BACKGROUND: Although the relationship between adolescents' body image and cyberviolence has been proved, little is known about the place of body image among other psychosocial determinants. The study aimed to assess the relationship between body satisfaction and cyberbullying in the context of other psychosocial factors. METHODS: We used data of 5817 adolescents (47.6% boys, mean age = 15.43) from the survey conducted in 2018 in Poland as a part of the Health Behaviour in School-Aged Children. Four groups of cyberbullying involvement were defined: only bullies, only victims, both bullies and victims, and not involved. Body satisfaction and ten other independent variables were classified as sociodemographic, socioeconomic, individual and social factors. A series of multinomial logistic regression models were estimated and compared using the pseudo R-sq Nagelkerke coefficient. RESULTS: Although family support seemed to be the most protective, the findings have proved that body satisfaction reduces significantly the risk of cyberbullying. The relationship was more pronounced in victims and bully-victims. A slightly stronger protective effect of body satisfaction has been observed in boys. CONCLUSIONS: The strengthening of body image may be an effective measure to prevent adolescents' cyberbullying, as well as to bring about improvements in social support, connections to others, and school performance.

After the bell: adolescents' organised leisure-time activities and well-being in the context of social and socioeconomic inequalities.

BACKGROUND: Previous research has linked adolescents' participation in organised leisure-time activities (OLTAs) to better health and well-being. It remains unclear whether these associations can be observed consistently across social and socioeconomic strata and countries. METHODS: The present study used nine nationally representative samples of adolescents aged 11, 13 and 15 years (total n=55 429) from the 2017/2018 Health Behaviour in School-aged Children survey from Europe and Canada. Regression models with mixed effects to account for nested nature of data were applied to estimate: (1) the associations of social and socioeconomic factors with OLTA participation; (2) strengths of the associations between breadth and pattern of OLTA participation with health and well-being indicators, after adjustment for the social and socioeconomic factors. RESULTS: Rates of OLTA participation varied by age, sex and country of adolescents. Participants from lower socioeconomic classes and non-nuclear families were less likely to participate in OLTAs across each of the nine countries. Moreover, breadth of OLTA participation was associated with higher well-being independent of socioeconomic status or family structure. All of the participation patterns were associated with higher life satisfaction, but sports (either alone or in combination with a non-sport OLTA) were also associated with fewer psychological complaints and excellent self-rated health. CONCLUSION: Adolescents' engagement in OLTAs was associated with adolescents' subjective well-being regardless of country, age, sex and variance in social and socioeconomic factors. Policies aimed at increasing adolescents' subjective well-being and OLTA participation should focus on adolescents from low socioeconomic classes and non-nuclear families.

Social Media Use and Cyber-Bullying: A Cross-National Analysis of Young People in 42 Countries.

PURPOSE: Social media use (SMU) has become an intrinsic part of adolescent life. Negative consequences of SMU for adolescent health could include exposures to online forms of aggression. We explored age, gender, and cross-national differences in adolescents' engagement in SMU, then relationships between SMU and victimization and the perpetration of cyber-bullying. METHODS: We used data on young people aged 11-15 years (weighted n = 180,919 in 42 countries) who participated in the 2017-2018 Health Behaviour in School-aged Childrenstudy to describe engagement in the three types of SMU (intense, problematic, and talking with strangers online) by age and gender and then in the perpetration and victimization of cyber-bullying. Relationships between SMU and cyber-bullying outcomes were estimated using Poisson regression (weighted n = 166,647 from 42 countries). RESULTS: Variations in SMU and cyber-bullying follow developmental and gender-based patterns across countries. In pooled analyses, engagement in SMU related to cyber-bullying victimization (adjusted relative risks = 1.14 [95% confidence interval (CI): 1.10-1.19] to 1.48 [95% CI: 1.42-1.55]) and perpetration (adjusted relative risk = 1.31 [95% CI: 1.26-1.36] to 1.84 [95% CI: 1.74-1.95]). These associations were stronger for cyber-perpetration versus cyber-victimization and for girls versus boys. Problematic SMU was most strongly and consistently associated with cyber-bullying, both for victimization and perpetration. Stratified analyses showed that SMU related to cyber-victimization in 19%-45% of countries and to cyber-perpetration in 38%-86% of countries. CONCLUSIONS: Accessibility to social media and its pervasive use has led to new opportunities for online aggression. The time adolescents spend on social media, engage in problematic use, and talk to strangers online each relate to cyber-bullying and merit public health intervention. Problematic use of social media poses the strongest and most consistent risk.

Clusters of Contemporary Risk and Their Relationship to Mental Well-Being Among 15-Year-Old Adolescents Across 37 Countries.

PURPOSE: Adolescents' mental well-being has become a growing public health concern. Adolescents' daily lives and their engagement in risks have changed dramatically in the course of the 21st century, leading to a need to update traditional models of risk to include new exposures and behaviors. To date, studies have examined the relationship between (mainly traditional) risk behaviors and adolescent mental well-being or looked at risk factors that jeopardize mental well-being such as lack of social support but have not combined them together to highlight the most significant risks for adolescent mental well-being today. The present study included new and traditional risk behaviors and risk factors, robustly derived an empirically based model of clusters of risk, and examined the relative association of these clusters to adolescent mental well-being. METHODS: Data from the 2017-2018 Health Behaviours in School-aged Children study were used. The sample included 32,884 adolescents (51.7% girls) aged 15 years from 37 countries and regions. The principal component analysis was used to determine the existence of clusters of risk, using 21 items related to adolescent mental well-being that included both risk behaviors (e.g., substance use) and risk factors (e.g., peer support). Analysis was conducted in both a randomly split training and test set and in gender separate models. Mixed-effects logistic regressions examined the association between clusters of risk and mental well-being indices (low life satisfaction and psychosomatic complaints). RESULTS: Seven clusters of risk were identified: substance use and early sex, low social support, insufficient nutrition, bullying, sugary foods and drinks, physical health risk, and problematic social media use (SMU). Low social support and SMU were the strongest predictors of low life satisfaction (odds ratios = 2.167 and 1.330, respectively) and psychosomatic complaints (odds ratio = 1.687 and 1.386, respectively). Few gender differences in predictors were found. Exposure to bullying was somewhat more associated with psychosomatic complaints for girls, whereas physical health risk was associated with reduced relative odds of low life satisfaction among boys. Split-sample validation and out-of-sample prediction confirmed the robustness of the results. CONCLUSIONS: The results highlight the importance of contemporary clusters of risk, such as low social support and SMU in the mental well-being of young people and the need to focus on these as targets for prevention. We propose that future studies should use composite risk measures that take into account both risk behaviors and risk factors to explain adolescents' mental well-being.

The association of exposure to PM10 with the quality of life in adult asthma patients.

OBJECTIVES: Air pollution has become a critical environmental issue, which severely threatens the well-being of asthma patients. The quality of life of these patients, when exposed to air pollutants such as particulate matter 10 (PM10), has been poorly studied. The current research examined the association between the concentration of PM10 in the air and the quality of life of patients with asthma. MATERIAL AND METHODS: The study group consisted of 300 adult asthma patients treated in 2 allergy outpatient clinics in Kraków, who declared they would not leave the city in the 14-day study period. Daily concentrations of PM10 from air monitoring stations were recorded over a period of 2 weeks, following which the patients filled out the standardized Asthma Quality of Life Questionnaire (AQLQ) regarding the monitored period to assess the total quality of life and its 4 domains (symptoms, limitation of activity, emotional functioning and environmental stimuli). RESULTS: The average PM10 exposure was 65.2 µg/m3 and only 30% of the patients were exposed to values of ≤50 µg/m3, i.e., the highest 24-h threshold value considered acceptable by the World Health Organization. The observed effect of an increased level of exposure to airborne PM10 was associated with reduced scores in AQLQ from 0.40 at the medium level to 0.46 at the high level, in comparison to the low level. The total score of the asthma-related quality of life and its domains showed poorer outcomes as the concentration of PM10 was increasing (every 0.08 pt per a 10 µg/m3 increase). CONCLUSIONS: The increase in the concentration of PM10 in the air impacts on the overall quality of life and its particular domains in people with exceptional predispositions, such as patients with bronchial asthma. Physicians taking care of asthma patients should pay special attention to the quality of patient's life in response to the course and control of that illness, in relation to air pollution. Int J Occup Med Environ Health. 2020;33(3):311-24.

Social and Behavioral Predictors of Adolescents' Positive Attitude towards Life and Self.

Positive attitude is an important cognitive component of optimism. Although optimism has been widely studied in adolescents' health, there is limited knowledge about social and behavioral determinants of their positive attitude. The aim of this study was to identify the main predictors of a positive attitude towards life and self in adolescence. Data were collected in 2010 from 2562 Polish adolescents, aged 15 to 17 years old, within the Health Behavior in School-Aged Children survey. A positive attitude was measured using the 4-item Positive Attitude Scale (PAS). Univariate analysis of variance was conducted and then hierarchical linear regression models adjusted for gender, age and family affluence were estimated. The mean PAS score was 13.25 (SD = 3.74), on the scale ranged 0-20. Eight out of 18 variables were included in the final model, which explained 25.1% of PAS variability. Communication in the family and with peers, as well as neighborhood social capital showed the strongest impact on positive attitude in adolescents. Physical activity, eating breakfast and school performance were also found to be important predictors. The results of the study highlight the need to include the development of interpersonal competences, promoting physical activity and supporting school performance, in adolescents' mental health promotion programs, particularly in girls.

Association of Early-Life Exposure to Income Inequality With Bullying in Adolescence in 40 Countries.

Importance: While the association between income inequality and interpersonal violence has been attributed to the psychosocial effects of inequality (eg, increased class anxiety, reduced social capital), longitudinal evidence for this pathway is limited by a reliance on small ecological studies and cross-sectional data. The developmental consequences of early-life inequality for subsequent involvement in violence have not been investigated. Objective: To examine the association between income inequality during infancy and early childhood and adolescents' involvement in bullying others, experiences of being bullied, or both. Design, Setting, and Participants: The Health Behavior in School-aged Children survey study was conducted in European and North American schools. This analysis used individual data on bullying (being bullied, bullying others, or both) from 6 consecutive school-based surveys of 11-year-old to 15-year-old students carried out in 40 countries between February 1994 to March 2014. Data analysis occurred from March 2018 to January 2019. Exposure: National Gini indices of income inequality for every year of life spanning a 35-year period (1979 to 2014). Main Outcomes and Measures: Being bullied, bullying others, and both outcomes were measured using a common definition and questions adapted from the Bully-Victim Questionnaire and translated to many languages. Results: The sample included 425 938 male students and 448 265 female students from 162 country-survey year groups in 29 196 schools. Linear regression coefficients indicated that early-life income inequality from birth to 4 years was positively associated with being bullied (male students: linear regression coefficient, 18.26 [95% CI, 11.04-25.47]; P < .001; female students: linear regression coefficient, 15.67 [95% CI, 10.02-21.33]; P < .001), and dual involvement in being bullied and bullying others (male students: linear regression coefficient, 5.55 [95% CI, 2.67-8.44]; P < .001; female students: linear regression coefficient, 2.45 [95% CI, 0.93-3.97]; P < .001), after differences in lifetime mean income inequality (from birth to when bullying was measured), national per capita income, family socioeconomic position, age, and cohort were controlled. No such association was found with bullying others after differences in being bullied were controlled. Conclusions and Relevance: Being bullied is associated with early-life exposure to income inequality. Although further research on the underlying pathways is needed to guide intervention, these results suggest temporality in the association between inequality and violence and suggest that growing up in areas of high income inequality is associated with victimization in adolescence.

Sufficient Social Support as a Possible Preventive Factor against Fighting and Bullying in School Children.

Background: This study aims to explore how sufficient social support can act as a possible preventive factor against fighting and bullying in school-aged children in 9 European countries. Methods: Data for this study were collected during the 2013/2014 Health Behaviour in School-aged Children (HBSC) survey. The sample consisted of 9 European countries, involving 43,667 school children in total, aged 11, 13 and 15 years. The analysed data focus on social context (relations with family, peers, and school) as well as risk behaviours such as smoking, drunkenness, fighting and bullying in adolescents. The relationships between social support and violent behaviour variables were estimated using multiple regression models and multivariate analyses. Results: Bullying, across 9 countries, was more prevalent than fighting, except for Armenia, Israel, and Poland. The prevalence among countries differed considerably, with fighting being most expressed in Armenia and bullying—in Latvia and Lithuania. The strongest risk factors for bullying and fighting were male gender (less expressed for bullying), smoking and alcohol consumption. In addition, for bullying the social support was similarly strong factor like above-mentioned factors, while for fighting—less significant, but still independent. All forms of social support were significantly relate with lower violent behaviour of school children, and family support was associated most strongly. Regardless the socioeconomic, historical, and cultural differences among selected countries, the enhancement and reinforcement of the social support from possible many different resources should be taken into consideration in prevention programs against school violence behaviours.

[Causes of death in children and adolescents aged 1-19 in poland in the light of international statistics since 2000].

BACKGROUND: Analyses of children and young people mortality continue to be an important component of health monitoring of this population. Such analyses provide the basis to assess the overall trends, the structure of the causes of death over longer periods, and the differences between Poland and other countries. PURPOSE: The purpose of the current study is to present the current status and the direction of changes since 2000 with regard to the level and underlying causes of mortality in children and adolescents aged 1-19 years in Poland on the background of statistics for leading European countries. MATERIAL AND METHODS: Interactive databases available online: the National Demographic Database provided by the Central Statistical Office and the International WHO-MDB Database were used. Poland, constantly belonging to Eur-B category, was compared with the combined group of 27 leading countries, classified as a very low total mortality group (Eur-A) according to WHO. Linear trends of overall and cause-specific mortality in 2000-2013 were estimated. The causes of death have been presented according to the main classes of the 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10). External and other causes were adopted as the two principal categories. RESULTS: In 2015, 1471 deaths of persons aged 1-19 were recorded in Poland (19.9 per 100 000, 25.4 and 14.2 for boys and girls, respectively). Changes in children and adolescents mortality by age have a non-linear nature (U-shaped), and the lowest level is recorded at the age of 5-9 years. According to 2014 data, 50.2% of deaths of children and adolescents aged 1-19 years occurred due to external causes, including non-intentional and intentional ones. This percentage increased from 18.4% in the 1-4 age group to 68.6% at the age of 15-19 years. Apart from external causes, the dominating causes of death are malignant neoplasms, congenital defects, or nervous system and respiratory system diseases. The ranking of those causes of death changes in successive age groups and over time. When age is considered, a higher proportion of congenital defects and respiratory system diseases was found in mortality younger children and a higher proportion of circulatory system diseases and undefined cases in mortality of adolescents. When trends were studied, a continuing elimination of infectious diseases was observed together with growing impact of rare diseases in all age groups. The excess mortality of Polish population at age 1-19 by comparison to Eur-A countries increased from 21% in 2000 to 56% in 2013, mainly due to unfavourable trends in adolescents. The rate of decline in the mortality of young children (1-4 years) was greater than in Eur-A countries, both in case of external and other causes. In the age group 5-14 years the higher rate of change was sustained only with regard to external causes. Among adolescents and young adults, the distance between Poland and Eur-A countries increased during the studied period. The shape of trend in the 15-24 age group was unfavourable for Poland, mainly with respect to external causes. This observation could be in part explained by increasing suicide trend in Poland since 2008, coexisting with rather constant level in Eur-A countries. CONCLUSIONS: The mortality rate among the population aged 1-19 years in Poland is systematically decreasing, but it still exceeds the average level recorded in leading European countries, particularly in relation to adolescents. When assessing the ability to reduce mortality in Poland to the level of Eur-A countries, attention must be paid to the causes considered as avoidable. Further studies ought to focus on the trends and international comparisons only foreshadowed in this study with regard to individual diagnoses, discussing possible preventive measures. Introduction of an ICD-11 classification will enable more accurate coding of causes of death, including a more precise analysis of the burden of rare diseases, which are an increasing challenge to public health in the population at the developmental age.

[How to effectively change health behaviours of patients at old age]. / Jak skutecznie zmieniac zachowania zdrowotne pacjentów w starszym wieku.

UNLABELLED: In the frame of the international CHANGE Project a training course for nurses has been elaborated in order to improve their interpersonal communication skills in motivating older patients to change their health behaviours. Family nurses, caring for community-dwelling older patients applied their newly-developed competences to promote healthy nutrition and regular physical activity among their patients. OBJECTIVES: To assess the effectiveness of the nurse training. Changes in physical activity and nutritional habits of older patients resulting from nurses' performance were evaluated as well as patients' intentions to change those behaviours. METHODS: During the 2 weeks following the training 108 older patients at age avg. 69.6 (SD 60-87) in Krakow city, were initially interviewed by nurses with a questionnaire assessing health behaviours (frequency of intake of particular food products, frequency of different types of physical activity) and motivation to change those behaviours. The nurses provided consultancy directly after questionnaire interviews, then visited patients for consultancy at least once and repeated their assessment 6-8 weeks after the first one. Wilcoxon's matched pairs test and paired t-test were applied to measure the effectiveness of the intervention. RESULTS: The results have shown a significant improvement in duration (p<0.04) and frequency (p=0.0531) of walking, change of attitudes toward physical activity (p<0.003), and intentions to exercise regularly (p<0.01), higher level of self-satisfaction with personal physical capacity (p<0.006) and well-being (p<0.005). The frequency of intake of fresh fruit, vegetables and water (p<0.0001), pasta, cereal or bread (p<0.02) has also increased significantly. CONCLUSIONS: The nurses' training in motivating older patients to change their health behaviours exerted an effect on patients' health beliefs, intentions and health behaviours.

[Perspectives on future decline in child and adolescent mortality in Poland]. / Perspektywy dalszego obnizenia umieralnosci dzieci i mlodziezy w polsce.

BACKGROUND: Mortality among children and adolescents is relatively low in higher developed countries, and the main causes of death reflect only a number of selected health problems among this population. However, it is worthwhile to refer to international statistics in order to show current trends and the distance that separates each country from the European average and the lowest rates noted in Europe. THE AIM of the study is to present current mortality data among children and adolescents aged 1-19 yrs in Poland compared to European Union statistics. METHODS: The study uses data published by the national Central Statistical Office and the interactive WHO HFA-MDB database (Health for All-Mortality Database). RESULTS: The presently recorded number of deaths, among children and adolescents aged 1-19, is slightly below 2.5 thousand, that is 29 per 100 000 persons. A higher mortality rate among boys in comparison with girls continues to prevail, and a higher mortality rate in the rural areas in comparison with towns. In spite of the falling trend, mortality among children and young people in Poland continues to be higher than that observed in most European Union countries (Poland ranks 19th in a total of27). Poland occupies a particularly unfavourable position in statistics related to deaths from external causes and ill-defined symptoms. During the years 1990-2007 the strongest declining trend was noted with respect to the mortality of children aged 1-4, which is less dependent on external factors. In older age groups the declining trend detected in previous years came to a halt in the year 2000. CONCLUSIONS: A further fall of the mortality rate of children and young people could be achieved by consistently implementing programmes preventing accidental injuries (road accidents, drowning, poisoning) and intentional injuries, particularly suicide. In order to improve the health of the young generation it is necessary to implement the postulate of the European Strategy for Child and Adolescent Health and Development on a consistent basis, including prevention of the effects of chronic diseases, mental health disorders and risk behaviour. There is a need for more concern about inequalities in health, especially differences resulting from place of residence and social group.