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.

School learning modes during the COVID-19 response and pre- to during pandemic mental health changes in a prospective cohort of Canadian adolescents.

PURPOSE: Considerable debate centered on the impact of school closures and shifts to virtual learning on adolescent mental health during the COVID-19 pandemic. We evaluated whether mental health changes differed by school learning modes during the pandemic response among Canadian adolescents and whether associations varied by gender and perceived home life. METHODS: We used prospective survey data from 7270 adolescents attending 41 Canadian secondary schools. Conditional change linear mixed effects models were used to examine learning mode (virtual optional, virtual mandated, in-person, and blended) as a predictor of change in mental health scores (depression [Centre for Epidemiologic Studies - Depression], anxiety [Generalized Anxiety Disorder-7], and psychosocial well-being [Flourishing scale]), adjusting for baseline mental health and covariates. Gender and home life happiness were tested as moderators. Least square means were calculated across interaction groups. RESULTS: Students learning in a blended learning mode had greater anxiety increases relative to their peers in other learning modes. Females learning fully in-person and males learning virtually when optional reported less of an increase in depression scores relative to their gender counterparts in other learning modes. Learning virtually when optional was associated with greater declines in psychosocial well-being in students without happy home lives relative to other learning modes. CONCLUSION: Findings demonstrate the importance of considering gender and home environments as determinants of mental health over the pandemic response and when considering alternative learning modes. Further research is advised before implementing virtual and blended learning modes. Potential risks and benefits must be weighed in the context of a pandemic.

Connections associated with a healthy spirituality: are these unrecognized intermediary determinants that shape health inequities in Canadian young people?

BACKGROUND: The health of adolescents is determined by structural and intermediary factors. Such factors operate through pathways that foster different opportunities to achieve health and wellbeing, contributing to inequities. Past analyses of cross-national adolescent health data show that measures of child spirituality, conceptualized as the strength of the connections in our lives, may operate as intermediary determinants in some Western countries. Inspired by this idea, the current analysis provides an in-depth exploration of such pathways among Canadian adolescents. Our objectives were to confirm the existence of relationships between economic position and seven indicators of adolescent health status, then explore whether any observed inequities could be explained by the strength of connections afforded by a healthy spirituality. METHODS: Cycle 8 of the Canadian Health Behaviour in School-aged Children (HBSC) study was conducted in 2017-18. A school-based sample (n = 18,962) of adolescents was obtained from across Canada following a standard cross-national protocol. Eligible participants completed a general survey about their health, health behaviours and their determinants. Survey data were used to model the potential effect of perceived levels of relative affluence on each of seven health indicators. Comparison of crude and adjusted relative risks estimates from weighted log-binomial regression models provided evidence of indirect mediating effects attributable to each of four domains of spirituality. RESULTS: As perceived levels of family affluence increased, the percentages of young people who reported each (7/7) of the negative health outcomes decreased. The spiritual health domain "connections to self" (i.e., the importance of meaning, purpose, joy and happiness in life) mediated the strength of relationships between relative affluence and each (7/7) of the outcomes in boys and girls. "Connections to others" (the importance of kindness, respect and forgiveness) mediated the strength of relationships between relative affluence and each (7/7) of the outcomes among girls. Inconsistent evidence of possible mediation was identified for connections to others in boys, as well as the other two domains of spirituality (connections to nature, then connections to the transcendent) in boys and girls. CONCLUSION: Specific connections afforded by a healthy spirituality could be intermediary determinants of health in Canadian adolescent populations.

Adolescent social media use and its association with relationships and connections: Canadian Health Behaviour in School-aged Children, 2017/2018.

Background: The development of healthy relationships and connections is of fundamental importance to adolescent well-being. The use of social media plays a vital role in the lives of young Canadians, yet the association between different types of social media use and the quality of relationships and connections remains unknown, and most existing analyses on this topic are based on modest and non-representative samples. Data and methods: Using 2017/2018 reports from the nationally representative Health Behaviour in School-aged Children study (n=17,149; ages 11 to 15 years), the strength, consistency and significance of associations was examined between intensive (frequent use to connect with other people) and problematic (use that depicts addictive qualities) social media use and available measures of adolescent relationships and connections. Results: Overall, intensive use (online communication with others almost all of the time) and problematic use (potential addiction to social media) were more common in girls than boys (38% of girls versus 30% of boys and 7.7% of girls versus 5.2% of boys, respectively), with prevalence levels that rose with age. Intensive use was associated with more positive social relationships with friends, especially among girls (relative risk [RR] = 1.40 [95% confidence interval (CI) 1.28 - 1.54]), while problematic use was consistently and negatively associated with strong relationships and connections in all groups in the study. Notably, problematic use was negatively associated with strong family relationships in boys (RR = 0.58 [95% CI 0.42 to 0.79]) and girls (RR=0.48 [95% CI 0.36 to 0.63]). Interpretation: Intensive use of social media has the potential to strengthen relationships and connections in adolescents. However, when social media use becomes addictive or "problematic", it is highly correlated with weaker relationships and a sense of social disconnection. Public health initiatives related to social media use should consider how different types of social media use have the potential to impact on different aspects of health.

Ending the Social Normalization of Violence against Children in Canada: A Framework, Rationale, and Appeal to Canadian Faith Leaders.

Corporal punishment remains the most common form of violence against children in Canada. Along with being legally permitted, it is made socially acceptable through cultural and social norms often disguised as discipline. Paraphrases of Judeo-Christian sacred texts such as "spare the rod; spoil the child" have been widely used to justify corporal punishment, and to create norms around the idea that it is a god-given responsibility of parents to inflict corporal punishment on their children "for their own good." Corporal punishment is then not only an acceptable part of raising children but can be a godly duty. Though Canada is a secular country, this social norm provides a moral hegemony under which violence becomes the status quo and has proven very difficult to change. In this commentary, we outline the ways that Christian religion has contributed to social norms around corporal punishment. We then argue that religious leaders have an opportunity-and moral responsibility-to contribute to change. We conclude with insights from social norms theory and offer evidence-based recommendations for ways forward that could help shift attitudes around corporal punishment in order to decrease its prevalence and harm. While each of these issues has been written about extensively in isolation, this commentary offers an analysis of these matters together under one umbrella. By making this relationship between Christianity and the social norms that propagate corporal punishment more visible, we draw attention to the role leaders in Christian churches could play in disrupting the social acceptance of violence against our youngest Canadian citizens. We provide a practical and evidence-based framework, rationale, and appeal to Canadian faith leaders to use their influence to add momentum to a critical health, rights-and religion-issue in Canada.

Do Spiritual Health Connections Protect Adolescents When They Are Bullied: A National Study of 12,593 Young Canadians.

It has long been established that bullying has many negative impacts on the mental health of adolescents. Young people who are victimized by bullying may cope by drawing on available assets to protect themselves from harm. One such asset with ancient roots but with the potential for contemporary application is the concept of spiritual health-the idea that the connections in our lives (whether to ourselves, others, nature, or something transcendent) affect our well-being. In this study, we examined 12,593 Canadians aged 11-15 years to determine the effects of being victimized by bullying on their mental health, as measured by frequent subjective health complaints. We then explored whether strong spiritual health connections were effect modifiers that buffer such negative pathways, thereby acting as protective health assets. Data were obtained from the 2017/18 Canadian Health Behaviour in School-aged Children study. Generalized linear regression models were used to estimate associations and evaluate effect modification in different age and gender groups. Approximately 21% of participants reported being victimized by bullying. Strength of "connections to self" (i.e., a sense of meaning/purpose or joy and happiness in one's life) was found to act as an effect modifier, but in girls alone. Contrary to expectations of a buffering effect, the strongest associations between victimization and frequent health complaints were identified for girls with high connections to self. Relative risks for poor mental health among these highly self-connected girls were 1.63 [95% CI: 1.26-2.12] and 1.25 [1.06-1.47] for younger and older girls, respectively. We interpreted this unexpected finding in light of cognitive theories of trauma, which suggest that adverse events may lead to worse health outcomes among those who place particular value on their world being meaningful, controllable or benevolent. Implications for clinical intervention and health promotion are considered.

Family as a health promotion setting: A scoping review of conceptual models of the health-promoting family.

BACKGROUND: The family is a key setting for health promotion. Contemporary health promoting family models can establish scaffolds for shaping health behaviors and can be useful tools for education and health promotion. OBJECTIVES: The objective of this scoping review is to provide details as to how conceptual and theoretical models of the health promoting potential of the family are being used in health promotion contexts. DESIGN: Guided by PRISMA ScR guidelines, we used a three-step search strategy to find relevant papers. This included key-word searching electronic databases (Medline, PSycINFO, Embase, and CINAHL), searching the reference lists of included studies, and intentionally searching for grey literature (in textbooks, dissertations, thesis manuscripts and reports.). RESULTS: After applying inclusion and exclusion criteria, the overall search generated 113 included manuscripts/chapters with 118 unique models. Through our analysis of these models, three main themes were apparent: 1) ecological factors are central components to most models or conceptual frameworks; 2) models were attentive to cultural and other diversities, allowing room for a wide range of differences across family types, and for different and ever-expanding social norms and roles; and 3) the role of the child as a passive recipient of their health journey rather than as an active agent in promoting their own family health was highlighted as an important gap in many of the identified models. CONCLUSIONS: This review contributes a synthesis of contemporary literature in this area and supports the priority of ecological frameworks and diversity of family contexts. It encourages researchers, practitioners and family stakeholders to recognize the value of the child as an active agent in shaping the health promoting potential of their family context.

Low risks for spiritual highs: Risk-taking behaviours and the protective benefits of spiritual health among Saskatchewan adolescents.

Objectives: Adolescent risk-taking behaviours, such as substance use and early sexual activity, can adversely impact physical health and psychosocial development. A connection to spiritual health may buffer against the negative health impacts of several risk-taking behaviours. The aim of this study was to determine if higher spiritual health was associated with lower risk-taking behaviours among school-attending adolescents in Saskatchewan, Canada. Methods: A representative sample of 4,751 adolescents in the Canadian province of Saskatchewan completed the Health Behaviour of School-aged Children (HBSC) questionnaire during the 2014 to 2015 school year. The main risk-taking behavioural outcomes were self-reported: smoking; alcohol; and cannabis use; as well as sexual intercourse. The main exposures related to spiritual health included four factors: connectedness to (1) one's self; (2) others; (3) nature; and (4) notions of the transcendent. Multivariable logistic regression analyses were used to test for associations between exposures and outcome measures. Results: The sample was balanced across gender, primarily Caucasian (71%), and primarily ages 11 to 15 years (48%). Adolescents indicated a high prevalence of spiritual health. Across all adjusted models, the results demonstrated that adolescents who value the various components of spiritual health showed a decreased likelihood of engaging in cigarette smoking, alcohol and marijuana use, and sexual intercourse. Conclusion: The findings indicate the potential for spiritual health to be considered as the basis for public- and community-health interventions, pending further evidence from experimental studies.

Violence, Adolescence, and Canadian Religious Communities: A Quantitative Study.

Exposure to violence is recognized as a major health concern among adolescent populations. The evidence base that links religious involvement with risks for child violence is inconsistent. In a national analysis involving a weighted sample of 24,307 young people, we studied the perpetration of violence (fighting and bullying), as well as victimization by violence (bullying only), among young people who were affiliated with religious groups. One in four young Canadians reported involvement in such groups. Study findings confirmed some unique patterns among this group. First, these religiously involved children reported the same or greater levels of perpetration of violence than other children. Second, religiously involved children reported the same or greater levels of experiencing victimization from violence. Third, religious involvement appeared to protect against engagement in certain overt risk-taking behaviors, but not violence. These patterns were consistent even after adjustment for family, community, socioeconomic, and school-related determinants. If religious communities are to fulfill mandates that foster the protection and nurturing of children into healthy relationships, violence is best addressed using evidence-based strategies. Development of such effective preventive strategies requires the incorporation of contemporary evidence about the distribution, determinants, and possible effects of violence in such groups. Findings from our study suggest that a silence around the issue of violence may in fact be true in the context of some Canadian religious communities. Yet, if these communities make an intentional commitment to protecting children from violence and promoting healthy relationships, and are willing to learn from evidence-based practices that have shown to protect children from participating in and experiencing violent and victim behaviors, perhaps these disturbing trends could be reversed. This message is germane for all levels of leadership in Canadian religious communities.

Distinguishing between spiritual health and religious involvement as determinants of adolescent health in Canada and the Czech Republic.

Spiritual health is a topic of emergent interest; however, lack of a clear distinction between spiritual health and religious involvement makes it difficult to understand the potential role of spiritual health as a determinant of health. Analyses of such relationships that cross countries and cultures are rare. We therefore assessed whether differences exist between spiritual health and religious involvement and their respective associations with general indicators adolescent health. The study was based on the 2013/2014 Health Behaviour in School-aged Children study conducted in Canada (n = 10 761) and the Czech Republic (n = 4411). In both countries, we failed to identify strong or statistically significant associations between self-reported religiosity and adolescent health. In contrast, adolescents with higher spiritual health scores consistently reported enhanced levels of general health status. Study findings point to the importance of a strong sense of spiritual health as a protective determinant of adolescent health, and raise questions about religious involvement as protective to adolescent health outcomes.

Structural validity of a brief scale adapted to measure adolescent spiritual health.

Spiritual health is established as an important protective health asset in child populations. Measurement and assessment of this elusive concept are, however, challenging. Brief and age-appropriate instruments are required for surveys and related population health research. One longstanding model describing child spirituality suggests that scales and measures consider four standard domains describing connections to self, others, nature, and the transcendent. In this validation study, we tested the structural validity and internal consistency of a brief, literacy-level appropriate instrument for adolescents that was based on prior adaptations of this model. The 2018 cross-national study population included 47,180 children aged 11-15 years from 9 countries. Based upon theory, factor pattern matrices, and Scree plots, the exploratory factor analysis best supported the four-factor model, with items organized according to the original four domains. Internal consistency of the items was acceptable (alpha>.7) to good (alpha>.8) within domains, again within each of the 9 countries. The confirmatory factor analysis again supported the four-factor model (by country, SRMR: 0.020 to 0.042; and AGFI and NFI fit: >0.98). Model fit indices for the four-factor model were improved compared with its unidimensional version. Moving forward, our analysis establishes the structural validity and internal consistency of this adapted brief spiritual health instrument to be used in surveys of adolescents.

"I'll use it differently now": using dual-systems theory to explore youth engagement with networked technologies.

OBJECTIVES: Many young Canadians experience high levels of networked connectivity, which some suggest may negatively impact their health. Adult monitoring has not been shown to be an effective long-term strategy for supporting young people in healthy engagement with tech. In this study, we explore the benefits of empowering young people to set healthy goals and monitor themselves. We engage with Shapka's (2019) critique of dual-systems theory, and consider the relationship between the neurological and behavioural systems in relation to adolescent internet use. METHODS: Using a youth participatory action research approach, we co-designed a project with six adolescents to explore the ways that their use of networked technologies was affecting their lives by disconnecting and observing how the lack of networked connectivity changed their experiences. The youth used a media diary to track their use of devices both before and after disconnecting. RESULTS: The main benefit of disconnecting appeared to be having the opportunity to reflect on one's own use of networked devices. This enabled the participants to reconnect in a more intentional way. Findings support Shapka's speculation that dual-systems theory, with a focus on regulation, may not be the most useful way of supporting adolescents in developing healthy habits around their wired tech. CONCLUSION: Adolescent experiences of networked technologies are complex, yet they are able to navigate this landscape with intelligent strategies. Their self-directed exploration of disconnection helped them to become reflexive practitioners who were able to revisit their use of networked technologies with new insights and self-control.

RéSUMé: OBJECTIFS: Les niveaux élevés de connectivité réseau sont courants chez les jeunes Canadiens, ce qui pourrait avoir des effets nuisibles sur leur santé. La surveillance par les adultes n'est pas une stratégie efficace à long terme pour aider les jeunes à établir une relation saine avec la technologie. Nous explorons ici les avantages de donner aux jeunes les moyens de se fixer des objectifs sains et de s'autosurveiller. Nous abordons la critique par Shapka de la théorie des systèmes duels (2019) et considérons la relation entre les systèmes neurologique et comportemental en lien avec l'utilisation d'Internet par les adolescents. MéTHODE: À l'aide d'une démarche de recherche-action participative avec des jeunes, nous avons conçu, en collaboration avec six adolescents, un projet pour explorer les effets de l'utilisation des technologies réseau dans leurs vies en les déconnectant et en observant en quoi l'absence de connectivité réseau modifiait leur expérience. Les jeunes ont noté leur utilisation d'appareils en réseau avant et après la déconnexion dans un « journal médias ¼. RéSULTATS: Le principal avantage de la déconnexion semblait être la possibilité de réfléchir à sa propre utilisation des appareils en réseau. Les participants ont ainsi pu rétablir cette connexion de façon plus intentionnelle. Nos constatations confirment l'hypothèse de Shapka selon laquelle la théorie des systèmes duels, axée sur la réglementation, n'est peut-être pas le meilleur moyen d'aider les adolescents à acquérir de saines habitudes face à leurs appareils en réseau. CONCLUSION: L'expérience des technologies réseau chez les adolescents est complexe, mais avec des stratégies intelligentes, ils réussissent à trouver leur voie. Leur exploration autodirigée de la déconnexion les a aidés à devenir des praticiens réfléchis, capables de retourner à leur utilisation des technologies réseau avec plus de retenue et des vues plus larges.

Electronic screen technology use and connection to nature in Canadian adolescents: a mixed methods study.

OBJECTIVES: Declines in exposure to nature may deprive young people of experiences that are positive for their mental health. One factor that may interfere with connections to nature is use of electronic screen technologies. The objectives of this study are to (1) document variations in the perceived importance of connections to nature nationally among adolescents; (2) explore relationships between these connections and the use of electronic screens, both epidemiologically and qualitatively; and (3) integrate core findings from both strands in order to provide evidence-based recommendations for health promotion. METHODS: The study involved a mixed methods design. Strand 1 involved a qualitative study of 74 Canadians (ages 10-18, years 2016-2018) with data collected through focus groups and interviews. Strand 2 involved a cross-sectional observational analysis of a national survey of 23,920 Canadians (ages 11-15, years 2013-2014). Findings from both strands were integrated through an established protocol. RESULTS: Increased use of electronic screen technology was consistently associated with lower perceived importance of connections to nature. Barriers to connecting to nature included choices that young people are making, the addictive properties of technology, and beliefs that being indoors is more comfortable and safer than being outdoors. When young people disconnected, their appreciation of being outdoors increased. INTERPRETATION: This novel study showed, quantitatively, that the time young people spend with electronic screens displaces time that they spend engaging in outdoor activities. Deeper reasons why such associations occur emerged in the qualitative strand. Temporary disconnection from screens may lead to renewed opportunities for outdoor exposures.

The role of family and computer-mediated communication in adolescent loneliness.

Adolescence is a developmental phase in which feelings of loneliness often increase. It is also a time period during which computer-mediated communication (CMC) is frequently used by youth to communicate with their peers. Strong family relationships protect youth from experiencing a wide range of adversities and mental health problems, including loneliness, and yet use of CMC to contact peers may leave adolescents feeling disconnected and lonely while also limiting the amount of time they spend with their family. This study examines the association between CMC and feelings of loneliness among Canadian youth, with family communication explored as an effect modifier. The study base was the Canadian 2013-2014 Health Behaviour in School-aged Children study used in a cross-sectional analysis (N = 30117; grades 6-10). Random-effects multilevel Poisson regression methods were used to quantify risks for adolescent loneliness among daily vs. non-daily users of verbal CMC (e.g., Skype, phone calls), text/instant messaging and social media CMC with friends. Effect modification was tested via the inclusion of modelled interaction terms. Family communication quality moderated the relationship between daily CMC use and loneliness among Canadian youth. Among youth experiencing high relative quality of family communication, daily use of verbal and social media CMC to contact friends was positively associated with reports of loneliness, compared to non-daily users. Findings suggest that family communication must remain central in societal discussions of youth loneliness, mental health and use of CMC.

Domains of spirituality and their associations with positive mental health: a study of adolescents in Canada, England and Scotland.

Spirituality is a concept with ancient roots yet contemporary relevance to mental health. Its assessment in populations of young people, however, remains an immense challenge. Efforts to perform such assessments typically involve use of unidimensional scales incorporating items related to four domains (connections to "self", "others", "nature", and the "transcendent"). For adolescents, it remains unclear whether these domains equally influence mental health, or if one domain is particularly important. Here we analyzed reports from adolescents who participated in the 2014 Health Behaviour in School-aged Children (HBSC) study conducted in Canada (n = 21,173), England (n = 4339) and Scotland (n = 5603). Reports of positive mental health were modelled as a function of ordinal scores describing each spiritual health domain, controlling for age, the other domains, and potential confounders. Subsequent analyses focused on the centrality of connections to "self" in these relationships. We identified strong and consistent associations between positive mental health and higher scores for each of the four spiritual health domains. In fully adjusted models, these effects were diminished or changed direction for connections to "others", "nature", and the "transcendent", while the positive association with "connections to self" remained. While associations exist between each of the four domains of spiritual health and positive mental health, it appears that associations with connections to "others", "nature", and the "transcendent" are sometimes mediated by connections to "self". Implications for assessment, models and related interventions and health promotion strategies, based on the idea that inner connections may be central to the protective effects of spiritual health, are considered.

The history and promise of holism in health promotion.

Holism is an ancient theme concept that has resurfaced in recent literature, and that requires informed and intentional use in order to preserve its utility. This paper provides a historical and conceptual reintroduction of the notion of holism as it relates to health, with the hopes of informing the term's use in public health discourse. It also addresses the challenges that a lack of conceptual clarity about holistic health imposes on public health and health promotion discussions. It describes how the use and conceptualizations of holism are shifting in health promotion and argues that failing to accurately define and delineate its scope risks diluting its utility for future health promotion applications. We address these two problems, and build an argument for a rediscovery of the theory of holism in public health and health promotion, globally.

Sex, drugs, risk and resilience: analysis of data from the Canadian Health Behaviour in School-aged Children (HBSC) study.

Background: Risk-taking behaviour among adolescents, particularly those experiencing childhood adversities, can predispose to injury, unwanted pregnancy, long-term morbidity and death. Resilience, i.e. adapting to threats and thriving, has rarely been examined as a protective factor for adolescent risk-taking. We studied whether the malleable traits of empathy, confidence, self-control and optimism, all markers of resilience, align with decreased risk-taking despite adversity, among 11-15 year olds. Methods: From responses of 22 643 Canadian youth to the Health Behaviour in School-aged Children (2014) survey we validated a five-item resilience scale. Using regression analyses, this scale and a single measure of self-control were considered as potential protective factors for a composite measure of risk-taking behaviour and of initiation of sexual activity before age 14. Results: There was a dose-dependent association between greater resilience and diminished risk-taking for boys and, even more so, among girls. This relationship remained significant after controlling for family and social support, implying that greater resilience may override the detrimental impact of childhood adversity on risk-taking. The least resilient youth were most likely to report early sexual activity, although this relationship was not linear. Generally, the impact of self-control on risk-taking was not statistically significant, perhaps because of shortcomings of the self-control indicator. Conclusion: Brief screening protocols can identify assets that protect against risk-taking behaviours among adolescents. The malleable nature of these traits offers primary care providers and public health personnel a novel and effective route to decreasing adolescent risk-taking and fostering future health.

Corporal punishment bans and physical fighting in adolescents: an ecological study of 88 countries.

OBJECTIVE: To examine the association between corporal punishment bans and youth violence at an international level. DESIGN: Ecological study of low-income to high-income 88 countries. SETTING: School-based health surveys of students. PARTICIPANTS: 403 604 adolescents. INTERVENTIONS: National corporal punishment bans. PRIMARY OUTCOME MEASURE: Age-standardised prevalence of frequent physical fighting (ie, 4+ episodes in the previous year) for male and female adolescents in each country. RESULTS: Frequent fighting was more common in males (9.9%, 95% CI 9.1% to 10.7%) than females (2.8%, 95% CI 2.5% to 3.1%) and varied widely between countries, from 0.9% (95% CI 0.8% to 0.9%) in Costa Rican females to 34.8% (95% CI 34.7 to 35.0) in Samoan males. Compared with 20 countries with no ban, the group of 30 countries with full bans (in schools and in the home) experienced 69% the rate of fighting in males and 42% in females. Thirty-eight countries with partial bans (in schools but not in the home) experienced less fighting in females only (56% the rate found in countries without bans). CONCLUSIONS: Country prohibition of corporal punishment is associated with less youth violence. Whether bans precipitated changes in child discipline or reflected a social milieu that inhibits youth violence remains unclear due to the study design and data limitations. However, these results support the hypothesis that societies that prohibit the use of corporal punishment are less violent for youth to grow up in than societies that have not.

Outdoor play and nature connectedness as potential correlates of internalized mental health symptoms among Canadian adolescents.

Exposures to outdoor environments have great potential to be protective factors for the mental health of young people. In a national analysis of Canadian adolescents, we explored how such exposures, as well as self-perceptions of connectedness with nature, each related to the prevalence of recurrent psychosomatic symptoms. The data source for this cross-sectional study, consisting of a weighted sample of 29,784 students aged 11-15 years from 377 schools, was the 2013/2014 cycle of the Health Behaviour in School-aged Children (HBSC) study. We modeled reports of exposure to the outdoors and then perceived connection(s) to nature as correlates of reduced psychosomatic symptoms. Associations varied by sex. Among girls, spending on average >0.5 h/week outdoors was associated with a 24% (95% CI: 5%, 40%) lower prevalence of high psychosomatic symptoms, compared to those who averaged no time playing outdoors. No such relationship was observed among boys. Perception of connection to nature as 'important' was similarly associated with a 25% (95% CI: 9%, 38%) reduction in the prevalence of high psychosomatic symptoms; this association did not differ by sex or age. Our analysis highlights the potential importance of adolescent engagement with nature as protective for their psychological well-being. It also emphasizes the importance of accounting for differences between boys and girls when researching, planning, and implementing public mental health initiatives that consider exposure to the outdoors.

Spirituality as a protective health asset for young people: an international comparative analysis from three countries.

OBJECTIVES: Spirituality has been proposed as a potential health asset a 'developmental engine' that works by fostering the search for connectedness, meaning and purpose. The aim is to examine to what extent spiritual health might be protective of young people's overall health and well-being. METHODS: In 2014, young people aged 11, 13, and 15 years in England, Scotland and Canada were surveyed as part of the HBSC study (n = 26,701). The perceived importance of spiritual health and domains (connections with self, others, nature, and the transcendent) was measured in these countries. Multi-level log-binomial models were used to explore relationships between spiritual health and three self-reported positive health outcomes: general health status, subjective life satisfaction and health complaints. RESULTS: Higher levels of perceptions of the importance of spiritual health, both overall and within the four domains, were associated with higher likelihoods of reporting each of the positive health outcomes. CONCLUSIONS: Spiritual health appears to operate as a protective health asset during adolescence and is significantly shaped by external relationships and connections.