Adolescents' problematic internet and smartphone use in (cyber)bullying experiences: A network analysis.

BACKGROUND: This study investigates both offline and online bullying perpetration and victimization in association with problematic internet use (PIU) and problematic smartphone use (PSU), while also considering the related psychosocial difficulties. METHODS: A total of 3939 adolescents (49.4% boys, aged 13-15 years) from a representative sample of schools in Slovakia was obtained from the Health Behavior in School-aged Children (HBSC) project in 2018. Due to the lack of similar complex research and the expected mutual associations among the constructs, we compared exploratory network models that provided separate estimates for boys and girls. RESULTS: The constructs formed similarly clustered networks for both genders, with a few notable differences. Unlike PIU, PSU was not associated with bullying experiences in boys or girls; however, PSU and PIU were partially related in girls. Bullying experiences formed a strong cluster in both networks. Two strong bridges were identified, and they are potential candidates for intervention in both boys and girls: first, traditional bullying victimization connected the cluster of bullying experiences to psychosocial difficulties; and, second, frequently missing sleep or meals due to internet use (behavioral salience) that is connected to the bullying cluster with PIU. CONCLUSIONS: The findings offer an indication for the preventive and interventive work of practitioners who deal with adolescents, as well as complex gender comparisons for the mutual relations of problematic internet and smartphone use, bullying experiences, and the psychosocial difficulties of youth. This study provides evidence that problematic digital media can play a role in bullying experiences irrespective of whether bullying happens offline or online.

Does family communication moderate the association between adverse childhood experiences and emotional and behavioural problems?

BACKGROUND: Adverse childhood experiences (ACEs) and poor family support and communication can increase emotional and behavioural problems (EBP). Therefore, we assessed the association of difficult communication with mother and with father separately with both emotional and behavioural problems (EBP), and whether adolescents' communication with mother and with father moderates the association of adverse childhood experiences (ACE) with the EBP of adolescents. METHODS: We used data from the Health Behaviour in School-aged Children study conducted in 2018 in Slovakia, comprising 5202 adolescents aged from 11 to 15 (mean age 13.53; 49.3% boys). EBP were measured using the Strengths and Difficulties Questionnaire. We used generalized linear regression adjusted for age, gender and family affluence to explore the modification of the associations between ACE and EBP by communication (easy vs. difficult communication) with mother and father. RESULTS: Difficult communication or a complete lack of communication due to the absence of mother and father increased the probability of emotional (exp (b): 0.96, 95% CI: 0.92|1.00; and 0.95, 95% CI: 0.91|0.99, respectively) and also of behavioural problems (exp (b): 0.96, 95% CI: 0.92|1.00; and 0.94, 95% CI: 0.90|0.97, respectively). We found a statistically significant interaction of communication with father on the association of ACE with EBP, showing that the joint effects were less than multiplicative. CONCLUSION: Difficult communication with mother and father is related to EBP among adolescents, and adolescents' communication with father moderates the association of ACE with both emotional and behavioural problems among adolescents.

Do sleeping habits mediate the association between time spent on digital devices and school problems in adolescence?

Background: This study examined the associations of Internet and computer screen time with school difficulties and the role of sleep quality and soft and energy drinks consumption. Methods: We used data from the cross-sectional Health Behaviour in School-aged Children study collected in 2014 among Slovak adolescents (aged 11.0-15.9 years, N = 7595, 48.1% boys). We examined the inter-relations between time spent with on digital devices (time spent playing digital games or Internet use), sleeping quality (sleeping shortage, sleeping difficulties), soft/energy drinks consumption and school problems (low academic achievement, disliking school, being pressured by schoolwork and truancy), using structural equation modeling. Results: Results showed that the more time adolescents spent on digital devices during leisure time, the more school problems they had. This association was mediated by a higher consumption of soft or energy drinks and a lower quality of sleeping. The direct effect of time spent on digital devices on school problems and its indirect effect via sleeping quality were relatively small (-0.26 and -0.30, respectively, standardized solution), compared with the indirect effect of time spent on digital devices via soft/energy drinks consumption as well as sleeping quality (0.65, standardized solution). Conclusions: Time spent on digital devices is associated with school problems, with sleeping and soft/energy drinks consumption playing a substantial role in this association.

Do Adolescents with T1DM Differ from Their Peers in Health, Eating Habits and Social Support?

OBJECTIVE: The aim of this study was to analyse differences in health, eating habits and social support in adolescents with type 1 diabetes mellitus (T1DM) in comparison to peers with another long-term illness or without any medical condition. METHODS: We used self-reported data from the cross-sectional Health Behaviour in School-aged Children study collected in 2014 among Slovak adolescents as well as data from adolescents with T1DM collected in outpatient settings (11 to 15 years old, N=8,910, 50.3% of boys). Logistic regression models and general linear models were used to analyse differences between adolescents with T1DM and their peers with and without long-term illness in self-rated health, life satisfaction, health complaints, regular breakfast, sweets and soft drink consumption, and perceived support from family, teachers and classmates. RESULTS: Adolescents with T1DM reported worse self-rated health and suffer from more health complaints, but they have lower chance of having breakfast irregularly in comparison to their peers with another long-term illness or without any medical condition. Moreover, compared with their peers, adolescents with T1DM perceived stronger support from teachers and classmates, but weaker support from their family. We did not confirm any differences in life satisfaction, sweets and soft drink consumption between adolescents with T1DM and their peers. CONCLUSIONS: Adolescents with T1DM reported more regular eating habits, no difference in life satisfaction and more social support outside the family in comparison to their peers. However, their worse self-rated health, more health complaints and weaker support from family should be considered in interventions targeting psychosocial adjustment of adolescents with T1DM.

Screen-based behaviour in school-aged children with long-term illness.

BACKGROUND: Evidence is lacking on the screen-based behaviour of adolescents with a chronic condition. The aim of our study was to analyse differences in screen-based behaviour of adolescents by long-term illness, asthma and learning disabilities. METHODS: We used data from the cross-sectional Health Behaviour of School-aged Children study collected in 2014 among Slovak adolescents (age 13 to 15 years old, N = 2682, 49.7 % boys). We analysed the associations between screen-based behaviour and long-term illness, asthma and learning disabilities using logistic regression models adjusted for gender. RESULTS: We found no associations between screen-based behaviour and long-term illness, except that children with asthma had a 1.60-times higher odds of excessively playing computer games than healthy children (95 % confidence interval of odds ratio (CI): 1.11-2.30). Children with learning disabilities had 1.71-times higher odds of risky use of the Internet (95 % CI: 1.19-2.45). CONCLUSION: Adolescents with a long-term illness or with a chronic condition or a learning disability do not differ from their peers in screen-based activities. Exceptions are children with asthma and children with learning disabilities, who reported more risky screen-based behaviour.

Age and Gender Differences in Prevalence of Screen Based Behaviour, Physical Activity and Health Complaints among Slovak School-aged Children.

AIM: The aim of this study was to assess age and gender differences in prevalence of screen based behaviour, physical activity and health complaints among Slovak school-aged children. METHODS: Data from the cross-sectional Health Behaviour of School-aged Children study collected in 2010 among Slovak children (age 11-15 years, N=8,042) was used. Logistic regression models adjusted to age and gender were used to analyse the associations between watching TV, working with a computer or playing computer games and physical activity and headache, backache, sleep difficulties, feeling low, irritability, and feeling nervous. RESULTS: Around one-quarter of adolescents is spending more than three hours a day with screen-based activities. While the age was significantly associated with watching TV and computer use, gender was significantly associated only with excessive computer use. As for physical activity only 25% of adolescents reported being physically active every day as recommended, and this number decreases with increasing age. Boys used to be more often active in comparison with girls. A sizeable number of adolescents suffer with selected health complaints every week. Moreover, the prevalence of health complaints increases with age and is significantly higher among girls. CONCLUSIONS: The prevalence of screen-based activities as well as insufficient physical activity and health complaints among adolescents is relatively high and it increases with age. Gender differences are also significant, except for watching TV.

Adolescents' academic performance: what helps them and what hinders them from achievement and success?

Introduction: Research on adolescents' academic performance has mostly focused on the contribution of objective factors, such as socioeconomic situation of the family or individual cognitive skills and school results. Evidence with a focus on adolescents' subjective experiences is scarce. The aim of this qualitative study was to explore factors related to adolescents' academic performance from their perspectives. Methods: We used data from 11 group semi-structured interviews conducted in 2020/2021 with 45 adolescents in the first year of high school in Slovakia (mean age = 14.98; 22.2% boys). Participants were selected from three types of high school with regards to the graduation system. We analysed the data using consensual qualitative research and thematic analysis. Results: Based on the statements of the adolescents, we identified five main themes of factors that affect their academic performance. Adolescents reported that the following contribute to their academic performance: the contents and methods of teaching; how teachers behave and do their jobs; the way in which adolescents study and what motivates them; support within and outside the school, and the environment and appearance of the school. Adolescents reported that improving the curricula and using teaching methods that balance theoretical information with practical skills training would help their academic performance immensely. Conclusion: We identified several factors related to adolescents' academic performance using their own perspectives and experiences. Strengthening the capacities of teachers may largely benefit adolescents' educational process and further academic performance.

Differences between problematic internet and smartphone use and their psychological risk factors in boys and girls: a network analysis.

BACKGROUND: Problematic internet and smartphone use are significant health challenges for contemporary adolescents. However, their mutual relationship is unclear because studies investigating these phenomena are scarce. The present study aimed to investigate the psychological risks and protective factors associated with problematic internet and smartphone use. METHOD: A representative sample of Slovak adolescents (N = 4070, Mage = 14.38, SDage = 0.77, 50.5% girls) from the Health Behavior in School-aged Children project was analyzed using network analysis separately for boys and girls. RESULTS: The results showed weak (for boys) and moderate (for girls) associations between problematic internet use and problematic smartphone use. Risk factors showed stronger associations with problematic internet use than problematic smartphone use, with the exception of fear of missing out, which was strongly associated with problematic smartphone use. The central nodes were externalizing problems for boys and internalizing problems, externalizing problems, and resilience for girls. CONCLUSION: The study concluded that while problematic internet use and problematic smartphone use are somewhat related, they differ at the psychological level. In addition, the phenomena are rather different between boys and girls.

Family Socioeconomic Status and Adolescent School Satisfaction: Does Schoolwork Support Affect This Association?

Background: The aim of this study is to explore the association of family socioeconomic status (SES) and internal and external schoolwork support with adolescents' school satisfaction and whether schoolwork support modifies these associations. Methods: Data come from the cross-sectional Health Behavior in School-aged Children study collected in 2018 from Slovak 15-year-olds (N = 1127; 52.7% boys). SES was measured by Family Affluence Scale (low; middle; high). School satisfaction was measured via school engagement and attitudes toward education. Schoolwork support was measured regarding two groups of sources inside and outside the family, separately. Logistic regression models were used to explore the associations of SES and schoolwork support with school satisfaction as well as the moderating effect of schoolwork support. Results: Adolescents with low SES were more likely to feel indifferent toward school and education (odds ratios/95%-confidence interval: 1.77/1.26-2.49), and similarly, adolescents who did not have schoolwork support inside or outside the family (1.38/1.02-1.87, and 1.50/1.01-2.22, respectively). Schoolwork support moderated the associations of SES with school satisfaction. Adolescents with low and middle SES without support inside or outside the family were more likely to feel indifferent than satisfied (2.72/1.21-6.10; 3.00/1.27-7.06; and 2.86/1.05-7.80; 6.04/1.72-21.24, respectively). Conclusion: Adolescents from low and middle SES without schoolwork support inside or outside the family are more likely to feel indifferent toward school and education.

School Satisfaction and Its Associations with Health and Behavioural Outcomes among 15-Years Old Adolescents.

Background: Health and behavioural outcomes of adolescents have been shown to be related to school pressure, demands or unfavourable relationships with classmates or teachers. These associations may relate to school satisfaction, but evidence on this is lacking. Therefore, our aim is to explore the associations of school satisfaction with hopelessness, health complaints, fighting and truancy. Methods: Data come from the cross-sectional Health Behaviour in School-aged Children study collected in 2018 from Slovak 15-year-old adolescents (N = 816; 50.9% boys). School satisfaction was measured by school engagement and attitudes towards education, grouped as: satisfied (both positive), inconsistent (one positive, one negative) and indifferent (both negative). Hopelessness, health complaints, fighting and truancy were measured using self-report questionnaires. Logistic regression models were used to explore the associations of school satisfaction with hopelessness, health complaints, fighting and truancy separately. Results: Indifferent adolescents were more likely to feel hopeless, to frequently experience two or more health complaints, to be involved in a fight and to skip school (odds ratios/95%-confidence interval: 2.57/1.49-4.45; 2.51/1.48-4.25; 1.92/1.02-3.60; and 2.34/1.25-4.40, respectively) than satisfied adolescents. Inconsistent adolescents were more likely to frequently experience two or more health complaints than satisfied adolescents (1.72/1.05-5.79). Conclusions: School satisfaction affects adolescents' health and social behaviour and may threaten their healthy development.

What Role Does Body Image in Relationship between Level of Health Literacy and Symptoms of Eating Disorders in Adolescents?

(1) Background: The aim of this study was to explore the associations between health literacy and symptoms for eating disorders among adolescents, taking into consideration age and gender and whether this association is mediated by body image. (2) Methods: We used data on 5054 adolescents (mean age = 13.9, 51.7% boys) from the Health Behaviour in School-Aged Children study conducted in 2018 in Slovakia. We used logistic regression models to examine associations between level of health literacy and symptoms for eating disorders mediated by body image. (3) Results: Adolescents with low and medium levels of health literacy had a higher occurrence of reporting two or more symptoms of eating disorders (odds ratio (OR)/95% CI: 2.25/1.78-2.84 and 1.37/1.15-1.65). Adjustment for body image reduced the significance of association between low level of health literacy and symptoms for eating disorders by 26.4%, and association between medium level of health literacy and symptoms for eating disorders by 29.7%. (4) Conclusions: Adolescents who have a low health literacy level were found to have a higher probability of having symptoms for eating disorders, especially when they perceive themselves as fat. The study refers to potential theoretical frameworks for health literacy intervention that may provide guidelines for the intervention design and materials.

Energy Drinks Consumption Associated with Emotional and Behavioural Problems via Lack of Sleep and Skipped Breakfast among Adolescents.

The aim of our study was to explore whether energy drink consumption is associated with both emotional and behavioural problems and whether this association might be mediated by amount of sleep and breakfast consumption among adolescents. The nationally representative Health Behaviour in School-aged Children (HBSC) study, realised in 2018 in Slovakia in schools, was used to acquire needed data, with the research sample of 8405 adolescents from 11 to 15 years old (mean age = 13.43; 50.9% boys) who completed the questionnaires on their own in a presence of researchers and research assistants. Emotional and behavioural problems were assessed by a Strengths and Difficulties Questionnaire, while energy drinks consumption, breakfast consumption and sleep duration was assessed by questions in line with the HBSC study protocol. Linear regression models assessed the associations between energy drinks consumption and emotional and behavioural problems. Mediation by sleep duration and breakfast consumption was assessed with parallel mediation models. Energy drink consumption was significantly associated with emotional (p < 0.001) and behavioural problems (p < 0.001), with higher consumption of energy drinks leading to more emotional and behavioural problems. Results from a parallel mediation analysis indicated that energy drink consumption is indirectly related to both emotional and behavioural problems through its relationship with the amount of sleep and breakfast consumption. Parents and professionals working with adolescents should be aware that unhealthy dietary habits and lack of sleep might be related to emotional and behavioural problems.

Eating disorders symptoms and excessive internet use in adolescents: the role of internalising and externalising problems.

BACKGROUND: Both eating disorders and excessive internet use represent significant health issues for contemporary adolescents. Yet, the link between them has seldom been investigated. We aim to study this association through their common underlying psychological factors: internalising problems and externalising problems. METHODS: A representative sample of 7,083 adolescents (Mage = 13.48 years; SDage = 1.32; 50.3% girls) from Slovakia was obtained from the Health Behaviour in School-aged Children (HBSC) project in 2018. Study variables included the Excessive Internet Use Scale (EIU) and the Strength and Difficulties Questionnaire (SDQ). Eating disorders symptoms (EDS) were assessed by SCOFF and selected items from the Eating Disorder Screen for Primary Care (ESP). Data were analysed separately for boys and girls with Structural Equation Modelling. RESULTS: There was a partial correlation between EDS and EIU (r = 0.36 for boys and r = 0.29 for girls) after controlling for the internalising and externalising of problems. Internalising and externalising problems were positively associated with EDS, while EIU was only associated with externalising problems. The results were comparable for both genders. CONCLUSION: The study provides evidence that, during adolescence, EDS and EIU are related and have a tendency to occur together. Also, they are related even when controlled for their shared underlying psychological factors, namely the emotional and attentional/behavioural difficulties.

The study found that, in adolescents, eating disorders symptoms are associated with excessive internet use even when controlled for their shared psychological factors. Self-control issues were associated with both the eating disorder symptoms and excessive internet use, while emotional issues were only associated with the eating disorder symptoms. The strength of the relationship was similar for boys and girls, even though the prevalence of eating disorders symptoms was double in girls.

Family Support as Smoking Prevention during Transition from Early to Late Adolescence: A Study in 42 Countries.

Family support has a beneficial impact on protecting health-risk behaviour in adolescents. This study aimed to explore whether family support is associated with risk of smoking during transition from early (11 years) to late (15 years) adolescence across 42 countries. The data from the cross-national Health Behaviour in School-aged Children (HBSC) study in 2017/2018 were employed (N = 195,966). Family support was measured using the four-item Family dimension of the Multidimensional Scale of Perceived Social Support (sum score 20 or more was categorised as high family support). Smoking was defined as a reported cigarette smoking at least 1-2 days in the last 30 days. The association between smoking and family support was assessed using a prevalence ratio (PR) obtained from the multivariate Poisson regression. Over two thirds of adolescents reported high levels of support from their family. Family support was found to significantly decrease with age in most of the countries, with the boys reported high level of family support more often than girls. The adolescents who reported having low family support also were more likely to smoke compared to their peers who reported having high family support (PR = 1.81; 95% CI: 1.71-1.91 in boys, and PR = 2.19; 95% CI: 2.08-2.31 in girls). The countries with a stronger effect of family support in reducing smoking risk indicated lower rates of adolescent smoking as well as lower increases in the cigarette smoking prevalence during the age period from 11 to 15 years. This study reinforces the need for family support, which is an important asset helping adolescents to overcome the risk of smoking during their transition from early to late adolescence.

Does Schoolmate and Teacher Support Buffer against the Effect of Adverse Childhood Experiences on Emotional and Behavioural Problems?

This study aims to explore the associations of schoolmate and teacher support with emotional and behavioural problems (EBP) and whether schoolmate and teacher support affects the associations of adverse childhood experiences (ACE) and of EBP in adolescence. We obtained data from 5220 students aged from 11 to 15 (48.7% boys), who participated in the Health Behaviour in a School-aged Children study (2018, Slovakia). Using logistic regression adjusted for gender, age and family affluence we assessed the modification of the relations of ACE and EBP by schoolmate and teacher support. Schoolmate and teacher support decreased the probability of EBP (Odds Ratios, 95% confidence intervals: 0.76, 0.74|0.79; and 0.86, 0.83|0.89, respectively). However, we found no statistically significant interactions of schoolmate and teacher support regarding the association of ACE with EBP. Schoolmate and teacher support decreased the likelihood of EBP among adolescents but do not buffer the relation of any previous ACE with EBP.

Does Resilience Mediate the Association of Adverse Early Childhood Experiences With Emotional and Behavioural Problems?

Objectives: To explore the role of resilience as a mediator in the association between adverse childhood experiences (ACE) and emotional and behavioural problems (EBP) among adolescents. Methods: We used data from the Slovak 2018 Health Behaviour in School-aged Children study, comprising 2,839 adolescents aged 13-15 (mean age 13.93; 49.6% boys). We used multivariate linear regression performed on 5000 bootstrap samples adjusted for age, gender, family affluence to explore mediation of the associations between ACE (measured using the adapted Adverse Childhood Experience Questionnaire) and EBP (measured using the Strengths and Difficulties Questionnaire) by resilience (measured with the Child and Youth Resilience Measure). Results: We found ACE [B = 0.78; 95% confidence interval (CI): 0.67|0.90] and resilience (B = -0.73; 95% CI: -0.79|-0.67) to be significantly associated with EBP. The association of ACE and EBP was mediated by resilience. The mediated indirect effect of resilience was ab = 0.25; 95% CI: 0.18|0.32. Conclusion: Resilience seems to play a mediator role in the relationship between ACE and EBP. Helping adolescents with ACE to build and use internal and external sources of resilience can decrease the negative impact of ACE on EBP.

The Associations between Family-Related Factors and Excessive Internet Use in Adolescents.

This study examined the relationship between Excessive Internet Use (EIU) in adolescents and their family environment, namely the family type, the family economic status, the effect of parental care, the level of parental control, the amount of parental monitoring, the quality of communication, and the time spent together. The study was based on data from an international survey, Health Behaviour in School Aged Children (HBSC), conducted in Slovakia. The sample representative for adolescents included 2547 participants (51% boys) aged 13-15. Multiple-step linear regression revealed that higher parental care and parental monitoring predicted lower EIU, while higher parental overprotection and lower socioeconomic status predicted higher EIU. The results suggest that both so-called optimal parenting (i.e., the balance of emotional warmth and protection) and the adolescent's autonomy lower the risk of EIU. Family factors explained about 14% of the variance, which suggests that aside from personal, cognitive and affective factors, a close social environment also plays an important role in adolescence EIU.

Difficulties in Getting to Sleep and their Association with Emotional and Behavioural Problems in Adolescents: Does the Sleeping Duration Influence this Association?

Sleep problems are common in adolescence with a negative impact on the mental health and functioning of adolescents. However, the roles of different sleep problems in relation to emotional and behavioural problems (EBPs), classified according to the 10th version of the International Classification of Diseases as emotional, conduct, hyperactivity and social functioning disorders, are not clear. The first aim of the study was to investigate the association between difficulties in getting to sleep and EBPs in adolescents. The second aim was to explore the role of sleep duration in this association. We used data from the Health Behaviour in School-aged Children (HBSC) study conducted in 2018 in Slovakia. Presented are results for specific age groups of 13-year-old (N = 1909) and 15-year-old (N = 1293) adolescents. Subjective measures of sleep variables were used. Binary logistic regression models adjusted for age and gender were used to assess associations between difficulties in getting to sleep, sleep duration and EBPs measured using the Strengths and Difficulties Questionnaire. Modification of the association between difficulties in getting to sleep and EBPs by sleep duration was also explored. We found that difficulties in getting to sleep at least once a week as well as insufficient sleep (less than 8 h) increased the probability of EBPs. Interactions of sleep duration with difficulties in getting to sleep on EBPs were found to be non-significant. The results suggest that caregivers and clinicians should screen and intervene for both sleep quality and quantity problems in adolescents as they might indicate and promote EBPs.

Social constraints associated with excessive internet use in adolescents: the role of family, school, peers, and neighbourhood.

OBJECTIVES: Excessive internet use (EIU) has been studied predominantly within the context of individual risk factors. Less attention has been paid to social factors, especially in a fashion complex enough to include the multiple domains of adolescent socialization. This study examined the relationship between EIU and constraints within family, school, peer groups, and neighbourhoods, while controlling for emotional and behavioural difficulties. METHODS: This study was based on survey data from the Health Behaviour in School-aged Children study, which was conducted in Slovakia in 2018. The sample of representative adolescents totalled 8400 (mean age: 13.44 years; SDage = 1.33; 50.9% boys). RESULTS: Multiple-step linear regression revealed that, after controlling for sociodemographic factors and emotional and behavioural difficulties, peer problems had the least effect, while the constraints related to family and neighbourhood stood out as especially problematic. Combined variables explained 20% variance of EIU. CONCLUSIONS: Social constraints proved to be important factors in adolescent EIU. The important role of a problematic neighbourhood is a novel finding and suggests that it should be targeted in prevention.

Body Fat Mediates Association between Active Living and Health among Adolescents.

The aim of this study was to explore the association of moderate-to-vigorous physical activity and organized leisure-time activities with self-rated health among adolescents and whether these associations are mediated by body fat percentage. We used data on 888 adolescents (mean age 12.97, SD 1.20, 56.0% boys) from the Health Behaviour in School-aged Children (HBSC) study conducted in 2018 in Slovakia. We used logistic regression models to examine associations within self-reported data (moderate-to-vigorous physical activity and organized leisure-time activities with self-rated health) and their mediation by anthropometric data (body fat percentage). The adolescents who were sufficiently physically active and with normal body fat were more likely to report good or excellent health (odds ratios-OR/95% confidence intervals-95% CI: 3.52/1.50-8.27 and 3.66/2.37-5.68). Similarly, the adolescents who were engaged in individual/team sport and with normal body fat were more likely to report good or excellent health (OR/95% CI: 2.04/1.31-3.17 and 3.66/2.37-5.68). Adjustment for body fat percentage reduced the association between moderate-to-vigorous physical activity and self-rated health by 27.6% and the association between leisure-time activities and self-rated health by 30.7%. Active living and normal body fat might contribute to better health in adolescence. Programs and efforts to increase physical activity and leisure-time activities in childhood and adolescence need to identify which aspects of these activities are important, effective, and crucial for the population of adolescents.