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

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

Behavioural factors enhancing mental health - preliminary results of the study on its association with physial activity in 15 to 16 year olds.

INTRODUCTION: Reliable information on the influence of behavioural factors on adolescent mental health may help to implement more effective intervention programmes. OBJECTIVE: The objective of the study was to determine whether physical activity influences the variability of selected indices of mental health. METHODS: The study comprised 2,015 students aged 15-16, who were investigated as part of the HBSC survey (Health Behaviour in School-aged Children) in the 2013/14 school year. The dependent variable was the mental health index GHQ-12 (0-36 points) and its two domains (social dysfunction, anxiety and depression). Physical activity was measured with the MVPA (moderate-to-vigorous physical activity). Multivariable linear models were estimated, with overall GHQ index and partial indices as dependent variables. RESULTS: Adolescents reported a mean GHQ-12 score of 12.57 (±7.06). In a multivariable analysis, the pressure with school work along with gender resulted to be the main GHQ-12 predictors. School achievements and a high level of physical activity were identified as strong protective factors. Taking into account other factors, the GHQ-12 index falls by 2.13 points when comparing adolescents with an extremely low and high MVPA. Protective effect of physical activity appeared to be stronger in small towns and villages than in big cities and was more visible in the domain of social dysfunction. CONCLUSIONS: Physical activity remains an important predictor of mental health, even when the impact of sociodemographic and environmental factors as well as the respondents' school achievements are considered. Researches of such types, taking into account more complex determinants, wider behavioural factors' spectre as well as other outcome measures connected with teenagers' mental condition, should be continue.

Peer victimization and subjective health among students reporting disability or chronic illness in 11 Western countries.

BACKGROUND: To compare the strength of the association between peer victimization at school and subjective health according to the disability or chronic illness (D/CI) status of students across countries. METHODS: This study used data from 55 030 students aged 11, 13 and 15 years from 11 countries participating in the 2005-06 Health Behaviour in School-aged Children survey. Self-completed questionnaires were administered in classrooms. Multivariate models of logistic regression (controlled for confounding factors and countries) were used to investigate differences in the association between peer victimization and poor subjective health according to the D/CI status. RESULTS: Overall, 13.5% of the students reported having been bullied at least two or three times a month. The percentage of victims was significantly higher among those reporting D/CI than among others in all countries studied. Victims of bullying were more likely to report poor self-rated health, low life satisfaction and multiple health complaints. However, there were no differences in the associations between peer victimization and subjective health indicators according to the D/CI status. CONCLUSIONS: In all countries studied, students reporting D/CI were more likely to report being victims of bullying. Victims of bullying reported more negative subjective health outcomes regardless of their D/CI status. Although inclusive education is currently a major topic of educational policies in most countries, additional efforts should be made to improve the quality of the integration of students with D/CI.

Quality of life in 13-year-olds depending on health status, residential neighbourhood deprivation and social capital - results from the Polish HBSC Study 2010-2018.

INTRODUCTION AND OBJECTIVE: Health-related quality of life (HRQL) should be used more extensively in monitoring the health of school-aged children. The presented study aimed to evaluate trends in KIDSCREEN-10 indices, considering mean scores and the level of social inequalities. MATERIAL AND METHODS: 3,937 children aged 13 participated in three Health Behavior in School-aged Children (HBSC) cross-sectional surveys conducted in Poland between 2010-2018. Subgroups were distinguished according to gender, health status, and three social factors (family affluence, neighbourhood social capital, and local deprivation). RESULTS: The average KIDSCREEN-10 index value was equal to: 22.36±4.54; 25.41±6.75; and 24.74±6.53 in 2010, 2014, and 2018,respectively. However, in 2018 no deterioration was recorded in boys, in poorer families or in regions with high social capital. The improvement in HRQL in 2014 was accompanied by an increase in disparities in health status and family wealth, as well as a decrease in disparities in local deprivation. An especially high increase in Glass index values was recorded for neighbourhood social capital (increasing from 0.542 in 2010 to 0.938 in 2018). The multivariate general linear model revealed the main effect of the year of the study, gender, chronic disease status, and the three social factors, as well as six significant 2-way interactions. CONCLUSIONS: Changes in the well-being of adolescents should be tracked over time using HRQL indices with proven psychometric properties. The level of social inequalities faced by young people should be included in policies and when designing interventions. The relevant initiatives should be targeted at different populations in order to properly address the needs of different groups of children and adolescents.

[The styles of coping in stressful situations and the strain of psychological complaints in relation to tobacco smoking in senior secondary school adolescents]. / Style radzenia sobie w sytuacjach stresowych i obciazenie dolegliwosciami psychicznymi a palenie tytoniu wsród mlodziezy ze szkól ponadgimnazjalnych.

INTRODUCTION: A stress-coping style is a relatively constant tendency to apply specific methods of coping with a situation perceived as stressful. The study examined the links between stress-coping styles and tobacco smoking among young people. The strain of psychological complaints was also considered. The aim of this paper is to examine the relationship between frequency of tobacco smoking and stress-coping styles and strain of psychological complaints. METHODS: The presented data came from the studies conducted in the Institute of Mother and Child in 2011 among 997 students of senior secondary schools of various types. The average age of the surveyed was 16.6. Selected scales and questions from the CHIP-AE questionnaire were used. The surveyed were divided into three groups: non-smokers, occasional smokers, frequent smokers. The scale of psychological complaints was used. The CISS questionnaire was used to examine stress-coping styles. Summary indexes of stress-coping styles were devised; the following styles were identified: task-oriented, emotion-oriented, distraction-oriented and social diversion-oriented. A single-factor variant analysis was used. RESULTS: It was concluded that of the surveyed adolescents, 55.6% had never smoked tobacco, 16.1% smoked occasionally and 28.4% smoked frequently. The percentage of frequent smokers was higher in boys (32%) than in girls (25%). A link was established between tobacco smoking and selected stress-coping styles as well as the strain from mental complaints. It was concluded that parallel to the rising frequency of smoking, the tendency increases to apply emotion-oriented, distraction-oriented and social diversion-oriented styles. The individuals who had never smoked had a lower index of the abovementioned stress-coping styles in comparison with the frequent smokers. No correlation was found between tobacco smoking and the task-oriented style. It was also determined that the frequent smokers, in comparison with the non-smokers, suffered more often from mental complaints (8.70 (SD=6.99) vs. 6.57(SD=6.05); p<0.001). CONCLUSIONS: Frequent tobacco use is related to a greater strain from mental complaints. Frequent tobacco smoking is also connected with the choice of stress-coping strategies which focus around one's own emotions and distractions, and are not related to making efforts aimed at solving the problem. It may be therefore assumed that tobacco smoking intensifies behaviours which make it impossible to solve a stressful situation.

[The relationship between casual paid work, the use of psychoactive substances and school problems among upper secondary school students]. / Zwiazek miedzy dorywcza praca zarobkowa a uzywaniem substancji psychoaktywnych oraz problemami szkolnymi uczniów szkól ponadgimnazjalnych.

BACKGROUND: The issue of casual work is rarely mentioned in Poland in the studies of adolescent health and its determinants. The article includes a preliminary analysis of the links among work, psychoactive substance abuse and school problems in older adolescents. MATERIAL AND METHODS: The examined data relate to the age-homogenous group of 989 upper secondary-school students surveyed in 2011.The questions were derived from the Polish version of the CHIP-AE (Child Health and Illness Profile - Adolescent Edition) questionnaire. Cigarette smoking, mild and strong alcoholic drinks consumption and marihuana use were analysed with regard to the preceding month. A combined index - a scale of psychoactive substance use (SUSP) was calculated from the perspective of the entire life. The other index - a scale of the intensity of school problems (SNPS) was built around four questions about the occurrence of such problems within the preceding month. RESULTS: Within the examined group, 27.2% of the surveyed admitted to working outside their household. One in five worked for more than 10 hours a week. Working adolescents significantly more often used psychoactive substances than their non-working peers. The risk of a significant threat from psychoactive substances rose twofold in the comparison of working and non-working youth - OR=1.99 [95% CI(OR): 1,44-2,74]. Correspondingly, there was an increase in the risk of intensified school problems (SNPS) - OR=2.25 [95% CI(OR): 1,64-3,08].Working more than 10 hours a week results both risk factors rising to 2.34 and 2.70 respectively. Over threefold rise in the frequency of neglecting work or its bad performance was identified (OR=3.19; [95% CI(OR): 1,90-5,36]), when comparing the adolescents with the smallest and the biggest intensity of school. problems in the working group. CONCLUSIONS: Upper secondary school students undertaking paid work outside their household are in the risk group for psychoactive substance use and school problems. It is advisable to conduct deeper research on the motives for undertaking work and its impact on the development of adolescents, including longitudinal studies and qualitative research.

Self-Regulation in Adolescents: Polish Adaptation and Validation of the Self-Regulation Scale.

Self-regulation is associated with life satisfaction, well-being, and life success. For adolescents, who may be exposed to peer pressure and engage in risky behaviors, the ability to self-regulate or control emotions, thoughts, and behaviors is crucial for healthy development. While self-regulatory skills have long been recognized as important for many areas of life, instruments to measure self-regulation remain limited, especially in Poland. The aim of this study was to adapt and validate the Self-Regulation Scale in the Polish adolescent sample. The data for this study were obtained as part of the Health Behavior in School-aged Children 2021/2022 pilot study. Exploratory and confirmatory factor analyses confirmed that the instrument has satisfying psychometric properties. A three-factor structure of the instrument was obtained with cognitive, behavioral, and emotional subscales, which corresponds to the original instrument and theoretical assumptions. The final version of instrument contains 24 items, and based on the statistical analysis, it is concluded that it is suitable to be used in adolescent samples.

Hospital schools during COVID-19: Teachers' perspective.

Temporary lockdowns have been introduced in many countries as a preventive measure against the spread of the virus in 2020 and 2021. School closures and remote education have posed some difficulties for both students and teachers. A qualitative study and the semi-structured interview method was chosen to collect hospital teachers' insights into their work experiences during the pandemic. The sample consisted of 21 participants who worked as hospital school teachers. The study revealed the following thematic areas: introduction of remote/hybrid teaching (Frequency=8), lack of the sense of employment stability (F=4), limited contact with students (F=6), necessity to adapt to dynamically changing conditions (F=3), sedentary character of work (F=3), improvement of the quality of work and work conditions (F=4). The research was conducted as part of the Back to School Project (project number: 2019-1-PL01-KA201-065602), with funding from Erasmus+. The data collected during the study will be used to create guidebooks for both hospital school and mainstream school teachers.

Demographic analysis of difficulties related to remote education in Poland from the perspective of adolescents during the COVID-19 pandemic.

INTRODUCTION AND OBJECTIVE: Due to the COVID-19 pandemic all schools in Poland were closed and obliged to conduct lessons remotely. The aim of the study is to present the demographic analysis of difficulties with remote learning, as perceived by students during coronavirus pandemic in Poland. MATERIAL AND METHODS: In April 2020, a nationwide online survey was conducted among adolescents aged 11-18 (N=2408). Quantitative and qualitative data were used. Teenagers were asked about the problems connected with remote learning. In order to examine the overall level of remote learning difficulties, a scale of remote learning difficulties (RLD) was devised (range 0-23 points). Differences connected with gender, age and place of residence were analysed. RESULTS: More than a half of the teenagers surveyed rated the increased demands from teachers as a major problem. This answer appeared statistically more often among girls than boys (59.6% v. 53.2%). Almost every third adolescent saw the lack of consultation (31.6%) as a significant problem. Difficulties related to learning in the remote system were most often described as considerable by the oldest students (17-18-years-old) and those living in rural areas. The big problem for them was usually much higher requirements of teachers and poor organization of distance learning. The mean level on the scale of remote learning burden was M=11.9 (SD=7.1). Technical difficulties and insufficient skills in using software constituted additional problems most frequently mentioned by students. CONCLUSIONS: There is a need to pay particular attention to organizing appropriate technical conditions for remote learning, especially in rural areas, where students have complained more often than in cities about equipment and problems with access to the Internet during the pandemic.

[Tobacco smoking and risky behaviour taking by youth]. / Palenie tytoniu a podejmowanie zachowan ryzykanckich przez mlodziez.

The mechanism underlying the association between smoking and other risky behaviours is not clear. In the most of papers smoking is considered as dependent variable. The aim of this study was to recognize tobacco smoking as predictor of more general syndrome measured on Adolescent Risk-Taking Scale (ARTS). The study was conducted in 2010 among 1272 Polish students from 2nd grade of upper-secondary schools. The frequency of tobacco smoking in the last 30 days was measured on scale ranged form 0 (never) do 6 (40 times or more). Risk-taking syndrome was measured by ARTS scale, including six items and being a part of CHIP-AE (Child Health and Illness Profile - Adolescent Version) questionnaire. Standardized 0-100 scale was constructed. All analyses were adjusted by gender. Polish version of ARTS scale has good psychometric properties with one factor structure and reliability at the level of 0.66 (alpha-Cronbach). Results showed that 42.3% of respondents smoke at least once in the past 30 days, without gender-related differences. The mean index of ARTS was equal to 27.8 in boys and 18.5 in girls, respectively. The correlation between results on smoking and ATRS scales was significant (r = 0.300; p < 0.001). Multivariate linear regression model showed that gender and smoking were independent predictor of ARTS score. These two factors explained 14.1% of ARTS variability. Smoking was entered to the model at the first step. Analogous gender specific models indicated that smoking explained 12.3% of ARTS variability in girls and 7.2% in boys. Young people who smoke are at high risk of many adverse effects, including: unsafe driving, sensation seeking and its consequences and delinquent behaviours. Probably they manifest so called negative identity, having lower self-control and lack of skills to refrain from danger situations and behaviors.

[The relationship between tobacco smoking and risk behaviour syndrome among 15-year-old adolescents in Poland and other European countries]. / Zwiazek palenia tytoniu z zespolem zachowan ryzykownych u mlodziezy 15-letniej w Polsce i innych krajach europejskich.

In most of studies on the multiple risk behaviour syndrome, tobacco smoking is consider as one of the main components. In this paper smoking was excluded from this syndrome. On the contrary, a set of behaviours that includes: alcohol abuse, cannabis use and aggressive behaviours (bullying, fighting) was described and its association with smoking related behaviours was evaluated. Data were collected from 15-year-old students (N = 50618) from 28 countries participating in Health Behaviour in School-aged Children (HBSC) survey in 2005/06. Representative samples of pupils completed a standardised questionnaire during school hours in each country. Risk Behaviour Syndrome (RBS) was measured on the scale ranged 0-12 points, categorized into 3 levels. We tried to answer the following questions: 1) is early tobacco onset related with the higher risk of being involved in multiple problem behaviours; 2) what is the prevalence of regular tobacco smoking among adolescents reporting multiple problem behaviours; 3) in what extent gender modifies above relationships; 4) are similar patterns observed in Poland and combined international sample. The results have shown, that in Poland 22.6% of boys and 5.0% of girls reported high level of RBS (6 points or more). The prevalence of every day smoking was equal to 14.9% and 10,1%, in boys and girls, respectively. This percentage increased to 38.8% and 61.0% in the group of boys and girls reporting high score on RBS scale. More boys than girls started to smoke at age 13 yrs or earlier (38.6% vs. 27.1%). Adolescents who begun smoking earlier, were more likely to be regular smokers at age 15, and more likely to report multiple risk behaviors. In all countries the influence of early tobacco onset on the RBS is more evident among girls.

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.

The Polish version of the short scale measuring health literacy in adolescence.

OBJECTIVE: Background: Recent years saw the development of international tools for measuring health competencies understood as health literacy (HL). One of them is the short index Health Literacy for School-Aged Children (HLSAC) implemented by the members of the Health Behaviour in School-aged Children (HBSC) network. So far, when researching the properties of this instrument, less attention has been devoted to the correlation of HLSAC with other tools related to health. The aim of the paper is to present selected psychometric features of the HLSAC index in a sample of Polish pupils, supplemented by the preliminary analysis of its association with the health locus of control. PATIENTS AND METHODS: Material and methods: The information collected relates to 630 junior secondary school students surveyed in Poland in 2016 as part of the HLSAC questionnaire pilot study. The Multidimensional Health Locus of Control (MHLC) scale by K. Wallston was used as the additional module for Poland. It differentiates among three dimensions of health control: internal, external - dependent on other people, and external - dependent on random factors. It was checked which HLC dimension correlates most strongly with HL. RESULTS: Results: It was demonstrated that the HLSAC scale consisting of 10 questions has a very good reliability in the Polish version (Cronbach alfa = 0.851) and a one-factor structure. Confirmatory factor analysis supported a unidimensional model (RMSEA = 0.082; CFI=0.922; TLI=0.877). The HLSAC most strongly correlates with the internal health locus of control (r=0.376; p<0.001), slightly less with the influence of other people (r=0.153; p<0.001), while the correlation with the random factor health locus of control is insignificant (p=0.947). It was found that there is a weak, however significant, positive correlation between family affluence and HLSAC (p=0.041). CONCLUSION: Conclusions: The analyses conducted demonstrated that the Polish version of HLSAC has good psychometric features. The relatively higher correlation between HLSAC and internal rather than external health locus of control was confirmed. The practical effect of the pilot study was to develop an improved version of the HLSAC scale, which has been recommended for the mainstream HBSC 2018 survey.

What does the Cantril Ladder measure in adolescence?

INTRODUCTION: The Cantril Scale (CS) is a simple visual scale which makes it possible to assess general life satisfaction. The result may depend on the health, living, and studying conditions, and quality of social relations. The objective of this study is to identify key factors influencing the CS score in Polish adolescents. MATERIAL AND METHODS: The survey comprised 1,423 parent-child pairs (54% girls; age range: 10-17; 67.3% urban inhabitants; 89.4% of parents were mothers). Linear and logistic models were estimated; the latter used alternative divisions into "satisfied" and "dissatisfied" with life. In addition to age and gender, child-reported KIDSCREEN-52 quality of life indexes were taken into account, along with some information provided by parents - child physical (CSHCN) and mental (SDQ) health, and family socio-economic conditions. RESULTS: According to the linear model, nine independent predictors, including six dimensions of KIDSCREEN-52, explain 47.2% of the variability of life satisfaction on the Cantril Scale. Self-perception was found to have a dominating influence (ΔR2 = 0.301, p < 0.001). Important CS predictors also included Psychological Well-being (ΔR2 = 0.088, p < 0.001) and Parent Relations (ΔR2 = 0.041, p < 0.001). The impact of socioeconomic factors was more visible in boys and in older adolescents. According to logistic models, the key factors enhancing the chance of higher life satisfaction are Moods and Emotions (cut-off point CS > 5) and School Environment (CS > 8 points). None of the models indicated a relationship between the CS and physical health. CONCLUSIONS: The Cantril Scale can be considered a useful measurement tool in a broad approach to psychosocial adolescent health.

Changes in family socio-economic status as predictors of self-efficacy in 13-year-old Polish adolescents.

OBJECTIVES: The aim of this study is to determine the impact that raised mother's education and a relative change in family affluence might have on adolescent general self-efficacy (GSE). METHODS: Data on 600 children born in Poland in January 1995 and their families were used. Data from early childhood and adolescence (2008) were considered and the change between these two periods was determined. RESULTS: Family affluence increased in 37.3 % of families with mothers, who had raised their education level (12.6 % of the sample), in comparison to 26.8 % in the group with no change, p < 0.001. The average GSE scores in those groups were 73.4 and 68.1, respectively, p < 0.001. In the best linear regression model adjusted for gender, the independent predictors of GSE turned out to be mother's education change and the family's current affluence. CONCLUSIONS: Raised mother's education level may encourage building up developmental assets in older children. Based on the structural model, where self-efficacy is the mediator of the relationship between socio-economic status change and the quality of life (KIDSCREEN-10) these results may be of importance in further research.

Burden of chronic health conditions in adolescence measured by school surveys.

UNLABELLED: The Chronic Conditions Short Questionnaire (CCSQ) included as an optional package in the Health Behaviour in School-aged Children (HBSC) study protocol identifies adolescents with chronic conditions, and helps to understand the psychosocial impact of such illnesses. However, reliability of the results depends on the proper definition of the group with chronic conditions. THE AIM: of this paper is to report on the validity of self-reported data on chronic conditions obtained from the CCSQ questionnaire used in a large school-based population study. MATERIAL AND METHODS: The data was obtained from the 2010 HBSC study conducted in Poland in a group of 4570 pupils aged 13-17. The CCSQ includes three questions about chronic illness or disabilities occurrence diagnosed by a physician, and its selected consequences (missing school classes, medication). Four complex continuous scales were used as validation modules: the subjective complaints checklist and three sub-scales from the abbreviated Child Health and Illness Profile (CHIP-AE) questionnaire. The oldest age group was additionally asked about functional difficulties in: seeing, hearing, speaking, moving and breathing. Analysis of Variance with the post hoc test was used to compare subgroups of students defined according to CCSQ and functional difficulties. RESULTS: Chronic conditions were reported by 20.3% of young respondents (95% confidence interval 19.2-21.5%). A statistically significant difference was found between the mean indexes of all validation scales when comparing healthy and chronically-ill students meeting criteria of CCSQ. The difference increases in comparison with chronically-ill students with functional difficulties, missing classes or taking medication. CONCLUSIONS: The CCSQ questionnaire is an appropriate tool for assessing the occurrence of long-term health problems from the perspective of adolescents. The instrument also importantly allows for an assessment of the impact of chronic and long-term conditions on medication usage and hindered access to education. Occurrence of long-term health problems is a significant confounding variable that should be routinely included in school surveys on health and health behaviours.

[Family and peer factors related to alcohol abuse and smoking by 15-year-old youth]. / Rodzinne I Rówiesnicze Czynniki Zwiazanez Upijaniem Sie I Paleniem Tytoniuprzez 15.Letnia Mlodziez.

INTRODUCTION: A characteristic feature of the period of adolescence is to experiment with e.g. alcohol drinking and tobacco smoking. Both family relations and relations with peer groups can be referred to undertaking this kind of behavior by adolescents. OBJECTIVE: The aim of this study was an attempt to assess relationships between joint family and peer-group relations and the frequency of binge drinking and tobacco smoking by 15-year-olds. MATERIAL AND METHODS: The study was conducted in 2010/2011 within the framework of the international HBSC study (Health Behaviour in School-aged Children) on a group of 1551 people aged 15 years (49.1% boys). It was carried out in schools. Items from the HBSC questionnaire were used to assess the frequency of undertaking risky behaviors. To assess the quality of relations within the family, questions from the FDM II scale (Family Dynamics Measure II) were used, whereas an abbreviated version of the IPPA (Inventory of Parent and Peer Attachment) scale was used to assess the quality of peer relations. Three patterns of relations with family and peers were identified by the use of the cluster analysis methods (k-means method). RESULTS: In the group of girls the differences in the proportions in clusters reflecting the patterns of relations with the family and peers were greater than in boys. 15-year olds who had good relations with peers and poor relations with their family got drunk and smoked tobacco more often than adolescents in other clusters. CONCLUSIONS: The frequency of undertaking risk behavior by adolescents is associated with perceptions of social relations. Good family relations, as a protective factor, may partially reduce the negative impact of the peer group on undertaking risk behavior by adolescents. There is a need for further research to answer the question about the trends in the correspondence between the quality of family and peer relations and undertaking risk behaviors.

[Self-esteem predictors in adolescents with diabetes]. / Predyktory poczucia wlasnej wartosci nastolatkow z cukrzyca.

INTRODUCTION: Self-esteem is the conviction concerning self-satisfaction and self-assessment of one's competence. It can influence the overall emotional state, and determine the motivation to take actions of characteristic teenagers. OBJECTIVE: Presentation of the results of research on predictors of self-esteem in healthy adolescents and their peers with diabetes. Is was investigated whether there were differences in factors that determine directly and indirectly the self-esteem within these groups. METHODS: The survey was conducted during the school year 2010/2011 as a part of cultural and linguistic adaptation of the CHIP-AE questionnaire (Child Health and Illness Profile - Adolescent Edition). Data were collected from 1177 students with average age of 15.4 years, who attended junior high and high schools of different types, in five provinces of Poland. In this group there were 117 adolescents with diabetes and 1060 healthy peers. The CHIP-AE questionnaire consists of six main dimensions: satisfaction, complaints, protective factors, risk factors, achievements and illness. Students are asked to respond mostly from the perspective of the last 4 weeks. Predictors of self-esteem were selected from the following fields of CHIP-AE questionnaire: physical health, self-efficiency, limitation of daily activities, academic achievement, burden of school work, social support, capability of solving social problems, family relationships, relationships with peers and with teachers. Multivariate regression models and structural equitation models were estimated for both the healthy and the ill adolescents. RESULTS: It has been proved that self-esteem of healthy adolescents was determined differently than that of their peers with diabetes. The most important elements forming self-esteem of adolescents with diabetes were as follows: self-assessment of physical fitness, academic achievements and social support. In the studied group an indirect impact of limitations of physical activity on self-perceived fitness and influence of physical activity on academic achievement has also been found. CONCLUSIONS: The self-esteem of teenagers with diabetes mellitus may be considered as a determinant of ability to cope with the constraints of the disease. More precise knowledge on predictors of self-esteem of teenagers with diabetes may help to improve their psychosocial functioning, and thus improve their health.

Psychological determinants of selected eating behaviours in adolescents.

BACKGROUND: In population studies, we can follow the occurrence of initial symptoms of abnormal eating behaviours which may, but do not have to, lead to clinical manifestation of serious associated health problems, such as overweight or obesity, anorexia nervosa or bulimia nervosa. THE MAIN AIM: of this study was to determine to what extent psychosocial factors are associated with selected eating behaviours, such as: dietary restrictions, uncontrolled eating and emotional eating. MATERIAL AND METHODS: Data from the postal survey conducted in 2008 on the sample of 605 children born in Poland in January 1995 served as a basis of this study. A short, 13-item Polish version of TFEQ (Three Factor-Eating Questionnaire) instrument was applied, representing three factors: Cognitive Restraint (CR), Uncontrolled Eating (UE) and Emotional Eating (EE). Multivariate linear regression models were estimated with eleven psychosocial factors, gender and body mass index BMI (1 - excess; 0 - lack of excess weight) as potential independent variables. RESULTS: The following variables appeared to be independent predictors of eating behaviours: 1) for CR: three risk factors - high BMI, gender (female) and low self-esteem; 2) for UE: two risk factors - high stress and low emotional support and one protective factor - positive attitude towards school; 3) for EE: two risk factors - high stress, low coping and two protective factors - high social acceptance and instrumental support. Psychosocial factors showed the strongest association with emotional eating (for final four predictors R2=0,078), and the weakest with dietary restrictions (for the only psychosocial predictor ÄR2=0,014). CONCLUSIONS: 1) Negative behaviours, such as: dietary restrictions, uncontrolled eating and emotional eating may have strong association with psychosocial factors in adolescence. 2) In this period of life, the strongest association of psychosocial factors with emotional eating, and the weakest with dietary restrictions was found. 3)The knowledge of disordered eating predictors may become the basis for providing more effective intervention programmes which should aim to make young people aware of the mechanisms leading to this kind of disorders and potential consequences for health at present and in the future.

School meals and policy on promoting healthy eating in schools in Poland.

AIM: to diagnose the situation regarding the infrastructure, organization of school meals, the kind of products available for students at school and the school policy on the promotion of healthy eating in the context of the increasing frequency of obesity among children and young people. METHOD AND MATERIAL: The research tool was the questionnaire "School environment and health", including a section on the facilities, organization of meals and the school's policy on healthy eating. It made use of the questions from the international HBSC (Health Behaviour in School-aged Children) school questionnaire. The anonymous questionnaire was sent out by post and was returned by 520 head masters of primary, lower-secondary and cluster schools. This means that 74.3% of the randomly chosen sample of schools responded. RESULTS: Almost 2/3 of the schools had a canteen and a school store. Hot meals were served in 84% of the schools but only in 28% of them to more than 50% of the students. School breakfast was organized by half of the schools of which 23% had it in all the classes. Almost all the schools served free meals for students with special needs. Most schools, particularly lower-secondary provided access to sweets, sweet drinks and salty snacks. Only 7-25% of schools have a written policy on limiting such products and increasing the consumption of fruits, vegetables, milk and whole-grain bread products. In on going national programmes: "A Glass of Milk" had a 74% participation rate (only 25% of the lower-secondary schools) and "Fruits in School" 38% (6% lower-secondary schools). The "Keep Fit" educational programme was implemented in 28% of primary schools and in 72% of lower-secondary schools. CONCLUSIONS: The majority of schools in Poland still do not appreciate the need for all students to eat a meal in school and have not become involved in prophylactic activities designed to prevent obesity. The undertaken activities are incoherent. There is a need to create a policy on healthy nutrition at school at the national, regional, local and school level.