The Role of School Connectedness and Friend Contact in Adolescent Loneliness, and Implications for Physical Health.

The current study investigated how adolescents' loneliness relates to school connectedness, classmate support, teacher support, and offline and online communication with friends. We also examined the association between loneliness, physical health, and sleep. Data came from the Scottish Health Behavior in School-aged Children (HBSC). The total sample was 2983 adolescents (F = 1479 [49.6%]) aged 14-17 years (M = 15.66, SD = 0.39) from 117 secondary schools in Scotland. Results showed that (1) higher teacher support, classmate support, and offline contact with friends predicted lower levels of loneliness, (2) online friendship engagement predicted higher levels of loneliness, and (3) poor health and sleep were positively associated with loneliness. The study offers new findings, highlighting the role played by classmates/peers and teachers in reducing loneliness. Supporting previous research, we also found associations between loneliness, poor sleep, and worse physical health.

Cross-national time trends in adolescent alcohol use from 2002 to 2014.

BACKGROUND: Adolescent alcohol consumption is a major public health concern that should be continuously monitored. This study aims (i) to analyze country-level trends in weekly alcohol consumption, drunkenness and early initiation in alcohol consumption and drunkenness among 15-year-old adolescents from 39 countries and regions across Europe and North America between 2002 and 2014 and (ii) to examine the geographical patterns in adolescent alcohol-related behaviours. METHODS: The sample was composed of 250 161 adolescents aged 15 from 39 countries and regions from Europe and North America. Survey years were 2002, 2006, 2010 and 2014. The alcohol consumption and drunkenness items of the HBSC questionnaire were employed. Prevalence ratios and 95% confidence intervals were estimated using Poisson regression models with robust variance. RESULTS: Data show a general decrease in all four alcohol variables between 2002 and 2014 except for some countries. However, there is variability both within a country (depending on the alcohol-related behaviour under study) and across countries (in the beginning and shape of trends). Some countries have not reduced or even increased their levels in some variables. Although some particularities have persisted over time, there are no robust patterns by regions. CONCLUSIONS: Despite an overall decrease in adolescent alcohol consumption, special attention should be paid to those countries where declines are not present, or despite decreasing, rates are still high. Further research is needed to clarify factors associated with adolescent drinking, to better understand country specificities and to implement effective policies.

How has the introduction of point-of-sale legislation affected the presence and visibility of tobacco retailing in Scotland? A longitudinal study.

BACKGROUND: Reducing the local availability of tobacco is identified as the 'next frontier' in tobacco control. This paper examines the roles of tobacco retail outlet density and tobacco visibility in changing exposure to tobacco retailing before and after the introduction of point-of-sale (POS) legislation in Scotland. METHODS: National tobacco retailer register data were analysed to examine time trends in tobacco retailer density (2012-2017). Results were stratified by local authority, neighbourhood deprivation and urbanity. Next, an annual retail audit using a POS tobacco visibility tool assessed changes in total product visibility in all retail outlets in four study communities between 2013 and 2017. A longitudinal survey (2013-2017) of 5527 adolescents aged 12-17 in the four study communities enabled the calculation of residential and journey-to-school measures of tobacco retailer exposure. Trends were stratified by deprivation, urbanity and socioeconomic status. RESULTS: Retail provision of tobacco declined following the introduction of the POS legislation in 2013. However, there were strong geographic differences; nationally, one-fifth of local authorities have increased provision since 2015. In the four study communities, tobacco retail provision was generally stable over the study period. Although product visibility of tobacco products reduced for adolescents there was growing socioeconomic disparity in the density of tobacco retailers and the visibility of tobacco storage. CONCLUSIONS: The POS ban reduced exposure to tobacco products in communities across Scotland. However, tobacco products remain widely available, and there is growing socioeconomic disparity in the availability and visibility of tobacco.

Adolescents' perceptions of tobacco accessibility and smoking norms and attitudes in response to the tobacco point-of-sale display ban in Scotland: results from the DISPLAY Study.

BACKGROUND: Scotland implemented a ban on open display of tobacco products in supermarkets in April 2013, and small shops in April 2015. This study aimed to quantify changes in perceived tobacco accessibility, smoking norms and smoking attitudes among adolescents in Scotland, following the implementation of partial and comprehensive point-of-sale (POS) tobacco display bans. METHODS: From the Determining the Impact of Smoking Point of Sale Legislation Among Youth (DISPLAY) Study's 2013-2017 annual surveys we retrieved data comprising 6202 observations on 4836 12-17-year-old adolescents from four schools. Applying generalised estimating equations, associations between time (postban: 2016-2017 vs preban:2013) and three outcomes were estimated. Outcomes were perceived commercial access to tobacco, perceived positive smoking norm (friends think it's OK to smoke) and positive smoking attitude (you think it's OK to smoke). Analyses were adjusted for sociodemographics, smoking status, family smoking, friend smoking and e-cigarette use. RESULTS: Crude trends showed an increase over time in perceived accessibility, norms and attitudes. However, after adjustment for confounders, mainly e-cigarette use, we found significant declines in perceived access (OR = 0.72, 95% CI 0.57 to 0.90) and in positive smoking attitude (OR = 0.67, 95% CI = 0.49 to 0.91), but no change in perceived positive smoking norm (OR = 1.00, 95% CI 0.78 to 1.29). Current/past occasional or regular e-cigarette use was associated with higher odds of perceived access (OR = 3.12, 95% CI 2.32 to 4.21), positive norm (OR = 2.94, 95% CI 2.16 to 4.02) and positive attitude (OR = 3.38, 95% CI 2.35 to 4.87). CONCLUSION: Only when taking into account that the use of e-cigarettes increased in 2013-2017 did we find that the POS tobacco display ban in supermarkets and small shops in Scotland was followed by reductions in adolescents' perceived accessibility of tobacco and positive attitudes towards smoking.

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.

Relationship between trying an electronic cigarette and subsequent cigarette experimentation in Scottish adolescents: a cohort study.

BACKGROUND: This study examines whether young never smokers in Scotland, UK, who have tried an e-cigarette are more likely than those who have not, to try a cigarette during the following year. METHODS: Prospective cohort survey conducted in four high schools in Scotland, UK during February/March 2015 (n=3807) with follow-up 1 year later. All pupils (age 11-18) were surveyed. Response rates were high in both years (87% in 2015) and 2680/3807 (70.4%) of the original cohort completed the follow-up survey. Analysis was restricted to baseline 'never smokers' (n=3001/3807), 2125 of whom were available to follow-up (70.8%). RESULTS: At baseline, 183 of 2125 (8.6%) never smokers had tried an e-cigarette and 1942 had not. Of the young people who had not tried an e-cigarette at baseline, 249 (12.8%) went on to try smoking a cigarette by follow-up. This compares with 74 (40.4%) of those who had tried an e-cigarette at baseline. This effect remained significant in a logistic regression model adjusted for smoking susceptibility, having friends who smoke, family members' smoking status, age, sex, family affluence score, ethnic group and school (adjusted OR 2.42 (95% CI 1.63 to 3.60)). There was a significant interaction between e-cigarette use and smoking susceptibility and between e-cigarette use and smoking within the friendship group. CONCLUSIONS: Young never smokers are more likely to experiment with cigarettes if they have tried an e-cigarette. Causality cannot be inferred, but continued close monitoring of e-cigarette use in young people is warranted.

Trends in the sexual behaviour of 15-year olds in Scotland: 2002-14.

Background: Early sexual initiation and inadequate contraceptive use can place adolescents at increased risk of unplanned pregnancy and sexually transmitted infections. These behaviours are patterned by gender and may be linked to social inequalities. This paper examines trends in sexual initiation and contraceptive use by gender and family affluence for Scottish adolescents. Methods: Cross-sectional data from four nationally representative survey cycles (2002, 2004, 2010, 2014) (n = 8895) (mean age = 15.57) were analysed. Logistic regressions examined the impact of survey year on sexual initiation, condom use and birth control pill (BCP) use at last sex; as well as any changes over time in association between family affluence and the three sexual behaviours. Analyses were stratified by gender. Results: Between 2002 and 2014, adolescent males and females became less likely to report having had sex. Low family affluence females were more likely to have had sex than high family affluence females, and this relationship did not change over time. Condom use at last sex was reported less by males since 2002, and by females since 2006. Low family affluence males and females were less likely to use condoms than high family affluence participants, and these relationships did not change over time. There were no effects of time or family affluence for BCP use. Conclusion: There has been a reduction in the proportion of 15-year olds in Scotland who have ever had sex, but also a decrease in condom use for this group. Economic inequalities persist for sexual initiation and condom use.

Relationship between e-cigarette point of sale recall and e-cigarette use in secondary school children: a cross-sectional study.

BACKGROUND: There has been a rapid increase in the retail availability of e-cigarettes in the UK and elsewhere. It is known that exposure to cigarette point-of-sale (POS) displays influences smoking behaviour and intentions in young people. However, there is as yet no evidence regarding the relationship between e-cigarette POS display exposure and e-cigarette use in young people. METHODS: This cross sectional survey was conducted in four high schools in Scotland. A response rate of 87 % and a total sample of 3808 was achieved. Analysis was by logistic regression on e-cigarette outcomes with standard errors adjusted for clustering within schools. The logistic regression models were adjusted for recall of other e-cigarette adverts, smoking status, and demographic variables. Multiple chained imputation was employed to assess the consistency of the findings across different methods of handling missing data. RESULTS: Adolescents who recalled seeing e-cigarettes in small shops were more likely to have tried an e-cigarette (OR 1.92 99 % CI 1.61 to 2.29). Adolescents who recalled seeing e-cigarettes for sale in small shops (OR 1.80 99 % CI 1.08 to 2.99) or supermarkets (OR 1.70 99 % CI 1.22 to 2.36) were more likely to intend to try them in the next 6 months. CONCLUSIONS: This study has found a cross-sectional association between self-reported recall of e-cigarette POS displays and use of, and intention to use, e-cigarettes. The magnitude of this association is comparable to that between tobacco point of sale recall and intention to use traditional cigarettes in the same sample. Further longitudinal data is required to confirm a causal relationship between e-cigarette point of sale exposure and their use and future use by young people.

Associations Between Recent Contraceptive Use and First Sex Behaviors of Scottish Adolescents: A Brief Report.

Objectives: We examined associations between recent contraceptive use and first-sex behaviors (early initiation, substance use, contraceptive use) among adolescents in Scotland. Methods: We used data from the Health Behavior in School-aged Children study. Results: Controlling for early initiation and substance use, girls and boys who used contraceptives at first sex were 7.5 and 12.3 times more likely to use contraceptives at most recent sexual intercourse than adolescents who did not (p < .001). We also present preliminary evidence on contraceptive use of Scottish adolescents in 2022. Conclusions: Experiences during adolescents' first sex may have lasting implications for later sexual behavior.

Health of the world's adolescents: a synthesis of internationally comparable data.

Adolescence and young adulthood offer opportunities for health gains both through prevention and early clinical intervention. Yet development of health information systems to support this work has been weak and so far lagged behind those for early childhood and adulthood. With falls in the number of deaths in earlier childhood in many countries and a shifting emphasis to non-communicable disease risks, injuries, and mental health, there are good reasons to assess the present sources of health information for young people. We derive indicators from the conceptual framework for the Series on adolescent health and assess the available data to describe them. We selected indicators for their public health importance and their coverage of major health outcomes in young people, health risk behaviours and states, risk and protective factors, social role transitions relevant to health, and health service inputs. We then specify definitions that maximise international comparability. Even with this optimisation of data usage, only seven of the 25 indicators, covered at least 50% of the world's adolescents. The worst adolescent health profiles are in sub-Saharan Africa, with persisting high mortality from maternal and infectious causes. Risks for non-communicable diseases are spreading rapidly, with the highest rates of tobacco use and overweight, and lowest rates of physical activity, predominantly in adolescents living in low-income and middle-income countries. Even for present global health agendas, such as HIV infection and maternal mortality, data sources are incomplete for adolescents. We propose a series of steps that include better coordination and use of data collected across countries, greater harmonisation of school-based surveys, further development of strategies for socially marginalised youth, targeted research into the validity and use of these health indicators, advocating for adolescent-health information within new global health initiatives, and a recommendation that every country produce a regular report on the health of its adolescents.

Inequalities in health complaints: 20-year trends among adolescents in Scotland, 1998-2018.

This study examined trends in inequalities in health complaints among early adolescents in Scotland from 1998 to 2018. We analysed data from the Health Behaviour in School-aged Children (HBSC) survey conducted in Scotland in 1998, 2002, 2006, 2010, 2014 and 2018. A self-report questionnaire was administered in schools to a nationally representative sample of 11-, 13-, and 15-year-olds (n = 29,250). Health complaints were measured using a scale comprising four psychological symptoms (feeling low, feeling nervous, irritability and sleep difficulties) and four somatic symptoms (headache, backache, stomachache and dizziness). Socio-economic status was measured using the Family Affluence Scale. Between 1998 and 2018, there were significant increases in the proportion of girls and boys reporting feeling low, feeling nervous, sleep difficulties and backache. Prevalence of the eight individual health complaints was higher among girls and adolescents from lower affluence families. Socio-economic inequalities increased over time, such that declines in mental health were greatest among low affluence adolescents. The data show worsening trends in health complaints among Scottish adolescents between 1998 and 2018, particularly for girls and adolescents from low affluence families. Increasing inequalities in mental health highlight the need to address the underlying social and structural determinants of adolescent mental health.

Encouraging greater empowerment for adolescents in consent procedures in social science research and policy projects.

The United Nations Convention on the Rights of the Child emphasizes the importance of allowing children and adolescents to influence decisions that are important to them following their age and maturity. This paper explores the principles, practices, and implications around using parental versus child/adolescent consent when participating in social science research and policy development. Experiences from two studies are presented: The Confronting Obesity: Co-creating policy with youth (CO-CREATE) and the Health Behaviour in School-aged Children (HBSC) study, a World Health Organization (WHO) Collaborative Cross-National study. Although parental consent may be an important gatekeeper for protecting children and adolescents from potentially harmful research participation, it may also be considered an obstacle to the empowerment of children and adolescents in case they want to share their views and experiences directly. This paper argues that evaluation of possible harm should be left to ethics committees and that, if no harm related to the research participation processes is identified and the project has a clear perspective on collaborating with the target group, adolescents from the age of 12 years should be granted the legal capacity to give consent to participate in the research project. Collaboration with adolescents in the development of the research project is encouraged.

Socioeconomic inequalities in childhood exposure to secondhand smoke before and after smoke-free legislation in three UK countries.

BACKGROUND: Secondhand smoke (SHS) exposure is higher among lower socioeconomic status (SES) children. Legislation restricting smoking in public places has been associated with reduced childhood SHS exposure and increased smoke-free homes. This paper examines socioeconomic patterning in these changes. METHODS: Repeated cross-sectional survey of 10 867 schoolchildren in 304 primary schools in Scotland, Wales and Northern Ireland. Children provided saliva for cotinine assay, completing questionnaires before and 12 months after legislation. RESULTS: SHS exposure was highest, and private smoking restrictions least frequently reported, among lower SES children. Proportions of saliva samples containing <0.1 ng/ml (i.e. undetectable) cotinine increased from 31.0 to 41.0%. Although across the whole SES spectrum, there was no evidence of displacement of smoking into the home or increased SHS exposure, socioeconomic inequality in the likelihood of samples containing detectable levels of cotinine increased. Among children from the poorest families, 96.9% of post-legislation samples contained detectable cotinine, compared with 38.2% among the most affluent. Socioeconomic gradients at higher exposure levels remained unchanged. Among children from the poorest families, one in three samples contained >3 ng/ml cotinine. Smoking restrictions in homes and cars increased, although socioeconomic patterning remained. CONCLUSIONS: Urgent action is needed to reduce inequalities in SHS exposure. Such action should include emphasis on reducing smoking in cars and homes.

Development of an algorithm to classify primary care electronic health records of alcohol consumption: experience using data linkage from UK Biobank and primary care electronic health data sources.

OBJECTIVES: Develop a novel algorithm to categorise alcohol consumption using primary care electronic health records (EHRs) and asses its reliability by comparing this classification with self-reported alcohol consumption data obtained from the UK Biobank (UKB) cohort. DESIGN: Cross-sectional study. SETTING: The UKB, a population-based cohort with participants aged between 40 and 69 years recruited across the UK between 2006 and 2010. PARTICIPANTS: UKB participants from Scotland with linked primary care data. PRIMARY AND SECONDARY OUTCOME MEASURES: Create a rule-based multiclass algorithm to classify alcohol consumption reported by Scottish UKB participants and compare it with their classification using data present in primary care EHRs based on Read Codes. We evaluated agreement metrics (simple agreement and kappa statistic). RESULTS: Among the Scottish UKB participants, 18 838 (69%) had at least one Read Code related to alcohol consumption and were used in the classification. The agreement of alcohol consumption categories between UKB and primary care data, including assessments within 5 years was 59.6%, and kappa was 0.23 (95% CI 0.21 to 0.24). Differences in classification between the two sources were statistically significant (p<0.001); More individuals were classified as 'sensible drinkers' and in lower alcohol consumption levels in primary care records compared with the UKB. Agreement improved slightly when using only numerical values (k=0.29; 95% CI 0.27 to 0.31) and decreased when using qualitative descriptors only (k=0.18;95% CI 0.16 to 0.20). CONCLUSION: Our algorithm classifies alcohol consumption recorded in Primary Care EHRs into discrete meaningful categories. These results suggest that alcohol consumption may be underestimated in primary care EHRs. Using numerical values (alcohol units) may improve classification when compared with qualitative descriptors.

The association between MPOWER tobacco control policies and adolescent smoking across 36 countries: An ecological study over time (2006-2014).

OBJECTIVE: To examine associations over time between national tobacco control policies and adolescent smoking prevalence in Europe and Canada. DESIGN: In this ecological study, national tobacco control policies (MPOWER measures, as derived from WHO data) in 36 countries and their changes over time were related to national-level adolescent smoking rates (as derived from the Health Behaviour in School-aged Children study, 2006-2014). MPOWER measures included were: Protecting people from tobacco smoke (P), offering help to quit tobacco use (O), warning about the dangers of tobacco (W), enforcing bans on advertising, promotion and sponsorship (E) and raising taxes on tobacco (R). RESULTS: Across countries, adolescent weekly smoking decreased from 17.7% in 2006 to 11.6% in 2014. It decreased most strongly between 2010 and 2014. Although baseline MPOWER policies were not directly associated with differences in average rates of adolescent smoking between countries, countries with higher baseline smoke-free policies (P) showed faster rates of change in smoking over the time period. Moreover, countries that adopted increasingly strict policies regarding warning labels (W) over time, faced stronger declines over time in adolescent weekly smoking. CONCLUSION: A decade after the introduction of the WHO MPOWER package, we observed that, in our sample of European countries and Canada, measures targeting social norms around smoking (i.e., smoke-free policies in public places and policies related to warning people about the dangers of tobacco) are most strongly related to declines in adolescent smoking.

School Satisfaction and School Pressure in the WHO European Region and North America: An Analysis of Time Trends (2002-2018) and Patterns of Co-occurrence in 32 Countries.

PURPOSE: The purpose of the study was to examine the trends between 2002 and 2018 in school pressure and school satisfaction among 15-year-old students, across countries and by gender, in the WHO European region and North America, and explore whether there are variations between countries and by gender in the co-occurrence of school pressure and school satisfaction. METHODS: Data from the 32 countries that participated in the Health Behaviour in School-aged Children study (HBSC) study between 2002 and 2018 were used. Statistical analyses included t-tests, binary logistic regression analyses, and chi-square tests, as required by each of the study aims. RESULTS: School satisfaction tended to increase over the period 2002-2018 among boys, whereas school pressure increased among girls. Also, gender differences tended to dissipate in school satisfaction and generally increase in school pressure. The co-occurrence of school satisfaction and school pressure in 2017/2018 shows that the majority of students are found in the "not pressured-not highly satisfied" and "pressured-not highly satisfied" groups. There were more boys in the former group and more girls in the latter group. CONCLUSION: Few students in the 32 countries belonged to the "not pressured-highly satisfied" group, which from a public health perspective may be seen as the most desirable group. The increases in school pressure in girls from 2002 to 2018 and their overrepresentation in the pressured groups require further attention.

Association between tobacco control policies and current smoking across different occupational groups in the EU between 2009 and 2017.

BACKGROUND: This study investigated the cross-national and longitudinal associations between national tobacco control policies and current smoking in 28 European Union (EU) member states between 2009 and 2017. It also examined the interaction between tobacco control policies and occupational status. METHODS: We used data from four waves of Eurobarometer (2009, 2012, 2014 and 2017). The total sample size was 105 231 individuals aged ≥15 years. Tobacco Control Scale (TCS) scores (range 0 to 100) for years 2005, 2007, 2012 and 2014 measured the strength of country-level tobacco control policies. Logistic multilevel regression analyses with three levels (the individual, the country-year and the country) were performed with current smoker as the dependent variable. RESULTS: Across the EU, average smoking prevalence fell from 29.4% (95% CI 28.5% to 30.2%) in 2009 to 26.3% (95% CI 25.4% to 27.1%) in 2017. We confirmed that cross-nationally, strong national tobacco control policies are significantly associated with a low probability of smoking. A one-point increase in TCS score was associated with lower odds of smoking (OR=0.990; 95% CI 0.983 to 0.998), but longitudinally (within-country) increases in TCS were not associated with current smoking (OR=0.999; 95% CI 0.994 to 1.005). Compared with those in manual occupations, the cross-national association was stronger in the upper occupational group (conditional OR for the interaction=0.985; 95% CI 0.978 to 0.992) and weaker in the economically inactive group (conditional OR for the interaction=1.009; 95% CI 1.005 to 1.013). CONCLUSION: Differences in tobacco control policies between countries were associated with the probability of smoking but the changes in TCS within countries over time were not. Differences between countries in tobacco control policies were found to be most strongly associated with the likelihood of smoking in the highest occupational groups and were found to have only a weak association with smoking among the economically inactive in this sample.

Do social support and eating family meals together play a role in promoting resilience to bullying and cyberbullying in Scottish school children?

This study investigates if cyberbullying is associated with wellbeing independently of traditional bullying and if social support and eating family meals together promotes resilience by buffering adolescents against the consequences of both types of bullying. Data for 5286 eleven, thirteen and fifteen year olds participating in the cross-sectional 2018 Scottish Health Behaviour in School-aged Children study were analysed. Adolescent self-report measures were used to assess traditional bullying, cyberbullying, classmate and teacher support and frequency of family meals together. Psychological wellbeing was assessed with the 5-item World Health Organization Wellbeing index. Analyses were conducted separately by gender with multilevel models, adjusting for sociodemographic factors. Resilience to bullying and cyberbullying was operationalised using statistical interactions. For both genders, cyberbullying and traditional bullying measures were associated with reduced wellbeing and all social support indicators were associated with increased wellbeing. In models containing both bullying measures, frequent traditional bullying victimisation was associated with a 7.2 (95% CI: 3.4-10.1) reduction in wellbeing score for boys and a 7.2 (95% CI: 4.5-10.0) reduction for girls, while cyberbullying was associated with 10.5 (95% CI: 5.8-15.1) reduction in wellbeing score for boys and 11.1 (95% CI: 6.7-15.5) reduction for girls. For both genders adjusting for classmate support explained away the relationships between traditional bullying and wellbeing, but cyberbullying was associated negatively with wellbeing independent of social support. Only one of 12 interaction tests provided any evidence of resilience. Cyberbullying was associated with a 7.8 (95% CI: 0.2-15.4) reduction in wellbeing score for girls who ate with their family every day, and 17.3 (95% CI: 10.5-24.1) reduction for girls who ate with their families less than weekly. In conclusion, cyberbullying is a strong, albeit rare, threat to adolescent wellbeing. Social support is important for wellbeing, but its ability to buffer adolescents against the consequences of bullying may be limited.

Trends in the perceived body size of adolescent males and females in Scotland, 1990-2014: changing associations with mental well-being.

OBJECTIVES: This paper explores trends in Scottish adolescents' body size perceptions and associated mental well-being outcomes. METHODS: Data were collected on Scottish 11-, 13-, and 15-year-olds by the Health Behaviour in School-aged Children study between 1990 and 2014 (n = 42,312). Logistic regression was used to examine changes in the prevalence of over- and underweight perceptions. Ordinal and linear regressions were used to examine changes in the association between body perception and mental well-being. RESULTS: Little change was observed in over- or underweight perceptions. However, relative to those perceiving their body as 'about right', those perceiving themselves as overweight reported decreasing confidence (all groups), decreasing happiness (11- and 13-year-old girls), and increasing psychological health symptoms (all girls and 15-year-old boys). Perceived underweight is associated with poor well-being, especially in males, but we present little evidence that this is a recent phenomenon. CONCLUSIONS: We present evidence suggesting that the association between body size perception and poor mental health in adolescence is changing over time. This may play a role in the recently observed worsening of mental well-being in Scottish adolescents.

Trends in bullying victimization in Scottish adolescents 1994-2014: changing associations with mental well-being.

OBJECTIVES: Bullying victimization among schoolchildren is a major public health concern. This paper aims to analyse the changing associations over two decades between bullying victimization and mental well-being in a representative Scottish schoolchildren sample. METHODS: Data were collected in six rounds of the cross-sectional Health Behaviour in School-aged Children study in Scotland, with 42,312 adolescents (aged 11, 13 and 15 years). Logistic and linear regressions were used to examine changes in the association between bullying victimization and mental well-being. RESULTS: The prevalence of bullying victimization rates in Scotland increased between 1994 and 2014 for most age-gender groups, apart from 13-year-old boys and 15-year-old girls. Over time, female victims reported less confidence and happiness and more psychological complaints than their non-bullied counterparts. This worsening effect over time was not observed in boys. CONCLUSIONS: Overall, our evidence indicates that the associations between bullying victimization and poor mental well-being strengthened overtime for bullied girls. This finding might partly explain the observed deterioration in mental health indicators among Scottish adolescent girls.