Gender-specific social and environmental correlates of active travel to school in four European countries: the HBSC Study.

Introduction: Despite the health benefits, a large proportion of girls and boys in Europe do not travel to school actively. A better understanding of the correlates associated with this behavior could guide interventions. This study examines perceived social and environmental correlates of active travel to school (ACTS) from the 2017/18 Health Behavior in School-Aged Children (HBSC) survey in four European countries, with a special emphasis on gender differences (n = 22,023). Methods: Logistic regression was conducted to analyze associations between the perceived importance of each correlate and ACTS behavior for 11-, 13-, and 15-year-old girls and boys from Germany, Czechia, Poland, and Slovakia. All models were adjusted for age, family affluence, and meeting World Health Organization recommendations for moderate-to-vigorous physical activity. Results: Rates of ACTS significantly differed between girls and boys. In Czechia, 65% of girls and boys traveled to school actively, followed by Slovakia (61.4% girls and 58.4% boys), Poland (57.7% girls and 60.2% boys), and Germany (42.6% girls and 48.6% boys). Girls were less likely to actively travel to school compared to boys (odds ratio [OR]: 0.92, 95% confidence interval [CI]: 0.87-0.97). Increasing age (OR: 0.95, 95% CI: 0.93-0.97) and a greater distance to school index (OR: 0.89, 95% CI: 0.88-0.90) were both negatively associated with ACTS. The perceived importance of living closer to school and of road and neighborhood safety was positively associated with ACTS, with a stronger association in boys than in girls for neighborhood safety. On the contrary, the perceived importance of having people to walk with was negatively associated with ACTS, with a stronger association in girls (OR: 0.74, 95% CI: 0.65-0.84) than in boys (OR: 0.77, 95% CI: 0.66-0.88). Discussion: This study provides insights into perceived social and environmental correlates associated with ACTS behavior. Future research should include gender-specific perceptions and more in-depth investigations of correlates encouraging ACTS, especially considering social aspects, safety issues, and the structuring of the environment in different cultural settings.

The Correlation between Adolescent Daily Breakfast Consumption and Socio-Demographic: Trends in 23 European Countries Participating in the Health Behaviour in School-Aged Children Study (2002-2018).

Breakfast is often considered the most important meal of the day and can benefit adolescent health in several ways. The aims of the present study were (1) to identify adolescents' socio-demographic (sex, family affluence and family structure) determinants of daily breakfast consumption (DBC) and (2) to describe trends in DBC among adolescents across 23 countries. Cross-sectional surveys of nationally representative samples of adolescents (aged 11, 13, and 15 years) (n = 589,737) participating in the Health Behaviour in School-aged Children (HBSC) survey from 2002 to 2018 were used. Multilevel logistic regression analyses modeled DBC over time, adjusted for family affluence, family structure and year of survey. Four countries showed an increased trend in DBC (the Netherlands, Macedonia, Slovenia, and England). A significant decrease in DBC was observed in 15 countries (Belgium-Fr, France, Germany, Croatia, Portugal, Spain, Hungary, Poland, Russian Federation, Ukraine, Denmark, Finland, Latvia, Lithuania and Sweden). In 4 countries no significant change was observed (Czech Republic, Scotland, Ireland and Norway). In most of the countries (n = 19), DBC was higher among the adolescents from high-affluence homes. In all the countries analysed, the adolescents living in two-parent households report higher DBC use than those in single-parent households. More than half of the countries showed a decrease in DBC. There is a need to implement key interventions by developing different strategies (education, incorporating educational curriculum and counselling programmes) to increase DBC. Comparing DBC patterns across HBSC countries is important for understanding regional and global trends, monitoring strategies, and developing health promotion programmes.

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

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

Sixteen-year trends in adolescent consumption of sugar-sweetened soda in six European countries with a soda tax and comparison countries: a repeated cross-sectional survey analysis.

OBJECTIVE: To examine changes in the proportions of daily, weekly and occasional consumers of sugar-sweetened soda in six European countries that introduced/updated a tax between 2001-2002 and 2017-2018 and in neighbouring comparison countries (without a tax). DESIGN: Repeated cross-sectional surveys. SETTING: Health Behaviour in School-aged Children study, spanning five survey years (school years 2001-2002 to 2017-2018). PARTICIPANTS: Nationally representative samples of 13-year- and 15-year-old adolescents (n 236 623, 51·0 % girls). RESULTS: Tax sizes (€0·02/l to €0·22/l) and pre-tax soda consumption were heterogeneous across countries. Prevalence of daily soda consumption reduced in the survey year following tax implementation in Latvia (from 17·9 to 11·9 %, P = 0·01), Finland (4·2 to 2·5 %, P = 0·001), Belgium (35·1 to 27·8 %, P < 0·001) and Portugal (17·4 to 14·9 %, P = 0·02), but not in Hungary (29·8 to 31·3 %, P = 0·47) or France (29·4 to 28·2 %, P = 0·27). However, reductions were similar (Finland) or smaller (Belgium, Portugal) than those in the comparison countries, except in Latvia where the reduction was larger (Pinteraction < 0·001). Prevalence of weekly soda consumption remained stable (Finland, Hungary and France) or increased (Latvia, Belgium); only Portugal experienced a decline (P < 0·001), which was larger than in the comparison country (Pinteraction < 0·001). Prevalence of occasional soda consumption (<1x/week) did not rise after implementation of the tax in Latvia, Finland, Hungary, France or Belgium, or the rise was similar to the comparison country in Portugal (Pinteraction = 0·15). CONCLUSIONS: Countries with a soda tax did not experience larger beneficial changes in post-tax adolescent consumption frequency of soda than comparison countries. Further studies, with different taxation types, are needed in the adolescent population.

Cross-national variation in the association between family structure and overweight and obesity: Findings from the Health Behaviour in School-aged children (HBSC) study.

Background: Trends of increased complexity in family structure have developed alongside increasing prevalence of overweight and obesity. This study examines cross-national variations in the likelihood of living with overweight and obesity among adolescents living with one parent versus two parents, as well as the influence of living with stepparents, grandparents and siblings. Furthermore, the study explores how these associations relate to age, gender and individual-level socioeconomic status (SES) and country-level SES. We hypothesised that adolescents living in one-parent versus two-parents families, were more likely to live with overweight and obesity. Methods: The study is based on nationally representative data from 41 countries participating in the 2013/14 Health Behaviors in School-Aged Children study (n = 211.798). Multilevel logistic regression analysis was used to examine the associations between family structure and overweight and obesity by age, gender, SES, and geographic region, among adolescents aged 11, 13 and 15 years. Results: Living with one versus two parent(s) was associated with a higher likelihood of overweight and obesity (ORadj.1.13, 95%CI 1.08,1.17). Age, gender, individual-level SES, and living with grandparents were also associated with a higher likelihood of overweight and obesity, whereas living with siblings was associated with a lower likelihood of overweight and obesity. The effect of family structure varied also by age and gender with no significant associations found between living with one parent and overweight and obesity in the 15-year-old age group. Some cross-national variation was observed, and this was partly explained by country-level SES. The effect of family structure increased by a factor 1.08 per one-unit change in country-level SES (OR 1.08, 95%CI1.03, 1.12). Conclusion: The study indicates that living in a one-parent family, as well as living together with grandparents, are associated with overweight and obesity among adolescents, particularly in the Nordic European region. Existing welfare policies may be insufficient to eliminate inequalities related to family structure differences.

Weight Status and Mental Well-Being Among Adolescents: The Mediating Role of Self-Perceived Body Weight. A Cross-National Survey.

PURPOSE: Overweight and obesity are associated with poor mental health in adolescents. However, little is known about whether the influence of overweight and obesity on mental well-being is mediated by self-perceived body weight. Exploring the mechanisms underlying the relationships between obesity and mental well-being is of interest to policy makers and others working in the field of adolescent health. METHODS: This study was based on nationally representative data from adolescents (age 15 years) who participated in the 2017/2018 Health Behaviour in School-aged Children study (47 countries, N = 76,998). Mixed regression models that included gender and socioeconomic status as covariates were used to identify associations between weight status and mental well-being (life satisfaction and subjective health complaints) and to explore whether self-perceived body weight (feeling too thin or too fat) has a mediating effect. Associations between weight status, self-perceived weight, and mental well-being were further assessed country by country. RESULTS: Self-perceived body weight mediated the observed associations between overweight or obesity and mental well-being. Perceiving one's body weight as "too thin" or "too fat" was associated with poorer mental well-being, regardless of weight status. Self-perceived body weight varied by gender, socioeconomic status, and country. DISCUSSION: Self-perceived body weight may explain, to a greater extent than body mass index, variation in mental well-being among adolescents. These results are important to policy makers, clinicians, and others targeting adolescent health.

What factors do young people define as determinants of their well-being? findings from the improve the youth project.

BACKGROUND: The UN has recognised well-being as a main goal of The Global Strategy for Women's, Children's and Adolescents' Health (2016-2030). OBJECTIVE: The aim was to identify the areas of mental health that are the most significant to teenagers. MATERIAL AND METHODS: The mixed-method approach was applied. Quantitative research included adolescents aged 11-15 years (6,026 in Portugal; 4,545 in Poland). HBSC study results (2013/2014) were analysed in terms of the following variables: self-rated health, life satisfaction (Cantril Ladder, KIDSCREEN-10 Index), and psychosomatic complaints (SCL scale). Focus workshops took place in 2018, with 72 teenagers aged 14 to 16. RESULTS: 16.6% of the Polish participants and 12.7% of the Portuguese participants were concerned about their health. Polish participants were less satisfied with their life [KIDSCREEN score: 25.48 for Poland (SD=6.39), and 29.96 (SD=6.03) for Portugal]. Both nations associated mental health (MH) with the family setting and relationships with friends. An additional association among Portuguese teenagers involved social issues, whereas Polish adolescents were more focussed on relationships with various people in their environment, as well as on experiencing issues at school and in the family. CONCLUSIONS: Adolescent MH is determined by stress, environmental pressure and high expectations. The viewpoints of adolescents are the most valuable source of knowledge for specialists, researchers and youth institutions, who can benefit greatly from taking advantage of this resource.

Translation, cultural adaptation and validation of the basic psychological needs satisfaction in active commuting to and from school (BPNS-ACS) scale in Polish students.

BACKGROUND: To promote active commuting to and from school, it is pertinent to understand the motivational factors that influence the choice of this form of transportation. OBJECTIVE: Translation, cultural adaptation and analysis of the factor structure as well as psychometric properties of the Basic Psychological Needs and Satisfaction in Active Commuting to and from School (BPNS-ACS) scale among Polish students and examination of the distribution of the scale scores according to gender, mode of commuting to and from school and the frequency of using bicycle for this purpose. MATERIAL AND METHODS: Data from 475 Polish students aged 11-18, including 53.9% of girls were analysed. The Confirmatory Factor Analysis of the Polish version of the BPNS-ACS, U Mann-Whitney and Kruskal Wallis H tests were performed. RESULTS: The BPNS-ACS consists of 12 items forming three dimensions: autonomy, competence and relatedness need satisfaction. The scale has acceptable psychometric properties: χ2(51)=195.424 (p ˂ 0.001); χ2/df=3.832; CFI=0.944, TLI=0.927, RMSEA=0.077 (90%CI 0.066-0.089), AIC=249.424, BIC=361.833, GFI=0.937, AGFI=0.904. BPNC-ACS scores on factors corresponding to the three basic psychological needs differ based on gender, mode of commuting to and from school and the frequency of cycling to or from school. CONCLUSIONS: Further exploration of the function of basic psychological needs in active commuting to and from school among Polish adolescents may be conducted using an adapted version of the BPNS-ACS scale.

Long-term trends in the consumption of sugary and diet soft drinks among adolescents: a cross-national survey in 21 European countries.

PURPOSE: To assess country-level trends in the prevalence of daily consumption of sugary (2002-2018) and diet (2006-2018) soft drinks among European adolescents, overall and by family material affluence. METHODS: We used 2002, 2006, 2010, 2014 and 2018 data from the 'Health Behaviour in School-aged Children' survey. Nationally representative samples of adolescents completed a standardised questionnaire at school, including a short food frequency questionnaire (n = 530,976 and 21 countries for sugary soft drinks; n = 61,487 and 4 countries for diet soft drinks). We classified adolescents into three socioeconomic categories for each country and survey year, using the Family Affluence Scale. Multilevel logistic models estimated time trends, by country. RESULTS: Sugary soft drinks: the prevalence of daily consumption (≥ 1×/day) declined in 21/21 countries (Plinear trends ≤ 0.002). Absolute [range - 31.7 to - 3.4% points] and relative [range - 84.8 to - 22.3%] reductions varied considerably across countries, with the largest declines in Ireland, England and Norway. In 3/21 countries, the prevalence of daily consumption decreased more strongly in the most affluent adolescents than in the least affluent ones (P ≤ 0.002). Daily consumption was more prevalent among the least affluent adolescents in 11/21 countries in 2018 (P ≤ 0.002). Diet soft drinks: overall, daily consumption decreased over time in 4/4 countries (Plinear trends ≤ 0.002), more largely among the most affluent adolescents in 1/4 country (P ≤ 0.002). CONCLUSIONS: Daily consumption of sugary and diet soft drinks in European adolescents decreased between 2002 (2006 for diet drinks) and 2018. Public health interventions should continue discouraging daily soft drink consumption, particularly among adolescents from lower socioeconomic groups.

Psychosocial Predictors of Body Weight Congruence in Adolescents Aged 15 and 17 Years in Poland: Findings from the Health Behaviour in School-Aged Children (HBSC) Study.

BACKGROUND: Body weight congruence (BWC) has implications for adolescent health. The main goal of this study was to examine the distribution of BWC and its relationship with six psychosocial factors. METHODS: A representative sample of N = 3508 adolescents aged 15 and 17 years (52.4% girls) derived from the Health Behaviour in School-aged Children study, conducted in 2017/2018 in Poland, was used. BWC groups were defined based on self-reported BMI and subjective assessment of weight: (1) correct perception; (2) overestimation, and (3). underestimation. Principal component analysis (PCA) extracted the following two factors: a socio-relational factor (SR) related to perceived social support and social self-efficacy, and a body attitudes and social media exposure factor (BAME). Using the total sample, multinomial logistic regression was applied to estimate their impact on the BWC, and gender-specific models were compared. RESULTS: Half (48.6%) of the adolescents correctly estimated their body weight, 31.0% overestimated it (girls 43.9%, boys 17.1%), and 20.0% underestimated it (boys 37.2%, girls 9.0%). Overestimation of body weight concerns 48.0% of normal weight girls, 50.0% of underweight girls, and 21.3% and 32.1% of normal weight and underweight boys, respectively. The percentage of normal weight (34.4%), and overweight and obese (30.8%) boys who underestimated their body weight was three times higher than the respective percentages of girls that underestimated their weight (9.0% and 11.9%). The SR factor protected adolescents from both underestimation (only in girls) and overestimation in the total sample (OR 0.74, 95%CI 0.68-0.81) and both genders. BAME increased this risk of overestimation in both genders (OR = 1.83, 95%CI 1.67-2.0), and the risk of underestimation among boys. CONCLUSIONS: Prevention programmes should include a wide range of psychosocial factors to improve BWC among adolescents.

Adaptation of the Behavioural Regulation in Active Commuting to School (BR-ACS) Questionnaire in Portuguese Youth.

This study aimed to translate and adapt the psychometric properties of the Behavioural Regulation in Active Commuting to School (BR-ACS) questionnaire to young Portuguese students. This study had two stages: (1) translation and adaptation of the questionnaire; (2) evaluation of the psychometric properties. A sample of 338 participants (212 female, 126 male) aged 11 to 19 years (Mage = 15.6 ± 2.1) from 31 cities and Madeira island participated in this study. The confirmatory factor analysis suggested an acceptable fit to the data for the first-order and third-order measurement models. The composite reliability values ranged from 0.71 (identified regulation) to 0.90 (integrated regulation), demonstrating internal consistency. The AVE values ranged from 0.40 (amotivation) to 0.69 (integrated regulation), demonstrating an acceptable convergent validity for all constructs. The model estimation had an acceptable fit, with values akin to those of the first-order tested model. Finally, the results of the multigroup analysis for the successive restricted models (CFI < 0.010 and RMSEA < 0.015) point out that the null hypothesis of factor invariance between gender cannot be rejected. The psychometric properties demonstrates the suitability of this questionnaire among Portuguese youths aged 11 to 19. This questionnaire will help understand the motivation aspects that underpin active commuting to school and consequently help to increase physical activity among Portuguese adolescents.

Everyday challenges faced by Polish teenagers during the COVID-19 pandemic in the context of selected demographic factors.

BACKGROUND: The enforced restrictions, including physical isolation and school lockdowns after the outbreak of the COVID-19 pandemic, have brought about anxiety and uncertainty the younger generation. OBJECTIVE: The main objective is to analyse the everyday challenges faced by adolescents in Poland during the time of social isolation in the COVID-19 pandemic. MATERIAL AND METHODS: A nationwide, online survey of adolescents aged 11-18 (N=2408) was conducted in April 2020. Quantitative and qualitative analyses were undertaken. Differences in the everyday challenges experienced during the COVID-19 pandemic connected with gender, age and place of residence were analysed. RESULTS: Girls were significantly more likely than boys to perceive the limitations in contacts with others (friends and family) and the concerns about the health of relatives as a big difficulty. Among the youngest students (11-12 years of age), the lack of contact with friends and family and worries about their health and the fear of infection ranked higher than for other students. For the oldest (17-18) the lack of private time and space and not being able to meet one's boyfriend/ girlfriend were the most troublesome. The necessity to stay at home and the inconvenience resulting from the lack of outdoor exercise were ranked higher by urban students than by students living in rural areas. CONCLUSIONS: When planning campaigns in the near future to support the mental health of adolescents in the context of the pandemic it is recommended to include especially the youngest adolescents and those living in small and medium-sized cities.

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

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

Translation and Validation of the Basic Psychological Need Satisfaction in Active Commuting to and from School (BPNS-ACS) Scale in Young Portuguese Students.

Active commuting to and from school (ACS) is a strategy to enhance physical activity levels in youths. To promote ACS, it is important to understand the factors that lead to this behaviour. With this in mind, an adaptation of the Basic Psychological Needs in Exercise Scale for ACS was developed, named the Basic Psychological Need Satisfaction in Active Commuting to and from School (BPNS-ACS) scale. This study aimed to translate and evaluate the psychometric properties of the BPNS-ACS scale in young Portuguese students. A cross-sectional study was designed. A total of 338 students (212 girls, 126 boys), aged between 11 and 19 years old from 31 Portuguese cities participated in this study. To provide validity evidence based on the questionnaire's internal structure, confirmatory factor analyses were performed to test the three dimensions of the BNPS-ACS scale. The results of the confirmatory factor analysis indicated an acceptable fit to the data. The internal consistency of the measures was accepted as the composite reliability values ranged from 0.78 to 0.94. The evaluation of psychometric properties provided evidence of the adequacy of this questionnaire among Portuguese youth aged 11 to 19 years old.

Time trends in consumption of sugar-sweetened beverages and related socioeconomic differences among adolescents in Eastern Europe: signs of a nutrition transition?

BACKGROUND: High intake of sugar-sweetened beverages (SSBs) contributes to detrimental cardio-metabolic indicators in youth. Monitoring of SSB consumption is lacking in Eastern Europe. OBJECTIVES: We assessed trends in the prevalence of adolescent daily consumption of SSBs in 14 Eastern European countries between 2002 and 2018, both overall and according to family material affluence. METHODS: We used 2002, 2006, 2010, 2014, and 2018 data of the Health Behaviour in School-Aged Children school-based study (repeated cross-sectional). Nationally representative samples of adolescents aged 11, 13, and 15 years were included (n = 325,184; 51.2% girls). Adolescents completed a standardized questionnaire, including a question on SSB consumption frequency. We categorized adolescents into 3 socioeconomic groups based on the relative Family Affluence Scale (FAS). Adjusted prevalences of daily SSB consumption by survey year, as well as country-level time trends between 2002 and 2018, were computed using multilevel logistic models (overall and by FAS groups). RESULTS: In 2018, the prevalence of adolescents consuming SSBs every day varied considerably between countries (range, 5.1%-28.1%). Between 2002 and 2018, the prevalence of daily SSB consumption declined in 10/14 countries (P for linear trends ≤ 0.004). The largest reductions were observed in Slovenia (OR, 0.48; 95% CI: 0.45-0.50) and the Russian Federation (OR, 0.67; 95% CI: 0.64-0.70). Daily SSB consumption was reduced at faster rates among the most affluent adolescents (who were larger consumers in 2002) than in the least affluent adolescents in 11/14 countries (P for linear trends ≤ 0.004). Thus, differences between FAS groups narrowed over time or even reversed, leading to larger proportions of daily consumers in the least affluent adolescents in 2018 in 5/14 countries (P ≤ 0.05). CONCLUSIONS: Adolescent daily consumption of SSBs decreased between 2002 and 2018 in most Eastern European countries. Declines were larger among higher-affluence adolescents. These results are useful to evaluate and plan interventions promoting healthy childhood diets.

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.

Making the best out of youth-The Improve the Youth project.

Adolescents' mental health determines their general health and their mental health as adults. Improve the Youth project (ITY) was created and implemented among Polish and Portuguese adolescents. The aim of the project was to investigate the well-being of Portuguese and Polish adolescents, and to evaluate differences between them in self-rated health, life satisfaction and perceived psychosomatic health. A mixed-method approach was applied. The quantitative part was based on Health Behaviour in School-aged Children (HBSC) 2014 data, including adolescents aged 11-15 years (6026 in Portugal; 4545 in Poland). This study meets the issues raised by the HBSC results, regarding mental health in adolescence, and it is aimed to improve adolescents' social participation and active citizenship. In most study areas, findings in Poland were less favourable than in Portugal. The qualitative part was developed to recognize the main threats for adolescent's well-being. In this, they emphasised that every opportunity to talk about their feelings and needs resulted in improvement of their mental health. Elevated levels of stress were connected to environmental pressure and high expectations that they were often unable to cope with. Nervousness, perceiving that it was impossible to meet expectations, the desire to keep up with their peers, fatigue, and uncertainty of the future increased the feelings of frustration. The differences found between countries may be due to cultural roots, surfacing the relevance of assessing adolescents' mental health needs in the social context of family, school and peers. This study also aims to raise awareness among educators and stakeholders to the importance of youth engagement.

Active Transport to School May Reduce Psychosomatic Symptoms in School-Aged Children: Data from Nine Countries.

It is widely proven that being physically active and avoiding sedentary behaviour help to improve adolescents' well-being and keep them in better health in general. We aimed to investigate the relationship between modes of transport to school and subjective complaints among schoolchildren. Analyses were based on the HBSC (Health Behaviour in School-aged Children) surveys conducted in 2017/18 in nine countries (N = 55,607; mean age 13.43 ± 1.64 yrs.). The main outcome showed that health complaints consisted of somatic and psychological complaints. Transport to school was characterized by mode of getting there (walking, biking, or another passive mode). A total of 46.1% of students walked and 7.3% cycled to school; 46.6% commuted by passive means. Biking to school was more frequent in Denmark (37.9%), Norway (26.5%), and Germany (26.6%). The multivariate generalized linear model adjusted for age, gender, country, and school proximity showed that biking to school is protective against reports of health complaints. The beta parameters were equal to -0.498 (p < 0.001) for the general HBSC-SCL index, -0.208 (p < 0.001) for the somatic complaint index, and -0.285 (p < 0.001) for the psychological complaints index. Young people who actively commute to school are less likely to report health complaints, especially psychological symptoms.

Childhood Obesity Surveillance Initiative (COSI) in Poland: Implementation of Two Rounds of the Study in the Context of International Methodological Assumptions.

Nowadays, childhood obesity is one of the key health problems in European countries. This article presents a study that is part of the World Health Organization (WHO) Childhood Obesity Surveillance Initiative (COSI) implemented in the WHO European Region since 2007. The main goal of the study is to monitor obesity in early school-aged children. The methodology of the study, the thematic scope of research tools, the organisational principles and the development of research carried out in Poland in the context of existing international assumptions are presented. In Poland, two rounds of the study were financed by the National Health Program, in cooperation with the WHO Office in Poland. The first study was carried out from November to December 2016 on a group of 3,408 children aged 8 years from 135 schools and 2,298 parents, in 9 voivodeships in Poland. The second round was carried out in the last quarter of 2018 in 12 voivodeships. A group of 2691 pupils aged 8 years from the 2nd grade of 140 primary schools in Poland and 2450 parents were examined. Data on body mass index distribution and lifestyle-related behaviours of children and their families were collected. Poland is the first country where blood pressure was measured in all participants of the COSI study. Considering the growing obesity epidemic, reliable monitoring of overweight and obesity in early childhood and the study of determinants of this phenomenon should be a priority for public health. The results obtained from this type of research are a reference point for the design and implementation of accurate prevention initiatives in this age group.

Importance of Self-Efficacy in Eating Behavior and Physical Activity Change of Overweight and Non-Overweight Adolescent Girls Participating in Healthy Me: A Lifestyle Intervention with Mobile Technology.

Very little is known about how multicomponent interventions directed to entire populations work in selected groups of adolescents. The aim was to evaluate the effectiveness of the Healthy Me one-year program on changes in healthy eating and physical activity among overweight and non-overweight female students. Randomization involved the allocation of full, partial or null intervention. The randomized field trial was implemented in 48 secondary schools (clusters) all over Poland among 1198 15-year-old girls. In this study, a sample of N = 1111 girls who participated in each evaluation study was analyzed. Using multimedia technologies, efforts were made to improve health behaviors and increase self-efficacy. The main outcome was a health behavior index (HBI), built on the basis of six nutritional indicators and one related to physical activity. HBI was analyzed before and immediately after intervention and at three months' follow-up, and the HBI change was modeled. Statistical analysis included nonparametric tests and generalized linear models with two-way interactions. Comparing the first and third surveys, in the overweight girls, the HBI index improved by 0.348 (SD = 3.17), while in the non-overweight girls it had worsened. After adjusting for other factors, a significant interaction between body weight status and level of self-efficacy as predictors of HBI changes was confirmed. The program turned out to be more beneficial for overweight girls.