Self-harm, in-person bullying and cyberbullying in secondary school-aged children: A data linkage study in Wales.

INTRODUCTION: Although the evidence base on bullying victimization and self-harm in young people has been growing, most studies were cross-sectional, relied on self-reported non-validated measures of self-harm, and did not separate effects of in-person and cyberbullying. This study aimed to assess associations of self-harm following in-person bullying at school and cyberbullying victimization controlling for covariates. METHODS: School survey data from 11 to 16 years pupils collected in 2017 from 39 Welsh secondary schools were linked to routinely collected data. Inverse probability weighting was performed to circumvent selection bias. Survival analyses for recurrent events were conducted to evaluate relative risks (adjusted hazard ratios [AHR]) of self-harm among bullying groups within 2 years following survey completion. RESULTS: A total of 35.0% (weighted N = 6813) of pupils reported being bullied, with 18.1%, 6.4% and 10.5% being victims of in-person bullying at school only, cyberbullying only and both in-person bullying at school and cyberbullying respectively. Adjusting for covariates, effect sizes for self-harm were significant after being in-person bullied at school only (AHR = 2.2 [1.1-4.3]) and being both in-person bullied at school and cyberbullied (AHR = 2.2 [1.0-4.7]) but not being cyberbullied only (AHR = 1.2 [0.4-3.3]). Feeling lonely during recent summer holidays was also a robust predictor (AHR = 2.2 [1.2-4.0]). CONCLUSIONS: We reaffirm the role of in-person bullying victimization on self-harm. Pupils were twice as likely to self-harm following in-person bullying as their nonvictimised peers. Interventions for young people that minimize the potential impacts of bullying on self-harm should also include strategies to prevent loneliness.

School environment and adherence to school meals among Brazilian public-school adolescents

ABSTRACT Objective: To assess whether the school environment is associated with adherence to school meals among adolescent students in Brazilian public schools. Methods: Data from the 2015 National School Health Survey were analyzed. The provision of school meals was assessed according to student report and adherence through the frequency of weekly consumption, classified as adherence (≥3x/week), unsatisfactory adherence (≤2x/week), and non-adherence (none). The following characteristics of the school environment were considered: availability of a properly functioning kitchen and dining hall, cafeteria, and alternative outlets inside or outside schools, and sale of unhealthy food in the cafeteria and alternative outlets. Prevalence estimates were calculated considering the sample's complex design. Results: 86.5% of public schools offered school meals, to which 31.3% of students adhered, 37.9% had unsatisfactory adherence, and 30.8% did not adhere to school meals. Adherence to school meals was higher among schoolchildren in the Midwest Region, from non-capitals, and rural area, while less adherence was observed among students from schools with a cafeteria, an alternative food outlet, and a cafeteria selling soft drinks. Conclusions: Low adherence to school meals is associated with the school geography and food environment. These results can support the formulation of actions to improve the school environment and help the universality of participation in the School Nutrition and Food Policy.

RESUMEN Objetivo: Evaluar si el ambiente escolar está asociado con la adherencia a las comidas escolares entre los estudiantes adolescentes de las escuelas públicas brasileñas. Métodos: Se analizaron datos de la Encuesta Nacional de Salud Escolar de 2015. La provisión de comidas escolares se evaluó de acuerdo con el informe del estudiante y la adherencia a través de la frecuencia de consumo semanal, clasificada como adherencia (≥3x/semana), adherencia insatisfactoria (≤2x/semana) y no adherencia (ninguna). Las características del entorno escolar consideradas fueron: la disponibilidad de una cocina y comedor, quiosco y punto alternativo de venta de alimentos dentro o en la entrada de la escuela, y la venta de alimentos no saludables en el quiosco y en los locales alternativos. Las estimaciones de la prevalencia se calcularon considerando el complejo diseño de la muestra. Resultados: 86.5% de las escuelas públicas ofrecieron comidas escolares, a las cuales se adhirió 31.3% de los estudiantes, 37.9% tuvo adherencia insatisfactoria y 30.8% no se adhirió a las comidas escolares. La adherencia a las comidas escolares fue mayor entre los escolares de la Región Centro-Oeste, de las no capitales y del área rural, mientras que se observó una menor adherencia entre los estudiantes de las escuelas con cafetería, un punto de venta de comida alternativa y una cantina que vende refrescos. Conclusiones: La baja adherencia a las comidas escolares se asocia con variables geográficas de la escuela, así como con el entorno alimentario escolar. Por tanto, estos resultados pueden apoyar la formulación de acciones que tengan como objetivo mejorar el entorno escolar y ayudar a la universalidad de la asistencia a la Política de Nutrición y Alimentación Escolar.

Prevalence of refractive errors and visual impairment in school children in Enugu South-East Nigeria.

AIMS: To determine the prevalence of refractive errors and causes of visual impairment in school children in Enugu State, South-eastern Nigeria. METHODS: A descriptive cross-sectional, school-based survey in children aged 5-15 years from selected primary and junior secondary schools (public and private) in both urban and rural communities of Enugu State was carried out. Ocular examinations were performed on them according to the Refractive Error in School-age Children (RESC) protocol. RESULTS: A total of 1167 children were examined. The mean age (standard deviation) was 10.58 ± 3.0 years. Females were 653 (54.4%) of the study population. The uncorrected, presenting and best-corrected visual acuity of ≤20/40 (6/12) in the better eye of the children in this study were 3.6%. 3.5% and 0.4%. Among the children that had visual impairment, refractive error accounted for 33.3% of reduced vision while the overall prevalence of refractive error was 2.1%. Prevalence of myopia was 1.9% and hyperopia, 0.1%. The most prevalent astigmatism was ≤0.75 dioptre cylinder. CONCLUSION: The prevalence of refractive error in this study is low, with myopia being more common. Despite the low prevalence of refractive error, school vision screening is still important for African children as it serves as an opportunity to identify other ocular morbidities among the children.

High and moderate adherence to Mediterranean lifestyle is inversely associated with overweight, general and abdominal obesity in children and adolescents: The MediLIFE-index.

Several lifestyle factors, such as diet and exercise, have been linked to pediatric obesity. However, relatively few studies have considered them simultaneously, as a pattern. To investigate the associations between students' lifestyle and overweight, general, and abdominal obesity, an a priori Mediterranean lifestyle index (ie, MediLIFE-index) was created. We hypothesized that students' characteristics and their probability to be overweight or obese would be lower towards a better adherence to a Mediterranean lifestyle pattern. This study included 174 209 students aged 6 to 18 years from all geographical regions of Greece who participated in the 2014-2015 EYZHN study. The total range of MediLIFE-index was 0-8 (higher values indicating greater adherence to the Mediterranean lifestyle). Index values were thereafter divided into three groups according to its tertiles (a) 'non-adherent'; (b) 'moderately adherent'; and (c) "highly adherent" to the Mediterranean lifestyle. The mean ±â€¯standard deviation of the MediLIFE-index was 5.1 ±â€¯1.6. Students with higher scores had lower BMI and waist circumference (all P < .001). Those who were "highly adherent" compared to those who were "non-adherent" were associated with lower likelihood of being overweight, obese or abdominal obese, by 6% (OR 0.94, 95% CI 0.92, 0.98), 30% (OR 0.70, 95% CI 0.67, 0.75) and 20% (OR 0.80, 95% CI 0.77, 0.83), respectively. The optimal discriminating value of the index for overweight was 4.5 (78% sensitivity and 80% specificity), while for obese/abdominal obese was 3.5 (82% sensitivity and 85% specificity). A useful tool was developed in order to identify children and adolescents with increased odds of being overweight, obese, or abdominal obese based on their lifestyle.

Risk behavioral survey in the sample of Slovak adolescents.

OBJECTIVE: The study was aimed to assess risky behavioral factors in the sample of Slovak adolescents. BACKGROUND: Health-risk behavior contributes to the leading causes of morbidity and mortality among youth and adults. MATERIALS AND METHODS: The Youth and Parents Risk Factor Behavior Survey (YABS), based on bilateral US-Slovak project, is an ongoing cross-sectional school-based survey initiated in Bratislava as a model region. There were 798 questionnaires for students distributed; the response rate was 64 %. The sample involved 525 adolescents aged 15‒19 years from eight selected secondary schools in Bratislava, 38 % boys and 62 % girls. More than 90 % of fathers and mothers were employed, but some families nevertheless experienced a lack of finances (48.1 %), almost 70 % of students were from complete families. RESULTS: The study revealed a very high prevalence of risky behavioral characteristics in this pilot sample of adolescents significantly related to age, gender, type of school, completeness of the family and lower parental education.  CONCLUSION: The most important health risk behaviors were identified (tobacco, alcohol, drug consumption, violence, risky sexual behavior, inadequate sleep, physical inactivity, and excessive IT devices use). Targeted intervention proposals will be suggested in future (Tab. 5, Ref. 42).

Characteristics of the school food environment associated with hypertension and obesity in Brazilian adolescents: a multilevel analysis of the Study of Cardiovascular Risks in Adolescents (ERICA).

OBJECTIVE: To characterize the food environment in schools that participated in the Study of Cardiovascular Risks in Adolescents (ERICA) and to identify individual and contextual factors associated with hypertension and obesity. DESIGN: National school-based survey. SETTING: Blood pressure, weight and height were measured, and characteristics of the schools were obtained in interviews with the principals. For each outcome, multilevel models of mixed effects were applied by logistic regression. PARTICIPANTS: School-going adolescents aged 12-17 years. RESULTS: A total of 73 399 adolescents were evaluated. The prevalence of hypertension was 9·6 (95 % CI 9·0, 10·3) % and that of obesity was 8·4 (95 % CI 7·9, 8·9) %. Approximately 50 % of the adolescents were able to purchase food at school and in its immediate vicinity and 82 % had access to no-charge meals through Brazil's National School Feeding Program. In the adjusted analysis, hypertension was associated (OR; 95 % CI) with the consumption of meals prepared on the school premises (0·79; 0·69, 0·92), the sale of food in the school's immediate vicinity (0·67; 0·48, 0·95) and the purchase of food in the school cafeteria (1·29; 1·11, 1·49). It was observed that there were lower odds of obesity among students who were offered meals prepared on the school premises (0·68; 0·54, 0·87). CONCLUSIONS: High frequency of sales of ultra-processed foods in schools was identified. Contextual and individual characteristics in the school food environment were associated with hypertension and obesity, pointing to the need for regulation and supervision of these spaces.

Menstrual hygiene management and school absenteeism among adolescent students in Indonesia: evidence from a cross-sectional school-based survey.

OBJECTIVE: To assess the prevalence of menstrual hygiene management (MHM) knowledge and practices among adolescent schoolgirls in Indonesia, and assess factors associated with poor MHM and school absenteeism due to menstruation. METHODS: A cross-sectional survey enrolled a representative sample of urban and rural school-going girls aged 12-19 years in four provinces of Indonesia. A semi-structured, self-administered questionnaire obtained socio-demographic characteristics, knowledge, practices and attitudes related to menstruation, MHM and school absenteeism. School water, sanitation and hygiene (WASH) facilities were also assessed. Univariate weighted population prevalence was estimated and multivariable logit regression analyses applied to explore associations. RESULTS: A total of 1159 adolescent girls with a mean age of 15 years (SD = 1.8) participated. Most girls (90.8%, 95% confidence interval (95% CI) = 79.7-96.1) had reached menarche. Over half (64.1%, 95% CI = 49.9-76.2) reported poor MHM practices, and 11.1% (95% CI = 8.1-15.2) had missed one or more days of school during their most recent menstrual period. Poor MHM practices were associated with rural residence (Adjusted odds ratio (AOR) = 1.73, 95% CI = 1.13-2.64), province (various AOR), lower school grade (AOR = 1.69, 95% CI = 1.05-2.74) and low knowledge of menstruation (AOR = 3.49, 95% CI = 1.61-7.58). Absenteeism was associated with living in rural areas (AOR = 3.96, 95% CI = 3.02-5.18), province (various AOR), higher school grade (AOR = 3.02, 95% CI = 2.08-4.38), believing menstruation should be kept secret (AOR = 1.47, 95% CI = 1.03-2.11), experiencing serious menstrual pain (AOR = 1.68, 95% CI = 1.06-2.68) and showed mixed associations with school WASH facilities. CONCLUSIONS: High prevalence of poor MHM and considerable school absenteeism due to menstruation among Indonesian girls highlight the need for improved interventions that reach girls at a young age and address knowledge, shame and secrecy, acceptability of WASH infrastructure and menstrual pain management.

Prevalence and Correlates of Direct Self-Injurious Behavior among Chinese Adolescents: Findings from a Multicenter and Multistage Survey.

Direct self-injurious behavior (DSIB) has become an important focus due to its perniciousness and perplexity. Little is known about its prevalence and correlative factors in Chinese adolescents, including how data may differ according to gender. A multicenter, multistage stratified cluster random sampling was used to examine the previous 12-month prevalence of DSIB, as well as the possible correlates of demographics, risky behaviors, suicidality, and psychosocial factors associated with DSIB in a school-based sample of 11,880 students (49.5 % boys and 50.5 % girls). Approximately 30 % of the adolescents in the sample reported at least one incident of DSIB in the past 12-month period. After controlling for demographic variables, analyses of the independent relationships of DSIB with risky behaviors, suicidality, and psychosocial factors were conducted for each gender. Smoking, binge drinking, running away from home, suicide ideation, suicide plans, positive affect, and physical symptoms were identified as common factors associated with DSIB for both genders in the final model. In addition, truancy, fighting, physical inactivity, motor impulsiveness, and depressed affect were found to be related to DSIB in boys, whereas suicide attempts and somatic complaints were found to be related to DSIB in girls. Separation anxiety and social anxiety associated negatively with DSIB in boys and girls, respectively. DSIB was not found to independently relate to attention impulsiveness, non-planned impulsiveness, self-esteem, or harm avoidance in either genders. DSIB was prevalent in Chinese adolescents. Programs intended to promote physical and mental health in adolescents should take into account gender differences in DSIB-associated factors, including risky behaviors, suicidality, and psychosocial factors.

An overview on the successes, challenges and future perspective of a national school-based surveillance program: the CASPIAN study.

The Childhood and Adolescence Surveillance and PreventIon of Adult Non-communicable disease (CASPIAN) study is implemented in the Islamic Republic of Iran from 2003. The aim of this national school- based surveillance program was to provide accurate data of regular surveys of this program to be reviewing methodology, protocols, data collection and questionnaires of these surveys. Information was obtained from articles and books were published from CASPIAN studies. The CASPIAN studies were repeated every two years, with blood sampling for biochemical factors every four years. Methods and questionnaires of all surveys were similar at their core level and some optional factors added in different surveys. The results of CASPIAN studies represent the public health of Iranian children and adolescents that are useful for policy makers and based on them, intervention programs can set in national and sub-national level.