Conducting national burden of disease studies and knowledge translation in eight small European states: challenges and opportunities.

BACKGROUND: Several countries across Europe are engaging in burden of disease (BoD) studies. This article aims to understand the experiences of eight small European states in relation to their research opportunities and challenges in conducting national BoD studies and in knowledge translation of research outputs to policy-making. METHODS: Countries participating in the study were those outlined by the WHO/Europe Small Countries Initiative and members of the Cooperation in Science and Technology (COST) Action CA18218 European Burden of Disease Network. A set of key questions targeting the research landscape were distributed to these members. WHO's framework approach for research development capacities was applied to gain a comprehensive understanding of shortages in relation to national BoD studies in order to help strengthen health research capacities in the small states of Europe. RESULTS: Most small states lack the resources and expertise to conduct BoD studies, but nationally representative data are relatively accessible. Public health officials and researchers tend to have a close-knit relationship with the governing body and policy-makers. The major challenge faced by small states is in knowledge generation and transfer rather than knowledge translation. Nevertheless, some policy-makers fail to make adequate use of knowledge translation. CONCLUSIONS: Small states, if equipped with adequate resources, may have the capacity to conduct national BoD studies. This work can serve as a model for identifying current gaps and opportunities in each of the eight small European countries, as well as a guide for translating country BoD study results into health policy.

Adolescent caffeine consumption and aggressive behavior: A longitudinal assessment.

Background: Adolescent caffeine consumption has been linked to aggressive behaviors, although no longitudinal tests have been reported to date. The purpose of this study was to test the longitudinal relations between daily adolescent caffeine consumption and aggressive behaviors. Methods: Two waves of survey data collected 12 months apart in the spring of 2018 and 2019, from the 2004 birth cohort in the Icelandic LIFECOURSE study, were analyzed using structural equation modeling (N = 2,278). Both direct and mediated models were employed. Results: Caffeine use at time 1 (T1) was associated with aggressive behavior at time 2 (T2) (ß = .12, p < .001) independent of aggressive behavior at T1. A considerable added relation was observed between caffeine at T1 and aggressive behavior at T2 via indirect (i.e., mediated) effects of aggressive behavior at T1 (standardized ß = .20, p < .001). Over 64% of the standardized total effect (ß = .31) observed between caffeine at T1 and aggressive behavior at T2 was due to mediation. Conclusion: Adolescent caffeine consumption forecasts aggressive behaviors. Caffeine use at T1 increased the likelihood of self-reported aggressive behaviors 12 months later irrespective of level of reported aggressive behavior at T1 while controlling for common confounders.

Decreasing income inequality and adolescent emotional distress: a population-based case study of Icelandic adolescents 2006-2016.

OBJECTIVES: In this study, we aim to test whether changes in community income inequality influence adolescent emotional distress. We take advantage of the unique combination of data and history available in Iceland. This affluent welfare society has experienced extreme shifts in income inequality, allowing us to test whether changes in community income inequality are related to changes in adolescent emotional distress. METHODS: Combining adolescent survey data (n = 24,107) with tax registry data on 76 neighborhood communities, we used a multilevel approach to model the data as longitudinal in order to test whether changes in community income inequality are related to changes in symptoms of anxiety and depression among adolescents. RESULTS: The results showed that, after adjusting for relevant individual and community covariates, decreases in community income inequality were associated with decreases in symptoms of anxiety among adolescents (b = - 0.367, p ≤ 0.001), but not with decreases in symptoms of depression. CONCLUSIONS: While the results provide a partial support for the income inequality thesis, we call for replications from other cultures and studies exploring the mediating role of social psychological processes.

Impact of a physical activity intervention on adolescents' subjective sleep quality: a pilot study.

BACKGROUND: The aim of this pilot study was to examine the impact of a brief physical activity intervention on adolescents' subjective sleep quality. Cross-sectional studies indicate that physically active adolescents have better subjective sleep quality than those with more sedentary habits. However, less is known about the effectiveness of physical activity interventions in improving adolescents' subjective sleep quality. METHODS: In a three-week physical activity intervention, four Icelandic upper secondary schools were randomized to either an intervention group with pedometers and step diaries or a control group without pedometers and diaries. Out of 84, a total of 53 students, aged 15-16 years, provided complete data or a minimum of two days step data (out of three possible) as well as sleep quality measures at baseline and follow-up. Subjective sleep quality, the primary outcome in this study, was assessed with four individual items: sleep onset latency, nightly awakenings, general sleep quality, and sleep sufficiency. Daily steps were assessed with Yamax CW-701 pedometers. RESULTS: The intervention group ( n = 26) had significantly higher average step-count ( p = 0.03, partial η2 = 0.093) compared to the control group ( n = 27) at follow-up. Subjective sleep quality improved ( p = 0.02, partial η2 = 0.203) over time in the intervention group but not in the control group. CONCLUSIONS: Brief physical activity interventions based on pedometers and step diaries may be effective in improving adolescents' subjective sleep quality. This has important public health relevance as the intervention can easily be disseminated and incorporated into school curricula.

Cumulative risk over the early life course and its relation to academic achievement in childhood and early adolescence.

Early-life risk factors, such as family disruption, maltreatment, and poverty, can negatively impact children's scholastic abilities; however, most previous studies have relied on cross-sectional designs and retrospective measurement. This study investigated the relation between cumulative risk factors during the early life course and subsequent academic achievement in a cohort of children and adolescents. Data for this study were based on registry-data material from the LIFECOURSE study of 1151 children from the 2000 birth cohort in Reykjavik, Iceland, assembled in 2014-2016. Multiple lifetime risk factors, including maternal smoking during pregnancy, parent's disability status, being born to a young mother, number of children in the household, family income, number of visits to school nurses, and reports of maltreatment, were assessed. Latent class analysis and Analysis of Covariance (ANCOVA) were used to predict academic achievement in the 4th and 7th grades. Individuals with no risk factors reported the highest average academic achievement in the 4th (M=66 points, SD=17) and 7th grades (M=67 points, SD=15). There was a significant main effect for 4th-grade risk factors and academic achievement (F [7, 1146]=12.06, p<0.001) and a similar relationship between the risk factor profile and achievement scores in 7th grade (F [7, 1146]=15.08, p<0.001). Each additional risk factor was associated with a drop in academic achievement at both grade levels. We conclude that academic achievement declines in proportion to the number of risk factors in early life.

Neighborhood income inequality, social capital and emotional distress among adolescents: A population-based study.

Theory holds that income inequality may harm adolescent mental health by reducing social capital within neighborhood communities. However, research on this topic has been very limited. We use multilevel data on 102 public schools and 5958 adolescents in Iceland (15 and 16 years old) to examine whether income inequality within neighborhoods is associated with emotional distress in adolescents. Moreover, we test whether indicators of social capital, including social trust and embeddedness in neighborhood social networks, mediate this contextual effect. The findings show that neighborhood income inequality positively influences emotional distress of individual adolescents, net of their personal household situations and social relations. However, although the indicators of social capital negatively influence emotional distress, they do not mediate the contextual effect of neighborhood income inequality. The study illustrates the role of economic disparities in adolescent mental health, but calls for more research on the underlying social and social-psychological mechanisms.

Gender differences in co-occurrence of depressive and anger symptoms among adolescents in five Nordic countries.

AIMS: The aim of this study was to carry out a comparative examination on gender differences in depressive and anger symptoms and their co-occurrence, using comparative self-report survey data from 16-19-year-old students in five Nordic countries. METHODS: In total, 8038 adolescents participated in the study, 4183 females (52%) and 3855 males (48%) with an average age of 17.1 years. Analysis of Covariance (ANCOVA) was used to test for gender differences in symptoms for the sample as a whole and also for each country. Furthermore, partial bivariate correlation was carried out and followed up by ANCOVA to test for gender differences in the co-occurrence of depressive and anger symptoms in the five countries. RESULTS: The results indicated that, on average, adolescent females reported higher levels of depressive symptoms than males in all the countries under study and higher levels of anger symptoms in four out of five countries. The relationship between depressive and anger symptoms turned out to be stronger for females than males for all the countries under study, demonstrating higher co-occurrence of depressive and anger symptoms on average among females than males. CONCLUSIONS: The findings underline the need for attending to both depressive and anger symptoms among adolescents when designing mental health interventions and treatments as co-occurrence of both types of symptoms is common, particularly among females.

Adolescent substance use and peer use: a multilevel analysis of cross-sectional population data.

BACKGROUND: Limited evidence exists concerning the importance of social contexts in adolescent substance use prevention. In addition to the important role schools play in educating young people, they are important ecological platforms for adolescent health, development and behaviors. In this light, school community contexts represent an important, but largely neglected, area of research in adolescent substance use and prevention, particularly with regard to peer influences. This study sought to add to a growing body of literature into peer contexts by testing a model of peer substance use simultaneously on individual and school community levels while taking account of several well established individual level factors. METHOD: We analyzed population-based data from the 2009 Youth in Iceland school survey, with 7,084 participants (response rate of 83.5%) nested within 140 schools across Iceland. Multilevel logistic regression models were used to analyze the data. RESULTS: School-level peer smoking and drunkenness were positively related to adolescent daily smoking and lifetime drunkenness after taking account of individual level peer smoking and drunkenness. These relationships held true for all respondents, irrespective of socio-economic status and other background variables, time spent with parents, academic performance, self-assessed peer respect for smoking and alcohol use, or if they have substance-using friends or not. On the other hand, the same relationships were not found with regard to individual and peer cannabis use. CONCLUSIONS: The school-level findings in this study represent context effects that are over and above individual-level associations. This holds although we accounted for a large number of individual level variables that studies generally have not included. For the purpose of prevention, school communities should be targeted as a whole in substance use prevention programs in addition to reaching to individuals of particular concern.

Data collection procedures for school-based surveys among adolescents: the Youth in Europe Study.

BACKGROUND: Collection of valid and reliable surveillance data as a basis for school health promotion and education policy and practice for children and adolescence is of great importance. However, numerous methodological and practical problems arise in the planning and collection of such survey data that need to be resolved in order to ensure the validity of the data and to maximize the response rate without being prohibitively costly. METHOD: This article builds on a 15-yearlong experience of such annual data collections in Iceland and describes the preparation, process, and collection of data that provide a common methodologic framework for the school-based survey, Youth in Europe, a population-based survey of 14- to 16-year-old adolescents, being collected across 18 European cities now participating in the European Cities Against Drugs (ECAD) program. RESULTS: We identified 11 critical steps for developing and implementing the surveys in light of the recent literature on the preparation and implementation practices in school-based data collection among adolescents. CONCLUSION: Limiting the disruption of daily operations in schools while at the same time ensuring both quality and clarity of data collection procedures in school-based surveys are of paramount importance for researchers, school personnel, and students.

Electronic screen use and mental well-being of 10-12-year-old children.

BACKGROUND: Today's children spend a great deal of time viewing electronic screen material, but the consequences of such behaviors, if any, are unknown. This study sought to identify (i) the magnitude of total daily electronic screen time and (ii) the relations between electronic screen use and mental well-being indicators, in a sample of 10-12-year-old children. METHODS: We analysed cross-sectional, population-based data of 10-12-year-old children from the 2007 Youth in Iceland school survey (n = 10,829, response rate: 81.7%, boys: 50.5%). Logistic regression models with odds ratios and 95% confidence intervals were conducted to assess the odds of each selected mental well-being indicator, depending on the number of daily hours spent on each electronic screen-based activity. All analyses were conducted separately for boys and girls and adjusted for family structure. RESULTS: The prevalence of self-reported screen use of 4 hours per day or more ranges from 2.8% to 6.6% among boys and from 1.0% to 3.8% among girls. All five screen-based activities were significantly associated with all seven well-being indicators (P < 0.001) with symptoms being more common with increased time spent on screen use. CONCLUSIONS: This study is the first of its kind to demonstrate a dose-response relationship between electronic screen use and mental well-being in 10-12-year-old children. Further research is needed to assess the validity and potential implications of these findings.

Substance use prevention through school and community-based health promotion: a transdisciplinary approach from Iceland.

During the last decade, Iceland has made impressive progress in reducing adolescent substance use. By engaging schools, youth organizations, and other community stakeholders concerned with youth development, Iceland has developed local partnerships that have worked assiduously to reduce risk factors and strengthen school and community-level protective factors for adolescent substance use that peaked in 1998. The nationwide implementation of this transdisciplinary approach to health promotion has led to a 60% decline in both experimentation and use of alcohol, tobacco and cannabis. This article describes the key components of the Icelandic approach to school and community-based health promotion. The potential for adapting elements of this approach to advance school-based healthcare policy and practice to prevent substance use and other health-compromising behaviors in other countries is discussed.

Health behavior and academic achievement among adolescents: the relative contribution of dietary habits, physical activity, body mass index, and self-esteem.

This study tested a structural equation model to estimate the relationship between health behaviors, body mass index (BMI), and self-esteem and the academic achievement of adolescents. The authors analyzed survey data from the 2000 study of Youth in Iceland , a population-based, cross-sectional sample of 6,346 adolescents in Iceland. The model demonstrated good fit with chi-square of 2685 (n = 5,810, df = 180), p < .001, Comparative Fit Index value of .94, and a root mean square error of approximation of .049. Lower BMI, physical activity, and good dietary habits were all associated with higher academic achievement; however, health behavior was positively and robustly associated with greater self-esteem. Self-esteem was positively influenced both through physical activity (beta = .16) and the consumption of fruits and vegetables (beta = .14). In contrast, poor dietary habits negatively influenced self-esteem and academic achievement, and self-esteem was negatively influenced by increasing levels of BMI (beta = -.05).

Substance use prevention for adolescents: the Icelandic Model.

Data from the European School Survey Project on Alcohol and other Drugs have shown that adolescent substance use is a growing problem in western and particularly Eastern European countries. This paper describes the development, implementation and results of the Icelandic Model of Adolescent Substance Use Prevention. The Icelandic Model is a theoretically grounded, evidence-based approach to community adolescent substance use prevention that has grown out of collaboration between policy makers, behavioural scientists, field-based practitioners and community residents in Iceland. The intervention focuses on reducing known risk factors for substance use, while strengthening a broad range of parental, school and community protective factors. Annual cross-sectional surveys demonstrate the impact of the intervention on substance use among the population of 14- to 16-year-old Icelandic adolescents. The annual data from two cohorts of over 7000 adolescents (>81% response rate) show that the proportions of those who reported being drunk during the last 30 days, smoking one cigarette or more per day and having tried hashish once all declined steadily from 1997 to 2007. The proportions of adolescents who reported spending time with their parents and that their parents knew with whom they were spending their time increased substantially. Other community protective factors also showed positive changes. Although these data suggest that this adolescent substance use prevention approach successfully strengthened a broad range of parental, school and community protective factors, the evidence of its impact on reducing substance use needs to be considered in light of the correlational data on which these observations are based.

Adolescent health behavior, contentment in school, and academic achievement.

OBJECTIVES: To examine the association between health behavior indicators, school contentment, and academic achievement. METHODS: Structural equation modeling with 5810 adolescents. RESULTS: Our model explained 36% of the variance in academic achievement and 24% in school contentment. BMI and sedentary lifestyle were negatively related to school contentment and academic achievement, but physical activity was positively related to school contentment and academic achievement (P < .01). School contentment was strongly related to academic achievement but only a weak mediator of the health behavior indicators. CONCLUSION: Findings may inform the efforts to improve academic achievement and the general health status of youth.

Health behaviour and academic achievement in Icelandic school children.

Interest in the relationship between health behaviours and academic achievement has recently intensified in the face of an epidemic of childhood and adolescent obesity and converging school reforms in the United States and other nations with advanced economies. Epidemiologic research has demonstrated that poor diet and lack of adequate physical activity place children at risk for being overweight and obese and thus influence future health status. Additional research has also shown that children and adolescents whose diets are nutritious and whose participation in physical activity is high tend to perform better on various measures of cognitive performance and academic achievement. We analysed cross-sectional survey data from 5810 Icelandic school children to explore the relationship between selected health behaviours and academic achievement. Body mass index, diet and physical activity explained up to 24% (P < 0.01) of the variance in academic achievement when controlling for gender, parental education, family structure and absenteeism. Variance explained increases to 27% when depressed mood (P < 0.05) and self-esteem (P < 0.01) are added to the model, but confounds the role of physical activity. Although not robust, these findings are consistent with previous work and affirm the complexity of the relationship of health to academic achievement.