Sixteen-year trends in fruit consumption and related socioeconomic inequalities among adolescents in Western European countries.

PURPOSE: To investigate time trends in daily fruit consumption among Western European adolescents and in related socioeconomic inequalities. METHODS: We used nationally representative data from 18 countries participating in five rounds (2002 to 2018) of the cross-sectional "Health Behaviour in School-aged Children" (HBSC) survey (n = 458,973). The questionnaire, standardised across countries and rounds, was self-administered at school by 11-, 13- and 15-year-old adolescents. Daily fruit consumption was assessed using a short food frequency questionnaire (sFFQ). Socioeconomic inequalities were measured using the Family Affluence Scale (FAS). Multilevel logistic regressions were applied to study linear time trends in daily fruit consumption, overall, by country and by FAS. RESULTS: Between 2002 and 2018, daily fruit consumption increased in 10 countries (OR range, 1.04 to 1.13, p < 0.05) and decreased in 3 (OR range 0.96 to 0.98, p < 0.05). In all survey years combined, prevalence of daily fruit consumption was significantly higher among high FAS groups (42.6%) compared to medium (36.1%) and low FAS groups (31.7%; all countries: p < 0.001). Between 2002 and 2018, socioeconomic inequalities in fruit consumption increased in Austria, Germany, Italy, Netherlands, Scotland, Sweden, and Switzerland. Only in Norway FAS inequalities decreased while the prevalence increased. CONCLUSION: The prevalence of daily fruit consumption generally increased among adolescents between 2002 and 2018 in Western European countries, yet socioeconomic inequalities increased in some countries. Public health interventions should continue to promote fruit consumption with special attention to lower socioeconomic groups.

Decline of childhood overweight and obesity in Italy from 2008 to 2016: results from 5 rounds of the population-based surveillance system.

BACKGROUND: Given the effects of childhood obesity on future health, and the lack of information of its prevalence in Italy, a national surveillance system was implemented in 2007. It is OKkio alla SALUTE, part of the WHO/Europe Childhood Obesity Surveillance Initiative (COSI). This study reports the 2008-2016 trends by sex, area of residence and socio-demographic characteristics in the prevalence of overweight and obesity in primary school children (8-9 years). METHODS: In each round of the surveillance held in 2008, 2010, 2012, 2014 and 2016, a nationally representative sample of about 45,000 children, was weighed and measured with standard equipment and methods by trained personnel. Children were classified as normal weight, overweight or obese using World Obesity Federation (WOF) (formerly the International Obesity Task Force (IOTF)) and WHO cut-offs. Children's sex, area of residence and mothers' education and citizenship, were obtained using self-reported questionnaires and were assessed using multivariate logistic regression models. RESULTS: Between 2008 and 2016, the overall prevalence of obesity dropped from 12.0 to 9.3% (WOF-IOTF) and from 21.2 to 17.0% (WHO), while the overall prevalence of overweight (including obesity) from 35.2 to 30.6% (WOF-IOTF) and from 44.4 to 39.4% (WHO). Reduction in the prevalence of overweight and obesity was greater in boys (- 14.5%, p for trend< 0.001; and - 24.7%, p = 0.001) compared to girls (- 11.1%, p < 0.001; and - 19.2%, p = 0.034). Decreasing trends were observed in overweight prevalences within children resident in the center and in the south. Decreasing trends in obesity prevalences were observed among boys resident in the north and in the south, and among girls resident in the center. Decreasing trends were observed in overweight prevalences within socio-demographic characteristics, except among children with low educated and foreign mothers; and in obesity prevalences for children with medium educated mothers, and girls with Italian mothers. CONCLUSIONS: From 2008 to 2016 a decrease of childhood overweight and obesity was observed in Italy. However, as these prevalences are still among the highest in Europe, there is need to continue their monitoring and implement more interventions to promote healthy lifestyles. More effort should be focused on children belonging to low social classes.

[Dietary behaviour of children attending primary school in Italy found by the surveillance system "OKkio alla salute"]. / I comportamenti alimentari dei bambini della scuola primaria in Italia fotografati dal sistema di sorveglianza nazionale OKkio alla salute.

OBJECTIVES: to describe the dietary behaviour of children attending primary school and the school activities which promote healthy dietary habits. DESIGN OF THE STUDY: surveillance system with biannual prevalence studies. SETTING AND PARTICIPANTS: the fourth round of data collection of the surveillance system OKkio alla SALUTE took place in 2014, promoted and financed by the Ministry of Health and coordinated by the National Institute of Health in collaborations with all regions. 2,408 schools, 48,426 children and 50,638 parents participated. Stratified cluster sampling (with third grade classes as units) was used; information was collected using questionnaires completed by children, parents, teachers and head-teachers. OUTCOME MEASURES: consumption of breakfast, mid-morning snack, fruit and vegetables, sweetened and gassy drinks; school initiatives to promote healthy dietary habits. RESULTS: 31% of children have an adequate breakfast and 8% skip this meal; 52% consume an energy-dense mid-morning snack; 25% do not eat fruit and vegetables daily; 41% drink sweetened/gassy beverages daily. The unhealthy dietary habits are more common among children who have less educated parents or live in the South (more deprived area of the Country). Data show an improvement in the period 2008-2014, except in the consumption of fruit and vegetables. 74% of the schools include nutritional education in the curriculum, 66% have started initiatives of healthy dietary habits and 55% distribute healthy food; 35% involve parents in their initiatives. In the schools of the South nutritional education and involvement of parents are more frequent, while the distribution of healthy food and refectories are less common. CONCLUSIONS: the high frequency of unhealthy dietary behaviour and their geographic and social inequalities show that there is a great potential for improvement. Schools are very involved in initiatives of promotion, but they need more support from the institutions and involvement of the families.

Overweight among students aged 11-15 years and its relationship with breakfast, area of residence and parents' education: results from the Italian HBSC 2010 cross-sectional study.

BACKGROUND: The international increase in overweight and obesity among children and adolescents over the past three decades confirms that childhood obesity is a global 'epidemic'. The World Health Organization considers childhood obesity to be a major public health concern. Childhood obesity is associated with cardiovascular, endocrine, musculoskeletal and gastrointestinal complications, and may have psycho-social consequences. The aim of this paper is to examine overweight (including obesity) prevalence and its association with geographic area of residence, parental education and daily breakfast consumption in Italian students aged 11-15 yrs. METHODS: A nationally representative sample of 11-15 year old students from 20 Italian Regions (Italian Health Behaviour in School-aged Children 2010-HBSC) was randomly selected (2,504 schools and 77,113 students). Self-reported anonymous questionnaires, prepared by the international HBSC network, were used to collect the data. BMI was calculated using self-reported weight and height and the International Obesity Task Force cut-offs. Multiple logistic regressions were performed to assess the relationship between the risk of overweight and parental education, area of residence and breakfast consumption in each age group and gender. RESULTS: Boys were more likely to be overweight or obese than girls (28.1% vs. 18.9% at 11 yrs-old, 24.8% vs. 16.5% at 13 yrs and 25.4 vs. 11.8% at 15 yrs). The prevalence of overweight and obesity was lower among the older girls. Overweight and obesity rates increased from the North of Italy to the South in both boys and girls and in all age groups. Boys 11-15 yrs living in southern Italy had an OR=2.05 (1.77-2.38) and girls 2.04 (95% CI 1.70-2.44) for overweight (including obesity) compared with those living in the North. Parent's low educational level and no daily breakfast consumption were also associated with overweight including obesity (p<0.05). CONCLUSION: The prevalence of obesity and overweight in Italian school-children 11-15 yrs old are high, in particular in the South and in boys. These findings suggest appropriate interventions are needed, at the community as well as the individual level, in particular in the southern regions. However, more research is warranted on intermediary factors to determine which interventions are likely to be most effective.

Dressed or undressed? How to measure children's body weight in overweight surveillance?

OBJECTIVE: To simplify body weight measurement and, particularly, to encourage children and their parents to participate in the Italian nutritional surveillance system OKkio alla SALUTE, children were measured with clothes and then the weight was corrected for the estimated weight of the clothes. In the present study we compared the children's weight measured in underwear, as recommended by the WHO (WWHO), with that obtained using the OKkio alla SALUTE protocol (WOK) and investigated how the latter affects the calculation of BMI and the assessment of overweight and obesity prevalence. DESIGN: Weight (twice in close sequence, with and without clothing) and height were measured. A checklist was used to describe the type of clothing worn. The estimated weight of clothing was subtracted from the WOK. BMI was calculated considering both values of weight and height; ponderal status was defined using both the International Obesity Task Force and WHO BMI cut-offs. SETTING: Thirty-seven third grade classes of thirteen primary schools in Rome and in two towns in the Lazio Region were recruited. SUBJECTS: The anthropometric measurements were taken on 524 children aged 8-9 years. RESULTS: The error in the calculation of BMI from WOK was very low, 0·005 kg/m2 (95 % CI -0·185, 0·195 kg/m2); the agreement between the percentages of overweight (not including obesity) and obese children calculated with the two methods was very close to 1 (κ = 0·98). CONCLUSIONS: The error in BMI and in nutritional classification can be considered minor in a surveillance system for monitoring overweight/obesity, but eases the procedure for measuring children.

Changes in Food Consumption and Eating Behaviours of Children and Their Families Living in Italy during the COVID-19 Pandemic: The EPaS-ISS Study.

The aim of the EPaS-ISS study was to describe the changes in food consumption and eating behaviours of children (mainly aged 8-9 years) and their families between the pre-COVID-19 period (before February/March 2020) and the COVID-19 period (from February/March 2020 to April 2022). A web questionnaire completed by parents was used to collect data. The sociodemographic characteristics of the children and their parents were also explored through the web questionnaire. Seventeen regions out of nineteen and the two autonomous provinces (PA) of Italy participated in the study. The survey was completed for 4863 children (47.9% females). The study showed that only small changes in children's food consumption happened between the pre-COVID-19 period and the COVID-19 period; in particular, about 25% of parents reported an increase in savoury snacks and sweet food. A decrease in fruit and vegetable (about 8%) and fish (14%) consumption was also found. However, the changes seem to have mainly affected children from most disadvantaged families. The results also indicate positive changes during the COVID-19 pandemic in some families' eating behaviours, such as eating more home-cooked meals (42%) and family meals (39%), as well as cooking more with children (42%).

Exploring changes in children's well-being due to COVID-19 restrictions: the Italian EpaS-ISS study.

BACKGROUND: While existing research has explored changes in health behaviours among adults and adolescents due to the COVID-19 outbreak, the impact of quarantine on young children's well-being is still less clear. Moreover, most of the published studies were carried out on small and non-representative samples. The aim of the EpaS-ISS study was to describe the impact of the COVID-19 pandemic on the habits and behaviours of a representative sample of school children aged mainly 8-9 years and their families living in Italy, exploring the changes in children's well-being during the COVID-19 pandemic compared to the immediately preceding time period. METHODS: Data were collected using a web questionnaire. The target population was parents of children attending third-grade primary schools and living in Italy. A cluster sample design was adopted. A Well-Being Score (WBS) was calculated by summing the scores from 10 items concerning the children's well-being. Associations between WBS and socio-demographic variables and other variables were analysed. RESULTS: A total of 4863 families participated. The children's WBS decreased during COVID-19 (median value from 31 to 25; p = 0.000). The most statistically significant variables related to a worsening children's WBS were: time of school closure, female gender, living in a house with only a small and unliveable outdoor area, high parents' educational level and worsening financial situation. CONCLUSIONS: According to parents ' perception, changes in daily routine during COVID-19 negatively affected children's well-being. This study has identified some personal and contextual variables associated with the worsening of children's WBS, which should be considered in case of similar events.

Inequalities in Childhood Nutrition, Physical Activity, Sedentary Behaviour and Obesity in Italy.

Unhealthy diets, physical inactivity and high body mass index (BMI) are preventable risk factors for non-communicable diseases throughout a person's lifespan. The higher prevalence of these risk factors in children from lower socio-economic groups has been generally observed. The aim of this study is to explore the effect of parents' socio-economic conditions on children's consumption of fruit, vegetables and sugar-sweetened drinks, and inactivity, sedentary behaviour, overweight and obesity. This study used data from the sixth cross-sectional survey of the surveillance "OKkio alla Salute" (Italian COSI), involving 2467 schools and 53,275 children in 2019. All the information was collected through four questionnaires addressed to parents, children, teachers and head teachers. The weights and heights of the children were measured with standard techniques and equipment to classify overweight/obesity according to the WOF-IOTF cut-offs. The results showed a high percentage of children who do not adhere to health recommendations and a high prevalence of overweight and obesity. In particular, "less healthy" behaviours and higher BMI were more frequent in children from families with a lower socio-economic status and those residing in Southern Italy. These findings highlight the need for effective interventions that address the differences in these health-related behaviours.

Trend in Breakfast Consumption among Primary School Children in Italy.

Eating breakfast daily improves cognitive function, may contribute to learning and academic performance in children and can decrease the risk of childhood obesity. The aim of this study was to analyse how breakfast consumption changed in the period from 2008/9 to 2019 in Italy among children aged 8-9 years old participating in the OKkio alla SALUTE surveys and to explore the associations with some socio-demographic and lifestyle factors. Information about children's daily breakfast consumption (adequate, inadequate, and no breakfast) and the socio-demographic characteristics of the children and their mothers was collected through four questionnaires addressed to parents, children, teachers and head teachers. Data were analysed for the 272,781 children from 21 Italian regions from 2008/9 to 2019. The prevalence of adequate breakfast decreased from 60.7% in 2008/9 to 55.7% in 2019 and no breakfast from 10.9 to 8.7%; conversely, inadequate breakfast increased from 28.4 to 35.6%. Logistic regression models showed that the occurrence of inadequate or no breakfast consumption was significantly higher among girls, children living in the southern regions and children with less educated mothers. These findings highlight the need for effective interventions to increase daily breakfast consumption and its adequacy among children.

Risk Behaviors among Migrant Adolescents in Italy.

Adolescence is a critical period for engaging in health risk behaviors. Migrant adolescents may face unique challenges due to acculturation stress. This study aims to monitor substance use and problem gambling among migrant adolescents living in Italy. Data from the 2017/18 Health Behavior in School-Aged Children survey in Italy were analyzed. The 18,794 participants included 15-year-olds, categorized as native or migrants, with ethnic backgrounds from Western, Eastern European, or non-Western/non-European countries. Girls had higher smoking rates, while boys exhibited higher prevalence of alcohol-related risk behaviors, cannabis use, and gambling. Boys from Eastern European countries displayed a greater risk of drunkenness (OR: 1.58, 95% CI: 1.06-2.37), particularly in the first generation, while those from Western countries showed a higher risk of multiple substance use (OR: 1.44, 95% CI: 1.05-1.96). Girls from Eastern European and non-Western/non-European countries had a lower risk of alcohol consumption (OR: 0.50, 95% CI: 0.29-0.85; OR: 0.55, 95% CI: 0.33-0.91, respectively). Finally, boys, especially those from Eastern European and non-Western/non-European countries, had a significantly higher risk of problem gambling (OR: 1.83, 95% CI: 1.04-3.22; OR: 2.10, 95% CI: 1.29-3.42, respectively). This disparity was more pronounced in the first generation, possibly due to acculturation challenges and socio-economic factors. Risk behaviors in adolescents are influenced by complex interplays of gender, cultural factors, and migration generation. Preventive strategies should consider these factors to effectively address substance use and gambling in this heterogeneous population.

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.

The Effect of Problematic Social Media Use on Happiness among Adolescents: The Mediating Role of Lifestyle Habits.

Background: Although the relationship between problematic social media use (PSMU) and happiness has been already explored, less is known about the mechanisms that translate PSMU into lower happiness through lifestyle habits. Therefore, the current study focuses on the association between PSMU and happiness, exploring a mediating effect of lifestyle habits (e.g., difficulties in getting to sleep and frequency of physical activity) among Italian adolescents. Methods: A total of 58,976 Italian adolescents (mean age = 13.6, SD = 1.63; age range = 10.5−16.5; 49.4% females) were included. The pattern of relationships specified by the theoretical model was examined through path analysis. Results: Difficulties in getting to sleep (ß = −0.037, p < 0.001) and frequency of physical activity (ß = −0.012, p < 0.001) were mediators in the relationship between PSMU and happiness. Multi-group analyses across gender and age groups (11, 13, and 15 years old) showed that the chain mediating effect of the frequency of physical activity on the difficulties in getting to sleep was not significant for females but significant for males and for all of the three age groups. Overall, females and older ages were sensitive to the whole model. Conclusion: Along with difficulties in getting to sleep and the frequency of physical activity, lifestyle habits may contribute to the association between PSMU and happiness. We also recommend that future studies focus on PSMU in females and older adolescents, as they show more general sleep problems and reduced physical activity.

Problematic Social Media Use and Cyber Aggression in Italian Adolescents: The Remarkable Role of Social Support.

The recent increase in electronic and social media use among young people has highlighted the importance of focusing on problematic social media use (PSMU) and the concurrent phenomenon of cyber aggression, as well as the role of social support. As part of the 2018 Health Behavior in School-aged Children study in Italy, this study aims to explore the role of family, peer, and teacher support in the association between cyberbullying and PSMU. METHODS: Data were collected from 4183 school classes in Italy for a total of 58,976 adolescents aged 11, 13, and 15 years. The prevalence of cyber aggression (both cybervictimization and perpetration) and PSMU was estimated across subgroups of different age, gender, and geographical residence. A set of multivariable logistic regressions was then used to investigate the association between cyberbullying and PSMU, considering the effect of social support. RESULTS: Cybervictimization was more frequent among girls than in boys. PSMU was higher in 11-year-old boys and 13-year-old girls; 8.3% and 12.7%, respectively. Social support was highest in 11-year-olds, for both sexes, and then decreased with increasing age. The risk of cyberbullying, both suffered and perpetrated, was higher in girls and in the presence of PSMU. Social support showed to be highly protective against PSMU and cyberbullying in all ages and both genders. CONCLUSION: Although cyber aggression is less represented in Italy than in other European countries, it is likely to increase. PSMU appears to be an important contributor to the risk of cyber aggression; however, social support has been shown to be capable of reducing the risk of both phenomena. Public health policies fostering familiar and school support can help protect adolescents' mental health, reducing the risk of problematic media use and cyberbullying.

Forecasting Frequent Alcohol Use among Adolescents in HBSC Countries: A Bayesian Framework for Making Predictions.

(1) Aim: To summarize alcohol trends in the last 30 years (1985/6-2017/8) among 15-year-olds in Health Behaviour in School-aged Children (HBSC) countries (overall sample size: 413,399 adolescents; 51.55% girls) and to forecast the potential evolution in the upcoming 2021/22 HBSC survey. (2) Methods: Using 1986-2018 prevalence data on weekly alcohol consumption among 15-year-olds related to 40 HBSC countries/regions, a Bayesian semi-parametric hierarchical model was adopted to estimate trends making a clusterization of the countries, and to give estimates for the 2022 HBSC survey. (3) Results: An overall declining trend in alcohol consumption was observed over time in almost all the countries. However, compared to 2014, some countries showed a new increase in 2018 and 2021/22 estimates forecast a slight increase in the majority of countries, pointing out a potential bounce after a decreasing period in frequent drinking habits. (4) Conclusions: The clusterization suggested a homogenization of consumption habits among HBSC countries. The comparison between 2022 observed and expected data could be helpful to investigate the effect of risk behaviour determinants, including the pandemic impact, occurring between the last two waves of the survey.

Physical Activity among Italian Adolescents: Association with Life Satisfaction, Self-Rated Health and Peer Relationships.

The aim of this study was to describe physical activity, both moderate-to-vigorous physical activity (MVPA) and vigorous physical activity (VPA), in a large nationally representative sample of Italian adolescents, aged 11, 13 and 15, and to evaluate if Italian adolescents were in line with the 2020 WHO recommendations. In order to assess the possible impact of physical activity on adolescent psychological and social wellbeing, the associations between MVPA and VPA with life satisfaction, self-rated health and peer relationships were also explored. Data from the 2018 Italian Health Behaviour in School-aged Children (HBSC) survey on 58,976 adolescents were analysed. Logistic regression analysis was used to investigate the association between physical activity and self-rated health, life satisfaction and peer relationships. The association of the Family Affluence Scale with self-rated health, life satisfaction and peer relationships was also studied. The results showed that the majority of Italian adolescents did not meet current physical activity WHO guidelines on MPVA. The prevalence of adolescents claiming to be involved "at least four or more times per week" in VPA was 29%. Overall, our findings highlighted a positive association between MVPA and VPA and life satisfaction, self-rated health and peer support. Data from this study underlined the need to encourage physical activity, especially among older adolescents and girls, who claimed lower levels of MPVA and VPA.

Mental Well-Being: 2010-2018 Trends among Italian Adolescents.

(1) Aims: To explore temporal trends 2010-2018 of well-being among Italian adolescents and to evaluate potential explanatory factors. (2) Methods: Italian nationality representative samples of students aged 11, 13, and 15 years were recruited in 2010, 2014, and 2018; Health Behaviour in School-aged Children (HBSC), for an overall number of 165,000 teenagers. Multivariable logistic regression models were performed to fit the trends over time of life satisfaction (LS), psychological (PSY-HC) and somatic health complaints (SOM-HC) considering the contextual factors: school work pressure, social support (family, school, peers), socioeconomic status, geographic area, and immigration background; (3) Results: From 2010 to 2018 while LS was steady, health complaints increased, mainly for PSY-HC, in all age and gender groups. Trend of PSY-HC affected mainly 15-years-olds: rates among boys varied from 29.6% to 35.9% (OR: 1.13, 95%CI: 1.02-1.25); among girls from 49.1% to 63.3% (OR: 1.56, 95%CI: 1.42-1.72). High school work pressure and poor social support play a central role in worsening well-being outcomes; (4) Conclusions: Our findings pictured a remarkable worsening trend of teenagers' well-being, especially among 15-year-old girls. Further research will be required to investigate this breaking up of the connection between psychophysical symptomatology and cognitive perception of life satisfaction.

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.