Trends in material and non-material inequalities in adolescent health and health behaviours: A 12-year study in 23 European countries.

Information on trends in adolescent health inequalities is scarce but the available evidence suggests that inequalities are increasing. Prior studies describe associations between material resources of socioeconomic status (SES) and health, while information on non-material SES resources and inequalities in health behaviours is lacking. To improve current understandings of evolutions in adolescent health inequalities, we examined how material and non-material SES resources were associated with changes in selected health outcomes (life satisfaction, physical and psychological symptoms) and health behaviours (physical activity, screen time, breakfast, fruit, vegetables, sweets and soft drinks consumption and alcohol and tobacco use) over a 12-year period. Repeated cross-sectional data came from the 2002, 2006, 2010 and 2014 waves of the Health Behaviour in School-aged Children (HBSC) survey from 23 European countries (n = 480,386). Measures of family affluence and occupational social class were used as indicators of material and non-material SES resources respectively. Regression-based slope indices of inequality indicated that absolute material and non-material inequalities remained stable from 2002 to 2014 in all health outcomes, except for life satisfaction for which a decrease in material inequalities was found between the highest and lowest affluence group (0.81 to 0.68 difference; p < 0.001). In terms of health behaviours, material inequalities decreased in screen time between highest and lowest affluence groups (0.53 to 0.34 h/day difference; p < 0.001), fruit (odds ratio [OR] 1.89 to 1.72 lower odds; p = 0.0088) and soft drinks consumption (OR 1.36 to 1.13 lower odds; p < 0.001) and remained stable in all others. Non-material inequalities increased in all health behaviours (except for sweets consumption) between highest and lowest occupational social class groups: physical activity (0.16 to 0.24 h/day difference; p = 0.0071), screen time (-0.41 to -0.58 h/day difference; p < 0.001), breakfast (0.21 to 0.51 day/week difference; p < 0.001), fruit (OR 1.23 to 1.48 higher odds; p < 0.001), vegetables (OR 1.39 to 1.74 higher odds; p < 0.001) and soft drinks consumption (OR 0.59 to 0.43 lower odds; p < 0.001) and alcohol (OR 0.99 to 0.85 lower odds; p = 0.0420) and tobacco use (OR 0.71 to 0.59 lower odds; p = 0.0183). In summary, non-material inequalities in most health behaviours increased, whereas material inequalities in adolescent health and health behaviours remain stable or decreased. Policies and interventions may consider non-material SES components as these can help in reducing future health inequalities.

Food and Mood: Daily Associations Between Missed Meals and Affect Among Early Adolescents.

OBJECTIVE: Youth frequently miss meals and experience hunger, yet no studies have assessed how these experiences relate to changes in daily emotional states. This daily diary study examined associations of missing breakfast, missing lunch, and hunger with daily positive and negative affect among young adolescents. METHODS: A community sample of 133 grade 5 and 6 students (50.4% boys, Mage = 10.77, 19.5% BIPOC) from two public schools completed baseline socio-demographic measures at the beginning of the study and daily measures at the end of the school day over 5 consecutive days. Measures included positive and negative affect, breakfast, lunch, and hunger. Multilevel regression models were constructed to test the associations. RESULTS: Among participating youth, 27.8% missed breakfast at least once, 15.0% missed lunch at least once, and 26.3% felt hungry at least once. Missing breakfast was associated with increased negative affect (B = 0.36, p = .030) and missing lunch was related to both increased negative affect (B = 0.52, p = .019) and decreased positive affect (B = -0.80, p = .002). Hunger was not related to daily affect. CONCLUSION: This study provides a unique view of youths' experiences of missing meals, hunger, and daily emotional states. The findings underscore the importance of youth being adequately nourished through school meal programs. Clinicians should screen for and address missing meals among their young patients.

Socioeconomic inequalities in adolescent health complaints: A multilevel latent class analysis in 45 countries.

Our study evaluated the relationship between adolescent health complaints and socioeconomic position in 45 countries. Data are from the 2017/2018 international Health Behaviour in School-aged Children survey which used proportionate sampling among adolescents aged 11 to 15 years old (n=228,979). Multilevel, multinomial regression analysis assessed the association between the multilevel latent classes with socioeconomic status (SES; at the household and country level). Three distinct latent classes were identified: No Complaints, Psychological Complaints, and a Physical and Psychological Complaints class; where, low household SES was highest for the physical and psychological complaints class. The findings suggest that health promotion policies and interventions among adolescents should consider the specific needs of adolescents living with low household SES as they report more subjective health complaints.

Does social support moderate the association between hunger and mental health in youth? A gender-specific investigation from the Canadian Health Behaviour in School-aged Children study.

BACKGROUND: Youth who go hungry have poorer mental health than their counterparts - there are gender differences in this relationship. This study investigated the role of social support in the association between hunger and mental health among a nationally representative sample of youth in Canada in gender-specific analyses. METHODS: We used a probability-based sample of 21,750 youth in grades 6-10 who participated in the 2017-2018 Canadian Health Behaviour in School-aged Children. Self-report data were gathered on hunger, mental health (measured via the World Health Organization-5 well-being index) and five sources of support - peer, family and teacher support as well as the school climate and neighborhood support. We conducted adjusted, gender-specific, multilevel regression analyses assessing the association between mental health, social support and hunger. RESULTS: We found that youth who reported lower support were more likely to experience going to bed hungry (relative to never hungry) across all support factors. As for the social support factors, all the social support factors were associated with a higher mental health score, even after controlling for hunger. Despite these results our final set of models showed that our measures of social support did not alleviate the negative association between hunger and mental health. As for gender-specific findings, the negative association between hunger and a mental health was more pronounced among females relative to their male counterparts. We also found that certain social support factors (i.e., family, teacher and neighborhood support) were associated with a higher mental health score among females relative to males while controlling for hunger status. CONCLUSIONS: We find that five social support factors are associated with a higher mental health score among ever hungry youth; however, social support did not overpower the negative association between hunger and mental health. Food insecurity is a challenge to address holistically; however, hungry youth who have high social support have higher odds of better mental health.

Teenage night owls or early birds? Chronotype and the mental health of adolescents.

Evidence suggests that the timing of sleep (chronotype) impacts mental health in young people, but previous studies have not accounted for sleep duration or school start time in this association, or examined a broad range of mental outcomes. In this study, we investigated the association between chronotype and mental health in a representative sample of adolescents from the 2014 Canadian Health Behaviour in School-Aged Children survey (29,635 students, 362 schools). We examined positive and negative aspects of mental health, using scores for emotional problems (range 0-33), emotional well-being (0-22), behavioural problems (0-28) and prosocial behaviours (0-25). We estimated chronotype using the time of mid-sleep on weekends and examined the associations using multilevel regressions, adjusted for sleep duration, school start time, individual, family and geographic characteristics. The average time of mid-sleep (chronotype) was 04:11 hr. An hour delay in mid-sleep time was associated with more emotional problems (0.34 [95% confidence interval 0.23, 0.45] point higher score), more behavioural problems (2.0% [95% confidence interval 1.4%, 2.6%] higher score), less emotional well-being (0.19 [95% confidence interval 0.09, 0.20] point lower score), and fewer prosocial behaviours (0.18 [95% confidence interval 0.08, 0.29] point lower score). A later chronotype was associated with poorer mental health, independent of sleep duration and school start time, and across internalizing and externalizing mental health domains. Further research is needed to clarify the mechanisms underlying this association. The timing of sleep, and not just its duration, may be an additional consideration for youth mental health.

Education disparities in young people with and without neurodisabilities.

AIM: To examine key outcomes in the education of young people with and without neurodisabilities, and to investigate additional disparities in educational achievement in relation to socio-economic background. METHOD: Data were collected on 2488 Canadian children (age range 10-11y) in 1994 and 1995 from the National Longitudinal Survey of Children and Youth whom were followed for 14 years. We performed separate, discrete-time survival analysis to investigate the effects of having a neurodisability on high school completion, enrolment in post-secondary education (PSE), and PSE completion. RESULTS: The baseline prevalence of neurodisabilities was 12%. Fewer children with neurodisabilities completed high school or enrolled in PSE, compared to children without neurodisabilities, irrespective of parental education. The likelihood that students with neurodisabilities completed PSE differed according to their parents' education: students with neurodisabilities living in less-educated families were about half as likely to complete PSE themselves. INTERPRETATION: Children with neurodisabilities receive less education than children without neurodisabilities. Children from families with low educational attainment appear to be particularly vulnerable. WHAT THIS PAPER ADDS: Twelve per cent of children in Canada aged 10 years to 11 years have a neurodisability. High school completion rate was 70% for children with neurodisabilities versus 94% for children without neurodisabilities. Children with neurodisabilities from less-educated families are particularly vulnerable to lower educational achievement.

Does the density of the health workforce predict adolescent health? A cross-sectional, multilevel study of 38 countries.

BACKGROUND: Scant evidence exists on the relation between the availability of health professionals and adolescent health, and whether the size of the health workforce equally benefits adolescents across socioeconomic strata. METHODS: We conducted a cross-sectional analysis of adolescent health in 38 countries. Data from 218 790 adolescents were drawn from the 2013/2014 Health Behavior in School-aged Children survey. We used multilevel regression analyses to examine the association between the density of the health workforce and psychosomatic and mental health symptoms with differences in country wealth and income inequality controlled. RESULTS: A higher density of psychologists was associated with better self-reported mental health in adolescents (P = 0.047); however, this finding was not robust to sensitivity analyses. The densities of physicians and psychiatrists were not significantly associated with better adolescent psychosomatic or mental health. Cross-level interactions between the health workforce and socioeconomic status did not relate to health, indicating that larger health workforces did not reduce socioeconomic differences in adolescent health. CONCLUSIONS: This study found that adolescents in countries with a higher density of health providers do not report better psychosomatic or mental health. Other social or structural factors may play larger roles in adolescent health.

School start time and sleep in Canadian adolescents.

Insufficient sleep is a serious problem in adolescents and school start time is thought to be a key contributor. This study provided the first comprehensive assessment of school start times across Canada and examined whether school start times were associated with sleep duration and tiredness among adolescents. We collected information on school start times from 362 schools that participated in the 2013/2014 Health Behaviour in School-aged Children study. We calculated sleep duration from weekday bedtime and wake time reported by 29 635 students (aged 10-18 years). We classified weekday sleep as sufficient if it met national recommendations, and used data on self-reported tiredness at school in the morning. Random-effects regression models estimated the association of school start time with sleep duration, sleep sufficiency and tiredness. On average, schools started at 08:43 hours. Students slept an average of 8:36 h on weekdays and 69% met sleep duration recommendations, but 60% reported feeling tired in the morning. Every 10-min delay in school start time corresponded with 3.2 [95% confidence interval (CI): 2.0, 4.5] additional minutes of sleep, a 1.6% (95% CI: 0.5, 2.8) greater probability of sufficient sleep and a 2.1% (95% CI: 1.0, 3.2) smaller probability of feeling tired at school in the morning. Students from schools that started later slept longer, were more likely to meet sleep recommendations and were less likely to report feeling tired in the morning. The study adds weight to the mounting evidence that delaying school start time benefits adolescent sleep.

The Great Recession, Adolescent Smoking, and Smoking Inequalities: What Role Does Youth Unemployment Play in 24 European Countries?

INTRODUCTION: Conflicting evidence has been reported on smoking behavior among adults during times of economic downturn. No study has yet investigated young people's smoking and inequalities in smoking during economic recessions. This study examines the association between country-level youth unemployment due to the economic recession and adolescent smoking and smoking inequalities in Europe. METHODS: The WHO collaborative "Health Behaviour in School-aged Children" study in 2009/2010 included 15-year-old adolescents from 24 European countries (N = 43 093). Socioeconomic position (SEP) was measured by the Family Affluence Scale. Logistic multilevel models were conducted. The absolute rate of youth unemployment in 2010 (during the recession) and the relative change rate in youth unemployment (2005/2006-2009/2010) were regressed on smoking and SEP inequalities in smoking in 2010, respectively. RESULTS: Youth unemployment rates were not significantly associated with overall smoking in adolescents. A higher absolute youth unemployment rate in 2010 related to lower likelihoods of smoking among middle (OR: 0.99; 95% CI: 0.98-0.99) and low affluent adolescents (OR: 0.99; 95% CI: 0.98-0.99) compared to high affluent adolescents. In contrast, an increase in youth unemployment (2005/2006-2009/2010) was not associated with overall likelihoods of smoking and inequalities in smoking. CONCLUSIONS: Our findings indicate that an increase in youth unemployment was not related to smoking and smoking inequalities. However, higher absolute levels of youth unemployment are related to lower likelihoods of smoking in lower SEP adolescents. Thus, smoking among vulnerable groups is more linked to the overall insecure circumstances and the affordability of cigarettes rather than to the economic recession itself. IMPLICATIONS: Economic recessions have often led to increases in adult and youth unemployment rates. Conflicting evidence has been reported on smoking behavior among adults during times of economic downturn. This study examines for the first time the impact of the economic recession on young people's smoking and socioeconomic inequalities in smoking. Findings highlight that rather than an increase in youth unemployment, the overall country-level youth unemployment rate is related to young people's tobacco use and particularly to lower odds in smoking among less affluent adolescents across Europe, a finding which is likely to be linked to the affordability of tobacco use.

Social inequality in adolescents' healthy food intake: the interplay between economic, social and cultural capital.

Background: Current explanations of health inequalities in adolescents focus on behavourial and economic determinants and rarely include more meaningful forms of economic, cultural, and social capital. The aim of the study was to investigate how the interplay between capitals constitutes social inequalities in adolescent healthy food intake. Methods: Data were collected in the 2013/14 Flemish Health Behavior among School-aged Children (HBSC) survey, which is part of the international WHO HBSC survey. The total sample included 7266 adolescents aged 12-18. A comprehensive set of 58 capital indicators was used to measure economic, cultural and social capital and a healthy food index was computed from a 17-item food frequency questionnaire (FFQ) to assess the consumption frequency of healthy food within the overall food intake. Results: The different forms of capital were unequally distributed in accordance with the subdivisions within the education system. Only half of the capital indicators positively related to healthy food intake, and instead 17 interactions were found that both increased or reduced inequalities. Cultural capital was a crucial component for explaining inequalities such that social gradients in healthy food intake increased when adolescents participated in elite cultural practices ( P < 0.05), and were consequently reduced when adolescents reported to have a high number of books at home ( P < 0.05). Conclusion: A combination of selected resources in the form of economic, cultural and social capital may both increase or reduce healthy food intake inequalities in adolescents. Policy action needs to take into account the unequal distribution of these resources within the education system.

Socioeconomic inequalities in adolescent health 2002-2010: a time-series analysis of 34 countries participating in the Health Behaviour in School-aged Children study.

BACKGROUND: Information about trends in adolescent health inequalities is scarce, especially at an international level. We examined secular trends in socioeconomic inequality in five domains of adolescent health and the association of socioeconomic inequality with national wealth and income inequality. METHODS: We undertook a time-series analysis of data from the Health Behaviour in School-aged Children study, in which cross-sectional surveys were done in 34 North American and European countries in 2002, 2006, and 2010 (pooled n 492,788). We used individual data for socioeconomic status (Health Behaviour in School-aged Children Family Affluence Scale) and health (days of physical activity per week, body-mass index Z score [zBMI], frequency of psychological and physical symptoms on 0-5 scale, and life satisfaction scored 0-10 on the Cantril ladder) to examine trends in health and socioeconomic inequalities in health. We also investigated whether international differences in health and health inequalities were associated with per person income and income inequality. FINDINGS: From 2002 to 2010, average levels of physical activity (3·90 to 4·08 days per week; p<0·0001), body mass (zBMI -0·08 to 0·03; p<0·0001), and physical symptoms (3·06 to 3·20, p<0·0001), and life satisfaction (7·58 to 7·61; p=0·0034) slightly increased. Inequalities between socioeconomic groups increased in physical activity (-0·79 to -0·83 days per week difference between most and least affluent groups; p=0·0008), zBMI (0·15 to 0·18; p<0·0001), and psychological (0·58 to 0·67; p=0·0360) and physical (0·21 to 0·26; p=0·0018) symptoms. Only in life satisfaction did health inequality fall during this period (-0·98 to -0·95; p=0·0198). Internationally, the higher the per person income, the better and more equal health was in terms of physical activity (0·06 days per SD increase in income; p<0·0001), psychological symptoms (-0·09; p<0·0001), and life satisfaction (0·08; p<0·0001). However, higher income inequality uniquely related to fewer days of physical activity (-0·05 days; p=0·0295), higher zBMI (0·06; p<0·0001), more psychological (0·18; p<0·0001) and physical (0·16; p<0·0001) symptoms, and larger health inequalities between socioeconomic groups in psychological (0·13; p=0·0080) and physical (0·07; p=0·0022) symptoms, and life satisfaction (-0·10; p=0·0092). INTERPRETATION: Socioeconomic inequality has increased in many domains of adolescent health. These trends coincide with unequal distribution of income between rich and poor people. Widening gaps in adolescent health could predict future inequalities in adult health and need urgent policy action. FUNDING: Canadian Institutes of Health Research.

Adolescent suicidal behaviours in 32 low- and middle-income countries.

OBJECTIVE: To estimate prevalence of suicidal ideation and suicidal ideation with a plan in each surveyed country and to examine cross-national differences in associated risk factors. METHODS: We analysed data of students aged 13-17 years who participated in the 2003-2012 Global School-based Health Surveys in 32 countries, of which 29 are low- and middle-income. We used random effects meta-analysis to generate regional and overall pooled estimates. Multivariable logistic regression was used to estimate risk ratios for the associated risk factors. Population attributable fractions were estimated based on adjusted risk ratios and the prevalence of the determinants within each exposure level. FINDINGS: Across all countries, the pooled 12-month prevalence of suicide ideation were 16.2% (95% confidence interval, CI: 15.6 to 16.7) among females and 12.2% (95% CI: 11.7 to 12.7) among males and ideation with a plan were 8.3% (95% CI: 7.9 to 8.7) among females and 5.8% (95% CI: 5.5 to 6.1) among males. Suicide ideation in the WHO Region of the Americas was higher in females than males, with an estimated prevalence ratio of 1.70 (95% CI: 1.60 to 1.81), while this ratio was 1.04 (95% CI: 0.98 to 1.10) in the WHO African Region. Factors associated with suicidal ideation in most countries included experiences of bullying and physical violence, loneliness, limited parental support and alcohol and tobacco use. CONCLUSION: The prevalence of adolescent suicidal behaviours varies across countries, yet a consistent set of risk factors of suicidal behaviours emerged across all regions and most countries.

Trends in Psychological Symptoms among Canadian Adolescents from 2002 to 2014: Gender and Socioeconomic Differences.

OBJECTIVE: To describe trends in psychological health symptoms in Canadian youth from 2002 to 2014 and examine gender and socioeconomic differences in these trends. METHOD: We used data from the Canadian Health Behaviour in School-aged Children (HBSC) study. We assessed psychological symptoms from a validated symptom checklist and calculated a symptom score (range, 0-16). We stratified our analyses by gender and affluence tertile based on an index of material assets. We then plotted trends in symptom score and calculated the probability of experiencing specific symptoms over time. RESULTS: Between 2002 and 2014, psychological symptom score increased by 1.01 (95% confidence interval [CI], 0.73 to 1.41), 1.08 (95% CI, 0.79 to 1.37), and 0.84 (95% CI, 0.55 to 1.13) points in girls in the low-, middle-, and high-affluence tertiles, respectively. In boys, psychological symptoms decreased by -0.39 (95% CI, -0.66 to -0.12) and -0.12 (95% CI, -0.43 to 0.19) points in the high- and middle-affluence tertiles, respectively, and increased by 0.30 (95% CI, -0.04 to 0.63) points in the low-affluence tertile. The probability of feeling anxious and having sleep problems at least once a week notably increased in girls from all affluence groups, while the probability of feeling depressed and irritable decreased among boys from the high-affluence tertile. CONCLUSION: Psychological symptoms increased in Canadian adolescent girls across all affluence groups while they remained stable in boys from low and middle affluence and decreased in boys from high affluence. Specific psychological symptoms followed distinct trends. Further research is needed to uncover the mechanisms driving these trends.

Adolescents' psychological health during the economic recession: does public spending buffer health inequalities among young people?

BACKGROUND: Many OECD countries have replied to economic recessions with an adaption in public spending on social benefits for families and young people in need. So far, no study has examined the impact of public social spending during the recent economic recession on health, and social inequalities in health among young people. This study investigates whether an increase in public spending relates to a lower prevalence in health complaints and buffers health inequalities among adolescents. METHODS: Data were obtained from the 2009/2010 "Health Behaviour in School-aged Children (HBSC)" study comprising 11 - 15-year-old adolescents from 27 European countries (N = 144,754). Socioeconomic position was measured by the Family Affluence Scale (FAS). Logistic multilevel models were conducted for the association between the absolute rate of public spending on family benefits per capita in 2010 and the relative change rate in family benefits (2006-2010) in relation to adolescent psychological health complaints in 2009/2010. RESULTS: The absolute rate of public spending on family benefits in 2010 did not show a significant association with adolescents' psychological health complaints. Relative change rates of public spending on family benefits (2006-2010) were related to better health. Greater socioeconomic inequalities in psychological health complaints were found for countries with higher change rates in public spending on family benefits (2006-2010). CONCLUSIONS: The results partially support our hypothesis and highlight that policy initiatives in terms of an increase in family benefits might partially benefit adolescent health, but tend to widen social inequalities in adolescent health during the recent recession.

Is educational differentiation associated with smoking and smoking inequalities in adolescence? A multilevel analysis across 27 European and North American countries.

This study aims to determine whether educational differentiation (i.e. early and long tracking to different school types) relate to socioeconomic inequalities in adolescent smoking. Data were collected from the WHO-Collaborative 'Health Behaviour in School-aged Children (HBSC)' study 2005/2006, which included 48,025 15-year-old students (Nboys = 23,008, Ngirls = 25,017) from 27 European and North American countries. Socioeconomic position was measured using the HBSC family affluence scale. Educational differentiation was determined by the number of different school types, age of selection, and length of differentiated curriculum at the country-level. We used multilevel logistic regression to assess the association of daily smoking and early smoking initiation predicted by family affluence, educational differentiation, and their interactions. Socioeconomic inequalities in both smoking outcomes were larger in countries that are characterised by a lower degree of educational differentiation (e.g. Canada, Scandinavia and the United Kingdom) than in countries with higher levels of educational differentiation (e.g. Austria, Belgium, Hungary and The Netherlands). This study found that high educational differentiation does not relate to greater relative inequalities in smoking. Features of educational systems are important to consider as they are related to overall prevalence in smoking and smoking inequalities in adolescence.

Trends in social inequalities in adolescent health complaints from 1994 to 2010 in Europe, North America and Israel: The HBSC study.

BACKGROUND: Studies have shown constant or increasing health inequalities in adulthood in the last decades, but less is known about trends in health inequalities among adolescents. The aim is to analyse changes in socioeconomic differences in subjective health complaints from 1994 to 2010 among 11- to 15-year-olds in Europe, North America and Israel. METHODS: Data were obtained from the international 'Health Behaviour in School-aged Children' (HBSC) survey. Analyses were based on the HBSC surveys conducted in 1994 (19 countries), 1998 (25 countries), 2002 (32 countries), 2006 (37 countries) and 2010 (36 countries) covering a time period of up to 16 years. Log binomial regression models were used to assess inequalities in multiple health complaints. Socioeconomic position was measured using perceived family wealth. RESULTS: Inequalities in multiple health complaints emerged in almost all countries, in particular since 2002 (RR 1.1-1.7). Trend analyses showed stable (29 countries), increased (5 countries), decreased (one country) and no social inequalities (2 countries) in adolescent health complaints. CONCLUSION: In almost all countries, social inequalities in health complaints remained constant over a period of up to 16 years. Our findings suggest a need to intensify efforts in social and health policy to tackle existing inequalities.

Adolescents' psychological health complaints and the economic recession in late 2007: a multilevel study in 31 countries.

BACKGROUND: The recent economic recession, which began in 2007, has had a detrimental effect on the health of the adult population, but no study yet has investigated the impact of this downturn on adolescent health. This article uniquely examines the effect of the crisis on adolescents' psychological health complaints in a cross-national comparison. METHODS: Data came from the World Health Organization collaborative 'Health Behaviour in School-aged Children' study in 2005-06 and 2009-10. We measured change in psychological health complaints from before to during the recession in the context of changing adult and adolescent unemployment rates. Furthermore, we used logistic multilevel regression to model the impact of absolute unemployment in 2010 and its change rate between 2005-06 and 2009-10 on adolescents' psychological health complaints in 2010. RESULTS: Descriptive results showed that although youth and adult unemployment has increased during the economic crisis, rates of psychological health complaints among adolescents were unaffected in some countries and even decreased in others. Multilevel regression models support this finding and reveal that only youth unemployment in 2010 increased the likelihood of psychological health complaints, whereas its change rate in light of the recession as well as adult unemployment did not relate to levels of psychological health complaints. CONCLUSION: In contrast to recent findings, our study indicates that the negative shift of the recent recession on the employment market in several countries has not affected adolescents' psychological health complaints. Adolescents' well-being instead seems to be influenced by the current situation on the labour market that shapes their occupational outlook.

Prospective associations between the family environment, family cohesion, and psychiatric symptoms among adolescent girls.

The present study used a longitudinal design to investigate whether parental values, interests, and the perceived level of expressiveness, cohesiveness and control in the family were associated with changes in psychiatric symptoms during early adolescence. We used data gathered at ages 12, 14 and 17 from 1,600 adolescent girls in the National Heart, Lung and Blood Institute Growth and Health Study. Using a novel approach we found significant informant effects of family cohesion on psychiatric symptoms, with stronger associations for adolescent ratings than parental ratings. Multivariate modelling adjusting for family cohesion (from parents and adolescents perspective), and parents' depressive and eating disorder symptoms indicated parental ratings on the intellectual and cultural orientation of the family predicted small but significant increases in eating disorder symptoms, anxiety and a reduction in self-worth 2-years later. Parental control also predicted a reduction in anxiety and family expressiveness was related to increases in self-worth.

School socioeconomic status and psychological complaints among adolescents in 44 countries: The mediating role of schoolwork pressure and classmate support and the moderating role of family SES and country-level income inequality.

Previous research has reported both positive and negative associations between school socioeconomic status (SES) and internalizing problems among adolescents. Little is known about cross-national differences in this association, as well as potential mediators and moderators. Therefore, this study investigated this association using representative cross-national samples of adolescents whilst exploring the mediating role of schoolwork pressure and classmate support, and the moderating role of family SES and country-level income inequality. Using data from adolescents aged 11-15 from 44 countries, participating in the 2017/2018 Health Behaviour in School-aged Children (HBSC) study (N = 202,202), we employed multilevel regression models with cross-level interactions. School SES was operationalized as the average family affluence of adolescents within a school and psychological complaints (e.g., feeling low/depressed) were used as an indication of internalizing problems. On average across countries, adolescents in higher SES schools reported more psychological complaints, with a large effect size. However, differences in this association were observed across countries, with a positive association in 19 out of 44 countries, a negative association in one country, and nonsignificant associations in the remaining countries. Schoolwork pressure partially mediated the average association between school SES and psychological complaints, as school SES was positively associated with schoolwork pressure which was associated with more psychological complaints. Our results did not support the mediating role of classmate support. Also, we found a moderating effect of family SES, indicating a stronger positive association between school SES and psychological complaints for those with a below average family SES compared to those with an average and above average family SES. No moderating effect was observed for country-level income inequality. These findings suggest that adolescents with low family SES attending higher SES schools are especially at risk for psychological complaints, and may therefore require tailored support. A promising strategy to reduce psychological complaints entails addressing schoolwork pressure.

Health trends in Canada 1990-2019: An analysis for the Global Burden of Disease Study.

OBJECTIVE: Monitoring trends in key population health indicators is important for informing health policies. The aim of this study was to examine population health trends in Canada over the past 30 years in relation to other countries. METHODS: We used data on disability-adjusted life years (DALYs), years of life lost (YLL), years lived with disability, life expectancy (LE), and child mortality for Canada and other countries between 1990 and 2019 provided by the Global Burden of Disease Study. RESULTS: Life expectancy, age-standardized YLL, and age-standardized DALYs all improved in Canada between 1990 and 2019, although the rate of improvement has leveled off since 2011. The top five causes of all-age DALYs in Canada in 2019 were neoplasms, cardiovascular diseases, musculoskeletal disorders, neurological disorders, and mental disorders. The greatest increases in all-age DALYs since 1990 were observed for substance use, diabetes and chronic kidney disease, and sense organ disorders. Age-standardized DALYs declined for most conditions, except for substance use, diabetes and chronic kidney disease, and musculoskeletal disorders, which increased by 94.6%, 14.6%, and 7.3% respectively since 1990. Canada's world ranking for age-standardized DALYs declined from 9th place in 1990 to 24th in 2019. CONCLUSION: Canadians are healthier today than in 1990, but progress has slowed in Canada in recent years in comparison with other high-income countries. The growing burden of substance abuse, diabetes/chronic kidney disease, and musculoskeletal diseases will require continued action to improve population health.

RéSUMé: OBJECTIF: La surveillance des tendances des indicateurs clés de la santé de la population est importante pour éclairer les politiques de santé. Dans cette étude, nous avons examiné les tendances de la santé de la population au Canada au cours des 30 dernières années par rapport à d'autres pays. MéTHODES: Nous avons utilisé des données sur les années de vie ajustées en fonction de l'incapacité (DALY), les années de vie perdues (YLL), les années vécues avec un handicap, l'espérance de vie (LE) et la mortalité infantile pour le Canada et d'autres pays entre 1990 et 2019, fournies par l'Étude mondiale sur le fardeau de la maladie. RéSULTATS: L'espérance de vie, les YLL ajustées selon l'âge et les DALY ajustées selon l'âge ont tous connu une amélioration au Canada entre 1990 et 2019, bien que le taux d'amélioration se soit stabilisé depuis 2011. Les cinq principales causes des DALY pour tous les âges au Canada en 2019 étaient les néoplasmes, les maladies cardiovasculaires, les affections musculosquelettiques, les affections neurologiques et les troubles mentaux. Les plus fortes augmentations des DALY pour tous les âges depuis 1990 ont été observées pour l'usage de substances, le diabète et les maladies rénales chroniques, ainsi que les troubles des organes sensoriels. Les DALY ajustées selon l'âge ont diminué pour la plupart des conditions, à l'exception de l'usage de substances, du diabète et des maladies rénales chroniques, ainsi que des troubles musculosquelettiques, qui ont augmenté de 94,6 %, 14,6 % et 7,3 % respectivement depuis 1990. Le classement mondial du Canada pour les DALY ajustées selon l'âge est diminué de la 9ième place en 1990 à la 24ième place en 2019. CONCLUSION: Les Canadiens sont en meilleure santé aujourd'hui qu'en 1990, mais les progrès se sont ralentis ces dernières années par rapport à d'autres pays à revenu élevé. La croissance du fardeau lié à l'abus de substances, au diabète/maladies rénales chroniques et aux affections musculosquelettiques exigera des actions continues pour améliorer la santé de la population.