Loneliness and personal well-being in young people: Moderating effects of individual, interpersonal, and community factors.

INTRODUCTION: Loneliness is prevalent among young people. But, there is little work exploring the association between loneliness with well-being among this age group. Framed by social-ecological theory, we examined demographic, interpersonal, and community factors associated with personal wellbeing and, critically, identified malleable moderators of the relationship between loneliness and well-being that could be targeted in intervention efforts. METHODS: We used cross-sectional, secondary data from 965 young people (aged 16-24) from the Community Life Survey in England. Loneliness was measured using a single-item direct measure; personal wellbeing was measured through a composite measure containing items assessing happiness, life satisfaction, and a sense that life is worthwhile (α = 0.88). Regression techniques were used to assess associations between individual, interpersonal, and community factors and well-being, and to identify moderators of the relationship between loneliness and well-being. RESULTS: Loneliness was negatively associated with well-being. Chatting with neighbors and having people to provide help moderated the relationship between loneliness and well-being. Full-time students and those with good physical health had higher well-being while being a carer was predictive of lower well-being. All community variables were strongly associated with increased well-being. Of all interpersonal variables investigated, only having people to count on was associated with increased well-being. CONCLUSIONS: Our results demonstrate that supportive relationships and close community ties are important for reducing the negative impact of loneliness on youth well-being. Interventions to improve well-being could benefit from targeting these aspects of young people's social and community lives, while acknowledging individual vulnerabilities, such as poor physical health.

The Role of School Connectedness and Friend Contact in Adolescent Loneliness, and Implications for Physical Health.

The current study investigated how adolescents' loneliness relates to school connectedness, classmate support, teacher support, and offline and online communication with friends. We also examined the association between loneliness, physical health, and sleep. Data came from the Scottish Health Behavior in School-aged Children (HBSC). The total sample was 2983 adolescents (F = 1479 [49.6%]) aged 14-17 years (M = 15.66, SD = 0.39) from 117 secondary schools in Scotland. Results showed that (1) higher teacher support, classmate support, and offline contact with friends predicted lower levels of loneliness, (2) online friendship engagement predicted higher levels of loneliness, and (3) poor health and sleep were positively associated with loneliness. The study offers new findings, highlighting the role played by classmates/peers and teachers in reducing loneliness. Supporting previous research, we also found associations between loneliness, poor sleep, and worse physical health.

Cross-national time trends in adolescent alcohol use from 2002 to 2014.

BACKGROUND: Adolescent alcohol consumption is a major public health concern that should be continuously monitored. This study aims (i) to analyze country-level trends in weekly alcohol consumption, drunkenness and early initiation in alcohol consumption and drunkenness among 15-year-old adolescents from 39 countries and regions across Europe and North America between 2002 and 2014 and (ii) to examine the geographical patterns in adolescent alcohol-related behaviours. METHODS: The sample was composed of 250 161 adolescents aged 15 from 39 countries and regions from Europe and North America. Survey years were 2002, 2006, 2010 and 2014. The alcohol consumption and drunkenness items of the HBSC questionnaire were employed. Prevalence ratios and 95% confidence intervals were estimated using Poisson regression models with robust variance. RESULTS: Data show a general decrease in all four alcohol variables between 2002 and 2014 except for some countries. However, there is variability both within a country (depending on the alcohol-related behaviour under study) and across countries (in the beginning and shape of trends). Some countries have not reduced or even increased their levels in some variables. Although some particularities have persisted over time, there are no robust patterns by regions. CONCLUSIONS: Despite an overall decrease in adolescent alcohol consumption, special attention should be paid to those countries where declines are not present, or despite decreasing, rates are still high. Further research is needed to clarify factors associated with adolescent drinking, to better understand country specificities and to implement effective policies.

Health promotion in adults with Down's syndrome: Experiences of caregivers.

Individuals with Down's syndrome rely on caregivers to support lifestyle behaviour change. It is therefore important to understand how caregivers put health recommendations into practice. Through conducting semi-structured interviews, the present study sought to understand the facilitators and barriers that caregivers faced when implementing health promotion advice. Five interviews were conducted with paid support staff and four with family carers of individuals attending a specialist multidisciplinary Down's syndrome health promotion screening clinic. Three main themes emerged in their accounts, including active promotion of weight management by caregivers, benefits of working practices such as record keeping and communication channels and the importance of having access to social care services and recreational activities. These findings have important implications for professionals working in specialised healthcare settings who may be able to tailor communication and services to better meet the needs of individuals with Down's syndrome and their caregivers.

Assessing the psychometric and ecometric properties of neighborhood scales using adolescent survey data from urban and rural Scotland.

BACKGROUND: Despite the well-established need for specific measurement instruments to examine the relationship between neighborhood conditions and adolescent well-being outcomes, few studies have developed scales to measure features of the neighborhoods in which adolescents reside. Moreover, measures of neighborhood features may be operationalised differently by adolescents living in different levels of urban/rurality. This has not been addressed in previous studies. The objectives of this study were to: 1) establish instruments to measure adolescent neighborhood features at both the individual and neighborhood level, 2) assess their psychometric and ecometric properties, 3) test for invariance by urban/rurality, and 4) generate neighborhood level scores for use in further analysis. METHODS: Data were from the Scottish 2010 Health Behaviour in School-aged Children Survey, which included an over-sample of rural adolescents. The survey responses of interest came from questions designed to capture different facets of the local area in which each respondent resided. Intermediate data zones were used as proxies for neighborhoods. Internal consistency was evaluated by Cronbach's alpha. Invariance was examined using confirmatory factor analysis. Multilevel models were used to estimate ecometric properties and generate neighborhood scores. RESULTS: Two constructs labeled neighborhood social cohesion and neighborhood disorder were identified. Adjustment was made to the originally specified model to improve model fit and measures of invariance. At the individual level, reliability was .760 for social cohesion and .765 for disorder, and between .524 and .571 for both constructs at the neighborhood level. Individuals in rural areas experienced greater neighborhood social cohesion and lower levels of neighborhood disorder compared with those in urban areas. CONCLUSION: The scales are appropriate for measuring neighborhood characteristics experienced by adolescents across urban and rural Scotland, and can be used in future studies of neighborhoods and health. However, trade-offs between neighborhood sample size and reliability must be considered.

Unhealthy food consumption in adolescence: role of sedentary behaviours and modifiers in 11-, 13- and 15-year-old Italians.

BACKGROUNDS AND AIM: Unhealthy eating behaviours increase with age and have been associated with adverse health consequences in adulthood. We examined the influence of screen-based sedentary behaviours (SBs) on unhealthy food consumption, such as energy-dense foods and sweetened drinks, among a representative sample of nearly 60 000 adolescents and assessed the role of possible modifiers. METHODS: Data come from the Italian 2009-10 Health Behaviour in School-aged Children (HBSC) survey. Data on Eating patterns, SBs, physical activity, peers network, BMI and socio-economic status (SES) were collected following the HBSC study protocol. Hierarchical logistic regression models were used. RESULTS: Unhealthy food consumption was significantly associated with a lower intake of fruit and vegetables and with the increase of SBs in both sexes and in all ages. The risk was interestingly higher in normal weight adolescents, in those with wider relationships with peers and in low SES children. CONCLUSIONS: This study adds evidence to support the importance of investing more resources in educational initiatives both to increase parents' awareness to support adolescents on dietary choices and on time spent in screen-based behaviours, independently of their adiposity status; and to develop youth's ability to access and appropriately use media and technologies. Policy makers should also increase their attention on introducing regulatory policies on television food advertising to which youth are exposed.

Trends in television time, non-gaming PC use and moderate-to-vigorous physical activity among German adolescents 2002-2010.

BACKGROUND: Studies in youth highlight that moderate-to-vigorous physical activity (MVPA) and screen-time behaviours such as television viewing and PC use are associated with a range of health outcomes. However, little is known about recent trends in these behaviours in adolescents. This paper presents time trends in German adolescents' television time, non-gaming PC use as well as MVPA from 2002 to 2010. METHODS: Data were derived from the cross-sectional German Health Behaviour in School-aged Children (HBSC) study in 2002, 2006 and 2010. Analyses were based on 16,918 11-to 15-year olds boys (49.1%) and girls. Outcome variables were time spent in TV viewing and using a PC (weekday and weekend day) as well as the number of days achieving 60 minutes of MVPA. Changes in both screen-time behaviours and MVPA over time were analysed using sex-specific linear regression, controlling for age and family affluence. RESULTS: TV viewing on weekdays, but not at weekends, declined steadily over time with a difference between 2002 and 2010 of 12.4 min/day in girls and 18.3 min/day in boys (p for trend<.01). We found a strong increase in PC use for non-gaming purposes over time for girls only, with a difference between 2002 and 2010 of 54.1 min/weekday and 68.8 min/weekend day (p<.001). For MVPA we found a slight statistically significant increase in terms of meeting PA guidelines as well as days/week in MVPA for boys and girls (p<.001). In 2010 14.0% of girls and 19.9% of boys met PA guideline. CONCLUSION: Although MVPA increased from 2002 to 2010 in German adolescents, the time spent in MVPA was still low. Despite the observed decrease in TV viewing, there was no overall decline in the observed screen-based behaviours, especially for girls. This is mainly due to a marked increase in use of a PC for chatting on-line, internet, emailing, homework etc. among girls during the last ten years which outweighs the corresponding decrease in TV viewing. The findings highlight a need for strategies and interventions aimed at reducing screen-time behaviours and promoting MVPA.

Associations Between Recent Contraceptive Use and First Sex Behaviors of Scottish Adolescents: A Brief Report.

Objectives: We examined associations between recent contraceptive use and first-sex behaviors (early initiation, substance use, contraceptive use) among adolescents in Scotland. Methods: We used data from the Health Behavior in School-aged Children study. Results: Controlling for early initiation and substance use, girls and boys who used contraceptives at first sex were 7.5 and 12.3 times more likely to use contraceptives at most recent sexual intercourse than adolescents who did not (p < .001). We also present preliminary evidence on contraceptive use of Scottish adolescents in 2022. Conclusions: Experiences during adolescents' first sex may have lasting implications for later sexual behavior.

Conceptualisation of health among young people: a protocol for systematic review and thematic synthesis of qualitative studies.

BACKGROUND: Self-reported health is a widely used health indicator in surveys and questionnaires. The measure gained attention when research identified its association with mortality in the 1970s and 1980s. The measure is also associated with morbidity and other health outcomes such as the utilisation of health services. Self-reported health is a particularly useful measure for young people because this age group is generally clinically healthy. However, it is known that many chronic conditions have long latency periods that are initiated early in life. Because of its predictive nature, self-reported health can be used to estimate young people's current and future health. Despite its widespread use, however, self-reported health remains a poorly understood concept. This paper presents the protocol for a systematic review that will identify and synthesise qualitative studies that investigate the factors that are considered by young people when they assess their health, and when they talk about health overall. METHODS: The population of the review is young people aged 10-24 years, with or without health conditions. We will search the databases of MEDLINE (Ovid®), PsycINFO (APA PsycNet), ProQuest Sociology Collection, and Web of Science Core Collection™. We will also utilise techniques of reference checking and forward citation searching, as this strategy has been shown to result in a higher number of high-quality studies in social science systematic reviews. Google Scholar and Google Search were used during preliminary searches; Google Scholar will be utilised for forward citation searching. We will include studies written in English, German, or Finnish; there will be no lower date limit. One reviewer will screen all citations. A second reviewer will independently screen a sample of 20% of the abstracts. Data will be extracted by one researcher, two other researchers will independently review all data extracted, and quality appraisal will be completed by the first reviewer. We will utilise the Quality Framework for the appraisal of included articles and thematic synthesis of qualitative studies. DISCUSSION: The results of this systematic review will improve the understanding of the factors that are considered during the self-assessments of health; this will improve the interpretation of the results of quantitative research. Also, an improved understanding of the conceptualisation of health will inform the development of health policies and interventions that support young people's health. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42022367519.

Different Categories of Social Media Use and Their Association With Body Image Among Adolescents in 42 Countries.

Objectives: Social media has become integrated into adolescents' lives and influences body image perceptions. Our study examined four patterns of social media use (SMU): non-active, active, intensive, and problematic. We hypothesised that intensive SMU and problematic SMU would be associated with negative body image (negative subjective body weight) and over/underestimated body weight congruence, compared to non-active and active SMU. In addition, we expect these associations to be stronger for girls. Methods: Data from 190,892 respondents aged 11, 13, and 15 from 42 countries involved in the Health Behaviour in School-aged Children study were analysed. Results: Findings revealed higher rates of intensive or problematic SMU among adolescents who perceived themselves as too fat or too thin. Two-level regression analyses showed intensive and problematic SMU as more likely to perceive themselves as too fat or too thin than active users. The association was significant among intensive and problematic girl social media users, whereas, among boys, the relationship was only significant for problematic users. Conclusion: Our findings highlight the importance of assessing SMU patterns to evaluate associations with body image.

Inequalities in health complaints: 20-year trends among adolescents in Scotland, 1998-2018.

This study examined trends in inequalities in health complaints among early adolescents in Scotland from 1998 to 2018. We analysed data from the Health Behaviour in School-aged Children (HBSC) survey conducted in Scotland in 1998, 2002, 2006, 2010, 2014 and 2018. A self-report questionnaire was administered in schools to a nationally representative sample of 11-, 13-, and 15-year-olds (n = 29,250). Health complaints were measured using a scale comprising four psychological symptoms (feeling low, feeling nervous, irritability and sleep difficulties) and four somatic symptoms (headache, backache, stomachache and dizziness). Socio-economic status was measured using the Family Affluence Scale. Between 1998 and 2018, there were significant increases in the proportion of girls and boys reporting feeling low, feeling nervous, sleep difficulties and backache. Prevalence of the eight individual health complaints was higher among girls and adolescents from lower affluence families. Socio-economic inequalities increased over time, such that declines in mental health were greatest among low affluence adolescents. The data show worsening trends in health complaints among Scottish adolescents between 1998 and 2018, particularly for girls and adolescents from low affluence families. Increasing inequalities in mental health highlight the need to address the underlying social and structural determinants of adolescent mental health.

Mental health and loneliness in Scottish schools: A multilevel analysis of data from the health behaviour in school-aged children study.

BACKGROUND: Adolescent loneliness and poor mental health represent dual public health concerns. Yet, associations between loneliness and mental health, and critically, how these associations vary in school settings are less understood. AIMS: Framed by social-ecological theory, we aimed to identify key predictors of adolescent mental health and examine school-level variation in the relationship between loneliness and mental health. SAMPLE: Cross-sectional data on adolescents from the 2018 wave of the Health Behaviour in School-aged Children study (HBSC) in Scotland were used (N = 5286). METHODS: Mental health was measured as a composite variable containing items assessing nervousness, irritability, sleep difficulties and feeling low. Loneliness was measured via a single item assessing how often adolescents felt 'left out'. Multilevel models were used to identify social-ecological predictors of mental health, associations with loneliness and between-school variation. RESULTS: Loneliness, as well as demographic, social and school factors, was found to be associated with mental health. Mental health varied across schools, with the between-school difference greater among adolescents with high levels of loneliness. Additionally, the negative effect of loneliness on mental health was stronger in schools with lower average mental health scores. CONCLUSIONS: The findings suggest that schools can play an important role in shaping adolescent mental health. Our study uniquely identifies that school-based interventions targeting mental health may be especially necessary among lonely adolescents, and programmes aimed at tackling loneliness may be more beneficial in schools with poorer mental health.

Adolescent use of social media and associations with sleep patterns across 18 European and North American countries.

OBJECTIVE: Over the past decade, concurrent with increasing social media use (SMU), there has been a shift toward poorer sleep among adolescents in many countries. The purpose of this study was to examine the cross-national associations between adolescent SMU and sleep patterns, by comparing 4 different categories of SMU (nonactive, active, intense, and problematic use). DESIGN, SETTING, AND PARTICIPANTS: Data were from 86,542 adolescents in 18 European and North American countries that participated in the 2017/18 Health Behaviour in School-aged study. MEASUREMENTS: Mixed-effects linear regression models were used to examine cross-national associations between 4 SMU categories and adolescent sleep duration, bedtime and social jetlag derived from self-reported data. RESULTS: For all countries combined, nonactive SMU was associated with longer sleep, earlier bedtimes, and less social jetlag, compared to active SMU, although the differences were minor. By comparison, intense and problematic SMU were associated with less sleep and later bedtimes on both school and nonschool days, and greater social jetlag, compared to active SMU. While findings were relatively consistent between countries, some differences were observed, suggesting that the national and cultural context may be important in interpreting results. CONCLUSIONS: These findings suggest that both intense and problematic SMU are associated with poorer sleep patterns in adolescents across most countries. Further research is needed to identify effective policies, programs, and messaging to promote the healthy use of social media and prevent potential negative impacts on adolescent sleep.

The prospective relationship between loneliness, life satisfaction and psychological distress before and during the COVID-19 pandemic in the UK.

Aim: Mental wellbeing in the UK seems to have deteriorated significantly during the COVID-19 pandemic, with the rates of loneliness, life satisfaction and psychological distress taking longer to return to the pre-pandemic levels than elsewhere. Nevertheless, there is little knowledge about the interactions between these outcomes, or the factors that played a role in the rates of change. The current study aims to address this gap by simultaneously investigating changes in loneliness, life satisfaction and psychological distress in the UK from pre-pandemic levels to those between April and November 2020, while critically assessing the role of a range of social ecological influencing factors. Subject and Methods: Longitudinal data from Understanding Society (N=3475) were used to explore the changes in loneliness, life satisfaction and psychological distress from pre-pandemic levels (2017-2019) through November 2020, the interactions between these outcomes, and the role of individual, social, community and geographic factors in the rates of change, using multivariate latent growth curve model. Results: Loneliness, life satisfaction and psychological distress deteriorated minimally between April and November 2020, compared to the pre-pandemic levels (2017-2019), while the rate of change in each outcome influenced the rates of change in the other two. Key individual (age, gender, physical health), social (number of friends and similarity to them), and environmental (neighbourhood quality) variables influenced baseline scores and the rates of change. Conclusion: Considering significant dynamic associations between loneliness, life satisfaction and psychological distress, we argue that interventions to tackle any one of the outcomes may have beneficial effects on others, while highlighting malleable factors and individual and community-level interventions to tackle loneliness.

Correction to: The prospective relationship between loneliness, life satisfaction and psychological distress before and during the COVID-19 pandemic in the UK.

[This corrects the article DOI: 10.1007/s10389-022-01719-x.].

12-Year Trends in Active School Transport across Four European Countries-Findings from the Health Behaviour in School-Aged Children (HBSC) Study.

Active school transport (AST) is a source of daily physical activity uptake. However, AST seems to have decreased worldwide over recent decades. We aimed to examine recent trends in AST and associations with gender, age, family affluence, and time to school, using data from the Health Behaviour in School-Aged Children (HBSC) study collected in 2006, 2010, 2014, and 2018 in the Czech Republic, Norway, Scotland, and Wales. Data from 88,212 students (11, 13 and 15 years old) revealed stable patterns of AST from 2006 to 2018, apart from a decrease in the Czech Republic between 2006 and 2010. For survey waves combined, walking to and from school was most common in the Czech Republic (55%) and least common in Wales (30%). Cycling was only common in Norway (22%). AST differed by gender (Scotland and Wales), by age (Norway), and by family affluence (everywhere but Norway). In the Czech Republic, family affluence was associated with change over time in AST, and the effect of travel time on AST was stronger. The findings indicate that the decrease in AST could be levelling off in the countries considered here. Differential associations with sociodemographic factors and travel time should be considered in the development of strategies for AST.

Accelerometry-assessed sleep duration and timing in late childhood and adolescence in Scottish schoolchildren: A feasibility study.

Children and adolescents commonly suffer from sleep and circadian rhythm disturbances, which may contribute to poorer mental health and wellbeing during this critical developmental phase. Many studies however rely on self-reported sleep measures. This study assessed whether accelerometry data collection was feasible within the school setting as a method for investigating the extent of sleep and circadian disruption, and associations with subjective wellbeing, in Scotland. Fourteen days of wrist-worn accelerometry data were collected from 69 pupils, aged 10-14 years. Objective measures of sleep timing, sleep duration and circadian rest-activity patterns were derived. Questionnaires assessed subjective sleep timing, depressive symptoms, and experiences of wearing the accelerometer. Pupils slept on average less than 8 hours per night, failing to meet standard age-specific recommendations. Sleep timing was later and duration longer on weekends compared to weekdays (B = 0.87, 95% confidence interval (CI) 0.70, 1.04; B = 0.49, 95% CI 0.29, 0.69), indicating social jetlag. Lower daytime activity was correlated with higher depressive symptoms (r = -0.84, p = 0.008). Compared to primary school pupils, secondary pupils had shorter sleep window duration and lower circadian relative amplitude. Over half of participants reported some discomfort/inconvenience wearing the accelerometer. These data highlight that inadequate sleep is prevalent in this sample of schoolchildren. Future, larger scale investigations will examine in more detail the associations between sleep, circadian function and physical activity with mental health and wellbeing.

Adolescents' Intense and Problematic Social Media Use and Their Well-Being in 29 Countries.

PURPOSE: This study examined (1) whether intense and problematic social media use (SMU) were independently associated with adolescent well-being; (2) whether these associations varied by the country-level prevalence of intense and problematic SMU; and (3) whether differences in the country-level prevalence of intense and problematic SMU were related to differences in mobile Internet access. METHODS: Individual-level data came from 154,981 adolescents (meanage = 13.5) from 29 countries that participated in the 2017/2018 Health Behaviour in School-aged Children (HBSC) survey. Intense SMU was measured by the time spent on social media, whereas problematic SMU was defined by symptoms of addiction to social media. Mental (life satisfaction and psychological complaints), school (school satisfaction and perceived school pressure), and social (family support and friend support) well-being were assessed. Country-level data came from aggregated individual-level data and data from the Organisation for Economic Co-operation and Development (OECD) on Internet access. RESULTS: Two-level regression analyses indicated that in countries with a lower prevalence of intense SMU, intense users reported lower levels of life satisfaction and family support and more psychological complaints than nonintense users. In contrast, in countries with a higher prevalence of intense SMU, intense users reported higher levels of family support and life satisfaction than nonintense users, and similar levels of psychological complaints. In all countries, intense users reported more friend support than nonintense users. The findings regarding problematic SMU were more consistent: In all countries, problematic users reported lower well-being on all domains than nonproblematic users. Observed differences in country-level prevalence rates of intense and problematic SMU could not be explained by mobile Internet access. CONCLUSIONS: Adolescents reporting problematic SMU are particularly at risk of lower well-being. In many countries, intense SMU may be a normative adolescent behavior that contributes positively to specific domains of their well-being.

Do Drinking Motives Mediate the Relationship between Neighborhood Characteristics and Alcohol Use among Adolescents?

Adolescents not only vary in their alcohol use behavior but also in their motivations for drinking. Young people living in different neighborhoods may drink for different reasons. The aims of this study were to determine if neighborhood characteristics were associated with adolescent drinking motives, and whether drinking motives mediate the relationship between neighborhood context and regular alcohol use. Data from the Scottish Health Behaviours in School-aged Children 2010 survey of students in their 4th year of secondary school were used. The study included 1119 participants who had data on neighborhood characteristics and had used alcohol in the past year. Students were asked questions about the local area where they lived, their alcohol use, and their motives for drinking alcohol, based on the Drinking Motives Questionnaire Revised Short Form (DMQR-SF). Multilevel multivariable models and structural equation models were used in this study. Coping motives showed significant variation across neighborhoods. Structural equation models showed coping motives mediated the relationships between neighborhood deprivation, living in an accessible small-town, and neighborhood-level disorder with regular alcohol use. Public health policies that improve neighborhood conditions and develop adaptive strategies, aimed at improving alcohol-free methods for young people to cope better with life's stresses, may be particularly effective in reducing inequalities in adolescent alcohol use if targeted at small towns and areas of increased deprivation.