Objective health literacy skills among ninth graders in Finland: outcomes from a national learning assessment.

BACKGROUND: Health literacy (HL) is an important determinant for maintaining and improving health throughout the lifespan. This underlines the need to monitor HL, including among adolescents, and to understand the factors explaining HL, with a view to decreasing differences in HL. The aim of this study was to objectively measure HL, and the relationship between HL and socio-demographic factors (gender, language of instruction, pupils' educational aspirations, parents' educational background and pupils' school achievement) among pupils (n = 3652) at the end of basic education in Finland. METHODS: A nationally representative assessment, which included 55 items on HL, was conducted as a traditional paper-and-pencil test in schools. The data were analysed via descriptive statistics and a two-level hierarchical linear model to determine how the socio-demographic factors affected HL. RESULTS: The pupils' average score on the HL test items was 58.9%, indicating a satisfactory HL level. A two-level hierarchical linear model showed that the variables (gender, language of instruction, pupils' educational aspirations, parents' educational background and pupils' school achievement) predicting the HL level had statistically significant effects. CONCLUSIONS: Among ninth graders (15-16 years old), almost one third of the boys and 8% of the girls exhibited an unsatisfactory HL level. The study also confirmed the importance of school-related factors in explaining HL differences. Since low HL has been linked to several unfavourable health indicators and has been viewed as an underestimated problem in times of pandemic and other health crises, the findings suggest that the HL level of Finnish ninth graders is a clear public-health issue.

Intersectoral partnerships and competencies for mental health promotion: a Delphi-based qualitative study in Finland.

The importance of intersectoral collaboration and partnership working in mental health promotion, together with the requisite competencies for effective collaboration, is widely acknowledged. This Delphi-based qualitative study examined how intersectoral collaboration and partnership work are constructed and adopted in mental health promotion practice. Descriptive data from a Delphi panel of mental health promotion practitioners working in the health sector (n = 32) were used as a data source. Thematic analysis was used to analyze the data. Applying the theory of collaborative advantage, eight themes of collaboration advantage and the related competencies were identified: management structure, leadership, communication and language, common aims, working processes, resources, trust, and commitment and determination. The themes capture the competencies required to influence and work with others to improve the mental health and wellbeing of individuals and communities. The identified theme areas can be used to inform education and training and capacity building for professional practice in mental health promotion. Future research is needed to explore other possible collaborative advantage themes in mental health promotion practice and the competencies required to facilitate effective partnerships across sectors. Further investigations are also needed on the identified theme areas in order to develop and guide capacity building and training in mental health promotion.

Empowerment-enabling home and school environments and self-rated health among Finnish adolescents.

Perceived health during adolescence has not only immediate consequences for individuals and for society, but also long-term. We need to understand better the health development in this period of the lifespan. Empowerment may be one pathway through which social factors and conditions translate into health effects. This study aimed to examine whether empowerment-enabling home and school environments are associated with self-rated health among adolescents, and whether the associations differ between genders, age or majority/minority language groups. Anonymous questionnaire data from respondents aged 11, 13 and 15 years were obtained from the Health Behaviour in School-aged Children study, conducted in Finland in 2014 in Finnish- and Swedish-speaking schools (n = 5925/1877). The proportion rating their health as excellent varied between 33.6 (11-year-olds) and 23.1% (15-year-olds), boys rating their health as excellent more often than girls in all age groups. Findings showed that indicators of both empowerment-enabling home and school environments were independently and positively related to adolescents' self-rated health. Whereas a respectful, accepting, kind and helpful attitude among classmates and a good home atmosphere were quite consistently associated with excellent health, there were gender and age differences with concern to the other empowerment-enabling indicators. Moreover, there were gender-, age- and language-related differences regarding adolescents' perceptions of how empowerment enabling their environments were. Home and school environments that create opportunities through encouragement and care, and through strengthening feelings of being secure, accepted and respected are potentially empowerment enabling. This study suggests that such environmental qualities are important for the perceived health of young people.

Associations between Adolescents' Interpersonal Relationships, School Well-being, and Academic Achievement during Educational Transitions.

A youth's ability to adapt during educational transitions has long-term, positive impacts on their academic achievement and mental health. Although supportive relationships with parents, peers, and teachers are protective factors associated with successful educational transitions, little is known about the reciprocal link between the quality of these interpersonal relationships and school well-being, with even less known about how these two constructs affect academic achievement. This longitudinal study examined how the quality of interpersonal relationships and school well-being worked together to affect academic achievement during the transition from primary school to lower secondary school. Data were collected from 848 Finnish adolescents (54% girls, mean age at the outset 12.3 years) over the course of sixth and seventh grade. The results support a transactional model illustrating the reciprocal associations between the quality of interpersonal relationships and school well-being during the transition to lower secondary school. As such, the presence of high quality interpersonal relationships promoted higher academic achievement through increased school well-being, whereas high school well-being promoted higher subsequent academic achievement through increased quality of interpersonal relationships. Overall, the results suggest that promoting learning outcomes and helping adolescents with challenges during educational transitions is a critical part of supporting school well-being and the formation of high-quality interpersonal relationships.

Mental health promotion competencies in the health sector in Finland: a qualitative study of the views of professionals.

AIMS: In this study, we aimed to investigate what competencies are needed for mental health promotion in health sector practice in Finland. METHODS: A qualitative study was carried out to seek the views of mental health professionals regarding mental health promotion-related competencies. The data were collected via two focus groups and a questionnaire survey of professionals working in the health sector in Finland. The focus groups consisted of a total of 13 professionals. Further, 20 questionnaires were received from the questionnaire survey. The data were analysed using the qualitative data analysis software ATLAS.ti Scientific Software Development GmbH, Berlin. A content analysis was carried out. RESULTS: In total, 23 competencies were identified and clustered under the categories of theoretical knowledge, practical skills, and personal attitudes and values. In order to promote mental health, it is necessary to have a knowledge of the principles and concepts of mental health promotion, including methods and tools for effective practices. Furthermore, a variety of skills-based competencies such as communication and collaboration skills were described. Personal attitudes and values included a holistic approach and respect for human rights, among others. CONCLUSIONS: The study provides new information on what competencies are needed to plan, implement and evaluate mental health promotion in health sector practice, with the aim of contributing to a more effective workforce. The competencies provide aid in planning training programmes and qualifications, as well as job descriptions and roles in health sector workplaces related to mental health promotion.

The cross-national measurement invariance of the health literacy for school-aged children (HLSAC) instrument.

BACKGROUND: Health literacy (HL) is an important determinant of health and health behaviours, and there is a need to monitor HL levels among all population groups. It is therefore essential to develop instruments to assess HL during childhood and adolescence. The aim of this study was to examine the cross-national measurement invariance of the instrument Health Literacy for School-aged Children (HLSAC) in four European countries. METHODS: The data were collected via standardized self-administered anonymous questionnaires within classrooms in Finland, Poland, Slovakia, and Belgium. There were in total 1468 respondents (aged 13, N = 690; aged 15, N = 778). The HLSAC instrument was used to measure the subjective HL of adolescents in each country. A multigroup confirmatory factor analysis was applied to test measurement invariance. RESULTS: Configural and metric invariance was established, but scalar invariance did not hold. However, the instrument exhibited high internal consistency (α = 0.85) and showed adequate fit with the data. Moreover, the partial invariance allowed comparison of mean values across the countries in question. There were significant mean value differences between countries and age-groups. CONCLUSIONS: HL mean values (as assessed via the HLSAC instrument) can be compared across countries. The instrument has utility for large-scale international HL studies on adolescents.

Socioeconomic differences in the use of alcohol and drunkenness in adolescents: Trends in the Health Behaviour in School-aged Children study in Finland 1990-2014.

AIMS: The aims of this study were to explore time-based trends of socioeconomic differences in alcohol use and drunkenness in Finnish adolescents from 1990 to 2014 and to investigate the significance of two indicators in detecting socioeconomic differences in alcohol use and drunkenness. METHODS: Data were retrieved from seven surveys conducted as part of the Health Behaviour in School-aged Children (HBSC) study in Finland from 1990 to 2014. The alcohol use and drunkenness of 15-year-old students, as well as socioeconomic status, including educational aspiration and perceived family wealth, were assessed via a self-report questionnaire. Logistic regression models were used to investigate the relationships between alcohol use, drunkenness and indicators of socioeconomic status. RESULTS: The study showed that the alcohol use and drunkenness of Finnish 15-year-old adolescents have decreased since the late 1990s. However, the level of decrease is not consistent among different socioeconomic groups and socioeconomic differences in drinking behaviour between two educational aspiration groups have persisted over two decades. Girls from the groups with low perceived family wealth were more likely to be frequently drunk in the time period 2006-2014. CONCLUSIONS: This study suggests that students with low educational aspiration should be the target population for interventions aiming at reducing the alcohol use and drunkenness of Finnish adolescents. In future interventions aimed at reducing heavier drinking, adolescents (especially girls) from less wealthy families should be the first priority. Further studies on trends in socioeconomic differences in alcohol use and drunkenness in adolescence should be conducted using different indicators of socioeconomic status and other social context factors should also be taken into account.

Subjective health literacy: Development of a brief instrument for school-aged children.

AIMS: The present paper focuses on the measurement of health literacy (HL), which is an important determinant of health and health behaviours. HL starts to develop in childhood and adolescence; hence, there is a need for instruments to monitor HL among younger age groups. These instruments are still rare. The aim of the project reported here was, therefore, to develop a brief, multidimensional, theory-based instrument to measure subjective HL among school-aged children. METHODS: The development of the instrument covered four phases: item generation based on a conceptual framework; a pilot study ( n = 405); test-retest ( n = 117); and construction of the instrument ( n = 3853). All the samples were taken from Finnish 7th and 9th graders. RESULTS: Initially, 65 items were generated, of which 32 items were selected for the pilot study. After item reduction, the instrument contained 16 items. The test-retest phase produced estimates of stability. In the final phase a 10-item instrument was constructed, referred to as Health Literacy for School-Aged Children (HLSAC). The instrument exhibited a high Cronbach alpha (0.93), and included two items from each of the five predetermined theoretical components (theoretical knowledge, practical knowledge, critical thinking, self-awareness, citizenship). CONCLUSIONS: The iterative and validity-driven development process made it possible to construct a brief multidimensional HLSAC instrument. Such instruments are suitable for large-scale studies, and for use with children and adolescents. Validation will require further testing for use in other countries.

Socioeconomic differences in adolescents' smoking: a comparison between Finland and Beijing, China.

BACKGROUND: Various studies have demonstrated the associations between socioeconomic status (SES) and health and health behaviour among adolescents. However, few studies have compared the socioeconomic difference in adolescent smoking between countries with different stage of smoking. The purpose of this study was to examine and compare the relationship between socioeconomic status (SES) and adolescent smoking in Beijing, China and Finland through the Health Behaviour in School-aged Children (HBSC) study. METHODS: The data used in this study were derived from the Chinese HBSC linked project survey 2008 in Beijing and the Finnish HBSC survey 2006. The final sample included 2005 Chinese and 1685 Finnish 15-year-old schoolchildren. The associations between Family Affluence Scale (FAS), as the SES measure, and adolescents' smoking behaviour, including ever smoked, weekly smoking and the early onset of smoking were examined separately in two countries through binary logistic regression. RESULTS: Compared to students from the high FAS group, Chinese boys from the low FAS group were more likely to report having ever smoked (OR = 2.12, 95 % CI = 1.49-3.01) and being early onset of smoking (OR = 2.17, 95 % CI = 1.44-3.26). Finnish girls from the low FAS group were more likely to report being weekly smokers (OR = 1.68, 95 % CI = 1.07-2.65). No significant difference was found for Chinese girls and Finnish boys. CONCLUSIONS: This study indicated different patterns of socioeconomic difference in smoking between Chinese and Finnish adolescents by gender and by smoking behaviour, which suggests that socioeconomic inequalities in smoking are different among adolescents in countries with different stage of smoking. Country specific policies and interventions for different target groups should be encouraged and designed for reducing the prevalence of adolescents' smoking.

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.

Socioeconomic inequalities in adolescent smoking across 35 countries: a multilevel analysis of the role of family, school and peers.

BACKGROUND: Tobacco-related heath inequalities are a major public health concern, with smoking being more prevalent among lower socioeconomic groups. The aim of this study is to investigate the mechanisms leading to socioeconomic inequalities in smoking among 15-year-old adolescents by examining the mediating role of psychosocial factors in the peer group, family and school environment. METHODS: Data were derived from the international WHO-collaborative 'Health Behaviour in School-aged Children (HBSC)' study 2005/2006, including 52 907 15-year-old students from 35 European and North American countries. Socioeconomic position was measured by the Family Affluence Scale. Multilevel logistic regression models were conducted to examine the contribution of family, school and peer factors in explaining the association between family affluence and weekly smoking. RESULTS: Across countries, adolescents from low affluent families had an increased risk of weekly smoking (OR(boys) 1.14, confidence interval (CI) 1.05-1.23; OR(girls) 1.36, CI 1.26-1.46) compared with adolescents from high affluent families. Family and school factors mediated the association between family affluence and smoking to a high extent up to 100% (boys) and 81% (girls) in joint analyses. The most important single factors were family structure, relationships with parents, academic achievement and school satisfaction. Peer factors did not mediate the association between family affluence and adolescent smoking. CONCLUSION: The association between socioeconomic status and adolescent weekly smoking can largely be explained by an unequal distribution of family- and school-related factors. Focusing on the parent-adolescent relationship and adolescent school achievement can help to better understand inequalities in adolescent smoking behaviour.

A review of settings-based health promotion with applications to sports clubs.

Sports clubs have a long and traditional history in many countries, yet they remain underdeveloped and underutilized settings for health promotion. Leisure time settings, in general, have been in minor role among settings-based health promotion initiatives. Current health concerns in western countries, such as sedentary lifestyles and obesity, have aroused a need to expand health promotion to include also settings with greater potential to reach and engage children and adolescents in more vigorous activity. To develop these alternative, most often non-institutional, settings to the level of the established ones, it is important to review what has been done, what has been accepted and what is known from research, theory and practice to have contributed to health. Given that settings approaches have been implemented with diverse scope and without close cooperation between different initiatives, the first aim of this paper is, on the basis of a review of commonly used theories and practices, to propose a mutual definition for the settings approach to health promotion. The second is to examine the applicability of the theoretical basis to youth sports club settings. Sports clubs are used as a reflective setting when reviewing the traditional ones.

Is physical activity associated with low-risk health behaviours among 15-year-old adolescents in Finland?

AIMS: To investigate the associations between physical activity and the pattern of risk health behaviour consisting of smoking, alcohol consumption, snuff (snus), cannabis, and condom use among 15-year-old adolescents, taking their educational aspirations and family affluence into account. METHODS: The data were collected in the Health Behaviour in School-aged Children (HBSC) study in Finland in 2006. Standardised questionnaires were issued at schools to a 15-year-old nationally representative sample, of which 84.5% (1710 pupils) participated. Logistic regression analysis was used to explore the associations between physical activity, pattern of risk health behaviour, family affluence, and educational aspirations. Separate models for daily moderate-to-vigorous physical activity (MVPA) and leisure-time physical activity (LTPA) were tested. Multi-level analysis was performed in order to control the nested characteristics of the data. RESULTS: Boys were significantly more physically active and used alcohol, cannabis, and snuff more often than girls. Girls had used a condom in their last intercourse less often than boys. The educational aspirations for higher education had the strongest association with the low-risk health behaviour, with the odds ratios in the MVPA model 3.30 (95% CI 2.41-4.55) for the boys and 3.46 (95% CI 2.56-4.67) for the girls. In the LTPA model, the corresponding odds ratios were 3.31 (95% CI 2.40-4.56) for the boys and 3.52 (95% CI 2.60-4.56) for the girls. CONCLUSIONS: Physical activity was not significantly associated with the low-risk health behaviour, whereas educational aspirations for higher education showed the strongest association. The results support the earlier studies indicating a social gradient in health-related behaviour already in adolescence.

Measuring Health Literacy in Basic Education in Finland: The Development of a Curriculum- and Performance-Based Measurement Instrument.

This paper describes the development of an objective curriculum- and performance-based health literacy (HL) measurement instrument to assess Finnish 9th graders' learning outcomes in the school subject termed Health Education (HE). There were four phases: (i) construction of the theoretical framework for the measurement, (ii) item generation, (iii) the field test (n = 252), and (iv) item analysis and item selection for the main study, in which 3652 ninth grade pupils (aged 15-16) participated. Initially, 303 HL test items were formulated, of which 107 were tested in two different field test versions. Both versions exhibited high reliability as measured by Cronbach's alpha coefficient. The main study contained 55 items. Testing and item analysis enabled the development of a comprehensive competence- and curriculum-based HL measurement instrument for school-aged children. Measurement of HL in schools provides information for national policies, and for developing HE as a school subject.

Test-retest reliability of selected items of Health Behaviour in School-aged Children (HBSC) survey questionnaire in Beijing, China.

BACKGROUND: Children's health and health behaviour are essential for their development and it is important to obtain abundant and accurate information to understand young people's health and health behaviour. The Health Behaviour in School-aged Children (HBSC) study is among the first large-scale international surveys on adolescent health through self-report questionnaires. So far, more than 40 countries in Europe and North America have been involved in the HBSC study. The purpose of this study is to assess the test-retest reliability of selected items in the Chinese version of the HBSC survey questionnaire in a sample of adolescents in Beijing, China. METHODS: A sample of 95 male and female students aged 11 or 15 years old participated in a test and retest with a three weeks interval. Student Identity numbers of respondents were utilized to permit matching of test-retest questionnaires. 23 items concerning physical activity, sedentary behaviour, sleep and substance use were evaluated by using the percentage of response shifts and the single measure Intraclass Correlation Coefficients (ICC) with 95% confidence interval (CI) for all respondents and stratified by gender and age. Items on substance use were only evaluated for school children aged 15 years old. RESULTS: The percentage of no response shift between test and retest varied from 32% for the item on computer use at weekends to 92% for the three items on smoking. Of all the 23 items evaluated, 6 items (26%) showed a moderate reliability, 12 items (52%) displayed a substantial reliability and 4 items (17%) indicated almost perfect reliability. No gender and age group difference of the test-retest reliability was found except for a few items on sedentary behaviour. CONCLUSIONS: The overall findings of this study suggest that most selected indicators in the HBSC survey questionnaire have satisfactory test-retest reliability for the students in Beijing. Further test-retest studies in a large and diverse sample, as well as validity studies, should be considered for the future Chinese HBSC study.

Haemoglobin, iron status and lung function of adolescents participating in organised sports in the Finnish Health Promoting Sports Club Study.

OBJECTIVES: To compare laboratory test results and lung function of adolescent organised sports participants (SP) with non-participants (NP). METHODS: In this cross-sectional study, laboratory tests (haemoglobin, iron status), and flow-volume spirometry were performed on SP youths (199 boys, 203 girls) and their NP peers (62 boys, 114 girls) aged 14-17. RESULTS: Haemoglobin concentration <120/130 g/L was found in 5.8% of SP and 5.1% NP (OR 1.20, 95% CI 0.54 to 2.68). Ferritin concentration below 15 µg/L was found in 22.7% of both SP and NP girls. Among boys ferritin <30 µg/L was found in 26.5% of SP and 30.2% of NP (OR 0.76, 95% CI 0.40 to 1.47). Among SP iron supplement use was reported by 3.5% of girls and 1.5% of boys. In flow-volume spirometry with bronchodilation test, 7.0% of SP and 6.4% of NP had asthma-like findings (OR 1.17, 95% CI 0.54 to 2.54); those using asthma medication, that is, 9.8% of SP and 5.2% of NP were excluded from the analysis. CONCLUSIONS: Screening for iron deficiency is recommended for symptomatic persons and persons engaging in sports. Lung function testing is recommended for symptomatic persons and persons participating in sports in which asthma is more prevalent.

Health promotion profile of youth sports clubs in Finland: club officials' and coaches' perceptions.

The purpose of this article is to examine the current health promotion orientation of youth sports clubs in Finland in view of the standards created previously for the health promoting sports club (HPSC). Ninety-seven youth sports clubs participated, and 273 sports club officials and 240 coaches answered the questionnaires. To describe clubs health promotion orientations, an HPSC index was created. The HPSC index was formulated on sub-indices by factor analysis. The sub-indices were: policy, ideology, practice and environment indexes. The results indicate that youth sports clubs are fairly health promoting in general. On average, the clubs fulfilled 12 standards for HPSC out of 22. Every fourth club was categorized as higher health promoting (> or = 15 fulfilled standards), and every third as lower health promoting (<11 fulfilled standards). The variation between clubs was wide. The clubs that had been recognized as exemplary and hence certified by the Young Finland Association were more likely to recognize health promotion than non-certified clubs (OR = 2.36, p = 0.016). The sports club officials were twice as likely to evaluate their clubs as higher health promoting than the coaches (OR = 2.04, p = 0.041). Under the sub-indices, ideologies were recognized best, others less. These findings indicate that minority of the youth sports clubs have realized health promotion comprehensively as a part of their activities. There is a lot of need for development, especially in the area of health promotion policies and practices. The instruments used proved valid and reliable and can therefore be recommended for international use.

Test-retest reliability of adolescents' self-reported physical activity item in two consecutive surveys.

BACKGROUND: National monitoring of school-aged physical activity (PA) behaviours is necessary to inform policy makers. The Finnish School-aged Physical Activity (FSPA - LIITU in Finnish) is a physical activity monitoring study, collecting data from young adolescents aged 11 to 15 years through a nationally representative sample. This study included a single self-reported item question on moderate to vigorous intensity physical activity (MVPA) from the preceding seven days. The question is used widely in the WHO Collaborative Cross-National Health Behaviour in School-aged Children (HBSC) study as a measure of meeting international PA recommendations. This study evaluated the test-retest reliability of the aforementioned MVPA item in two consecutive surveys while observing gender and age categorisation differences. METHODS: In this study, Finnish adolescents with mean ages of 11.5y, 13.5y and 15.5y (n = 2752) completed the HBSC and FSPA surveys in two 45 min class periods without a break in 2014. The HBSC survey completion mode was through pen and paper, and the FSPA study through a web-based questionnaire. The same MVPA question appeared in both surveys. Response alternatives (0-7 days per week) were grouped into four, and two categories in the analyses. Cohen's Kappa and ICC statistics were performed to test the intra-rater test-retest reliability of the measure. RESULTS: According to Cohen's Kappa, there was moderate agreement through the use of four (0.503) and two (0.599) categories, however, the proportion of adolescents that met the recommended daily 60 min of MVPA was 8% lower in the FSPA study than in the HBSC study (19% vs 27%). In addition, ICC for MVPA, as continuous variable (0-7 days) had good to excellent reliability (range 0.694-0.765) for boys and girls aged 13 to 15 years, but only fair (0.565) for boys aged 11. CONCLUSIONS: This study demonstrated that single item MVPA item was considered to have acceptable reliability of the measure for monitoring purposes of 13- and 15-year old boys, and 11y-, 13- and 15y-old girls meeting the international PA recommendations. There were differences in the prevalence in daily MVPA due to survey design.

Counselling for physical activity, life-space mobility and falls prevention in old age (COSMOS): protocol of a randomised controlled trial.

INTRODUCTION: The most promising way to promote active life years in old age is to promote regular participation in physical activity (PA). Maintaining lower extremity muscle function with good balance has been associated with fewer falls and the need of help from others. This article describes the design and intervention of a randomised controlled trial (RCT) investigating the effectiveness of a health and PA counselling programme on life-space mobility and falls rates in community-dwelling older adults at the Health Kiosk and/or Service Centre. METHODS AND ANALYSIS: Community-dwelling men and women (n=450) aged 65 years and over with early phase mobility limitation will be recruited to a 24-month RCT with a 24-month follow-up. Participants will be randomly allocated into either a health and PA counselling group (intervention) or relaxation group (control intervention). All participants will receive five group specific face-to-face counselling sessions and 11 phone calls. The counselling intervention will include individualised health counselling, strength and balance training, and guidance to regular PA. The control group will receive relaxation exercises. Outcomes will be assessed at baseline, 12, 24 and 48 months. Primary outcomes are average life-space mobility score and falls rates. Life-space mobility will be assessed by a validated questionnaire. Falls rates will be recorded from fall diaries. Secondary outcomes are data on fall-induced injuries and living arrangements, number of fallers, fracture risk, mean level of PA, physical performance, quality of life, mood, cognition, balance confidence and fear of falling. Data will be analysed using the intention-to-treat principle. Cost-effectiveness of the programme will be analysed. Ancillary analyses are planned in participants with greater adherence. ETHICS AND DISSEMINATION: Ethical approval was obtained from the Ethics Committee of the Tampere University Hospital (R15160). Outcomes will be disseminated through publication in peer-reviewed journals and presentations at international conferences. TRIAL REGISTRATION: ISRCTN65406039; Pre-results.

Musculoskeletal examination in young athletes and non-athletes: the Finnish Health Promoting Sports Club (FHPSC) study.

OBJECTIVES: To determine the inter-rater repeatability of a musculoskeletal examination and to compare findings between adolescent athletes and non-athletes in Finland. METHODS: In this cross-sectional study, a musculoskeletal examination assessing posture, mobility and movement control was carried out by a sports and exercise medicine physician on 399 athletes aged 14-17 years and 177 non-athletes. Within 2 weeks another sports and exercise medicine physician repeated the examination for 41 adolescents to test the inter-rater repeatability. RESULTS: In total, 10 of the 11 tests performed had at least moderate inter-rater reliability (κ ≥0.4 or percentage agreement >80%). Athletes more often than non-athletes had one shoulder protruded (8.0% vs 4.0%, OR 2.81, 95% CI 1.16 to 6.81). Forty-six per cent of athletes had good knee control in the two-legged vertical drop jump test compared with 32% of non-athletes (OR 1.99, 95% CI 1.29 to 3.06). Athletes had better core muscle control with 86.3% being able to remain in the correct plank position for 30 s compared with 68.6% of non-athletes (OR 2.70, 95% CI 1.67 to 4.36). In the deep squat test, good lumbar spine control was maintained only by 35.8% of athletes and 38.4% of non-athletes. CONCLUSION: A basic musculoskeletal examination is sufficiently reliable to be performed by trained physicians as a part of a periodic health evaluation. Shortfalls in mobility, posture and movement control are common in both athletes and non-athletes. These deficits could have been caused by sedentary behaviour, monotonous training, or both.