University students' sense of coherence, future worries and mental health: findings from the German COVID-HL-survey.

Early-on in the COVID-19 pandemic when universities were closed as part of the nation-wide public health response to the COVID-19 outbreak, studying and student life significantly changed. Based on limited evidence the aim of this study was to explore the relationship between sense of coherence (SoC), future worries and mental health outcomes among German university students during the early phase of the pandemic. A cross-sectional online survey with n = 14 916 participants was carried out by inviting all private and public universities in Germany. All data were analysed using univariate, bivariate and multivariate statistics. Findings indicate a low and very low wellbeing for 38% of university students. Moreover, 29% reported being affected by at least two health complaints more than once week. Both health outcomes follow a social gradient and could be more frequently observed for respondents with lower subjective social status and female students. Regression analysis revealed significant association between the SoC dimensions and wellbeing (OR: 1.2-2.03) as well as health complaints (OR: 1.58-1.71). A high level of future worries was associated with low/very low wellbeing (OR: 2.83) and multiple health complaints (OR: 2.84). Based on the results, the public health response to the pandemic and university health promotion should therefore consider student mental health as an important target within their policy and action frameworks.

[Health Literacy of People with and without Disabilities and Chronic Diseases in Germany: Results of the Study "German Health Update" 2014/2015-EHIS]. / Gesundheitskompetenz von Menschen mit und ohne Behinderung und chronischer Erkrankung in Deutschland: Ergebnisse der Studie "Gesundheit in Deutschland Aktuell" 2014/2015-EHIS.

BACKGROUND: People with disabilities and chronic diseases represent a population group in vulnerable circumstances, and often have difficulty finding, understanding, assessing, and applying health information. The aim of this study was to examine the health literacy of people doubly burdened with both disabilities and chronic diseases in comparison to two other groups, namely people with either disabilities or chronic diseases and people without impairment. MATERIAL AND METHODS: Our data is based on the representative survey "German Health Update" 2014/2015-EHIS. The sample consists of n=21,647 people, including 2,875 (13.3%) people with disabilities and chronic diseases, 7,598 people (35.1%) with disability or chronic diseases and 11,174 (51.6%) people without impairment. Health literacy was measured using the short form of the questionnaire of the European Health Literacy Survey (HLS-EU-Q16). Uni, bi- and multivariate analyses were conducted. RESULTS: 43.7% of respondents with both disabilities and chronic diseases had quite a lot difficulties in dealing with health information in comparison to people with disabilities or chronic diseases (37.7%) or those with no impairment (33.0%). People with double burdens had a 1.22-fold (CI: 1.10-1.35; p<0.001) and people with a single burden had a 1.08-fold (CI: 1.01-1.16; p=0.031) increased likelihood to find it difficult or very difficult to find, understand, evaluate and apply health-related information compared to people without impairment. CONCLUSION: The results show a gradient to the disadvantage of people with disabilities and/or chronic diseases. Health literacy among people with disabilities and/or chronic diseases should be adequately promoted in order to support their health, their participation as well as the quality and efficiency of and the reduction of barriers to access health care.

[Digital health literacy of pupils. Level and associations with physical activity and dietary behavior]. / Digitale Gesundheitskompetenz von Schülerinnen und Schülern. Ausprägung und Assoziationen mit dem Bewegungs- und Ernährungsverhalten.

BACKGROUND: While there are increasing empirical findings on general health literacy (HL), there is a lack of evidence on digital HL in adolescence and its association with health behavior. METHODS: A cross-sectional study of 490 students from grade eight and nine from the federal state of Hesse was conducted from October 2019 to February 2020. Digital HL was assessed using five subscales of the Digital Health Literacy Instrument (DHLI), while consumption of fruits, vegetables, and soft drinks as well as weekly physical activity were used as indicators of health behavior. In addition to gender and grade level, subjective social status (SSS) was used as a social characteristic. Univariate, bivariate, and multivariate analyses were performed, with binary-logistic regression adjusted for gender and SSS. RESULTS: Across all items, 15.3 to 37.5% of adolescents reported difficulties in acquiring and dealing with digital health information. Stratified by social characteristics, gender and socioeconomic differences were found with girls and respondents reporting a lower SSS more often showed a limited digital HL. Adolescents with moderate and low digital HL reported higher levels of low physical activity and non-daily fruit and daily soft drink consumption. DISCUSSION: The findings suggest a need for interventions to promote digital HL among adolescents, particularly for those of low SSS. In this context, the differential relationship patterns with health behaviors provide an avenue for the development of specific interventions. The school as a place of teaching and learning is a suitable setting because, among other things, of its fit with the mandatory strategy of media literacy education in schools.

Digital Health Literacy and Web-Based Information-Seeking Behaviors of University Students in Germany During the COVID-19 Pandemic: Cross-sectional Survey Study.

BACKGROUND: Digital communication technologies are playing an important role in the health communication strategies of governments and public health authorities during the COVID-19 pandemic. The internet and social media have become important sources of health-related information on COVID-19 and on protective behaviors. In addition, the COVID-19 infodemic is spreading faster than the coronavirus itself, which interferes with governmental health-related communication efforts. This jeopardizes national public health containment strategies. Therefore, digital health literacy is a key competence to navigate web-based COVID-19-related information and service environments. OBJECTIVE: This study aimed to investigate university students' digital health literacy and web-based information-seeking behaviors during the early stages of the COVID-19 pandemic in Germany. METHODS: A cross-sectional study among 14,916 university students aged ≥18 years from 130 universities across all 16 federal states of Germany was conducted using a web-based survey. Along with sociodemographic characteristics (sex, age, subjective social status), the measures included five subscales from the Digital Health Literacy Instrument (DHLI), which was adapted to the specific context of the COVID-19 pandemic. Web-based information-seeking behavior was investigated by examining the web-based sources used by university students and the topics that the students searched for in connection with COVID-19. Data were analyzed using univariate and bivariate analyses. RESULTS: Across digital health literacy dimensions, the greatest difficulties could be found for assessing the reliability of health-related information (5964/14,103, 42.3%) and the ability to determine whether the information was written with a commercial interest (5489/14,097, 38.9%). Moreover, the respondents indicated that they most frequently have problems finding the information they are looking for (4282/14,098, 30.4%). When stratified according to sociodemographic characteristics, significant differences were found, with female university students reporting a lower DHLI for the dimensions of "information searching" and "evaluating reliability." Search engines, news portals, and websites of public bodies were most often used by the respondents as sources to search for information on COVID-19 and related issues. Female students were found to use social media and health portals more frequently, while male students used Wikipedia and other web-based encyclopedias as well as YouTube more often. The use of social media was associated with a low ability to critically evaluate information, while the opposite was observed for the use of public websites. CONCLUSIONS: Although digital health literacy is well developed in university students, a significant proportion of students still face difficulties with certain abilities to evaluate information. There is a need to strengthen the digital health literacy capacities of university students using tailored interventions. Improving the quality of health-related information on the internet is also key.

[Trajectories of Self-rated Health in Secondary Education: Results from the German National Educational Panel Study]. / Entwicklung der selbstberichteten Gesundheit über die Sekundarstufe: Ergebnisse des Nationalen Bildungspanels.

AIM OF THE STUDY: Self-rated health is an important indicator of current and future health. However, panel data-based findings are lacking that take into consideration the background features of differentiated development of self-reported adolescent health. This paper examines the development of self- rated health through secondary education from grade 5-12 in Germany, analyzing differences according to indicators of socio-economic position and other background characteristics such as gender and family structure. METHODOLOGY: 5th to 10th grade data from the "Class 5" cohort and 9th to 12th grade data from the "9th grade" cohort of the National Education Panel were combined. Growth curve models based on multi-level analysis were used to examine the level and course of self-rated health and to examine differences according to type of school, parenting, household income, gender and family structure. The final model contains 28,987 observations from 11,290 individuals over 8 time points. RESULTS: Self-reported health declines slightly from 5th to 12th grade. Adolescents attending high school, living in higher-income households or parents with higher education status reported better health. Boys and adolescents growing up in nuclear families showed a more favorable course of self-rated health through secondary education. CONCLUSION: This study provides a comprehensive overview of the development of self-rated health of adolescents in secondary education. In addition to the static differences according to background characteristics, girls and adolescents who do not live in nuclear families also had a worse prognosis for the development of self-rated health over the school career.

[Mental Health of Children and Adolescents with and without Disabilities and Health-related Impairment: Results of the Representative German Child and Adolescent Health Survey (KiGGS Wave 2)]. / Psychische Gesundheit von Kindern und Jugendlichen mit und ohne Behinderung und krankheitsbedingter Einschränkung: Ergebnisse der repräsentativen Kinder- und Jugendgesundheitsstudie (KiGGS Welle 2).

BACKGROUND AND OBJECTIVE: Children and adolescents with disabilities and health-related impairment belong to a vulnerable population group. There are only few German findings on mental health that distinguish between children and adolescents with and without disabilities and health-related impairment. MATERIALS AND METHODS: Data were used from the German KiGGS Wave 2 of the Robert Koch-Institute from 2014-2017. A total of 11,830 children and adolescents aged 3-17 years were included using the parent perspective and 5,222 children and adolescents between 11-17 years using their self-assessments. Mental health outcomes were mental health problems (SDQ, parental assessment) and health-related quality of life (kidscreen, self-assessment). Univariate and bivariate analyses were conducted using cross-tables with Chi square tests and multivariate analyses using binary logistic regression models. RESULTS: In 16.5% of children aged 3-17 years, parents reported mental health problems; 48.4% of the interviewed children and adolescents aged 11-17 years reported a low health-related quality of life. Children with disabilities and health-related impairment had a significantly higher probability of mental health problems (OR: 5.11) and a low health-related quality of life (OR: 1.50). CONCLUSION: The findings suggest a need for action to strengthen mental health in children and adolescents with disabilities and/or health-related impairment. In this context, the educational settings of kindergarten and school are of great importance.

[The Importance of the "Big Five" Personality Traits for Subjective Health and Life Satisfaction in Adolescence: Results of the National Educational Panel Study (NEPS)]. / Die Bedeutung der "Big Five"-Persönlichkeitsmerkmale für die subjektive Gesundheit und Lebenszufriedenheit im Jugendalter: Ergebnisse des Nationalen Bildungspanels (NEPS).

BACKGROUND: The role of personality traits in self-rated health and well-being of adolescents has barely been studied in Germany so far. The aim of this study was to analyze the association between the Big Five personality traits and self-reported health as well as life satisfaction of adolescents in Germany. METHODS: The study data are based on the National Educational Panel Study (NEPS), starting cohort 3 (wave 3, 2012). This sample includes (n=5,440) 7th grade adolescents in regular schools. Personality traits were measured by the Big Five-Inventory (BFI-10): Extraversion, Agreeableness, Conscientiousness, Neuroticism, Openness. Statistical analyses were carried out using bivariate methods and binary-logistic multilevel models, taking into account individuals nested in school classes and schools. RESULTS: Adolescents with pronounced neuroticism had a higher risk of both poor self-rated health (OR: 1.33) and low life satisfaction (OR: 1.46). In contrast, adolescents with high levels of conscientiousness had a reduced risk of poor health (OR: 0.72) and low life satisfaction (OR: 0.59). High levels of extraversion (OR: 0.78) and agreeableness (OR: 0.72) also correlated with higher life satisfaction, but not with better self-reported health. The characteristic of openness was not associated with either self-reported health or the life satisfaction of adolescents. CONCLUSION: The results suggest that certain personality traits, namely the Big Five can be important indicators of health and life satisfaction of adolescents in early adolescence. However, further studies are needed to assess the link between the Big Five and its generalizability to other age groups.

[Gradients in Mental Health and Health Consciousness by the Degree of Disabilities - Results from representative GEDA-Survey in Germany]. / Behinderungsspezifischer Gradient in der psychischen Gesundheit und dem Gesundheitsbewusstsein.

PURPOSE: People with disabilities belong to a vulnerable population group, especially with regard to their economic and health situation. In the social-epidemiological research, hardly any studies on mental health and health awareness among people with disabilities are available using representative data, in particular not differentiated according to their degree of disability (DoD). Therefore, the aim of this study is to investigate 1) differences in mental health and health awareness between people with disabilities compared to people without disabilities. In addition, the study 2) shows differences mental health outcomes and health awareness, differentiated according to the DoD. METHODS: Data is used from the representative study "Gesundheit in Deutschland Aktuell (GEDA) 2012" (N=19,294). Outcomes were self-reported health, health awareness, depression or depressive mood, mental discomfort, vitality and psychological well-being. The exposure variable used was the recognized disability (DoD≥50 vs. DoD<50 vs. no disability). Univariate and bivariate analyses were conducted using cross-tables and multivariate analyses using binary logistic regression models, controlled for socio-demographic, economic and health-related features. RESULTS: People with disabilities often rate their mental health worse than people without disabilities. The bi- and multivariate analyses revealed a disability-specific gradient for all outcome measures according to the DoD (p<0,001). People with disabilities had a significantly higher likelihood of poor mental health compared to people without disabilities. People with severe disabilities (DoD≥50) had a more than 4,6-fold increased likelihood risk of poor self-reported health and 2,5-fold likelihood of depression or depressed mood compared to people without disabilities. A high level of health awareness was more prevalent in PWD than in those without disabilities. CONCLUSION: The study highlights that People with disabilities more frequently reported mental health problems than people without disabilities. Targeted measures are necessary, which address in particular the target group of the people with disabilities. There is further need to strengthen access to health services and programs, assistive technologies and support services, and to make health of people with disabilities to the subject of research and health promotion in line with the WHO Action Plan on "Better health for all people with disabilities" (2014-2021).

Psychosoziale Arbeitsbedingungen und Burnout-Symptome in der stationären somatischen und psychiatrischen Gesundheits- und Krankenpflege.

Psychosocial working conditions and symptoms of burnout in somatic and psychiatric nursing Abstract. Background: While mental workload and stress among nurses are generally well-documented, differences within the nursing profession have hardly been investigated so far. Aim: This study aims to examine the differences and associations between psychosocial working conditions and symptoms of burnout of nurses working in somatic and psychiatric settings. Methods: A cross-sectional study has been conducted with employees in one somatic and one psychiatric hospital (n = 576). The Copenhagen Psychosocial Questionnaire and the Copenhagen Burnout Inventory were used to assess psychosocial workloads and burnout symptoms. The data analysis was carried out by univariate, bivariate and multivariate (regression) analyses. Results: About 50 % of respondents report at least a moderate level of symptoms of burnout with somatic nurses more frequently affected. While quantitative and physical demands are higher in somatic nursing, psychiatric nurses have a higher degree of emotional demands, socialß = 0.33) in somatic nursing and emotional demands (ß = 0.29) in psychiatric nursing serve as strongest predictors of burnout symptoms. Conclusions: Findings suggest specific profiles of psychosocial workload in somatic and psychiatric nursing as well as a high need for differentiated approaches for occupational health promotion.

Trajectories of students' well-being in secondary education in Germany and differences by social background.

BACKGROUND: Subjective well-being (SWB) is an important indicator of quality of life, but prior research mostly analyzed adolescents' subjective well-being in cross-sectional studies. There is a lack of studies examining changes in subjective well-being throughout adolescence using longitudinal panel data. This study examined trajectories of subjective well-being of adolescents in Germany throughout secondary education and differences by socioeconomic position, gender and family structure. METHODS: We use the German National Educational Panel Study and combine data from annual survey waves of two of its cohorts. These were first surveyed in 2010 and cover 5th to 10th and 9th to 12th grade level. Using growth curve modelling based on multilevel models, differences in levels and trajectories of subjective well-being overall and differentiated by school type, parental education, household income, gender and family structure were identified. The analyses include 34 504 observations of 12 564 students. RESULTS: Subjective well-being decreased from 5th to 12th grade. Students attending lower track schools showed lower subjective well-being, but also a lesser decrease over time. Students living in low-income households or in single-parent or step-families showed lower subjective well-being. Female students showed higher subjective well-being than males in 5th grade, but also a higher decrease over time, leading to lower subjective well-being than males by 12th grade. CONCLUSION: This study provides a comprehensive picture of subjective well-being throughout secondary education. Adolescents' subjective well-being is linked to social factors regarding family and living conditions as well as school features. Overall, disadvantaged adolescents experience longer periods of lower subjective well-being, thus accumulating the effects of worse psychosocial health opportunities over time.

Is being a "small fish in a big pond" bad for students´ psychosomatic health? A multilevel study on the role of class-level school performance.

BACKGROUND: Features of schools and classes are closely related to students´ health and wellbeing. However, class composition (e.g. in terms of school performance) has rarely been examined in relation to students´ health and wellbeing. This study focuses on the so called Big-Fish-Little-Pond-Effect (BFLPE), by investigating whether the level of high-performing students in classroom is negatively associated with psychosomatic complaints of students who perceive themselves as poor performers. METHODS: Data were derived from the German sample of the WHO-Collaborative "Health Behaviour in School-aged Children (HBSC)" study 2013/2014. The sample included 5226 11-, 13- and 15-year-old students. Individual perceived school performance (PSP) was included (very good/good vs. average/below average PSP) at the individual student-level. At the class-level, school performance in class was generated by aggregating the share (in percentage) of students who report a very good/good PSP to the class-level, indicating the percentage of students with good/very good PSP in classroom. Using multilevel regression models, the association between class-level school performance (in percentage of students with very good/good PSP) and individual psychosomatic complaints were analyzed, stratified by students´ individual PSP. RESULTS: Students who report average/below average PSP showed higher likelihoods of psychosomatic complaints (Odds Ratio: 1.75; 95% Confidence Interval: 1.52-2.03) compared to counterparts with very good/good PSP. The aggregated class-level PSP was not significantly associated with psychosomatic complaints. However, in line with the BFLPE, results further revealed that students with average/below average PSP, who attend classes with a higher percentage of students who report very good/good PSP, had higher likelihoods of psychosomatic complaints (Odds Ratio: 1.91; 95% Confidence Interval: 1.01-4.01) compared to classmates with very good/good PSP. CONCLUSIONS: This study revealed that class composition in terms of PSP was differentially associated with students´ psychosomatic complaints, depending on their individual PSP. Findings highlight the vulnerability of students with poor PSP placed in classes with a higher percentage of students with good PSP. Results of this study therefore indicate a need for initiatives for low performing students from teachers and school staff in class.

Perceived school climate, academic well-being and school-aged children's self-rated health: a mediator analysis.

Background: Schools are crucial settings for young people's development. Rare studies have examined the impact of perceived school-climate and academic well-being on young people's self-rated health in joint analyses. This study focuses on the role of perceived school-climate and academic well-being for young people's self-rated health and examines whether school climate is mediated by indicators of academic well-being. Methods: Data were obtained from the German National Educational Panel Study, including seventh grade students (n = 6838) aged 11-12, nested in 710 classes within 277 schools. Indicators of school climate (teacher control, demands, autonomy, interaction, goal setting and orientation, teaching quality) and academic well-being (satisfaction with school, helplessness in major school subjects) were reported from students. Multilevel modelling was used to analyze the relative importance of perceived school-climate and academic well-being on school-aged children's self-rated health. Results: Results showed that academic well-being is strongly related to self-rated health. The better students perceive their academic well-being, the lower the likelihood of poor self-rated health. In contrast, indicators of perceived school climate are only indirectly related to self-rated health, mediated by academic well-being or are not at all associated with self-rated health. Conclusions: This study suggests that school climate is important for academic well-being but not as important for students' self-rated health as academic well-being. Health promotion initiatives in schools have to ensure that school climate serves to enhance students' academic well-being to avoid health problems in the long-run.

[Social Determinants of Subjective Health, Life Satisfaction and Absence From School due to Illness Among Adolescents: First results of the German National Educational Panel Study (NEPS)]. / Soziale Determinanten der subjektiven Gesundheit, Lebenszufriedenheit und krankheitsbedingten Schulfehltage von Heranwachsenden in Deutschland: Erste Ergebnisse des Nationalen Bildungspanels (NEPS).

The aim of this study is to examine the impact of social determinants on subjective health, life satisfaction and absence from school due to illness among adolescents in secondary schools, by using data from the German National Educational Panel Study (NEPS).Data was obtained from the National Educational Panel Study (NEPS). The sample included (n=5 790) 6th grade pupils in regular schools in 2011 (Starting Cohort 3, Wave 2). The socioeconomic background of adolescents was measured by pupils' school type as well as household income and parental education level. Family structure and gender were considered as additional social determinants in the analyses. Bivariate and multiple logistic regression techniques were applied.The results show that type of school and low household income were related to poor subjective health among students. Life satisfaction varied by family structure and school type. For absence from school due to illness, we found a weak association with students in low track schools.The results indicate that especially the school type had the most important impact on subjective health, life satisfaction and absence from school due to illness. Health promotion and preventive strategies should particularly focus on pupils in low track schools and in relation to socially unequal distribution of educational opportunities also on young people from households with low socioeconomic status.

[Class Climate, Academic Well-Being and Self-Rated Health Among School Children in Germany: Findings of the National Educational Panel Study (NEPS)]. / Klassenklima, schulisches Wohlbefinden und Gesundheit von Schülerinnen und Schülern in Deutschland: Ergebnisse des Nationalen Bildungspanels (NEPS).

OBJECTIVES: The aim of this study was to examine the associations between features of class climate and school wellbeing, based on self-rated health and reports of absence from school due to illness among adolescents in secondary schools, by using data from the German National Educational Panel Study (NEPS). METHODS: Data was obtained from the National Educational Panel Study (NEPS). The sample includes (n=7,348) seventh grade students in regular schools (Starting Cohort 3, Wave 3, 2012). Measures of class climate comprise indicators about demands, control and orientation, autonomy and interaction among students as well as teaching quality in German language class. School wellbeing was measured by satisfaction with school and helplessness in main school subjects. Bivariate and logistic multilevel logistic regression techniques are applied, by controlling for student age, gender and school type attended. RESULTS: Multilevel results showed that particularly among students with higher school satisfaction, there was a higher likelihood of self-rated health and less school absence due to illness. In contrast, perceived helplessness in major subjects and learning orientation were negatively associated with both outcomes. Further, students attending low track schools had a higher risk of school absence than students in high track schools. CONCLUSION: The results highlight the fact that particularly students' school wellbeing in terms of school satisfaction and perceived helplessness in the subjects German and mathematics are associated with self-rated poorer health and school absence due to illness. Therefore, health promotion initiatives should particularly focus on students' school wellbeing as well as on students attending low track schools.

[Trends in educational inequalities in smoking among adolescents in Germany : Evidence from four population-based studies]. / Zeitliche Entwicklung von Bildungsunterschieden im Rauchverhalten von Jugendlichen in Deutschland : Ergebnisse aus vier bevölkerungsweiten Studien.

BACKGROUND: In Germany, smoking prevalence among adolescents has significantly declined since the early 2000s. However, data show that adolescent smoking rates considerably differ between different types of secondary schools. The aim of our study was to examine how educational inequalities in adolescent smoking behaviour have developed over time. METHODS: Data were used from four population-based studies (each consisting of repeated cross-sectional surveys from 2001-2015): the representative surveys of the Federal Centre for Health Education, the German Health Interview and Examination Survey for Children and Adolescents, the Health Behaviour in School-aged Children Study, and the European School Survey Project on Alcohol and Other Drugs. Each study comprised different age groups (within the age range of 11-17 years) and used different smoking measures. Adolescents' educational status was based on the attended type of secondary school. Absolute and relative educational inequalities were presented as prevalence differences and prevalence ratios, respectively. RESULTS: Despite methodical differences, all four studies similarly reveal that adolescent smoking rates have significantly declined in all educational groups. However, lower smoking rates among secondary school students attending higher educational tracks could be observed. While absolute educational inequalities tended to decrease over time, relative inequalities between educational groups remained rather stable or even increased. DISCUSSION: Declining adolescent smoking rates suggest that smoking may have lost some of its attractiveness for young people. Our findings further emphasize the importance of tobacco control measures such as raising cigarette taxes, smoking bans, and increasing minimum legal age for tobacco purchase. As relative educational inequalities in adolescent smoking rates did not diminish over time, setting- and target group-specific interventions should focus more on students in middle and lower secondary school tracks.

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.

Individual and contextual determinants of perceived peer smoking prevalence among adolescents in six European cities.

BACKGROUND: Young people perceiving a high peer smoking prevalence are more likely to initiate smoking. It is unclear which factors contribute to perceived peer smoking prevalence and if these factors vary according to education. This study aimed to assess the determinants of perceived smoking prevalence and assessed its variation at school and country-level. METHODS: Data of 10,283 14-17-year-old students in 50 secondary schools in six European cities were derived from the 2013 SILNE survey. The outcome was the perceived smoking prevalence score among peers at school (0-10 scale, 10 represented 100% smoking prevalence). Multilevel linear regression models estimated the associations of factors with perceived prevalence score and variance at school and country-levels. Analyses were also stratified by academic achievement of the adolescent and parental education. RESULTS: Determinants of a higher perceived prevalence score were female sex, ever smoking, having friends who smoke, low academic achievement, low parental educational level, and higher actual prevalence of smoking in the school. The perceived prevalence score was not associated with school policies or with the availability of cigarettes near the school. Determinants were very similar across levels of academic achievement and parental education. Perceived prevalence scores substantially varied between schools and countries: 10% and 11% of total variance was related to schools and countries respectively. CONCLUSION: Across educational levels, perceptions of peer smoking are strongly determined by both individual characteristics and school and national contexts. Future studies should assess why perceived smoking prevalence varies between schools and countries and identify modifiable factors.

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.

Academic well-being and smoking among 14- to 17-year-old schoolchildren in six European cities.

It is well established that poor academic performance is related to smoking, but the association between academic well-being and smoking is less known. We measured academic well-being by school burnout and schoolwork engagement and studied their associations with smoking among 14- to 17-year-old schoolchildren in Belgium, Germany, Finland, Italy, the Netherlands, and Portugal. A classroom survey (2013 SILNE survey, N = 11,015) was conducted using the Short School Burnout Inventory and the Schoolwork Engagement Inventory. Logistic regression, generalized linear mixed models, and ANOVA were used. Low schoolwork engagement and high school burnout increased the odds for daily smoking in all countries. Academic performance was correlated with school burnout and schoolwork engagement, and adjusting for it slightly decreased the odds for smoking. Adjusting for socioeconomic factors and school level had little effect. Although high school burnout and low schoolwork engagement correlate with low academic performance, they are mutually independent risk factors for smoking.