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.

Associations between adolescents' energy drink consumption frequency and several negative health indicators.

BACKGROUND: The purpose of this study was to identify how various negative health indicators are associated with energy drink consumption frequency among 13- and 15-year-old Finnish adolescents. METHODS: Data (N = 2429) from the nationally representative international Health Behaviour in School-aged Children study (2018) were analyzed via descriptive analysis and logistic regression analyses, with control for salient covariates. Relative risks (RR) were derived from the adjusted odds ratios. RESULTS: Even infrequent energy drink consumption was associated with various negative health indicators. Moreover, as compared to non-users, frequent energy drink consumers were more likely to report several health-compromising behaviors: current smoking (RR = 9.85, 95% CI: 5.68-16.02), current snus use (RR = 3.62, 95% CI: 1.80-6.85), cannabis use (RR = 3.42, 95% CI: 1.69-6.52), alcohol consumption (RR = 3.08, 95% CI: 2.49-3.71), problematic social media use (RR = 2.53, 95% CI:1.68-3.72), short sleep (RR = 2.12, 95% CI: 1.69-2.60), skipping breakfast (RR = 1.87, 95% CI: 1.51-2.29), drunkenness (RR = 1.59, 95% CI: 1.11-2.23), inadequate tooth brushing (RR = 1.28, 95% CI: 1.05-1.54). In addition, frequent energy drink consumption was associated with perceived negative health indicators: feelings of insufficient sleep (RR = 1.56, 95% CI: 1.11-2.15), low self-rated health (RR = 1.48, 95% CI: 1.15-1.87), and multiple health complaints (RR = 1.31, 95% CI: 1.07-1.56). CONCLUSIONS: Energy drink consumption, even infrequent, was associated with several negative health indicators, and the reporting of these increased with the frequency of energy drink consumption. The findings support the concerns of health authorities regarding the negative associations between energy drink consumption and health, even among persons as young as 13 years. There is evidence to support specific policy level actions, including restrictions on the sale of energy drinks to adolescents. This measure has been proposed in a Finnish government program, but implementation has yet to occur. Moreover, marketing of these beverages in platforms that are popular among adolescents (e.g., the social media) should be rigorously evaluated, and comprehensive interventions and actions implemented to ensure that adolescents, parents/guardians, and professionals working with adolescents (e.g., in schools) have a good understanding of the links between energy drink consumption and health.

Loneliness, subjective health complaints, and medicine use among Finnish adolescents 2006-2018.

AIMS: Loneliness is an important public health challenge for all ages. This study reports time trends of loneliness among adolescents over a 12-year period and analyses the strength of the associations between loneliness, health complaints, and medicine use. METHODS: Data were derived from the cross-sectional Finnish Health Behaviour in School-aged Children study conducted in 2006, 2010, 2014, and 2018. The study population is based on a random sample of schools with 20,444 participants aged 11-15 years. The trends were analysed with a Mantel-Haenszel test, and the strength of the associations was evaluated by mixed-effects logistic and linear regressions. RESULTS: An increasing prevalence in frequent loneliness (2006: 11%; 2018: 15%) was evident over the 12-year study period, especially in girls and 15-year-olds. Among all adolescents, loneliness was associated with a higher risk of recurrent health complaints and medicine use to treat the corresponding health issues, especially nervousness (odds ratio 5.8) and sleeping difficulties (odds ratio 7.6). CONCLUSIONS: Adolescence is a period of higher risk of frequent loneliness and associated health complaints. In this study, loneliness was common among adolescence and an increasing trend of loneliness was observed between 2006 and 2018. Also, psychosomatic health complaints and medicine use were strongly associated with loneliness. Persistent loneliness is a significant health risk and failure to resolve loneliness before entering adulthood may imply significant concerns for future well-being.

Energy Drink Consumption Among Finnish Adolescents: Prevalence, Associated Background Factors, Individual Resources, and Family Factors.

Objectives: Energy drink consumption among adolescents has become a notable global phenomenon, and has been associated with numerous negative health outcomes. In order to understand the popularity of energy drinks among adolescents, and to target interventions, it is important to identify the determinants underpinning consumption. Methods: The nationally representative data (cross-sectional) were drawn from the Health Behaviour in School-aged Children (HBSC) surveys, conducted in 2014 and 2018, each comprising 13- and 15-year-old Finnish adolescents (n = 7405). Results: Weekly energy drink consumption increased among Finnish adolescents between 2014 (18.2%) and 2018 (24.4%), especially among girls. In 2018, boys typically consumed more than girls, and 15-year-olds more than 13-year-olds. Moreover, in 2018, weekly energy drink consumption was more prevalent among 15-year-old adolescents with a non-academic educational aspiration (46.0%) than among adolescents with an academic aspiration (18.3%). Gender (boys more than girls), older age (only in 2018), less parental monitoring, lower school achievement, and a lower level of health literacy explained around 28% of the variance in weekly energy drink consumption in both years. Conclusion: According to the findings, interventions to decrease the energy drink consumption, should be targeted at all adolescents, but especially at those with fewer individual resources. The interventions should also pay attention to family-level factors.

Problematic Social Media Use and Health among Adolescents.

(1) Background: The use of social media has become an integral part of adolescents' daily lives. However, the intensive use of social media can develop into a health-threatening addiction, but unfavourable health consequences can occur even with less use. Social media user groups categorized as no-risk, moderate risk (of developing problematic behaviour), and problematic use were examined with reference to their prevalence, their associations with individual determinants and health, and the increased health risk between groups. (2) Methods: The Finnish nationally representative HBSC data (persons aged 11, 13, and 15, n = 3408) and descriptive and binary logistic regression analysis were applied. (3) Results: Problematic social media use (9.4%) was most common among older age groups, and among persons with moderate/low school achievement, low health literacy, and low parental monitoring. Belonging to a moderate risk group (33.5%) was most frequent among girls, and among adolescents with low/moderate parental monitoring and health literacy. All the negative health indicators systematically increased if the respondent belonged to a moderate risk or problematic use group. (4) Conclusions: The study confirmed the association between problematic social media use and negative health outcomes and highlighted the need to pay close attention to adolescents at moderate risk who exhibited negative health outcomes.

Does health literacy explain regional health disparities among adolescents in Finland?

Health literacy (HL)-as a broad range of health-related competencies-has been proposed to be a promising construct in understanding health disparities better, also among adolescents. Several factors have been found to explain differences in adolescents' HL levels; however, not much is known about how different regions of a country or majority/minority status is associated with HL, or whether HL is associated with regional health disparities. The aim of this study was to examine and compare HL and health levels among majority- and minority-language-speaking adolescents living in different regions of Finland, and to explore if HL explains regional health disparities, taking into account other important structural stratifying factors. The study uses Health Behaviour in School-aged Children survey data, collected among 13- and 15-year-old pupils in Finnish- and Swedish-speaking schools in Finland in 2014 (N = 3853/1123; 85/83%). Findings suggest that regional differences in HL levels and regional health disparities exist in both language groups. Health disparities were present in the Finnish-speaking sample among boys, the proportion rating their health as excellent ranging from 23 to 31% across regions, and in the Swedish-speaking sample among girls, the corresponding numbers ranging from 13 to 20%. In addition to other important structural stratifying factors, comprehensive HL explains these regional health disparities. This study adds to prior studies on the role of HL as a modifiable health resource by showing that regional health disparities among adolescents can partially be attributed to corresponding HL differences.

How Are Adolescents Sleeping? Adolescent Sleep Patterns and Sociodemographic Differences in 24 European and North American Countries.

PURPOSE: Insufficient and poor sleep patterns are common among adolescents worldwide. Up to now, the evidence on adolescent sleep has been mostly informed by country-specific studies that used different measures and age groups, making direct comparisons difficult. Cross-national data on adolescent sleep that could inform nations and international discussions are lacking. We examined the sleep patterns of adolescents across 24 countries and by gender, age, and affluence groups. METHODS: We obtained sleep data on 165,793 adolescents (mean age 13.5 years; 50.5% girls) in 24 European and North American countries from the recent cross-sectional Health Behaviour in School-aged Children surveys (2013-2014 and 2017-2018). For each country, we calculated the age-standardized mean in sleep duration, timing, and consistency and the proportions meeting sleep recommendations on school and nonschool days from self-reported bedtimes and wake times. We conducted stratified analyses by gender, age, and family affluence group. RESULTS: Adolescent sleep patterns varied cross-nationally. The average sleep duration ranged between 7:47 and 9:07 hours on school days and between 9:31 and 10:22 hours on nonschool days, and the proportion of adolescents meeting sleep recommendations ranged between 32% and 86% on school days and between 79% and 92% on nonschool days. Sleep patterns by gender and affluence groups were largely similar, but older adolescents slept less and went to bed later on school days than younger adolescents in all countries. CONCLUSIONS: The sleep patterns of adolescents vary across countries and sociodemographic groups. Insufficient sleep on school days is common in many countries. Public health and policy efforts to promote healthy adolescent sleep are encouraged.

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.

Health asset profiles and health indicators among 13- and 15-year-old adolescents.

OBJECTIVES: We examined the associations between adolescents' health assets and various health indicators (smoking, alcohol use, sleep length, physical activity, healthy eating, oral health, self-reported health, multiple health complaints). METHODS: A nationally representative sample was drawn from Finnish-speaking schools, comprising 13- and 15-year-old adolescents (n = 3833). The measures taken covered the adolescents' health assets, which were labelled Family-financial, Psychological, Family-social, Friends-social, School-social, and Human. Our analysis applied two-step cluster analysis and multilevel mixed-effects binary logistic regression. RESULTS: Six asset profiles were identified: 'Limited in most assets, despite medium affluence', 'Mostly average assets, but low affluence', 'Mostly average assets, though high affluence', 'Mostly above average assets', 'Rich in most assets', and 'Rich in all assets'. There were significant differences between the profiles in terms of risk level and desirable level health outcomes. CONCLUSIONS: Adolescents differ in their asset profiles. Having multiple health assets appears to protect adolescents from risky behaviour or poor health, and to promote positive health. There is a need for health initiatives to develop a range of health-protecting and health-promoting assets, rather than focus on only one.

Leisure-time physical activity and participation in organized sports: Changes from 1985 to 2014 in Finland and Norway.

Participation in organized sports is a popular and important part of the lives of children and adolescents and is associated with improved psychological and social health, as well as an increased likelihood of meeting physical activity (PA) recommendations. Changes in modern society, including increased car ownership and use of technology and electronic media, have led to an additional focus on the importance of health-enhancing PA among children and adolescents. The aim of this article was to study the secular changes in self-reports of participation in organized sports clubs and leisure-time vigorous physical activity (LVPA), and whether the relationship between participation in organized sports clubs and LVPA has changed from 1985 to 2014. Questionnaire data were collected in two cross-sectional samples of Finnish and Norwegian 11-, 13- and 15-year-olds in 1985/1986 (n = 7137) and 2014 (n = 9218). Overall, participation in organized sports clubs and level of LVPA appears to have changed in the same direction in the two Nordic countries. The proportion of 11-year-olds reporting to be participants in organized sports clubs increased from 1985/1986 to 2014. There was an overall increase in self-reported LVPA. The association between participation in sports clubs and LVPA was stronger in 2014 than in 1985/1986. The findings indicated subgroup differences, in particular with regard to a steeper increase in LVPA and participation in sports clubs among Finnish girls. We suggest that attention should be given to the role of organized sports to better understand secular changes in PA.

Does Sleep Mediate the Association between School Pressure, Physical Activity, Screen Time, and Psychological Symptoms in Early Adolescents? A 12-Country Study.

This study examines the mediating role of sleep duration and sleep onset difficulties in the association of school pressure, physical activity, and screen time with psychological symptoms in early adolescents. Data were retrieved from 49,403 children (13.7 ± 1.6 years old, 48.1% boys) from 12 countries participating in the World Health Organization (WHO) "Health Behaviour in School-aged Children" 2013/2014 study. A validated self-report questionnaire assessed psychological symptoms (feeling low, irritability or bad temper, feeling nervous), school pressure, physical activity (number of days/week 60 min moderate-to-vigorous), screen time, sleep duration on week- and weekend days, and perceived difficulties in getting asleep. Multilevel mediation analyses were conducted. School pressure and screen time were positively associated with psychological symptoms, whereas physical activity was negatively associated. With the exception of sleep duration in the association between physical activity and psychological symptoms, all associations were significantly mediated by sleep duration on week- and weekend days and sleep onset difficulties. Percentages mediated ranged from 0.66% to 34.13%. This study partly explains how school pressure, physical activity, and screen time are related to adolescents' psychological symptoms. Future interventions improving adolescents' mental well-being could target schoolwork, physical activity, and screen time, as these behaviours are directly and indirectly (through sleep) related to psychological symptoms.

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.

Does health literacy explain the link between structural stratifiers and adolescent health?

BACKGROUND: The concept of health literacy (HL) may help us to better understand the mechanisms leading to health disparities, and to focus on the factors that can be influenced. However, not much is yet known about how HL is related to health disparities, or whether the association exists among adolescents. The aim of the study was to examine the associations between structural stratifiers, HL and health indicators among adolescents. METHODS: The nationally representative Finnish Health Behaviour in School-aged Children survey data (n=3833) were collected from 13- and 15-year-old pupils in the spring of 2014. Pearson correlation coefficients were calculated, and separate path models were estimated for the perceived health and health behaviour measures. RESULTS: HL was found to be an independent factor explaining disparities in health. Higher HL was related to positive health outcomes. HL also acted as a mediator between health behaviours and structural stratifiers, except for gender. School achievement and educational aspirations were among the factors explaining the HL level, which in turn, explained the health indicators. CONCLUSION: The concept of HL is of use in understanding health disparities. In particular, HL provides a mechanism via which school achievement and educational plans affect health outcomes. Low HL places adolescents who have poor school achievement and who do not intend to continue on an academic path in an unequal position with respect to their health.

Trends in sleeping difficulties among European adolescents: Are these associated with physical inactivity and excessive screen time?

OBJECTIVES: We examined changes in sleep-onset difficulties over time and associations with physical activity and screen time behavior among adolescents. METHODS: We used data from last four survey waves of the Health Behavior in School-Aged Children (HBSC) study (2002-2006-2010-2014). Multilevel logistic regression analyses were conducted to explore associations between regular sleeping difficulties, excessive screen time exposure and being insufficiently physically active (i.e., < 60 min daily) among 33 European and non-European countries. RESULTS: Findings indicate an increase in the prevalence of sleep-onset difficulties and in excessive screen time exposure and a small but significant increase in physical activity levels. Additionally, adolescents exceeding 2-h daily screen time had 20% higher odds of reporting sleep-onset difficulties, while no association was found for physical activity. The strength of the association between screen time and sleep-onset difficulties increased over time, which may reflect a change in type of screen time use (e.g., the increased use of easy accessible screens such as smartphones and tablets). CONCLUSIONS: Effective strategies to reduce screen time are key to reverse the detrimental trend in sleep-onset difficulties among adolescents.

Prevalence of self-reported chronic pain among adolescents: Evidence from 42 countries and regions.

BACKGROUND: Reports of the overall chronic pain prevalence and its associated demographic characteristics among adolescents vary greatly across existing studies. Using internationally comparable data, this study investigates age, sex and country-level effects in the prevalence of chronic single-site and multi-site pain among adolescents during the last six months preceding the survey. METHODS: Data (n = 214,283) from the 2013/2014 Health Behaviour in School-aged Children (HBSC) study were used including nationally representative samples of 11-, 13- and 15-year-olds from general schools in 42 participating countries. Multilevel logistic regression analyses were used. RESULTS: The overall proportion of adolescents reporting chronic weekly pain during the last six months was high (44.2%). On average, in comparison with different specific localized types of single-site pain, the prevalence of multi-site pain was more common varying from 13.2% in Armenia to 33.8% in Israel. Adolescent age and sex were strong predictors for reporting pain, but significantly different demographic patterns were found in the cross-country analyses. The most consistent findings indicate that multi-site pain was more prevalent among girls across all countries and that the prevalence increased with age. CONCLUSIONS: Internationally comparable data suggest that self-reported chronic pain among adolescents is highly prevalent, but different age and sex patterns across countries exist. Adolescents with chronic pain are not a homogenous group. Chronic pain co-occurrence and differences in chronic pain characteristics should be addressed in both clinical and public health practice for effective adolescent chronic pain management and prevention. SIGNIFICANCE: Chronic pain co-occurrence is common during adolescence across countries, the prevalence being among girls and in older age groups. Significant cross-country variations in the chronic pain prevalence and chronic pain patterns among adolescents exist. Significant country differences emerge for specific chronic pain patterns in association with adolescent demographics.

Loneliness and subjective health complaints among school-aged children.

AIM: The first aim of this study was to explore the prevalence of loneliness and subjective health complaints (SHCs) among school-aged children in Finland. The second aim was to analyse to what extent perceived loneliness explains any variance in SHCs among school-aged children. METHOD: A representative sample of 5925 Finnish children and adolescents from grades 5 ( Mage=11.8 years), 7 ( Mage=13.8) and 9 ( Mage=15.8) completed the Health Behaviour in School-aged Children (HBSC) survey. Descriptive statistics were used to examine the prevalence of health complaints and loneliness. Structural equation modelling was used to test how strongly loneliness was associated with SHCs. RESULTS: The prevalence of loneliness and SHCs was higher among girls and increased with age. Loneliness was a significant predictor of health complaints, especially of psychological symptoms among girls and among ninth grade students. CONCLUSIONS: The findings indicate that loneliness is a major risk to the health and well-being of school-aged children. The strong association between loneliness and SHCs highlights the importance of active preventive actions to reduce loneliness.

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.

Physical Activity Among Adolescents With Long-Term Illnesses or Disabilities in 15 European Countries.

Physical activity (PA) is an important health-promoting behavior from which adolescents with long-term illnesses or disabilities (LTID) can benefit. It is important to monitor differences across countries in adherence with PA recommendations for health. The aim of this study was to compare PA levels among 15 European countries after disaggregating data by disability. Data from pupils (mean age = 13.6 years, SD = 1.64) participating in the 2013/2014 Health Behavior in School-aged Children study were analyzed to compare adolescents without LTID, with LTID, and with LTID that affects their participation (affected LTID). Logistic regression models adjusted for age and family affluence, stratified by gender and country group with PA recommendations for health as the outcome variable. With the data pooled, 15% (n = 9,372) of adolescents reported having LTID and 4% (n = 2,566) having affected LTID. Overall, fewer boys with LTID met PA recommendations for health than boys without LTID, although it was not statistically significant either at the national levels or for girls.

Health literacy and participation in sports club activities among adolescents.

AIMS: The aim of this research was to compare the levels of perceived health literacy among adolescents who do or do not participate in sports club activities. Organized sport club activities reach a high proportion of adolescents, and have the potential to contribute to the development of their health literacy. METHODS: The cross-sectional data on health literacy among school children in Finland (aged 13 and 15, n=3852) were measured, as a part of the Health Behaviour in School-Aged Children (HBSC) study, using the Health Literacy for School-aged Children (HLSAC) instrument. Sports club participation and its association with health literacy were examined in relation to age, gender, family affluence, school achievement, and physical activity. The statistical analyses included cross-tabulation and the multilevel mixed-effects logistic regression analyses. RESULTS: Perceived health literacy was higher among adolescents who participated in sports club activities. This conclusion was valid for boys and girls, for both age groups, among those who were physically active 6-7 days a week, had at least moderate school achievement, and those who belonged to the middle or high affluence families. From the health literacy perspective, participation in sports club activities was especially beneficial for those having low or moderate school achievement level. CONCLUSIONS: The sports club setting may work towards equalizing health literacy differences related to school achievement. However, the clubs should ensure that access is available to as many adolescents as possible; by this means they may spread beneficial influences, supporting the development of health literacy among broader population groups.

Clustering of energy balance-related behaviours, sleep, and overweight among Finnish adolescents.

OBJECTIVES: To examine how clusters of energy balance-related behaviours (EBRBs), including sleep related factors, were associated with overweight among adolescents. METHODS: In Finland, 4262 adolescents, aged 13-15, participated in the cross-national Health Behaviour in School-aged Children study. The adolescents completed questionnaires assessing EBRBs [sleep duration, discrepancy and quality, physical activity (PA), screen time, junk food, fruit, and vegetable intake] and height and weight. Clusters were identified with κ-means cluster analysis and their associations with overweight with logistic regression analyses. RESULTS: Common clusters for boys and girls were labelled "Healthy lifestyle" and "High screen time, unhealthy lifestyle". In addition, the cluster "Low/moderate screen time, unhealthy lifestyle" was identified among boys, and the cluster "Poor sleep, unhealthy lifestyle" among girls. Only girls in the cluster "High screen time, unhealthy lifestyle" were at increased risk for overweight. CONCLUSIONS: Girls, whose EBRB was characterized by high screen time and low PA, but not with poor sleep, were at increased risk for overweight. Future studies should examine ways to promote PA among adolescent girls with high interest in screen-based activities.