National-Level Schoolwork Pressure, Family Structure, Internet Use, and Obesity as Drivers of Time Trends in Adolescent Psychological Complaints Between 2002 and 2018.

Little is known about societal processes that contribute to changes in adolescent mental health problems. This study aims to fill this gap using data from the Health Behavior in School-aged Children study between 2002 and 2018 (ncountries = 43, nindividuals = 680,269, Mage = 14.52 (SD = 1.06), 51.04% female), supplemented with other international data. National-level psychological complaints increased more strongly among girls than boys. National-level schoolwork pressure, single-parent households, time spent on internet, and obesity were generally rising. In both boys' and girls' samples, increases in national-level schoolwork pressure, obesity, and time spent on internet use were independently associated with increases national-level psychological complaints. However, national-level obesity and psychological complaints were more strongly related among girls than boys. Results highlight the potential impact of societal-level processes on adolescent mental health problems.

Domains of spirituality and their importance to the health of 75 533 adolescents in 12 countries.

Spirituality is an ancient concept with many contemporary applications to the field of health promotion. While recognized in the UN Convention on the Rights of the Child as a basic human right, definitional misunderstandings about what spirituality is, and is not, and the mechanisms by which it affects the health of young people, remain. In this cross-national analysis involving >75 000 adolescents from 12 countries, we examined the relative importance of each of four spiritual health domains (connections to self, others, nature and the transcendent) in the lives of young people, and how these connections relate to a standard indicator of positive mental health status. Descriptive and applied regression analyses confirmed two major findings: (i) boys and girls in all 12 countries ranked the importance of each of the four domains in the same order, with 'connections to self' identified as most important; and (ii) both direct and indirect pathways are evident that connect the remaining three domains to positive mental health status, but through strong connections to self. Based on our scale items, fostering a strong connection to self, which involves cultivating a sense of meaning, purpose and joy in the lives of adolescents, appears most fundamental to fostering optimal mental health. This may be achieved directly or, dependent upon context and culture, indirectly with emphasis on the connections afforded by the other three domains. Such findings provide important insights to guide the content of adolescent health promotion interventions.

Spirituality is considered by many to be an important domain of health. It is sometimes measured in four domains of connections: to oneself, to others, to nature and to the transcendent. While the importance of such connections is recognized as a fundamental human right for children, few international studies have studied their impacts on the health and well-being of young people. In this study of young people conducted over 4 years in 12 countries, we examined the perceived importance of each of four spiritual health domains and how they each related to positive mental health status in >75 000 adolescents. 'Connections to self' were consistently viewed as most important among boys and girls in all 12 countries. Fostering of strong connections to self, which involves cultivating a sense of meaning, purpose and joy in the lives of adolescents, appears most fundamental to achieving mental health and well-being. This may be achieved directly through a focus on connections to self, or indirectly by focusing on the indirect effects of the other three domains on mental health. This opens up many opportunities for health promotion in child populations, internationally.

Loneliness in young people: a multilevel exploration of social ecological influences and geographic variation.

BACKGROUND: Loneliness is a growing public health concern, yet little is known about loneliness in young people. The current study aimed to identify social ecological factors related to loneliness and examine the extent to which geographic region may account for differences in loneliness. METHODS: The data come from a cross-sectional sample of 6503 young people living in the UK. Loneliness was measured using the UCLA 3-item scale. Bivariate analyses were used to test associations between each predictor and loneliness. Multilevel models were used to identify key social ecological factors related to loneliness, and the extent to which loneliness may vary across geographic regions (local authority districts). RESULTS: Sociodemographic, social, health and well-being, and community factors were found to be associated with loneliness. Geographic region was associated with 5-8% of the variation in loneliness. The effect of gender, sexual orientation and minority ethnic background on loneliness differed across regions. CONCLUSIONS: This is the first study to highlight modifiable social and community factors related to youth loneliness, and individual vulnerabilities, such as poor mental well-being. Results related to geographic differences suggest that local-level initiatives may be most appropriate in tackling loneliness, rather than wider, less contextualized national efforts.

Association of alcohol control policies with adolescent alcohol consumption and with social inequality in adolescent alcohol consumption: A multilevel study in 33 countries and regions.

Background Previous research found inconsistent associations between alcohol control policies and socioeconomic inequality with adolescent drinking outcomes. This study expands the focus beyond individual associations to examine whether a combination of policies is related to socioeconomic inequality in adolescent drinking outcomes and whether this relationship varies across survey years. Methods Multilevel modelling of 4 waves of repeat cross-sectional survey data (2001/02, 2005/06, 2009/10, and 2013/14) from the Health Behaviour in School-aged Children (HBSC) study was carried out. The sample was composed of 671,084 adolescents (51% girls) aged 11, 13, and 15 (mean age=13.58; SD=1.65) from 33 European and North American countries/regions. The dependent variables were lifetime alcohol consumption, weekly alcohol consumption, and lifetime drunkenness. Independent variables were of three types: individual-level variables (age, sex, Family Affluence Scale, and the Perceived Family Wealth), time-level variable (survey year), and context-level variables (minimum legal drinking age, physical availability, advertising restrictions, a total alcohol policy index, and affordability of alcohol). Results The total alcohol policy index showed a negative relationship with both lifetime and weekly consumption. Higher affordability of alcohol was related to higher lifetime and weekly consumption and higher lifetime drunkenness. Family Affluence Scale was positively related to all three alcohol measures and Perceived Family Wealth was negatively related to lifetime drunkenness, with these associations increasing across survey years. The total alcohol policy index buffered the associations of Family Affluence Scale and Perceived Family Wealth with adolescent drinking outcomes. Conclusion A combination of alcohol control policies is more effective in reducing adolescent drinking outcomes than single policy measures. Reducing the affordability of alcohol stood out as the most successful single measure. Socioeconomic inequalities (i.e. higher alcohol consumption and drunkenness in adolescents with higher family affluence and higher drunkenness in adolescents perceiving their families to be poor) have persisted and even increased across survey years. A combined alcohol control policy can help in tackling them.

Associations between perceived social and physical environmental variables and physical activity and screen time among adolescents in four European countries.

OBJECTIVES: Associations between the perceived social and physical environment and self-reported moderate-to-vigorous physical activity (MVPA) and screen time (ST) were examined among adolescents in four European countries. METHODS: Representative samples were surveyed with standardised methodologies. Associations between environmental variables and meeting MVPA recommendations and tertiles of ST were tested in gender-specific logistic regression models. Moderation by country and country-specific relationships were also examined. RESULTS: The most consistent findings across countries were found for the significant associations between neighbourhood social environment and MVPA in both boys and girls. Significant associations with the physical environment varied more between countries and by gender. The most consistent negative associations with ST were found for the social environmental variable of having parental rules for spending time outside the home. CONCLUSIONS: The present findings provided evidence for the generalisability of the associations between environmental correlates and MVPA across four European countries. The findings show clear differences in correlates for MVPA and ST. Further research is needed to better understand the unique aspects of the social and physical environment which explain each of the two behaviours.

Trends in adolescent eating behaviour: a multilevel cross-sectional study of 11-15 year olds in Scotland, 2002-2010.

BACKGROUND: Improving the diet of the Scottish population has been a government focus in recent years. Health promotion is known to be more effective in affluent groups. Alongside trends in eating behaviour, changes in socioeconomic inequalities must be monitored. METHODS: Eating behaviour data from the 2002, 2006 and 2010 Scotland Health Behaviour in School-Aged Children survey were modelled using multilevel linear modelling. RESULTS: Fruit and vegetable consumption increased between 2002 and 2010 by 0.26 and 0.27 days per week, respectively, while consumption of sweets, chips and crisps fell by 0.73, 1.25 and 0.99 days per week, respectively. An overall healthy eating score, calculated by summing food item weekly consumption, increased significantly (at 95% level of significance) over this period. Fruit and vegetable consumption was more frequent among children with high family affluence (individual measure of socioeconomic status), while consumption of crisps and chips was less frequent. When an interaction term was added between year and family affluence, this was not significant for any outcome. Variance at the education authority and school levels remained significant for all outcomes. CONCLUSIONS: Adolescent eating behaviours in Scotland have improved over time across the family affluence scale gradient as a whole, with persistent inequalities. Alongside population programmes, initiatives directed at more deprived groups are required.

Dietary trends among Scottish schoolchildren in the 1990s.

BACKGROUND: In recent years, healthy eating messages have sought to highlight the advantages of a healthy balanced diet, but there is little evidence that the recommendations have been translated into sustained behavioural change. In Scotland, the national diet has become a major focus in key policy documents, and the diet of children and young people has been consistently highlighted as an area of particular concern. This paper reports on dietary trends among Scottish schoolchildren during the 1990s. METHODS: Data were collected from a representative sample of Scottish schoolchildren as part of the WHO Cross-national Health Behaviour of School-aged Children (HBSC) study. Three consecutive national surveys were undertaken in Scotland, in 1990, 1994 and 1998, using self-completion food frequency questionnaires with 11-, 13- and 15-year-old school pupils. RESULTS: Between 1990 and 1998, fruit and vegetable consumption increased among Scottish schoolchildren, especially among girls, but levels of consumption fell below current dietary recommendations. There has been a concomitant increase in consumption of high-fat and high-sugar foods, and consumption of these foods is higher among boys and children from lower socio-economic groups. CONCLUSION: The findings emphasize the need for continued health promotion efforts to improve the diet of schoolchildren in Scotland especially among lower socio-economic groups.