Macro-level determinants of young people's subjective health and health inequalities: a multilevel analysis in 27 welfare states.

OBJECTIVES: Cross-national studies have rarely focused on young people. The aim of this study is to investigate whether macro-level determinants are associated with health and socioeconomic inequalities in young people's health. STUDY DESIGN: Data were collected from the Health Behaviour in School-aged Children (HBSC) study in 2006, which included 11- to 15-year old adolescents from 27 European and North American countries (n=134,632). This study includes national income, health expenditure, income inequality, and welfare regime dummy-variables as macro-level determinants, using hierarchical regression modelling. MAIN OUTCOME MEASURE: Psychosomatic health complaints and socioeconomic inequalities in psychosomatic health complaints. RESULTS: Adolescents in countries with higher income inequality and with liberal welfare tradition were associated with more health complaints and a stronger relationship between socioeconomic status and macro-level determinants compared to adolescents from countries with lower income inequality or the Social Democratic regime. National income and health expenditure were not related to health complaints. Countries with higher national income, public health expenditure and income inequality showed stronger associations between socioeconomic status and psychosomatic health complaints. CONCLUSION: Results showed that macro-level characteristics are relevant determinants of health and health inequalities in adolescence.

Physical and emotional health problems experienced by youth engaged in physical fighting and weapon carrying.

Then aims of the current study were 1) to provide cross-national estimates of the prevalence of physical fighting and weapon carrying among adolescents aged 11-15 years; (2) To examine the possible effects of physical fighting and weapon carrying on the occurrence of physical (medically treated injuries) and emotional health outcomes (multiple health complaints) among adolescents within the theoretical framework of Problem Behaviour Theory. 20,125 adolescents aged 11-15 in five countries (Belgium, Israel, USA, Canada, FYR Macedonia) were surveyed via the 2006 Health Behaviour in School Aged Children survey. Prevalence was calculated for physical fighting and weapon carrying along with physical and emotional measures that potentially result from violence. Regression analyses were used to quantify associations between violence/weapon carrying and the potential health consequences within each country. Large variations in fighting and weapon carrying were observed across countries. Boys reported more frequent episodes of fighting/weapon carrying and medically attended injuries in every country, while girls reported more emotional symptoms. Although there were some notable variations in findings between different participating countries, increased weapon carrying and physical fighting were both independently and consistently associated with more frequent reports of the potential health outcomes. Adolescents engaging in fighting and weapon carrying are also at risk for physical and emotional health outcomes. Involvement in fighting and weapon carrying can be seen as part of a constellation of risk behaviours with obvious health implications. Our findings also highlight the importance of the cultural context when examining the nature of violent behaviour for adolescents.

Perceived teacher unfairness and headache in adolescence: a cross-national comparison.

OBJECTIVES: The present study examines the prevalence of headache in early adolescents in 21 European and North-American countries and the role of perceived teacher unfairness in predicting this health complaint across different countries. METHODS: Data were taken from the "Health Behaviour in School-aged Children" study (HBSC), a World Health Organization cross-national survey on health behaviors in 11-, 13- and 15-year-old students. Headache and perceived teacher unfairness were measured through a self-administered questionnaire filled out by 115,212 adolescents. RESULTS: The overall prevalence of frequent headaches (at least once a week) was 28.8%, ranging from 18.9% in Slovenia to 49.4% in Israel. After adjusting for gender, grade, family affluence, school achievement, being bullied and lifestyles (drinking, smoking, eating and physical activity), teacher unfairness showed a significant association with frequent headache in all but two countries (Ukraine and Luxembourg). CONCLUSIONS: Our results show that headache is a common health symptom in European and North-American countries, even though there are substantial differences in its prevalence across countries. The study indicates that perceived teacher unfairness can be a significant predictor of frequent headache during adolescence, and this association is consistent across countries.

Overweight and its impact on the health-related quality of life in children and adolescents: results from the European KIDSCREEN survey.

PURPOSE: To analyse the impact of overweight on HRQoL in a European sample of children and adolescents. METHODS: Analyses were conducted using data on 17,159 children and adolescents aged 8-18 from 10 European countries (Germany, Spain, France, Netherlands, Austria, United Kingdom, Switzerland, Hungary, Czech Republic and Poland) participating in the KIDSCREEN Health Interview Survey. In the studied sample (N = 13,041), there were slightly more girls (52.6%) than boys (47.4%). Gender- and age-specific cut-offs of Cole et al. (BMJ 320:1240, 2000) were used to define overweight and obesity. The two groups were collapsed into one 'overweight' category. HRQoL was assessed on 10 dimensions using the KIDSCREEN-52. Univariate analysis of covariance (ANCOVA) was performed for group comparisons (normal weight vs. overweight). Partial eta squared (η (p) (2) ) was used as a measure of effect strength. RESULTS: Overall, 14.2% (N = 1,849) of the sample was overweight, with prevalence rates ranging between 9.4% in France and 17.6% in Spain. Across all countries, overweight children and adolescents had lower mean HRQoL scores than normal weight children and adolescents. The strongest HRQoL impairments emerged on the physical well-being (η (p) (2)  = 0.012) and self-perception dimensions (η (p) (2)  = 0.021), both P < 0.001. CONCLUSIONS: This is one of the first studies comparing the impact of HRQoL at European level using a generic and internationally valid HRQoL instrument, and the results show that, irrespective of national background, overweight children and adolescents are significantly impaired on their HRQoL, in particular on the physical well-being and the self-perception domain.

Measuring mental health and well-being of school-children in 15 European countries using the KIDSCREEN-10 Index.

OBJECTIVES: To test the psychometric properties and measurement results of the KIDSCREEN-10 Mental Health Index in school children from 15 European countries. METHODS: Within the cross-sectional Health Behaviour in School-aged Children 2005/2006 Survey, 78,000 pupils aged 11, 13, 15 answered the KIDSCREEN and additional measures. Cronbach's alpha, Rasch partial credit model itemfit and ANOVAs were conducted. RESULTS: Cronbach's alpha was 0.81, Rasch infit mean square residuals were 0.7-1.3. Mean scores varied 0.8 standard deviation across countries. Older pupils (effect size [ES] = 0.6), girls (ES = 0.2), pupils with low socio-economic status (ES = 0.5) or frequent health complaints (r = 0.5) reported decreased mental health. CONCLUSIONS: The KIDSCREEN-10 displayed good psychometric properties. Measured differences between countries, age, gender, SES, and health complaints comply with theoretical considerations.

Subjective health, symptom load and quality of life of children and adolescents in Europe.

OBJECTIVES: To examine cross-cultural differences in the prevalence of school children's subjective health types and the pattern of socio-demographic and socio-economic differences. METHODS: Within the cross-sectional Health Behaviour in School-aged Children 2005/2006 Survey 200,000 school children aged 11, 13 and 15 answered a general health item, the Cantrill life satisfaction ladder and a subjective health complaints checklist. ANOVA and multilevel logistic regression models were conducted. RESULTS: Overall, 44% of the respondents reported multiple recurrent health complaints, only poor to fair general health, low life satisfaction or a combination of these. Older adolescents (OR: 1.1-1.6) and girls (OR: 1.2-1.4) reported more health problems, the gender difference increased with age (OR: 1.3-1.6). Low socio-economic status was also associated with health problems (OR: 1.4-2.3). Sizeable cross-national variation in the prevalence of health types and the impact of the above mentioned factors were observed, yet the main pattern of impact could be confirmed cross-culturally. CONCLUSIONS: Increasing social and gender role pressure with growing age, as well as restricted access to material resources and psychosocial strains are discussed as potential explanations for the observed health inequalities.

Factors associated with self-rated health status in university students: a cross-sectional study in three European countries.

BACKGROUND: Self-rated health status (SRHS) is a reliable and valid measure for assessing the subjective and objective health of individuals. Previous studies have either focused predominantly on the elderly or investigated only a narrow range of factors potentially associated with SRHS. In examining student populations, these past studies were limited to single countries. The objectives of this study were to assess which candidate variables were independently associated with SRHS in university students, to compare these variables by country and by gender, and to investigate which of the variables was most important as a rating frame for SRHS. METHODS: The data is from the Cross-National Student Health Survey, conducted in 2005 in universities in Germany, Bulgaria, and Poland (n = 2103; mean age = 20.7 years). SRHS was assessed with a single question using a five-point scale ranging from "excellent" to "poor". The study also measured a wide range of variables including: physical and psychological health, studying, social contacts/social support, and socio-demographic status. RESULTS: Psychosomatic complaints (considered an aspect of physical health and, adjusted for psychological health) were the most important indicators in forming a rating frame for students' SRHS. There were few differences in the effects of variables associated with SRHS by gender (well-being: a measure of psychological health) and the variables associated with SRHS by country (well-being and self-efficacy). The remaining variables showed homogenous effects for both genders and for all three countries. CONCLUSION: The results suggest that SRHS can be reasonably used to compare students' health across countries. SRHS is affected by different physical, psychological and psychosomatic aspects of health; however, its strongest association is with psychosomatic complaints.