Encouraging greater empowerment for adolescents in consent procedures in social science research and policy projects.

The United Nations Convention on the Rights of the Child emphasizes the importance of allowing children and adolescents to influence decisions that are important to them following their age and maturity. This paper explores the principles, practices, and implications around using parental versus child/adolescent consent when participating in social science research and policy development. Experiences from two studies are presented: The Confronting Obesity: Co-creating policy with youth (CO-CREATE) and the Health Behaviour in School-aged Children (HBSC) study, a World Health Organization (WHO) Collaborative Cross-National study. Although parental consent may be an important gatekeeper for protecting children and adolescents from potentially harmful research participation, it may also be considered an obstacle to the empowerment of children and adolescents in case they want to share their views and experiences directly. This paper argues that evaluation of possible harm should be left to ethics committees and that, if no harm related to the research participation processes is identified and the project has a clear perspective on collaborating with the target group, adolescents from the age of 12 years should be granted the legal capacity to give consent to participate in the research project. Collaboration with adolescents in the development of the research project is encouraged.

Left behind: inequalities in the negative impacts of the COVID-19 pandemic among adolescents in the WHO European Region: impact of the COVID-19 pandemic on young people’s health and well-being from the findings of the HBSC survey round 2021/2022

This report summarizes findings from the Health Behaviour in School-aged Children survey round 2021/2022regarding the unequal impact of the COVID-19 pandemic on adolescents’ health and health behaviours in22 countries and regions of the WHO European Region. Risk factors contributed to different extents to thepandemic’s impact on adolescents’ health and health behaviours. More girls and 15-year-olds than boys andyounger adolescents reported negative impacts of the pandemic on the four health outcomes considered.The largest gender and age inequalities were seen in mental health. Social inequalities, such as havingan immigration background, coming from a family that was not well-off, having at least one unemployedparent and/or living in a single-parent household, were linked to adolescents experiencing negative impactsof the pandemic on their health and health behaviours in many countries and regions. Having experiencedthe hospitalization of a family member due to COVID-19 was also an important risk factor for negative healthand health behaviour outcomes in more than half of the countries and regions. The large cross-country/regionvariation in the contribution (or lack of contribution) of different risk factors to negative pandemic impactsunderlines the need for country-/region-specific interventions in times of crises.

Identifying Cardiovascular Risk Profiles Clusters among Mediterranean Adolescents across Seven Countries.

Cardiovascular diseases (CVDs) are the number one cause of death globally and are partially due to the inability to control modifiable lifestyle risk factors. The aim of this study was to analyze the profiles of adolescents from seven Mediterranean countries (Greece, Israel, Italy, Macedonia, Malta, Portugal, Spain) according to their modifiable lifestyle risk factors for CVD (overweight/obesity, physical activity, smoking, alcohol consumption). The sample consisted of 26,110 adolescents (52.3% girls) aged 11, 13, and 15 years who participated in the Health Behavior in School-aged Children (HBSC) survey in 2018 across the seven countries. Sociodemographic characteristics (sex, age, country of residence, socioeconomic status) and CVD modifiable lifestyle risk factors (overweight/obesity, physical activity, smoking, alcohol consumption) were recorded. A two-step cluster analysis, one-way analysis of variance, and chi-square test were performed. Four different cluster groups were identified: two low-risk groups (64.46%), with risk among those with low physical activity levels; moderate-risk group (14.83%), with two risk factors (unhealthy weight and low physical activity level); and a high-risk group (20.7%), which presented risk in all modifiable lifestyle risk factors. Older adolescents reported a higher likelihood of being in the high-risk group. Given that the adolescence period constitutes an important time for interventions aimed at CVD prevention, identifying profiles of moderate- and high-risk adolescents is crucial.

A Comparative Study of Health and Well-being Among Cisgender and Binary and Nonbinary Transgender Adolescents in Spain.

Purpose: The aim of this study was to describe the well-being and mental health of Spanish adolescents by gender identity using a nationally representative sample. Methods: The sample comprised 1212 15-18-year-old adolescents who participated in the 2018 Spanish edition of the international Health Behaviour in School-aged Children study. Of the total sample, 90 were identified as binary transgender adolescents, 213 as nonbinary transgender adolescents, and 909 as cisgender adolescents (selected through a matching process from an original sample of 17,375 cisgender adolescents). Comparisons of frequencies and means (chi-square, t-test, and analysis of variance) were used to analyze self-reported health, life satisfaction, health-related quality of life (HRQOL), psychosomatic complaints, and sense of coherence (SOC). Results: Nonbinary transgender adolescents reported the lowest levels of perceived excellent health (p < 0.001), the highest frequency of psychological complaints (p < 0.001) and physical complaints (p < 0.05), and a lower SOC (p < 0.05) compared with both cisgender and binary transgender adolescents. Likewise, nonbinary transgender adolescents reported lower levels of life satisfaction (p < 0.001) and HRQOL (p < 0.001) than cisgender adolescents. Conclusions: The differences found between binary and nonbinary transgender youth highlight the diversity within the transgender community. Both research and intervention programs should consider the unique experiences within the transgender community to adapt sensitively to their needs.

Cross-national time trends in adolescent alcohol use from 2002 to 2014.

BACKGROUND: Adolescent alcohol consumption is a major public health concern that should be continuously monitored. This study aims (i) to analyze country-level trends in weekly alcohol consumption, drunkenness and early initiation in alcohol consumption and drunkenness among 15-year-old adolescents from 39 countries and regions across Europe and North America between 2002 and 2014 and (ii) to examine the geographical patterns in adolescent alcohol-related behaviours. METHODS: The sample was composed of 250 161 adolescents aged 15 from 39 countries and regions from Europe and North America. Survey years were 2002, 2006, 2010 and 2014. The alcohol consumption and drunkenness items of the HBSC questionnaire were employed. Prevalence ratios and 95% confidence intervals were estimated using Poisson regression models with robust variance. RESULTS: Data show a general decrease in all four alcohol variables between 2002 and 2014 except for some countries. However, there is variability both within a country (depending on the alcohol-related behaviour under study) and across countries (in the beginning and shape of trends). Some countries have not reduced or even increased their levels in some variables. Although some particularities have persisted over time, there are no robust patterns by regions. CONCLUSIONS: Despite an overall decrease in adolescent alcohol consumption, special attention should be paid to those countries where declines are not present, or despite decreasing, rates are still high. Further research is needed to clarify factors associated with adolescent drinking, to better understand country specificities and to implement effective policies.

Intersectionality and Adolescent Mental Well-being: A Cross-Nationally Comparative Analysis of the Interplay Between Immigration Background, Socioeconomic Status and Gender.

PURPOSE: Intersectionality theory highlights the importance of the interplay of multiple social group memberships in shaping individual mental well-being. This article investigates elements of adolescent mental well-being (life dissatisfaction and psychosomatic complaints) from an intersectional perspective. It tests mental well-being consequences of membership in combinations of multiple social groups and examines to what extent such intersectional effects depend on the national context (immigration and integration policies, national-level income, and gender equality). METHODS: Using Multilevel Analysis of Individual Heterogeneity and Discriminatory Accuracy, we assessed the role of the national context in shaping the interplay between immigration background, socioeconomic status, and gender, using data from 33 countries from the 2017/2018 Health Behaviour in School-aged Children survey. RESULTS: We found no uniform intersectionality effects across all countries. However, when allowing the interplay to vary by national context, results did point toward some intersectional effects. Some aggravated negative effects were found for members of multiple disadvantaged social groups in countries with low levels of income equality and restrictive migration policies, whereas enhanced positive effects were found for members of multiple advantaged groups in these countries. Similarly, mitigated negative effects of membership in multiple disadvantaged groups were shown in countries with higher levels of income equality and more inclusive migration policies, whereas mitigated positive effects were found for multiply advantaged individuals. Although for national-level gender equality results pointed in a similar direction, girls' scores were counterintuitive. High national-level gender equality disproportionately benefitted groups of disadvantaged boys, whereas advantaged girls were doing worse than expected, and reversed effects were found for countries with low gender equality. CONCLUSIONS: To fully understand social inequalities in adolescent mental well-being, the interplay between individual-level and national-level indicators must be explored.

The Role of Body Image in Internalizing Mental Health Problems in Spanish Adolescents: An Analysis According to Sex, Age, and Socioeconomic Status.

During adolescence there is a relatively high prevalence of weight problems and eating disorders. Furthermore, body image plays an important role in weight control and eating behaviors as well as in mental health. This study analyses the influence of body mass index, perception of being overweight, and body image satisfaction (BIS) on internalizing symptoms related to mental health in adolescents. In addition, sex, age, socioeconomic status (SES), dieting, and physical activity are taken into consideration. This research is based on the international study Health Behaviour in School-aged Children (HBSC). The sample consists of 4531 Spanish adolescents from 13 to 18 years old. Participants were selected through random multi-stage sampling stratified by conglomerates. Two instruments were employed: the HBSC questionnaire and the Youth Self-Report (Achenbach System of Empirically Based Assessment, ASEBA). Results demonstrated that BIS -the emotional component related to body image- was the main predictor of adolescent internalizing symptoms. In addition, results show double-inequalities according to the interaction effects of sex, age, and SES. Likewise, interesting results are shown regarding how dieting behaviors to lose or gain weight/volume and physical activity relate to body image perception and satisfaction, as well as with internalizing symptoms. This study highlights important body image aspects relevant to intervention and prevention of internalized mental health problems in adolescence.

Direct and Indirect Influences of Objective Socioeconomic Position on Adolescent Health: The Mediating Roles of Subjective Socioeconomic Status and Lifestyles.

The use of composite indices and subjective measures to evaluate socioeconomic position, taking into account the effect of inequalities on adolescent health-related behaviors, can contribute to understanding the effect of inequalities on health during adolescence. The aim of this study was to examine the direct and indirect contribution of objective and subjective socioeconomic factors in a broad range of health and lifestyles outcomes. The data come from a representative sample of adolescents (N = 15,340; M age = 13.69) of the Health BehaviorinSchool-agedChildren study in Spain. Structural equation modeling was used for data analysis. A global index for evaluating objective socioeconomic position predicted both health and healthy lifestyles. Subjective socioeconomic status mediated the relationship between objective socioeconomic position and health but did not have a significant effect on healthy lifestyles when objective indicators were considered. Lastly, fit indices of the multiple-mediator model-including the direct effect of objective socioeconomic position on health and its indirect effects through the subjective perception of wealth and lifestyles-explained 28.7% of global health variance. Interventions aimed at reducing the impact of health inequalities should address, in addition to material deprivation, the psychological and behavioral consequences of feeling poor.

Indicadores para detectar y evaluar el impacto de las desigualdades socioeconómicas en los estilos de vida y la salud de los adolescentes españoles / No disponible

En este estudio se comparan distintos indicadores socioeconómicos en cuanto a su capacidad para predecir desigualdades en la salud y los estilos de vida de la población adolescente. Los resultados muestran que la relación entre los diferentes indicadores socioeconómicos, a pesar de ser significativa, es débil, sugiriendo que cada uno evalúa en cierto grado aspectos distintos del constructo socioeconómico. Además, mientras que el nivel educativo de los progenitores, y especialmente el nivel educativo de las madres, es la variable que muestra mayor capacidad para detectar desigualdades en los estilos de vida adolescentes, la percepción subjetiva de riqueza se revela como el predictor más importante de las desigualdades en salud. Adicionalmente, los resultados de este estudio muestran que no todas las conductas relacionadas con los estilos de vida adolescente y su bienestar están igualmente influenciadas por determinantes socioeconómicos. De esta forma, mientras que las conductas relacionadas con los hábitos de alimentación o la salud adolescente se ven fuertemente influidas por factores socioeconómicos, el efecto de las desigualdades es menos claro en conductas tales como el consumo de tabaco y alcohol. Esta investigación subraya la importancia de la elección de un determinado indicador en estudios que evalúan los efectos de las desigualdades socioeconómicas en los estilos de vida y la salud adolescente

In this research we compare different socioeconomic indicators according to their capacity to detect socioeconomic inequalities in adolescent health and lifestyles. The results showed that the relationship between the different socioeconomic indicators, despite being significant, had a weak association, suggesting that each indicator evaluates different dimensions of the socioeconomic construct. In addition, whereas parental education, and especially maternal education, was the most relevant indicator for predicting socioeconomic inequalities in adolescent lifestyles, the perceived family wealth was the most important predictor of inequalities in adolescent health. Additionally, the results of this study show that not all behaviours related to healthy lifestyles and adolescent health were equally influenced by socioeconomic determinants. Along these lines, whereas eating behaviours or health outcomes showed to be highly influenced by socioeconomic factors, the impact of socioeconomic inequalities in behaviours such as alcohol consumption or tobacco use was less clear. This research highlights the importance of choosing a specific indicator in studies that evaluate the effects of socioeconomic inequalities in adolescent health and lifestyles