Candace Currie

Comparison of overweight and obesity prevalence in school-aged youth from 34 countries and their relationships with physical activity and dietary patterns

The purposes of this systematic review were to present and compare recent estimates of the prevalence of overweight and obesity in school‐aged youth from 34 countries and to examine associations between overweight and selected dietary and physical activity patterns. Data consisted of a cross‐sectional survey of 137 593 youth (10–16 years) from the 34 (primarily European) participating countries of the 2001–2002 Health Behaviour in School‐Aged Children Study. The prevalence of overweight and obesity was determined based on self‐reported height and weight and the international child body mass index standards. Logistic regression was employed to examine associations between overweight status with selected dietary and physical activity patterns. The two countries with the highest prevalence of overweight (pre‐obese + obese) and obese youth were Malta (25.4% and 7.9%) and the United States (25.1% and 6.8%) while the two countries with the lowest prevalence were Lithuania (5.1% and 0.4%) and Latvia (5.9% and 0.5%). Overweight and obesity prevalence was particularly high in countries located in North America, Great Britain, and south‐western Europe. Within most countries physical activity levels were lower and television viewing times were higher in overweight compared to normal weight youth. In 91% of the countries examined, the frequency of sweets intake was lower in overweight than normal weight youth. Overweight status was not associated with the intake of fruits, vegetables, and soft drinks or time spent on the computer. In conclusion, the adolescent obesity epidemic is a global issue. Increasing physical activity participation and decreasing television viewing should be the focus of strategies aimed at preventing and treating overweight and obesity in youth.

Researching health inequalities in adolescents: The development of the Health Behaviour in School-Aged Children (HBSC) Family Affluence Scale

Socioeconomic inequalities in adolescent health have been little studied until recently, partly due to the lack of appropriate and agreed upon measures for this age group. The difficulties of measuring adolescent socioeconomic status (SES) are both conceptual and methodological. Conceptually, it is unclear whether parental SES should be used as a proxy, and if so, which aspect of SES is most relevant. Methodologically, parental SES information is difficult to obtain from adolescents resulting in high levels of missing data. These issues led to the development of a new measure, the Family Affluence Scale (FAS), in the context of an international study on adolescent health, the Health Behaviour in School-Aged Children (HBSC) Study. The paper reviews the evolution of the measure over the past 10 years and its utility in examining and explaining health related inequalities at national and cross-national levels in over 30 countries in Europe and North America. We present an overview of HBSC papers published to date that examine FAS-related socioeconomic inequalities in health and health behaviour, using data from the HBSC study. Findings suggest consistent inequalities in self-reported health, psychosomatic symptoms, physical activity and aspects of eating habits at both the individual and country level. FAS has recently been adopted, and in some cases adapted, by other research and policy related studies and this work is also reviewed. Finally, ongoing FAS validation work is described together with ideas for future development of the measure.

Adolescence and the social determinants of health

The health of adolescents is strongly affected by social factors at personal, family, community, and national levels. Nations present young people with structures of opportunity as they grow up. Since health and health behaviours correspond strongly from adolescence into adult life, the way that these social determinants affect adolescent health are crucial to the health of the whole population and the economic development of nations. During adolescence, developmental effects related to puberty and brain development lead to new sets of behaviours and capacities that enable transitions in family, peer, and educational domains, and in health behaviours. These transitions modify childhood trajectories towards health and wellbeing and are modified by economic and social factors within countries, leading to inequalities. We review existing data on the effects of social determinants on health in adolescence, and present findings from country-level ecological analyses on the health of young people aged 10-24 years. The strongest determinants of adolescent health worldwide are structural factors such as national wealth, income inequality, and access to education. Furthermore, safe and supportive families, safe and supportive schools, together with positive and supportive peers are crucial to helping young people develop to their full potential and attain the best health in the transition to adulthood. Improving adolescent health worldwide requires improving young peoples daily life with families and peers and in schools, addressing risk and protective factors in the social environment at a population level, and focusing on factors that are protective across various health outcomes. The most effective interventions are probably structural changes to improve access to education and employment for young people and to reduce the risk of transport-related injury.

The Health Behaviour in School-aged Children: WHO Collaborative Cross-National (HBSC) Study: origins, concept, history and development 1982–2008

This paper traces the history of the HBSC study from its origins in the early 1980’s to the present day describing how it was first conceptualised scientifically and how this influenced issues of study design. The challenges of managing a cross-national study are explained as are changes and adaptations over time with growth of the study from 3 to over forty country members. The key partnership with the World Health Organisation and its benefits are presented. With developments in scientific management and theoretical perspectives, HBSC has made a substantial contribution to the area of youth health. The last decade has seen increased dissemination to policy makers and evidence that scientific information arising from the study has influenced strategic policy development and practical health improvement programmes. This paper considers some of the key success factors and challenges for the study as it attempts to maximise its scientific output and channels the research findings into health improvement for young people. Future challenges for the study are also considered.

Socioeconomic Inequality in Exposure to Bullying During Adolescence: A Comparative, Cross-Sectional, Multilevel Study in 35 Countries

OBJECTIVES We examined the socioeconomic distribution of adolescent exposure to bullying internationally and documented the contribution of the macroeconomic environment. METHODS We used an international survey of 162,305 students aged 11, 13, and 15 years from nationally representative samples of 5998 schools in 35 countries in Europe and North America for the 2001-2002 school year. The survey used standardized measures of exposure to bullying and socioeconomic affluence. RESULTS Adolescents from families of low affluence reported higher prevalence of being victims of bullying (odds ratio [OR] = 1.13; 95% confidence interval [CI] = 1.10, 1.16). International differences in prevalence of exposure to bullying were not associated with the economic level of the country (as measured by gross national income) or the school, but wide disparities in affluence at a school and large economic inequality (as measured by the Gini coefficient) at the national level were associated with an increased prevalence of exposure to bullying. CONCLUSIONS There is socioeconomic inequality in exposure to bullying among adolescents, leaving children of greater socioeconomic disadvantage at higher risk of victimization. Adolescents who attend schools and live in countries where socioeconomic differences are larger are at higher risk of being bullied.

Self-esteem, and physical development in early adolescence: pubertal timing and body image

Relations between self-esteem, pubertal timing, and body image were investigated with a representative sample of Scottish schoolgirls 11 (n = 1,012, X = 11.53 years, SD = 0.32) and 13 (n = 799, X = 13.53, SD = 0.32) years of age. Data were derived from the Health Behaviour in School Children: WHO Cross-National Survey, specifically the Scottish survey. Among 11-year-olds, early maturation and lower ratings of body image (body size and perceived appearance) were associated with lower reported levels of selfesteem. There also was evidence that body image mediated the relation of pubertal timing on self-esteem for this age group. Among 13-year-olds, reports of body size concerns and poorer perceived appearance were predictive of lower ratings of self-esteem, as was late maturation. In this case, there was no evidence of mediation. Results lend support to the contention that pubertal timing influences body image and self-esteem.

Adolescent smoking and family structure in Europe.

This paper examines the relationship between family structure and smoking among 15-year-old adolescents in seven European countries. It also investigates the association between family structure and a number of known smoking risk factors including family socio-economic status, the adolescents disposable income, parental smoking and the presence of other smokers in the adolescents home. Findings are based on 1998 survey data from a cross-national study of health behaviours among children and adolescents. Family structure was found to be significantly associated with smoking among 15-year-olds in all countries, with smoking prevalence lowest among adolescents in intact families and highest among adolescents in stepfamilies. Multivariate analysis showed that several risk factors were associated with higher smoking prevalences in all countries, but that even after these other factors were taken into account, there was an increased likelihood of smoking among adolescents in stepfamilies. Further research is needed to determine the possible reasons for this association.

The broader impact of walking to school among adolescents: seven day accelerometry based study

How children travel to and from school may significantly influence their overall physical activity levels.1 2 We measured moderate to vigorous physical activity (MVPA) among adolescents and explored their means of travel to and from school. We recruited four classes, each of about 30 pupils aged 13-14 years, from four schools in the Edinburgh area. We visited the classes three times: to introduce the study and distribute consent forms and information for pupils and parents or guardians; to allocate accelerometers (instruments used to measure vertical movement); and to collect accelerometers and issue questionnaires. Inclusion in the study required consent from pupils and primary guardians. In spring 2004 we obtained objective measures of the childrens activity with precalibrated accelerometers (MTI, Fort Walton, Florida; model 7164), which record activity accumulated each minute.3 We asked the pupils to wear the accelerometers on their hip from waking until bedtime, except while showering, bathing, swimming, and participating in other water based activities. We used age specific cut-off points (on …

Socioeconomic inequalities in adolescent health 2002–2010: a time-series analysis of 34 countries participating in the Health Behaviour in School-aged Children study

BACKGROUND Information about trends in adolescent health inequalities is scarce, especially at an international level. We examined secular trends in socioeconomic inequality in five domains of adolescent health and the association of socioeconomic inequality with national wealth and income inequality. METHODS We undertook a time-series analysis of data from the Health Behaviour in School-aged Children study, in which cross-sectional surveys were done in 34 North American and European countries in 2002, 2006, and 2010 (pooled n 492,788). We used individual data for socioeconomic status (Health Behaviour in School-aged Children Family Affluence Scale) and health (days of physical activity per week, body-mass index Z score [zBMI], frequency of psychological and physical symptoms on 0-5 scale, and life satisfaction scored 0-10 on the Cantril ladder) to examine trends in health and socioeconomic inequalities in health. We also investigated whether international differences in health and health inequalities were associated with per person income and income inequality. FINDINGS From 2002 to 2010, average levels of physical activity (3·90 to 4·08 days per week; p<0·0001), body mass (zBMI -0·08 to 0·03; p<0·0001), and physical symptoms (3·06 to 3·20, p<0·0001), and life satisfaction (7·58 to 7·61; p=0·0034) slightly increased. Inequalities between socioeconomic groups increased in physical activity (-0·79 to -0·83 days per week difference between most and least affluent groups; p=0·0008), zBMI (0·15 to 0·18; p<0·0001), and psychological (0·58 to 0·67; p=0·0360) and physical (0·21 to 0·26; p=0·0018) symptoms. Only in life satisfaction did health inequality fall during this period (-0·98 to -0·95; p=0·0198). Internationally, the higher the per person income, the better and more equal health was in terms of physical activity (0·06 days per SD increase in income; p<0·0001), psychological symptoms (-0·09; p<0·0001), and life satisfaction (0·08; p<0·0001). However, higher income inequality uniquely related to fewer days of physical activity (-0·05 days; p=0·0295), higher zBMI (0·06; p<0·0001), more psychological (0·18; p<0·0001) and physical (0·16; p<0·0001) symptoms, and larger health inequalities between socioeconomic groups in psychological (0·13; p=0·0080) and physical (0·07; p=0·0022) symptoms, and life satisfaction (-0·10; p=0·0092). INTERPRETATION Socioeconomic inequality has increased in many domains of adolescent health. These trends coincide with unequal distribution of income between rich and poor people. Widening gaps in adolescent health could predict future inequalities in adult health and need urgent policy action. FUNDING Canadian Institutes of Health Research.

Cross-national Study of Fighting and Weapon Carrying as Determinants of Adolescent Injury

Objectives. We sought to (1) compare estimates of the prevalence of fighting and weapon carrying among adolescent boys and girls in North American and European countries and (2) assess in adolescents from a subgroup of these countries comparative rates of weapon carrying and characteristics of fighting and injury outcomes, with a determination of the association between these indicators of violence and the occurrence of medically treated injury. Design and Setting. Cross-sectional self-report surveys using 120 questions were obtained from nationally representative samples of 161082 students in 35 countries. In addition, optional factors were assessed within individual countries: characteristics of fighting (9 countries); characteristics of weapon carrying (7 countries); and medically treated injury (8 countries). Participants. Participants included all consenting students in sampled classrooms (average age: 11–15 years). Measures. The primary measures assessed included involvement in physical fights and the types of people involved; frequency and types of weapon carrying; and frequency and types of medically treated injury. Results. Involvement in fighting varied across countries, ranging from 37% to 69% of the boys and 13% to 32% of the girls. Adolescents most often reported fighting with friends or relatives. Among adolescents reporting fights, fighting with total strangers varied from 16% to 53% of the boys and 5% to 16% of the girls. Involvement in weapon carrying ranged from 10% to 21% of the boys and 2% to 5% of the girls. Among youth reporting weapon carrying, those carrying handguns or other firearms ranged from 7% to 22% of the boys and 3% to 11% of the girls. In nearly all reporting countries, both physical fighting and weapon carrying were significantly associated with elevated risks for medically treated, multiple, and hospitalized injury events. Conclusions. Fighting and weapon carrying are 2 common indicators of physical violence that are experienced by young people. Associations of fighting and weapon carrying with injury-related health outcomes are remarkably similar across countries. Violence is an important issue affecting the health of adolescents internationally.