Charlotte Meilstrup

Fruit and vegetable intake is associated with frequency of breakfast, lunch and evening meal: cross-sectional study of 11-, 13-, and 15-year-olds

BackgroundFrequency of eating breakfast, lunch and evening meal as a determinant of fruit and vegetable intake among young people is little studied. We investigated whether irregular meal consumption was associated with fruit and vegetable intake among adolescents. We used separate analyses, and special emphasis was on the potentially modifying effect of sex and age.MethodsData were from the Danish contribution to the international collaborative Health Behavior in School-Aged Children Study (HBSC) in 2002. We used a questionnaire-based, cross-sectional design to study schoolchildren aged 11, 13 and 15 years (n = 3913) selected from a random sample of schools in Denmark. Fruit intake and vegetable intake were measured by a food frequency questionnaire and analyses were conducted using multivariate logistic regression.ResultsOverall, statistically significant associations were found between irregular breakfast, lunch and evening meal consumption and low frequency of fruit intake and vegetable intake (breakfast: fruit OR = 1.42, vegetables OR = 1.48; lunch: fruit OR = 1.68, vegetables OR = 1.83; evening meal: vegetables OR = 1.70). No association was found for irregular evening meal consumption and low frequency of fruit intake. Analyses stratified by sex showed that the associations between irregular breakfast consumption and both fruit and vegetable intake remained statistically significant only among girls. When analyses were stratified by both sex and age, different patterns appeared. Overall, skipping meals seemed to be a less serious risk factor for low frequency of fruit and vegetable intake among younger participants compared with those who were older. This was especially evident for skipping breakfast. The same tendency was also seen for skipping lunch and evening meal, although the age pattern varied between boys and girls and between fruit and vegetable intake.ConclusionOur results showed that irregular breakfast, lunch and evening meal consumption among adolescents was associated with a low frequency of fruit and vegetable intake and that sex and age may play a modifying role. The different associations observed in different age and sex groups indicate the importance of analysing fruit and vegetable intake and meal types separately. The results highlight the importance of promoting regular meal consumption when trying to increase the intake of fruit and vegetables among adolescents.

Trends in health complaints from 2002 to 2010 in 34 countries and their association with health behaviours and social context factors at individual and macro-level

BACKGROUND This article describes trends and stability over time in health complaints in adolescents from 2002 to 2010 and investigates associations between health complaints, behavioural and social contextual factors at individual level and economic factors at macro-level. METHODS Comprising N = 510 876 11-, 13- and 15-year-old children and adolescents in Europe, North America and Israel, data came from three survey cycles of the international Health Behaviour in School-aged Children (HBSC) study. Age- and gender-adjusted trends in health complaints were examined in each country by means of linear regression. By using the country as the random effects variable, we tested to what extent individual and contextual variables were associated with health complaints. RESULTS Significant associations are stronger for individual level determinants (e.g. being bullied, smoking) than for determinants at macro-level (e.g. GDP, Gini), as can be seen by the small effect sizes (less than 5% for different trends). Health complaints are fairly stable over time in most countries, and no clear international trend in health complaints can be observed between 2002 and 2010. The most prominent stable determinants were being female, being bullied, school pressure and smoking. CONCLUSION Factors associated with health complaints are more related to the proximal environment than to distal macro-level factors. This points towards intensifying targeted interventions, (e.g. for bullying) and also targeting specific risk groups. The comparably small effect size at country-level indicates that country-level factors have an impact on health and should not be ignored.

Promotion of Social and Emotional Competence: Experiences from a Mental Health Intervention Applying a Whole School Approach.

Purpose – Within the framework of Health Promoting Schools Up is an intervention using a whole school approach aimed at promoting mental health by strengthening social and emotional competence among schoolchildren. Social and emotional competence is an integral part of many school-based mental health interventions but only a minority of interventions measure changes in competences. The purpose of this paper is to present the intervention Up and document changes in social and emotional competence among schoolchildren before and after the intervention. Design/methodology/approach –Up consists of four components: education and activities for schoolchildren; development of staff skills; involvement of parents; and initiatives in everyday life at school. Up was implemented in two Danish schools in 2010-2011. Social and emotional competence was measured among 11-15-year old schoolchildren before (response rate 96.2 per cent, n=589) and after (response rate 83.9 per cent, n=532) the intervention. Findings – Chan...

From rhetoric to action: Adapting the Act-Belong-Commit Mental Health Promotion Programme to a Danish context

In response to recent calls for implementing mental health promotion (MHP) in Denmark, the Danish National Institute of Public Health undertook a perusal of existing MHP frameworks. While a small number of such frameworks exist, the Act-Belong-Commit campaign that originated in Western Australia, was the only comprehensive, population-wide program identified that had a strong evidence base, demonstrated success in implementation and universal principles of well-being. Following a successful funding application to the Ministry of Health, the National Institute for Public Health, is leading a partnership to implement the Act-Belong-Commit campaign in Denmark in 2015–2017. This article describes the Act-Belong-Commit campaign and its implementation in Australia and how the National Institute of Public Health plans to introduce the campaign into Denmark. It is hoped that our planning for Denmark will be helpful to other countries planning to adopt the Act-Belong-Commit campaign.

Socioeconomic differences in emotional symptoms among adolescents in the Nordic countries: Recommendations on how to present inequality

Aims: This comparative study examines absolute and relative socioeconomic differences in emotional symptoms among adolescents using standardised data from five Nordic countries and gives recommendations on how to present socioeconomic inequality. Methods: The Health Behaviour in School-aged Children (HBSC) international cross-sectional study from 2005/2006 provided data on 29,642 11–15-year-old adolescents from nationally random samples in Denmark, Finland, Iceland, Norway and Sweden. The outcome was daily emotional symptoms. Family Affluence Scale (FAS) was used as indicator of socioeconomic position. We applied four summary measures of inequality: Prevalence Difference, Odds Ratio, Slope Index of Inequality and Relative Index of Inequality, and presented the socioeconomic inequality by a graphical illustration of the prevalence of emotional symptoms, the size of the FAS groups and the summary indices of inequality in each country. Results: The prevalence of emotional symptoms ranged from 8.1% in Denmark to 13.2% in Iceland. There were large country variations in the size of the low FAS-group ranging from 2% in Iceland to 12% in Finland. The largest absolute and relative socioeconomic inequalities were found in Iceland and the smallest in Finland for girls and in Denmark for boys. Conclusions: Emotional symptoms were more common among Nordic adolescents from low affluence families. This association appeared in the study of both absolute and relative inequality. A comprehensive presentation of socioeconomic inequality should include the prevalence of the health outcome, the size of the socioeconomic groups, and the regression line representing the summary indices of inequality.

Emotional symptoms among adolescents: epidemiological analysis of individual-, classroom- and school-level factors

BACKGROUND Large proportions of schoolchildren suffer from emotional symptoms and there are large variations across schools. It is unknown to what degree this variation is due to composition of schoolchildren in each school or to contextual factors. Objectives are to identify factors at individual, classroom and school levels associated with emotional symptoms. METHOD Data stem from the Danish contribution to the international Health Behaviour in School-aged Children study 2010 including 4922 schoolchildren aged 11-15-years from a random sample of schools and including data from school leaders. Emotional symptoms are defined as daily presence of at least one of four symptoms: feeling low, irritable or bad tempered, nervous and having difficulties falling asleep. Multilevel multivariable logistic regression analyses are applied to identify and quantify factors at individual, classroom and school level. RESULTS Schoolchildren from low (odds ratio (OR) 1.70, 95% CI: 1.33-2.17) and medium (OR 1.50, 95% CI: 1.22-1.85) occupational social class (OSC), girls (OR 1.32, 95% CI: 1.13-1.56) and schoolchildren exposed to bullying (OR 3.82, 95% CI: 2.71-5.40), had increased odds for emotional symptoms. A negative classroom climate was associated with emotional symptoms (OR 1.29, 95% CI: 0.99-1.69) and so was being part of classrooms with a high prevalence of bullying (OR 1.28, 95% CI: 1.0-1.60). CONCLUSION Female sex, low OSC, single parent family, exposure to bullying and a high prevalence of bullying within a class are all associated with emotional symptoms. Most variation across schools is explained by individual-level factors but psychosocial aspects of the classroom environment also play a role.

High and low levels of positive mental health: are there socioeconomic differences among adolescents?

Purpose – It is important within public health goals to promote adolescents’ mental health and to reduce socioeconomic inequalities in mental health. Among adults there are indications that the socioeconomic pattern of low positive mental health (PMH) differs from the socioeconomic pattern of high PMH. Knowledge regarding the social epidemiology of PMH among young people is lacking. The purpose of this paper is to examine the socioeconomic patterning of aspects of low and high PMH among adolescents. Design/methodology/approach – The Health Behaviour in School-aged Children Methodology Development Study 2012 provided data on 3,670 adolescents aged 11-15 in two municipalities in Denmark. Socioeconomic differences in aspects of low and high PMH (self-esteem, social competence and self-efficacy) were investigated by calculating sex-specific prevalence of PMH in socioeconomic groups measured by parents’ occupational social class. Using multi-level logistic regression analyses, odds ratios for low and high PMH ...