Joanna Mazur

KIDSCREEN-52 quality-of-life measure for children and adolescents

This study describes the development and reports the first psychometric results of the European KIDSCREEN-52 generic health-related quality-of-life questionnaire for children and adolescents. The KIDSCREEN-52, including ten dimensions, was applied in a European survey involving 12 countries (i.e., Austria, Switzerland, Czech Republic, Germany, Greece, Spain, France, Hungary, The Netherlands, Poland, Sweden and the UK) and 22,110 children and adolescents aged between 8 and 18 years of age. Questionnaire development included a literature search, expert consultation, and focus group discussions with children and adolescents. After definition of dimensions and collection of items, a translation process following international translation guidelines, cognitive interviews and a pilot test were performed. Analysis regarding psychometric properties showed Cronbach-α ranged from 0.77 to 0.89. Correlation coefficients between KINDLR and KIDSCREEN-52 dimensions were high for those assessing similar constructs (r = 0.51–0.68). All KIDSCREEN-52 dimensions showed a gradient according to socioeconomic status and most dimensions showed a gradient according to psychosomatic health complaints. The first results demonstrate that the KIDSCREEN-52 questionnaire is a promising cross-cultural measure of health-related quality-of-life assessment for children and adolescents in Europe.

THE KIDSCREEN-52 QUALITY OF LIFE MEASURE FOR CHILDREN AND ADOLESCENTS: PSYCHOMETRIC RESULTS FROM A CROSS-CULTURAL SURVEY IN 13 EUROPEAN COUNTRIES

OBJECTIVE This study assesses the reliability and validity of the European KIDSCREEN-52 generic health-related quality of life (HRQoL) questionnaire for children and adolescents. RESEARCH DESIGN The KIDSCREEN-52, which measures HRQoL in 10 dimensions, was administered to a representative sample of 22,827 children and adolescents (8 to 18 years) in 13 European countries. Psychometric properties were assessed using the Classical Test Theory approach, Rasch analysis, and structural equation modeling (SEM). A priori expected associations between KIDSCREEN scales and sociodemographic and health-related factors were examined. Test-retest reliability was assessed in 10 countries. RESULTS For the overall sample, Cronbachs alpha values ranged from 0.77 to 0.89. Scaling success (Multitrait Analysis Program) was >97.8% for all dimensions and Rasch analysis item fit (INFITmsq) ranged from 0.80 to 1.27. The intraclass correlation coefficients ranged from 0.56 to 0.77. No sizeable differential item functioning (DIF) was found by age, sex or health status. Four items showed DIF across countries. The specified SEM fitted the data well (root mean square error of approximation: 0.06, comparative fit index: 0.98). Correlation coefficients between Pediatric Quality of Life Inventory, Child Health and Illness Profile-Adolescent Edition, and Youth Quality of Life Instrument scales and KIDSCREEN dimensions assessing similar constructs were moderate for those (r = 0.44 to 0.61). Statistically significant differences between children with and without physical and mental health problems (Children with Special Health Care Needs screener: d = 0.17 to 0.42, Strengths and Difficulties Questionnaire: d = 0.32 to 0.72) were found in all dimensions. All dimensions showed a gradient according to socioeconomic status. CONCLUSIONS The KIDSCREEN-52 questionnaire has acceptable levels of reliability and validity. Further work is needed to assess longitudinal validity and sensitivity to change.

Cross national study of injury and social determinants in adolescents

Objectives: To compare estimates of the prevalence of injury among adolescents in 35 countries, and to examine the consistency of associations cross nationally between socioeconomic status then drunkenness and the occurrence of adolescent injury. Design: Cross sectional surveys were obtained from national samples of students in 35 countries. Eight countries asked supplemental questions about injury. Setting: Surveys administered in classrooms. Subjects: Consenting students (n = 146 440; average ages 11–15 years) in sampled classrooms. 37 878 students (eight countries) provided supplemental injury data. Exposure measures: Socioeconomic status (material wealth, poverty) and social risk taking (drunkenness). Outcome measures: Specific types and locations of medically treated injury. Results: By country, reports of medically treated injuries ranged from 33% (1060/3173) to 64% (1811/2833) of boys and 23% (740/3172) to 51% (1485/2929) of girls, annually. Sports and recreation were the most common activities associated with injury. High material wealth was positively (OR>1.0; p<0.05) and consistently (6/8 countries) associated with medically treated and sports related injuries. Poverty was positively associated with fighting injuries (6/8 countries). Drunkenness (social risk taking) was positively (p<0.01) and consistently (8/8 countries) associated with medically treated, street, and fighting injuries, but not school and sports related injuries. Conclusion: The high prevalence of adolescent injury confirms its importance as a health problem. Social gradients in risk for adolescent injury were illustrated cross nationally for some but not all types of adolescent injury. These gradients were most evident when the etiologies of specific types of adolescent injury were examined. Prevention initiatives should focus upon the etiologies of specific injury types, as well as risk oriented social contexts.

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.

The contribution of club participation to adolescent health: evidence from six countries

Background: Social networks have been recognised as an important factor for enhancing the health of people and communities. Bridging social capital, characterised by numerous and varied weak ties, exemplifies a particular type of network that can help people reach their goals and improve their health. This study seeks to contribute to the evidence base on the use of positive social networks for young people’s health by exploring the importance of club participation in predicting the health and health-related behaviours of 15-year-old girls and boys across Europe and North America. Methods: Data are derived from a 2005–6 World Health Organization collaborative study, to establish the relationships between different types of club and a range of health outcomes (self-perceived health, wellbeing and symptoms) and health-related behaviours (smoking, drinking). Multi-level logistic regression was used to assess the independent effects of club participation by controlling for gender and socioeconomic position. Data were compared across six countries. Results: All the considered outcomes, both in terms of perceived health and wellbeing and health behaviours were associated with participation in formal associations. The associations are in the expected direction (participation corresponding to better health) except for some particular association types. Conclusions: Participation in formal associations seems supportive for good health and health behaviours in adolescence, and should be promoted in this age group.

Psychometric Validation of the Revised Family Affluence Scale: a Latent Variable Approach

The aim was to develop and test a brief revised version of the family affluence scale. A total of 7120 students from Denmark, Greenland, Italy, Norway, Poland, Romania, Scotland and Slovakia reported on a list of 16 potential indicators of affluence. Responses were subject to item screening and test of dimensionality. Bifactor analysis revealed a strong general factor of affluence in all countries, but with additional specific factors in all countries. The specific factors mainly reflected overlapping item content. Item screening was conducted to eliminate items with low discrimination and local dependence, reducing the number of items from sixteen to six: Number of computers, number of cars, own bedroom, holidays abroad, dishwasher, and bathroom. The six-item version was estimated with Samejima’s graded response model, and tested for differential item functioning by country. Three of the six items were invariant across countries, thus anchoring the scale to a common metric across countries. The six-item scale correlated with parental reported income groups in six out of eight countries. Findings support a revision to six items in the family affluence scale.

The epidemiology of non-fatal injuries among 11-, 13- and 15-year old youth in 11 countries: findings from the 1998 WHO-HBSC cross national survey.

The primary objective was to present a cross-country comparison of injury rates, contexts and consequences. The research design was the analysis of data from the 1998 cross-national Health Behaviour in School-aged Children survey and 52 955 schoolchildren from 11 countries, aged 11, 13 and 15 years, completed a self-administrated questionnaire. A total of 41.3% of all children were injured and needed medical treatment in the past 12 months. Injury rates among boys were higher than among girls, 13.3% reported activity loss due to injury and 6.9% reported severe injury consequences. Most injuries occurred at home and at a sport facility, mainly during sport activity. Fighting accounted for 4.1% of injuries. This paper presents the first cross-national comparison of injury rates and patterns by external cause and context. Findings present cross-country similarities in injury distribution by setting and activity. These findings emphasize the importance of the development of global prevention programmes designed to address injuries among youth.

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.

Factors affecting exclusive breastfeeding in Poland: cross-sectional survey of population-based samples

Summary.Objective: To identify factors affecting exclusive breastfeeding in maternity hospital care and during the first six months after birth.Methods: Two cross-sectional surveys form the basis of this study: the first, conducted in 1995 on maternity wards (n = 11 422 newborns) and the second, conducted in 1997 in primary care centers (n = 10156 infants under six months).Results: The most meaningful factors in hospital care were: cesarean section, breastfeeding initiation after 2 h, lack of skin to skin contact, use of pacifiers, separation longer than 1h/24 h and health problems of infants. After hospital discharge the most significant factors were: use of pacifiers, mothers reluctance to exclusive breastfeeding longer then four months, low level of mother and father education.Conclusions: Most of identified factors can be modified so our results can help to introduce more effective target intervention.Zusammenfassung.Faktoren, die ausschliessliches Stillen in Polen beeinflussen: Querschnittsuntersuchungen auf der BevölkerungsebeneFragestellung: Es sollen Faktoren identifiziert werden, die das ausschliessliche Stillen in Geburtskrankenhäusern und während der ersten sechs Monate nach der Geburt beeinflussen.Methoden: Zwei landesweite Querschnittstudien dienen als Grundlage für diese Studie: die erste wurde 1995 in Entbindungsabteilungen durchgeführt (n = 11422 Neugeborene), die zweite, durchgeführt 1997 in Institutionen zur medizinischen Grundversorgung (n = 10156 Kinder unter sechs Monate).Resultate: Die wichtigsten Faktoren während der Krankenhausaufenthalt waren: Kaiserschnitt, erstes Stillen nach zwei Stunden, Mangel an Berührung, Gebrauch von Beruhigungsmitteln, Trennung für länger als 1 Std./24 Std. und Gesundheitsprobleme der Kinder. Die wichtigsten Faktoren nach der Krankenhausentlassung waren: Gebrauch von Beruhigungsmitteln, Widerwille der Mutter gegen ausschliessliches Stillen länger als vier Monate, niedriges Ausbildungsniveau von Mutter und Vater.Schlussfolgerung: Die meisten identifizierten Faktoren sind modifizierbar, so dass unsere Resultate dazu beitragen können, gezielte effektive Interventionsmassnahmen zu entwickeln.Résumé.Facteurs affectant l’allaitement maternel exclusif en Pologne: étude populationnelle transversaleObjectifs: Identifier les facteurs qui affectent l’allaitement maternel exclusif dans les maternités et durant les premiers six mois suivant la naissance.Méthodes: Deux enquêtes ont servi de base à cette étude: la première, conduite en 1995 dans des maternités (n = 11422 nouveau-nés), la seconde, conduite en 1997 dans des centres de santé (n = 10156 enfants âgés de moins de 6 mois).Resultats: Les facteurs ayant le plus d’importance dans les maternités sur l’allaitement exclusif se sont révélés être: une césarienne, un allaitement débuté 2 h après la naissance, le manque de contact “peau à peau”, l’usage d’une sucette, la séparation durant plus de 1 h par 24 h et les problèmes de santé des nourrissons. Après avoir quitté l’hôpital, les facteurs les plus significatifs étaient: l’usage d’une sucette, le manque d’envie des mères de nourrir uniquement au sein au delà de quatre mois, le bas niveau d’éducation de la mère et du père.Conclusions: La plupart des facteurs identifiés peuvent être modifiés. Nos résultats pourraient aider à rendre les interventions plus ciblées et donc plus efficaces.

Trends in multiple recurrent health complaints in 15-year-olds in 35 countries in Europe, North America and Israel from 1994 to 2010

BACKGROUND Health complaints are a good indicator of an individuals psychosocial health and well-being. Studies have shown that children and adolescents report health complaints which can cause significant individual burden. METHODS Using data from the international Health Behaviour in School-aged Children study, this article describes trends in multiple recurrent health complaints (MHC) in 35 countries among N = 237 136 fifteen-year-olds from 1994 to 2010. MHC was defined as the presence of two or more health complaints at least once a week. Logistic regression analysis was performed to evaluate trends across the five survey cycles for each country. RESULTS Lowest prevalence throughout the period 1994-2010 was 16.9% in 1998 in Austria and highest in 2006 in Israel (54.7%). Overall, six different trend patterns could be identified: No linear or quadratic trend (9 countries), linear decrease (7 countries), linear increase (5 countries), U-shape (4 countries), inverted U-shape (6 countries) and unstable (4 countries). CONCLUSION Trend analyses are valuable in providing hints about developments in populations as well as for benchmarking and evaluation purposes. The high variation in health complaints between the countries requires further investigation, but may also reflect the subjective nature of health complaints.