Jorma Tynjälä

Oral Hygiene Habits of 11-year-old Schoolchildren in 22 European Countries and Canada in 1993/1994

This study is part of the Cross-National Survey on Health Behaviour in School-aged Children-a WHO Collaborative Study, which started in 1982. The aim of the study was to describe the oral hygiene habits (toothbrushing and flossing) of 11-year-old schoolchildren in 22 European countries (Austria, Belgium, the Czech Republic, Denmark, Estonia, Finland, France, Germany, Greenland, Hungary, Israel, Latvia, Lithuania, Northern Ireland, Norway, Poland, Russia, Scotland, the Slovak Republic, Spain, Sweden, and Wales) and Canada. The data were collected from standardized anonymous questionnaires in school classrooms during the 1993-1994 school year. At least 1300 schoolchildren, representing the whole country, participated in the study in each country. Oral hygiene habits were analyzed according to gender, age, country, school performance, and family economy. The children brushed most favorably in Sweden, Denmark, Germany, Austria, and Norway (83-73% brushed twice a day). More-than-once-a-day toothbrushing was especially uncommon (from 26 to 33%) among boys in Finland, Lithuania, Russia, Estonia, and Latvia. Toothbrushing frequency differed significantly according to school performance in Canada, the Czech Republic, Scotland, Poland, Northern Ireland, and Wales and between different socio-economic groups in Northern Ireland, Wales, the Czech Republic, Scotland, Poland, and Russia. Use of dental floss was rare. In general, flossing was less frequent among boys than among girls. Daily flossing was most common among Canadian adolescents (25%). In conclusion, there are considerable differences in toothbrushing frequency among children in European countries.

Perceived tiredness among adolescents and its association with sleep habits and use of psychoactive substances.

This study investigated the variation in perceived tiredness among 11, 13 and 15‐year‐old Finnish adolescents (n=4187). Additionally interrelationships between sleep habits, use of psychoactive substances (alcohol, tobacco and coffee) and perceived tiredness among 15‐year‐olds were examined. This study is part of an international, WHO‐coordinated survey of school childrens health and lifestyle (the HBSC Study). In Finland, research data represented the whole country. The data were collected in March–May 1994. Pupils responded anonymously to a standardized questionnaire during a class period. Subjective tiredness was very common and increased with age among adolescents. Perceived tiredness on at least four school mornings a week increased from 24 to 35% among boys and from 16 to 34% among girls. Feeling tired more often than once a week increased from 20 to 37% in girls and from 24 to 50% in boys. Structural equation models showed that interrelationships between three factors – sleep habits, use of psychoactive substances and perceived tiredness – were statistically significant. For these three factors the two remaining factors explained 24% of the variance of perceived tiredness among boys and 20% among girls, and the two remaining factors explained 42% (16%) of the variation in sleep habits. For the variance of the use of psychoactive substances sleep habits and perceived tiredness explained 26% (12%). Subjective tiredness is strongly age related; this together with the use of psychoactive substances and sleep habits regulate adolescents’ daily life and well‐being.

Secular trends in moderate-to-vigorous physical activity in 32 countries from 2002 to 2010: a cross-national perspective

BACKGROUND Sufficient levels of moderate to vigorous physical activity (MVPA) give substantial health benefits to adolescents. This article examines trends in physical activity (PA) from 2002 to 2010 across 32 countries from Europe and North America. METHODS Representative samples included 479 674 pupils (49% boys) aged 11 years (n = 156 383), 13 years (n = 163 729) and 15 years (n = 159 562). The trends in meeting the recommendations for PA (at least 60 min daily) were evaluated using logistic regression. RESULTS There was a slight overall increase between 2002 and 2010 (17.0% and 18.6%, respectively). MVPA increased significantly (P ≤ 0.05) among boys in 16 countries. Conversely, nine countries showed a significant decrease. Among girls, 10 countries showed a significant increase (P ≤ 0.05). Eight countries showed a significant decrease. For all countries combined, girls were slightly less likely to show an increase in PA over time. CONCLUSIONS The majority of adolescents do not meet current recommendations of PA. Further investment at national and international levels is therefore necessary to increase PA participation among children and adolescents and reduce the future health burden associated with inactivity.

Test-retest reliability of selected items of Health Behaviour in School-aged Children (HBSC) survey questionnaire in Beijing, China

BackgroundChildrens health and health behaviour are essential for their development and it is important to obtain abundant and accurate information to understand young peoples health and health behaviour. The Health Behaviour in School-aged Children (HBSC) study is among the first large-scale international surveys on adolescent health through self-report questionnaires. So far, more than 40 countries in Europe and North America have been involved in the HBSC study. The purpose of this study is to assess the test-retest reliability of selected items in the Chinese version of the HBSC survey questionnaire in a sample of adolescents in Beijing, China.MethodsA sample of 95 male and female students aged 11 or 15 years old participated in a test and retest with a three weeks interval. Student Identity numbers of respondents were utilized to permit matching of test-retest questionnaires. 23 items concerning physical activity, sedentary behaviour, sleep and substance use were evaluated by using the percentage of response shifts and the single measure Intraclass Correlation Coefficients (ICC) with 95% confidence interval (CI) for all respondents and stratified by gender and age. Items on substance use were only evaluated for school children aged 15 years old.ResultsThe percentage of no response shift between test and retest varied from 32% for the item on computer use at weekends to 92% for the three items on smoking. Of all the 23 items evaluated, 6 items (26%) showed a moderate reliability, 12 items (52%) displayed a substantial reliability and 4 items (17%) indicated almost perfect reliability. No gender and age group difference of the test-retest reliability was found except for a few items on sedentary behaviour.ConclusionsThe overall findings of this study suggest that most selected indicators in the HBSC survey questionnaire have satisfactory test-retest reliability for the students in Beijing. Further test-retest studies in a large and diverse sample, as well as validity studies, should be considered for the future Chinese HBSC study.

Trends in self‐reported sleep problems, tiredness and related school performance among Finnish adolescents from 1984 to 2011

The aim of this study was to investigate long‐term trends in insomnia symptoms, tiredness and school performance among Finnish adolescents. A time–series from 1984 to 2011 was analysed from two large‐scale survey studies, the Finnish School Health Promotion Study and the Health Behavior in School‐Aged Children study. A total of 1 136 583 adolescents aged 11–18 years answered a standardized questionnaire assessing frequency of insomnia symptoms, tiredness and school performance. A clear approximately twofold increasing trend in insomnia symptoms and tiredness was found from the mid‐1990s to the end of the 2000s. The increase was evident in all participating age groups and in both genders. After 2008, the increase seems to have stopped. Insomnia symptoms and tiredness were associated with lower school performance and they were more prevalent among girls (11.9 and 18.4%) compared to boys (6.9 and 9.0%, respectively). Unexpectedly, we also observed an increasingly widening gap in school performance between normally vigilant and chronically tired pupils. The underlying causes of these phenomena are unknown, but may concern changes in the broader society. The observed recent increasing trend in adolescents’ sleep problems is worrisome: poor sleep quality has also been suggested to associate with clinical or subclinical mood or anxiety disorders and behavioural problems and predispose to sleep and psychiatric disorders later in life. Our results justify further studies and call for serious attention to be paid to adolescents sleep in the Finnish educational system and society at large.

Use of xylitol chewing gum among Finnish schoolchildren.

The preventive, and partly the remineralizing, effect of xylitol was shown in Finland in the Turku Sugar Studies in 1971-73. Since then, several clinical trials in many countries have confirmed these results. In Finland, oral health personnel have recommended daily use of xylitol chewing gum in their dental health education. Moreover, commercial companies have advertised xylitol, emphasizing in particular its caries preventive effects. All Nordic dental associations have given their recommendations for xylitol use. The aim of this study was to describe how this health habit has been adopted by Finnish schoolchildren. The study was part of the comprehensive cross-national survey on Health Behavior in School-aged Children (HBSC Study)--a WHO Collaborative Study. The data were collected using standardized questionnaires to which pupils in grades 5 (11 years), 7 (13 years) and 9 (15 years) responded anonymously in school classrooms during the spring term 1998. The response rate varied between 87% (15-year-old boys) and 94% (11- and 13-year-old girls). Among boys, the percentages of daily users of xylitol chewing gum were 47% (11 years), 46% (13 years), and 44% (15 years), and among girls, 57% (11 years), 65% (13 years), and 69% (15 years), respectively. Use of sugar-sweetened chewing gum was very rare (1%), as also was use of chewing gum with other artificial sweeteners (1%). It may be concluded that since 1991 the use of xylitol chewing gum has further increased in Finland and currently more than a half of all schoolchildren benefit from it.

Is physical activity associated with low-risk health behaviours among 15-year-old adolescents in Finland?

Aims: To investigate the associations between physical activity and the pattern of risk health behaviour consisting of smoking, alcohol consumption, snuff (snus), cannabis, and condom use among 15-year-old adolescents, taking their educational aspirations and family affluence into account. Methods: The data were collected in the Health Behaviour in School-aged Children (HBSC) study in Finland in 2006. Standardised questionnaires were issued at schools to a 15-year-old nationally representative sample, of which 84.5% (1710 pupils) participated. Logistic regression analysis was used to explore the associations between physical activity, pattern of risk health behaviour, family affluence, and educational aspirations. Separate models for daily moderate-to-vigorous physical activity (MVPA) and leisure-time physical activity (LTPA) were tested. Multi-level analysis was performed in order to control the nested characteristics of the data. Results: Boys were significantly more physically active and used alcohol, cannabis, and snuff more often than girls. Girls had used a condom in their last intercourse less often than boys. The educational aspirations for higher education had the strongest association with the low-risk health behaviour, with the odds ratios in the MVPA model 3.30 (95% CI 2.41–4.55) for the boys and 3.46 (95% CI 2.56–4.67) for the girls. In the LTPA model, the corresponding odds ratios were 3.31 (95% CI 2.40–4.56) for the boys and 3.52 (95% CI 2.60–4.56) for the girls. Conclusions: Physical activity was not significantly associated with the low-risk health behaviour, whereas educational aspirations for higher education showed the strongest association. The results support the earlier studies indicating a social gradient in health-related behaviour already in adolescence.

Results from Finland's 2014 Report Card on Physical Activity for Children and Youth.

The Finnish 2014 Report Card on Physical Activity (PA) for Children and Youth is the first assessment of Finlands efforts in promoting and facilitating PA opportunities for children and youth using the Active Healthy Kids Canada grading system. The Report Card relies primarily on research findings from 6 Research Institutes, coordinated by the University of Jyväskylä. The Research Work Group convened to evaluate the aggregated evidence and assign grades for each of the 9 PA indicators, following the Canadian Report Card protocol. Grades from A (highest) to F (lowest) varied in Finland as follows: 1) Overall physical activity-fulfillment of recommendations (D), 2) Organized sport participation (C), 3) Active play (D), 4) Active transportation (B), 5) Sedentary behaviors (D), 6) Family and peers (C), 7) School (B), 8) Community and the built environment (B), and 9) Government (B). This comprehensive summary and assessment of indicators related to PA in Finnish children and youth indicates that Finland still has many challenges to promote a physically active life style for youth.

Emotional health of Canadian and Finnish students with disabilities or chronic conditions

The purpose of this study was to investigate the dimensions of emotional health in two population-based groups (Finland and Canada) of adolescents (ages 13 and 15 years) who self-identify as having a disability or chronic condition, as conceptualized by the WHO International Classification of Functioning, Disability and Health. Data from the 2002 WHO Health Behaviour in School-aged Children survey were used to compare the prevalence of emotional health (items on feeling low, feeling nervous) within and between countries. Eighteen percent of the Canadian and Finnish samples indicated they had a long-time disability, illness or medical condition. Canadian adolescents with disability or chronic conditions felt low significantly more frequently than their classmates without disability or chronic conditions. In both countries, students with disabilities who had more than one functional difficulty were significantly more likely to report feeling low and nervous. These results illustrate that the severity of disability as measured by the number of functional difficulties, and not merely the presence of disability or chronic condition, or particular functional difficulties, may play an important role in the emotional health of adolescents. Health promotion programs may use this information to guide practice to support the emotional health of students with disabilities.

Self-reported recurrent pain and medicine use behaviours among 15-year olds: results from the international study.

There is considerable variation in adolescent pain prevalence across epidemiological studies, with limited information on pain‐related behaviours among adolescents, including medicine use. The aims of this study were (1) to examine the prevalence of recurrent pain among 15‐year‐old adolescents internationally; (2) to investigate the association between recurrent pain and medicine use behaviours among boys and girls; and (3) to evaluate the consistency of these associations across countries.