Raili Välimaa

Subjective health, symptom load and quality of life of children and adolescents in Europe.

Objectives:To examine cross-cultural differences in the prevalence of school childrens subjective health types and the pattern of socio-demographic and socio-economic differences.Methods:Within the cross-sectional Health Behaviour in Schoolaged Children 2005/2006 Survey 200,000 school children aged 11, 13 and 15 answered a general health item, the Cantrill life satisfaction ladder and a subjective health complaints checklist. ANOVA and multilevel logistic regression models were conducted.Results:Overall, 44% of the respondents reported multiple recurrent health complaints, only poor to fair general health, low life satisfaction or a combination of these. Older adolescents (OR: 1.1–1.6) and girls (OR: 1.2–1.4) reported more health problems, the gender difference increased with age (OR: 1.3–1.6). Low socio-economic status was also associated with health problems (OR: 1.4–2.3). Sizeable cross-national variation in the prevalence of health types and the impact of the above mentioned factors were observed, yet the main pattern of impact could be confirmed cross-culturally.Conclusions:Increasing social and gender role pressure with growing age, as well as restricted access to material resources and psychosocial strains are discussed as potential explanations for the observed health inequalities.

Smoking trends among adolescents from 1990 to 2002 in ten European countries and Canada

BackgroundDaily smoking adolescents are a public health problem as they are more likely to become adult smokers and to develop smoking-related health problems later on in their lives.MethodsThe study is part of the four-yearly, cross-national Health Behaviour in School-aged Children study, a school-based survey on a nationally representative sample using a standardised methodology. Data of 4 survey periods are available (1990–2002). Gender-specific daily smoking trends among 14–15 year olds are examined using logistic regressions. Sex ratios are calculated for each survey period and country. Interaction effects between period and gender are examined.ResultsDaily smoking prevalence in boys in 2002 ranges from 5.5% in Sweden to 20.0% in Latvia. Among girls, the daily smoking prevalence in 2002 ranges from 8.9% in Poland to 24.7% in Austria. Three daily smoking trend groups are identified: countries with a declining or stagnating trend, countries with an increasing trend followed by a decreasing trend, and countries with an increasing trend. These trend groups show a geographical pattern, but are not linked to smoking prevalence. Over the 4 surveys, the sex ratio has changed in Belgium, Switzerland, and Latvia.ConclusionAmong adolescents in Europe, three groups of countries in a different stage of the smoking epidemic curve can be identified, with girls being in an earlier stage than boys. In 2002, large differences in smoking prevalence between the countries have been observed. This predicts a high mortality due to smoking over 20–30 years for some countries, if no policy interventions are taken.

Screen-based activities and physical complaints among adolescents from the Nordic countries

BackgroundA positive association between time spent on sedentary screen-based activities and physical complaints has been reported, but the cumulative association between different types of screen-based activities and physical complaints has not been examined thoroughly.MethodsThe cross-sectional association between screen-based activity and physical complaints (backache and headache) among students was examined in a sample of 31022 adolescents from Denmark, Sweden, Norway, Finland, Iceland and Greenland, as part of the Health behaviour in school-aged children 2005/06 (HBSC) study. Daily hours spent on screen-based activities and levels of physical complaints were assessed using self-reports.ResultsLogistic regression analysis indicated that computer use, computer gaming and TV viewing contributed uniquely to prediction of weekly backache and headache. The magnitude of associations was consistent across types of screen based activities, and across gender.ConclusionThe observed associations indicate that time spent on screen-based activity is a contributing factor to physical complaints among young people, and that effects accumulate across different types of screen-based activities.

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.

Factors associated with perceived health among 12-year-old school children. Relevance of physical exercise and sense of coherence

Background: Poor perceived health during childhood may affect an individuals well-being throughout life. In adult studies, sense of coherence (SOC) has been shown to be associated with perceived health. Aims: The aim of this study was to determine which factors with an emphasis on SOC and physical exercise were associated with perceived health among 12-year-old children. Methods: A total of 1,231 12-year-old school children (83%) completed a questionnaire. Most of the 37 questions had multiple-choice types of response. The questions were largely based on those used in the Health Behaviour in School-aged Children (HBSC) study coordinated by the WHO. SOC was determined using the 13-item scale developed by Antonovsky. Factors used in calculating performance at school were marks (given by the teachers, range 4—10, 10 being the best) in mathematics, native language, and first foreign language. Statistical analysis involved the use of logistic regression models and the so-called generalized estimation technique because of the multi-level study design. Results: In a multivariate model adjusted for reported psychosomatic symptoms, insufficient physical exercise was clearly (OR 4.6) associated with poor perceived health. Other variables with significant associations (OR 1.4—1.7) were a mark below 9 in mathematics, belonging to the weakest SOC tertile, reporting of problems of perceived support from teachers, and reporting of various problems involving the class climate. Conclusions: Among the studied variables physical exercise was the most strongly associated with perceived health, even when several social and psychological risk factors were included in the analysis. SOC and variables of social support were also of importance.

How Comprehensive School Students Perceive their Psychosocial School Environment

The aim of this study was to describe students’ perceptions of their psychosocial school environment and to examine the associations between such perceptions and students’ perceived school performance. Our analyses were based on data from the Health Behaviour in School‐Aged Children 2006 study, involving responses by Finnish students from grades 7 and 9. The results indicated that students’ perceptions of their school environment were fairly positive, but that a remarkably large proportion of the students reported negative attitudes towards school. School engagement, school strain, and teacher‐student relations were found to be the most influential predictors in the psychosocial school environment regarding perceived school performance; as were the grade and educational aspirations out of the selected background factors. The findings imply that despite good academic achievement in Finnish comprehensive schools, there is still a need to improve students’ school engagement and their satisfaction with school.

The Role of Individual- and Macro-Level Social Determinants on Young Adolescents’ Psychosomatic Complaints:

This study examines the social determinants of psychosomatic complaints in young adolescents. Using data from the Health Behaviour in School-aged Children (HBSC) study, psychosomatic complaints are studied in 98,773 adolescents (11- and 13-year-olds; 48% 11-year-olds, 52% 13-year-olds; 52% females, 48% males) from 34 European countries. Individual-level determinants, including family-, peer- and school-related factors as well as country-level determinants (Human Development Index [HDI]) are considered. In line with existing evidence, results revealed more psychosomatic complaints in young adolescents experiencing stress inducing familial-, peer- and school-related factors. Negative effects of poor friendships, negative class climate, school pressure, and high media use were more pronounced for girls. After controlling for these factors, a higher HDI was related to a lower risk for psychosomatic complaints. Gender-specific intervention programs should aim at improving the quality of relationships, especially among peers, to prevent psychosomatic complaints among young 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.

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.

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.