Torbjørn Torsheim

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.

The destructiveness of laissez-faire leadership behavior.

The aim of the study is to test the assumption that laissez-faire leadership behavior is not a type of zero-leadership, but a type of destructive leadership behavior that shows systematic relationships with workplace stressors, bullying at work, and psychological distress. A survey of 2,273 Norwegian employees was conducted and analyzed. Laissez-faire leadership was positively correlated with role conflict, role ambiguity, and conflicts with coworkers. Path modeling showed that these stressors mediated the effects of laissez-faire leadership on bullying at work and that the effects of laissez-faire leadership on distress were mediated through the workplace stressors, especially through exposure to bullying. The results support the assumption that laissez-faire leadership behavior is a destructive leadership behavior.

Development of a Facebook Addiction Scale.

The Bergen Facebook Addiction Scale (BFAS), initially a pool of 18 items, three reflecting each of the six core elements of addiction (salience, mood modification, tolerance, withdrawal, conflict, and relapse), was constructed and administered to 423 students together with several other standardized self-report scales (Addictive Tendencies Scale, Online Sociability Scale, Facebook Attitude Scale, NEO–FFI, BIS/BAS scales, and Sleep questions). That item within each of the six addiction elements with the highest corrected item-total correlation was retained in the final scale. The factor structure of the scale was good (RMSEA = .046, CFI = .99) and coefficient alpha was .83. The 3-week test-retest reliability coefficient was .82. The scores converged with scores for other scales of Facebook activity. Also, they were positively related to Neuroticism and Extraversion, and negatively related to Conscientiousness. High scores on the new scale were associated with delayed bedtimes and rising times.

The characteristics of the outdoor school environment associated with physical activity

The school is an important setting for physical activity. The purpose of the present study was to examine the association between physical environmental characteristics and participation in daily physical activity during school breaks. Data from 130 schools and 16 471 students (Grades 4–10) in Norway were obtained in 2004 through self-administered questionnaires to principals and students. Multilevel logistic regression models revealed that boys at secondary level with a larger number of outdoor facilities at school had 2.69 times [95% confidence interval (CI) = 1.21–5.98] and girls 2.90 times (95% CI = 1.32–6.37) higher odds of being physically active compared with students in schools with fewer facilities. Boys at secondary level with areas for hopscotch/skipping rope had 2.53 times (95% CI = 1.55–4.13), with a soccer field 1.68 times (95% CI = 1.15–2.45), with playground equipment 1.66 times (95% CI = 1.16–2.37) and with a sledding hill 1.70 times (95% CI = 1.23–2.35) higher odds to be physically active compared with students in schools without these facilities. A sledding hill was also associated with girls’ physical activity participation in secondary school (odds ratio = 1.58, 95% CI = 1.11–2.24). Outdoor facilities in secondary schools are associated with students’ daily physical activity participation during school breaks. Therefore, improving the outdoor environment should be considered in physical activity promotion school programs in secondary schools.

Tracking of leisure-time physical activity during adolescence and young adulthood: a 10-year longitudinal study

BackgroundThe purpose of this study was to show how participation in leisure-time physical activity changes between ages 13 to 23, and to what extent engaging in specific types of sports tracks into young adulthood.MethodsThe sample comprised 630 subjects who responded to questionnaires at age 13, with seven follow-ups over a 10-year period in the Norwegian Longitudinal Health Behaviour Study. The associations between adolescent participation in global and specific types of leisure-time physical activity were examined by analyses of variance, regression analysis and growth curve analysis.ResultsThe findings suggest that the transition from adolescence to adulthood is, on average, a period of decline in physical activity, but with the decline levelling off into adulthood. The decline was significantly greater among males than females. There were substantial individual differences in the amount of change, in particular among males.Jogging alone and cycling, recreational activities such as skiing and hiking, and ball games, showed a high degree of tracking from age 15 to 23.The findings indicate low associations between participation in specific types of activities during adolescence and global leisure-time physical activity in young adulthood, while participation in several adolescent physical activities simultaneously was moderately related to later activity. Thus, being involved in various types of physical activity may offer good opportunities for establishing lifelong involvement in physical activity, independent of the specific type of activity.ConclusionThe observed variation in change might suggest a need for a more targeted approach, with a focus on subgroups of individuals. The group of inactive youth may be considered as a high risk group, and the findings suggest that adolescent males who are inactive early seem likely to continue to be inactive later.The observed heterogeneity in change highlights the limitation of previous approaches to analyzing physical levels over time, and suggests that multilevel analysis should be used in future research on longitudinal data on physical activity.

School-Related Stress, School Support, and Somatic Complaints A General Population Study

This study examines the relationship between school-related stress, social support from teachers and classmates, and somatic complaints in the general population of Norwegian adolescents. The study was undertaken as part of the World Health Organization’s survey “Health Behaviour in School-Aged Children” (HBSC). A representative sample of 4,952 Norwegian 11- to 15-year-olds completed self-report measures on school-related stress, social support from teacher and classmates, and the HBSC symptom checklist. Multivariate logistic regression analysis revealed that students with high levels of school-related stress had a higher odds ratio (OR) for weekly headache (4.1), abdominal pain (3.9), backache (4.8), dizziness (5.4), and coexisting somatic complaints(6.1). For social support, the associations were weaker but students with low classmate support had a consistently higher OR for weekly symptoms. Interaction terms of school-related stress and social support did not reach significance. Findings suggest that adolescents’ frequency of somatic complaints partly may reflect their adaptation to ordinary school demands.

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.

Subjective health complaints in adolescence: dimensional structure and variation across gender and age

AIMS The aim of this study is to investigate dimensional structures in subjective health complaints in adolescents and to examine the variation in levels and dimensionality across gender and age groups. METHODS Data from two studies were used: (1) a study based on a convenience sample, consisting of 1427 Norwegian students (11- to 15-year-olds) from schools participating in the European Network of Health Promoting Schools; (2) a nationwide survey amongst 7,059 Norwegian students (aged 11, 13, 15, and 16) from the Health Behaviour in School-aged Children (HBSC) study. Subjective health complaints were measured by revised versions of the HBSC symptoms checklist (HBSC-SCL). RESULTS In study 1 confirmatory factor analysis revealed that a model of two highly correlated factors, which can be labelled somatic and psychological, fitted the data reasonably well (CFI = 0.91). This two-factor model was applied in study 2 and latent means were tested across sub-samples defined by gender and age. The results indicate that girls show higher mean levels compared with boys on both factors. There is also an indication of an increase in these factors with age amongst girls, while amongst boys there is less, if any, difference across age groups. The correlation between the somatic and psychological factors was virtually constant across age groups and gender. CONCLUSIONS The identification of a somatic and a psychological factor indicates the existence of two different dimensions that may have different aetiologies. The gender difference in latent means across age groups may suggest a different developmental pattern amongst girls and boys.

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.

Country material distribution and adolescents’ perceived health: multilevel study of adolescents in 27 countries

Objective: To assess the impact of country material distribution on adolescents’ perceptions of health. Design: Cross sectional multilevel study. Setting: Data were collected from the school based health behaviour in school aged children: WHO cross national study 1997/98, which includes students from 27 European and North American countries. Participants: 12 0381 students in year 6, 8, and 10 who were attending school classes on the day of data collection. Main result: Adolescents in countries with a high dispersion of family affluence were more likely to have self rated poor health even after controlling for individual family level of affluence and family social resources. Conclusion: There are substantial inequalities in subjective health across European and North American countries related to the distribution of family material resources in these countries.