Zuzana Katreniakova

Adolescents’ psychological well-being and self-esteem in the context of relationships at school

Background: The school environment has shown itself to be an important factor in explaining adolescent behaviour. The relationships and experiences that pupils have at school have been found to influence their development, psychological well-being, self-esteem and social adjustment. Purpose: The aim of the study is to explore whether there is a relationship between pupil–peer and pupil–teacher relationships and psychological well-being and self-esteem, and whether this relationship varies according to pupils’ experience of bullying or being bullied. Sample: Data consisted of a sample of 3694 students (mean age ± SD 14.3 ± 0.62 years; 51% girls) from elementary schools in Slovakia. Design and method: Questionnaires were administered to the students. In terms of data analysis, linear regression was firstly used in the whole sample to explore pupil–peer and pupil–teacher relationships and psychological well-being (the depression/anxiety and social dysfunction subscales of GHQ-12) and self-esteem (positive and negative self-esteem subscales of RSE). Next, the whole sample was divided into four groups in terms of involvement in bullying (normative contrasts, passive victims, aggressive non-victims and aggressive victims). Linear regression was used to explore the associations between pupil–peer and pupil–teacher relationships with the two factors of psychological well-being and two factors of self-esteem in these four groups. Results: As findings showed, better pupil–peer relationships and also pupil–teacher relationships were significantly related statistically to less depression/anxiety and social dysfunction, as well as to more positive and less negative self-esteem. All bullying categories were significantly related to pupil–peer relationships and the four dependent variables. However, in the categories of aggressive victims and aggressive non-victims, the pupil–teacher relationship was not significantly related to their psychological well-being and self-esteem. Also, in all subgroups, better pupil–peer relationships were significantly related to less depression/anxiety and social dysfunction, as well as with more positive and less negative self-esteem. Conclusion: Given the differences found in the connections between pupil–teacher relationships and well-being and self-esteem, between those who bullied and those who were bullied, it would seem that the school environment can play an important role in implementing anti-bullying prevention strategies.

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.

The effect of urban-area unemployment on the mental health of citizens differs between Slovak and Dutch cities

Conclusive evidence on the association of mental health problems (MHP) with area unemployment is lacking in regard to Central European cities. We obtained data on residents aged 19-64 from Slovak and Dutch cities from the FP7 EURO-URHIS 2 project. Multilevel logistic regression showed that the association between MHP (GHQ-12-total score ≥2) and area unemployment was strong in the Netherlands, but absent in Slovakia. Slovak citizens from the most favourable neighbourhoods had nearly double the risk of MHP than their Dutch counterparts. Individual-level socioeconomic characteristics did not explain area differences. The effect of urban-area unemployment seems to differ between Central European and Western European countries.

Health-risk behaviours in deprived urban neighbourhoods: a comparison between Slovak and Dutch cities

ObjectivesInternational comparisons of the associations of area-level socioeconomic position (SEP) and health-risk behaviours (HRBs) are for the most part lacking. The aims of this study were to compare Slovakia and the Netherlands regarding differences in the prevalence of HRBs by neighbourhood and individual deprivation, and to determine whether area differences could be explained by the SEP of residents.MethodsWe obtained data on residents aged 19–64 from Slovak and Dutch cities from the FP7 EURO-URHIS2 project and employed multilevel logistic regression.ResultsThe association between neighbourhood-level unemployment and HRBs differed between countries. In the Netherlands, the prevalence of almost all HRBs was higher in deprived areas, except for the consumption of fruits and vegetables. These area effects diminished after controlling for individual-level SEP. In Slovakia, no area effects were observed, although Slovak residents showed a higher risk for most HRBs. At the individual level, an inverse SE gradient was found for almost all HRBs in both countries.ConclusionsLocal analyses of small area health differences and health determinants are critical for efficient implementation of neighbourhood-based interventions.

Competitive funding and structures for public health research in European countries

INTRODUCTION The European Union is giving increasing emphasis to research as a driver for innovation and economic development. The European collaborative study PHIRE (Public Health Innovation and Research in Europe) investigated the funding and structures of public health research at national level in European countries. METHODS Background materials were prepared for national public health associations of European countries to hold workshops or discussions with research and policy stakeholders on their public health research systems. The reports, supplemented from internet sources for 23 EU countries (four did not contribute), provided information for framework analysis. RESULTS All countries have public funding and administrative structures for research, but structures for public health research are more varied. In most countries, competitive health research funding is controlled by the Ministry of Science, with little input from the Ministry of Health. In four countries, Ministries of Health provide competitive funding alongside Ministries of Science, and in two countries there is a single health research council. There is no comparative reporting of public health research funding, and little connection with European public health research programmes. CONCLUSION Europe needs a comprehensive picture of national and regional systems of public health research, in order to critically assess them and better adapt to changes and challenges, and to achieve a European Research Area for public health.

Civil society engagement in innovation and research through the European Public Health Association.

BACKGROUND The European Public Health Association (EUPHA) proposed and led PHIRE (Public Health Innovation and Research in Europe), with co-financing by the European Commission, to assess public health innovation and research at national level in Europe. PHIRE was also designed to promote organizational development and capacity building of EUPHA. We assess the success and limitations of using EUPHAs participative structures. METHODS In total, 30 European countries were included-27 EU countries, Iceland, Norway and Switzerland. EUPHA thematic section presidents were asked to identify country informants to report, through a web-based questionnaire, on eight public health innovations. National public health associations (EUPHA member organizations) were requested to identify their national public health research programmes and calls, review the health research system, coordinate a stakeholder workshop and provide a national report. The section and national reports were assessed for responses and completeness. RESULTS Half of the final responding CIs were members of EUPHA sections and the other half gained from other sources. Experts declined to respond for reasons including lack of time, knowledge of the innovation or funding. National public health associations held PHIRE workshops with Ministries of Health in 14 countries; information for 10 countries was gained through discussions within the national association, or country visits by PHIRE partners. Six countries provided no response. Some national associations had too weak organizational structures for the work or insufficient financial resources or criticism of the project. CONCLUSION EUPHA is the leading civil society organization giving support to public health research in Europe. PHIRE created new knowledge and supported organizational development. EUPHA sections gained expert reports on public health innovations in European countries and national public health associations reported on national public health research systems. Significant advances could be made if the European Commission worked more directly with EUPHAs expert members and with the national public health associations.

Associations between self-rated health, mental health problems and physical inactivity among urban adolescents

Background Self-rated health is a valid and reliable subjective indicator of general health. We aimed to assess the associations between self-rated health, mental health problems, physical activity, sedentary behaviour and BMI among Slovak urban adolescents. Methods Data were collected within the EU-FP7: EURO-URHIS 2 (The European Health Indicator System Part 2) project in two largest Slovak cities: Bratislava and Kosice. Sample included 1111 adolescents (response rate 73.7%, mean age 14.32 ± 0.48 years, 52.8% boys). Self-rated health was measured with the first item from the Short Form Health Survey 36 questionnaire, mental health problems were assessed by the Strengths and Difficulties Questionnaire and for physical activity and sedentary behaviour questions from the WHO HBSC questionnaire were used. Logistic regression was performed to determine the associations between self-rated health and the independent variables. Results Self-rated health was found to be significantly associated with mental health problems, sedentary behaviour and BMI. However, the strongest association was found with engagement in physical activity every day (OR 8.0; 95% CI 1.6-39.9). Conclusions Previous research revealed that self-rated health was associated with various mental health problems. Our findings add to these results by showing that physical activity and sedentary behaviour are also very important additional factors related to self-rated health. Better understanding of these associations can help in developing more effective public health intervention programmes for adolescents.

Are area-level and individual-level socioeconomic factors associated with self-rated health in adult urban citizens? Evidence from Slovak and Dutch cities

Background Evidence shows that living in disadvantaged areas is associated with poor health. This may be due to the socioeconomic (SE) characteristics of both these residents and the areas where they live. Evidence regarding this on Central European (CE) countries is scarce. Our aim was to assess whether the prevalence of poor self-rated health (SRH) was higher in deprived urban areas, whether this can be explained by individual SE status (SES) and whether this differed between Slovakia and the Netherlands per age group. We examined the association of urban-level data and individual-level SE factors from different urban areas in different countries (Slovakia, the Netherlands) using comparable urban health indicators and area indicators. We also obtained unique data from the EU-FP7 EURO-URHIS 2 project. Multilevel logistic regression showed that poor SRH was associated with area deprivation in both countries. Regarding age by country, poor SRH occurred more frequently in the more deprived areas for the younger age group (≤64) in the Netherlands but for the older age group (≥65 years) in Slovakia. Moreover, Slovak citizens reported poor SRH significantly more often than Dutch residents. Individual SES was significantly associated with poor SRH in both age groups and both countries for most area-level SE measures. Individual SES is associated with SRH more strongly than area deprivation. Therefore, it is important to account for relative deprivation at an individual level when considering health-enhancing activities. Moreover, the effect of urban-area deprivation seems to differ between CE and WE countries.

The effect of neighbourhood unemployment on health-risk behaviours in elderly differs between Slovak and Dutch cities

BACKGROUND Health-risk behaviours (HRB) increase the risk of disability and chronic diseases at an older age. This study aimed to compare Slovakia and the Netherlands regarding differences in the prevalence of HRB by neighbourhood and individual deprivation and to determine whether area differences could be explained by the socio-economic position (SEP) of the residents. METHODS We obtained data on non-institutionalized residents aged ≥ 65 years from the EU-FP7: EURO-URHIS 2 project from Slovak (N = 665, response rate 44.0%) and Dutch cities (N = 795, response rate 50.2%). HRB concerned daily smoking, binge drinking, physical activity, consumption of fruits and vegetables and body mass index. Area deprivation was measured by the neighbourhood unemployment rate. Individual SEP was measured by education and household income with financial strain. We used multilevel logistic regression. RESULTS In Slovakia, no HRB was associated with either neighbourhood unemployment or individual SEP. The elderly in the Netherlands from the least favourable neighbourhoods were more likely to be daily smokers [odds ratio (OR) 2.32; 95% confidence interval (CI) 1.25, 4.30] and overweight (OR 1.84; 95% CI 1.24, 2.75) than residents from the most favourable ones. For the Dutch elderly the gradients varied per HRB and per individual-level SEP indicator. Individual SEP explained country differences in the association of area unemployment with smoking and lack of physical activity but not that with overweight. CONCLUSION Countries differed in the associations with HRB of both neighbourhood unemployment and individual SEP among the elderly urban residents. The local importance of socio-economic factors on both levels should be considered when developing health-promotion activities for the elderly.

Elderly from lower socioeconomic groups are more vulnerable to mental health problems, but area deprivation does not contribute: a comparison between Slovak and Dutch cities

Background Little is known about factors associated with mental health problems (MHP) of the elderly in socioeconomically deprived neighbourhoods, and comparisons between Central European and Western European countries on this topic are lacking. We examined whether MHP occurred more frequently in deprived neighbourhoods and among deprived people. Next, we examined whether the association of MHP with area deprivation differed by country and whether this could be explained by the socioeconomic (SE) characteristics of the residents. We obtained data on non-institutionalized residents aged 65 years and above from the EU-FP7: EURO-URHIS 2 project from Slovak ( N = 665, response rate 44.0%) and Dutch cities ( N = 795, response rate 50.2%). An elevated score on General Health Questionnaire-12 (≥2) indicated MHP. Education and household income with financial strain were used as measures of individual SE status. We employed multilevel logistic regression. Overall rates of MHP were significantly higher in Slovakia (40.6%) than in the Netherlands (30.6%). The neighbourhood unemployment rate was not associated with the mental health of elderly in either country. Rates of MHP were significantly higher among elderly with low and medium income [odds ratio (OR) = 1.75, 95% confidence interval (CI) = 1.16-2.62; OR = 1.64, 95% CI = 1.12-2.41, respectively] and financial strain (OR = 2.26, 95% CI = 1.56-3.28) when compared with those with high income and no strain, respectively. Individual-level SE characteristics explained differences between the two countries. The risk of MHP among the elderly is associated with their individual-level SE position but not with neighbourhood deprivation in both Slovakia and the Netherlands.