Improving the health of adolescents: the Nordic countries can help fill the evidence gap:Scandinavian Journal of Public Health

While in the Nordic countries we have well-developed welfare policies and several structural, statutory measures in place aiming to promote public health, studies from these countries are often absent from systematic reviews of research literature assessing the effects of policy measures designed to promote health. Using adolescent health promotion and efforts related to primary prevention of obesity as an example, this short commentary aims to illustrate the paucity of well-designed studies investigating the effects of public health policies affecting adolescents. This paper argues that the Nordic research community is in a good position to help fill this gap, and to contribute more widely to the international literature on evaluation of policy interventions

Associations between family structure and adolescents’ food habits

Objective: To investigate family structure differences in adolescents’ consumption of fruit, vegetables, sweets and sugar-added soft drinks with adjustments for socio-demographic and socio-economic variables. Design: Cross-sectional data from the Health Behaviour in School-aged Children survey. Setting: Norwegian primary and secondary schools. Participants: Adolescents (n 4475) aged 11, 13, 15 and 16 years. Results: After adjusting for covariates, living in a single-mother family was associated with lower vegetable consumption (OR 0·76, 95 % CI 0·63, 0·91) and higher soft drink consumption (OR 1·29, 95 % CI 1·06, 1·57). Living in a mother and stepfather family was negatively associated with fruit (OR 0·71, 95 % CI 0·54, 0·95) and vegetable (OR 0·72, 95 % CI 0·54, 0·97) consumption. Living in a single-father family was associated with lower sweets consumption (OR 0·48, 95 % CI 0·32, 0·72). No significant interactions were demonstrated between family structure and socio-demographic or socio-economic covariates. Conclusions: The study suggests that an independent association between family structure and adolescents’ food habits exists.publishedVersio

Can school nurses improve the school environment in Norwegian primary schools? A protocol for a randomized controlled trial

This protocol describes a randomized controlled trial where additional school nurse resources are assigned to work systemically with schools to improve the school environment and reduce bullying among and absence of 5th–7th grade students. Approximately 9000 students will have participated each year from 2018 to 2020 from 107 schools located in 12 Norwegian municipalities. Academic performance is studied as a secondary outcome.acceptedVersio

Monitoring food marketing to children: A joint Nordic monitoring protocol for marketing of foods and beverages high in fat, salt and sugar (HFSS) towards children and young people

The protocol describes methods for how to monitor marketing of foods and beverages high in fat, salt and sugar towards children and young people at a given time as cross-sectional studies, as well as allowing for monitoring of trends. The data provided could also be used for evaluation purposes, for instance providing relevant data for evaluating regulation practices and schemes in the respective countries; to study advertising and marketing practices, contents and forms over time. In addition to being a tool for monitoring purposes within each country, the protocol will also enable comparisons between the Nordic countries by establishing a joint understanding on how each marketing channel should be monitored. The protocol has been developed as a Nordic project between representatives and experts from Iceland, Finland, Sweden, Denmark and Norway together with international experts

Youth involvement in policy processes in public health, education, and social work: Protocol for a scoping review

The objective of this scoping review is to understand the extent and impact of youth involvement in policy processes within public health, education, and social work. Youth involvement in policy processes may enhance the relevance of policies and strengthen democratic practices. This scoping review aims to explore the nature, extent, and impact of youth involvement in policy processes in public health, education, and social work, with a focus on health, well-being, and obesity prevention. Empirical studies published from 1989 and evaluating involvement of youth aged 10 to 19 years old from all socioeconomic backgrounds and countries. Studies will be searched in seven databases. Data will be extracted and synthesized narratively by rights-based perspectives on youth involvement, practical processes of the involvement, and social experiences using descriptive statistics and visuals

Associations between social media, adolescent mental health, and diet: A systematic review

SummarySocial media use is integral to many adolescents' lives. It brings benefits but can also have detrimental effects on both physical and mental health. We conducted a systematic review examining associations between social media use, adolescent mental health (including body image, self‐esteem, stress, interpersonal relationships and loneliness, anxiety, and depressive symptoms), and dietary outcomes. Quantitative studies published between 2019 and 2023 investigating both mental health and diet were searched in 11 databases. The risk of bias was appraised using ROBINS‐E. Data were narratively synthesized by type of association, PROGRESS‐Plus health equity characteristics, and related to social media influencers. Twenty‐one studies were included, of which only one focused on influencers. Sex/gender was the only equity characteristic assessed (n = 8), with mixed results. The findings suggest significant positive correlations between social media use and both depressive and disordered eating symptoms, body dissatisfaction, and anxiety. Four studies identified body image, self‐esteem, or anxiety as moderators acting between social media exposure and dietary outcomes. Policy interventions mitigating the impact of social media on adolescents—particularly body image and disordered eating—are needed, alongside follow‐up studies on causal pathways, the role of influencers, equity impacts, dietary intake, and the best measurement tools to use.</jats:p

Cross-national variation in the association between family structure and overweight and obesity: Findings from the Health Behaviour in School-aged children (HBSC) study

Background Trends of increased complexity in family structure have developed alongside increasing prevalence of overweight and obesity. This study examines cross-national variations in the likelihood of living with overweight and obesity among adolescents living with one parent versus two parents, as well as the influence of living with stepparents, grandparents and siblings. Furthermore, the study explores how these associations relate to age, gender and individual-level socioeconomic status (SES) and country-level SES. We hypothesised that adolescents living in one-parent versus two-parents families, were more likely to live with overweight and obesity. Methods The study is based on nationally representative data from 41 countries participating in the 2013/14 Health Behaviors in School-Aged Children study (n = 211.798). Multilevel logistic regression analysis was used to examine the associations between family structure and overweight and obesity by age, gender, SES, and geographic region, among adolescents aged 11, 13 and 15 years. Results Living with one versus two parent(s) was associated with a higher likelihood of overweight and obesity (ORadj.1.13, 95%CI 1.08,1.17). Age, gender, individual-level SES, and living with grandparents were also associated with a higher likelihood of overweight and obesity, whereas living with siblings was associated with a lower likelihood of overweight and obesity. The effect of family structure varied also by age and gender with no significant associations found between living with one parent and overweight and obesity in the 15-year-old age group. Some cross-national variation was observed, and this was partly explained by country-level SES. The effect of family structure increased by a factor 1.08 per one-unit change in country-level SES (OR 1.08, 95%CI1.03, 1.12). Conclusion The study indicates that living in a one-parent family, as well as living together with grandparents, are associated with overweight and obesity among adolescents, particularly in the Nordic European region. Existing welfare policies may be insufficient to eliminate inequalities related to family structure differences.publishedVersio

Co-creating obesity prevention policies with youth: Policy ideas generated through the CO-CREATE project

Despite growing recognition of the importance of applying a systems lens to action on obesity, there has only been limited analysis of the extent to which this lens has actually been applied. The CO-CREATE project used a youth-led participatory action research approach to generate policy ideas towards the reduction of adolescent overweight and obesity across Europe. In order to assess the extent to which these youth-generated policy ideas take a systems approach, we analyzed them using the Intervention Level Framework (ILF). The ILF ascribes actions to one of five system levels, from Structural Elements, the least engaged with system change, up to Paradigm, which is the system's deepest held beliefs and thus the most difficult level at which to intervene. Of the 106 policy ideas generated by young people during the CO-CREATE project, 91 (86%) were categorized at the level of Structural Elements. This emphasis on operational rather than systems level responses echoes findings from a previous study on obesity strategies. Analyzing the distribution of systems level responses using the ILF has the potential to support more effective action on obesity by allowing identification of opportunities to strengthen systems level responses overall.publishedVersio

Learning from the CO-CREATE project: A protocol for systems thinking across research (STAR).

The CO-CREATE project aimed to work with young people to create, inform, and disseminate obesity-preventive evidence-based policies using a complex systems perspective. This paper draws lessons from this experience and proposes a protocol for embedding systems thinking within a research project. We first draw on existing systems thinking frameworks to analyze how systems thinking was translated across CO-CREATE, including the flow and relationship between the work packages and in the methods used. We then take the lessons from CO-CREATE and the principles of existing systems thinking frameworks-which focus on various points of intervention planning and delivery but not on research projects as a whole-to formulate a protocol for embedding systems thinking across a research project. Key lessons for future planning and delivery of systems-oriented research projects include incorporating "boundary critique" by capturing key stakeholder (adolescent) values and concerns; working to avoid social exclusion; ensuring methodological pluralism to allow for reflection and responsiveness (with methods ranging from group model building, Photovoice, and small group engagement); getting policy recipients to shape key questions by understanding their views on the critical drivers of obesity early on in the project; and providing opportunity for intraproject reflection along the way