Bidirectional Relationship of Sleep with Emotional and Behavioral Difficulties: A Five-year Follow-up of Finnish Adolescents

The long-term effects of sleep on adolescent psychosocial well-being are mostly unknown, although insufficient sleep has been associated with emotional and behavioral difficulties in cross-sectional studies. With a five-year follow-up of Finnish adolescents (Time 1: n = 8834; Mean age = 13 years, 51.1% female, Time 2: n = 5315, Mean age = 15 years, 51.6% female, Time 3: n = 3712; Mean age = 17 years; 50.2% female), the purpose of this longitudinal study was to investigate the relations between self-reported sleep duration, sleep problems, and emotional and behavioral difficulties during adolescence. Emotional and behavioral difficulties were assessed using The Strengths and Difficulties Questionnaire (SDQ) measuring emotional symptoms, conduct problems, hyperactivity, peer problems and total difficulties. Sleep duration was calculated by counting the hours between self-reported bedtime and wake-up time. Sleep problems were assessed with a single question about the general sleep problems. According to the cross-lagged models for sleep and emotional and behavioral difficulties, the findings of this study indicate a developmental process during adolescence where, firstly, short sleep duration is a stronger predictor for current and prospective emotional and behavioral difficulties than vice versa. Secondly, increased emotional and behavioral difficulties expose adolescents to current and later sleep problems more strongly than reverse. Thus, the results show that short sleep duration predisposed to emotional and behavioral difficulties across adolescence, which then led to more prospective sleep problems. These findings suggest a developmental process where sleep and emotional and behavioral difficulties are intertwined in shaping adolescents' health.Peer reviewe

Low schoolwork engagement and schoolwork difficulties predict smoking in adolescence?

Low academic achievement has been associated with smoking but factors behind this association are poorly known. Such factors could include schoolwork disengagement and schoolwork difficulties. To assess the extent to which they contribute to the explanation of how health inequalities emerge, we study in a longitudinal design whether these have an independent effect on smoking or whether their effect is mediated through academic achievement. Longitudinal data were collected in the Helsinki metropolitan area, Finland in 2011 and 2014. Participants were seventh-graders (12 13 years, N=9497). In the follow-up, 6534 students reported their smoking status in the ninth grade (15 16 years). Smoking, schoolwork behavioural engagement, i.e. participation in academic activities, and disengagement, schoolwork difficulties and cognitive competence were self-reported by adolescents. Academic achievement was obtained from the Finnish national application register on upper secondary education. A mediation analysis was executed with bootstrapped confidence intervals. Higher schoolwork behavioural engagement and cognitive competence in the seventh grade predicted that adolescents were more likely not to smoke in the ninth grade (all P <0.001) while higher schoolwork disengagement and schoolwork difficulties predicted adolescents smoking (all P <0.001). The effects were mediated through academic achievement. Students behavioural disengagement with schoolwork and schoolwork difficulties are risks for smoking initiation. Their effect is mediated through poor school achievement. As smoking often continues in adulthood and poor school performance typically leads to lower education, schoolwork disengagement and difficulties in adolescence constitute potential pathways to inequalities in health.Peer reviewe

Cardiac Autonomic Function in Adults Born Preterm

Objective To evaluate cardiac autonomic function in adults born preterm. Study design We studied the association between prematurity and cardiac autonomic function using heart rate variability measurements in 600 adults (mean age of 23.3 years) from a geographically based cohort in Northern Finland. There were 117 young adults born early preterm (= 37 weeks, controls). Autonomic function was analyzed by calculating time and frequency domain heart rate variability measurements using linear regression. Results Compared with controls, the mean difference in root mean square of successive differences (indicating cardiac vagal activity) was -12.0% (95% CI -22.2%, -0.5%, adjusted for sex, age, source cohort, and season P = .04) for the early preterm group and -7.8% (-16.8%, 2.0%, P = .12) for the late preterm group. Mean differences with controls in low frequency power (indicating cardiac vagal activity, including some sympathetic- and baroreflex-mediated effects) were -13.6% (-26.7%, 1.8%, P = .08) for the early pretermgroup and -16.4% (-27.0%, -4.3%, P = .01) for the late preterm group. Mean differences in high frequency power (quantifying cardiac vagal modulation in respiratory frequency) were -19.2% (-36.6%, 2.9%, P = .09) for the early preterm group and -13.8% (-29.4%, 5.3%, P = .15) for the late preterm group. Differences were attenuated when controlled for body mass index and physical activity. Conclusions Our results suggest altered autonomic regulatory control in adults born preterm, including those born late preterm. Altered autonomic regulatory control may contribute to increased cardiovascular risk in adults born preterm.Peer reviewe

Postexercise Heart Rate Recovery in Adults Born Preterm

Objective To evaluate postexercise heart rate recovery (HRR) in adults born preterm. Study design We studied the association between preterm birth and postexercise HRR in 545 adults (267 women) at 23.3 years of age (range 19.9-26.3 years). One hundred three participants were born early preterm ( Results Mean peak HR was 159.5 bpm in the early preterm (P = .16 with controls), 157.8 bpm in the late preterm (P = .56), and 157.0 bpm in the control group. Mean HRR 30 seconds after exercise was 3.2 bpm (95% CI 1.1-5.2) lower in the early preterm group and 2.1 bpm (0.3-3.8) lower in the late preterm group than the full term controls. Mean 60s HRR was 2.5 (-0.1 to 5.1) lower in the early preterm group and 2.8 bpm (0.6-4.9) lower in the late preterm group. Mean maximum slope after exercise was 0.10 beats/s (0.02-0.17) lower in the early preterm group and 0.06 beats/s (0.00-0.12) lower in the late preterm group. Conclusions Our results suggest reduced HRR after exercise in adults born preterm, including those born late preterm. This suggests altered reactivation of the parasympathetic nervous system, which may contribute to cardiovascular risk among adults born preterm.Peer reviewe

Metropolialueen nuorten siirtyminen toisen asteen koulutukseen : Keiden koulupolku on suora, keiden viivästynyt tai mutkainen?

Peer reviewe

Health and educational aspirations in adolescence: A longitudinal study in Finland

BackgroundThe health selection hypothesis suggests that poor health leads to low educational attainment during the life course. Adolescence is an important period as poor health might prevent students from making the best educational choices. We test if health in adolescence is associated with educational aspirations and whether these associations persist over and above sociodemographic background and academic achievement.MethodsUsing classroom surveys, a cohort of students (n = 5.614) from the Helsinki Metropolitan Region was followed from the 7th (12–13 years,) up to the 9th grade (15–16 years) when the choice between the academic and the vocational track is made in Finland. Health factors (Strengths and Difficulties Questionnaire (SDQ), self-rated health, daily health complaints, and long-term illness and medicine prescribed) and sociodemographic background were self-reported by the students. Students’ educational aspirations (applying for academic versus vocational track, or both) and their academic achievement were obtained from the Joint Application Registry held by the Finnish National Agency for Education. We conducted multilevel multinomial logistic regression analyses, taking into account that students are clustered within schools.ResultsAll studied health factors were associated with adolescents’ educational aspirations. For the SDQ, daily health complaints, and self-rated health these associations persisted over and above sociodemographic background and academic achievement. Students with better health in adolescence were more likely to apply for the academic track, and those who were less healthy were more likely to apply for the vocational track. The health in the group of those students who had applied for both educational tracks was in between. Inconsistent results were observed for long-term illness. We also found robust associations between educational aspirations and worsening health from grade 7 to grade 9.ConclusionsOur findings show that selection by health factors to different educational trajectories takes place at early teenage much before adolescents choose their educational track, thus supporting the health selection hypothesis in the creation of socioeconomic health inequalities. Our findings also show the importance of adolescence in this process. More studies are needed to reveal which measures would be effective in helping students with poor health to achieve their full educational potential.</p

Nuorten aikuisten toimintakyvyn väestöryhmittäiset erot

Toimintakyvyn tutkimuksessa tarkastellaan usein ikääntyneiden toimintakykyä, mutta jo nuorilla aikuisilla on havaittavissa toimintakyvyn rajoitteita ja väestöryhmien välisiä eroja toimintakyvyssä. Tutkimuksessa selvitettiin nuorten aikuisten toimintakykyä eri ulottuvuuksilla, toimintakyvyn rajoitteiden kasautumista sekä näiden väestöryhmittäisiä eroja. Aineistona oli Alueellisen terveys- ja hyvinvointitutkimuksen (ATH) 20–34-vuotiaat vastaajat vuosilta 2012 ja 2013 (8070 vastaajaa, vastausprosentti 37). Menetelminä käytettiin ristiintaulukointia, logistista regressioanalyysia, luottamusvälejä ja ikävakiointia. Nuorilla miehillä oli naisia parempi liikkumiskyky. Psyykkisen toimintakyvyn rajoitteet olivat molemmilla sukupuolilla toimintakyvyn ulottuvuuksien rajoitteista yleisimpiä. Sosiaalisen toimintakyvyn rajoitteet olivat miehillä naisia yleisempiä. Työkyvyssä ja päivittäisistä toimista suoriutumisessa ei ollut tilastollisesti merkitseviä eroja miesten ja naisten välillä. Seitsemällä prosentilla vastaajista oli rajoitteita vähintään kolmella viidestä toimintakyvyn ulottuvuudesta. Sekä yksittäisten toimintakyvyn ulottuvuuksien rajoitteet että rajoitteiden kasautuminen olivat yhteydessä vähäiseen koulutukseen ja toimeentulovaikeuksiin. Avioliitossa olevilla rajoitteiden kasautuminen oli muita vähäisempää. Naisilla työllisillä, kotiäideillä ja opiskelijoilla oli toimintakyvyn rajoitteiden kasautumista harvemmin kuin työttömillä ja työvoiman ulkopuolisilla. Vaikka nuorten aikuisten toimintakykyongelmat ovat vielä suhteellisen harvinaisia, on väestöryhmien välillä havaittavissa merkittäviä eroja toimintakyvyssä ja toimintakykyrajoitteiden kasautumista tietyille väestöryhmille. Tulevien vuosien terveys- ja hyvinvointierojen vähentämiseksi nuorten aikuisten toimintakykyerojen kaventamiseen tulisi kiinnittää huomiota. Abstract Socio-demographic differences in functional ability among young adults in Finland Studies concerning functional ability often focus on ageing employees and senior citizens. Nevertheless, limitations in functional ability exist also among young adults and studies has shown that occurrence of limitations might be associated with socio-demographic characteristics. The aim of this study is to examine 1) whether there are limitations in different dimensions of functional ability among young adults in Finland; 2) whether the limitations on several dimensions cumulate on same persons; and 3) whether there are differences between socio-demographic groups regarding functional ability. Data of Regional Health and Wellbeing Study (ATH) 2012-2013 include 8,070 young adults aged 20-34. The response rate was 37%. Analysis methods included cross tabulation, logistic regression analysis and confidence intervals. Age standardization and sample weights were applied. Physical functional ability was better among men than among women. Among both men and women, limitations in psychological functional ability were most common out of all functional dimensions. Limitations in social functional ability were more common among men than women. There were no differences between men and women in ability to work or capacity to perform daily chores. Seven percent of all respondents had limitations on at least three out of five dimensions of functional ability. Both the occurrence and the accumulation of limitations in functional abilities were associated with lower level of education and financial problems. Married respondents were less likely to have accumulations of limitations. Among women, employees, students and housewives had less accumulation of limitations than unemployed women or women outside the labour force. Although limitations of functional ability are relatively rare among young adults, the results show that there are significant differences in both occurrence and accumulation of limitations between socio-demographic groups. It is essential to identify the most vulnerable socio-demographic groups among young adults in order to prevent widening gaps in health and wellbeing in future

Metropolialueen nuorten siirtyminen yläkoulusta toiselle asteelle: osaaminen ja hyvinvointi

Kouluikäisten oppiminen ja hyvinvointi ovat olleet pääosin erillisiä saarekkeita niin tutkimuksessa, lainsäädännössä kuin koulujen käytännön toiminnassa. Vuonna 2011 metropolialueen 14 kunnan seitsemännen luokan oppilaille (N ≈ 10 000) tehdyssä tutkimuksessa yhdistettiin oppiminen ja hyvinvointi. Tutkimus uusittiin oppilaiden ollessa yhdeksännellä luokalla. Seurantaa jatkettiin yhdistämällä aineistoon toisen asteen yhteisvalintatiedot ja selvittämällä nuorten toisen asteen opintojen tilannetta ensimmäisen lukuvuoden keväällä. Kuvaamme tässä raportissa niitä oppimiseen ja hyvinvointiin liittyviä tekijöitä, jotka selittävät oppilaiden eriytyviä kehityspolkuja yläkoulun aikana ja oppilaiden hakeutumista erilaisille opintopoluille toisen asteen valinnassa. Lisäksi selvitämme koulujen oppimisen tuen käytänteitä ja opiskeluhuollon resursseja sekä koulujen yhteistä toimintakulttuuria luovia koulujen toimintakäytänteitä hyvinvoinnin näkökulmasta Terveyden ja hyvinvoinnin laitoksen TEAviisarin ja valtakunnallisen VALAISE-seurantahankkeen rehtorikyselyn perusteella