An international scoring system for self-reported health complaints in adolescents

Background: Aimed to develop a unitary scoring system for the 'Health Behaviour in school-aged Children' (HBSC) symptom checklist that would facilitate cross-national comparisons and interpretation. Rasch measurement analysis and investigation of differential item functioning (DIF) were conducted. Methods: Data were obtained from the 'WHO collaborative study HBSC 2001/2002'. A total of 162 305 students aged 11, 13 and 15 years from 35 European and North American Countries were surveyed. Unidimensionality of the items and local independence were tested using means of confirmatory factor analysis. DIF across countries, age groups and gender was investigated using a logistic regression procedure. Item and person parameters were estimated according to the Rating Scale Model (RSM). Results: All items proved to be unidimensional. One item displayed noticeable DIF across countries and was discarded. The remaining items were functioning equally across subgroups. The RSM analysis resulted in Rasch model conform item parameter estimation. Infit mean square values between 0.84 and 1.35 revealed acceptable item fit. Conclusion: The control of DIF enables comparable and unbiased assessment of subjective health complaints across countries, age groups and gender. A scoring algorithm could be developed which enables a cross-cultural comparable and interval-scaled assessment of subjective health complaints.publishersversionPeer reviewe

Cross-national time trends in adolescent alcohol use from 2002 to 2014

Funding: UK Medical Research Council [MC_UU_12017/12] and the Chief Scientist Office [SPHSU12] to J.I.Background: Adolescent alcohol consumption is a major public health concern that should be continuously monitored. This study aims (i) to analyze country-level trends in weekly alcohol consumption, drunkenness and early initiation in alcohol consumption and drunkenness among 15-year-old adolescents from 39 countries and regions across Europe and North America between 2002 and 2014 and (ii) to examine the geographical patterns in adolescent alcohol-related behaviours. Methods: The sample was composed of 250 161 adolescents aged 15 from 39 countries and regions from Europe and North America. Survey years were 2002, 2006, 2010 and 2014. The alcohol consumption and drunkenness items of the HBSC questionnaire were employed. Prevalence ratios and 95% confidence intervals were estimated using Poisson regression models with robust variance. Results: Data show a general decrease in all four alcohol variables between 2002 and 2014 except for some countries. However, there is variability both within a country (depending on the alcohol-related behaviour under study) and across countries (in the beginning and shape of trends). Some countries have not reduced or even increased their levels in some variables. Although some particularities have persisted over time, there are no robust patterns by regions. Conclusions: Despite an overall decrease in adolescent alcohol consumption, special attention should be paid to those countries where declines are not present, or despite decreasing, rates are still high. Further research is needed to clarify factors associated with adolescent drinking, to better understand country specificities and to implement effective policies.Publisher PDFPeer reviewe

National Income and Income Inequality, Family Affluence and Life Satisfaction Among 13 year Old Boys and Girls: A Multilevel Study in 35 Countries

Adolescence is a critical period where many patterns of health and health behaviour are formed. The objective of this study was to investigate cross-national variation in the relationship between family affluence and adolescent life satisfaction, and the impact of national income and income inequality on this relationship. Data from the 2006 Health Behaviour in School-aged Children: WHO collaborative Study (N = 58,352 across 35 countries) were analysed using multilevel linear and logistic regression analyses for outcome measures life satisfaction score and binary high/low life satisfaction. National income and income inequality were associated with aggregated life satisfaction score and prevalence of high life satisfaction. Within-country socioeconomic inequalities in life satisfaction existed even after adjustment for family structure. This relationship was curvilinear and varied cross-nationally. Socioeconomic inequalities were greatest in poor countries and in countries with unequal income distribution. GDP (PPP US$) and Gini did not explain between country variance in socioeconomic inequalities in life satisfaction. The existence of, and variation in, within-country socioeconomic inequalities in adolescent life satisfaction highlights the importance of identifying and addressing mediating factors during this life stage

National and school policies on restrictions of teacher smoking: a multilevel analysis of student exposure to teacher smoking in seven European countries

The paper examines the association between restrictions on teacher tobacco smoking at school and student exposure to teachers who smoke during school hours. The data are taken from a European Commission-funded study 'Control of Adolescent Smoking' (the CAS study) in seven European countries. Multilevel modelling analyses were applied to investigate associations between national legislation concerning tobacco smoking in school, local school smoking restrictions and students' exposure to teachers who smoke at school. The analyses integrate data from three levels: national (types of policy and how restrictive they are), school (survey among teachers, n=455) and student (survey among 15-year-old students, n=10890). The results suggest that both national- and school-level policies on restriction of smoking among teachers are associated with a decreased probability of students reporting that they are exposed to teachers who smoke indoors, but an increased probability of being exposed to teachers smoking outdoors

Sense of coherence and school-related stress as predictors of subjective health complaints in early adolescence: interactive, indirect or direct relationships?

The role of sense of coherence (SOC) on the relationship between adolescent school-related stress and subjective health complaints was tested with structural equation modelling. As part of the crossnational WHO-survey 'Health behaviour in school-aged children 1997/98' Norwegian representative samples of 1592 grade 6, 1534 grade 8, and 1605 grade 10 students completed measures on SOC, school-related stress and subjective health complaints. A test of nested structural models revealed that both stress-preventive ([Delta] [chi]2 814. 86, pSense-of-coherence Moderator Stress Adolescence Health-complaints Resilience

Material deprivation and self-rated health: a multilevel study of adolescents from 22 European and North American countries

This cross-sectional study examined the combined and interactive effects of material deprivation and area deprivation on adolescent self-rated health, using data from the World Health Organization collaborative study 'Health Behaviour in School-aged Children 1997/1998'. Included in the present study were 94,915 11-15-year-old students from a total of 22 European and North American countries. Multilevel logistic regression analyses revealed significant additive main effects of individual material deprivation and area deprivation, but not interactive effects. The most deprived students had an odds ratio for self-rated poor health almost three times higher than the least deprived students. Area deprivation effects were stronger at the country level than at the school level, and stronger among 11-year-olds than among 13- and 15-year-olds. A combined 'individual and area deprivation' model predicted that the most disadvantaged 11-year-old students were eight times more likely to have poor self-rated health compared to the least disadvantaged student (OR (95% CI) = 7.96 (3.38, 18.75)). The findings highlight the multilevel effects of deprivation at the individual, local, and national level. (C) 2003 Elsevier Ltd. All rights reserved.<br/

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 devlopment 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 I-AS validation work is described together with ideas for future development of the measure. (c) 2007 Elsevier Ltd. All rights reserved