Adolescents' multiple and individual risk behaviors: Examining the link with excessive sugar consumption across 26 industrialized countries

Improving Child and Adolescent Mental Health: A Bibliometric Analysis of Related Intervention Studies

In response to the increase in adolescent mental health problems, related intervention research has flourished. This study examined 2258 mental health intervention studies captured by the Web of Science, focusing on their distribution, interdisciplinary collaboration, and emerging trends, using bibliometric analysis. Our findings revealed a rise in studies and enhanced collaboration across disciplines, with studies from the United States, Australia, and the United Kingdom showing high academic output, intellectual impact, and strong scientific partnerships. However, there is a noticeable Western-centrism in the research. Identifying current trends and key areas of focus offers valuable insights for future practices in child and adolescent mental health.

Bullying and oral health in Egyptian adolescents: the moderating role of sense of coherence and resistance to peer influence

BACKGROUND

Bullying is the intentional, repeated and prolonged aggressive behavior towards victim(s) who feel powerless to defend themselves. It could influence adolescents' mental health. Some adolescents possess coping skills which enable them to overcome such adversities. The present study assessed the association between bullying, sense of coherence (SOC), resistance to peer influence (RPI) and oral health in Egyptian adolescents.

MATERIALS AND METHODS

A cross-sectional survey that included 12-16 year old adolescents attending 6 schools in Damanhour, Egypt was conducted from March to December 2023. Data were collected through clinical examination and self-administered questionnaires. Clinical examination assessed dental caries (DMFT), oral hygiene (plaque index) and gingival condition (gingival index). Toothbrushing frequency and sugar consumption were assessed by (World Health Organization-child form), bullying (Revised Olweus Bully Victim Questionnaire), SOC (Sense of Coherence Scale-Short Form) and RPI (Resistance to Peer Influence Questionnaire). The independent variables were bullying, SOC and RPI. The dependent variables were untreated caries, gingival inflammation and toothbrushing frequency. Multivariable multilevel regression assessed the relationship between the independent and dependent variables after adjusting for potential confounders. Adjusted regression coefficients (B), adjusted odds ratios (AOR) and 95% confidence intervals (CI) were calculated. Effect modifications by SOC and RPI were evaluated.

RESULTS

The response rate was 95.25% (N = 602), mean (SD) age was 14.01 (1.15). Half of the students (49.83%) were girls. About 42% had untreated caries, only 15.78% brushed their teeth twice daily and the mean (SD) gingival index was 1.57 (0.40). About 25% were victims, (9.30%) bullies and (18.60%) bully-victims. Victims showed significantly lower odds of twice daily toothbrushing (AOR = 0.52, p = 0.04). Bullies and bully-victims showed non-significantly higher odds of untreated caries (AOR = 1.42, p = 0.25), (AOR = 1.21, p = 0.42), respectively. Bullying was not associated with gingival inflammation. Higher SOC and RPI mitigated the impact of bullying on untreated caries and toothbrushing frequency.

CONCLUSION

Bullying was associated with higher odds of untreated caries and lower odds of twice daily toothbrushing in Egyptian adolescents. Higher SOC and RPI alleviated this relationship, highlighting the importance of individual coping strategies to oral health.

Obesity, Metabolic Syndrome, and Sugar-Sweetened Beverages (SSBs) in America: A Novel Bioethical Argument for a Radical Public Health Proposal

The prevalence of obesity, metabolic syndrome, and the associated long-term chronic diseases (cardiovascular disease, type II diabetes, cancer, Alzheimer's disease, depression) have reached epidemic levels in the United States and Western nations. In response to this public health calamity, the author of this paper presents and defends a novel bioethical argument: the consistency argument for outlawing SSBs (sugar-sweetened beverages) for child consumption (the "consistency argument"). This argument's radical conclusion states that the government is justified in outlawing SSBs consumption for child consumption. The reasoning is as follows: if one accepts that the physical harm caused by chronic alcohol consumption justifies the government outlawing alcoholic beverages for child consumption, and there is strong evidence that comparable physical harms result from chronic SSBs consumption, then, mutatis mutandis, the government is also justified in outlawing child consumption of SSBs. To support this argument, the author provides extensive evidence based on epidemiological observational studies, interventional studies, controlled trials, large meta-analyses, and the pathophysiology and biological mechanisms of action behind SSBs and chronic disease. Chronic consumption of large doses of SSBs and alcoholic beverages both drive the same diseases: obesity and insulin resistance, cardiovascular disease, hypertension, and cancer. Chronic SSB consumption carries the additional risk of Alzheimer's disease, dementia, and depression. The author concludes this paper by considering prominent objections to the consistency argument, and then demonstrating that each objection is unsound.

Association between ultra-processed dietary pattern and bullying: the role of deviant behaviors

Background

Ultra-processed foods have been associated with several negative outcomes, but it is not clear whether they are related to bullying perpetration. Moreover, no previous study has investigated the potential role of deviant behaviors as a mediator of this association. Our objective was to evaluate the association between ultra-processed dietary pattern and bullying, and the mediating effect of deviant behaviors in this association, among school adolescents.

Methods

We used data from a representative sample of 9th grade Brazilian adolescents (N = 2,212) from the São Paulo Project for the social development of children and adolescents (SP-PROSO). Exploratory factor analysis was used to obtain the dietary patterns, through questions of frequency of consumption in the last week of several foods. The ultra-processed dietary pattern was considered as exposure. The outcomes were the types of bullying (any type, social exclusion, psychological/verbal aggression, physical aggression, property destruction, and sexual harassment). Deviant behaviors (mediator) were assessed through a score. Mediation analyses were carried out using logistic regression based on the KHB method.

Results

After adjusting for covariates, the mediating effect of deviant behaviors was found in the association between ultra-processed dietary pattern and all the types of bullying perpetration, especially for psychological/verbal aggression (39.4%). A small mediating effect of deviant behaviors in the association of ultra-processed dietary pattern with physical aggression (17.7%) and property destruction (18.5%) was observed, but this effect explained only a small portion of the total effect of such association (significant direct effect).

Conclusion

The ultra-processed dietary pattern was associated with bullying, and the association was mediated through deviant behaviors. Policies and actions for improving the adolescent's diet and managing the adoption of deviant and bullying behaviors by this public are required.

Association Between Dietary Patterns and Bullying Among Adolescents in Sao Paulo-Brazil

Previous studies have assessed the association between food consumption and bullying perpetration, but most of them have not broadly assessed food consumption, neither the distinction between forms of bullying. The aim of the study was to evaluate the association between dietary patterns with bullying roles and its different types of bullying perpetration among adolescents. Data on a representative sample of ninth-grade students (N = 2,163; mean age = 14.8 years) taken from Sao Paulo Project for the social development of children and adolescents (SP-PROSO) were used. The independent variables were healthy and unhealthy dietary patterns obtained by exploratory factor analysis. The dependent variables were bullying role (victim-only, bully-only, bully-victim) and bullying perpetration (any type, social exclusion, psychological/verbal aggression, physical aggression, property destruction, sexual harassment). Multinomial and logistic regression models were performed for the total sample and stratified by sex (only for association with sexual harassment), adjusting for covariates. Adolescents who engaged in a healthy dietary pattern were less likely to be bullies (RR 0.67 [0.49, 0.92]), while adolescents with an unhealthy dietary pattern were more likely to be bully-victims (RR 1.29 [1.12, 1.48]). Unhealthy dietary pattern was associated with any type of bullying perpetration (OR 1.24 [1.12, 1.38]), mainly with sexual harassment and physical aggression. Boys who had an unhealthy dietary pattern were more likely to sexually harass another adolescent (OR 2.10 [1.20, 3.66]). In conclusion, adolescents who had a healthy dietary pattern were less likely to perpetrate bullying. Unhealthy dietary pattern was associated with bullying perpetration, especially with sexual harassment by boys.

Nutritional Criminology: Why the Emerging Research on Ultra-Processed Food Matters to Health and Justice

There is mounting concern over the potential harms associated with ultra-processed foods, including poor mental health and antisocial behavior. Cutting-edge research provides an enhanced understanding of biophysiological mechanisms, including microbiome pathways, and invites a historical reexamination of earlier work that investigated the relationship between nutrition and criminal behavior. Here, in this perspective article, we explore how this emergent research casts new light and greater significance on previous key observations. Despite expanding interest in the field dubbed 'nutritional psychiatry', there has been relatively little attention paid to its relevancy within criminology and the criminal justice system. Since public health practitioners, allied mental health professionals, and policymakers play key roles throughout criminal justice systems, a holistic perspective on both historical and emergent research is critical. While there are many questions to be resolved, the available evidence suggests that nutrition might be an underappreciated factor in prevention and treatment along the criminal justice spectrum. The intersection of nutrition and biopsychosocial health requires transdisciplinary discussions of power structures, industry influence, and marketing issues associated with widespread food and social inequalities. Some of these discussions are already occurring under the banner of 'food crime'. Given the vast societal implications, it is our contention that the subject of nutrition in the multidisciplinary field of criminology-referred to here as nutritional criminology-deserves increased scrutiny. Through combining historical findings and cutting-edge research, we aim to increase awareness of this topic among the broad readership of the journal, with the hopes of generating new hypotheses and collaborations.

Pattern of lifestyle behaviors and associated risk of being bullied at schools: A latent class analysis of 25,379 adolescents in Jiangsu Province of China

School bullying is a worldwide problem. Although previous studies examined the association between different lifestyle behaviors and bullying victimization, the complex co-occurrence of these behaviors was not identified, and their association with the risk of being bullied remains unclear. We aimed to identify the behavioral patterns of adolescents and to explore their association with bullying victimization. This cross-sectional study employed data from the "Surveillance for Common Diseases and Health Risk Factors among Students" project implemented in Jiangsu Province of China in 2019, and a total of 25,379 school-enrolled students were included. We used a latent class analysis to identify behavioral patterns and a regression mixture model to explore various demographic characteristics, such as age, sex, and family structure in relation to bullying victimization across different patterns. We considered respondents having targeted behaviors, including smoking, alcohol consumption, illicit drug use, sugar consumption, no fruit consumption, low physical activity, electronic media use, and insufficient sleep. Four behavioral patterns were identified, including the "adolescents without apparent targeted behaviors" (19.65%), "substance and electronic media users" (12.76%), "typical electronic media users" (54.49%), and "typical substance users" (8.10%). The risk of being bullied was the highest in the "substance and electronic media users" (probability: 0.33), tripled that in "adolescents without apparent targeted behaviors" (odds ratio: 3.60, 95% confidence interval: 3.01-4.30). Risk of being bullied was reduced for those "substance and electronic media users" living with a nuclear family. Behavioral patterns and their association with being bullied differ between groups of school-aged adolescents. To better inform decision-making based on the current real-world findings, the implementation of bullying prevention programs could target specific behavioral patterns.

Aggressive behavior in adolescent: The importance of biopsychosocial predictors among secondary school students

Introduction

Overt aggression is a common type of aggression observed among adolescents, which is apparent and outward confrontational acts manifested physically and verbally, such as fighting and shouting. It has become a major public health concern, as it results in detrimental health impacts like injury, mental health, and social problems.

Methods

An observational study was conducted among 16-year-old school students to determine their biopsychosocial predictors, using stratified proportionate population sampling. Pre-tested surveys were distributed to measure students' aggression, biological, psychological, and social factors.

Results

A total of 463 students from four public secondary schools participated in the study, with a median aggression score was 23.00 (IQR=12.00). The significant predictors of aggression from multivariate analysis were Malay race, frequent dessert intakes, attitude towards aggression, low family income, and peer deviant affiliation (F [8, 244] = 15.980, p < 0.001, adjusted R ² = 0.290).

Discussion

Adolescent aggression determinants are collectively impacted as a result of biological, psychological, and social predictors and need to be focused on in interventional strategies.

Factors associated with a cariogenic diet among adolescents: a structural equation modeling approach

OBJECTIVE

To investigate the factors directly and indirectly associated with a cariogenic diet among southern Brazilian adolescents.

MATERIALS AND METHODS

This cross-sectional study included 15-19-year-old students attending high schools in Santa Maria, southern Brazil. The participants completed a questionnaire on sociodemographic and behavioral variables. The Oral Health Impact Profile-14 was applied to collect data on oral health-related quality of life (OHRQoL). Clinical examination was used to assess the dental caries status (decayed, missing, and filled teeth index). A cariogenic diet was considered a latent variable measured by the self-perception of a healthy diet and the frequency of consumption of sugary foods and drinks. Structural equation modeling was used to analyze the direct and indirect pathways to a cariogenic diet.

RESULTS

A total of 1197 adolescents were included. Low toothbrushing frequency (standardized coefficient (SC), 0.10; p < 0.05), cigarette smoking (SC, 0.15; p < 0.01), and alcoholic beverages (SC, 0.14; p < 0.01) were directly linked to a cariogenic diet, which, in turn, was directly linked to untreated dental caries (SC, 0.18; p < 0.01) and poor OHRQoL (SC, 0.16; p < 0.01). In addition, household income (via toothbrushing frequency) and age (via alcoholic beverages) were indirectly linked to a cariogenic diet.

CONCLUSION

A cariogenic diet was consistently associated with a range of unhealthy behaviors during adolescence as well as poor household income.

CLINICAL RELEVANCE

Health promotion strategies to restrict sugar consumption and encourage healthier lifestyles should be aware of the synergism observed among unhealthy behaviors during adolescence.

Soft drink consumption and depressive symptoms among the adolescents of United States: The mediating role of aggressive behaviors

BACKGROUND

There is limited evidence for the association among soft drink consumption, aggressive behaviors, and depressive symptoms among the adolescents.

METHODS

Data were derived from a national representative sample of Youth Risk Behavior Surveys of United States during 2011 to 2019. Binary logistic regression models with complex sampling design were used to estimate the effect of soft drink consumption on aggressive behaviors and depressive symptoms. Mediating analysis was used to explore the association between soft drink consumption and depressive symptoms by aggressive behaviors.

FINDINGS

The total prevalence of depressive symptoms was 3l.2 % (30.3 %-32.0 %). Compared with none of soft drink consumption, <1 time/day (OR: 1.29, 95%CI: 1.19-1.41), 1-2 times/day (OR: 1.49, 95%CI: 1.33-1.67), and ≥3 times/day (OR: 1.95, 95%CI: 1.70-2.24) were significantly associated with increased risk of aggressive behaviors. High levels of soft drink consumption (1-2 times/day, OR: 1.19, 95%CI: 1.07-1.32; ≥3 times/day, OR: 1.61, 95%CI: 1.42-1.81) and aggressive behaviors (OR: 1.98, 95%CI: 1.84-2.13) were found to be significantly associated with increased risk of depressive symptoms. A linear dose-response relationship of soft drink consumption with aggressive behaviors and depressive symptoms was found in this study (all p < 0.001). Aggressive behaviors partially mediated the association between soft drink consumption and depressive symptoms and each pathway was statistically significant.

LIMITATIONS

The causal relationship was not able to certain because of the cross-sectional design.

CONCLUSIONS

The mediating role of aggressive behaviors on the association of high levels of soft drink consumptions with depressive symptoms should be paid more attention among the adolescents.

The associations of dietary habits with health, well-being, and behavior in adolescents: A cluster analysis

INTRODUCTION

Dietary habits may be associated with adolescents' health and behavior. However, previous findings are inconsistent and often unadjusted for sociodemographic confounders. The aim of this study was to investigate (1) whether dietary habits (consumption of fruits, vegetables, sweets, soft drinks, breakfast, and family meals) cluster among adolescents and (2) how these clusters associate with a range of health, well-being, and behavior outcomes in a large population-based sample of adolescents.

METHODS

The study included adolescents (n = 7529; n = 3891 [51.7%] girls; mean [standard deviation] age = 14.9[2.1] years) from the 2018 Luxembourg Health Behaviour in School-aged Children study. We used cluster analysis to define clusters of dietary habits (consumption of fruits, vegetables, sweets, soft drinks, breakfast, and family meals) and logistic regression analyses to assess the cross-sectional associations of the clusters with health, well-being and behavior, adjusted for age, gender, family affluence, and migration background.

RESULTS

Cluster analysis yielded five clusters of dietary habits: (1) healthy, (2) family meal and breakfast skippers, (3) sugar consumption, (4) unbalanced diet, and (5) unhealthy. The healthy cluster was associated with better health and positive mental health and behavior, whereas the less healthy clusters were associated with worse health, mental health problems, and risk behavior.

CONCLUSION

Findings suggest that healthy dietary habits associate with positive health and behavior, whereas unhealthy dietary habits associate with health problems and risk behavior during adolescence. More research is needed to investigate the underlying mechanisms. Interventions should include dietary habits as a component of lifestyle modification to improve adolescents' health, well-being, and behavior.

Sex-Based Differences in Factors Associated With Sugar-Sweetened Beverage Consumption Among Korean High School Students

This study aimed to identify sex-based differences in the individual and environmental factors associated with sugar-sweetened beverage (SSB) consumption among Korean high school students. Secondary data were obtained from the 15th (2019) Korea Youth Risk Behavior Web-based Survey. In this study, we analyzed data from 13,066 high school students (5,874 boys and 7,192 girls) who answered questions regarding SSB consumption and individual and environmental factors. Complex sampling analysis (descriptive statistics and logistic regression analysis) was conducted using the SPSS Statistics 26.0 software. Most adolescents (97% boys and 95.2% girls) reported having consumed SSBs in the last seven days. Individual factors, such as increased stress, sleep dissatisfaction, and fast-food intake (more than thrice a week) were positively associated with SSB consumption among adolescent boys and girls. Environmental factors like high education levels (above college) of mothers were negatively associated with SSB consumption among both boys and girls. Furthermore, current alcohol consumption, smoking, low vegetable intake (less than thrice a week) in boys, and more than 2 h a day of screen-based sedentary behavior in girls were positively associated with SSB consumption. According to the results, individual factors associated with SSB consumption varied according to the sex of adolescents. Thus, sex differences in factors associated with SSB consumption in adolescents should be considered as basic knowledge for developing strategies for reducing SSB consumption.

Applying an Evolutionary Approach of Risk-Taking Behaviors in Adolescents

Risk-taking behaviors in adolescents have traditionally been analyzed from a psychopathological approach, with an excessive emphasis on their potential costs. From evolutionary theory we propose that risk-taking behaviors can be means through which adolescents obtain potential benefits for survival and reproduction. The present study analyses sex differences in three contexts of risk (i.e., risk propensity, expected benefits and risk perception) in the evolutionary specific domains and the predictive value of these domains over risk-taking behaviors, separately in female and male adolescents. 749 adolescents (females = 370) valued their risk perception, expected benefits and risk propensity through the Evolutionary Domain-Specific Risk Scale, as well as their engagement in risk-taking behaviors through the Risky Behavior Questionnaire. Male adolescents showed lower risk perception in two evolutionary domains, expected higher benefits in two other domains and showed higher risk propensity in six domains. Female adolescents showed lower risk perception in two domains. Additionally, risk perception, expected benefits and risk propensity in the evolutionary domains predicted the engagement in risk-taking behaviors in male adolescents, whereas in female adolescents only expected benefits and risk propensity showed a predictive effect over risk-taking behaviors. These results suggest the potential role of evolutionary mechanisms on risk-taking behaviors in adolescents. Results have practical implications for interventions programs aimed at reducing risk-taking behaviors. In addition to considering sex differences, intervention programs should consider alternative behaviors through which adolescents can reach their evolutionary goals, and handle the risks related to those behaviors that cannot be replaced but have potential benefits for adolescents.

Soft Drink Consumption and Mental Health in Adolescents: A Longitudinal Examination

PURPOSE

Previous studies showed associations between soft drink consumption and mental health problems in adolescents, but the direction of these effects is unknown. This study examines the hypotheses that soft drink consumption predicts aggression and depressive symptoms over time and that these mental health problems predict soft drink consumption.

METHODS

Interviews were conducted with 5,147 children and their caregivers from three sites at child ages 11, 13, and 16. At each time point, youth reported on their frequency of consuming soft drinks, aggressive behavior, and depressive symptoms. An autoregressive cross-lagged path model tested reciprocal relationships between soft drink consumption, aggressive behavior, and depressive symptoms over time.

RESULTS

More frequent consumption of soft drinks was associated with more aggressive behavior at each time point and depressive symptoms at ages 11 and 13 (r = .04 to .18, p ≤ .002). After adjusting for covariates and stability of each behavior over time, soft drink consumption at ages 11 and 13 predicted more aggressive behavior at the next time point (β = .08 and .06, p < .001). Aggressive behavior at age 13 also predicted more soft drink consumption at age 16 (β = .06, p = .002). Soft drink consumption at age 13 predicted fewer depressive symptoms (β = -.04, p = .007), but depressive symptoms did not predict soft drink consumption.

CONCLUSIONS

More frequent consumption of soft drinks may contribute to aggressive behavior in adolescents over time; there is some support for reciprocal relationships. There is no evidence for soft drink consumption contributing to adolescents' depression. Future research should examine longitudinal effects over shorter intervals.

Exploration of Barriers to the Uptake of Nutritional Services Among Adolescent Girls from the Rural Communities of Tigray Region, Northern Ethiopia: A Qualitative Study

Background

Adolescence is a time of tremendous physical growth and mental development, with high nutrient requirements. Ethiopia is among the countries with a high prevalence of nutritional deficiencies among the women of reproductive age group, whilst adolescent girls from rural areas suffered disproportionately. However, there is a dearth of evidence regarding the barriers that hinder adolescent girls to utilize the available nutritional services.

Purpose

The current study aimed to qualitatively explore the range of barriers for the uptake of nutritional interventions among adolescent girls in rural communities of Tigray, Northern Ethiopia.

Methods and Participants

We employed an explorative qualitative study among purposively selected adolescent girls and school teachers from rural districts of Tigray region. We conducted 11 focused group discussions with adolescent girls, 17 in-depth interviews (seven with teachers, seven with in-school adolescent girls, and three with out-of-school adolescent girls) using a semi-structured guide. Data was audio-taped, transcribed verbatim in local language, translated into English, and imported into ATLAS.ti version 7.5 qualitative data analysis software for analysis.

Results

Adolescents perceived that stunting, anemia, and thinness are among the main nutritional problems in their community. Food insecurity, limited nutrition awareness in the community, limited access to a water source, high workload, service provider's little attention for adolescents' nutrition, and food taboo have emerged as barriers for the uptake of adolescent girls' nutritional interventions. Though limited in reach, available nutritional interventions include awareness creation, nutritional supplementation, and disease prevention.

Conclusion

Food insecurity poses a strong challenge to adolescent girls' nutrition. As access to safe drinking water continues to be a considerable bottleneck for nutritional interventions, a multi-sectoral response to integrate water, sanitation, and hygiene (WASH) services is required. Bounded by food taboo, high burden of workload among the adolescent girls, women empowerment and nutritional status seem to be the unfinished agenda in resource limited settings such as the rural areas of Tigray region.

Soft drink consumption and mental health problems: Longitudinal relations in children and adolescents

BACKGROUND

Increased soft drink consumption has been proposed as both predictor and result of mental health problems. Although possible mechanisms for both directions have been suggested, understanding of the association is limited. Most previous research has been cross-sectional and could not assess directionality.

METHOD

This study investigated the directionality of the association between soft drink consumption and mental health using longitudinal panel data of 5882 children and adolescents from the nationally representative German KiGGS baseline study (2003-2006) and KiGGS Wave 1 (2009-2012). Soft drink consumption and mental health problems were assessed by standardized questionnaire (baseline) and telephone interview (Wave 1). Four cross-lagged panel models were specified and compared regarding their fit indices. Specific paths were tested for significance.

RESULTS

Positive cross-sectional associations between soft drink consumption and mental health problems were found at both measurement points (ps < .01), even after controlling for third variables (including age, gender, and socioeconomic status). Only the lagged effect of mental health problems on soft drink consumption reached statistical significance (β = 0.031, p = .020), but not the effect in the opposite direction. The corresponding model also showed the best model fit overall.

CONCLUSIONS

Mental health problems predicted soft drink consumption over an average of six years, but not vice versa. These findings suggest that consuming soft drinks might be a dysfunctional strategy of coping with mental health problems for children and adolescents and highlight the importance of considering mental health problems in the prevention of soft drink overconsumption and obesity.

Clusters of Contemporary Risk and Their Relationship to Mental Well-Being Among 15-Year-Old Adolescents Across 37 Countries

PURPOSE

Adolescents' mental well-being has become a growing public health concern. Adolescents' daily lives and their engagement in risks have changed dramatically in the course of the 21st century, leading to a need to update traditional models of risk to include new exposures and behaviors. To date, studies have examined the relationship between (mainly traditional) risk behaviors and adolescent mental well-being or looked at risk factors that jeopardize mental well-being such as lack of social support but have not combined them together to highlight the most significant risks for adolescent mental well-being today. The present study included new and traditional risk behaviors and risk factors, robustly derived an empirically based model of clusters of risk, and examined the relative association of these clusters to adolescent mental well-being.

METHODS

Data from the 2017-2018 Health Behaviours in School-aged Children study were used. The sample included 32,884 adolescents (51.7% girls) aged 15 years from 37 countries and regions. The principal component analysis was used to determine the existence of clusters of risk, using 21 items related to adolescent mental well-being that included both risk behaviors (e.g., substance use) and risk factors (e.g., peer support). Analysis was conducted in both a randomly split training and test set and in gender separate models. Mixed-effects logistic regressions examined the association between clusters of risk and mental well-being indices (low life satisfaction and psychosomatic complaints).

RESULTS

Seven clusters of risk were identified: substance use and early sex, low social support, insufficient nutrition, bullying, sugary foods and drinks, physical health risk, and problematic social media use (SMU). Low social support and SMU were the strongest predictors of low life satisfaction (odds ratios = 2.167 and 1.330, respectively) and psychosomatic complaints (odds ratio = 1.687 and 1.386, respectively). Few gender differences in predictors were found. Exposure to bullying was somewhat more associated with psychosomatic complaints for girls, whereas physical health risk was associated with reduced relative odds of low life satisfaction among boys. Split-sample validation and out-of-sample prediction confirmed the robustness of the results.

CONCLUSIONS

The results highlight the importance of contemporary clusters of risk, such as low social support and SMU in the mental well-being of young people and the need to focus on these as targets for prevention. We propose that future studies should use composite risk measures that take into account both risk behaviors and risk factors to explain adolescents' mental well-being.

Association between Soft Drink Consumption and Aggressive Behaviour among a Quarter Million Adolescents from 64 Countries Based on the Global School-Based Student Health Survey (GSHS)

Soft drink consumption has become a significant public health concern that is associated with various adverse health outcomes. We aim to examine the association between soft drink consumption and aggressive behavior among adolescents. We used open access data from 79 studies in 64 countries, including 263,890 adolescents aged 12–18 years who completed the global school-based student health survey (GSHS). Self-reported data on past 30-day carbonated soft drink consumption (number of times per day) and past 12-month physical fighting were utilized for analysis. Of the 263,890 participants (48% boys) aged 12–18 years, the weighted mean frequency of soft drink consumption varied from 0.5 in Kiribati to 2.5 times/day in Surname, while the weighted prevalence of frequent aggressive behavior varied from to 2.7% in Laos to 49.2% in Tuvalu. We found that each increment of soft drink consumption (time/day) was associated with an 11% (95%CI 10–13%) increase of the likelihood of frequent physical fighting. This result remained significant after adjusting for various covariates. In this large pooled sample of multinational data, there is a significant positive association between soft drink consumption and aggressive behavior among adolescents. Reducing soft drink consumption may help reduce aggressive behavior, a major risk factor for violence.

High Carbonated Soft Drink Intake is Associated with Health Risk Behavior and Poor Mental Health among School-Going Adolescents in Six Southeast Asian Countries

Carbonated soft drink (CSD) intake has been associated with various risk behaviors in adolescents in high-income countries, but there is lack of evidence of this association in cross-nationally representative samples of school adolescents in low- and middle-income countries. This study aimed to assess the association between CSD intake, health risk behavior, and poor mental health behavior among school-going adolescents in six Southeast Asian countries. Cross-sectional national "Global School-Based Student Health Survey (GSHS)" data from 36173 school-going adolescents from Bangladesh, Indonesia, Laos, Philippines, Thailand, and Timor-Leste were analyzed. Results indicate that across all six Southeast Asian countries, in the past 30 days 23.9% of study participants had consumed no CSD, 38.8% had consumed CSD <once/day, 19.9% once a day and 17.5% ≥ two times/day. In the final adjusted logistic regression model CSD intake was associated with increased odds of having been attacked, having sustained an injury, being in a physical fight, being bullied, school truancy, tobacco use, alcohol use, and lifetime drunkenness. In addition, the consumption of CSD ≥two times/day was associated with increased odds of ever used cannabis and ever used amphetamine. Higher intake of CSD was positively associated with a history of loneliness, anxiety, suicide ideation, suicide planning, and suicide attempts. CSD intake in low- and middle-income countries is associated with several health risk behaviors and poor mental health that are similar to those observed in high-income countries.

High carbonated soft drink consumption is associated with externalizing but not internalizing behaviours among university students in five ASEAN states

Background

The investigation aimed to estimate the association between carbonated soft drink consumption frequency and externalizing and internalizing behaviour among university students in five ASEAN counties.

Methods

A cross-sectional survey included 3353 university students from Indonesia, Malaysia, Myanmar, Thailand and Vietnam, median age 20 years (interquartile range 3 years).

Results

In all five ASEAN countries, the study found a prevalence no soft drink consumption in the past 30 days of 20.3%, less than one time a day 44.7%, once a day 25.4% and two or more times a day 9.6%. In the adjusted logistic regression analysis, higher frequency of soft drink consumption (one and/or two or more times a day) was associated with externalizing behaviour (in physical fight, injury, current tobacco use, problem drinking, drug use, pathological internet use and gambling behaviour), and higher frequency of soft drink consumption (two or more times a day) was associated with depression in females, but no association was found for the general student population in relation to internalizing behaviour (depression, posttraumatic stress disorder, suicidal ideation, suicide plan, suicide attempt and sleeping problem).

Conclusions

Findings suggest that carbonated soft drink consumption is associated with a number of externalizing but not internalizing health risk behaviours.

Alcohol Use and Misuse Among School-Going Adolescents in Thailand: Results of a National Survey in 2015

The aim of this study was to assess the prevalence of alcohol use and misuse, and to identify its associated factors among in-school adolescents in the 2015 Thailand Global School-based Student Health Survey (GSHS). The sample included 5994 school-going adolescents (mean age 14.5 years, SD = 1.7) from Thailand that responded to the 2015 GSHS. Overall, 22.2% were current alcohol users, 24.3% had ever been drunk, 12.1% had drunk two or more alcoholic drinks in a day in the past 30 days and 10.8% had gotten into trouble because of drinking alcohol. In adjusted Poisson regression analysis, older age, psychological distress, current tobacco use, the consumption of one or more soft drinks a day, school truancy, having been in a physical fight in the past 12 months, and having been seriously injured in the past 12 months were associated with current alcohol use. Older age, psychological distress, current tobacco use and injury also increased the odds for lifetime drunkenness, having two or more drinks in a day and trouble resulting from drinking. Soft drink consumption and having been in a physical fight also increased the odds for lifetime drunkenness and having two or more drinks in a day and school truancy also increased the odds for lifetime drunkenness and trouble resulting from drinking. In addition. Parental tobacco use was associated with lifetime drunkenness and trouble resulting from drinking, cannabis use with trouble resulting from drinking, and parental support was protective from trouble resulting from drinking. There were no significant sex differences regarding any of the four alcohol use indicators. More than one in five school-going adolescents in Thailand use and misuse alcohol, and strategies to prevent alcohol misuse, including a cluster of risk behaviours, are needed.