Unintentional injuries and violence among adolescents aged 12-15 years in 68 low-income and middle-income countries: a secondary analysis of data from the Global School-Based Student Health Survey

Noncommunicable disease risk behaviors and protective factors among children in Samoa: Retrospective trend analysis of global school-based health surveys in 2011 and 2017

Pacific Island countries experience a high prevalence of noncommunicable diseases (NCDs), which may be prevented by reducing risk behaviors and strengthening protective factors in childhood and adolescence. To better inform preventative interventions, our objective was to use publicly available data from the Global School-based Student Health Survey (GSHS), to provide cross-sectional and trend estimates for the prevalence of NCD risk and protective factors among school-aged children in 2011 and 2017 in Samoa. Two waves of cross-sectional data included 4,373 children (51.98% female), with a median age of 15 years, who were mainly in school years 9-10 in Samoa. Retrospective analyses were adjusted for the GSHS multistage stratified cluster sample design. Weighted prevalences of overweight/obesity, dietary behaviors, physical activity, and sedentary behavior, oral and hand hygiene, emotional and mental health, and community protective factors were reported by study year. Logistic regressions were fitted to assess differences in the prevalence of risk and protective factors, adjusted for age group, sex, and school year. In 2011 and 2017, the prevalence of overweight/obesity remained consistently high in females (59.12% and 64.29%, p = 0.428) and increased from 44.21% to 53.65% in males (p = 0.039). Time spent sitting for long periods, smoking cigarettes, using other tobacco products, and drinking alcohol were lower in 2017 compared to 2011 (all p<0.05). Many children reported experiencing bullying (33.27% for females and 59.30% for males in 2017), while physical fighting was common among males (73.72% in 2011 and 57.28% in 2017). The high prevalence of obesity and related NCD risk factors require urgent public health action in Samoa. Alongside the continued reduction of tobacco and alcohol use, emotional and mental wellness should be prioritized in interventions and programs to promote healthy behaviors and lifestyle changes starting in childhood.

Temporal Trends of Physical Fights and Physical Attacks Among Adolescents Aged 12-15 years From 30 Countries From Africa, Asia, and the Americas

PURPOSE

There is a scarcity of literature on temporal trends in physical fighting and physical attacks among the global adolescent population. Therefore, we aimed to examine these trends in a nationally representative sample of school-going adolescents aged 12-15 years from 30 countries in Africa, Asia, and the Americas, for which temporal trends of physical fighting and physical attacks are largely unknown.

METHODS

Cross-sectional data from the Global School-based Student Health Survey 2003-2017 were analyzed. Self-reported data on past 12-month physical fights and physical attacks were collected. For each survey, the prevalence and 95% confidence interval of physical fights and physical attacks were calculated. Linear regression models were used to examine crude linear trends.

RESULTS

Data on 190,493 students aged 12-15 years were analyzed [mean (standard deviation) age 13.7 (1.0) years; 48.9% boys]. The mean prevalence of past 12-month physical fight and physical attack was 36.5% and 37.2%, respectively. Significant decreasing trends in physical fights were observed in 16/30 countries, while significant increasing trends were found in 2/30 countries. For physical attacks, significant decreasing and increasing trends were observed in 13/26 and 1/26 countries, respectively. The remaining countries showed stable trends.

DISCUSSION

It is encouraging that decreasing trends in physical fighting and physical attacks were observed across a large number of countries. However, stable trends were also common, while increasing trends also existed, suggesting that global efforts to address adolescent violence are still required.

Global, regional, national trends of femur fracture and machine learning prediction: Comprehensive findings and questions from global burden of disease 1990-2019

Background

Femur fracture is a type of fracture with high disability and mortality. There is no comprehensive analysis and prediction of the global distribution of femur fractures, so we conducted this study.

Methods

Age-standardized incidence rate (ASIR), age-standardized prevalence rate (ASPR), and years living with disability (YLDs) of femur fractures (excluding femoral neck) were downloaded from the Global burden of disease database. Trend analysis was performed, and 6 time-series machine learning algorithms were applied to predict the global ASIR, ASPR, and YLDs.

Results

ASPR for femur fracture had been increasing in most countries worldwide from 1990 to 2019, with the highest in East Asia (AAPC = 1.25 95%Confidence Interval (1.2, 1.3)) and lowest in Central Latin America (AAPC = -0.74 95%CI (-0.81, -0.67)). However, ASIR showed a significant downward trend worldwide, with East Saharan Africa decreasing the most (AAPC = -4.04 95%CI (-5.56, -2.47)), and East Asia elevating the most (AAPC = 1.11 95%CI (0.87, 1.42)). YLDs were increasing over the world, with East Asia still elevating the most AAPC= (3.9 95%CI (3.85, 3.95)), with the only region of decrease being Eastern Europe (AAPC = -0.28 95%CI (-0.3, -0.26)). Both ASPR and ASIR were higher in women than in men in the >75 year group, whereas YLDs was lower in women than in men in the >60 year group. Globally, the ARIMA model was optimal in the prediction of ASPR, the PROPHET model effected in the prediction of ASIR, and the PROPHET WITH XGBOOST model was the best in the prediction of YLDs. The projections showed increase in both ASPR and YLDs, except for ASIR decreasing by 2030.

Conclusions

Our study found a rise in femur fracture ASPR and ASIR from 1990 to 2019 in war conflict areas and East Asia, meanwhile, the YLDs of femur fracture increased in populous countries. In both 1990 and 2019, both ASPR and ASIR were higher in women over 75 years than that in men, but YLDs was higher in men over 60 years than that in women. In 2020-2030, while global femur fracture ASIR might decline, both ASPR and YLDs might rise.

The Translational Potential of this article

Femur fracture is a high-energy injury due to direct violence, and in war, conflicting and underdeveloped regions such as East Asia. Accidental injuries may occur due to the rapid development of industry and the frequent traffic accidents. This study suggests that we should focus on elderly women (≥75 years) in the above regions in the future. For older men (>60 years old), more attention should be paid to post-fracture functional rehabilitation and early reintegration into society to reduce the disability rate and lower the socio-economic burden.

Using decision tree to predict non-suicidal self-injury among young adults: the role of depression, childhood maltreatment and recent bullying victimization

Importance: Non-suicidal self-injury (NSSI) is a significant mental health issue requiring a deeper understanding of its underlying causes, such as childhood maltreatment, adult bullying victimization, and depression. Previous studies have not adequately addressed the cumulative risks of these factors on NSSI among college students. This population-based study investigates these cumulative risk factors.Design, setting, and participants: The cross-sectional study included 63 university's college students with a mean age of 19.6 years (N = 95,833).Main outcomes and measures: Two Chi-Square Automatic Interaction Detection (CHAID) decision tree models were used to classify subgroups based on childhood maltreatment and adult bullying victimization experiences and to investigate their cumulative risks of NSSI. Recursive partitioning algorithms determined each predictor variable's relative importance.Results: The CHAID model accurately predicted NSSI behaviours with an overall accuracy rate of 77.8% for individuals with clinically relevant depressive symptoms and 97.2% for those without. Among depressed individuals, childhood emotional abuse was the strongest NSSI predictor (Chi-Square, 650.747; adjusted P < .001), followed by sexual and physical abuse. For non-depressed individuals, emotional abuse in childhood was the strongest NSSI predictor (Chi-Square, 2084.171; adjusted P < .001), with sexual and verbal bullying in the past year representing the most significant proximal risks.Conclusions and relevance: Emotional abuse during childhood profoundly impacts individuals, increasing the risk of NSSI in both depressed and non-depressed individuals. Clinically relevant depressive symptoms have a moderating effect on the relationship between childhood maltreatment, adult bullying victimization, and NSSI. Identifying these factors can inform targeted interventions to prevent NSSI development among young adults.

Prevalence and correlates of unintentional nonfatal injuries among school-going adolescents in Central America

OBJECTIVES

The aim of this study is to report on the frequency of serious physical injuries (SPI) among adolescents in Central America during the previous decade, 2009-2018.

METHODS

In total, 15,807 school adolescents (14.4 years mean age; SD=1.4) from six Central American countries participated in cross-sectional Global School-based Student Health Surveys in 2009-2018 (ranging from 1,779 students in Honduras in 2012 to 4,374 students in Guatemala in 2015).

RESULTS

The prevalence of SPI was 33.8 % (22.9 % once, 7.4 % 2 or 3 times and 3.6 % 4 or more times), ranging from 31.8 % in Guatemala to 45.0 % in Belize and 45.6 % in Panama. The most frequent causes of SPI included fall (11.4 %, ranging from 6.9 % in Costa Rica to 15.6 % in Panama), and the type of SPI was fracture/dislocation (5.7 %, ranging from 4.3 % in Costa Rica to 6.7 % in Panama). In adjusted Poisson regression, male sex, food insecurity, a history of alcohol intoxication, soft drink consumption, fast food intake, truancy, multiple sexual partners, psychological distress, physical fight, physically attacked, bullied, and suicide attempt were significantly associated with a higher number of injury event counts.

CONCLUSIONS

Overall, about one in three adolescents in Central America had sustained unintentional injuries in the past 12 months and several contributing factors were identified which if addressed could aid injury prevention among adolescents.

Prevalence and factors associated with serious injuries and aggressive behaviours among in-school adolescents in Panama

Introduction

Injuries during adolescence cause lifelong harm and death. Our study used a nationally representative sample to examine the prevalence and risk factors associated with serious injuries among in-school adolescents in Panama.

Methods

We analysed Panama's 2018 Global School-Based Student Health Survey data using SPSS. Percentages were used to summarise the results of the prevalence of serious injuries. Binomial logistic regression analysis was performed to examine the risk factors of serious injuries. The results were presented as an adjusted odds ratio (AOR) at a 95% confidence interval (CI).

Results

The prevalence of serious injury among in-school adolescents in Panama is 45%. Furthermore, the study found that males (AOR= 1.495, CI=1.272--1.756), truancy (AOR=1.493, CI=1.249--1.785), overweight (AOR= 1.246, 95% CI=11.057--1.469), drinking alcohol (AOR= 1.397, CI=1.151--1.695), experiencing physical attack (AOR= 2.100, CI=11.646--2.681), engaging in a physical fight (AOR=1.586, CI=1.289--1.952) and bullied outside school (AOR=1.276, CI=1.005--1.621) significantly predict serious injuries among adolescents in Panama.

Conclusion

Multidisciplinary approaches targeting the correlates observed will help reduce the high prevalence of serious injuries among in-school adolescents in Panama.

The prevalence of suicidal behaviour and its associated risk factors among school-going adolescents resident in the United Arab Emirates

Suicidal behaviour which includes suicidal ideation, having a plan to commit suicide and suicide attempts remains a global public health issue as it substantially impacts adolescent health and wellbeing. Suicidal behaviour, however, remains understudied in Middle Eastern contexts. This study analysed data from the 2016 Global School-based Student Health Survey collected in the United Arab Emirates (UAE). A sample of 5826 adolescents aged between 11 and 18 years were sampled. Potential risk factors associated with an elevated risk for engagement in suicidal behaviour were examined. These factors were stratified into categories for analysis (demographics, psychosocial, risky health, and socio-environmental). The age-adjusted prevalence of suicidal behaviour amongst the school-going adolescent population in the UAE was 54%. Analyses indicated that elevated risk was significantly associated with anxiety difficulties, the experience of loneliness, and amongst those who smoked tobacco. None of the socio-environmental factors emerged as significant. A dose-dependent relationship was evident in that the degree of risk that was evident appeared to compound as the number of adverse risk factors increased. The data suggest that suicidal behaviour may be highly prevalent in this location. Findings highlight the immense need to develop preventative interventions, some of which may be school-delivered and targeted at parents. Our findings provide initial indications as to which risk factors could be targeted for remediation in developing these interventions.

In-school adolescents' sociodemographic correlates of serious unintentional injuries in Saint Vincent and the Grenadines: A cross-sectional study

Background

As a public health concern, serious adolescent injuries constitute considerable global morbidity and mortality. Despite the proliferation of literature on this problem, the evidence on the determinants of injuries among in-school adolescents in Saint Vincent and the Grenadines (SVG) is insufficient.

Method

The study analyzed data from the 2018 Global School-based Student Health Survey to examine the prevalence and determinants of serious injuries in a nationwide adolescent sample in SVG. χ 2 And binomial logistic regression analyses were carried out, along with an adjusted odds ratio and a 95% confidence interval.

Results

Serious injuries among this population were estimated at 50.5%. Student grades, gender, truancy, amphetamine or methamphetamine use, marijuana or alcohol use, cigarette smoking, physical assault, physical fight, cyberbullying, suicidal behavior (ideation, plan, and attempt), parental or guardian tobacco use, and multiple sexual partners were significantly associated with serious injuries. After adjusting for other variables, being a male, having experienced a physical attack, fighting physically, attempting suicide, and having multiple sexual partners predicted serious injuries among in-school adolescents in SVG.

Conclusion

The use of integrative health promotion and injury prevention programmes (e.g., antiviolence campaigns) and educational measures could help minimize or eradicate this menace in SVG.

A pooled analysis of temporal trends in the prevalence of anxiety-induced sleep loss among adolescents aged 12-15 years across 29 countries

Background

Previous studies examining trends in sleep loss among adolescents have mainly focused on single countriy and region. This study aims to analyze temporal trends in the prevalence of anxiety-induced sleep loss among adolescents from 29 countries in five regions.

Methods

This study used data from the Global School-based Student Health Survey 2003-2018, which surveyed 215,380 adolescents from 29 countries with at least two cross-sectional surveys per country. The weighted country-specific prevalence of anxiety-induced sleep loss and trends across the survey years were evaluated. Random- or fixed-effects meta-analyses were used to calculate pooled prevalence and temporal trends across 29 countries.

Results

Temporal variations in anxiety-induced sleep loss across countries were identified. Increasing (Suriname, Vanuatu, and Myanmar), decreasing (Namibia, Jamaica, the Philippines, Samoa, and Indonesia), and stable (all other countries) trends in anxiety-induced sleep loss were noted. The pooled weighted prevalence of anxiety-induced sleep loss was 11.35 and 10.67% in the first and last surveys, respectively. There was no meaningful change in the propensity to have anxiety-related sleep disorders over time, with the reduction and OR of these two surveys being 0.54 (-0.53-1.61) and 0.98 (0.88-1.10). For subgroup analyses, no significant differences in pooled anxiety-induced sleep loss trends were seen between the two surveys for different sexes, regions, incomes, survey years in the first wave, survey periods, or number of surveys.

Conclusion

Trends in the prevalence of anxiety-induced sleep loss in adolescents varied significantly across different countries. Generally, a stable trend was observed in 21 of the 29 countries surveyed. Our study provides data that can aid policymakers in establishing country-specific strategies for reducing anxiety-induced sleep loss in adolescents.

Association between adolescents who are victims of bullying and weapon possession

OBJECTIVE

To verify the association between victims of bullying and weapon possession among school adolescents.

METHODS

This cross-sectional study was carried out with 2,296 high school students aged 14-19 years. An instrument containing questions from the validated Youth Risk Behavior Survey questionnaire and the National School Health Survey was used. To describe the profile of interviewees, absolute and relative frequencies were calculated, and the chi-square test was applied to verify the existence of associations. To test the association of bullying with weapon possession, Poisson logistic regression (univariate and multivariate) was used. The significance level used for all analyses was 5%.

RESULTS

Among adolescents interviewed, 23.1% reported being victims of bullying. Among victims of bullying, 37.6% (PR = 1.68; 95% CI = 1.30 - 2.17) reported having already carried some type of weapon (knife, revolver, or truncheon) in the last 30 days, while the reported firearm possession was 38% (PR = 1.67; 95% CI = 1.16 - 2.40) and 47.5% of these adolescents carried some type of weapon (knife, revolver or truncheon) in the school environment (PR = 2.10; 95% CI = 1.50 - 2.93).

CONCLUSIONS

It could be observed that adolescents who are victims of bullying are twice as likely of carrying some type of weapon (knife, revolver, or truncheon) to the school environment, and are also more likely of carrying a firearm.

Sex differences in high-risk health behaviors among school-going adolescents in Yazd, Iran; a cross-sectional study

Objective

Adolescents are exposed to a wide range of high-risk health behaviors. This study aimed to investigate the high-risk health behaviors of adolescents in an Iranian adolescent population and gender differences.

Method

This cross-sectional descriptive study recruited high school students in Yazd city in center of Iran. Schools were randomly selected. In each school, all selected classes were included. Sampling in each class was census. The study investigated self-reported high-risk health behaviors. Students completed the Global School-based Student Health Survey (GSHS), an anonymous, validated questionnaire.

Results

2420 students participated in this study (52.5% male). The age range was 12-19 years. Daily consumption of ≥1 serving of fruit and vegetables per day was reported by 77.4% and 49.5% of respondents, respectively. Adequate physical activity was reported by only 18.4% of adolescents, and significantly less frequently by girls than boys (p < 0.001). 11.8% were current smokers (M/F ratio: 2.6), and 20.5% (M/F ratio: 1.5) were ever used hookah. The prevalence of ever alcohol and substance abuse was 15.5% and 8.8%, respectively. The prevalence of tobacco and substance use was significantly higher in participants' boys than in girls (p < 0.001). Males were over twice more likely to report frequent fighting in the past 12 months than girls. Overall, girls reported more parental supervision than boys (82.1% vs. 73.4%) and parental monitoring (90.6% vs. 86.8%), while boys reported higher levels of awareness over leisure activities than girls (65.8% vs. 58.4%).

Conclusions

High-risk health behaviors are more common in boys than girls. Health policymakers should use these results in prioritizing and designing health interventions to promote youth health. Further studies are recommended to identify the factors influencing the prevalence of these behaviors.

Evaluating the short-term effect of ambient temperature on non-fatal outdoor falls and road traffic injuries among children and adolescents in China: a time-stratified case-crossover study

Although studies have suggested that non-optimal temperatures may increase the risk of injury, epidemiological studies focusing on the association between temperature and non-fatal injury among children and adolescents are limited. Therefore, we investigated the short-term effect of ambient temperature on non-fatal falls and road traffic injuries (RTIs) among students across Jiangsu Province, China. Meteorological data and records of non-fatal outdoor injuries due to falls and RTIs among students aged 6-17 were collected during 2018-2020. We performed a time-stratified case-crossover analysis with a distributed lag nonlinear model to examine the effect of ambient temperature on the risk of injury. Individual meteorological exposure was estimated based on the address of the selected school. We also performed stratified analyses by sex, age, and area. A total of 57322 and 5455 cases of falls and RTIs were collected, respectively. We observed inverted U-shaped curves for temperature-injury associations, with maximum risk temperatures at 18 °C (48th of daily mean temperature distribution) for falls and 22 °C (67th of daily mean temperature distribution) for RTIs. The corresponding odds ratios (95% confidence intervals) were 2.193 (2.011, 2.391) and 3.038 (1.988, 4.644) for falls and RTIs, respectively. Notably, there was a significant age-dependent trend in which the temperature effect on falls was greater in older students (P-trend < 0.05). This study suggests a significant association between ambient temperature and students' outdoor falls and RTIs. Our findings may help advance tailored strategies to reduce the incidence of outdoor falls and RTIs in children and adolescents.

ELECTRONIC SUPPLEMENTARY MATERIAL

Supplementary material is available in the online version of this article at 10.1007/s11783-023-1705-1 and is accessible for authorized users.

Unintentional Injuries Among Young Adolescents at a Level-One Trauma Center in Saudi Arabia: A Cross-Sectional Study

Background Unintentional injuries are the leading preventable cause of mortality across different demographics. This study aims to assess the prevalence, severity, contributing factors, and clinical outcomes of unintentional injuries among adolescent patients. Methods A retrospective study was conducted using the charts of patients admitted with unintentional injuries (motor vehicle accidents (MVA), falls, pedestrian injuries, burns, etc.) to the emergency department (ED) from January 2016 to December 2018 at a level-one trauma center in Riyadh, Saudi Arabia. A total of 721 patients' charts were reviewed, but only 52 patients were consecutively included as per the definition of an adolescent. All variables, including severity and outcome, were assessed. Results The overall prevalence of unintentional injuries was 7.2 per 100 adolescent patients. The most common cause of unintentional injury were MVAs, which were reported in 35 (71%), with head and neck region injuries among 38 (73%) patients. The overall mortality was noted at 10 per 52 (19%) patients. The mean Injury Severity Score (ISS) score was 17.81±12.76. The patients who stayed longer in the ED were not associated with pelvic and lower extremity injuries, with a p-value=0.008. The ISS was the significant predictor of mortality, with an odds ratio (OR) of 1.6, a confidence interval (CI) of 1.02-2.65, and a p-value=0.04. Conclusion MVAs were the main cause of unintentional injuries among adolescents. Future recommendation plans for adolescents should include stricter implementation of road traffic laws to control this early, preventable death among adolescents.

Prevalence of depression and anxiety, and associated factors, among Chinese primary and high school students: A cross-sectional, epidemiological study

INTRODUCTION

This study aimed to investigate the prevalence of depression and anxiety, and associated factors, among Chinese children and adolescents aged 8-18 years who attend primary or high school.

METHODS

A total of 23 005 primary and high school students were recruited from February to December, 2019 for this cross-sectional study. The questionnaire included demographic information, questions assessing suicidality, resilience, depression (Center for Epidemiological Studies Depression Scale for Children), and anxiety (Screen for Child Anxiety Related Disorders). Binary logistic regression was used to analyze the independent correlates of depression and anxiety.

RESULTS

Overall, 13.06% of participants experienced depressive symptoms, 22.34% experienced anxiety symptoms, 26.34% experienced transient suicidal ideation, 2.23% had serious suicidal ideation, and 1.46% had a history of suicide attempts. Anxiety (odds ratio [OR], 4.935; 95% confidence interval [CI][4.442-5.485]), suicidality (OR, 2.671; 95% CI[2.203-3.237]), skipping breakfast (OR, 1.920; 95% CI[1.348-2.736]), sleep duration (OR, 0.470; 95% CI[0.398-0.556]) and self-expectations (OR, 1.924; 95% CI[1.550-2.389]) were associated with depression (all p < .05). Depression (OR, 4.424; 95% CI[3.983-4.914]), female sex (OR, 1.903; 95% CI[1.759-2.060]), school-based traumatic experience(s) (OR, 1.905; 95% CI[1.747-2.077]), relationships with teachers (OR, 1.575; 95% CI[1.103-2.249]), and suicidality (OR, 1.467; 95% CI[1.218-1.766]) were associated with anxiety symptoms (all p < .05).

DISCUSSION

Depression and anxiety are common among school-age children and adolescents in China. Childhood school- and family-based traumatic experience(s), female sex, and lifestyle factors (eating breakfast, sleep duration, exercising, and Internet use) are significantly associated with mental health among children and adolescents. Developing interventions targeting these factors to protect students from depression and anxiety are needed.

Social indicators with serious injury and school bullying victimization in vulnerable adolescents aged 12-15 years: Data from the Global School-Based Student Survey

OBJECTIVE

The prevalence rates of injury and bullying victimization in adolescents are continuing to rise; however, little is known about the influence of social determinants, especially for vulnerable adolescents. We aimed to estimate the prevalence of serious injury and bullying victimization in vulnerable adolescents with mental health issues or poor social support and examine the associations between social indicators and these two outcomes.

METHOD

We used the most recent datasets from the Global School-based Student Health Survey, and vulnerable adolescents aged 12-15 years from 54 countries were included. The pooled overall and regional estimates were obtained by random-effects models. Multivariable logistic regression was performed to estimate the adjusted association between five common social indicators and the two outcomes. Dose-response association was estimated by using a restricted cubic spline.

RESULTS

The prevalence rates of serious injury and bullying victimization were high in vulnerable adolescents, with apparent variation between regions and countries. The pooled prevalence of serious injury ranged from 45.10 % to 50.11 %, whereas the pooled prevalence of bullying victimization ranged from 35.54 % to 45.21 %. Social indicators of national wealth, health status, income and gender inequality were significantly associated with the prevalence of serious injury and bullying victimization in vulnerable adolescents.

CONCLUSIONS

Serious injury and school bullying victimization are prevalent in vulnerable adolescents aged 12-15 years. Social indicators were prominent associated factors of serious injury and bullying victimization in vulnerable adolescents. The results emphasize the importance of social environment when developing intervention measures to address injury and bullying among disadvantaged teenagers.

Geographical variation in the association between physical violence and sleep disturbance among adolescents: A population-based, sex-stratified analysis of data from 89 countries

OBJECTIVE

To examine geographical variations in involvement in physical violence and sleep disturbance among adolescents.

DESIGN

Cross-sectional study.

SETTING

Eighty-nine low- to middle-income and high-income countries PARTICIPANTS: Adolescents 13-17 years of age.

MEASUREMENTS

Multiple binary logistic regression analyses and meta-analyses were performed to assess the link between physical violence (number of physical fights) and sleep disturbance ("mostly" or "always" experienced worry-induced sleep loss).

RESULTS

Among 296,212 adolescents, 8.9% reported sleep disturbance (male: 7.5%, female: 9.6%), with the highest prevalence among adolescents from the Eastern Mediterranean region (14.1%) and high-income countries (14.1%). Overall, sleep disturbance prevalence increased gradually with the increased episodes of physical violence. Adolescents who were involved in physical violence once, 2-3 times, and 4+ times were respectively 18%, 26%, and 77% more likely than their counterparts to experience sleep disturbance (1 time: OR 1.18, 95% CI 1.13-1.24; 2-3 times: 1.26, 1.20-1.34; 4+ times: 1.77, 1.66-1.88). The association between physical violence and sleep disturbance was observed in all regions and country-income groups, with the highest odds of sleep disturbance among adolescents experiencing 4+ times of physical violence in the European region (2.34, 1.17-4.67) and upper-middle-income countries (1.91, 1.73-2.11). The association of physical violence with sleep disturbance by sex was significant in all regions and country-income groups, except the European region.

CONCLUSIONS

Exposure to physical violence is associated with increased odds of sleep disturbances in adolescents. School and community-level interventions, vigilance, and programs to promote violence-free environments may improve the sleep health of adolescents exposed to physical violence.

Prevalence and correlates of physical fighting among adolescents in Paraguay: Findings from the 2017 national school-based health survey

BACKGROUND

Interpersonal violence among adolescents is a serious public health issue across the globe and has been one of the leading causes of death among Paraguayan adolescents. This study aims to investigate the prevalence of physical fighting among adolescents in Paraguay in order to identify problematic fighting behaviour. We also aim to examine the correlates of physical fighting and the extent to which previously identified factors correlate with physical fighting.

METHODS

We used the Paraguay 2017 Global School-based Student Health Survey (GSHS). This survey collects health-related information on school-attending adolescents aged 13-17 years. We defined physical fighting as having participated in at least two physical fights in the previous 12 months. We chose 16 independent variables: 12 individual-level variables and four social-level variables. Multivariable logistic regression models were developed to identify factors associated with physical fighting. One of the limitations of this study is that it only captured the responses of the students who attended school on the day of the survey.

FINDINGS

A total of 3,149 students completed the survey questionnaire, with the response rates for the school, student, and total response being 100%, 87%, and 87%, respectively. In 2017, 8% of the survey participants (11.4% of the males, and 4.7% of the females) had been involved in two or more physical fights during the past 12 months. In the multivariable model, having been physically attacked, male gender, physical activity, alcohol use, early sexual debut, and suicide planning were significantly associated with involvement in physical fighting. Having helpful peers and supportive parents was not statistically significant in the model adjusted for all variables.

CONCLUSIONS

Although Paraguay shows relatively lower prevalence of physical fighting than other countries, the high association between physical fighting and having been physically attacked is noteworthy. Considering the serious interpersonal violence among Paraguayan adolescents, preventive attributes should be considered, and further assessment of other types of interpersonal violence should be made.

Body Image Dissatisfaction and Aggressive Behavior Among Chinese Children at Different Pubdertal Stages: A Path Analysis

Background

Body image dissatisfaction and aggressive behavior have become important public health problem in children and adolescents, and body image dissatisfaction may increase the occurrence of aggressive behavior. The aim of this study was to explore the correlation between body image dissatisfaction and aggressive behavior among Chinese children in different developmental stages.

Methods

The stratified cluster sampling method was used to effectively survey 518 children aged 8–15 years. The Body Shape Questionnaire and the Buss-Warren Aggressive Questionnaire scale were used to measure body image dissatisfaction and aggressive behavior. Pubertal development stages were divided into three stages according to Tanner criteria.

Results

There was a main correlation path of body image dissatisfaction - hostility - anger - indirect aggression - physical aggression in boys with stage I and stage II and in girls with stage I and stage III. In addition, there were direct paths of hostility - indirect aggression, hostility - verbal aggression, anger - physical aggression, and anger - verbal aggression in boys with stage I; hostility - indirect aggression, hostility - verbal aggression, and anger - physical aggression in boys with stage II and in girls with stage I; and anger - physical aggression, and anger - verbal aggression in girls with stage III.

Conclusion

Body image dissatisfaction might positively correlate with aggression through hostility among Chinese children and adolescents, and their association paths were different in different puberty stages.

Stakeholders' attitudes towards the installations of closed-circuit television cameras in reducing school violence

Purpose

While schools worldwide have employed closed-circuit television (CCTV) to discourage school violence, the literature shows that stakeholder attitudes toward adopting this technology are inconsistent across cultures. Generally, they are concerned with effectiveness, necessity, privacy, and operational transparency. Based on the Technology Acceptance Model for Video Surveillance (TAM-VS) theory, this study examined the attitudes of educational stakeholders, namely educators and students, toward adopting CCTV in Vietnam. This study aims to investigate which criteria Vietnamese stakeholders use to evaluate the necessity of CCTV and whether the concerns of Vietnam, a developing country, are similar to those of developed countries.

Methods

This study addressed these research questions by purposely sampling and interviewing 49 Vietnamese high school students, recent high school graduate students, teachers, and administrators. It employed semi-structured and in-depth interviews to gather content-rich data and applied thematic analysis to discover new insights from stakeholders under the modified TAM-VS framework. The study also followed the COREQ guidelines to improve the transparency and rigor of the data collection and analysis.

Findings

On an exploratory basis, most Vietnamese stakeholders believed that while CCTV cannot comprehensively prevent school violence, its effectiveness overshadows privacy concerns. Regarding operational transparency concerns, participants suggested that better communication, consent collection, and the right to amend school policies related to CCTV are important. From the participants’ perspective, the three criteria for evaluating the necessity of CCTV were (1) its effectiveness in controlling school violence, (2) serving other purposes to enhance overall schooling performance, and (3) insufficient existing methods.

Conclusions

This study provides context-rich insights into the perceptions of the necessity, effectiveness, privacy, and operational transparency concerns of CCTV across different stakeholders in the education and developing country context. On the practical contribution, the research identifies strategies that school administrators can employ to promote CCTV acceptance in Vietnamese high schools.

Childhood Adversity Trajectories and Violent Behaviors in Adolescence and Early Adulthood

Violence and other antisocial behaviors, including fighting and weapon carrying, are highly prevalent among adolescents but usually decrease in young adulthood. Childhood adversities, including exposure to abuse, intimate partner violence, and household substance use and mental health problems, have been linked to violent behaviors in adolescence and adulthood. However, few studies of childhood adversity as determinants of persistent violent behavior among community-based samples have been conducted. Furthermore, the effects of adversity timing and duration on subsequent violent behaviors are unclear. We examined the association between five childhood adversity trajectories (representing stable-low, stable-mild, decreasing, increasing, and stable-high adversity from birth through age 11.5 years) and physical fighting and weapon carrying at ages 13-20 years among a sample of young adults followed continuously since birth from the Avon Longitudinal Study of Parents and Children (n = 9,665). The prevalence of violent behaviors declined sharply as participants aged (e.g., whereas 42.8% reported engaging in physical fighting in the past year at ages 13-15 years, this dropped to 10.4% at ages 17-20 years). Childhood adversity trajectories exhibited a strong dose-response relation with physical fighting and weapon carrying, with particularly pronounced relations for violent behaviors persisting across both adolescence and early adulthood (e.g., for physical fighting at both ages 13-15 years and 17-20 years compared to no fighting at either period, adjusted odds ratio [aOR] = 1.62, 95% confidence interval [CI] = 1.31-2.00 for stable-mild; aOR = 2.33, 95% CI = 1.64-3.33 for decreasing; aOR = 3.18, 95% CI = 2.20-4.60 for increasing; and aOR = 3.73, 95% CI = 2.13-6.52 for stable-high adversity, compared to stable-low adversity). This work highlights the substantial implications of exposure to childhood adversity for youth violence prevention.

Participation in Bullying and Associated Health Characteristics, Risk Factors and Leisure Activities: A Profile of School-Age Children in Serbia

The aim of this study was to examine the prevalence and association of school-age children’s participation in bullying, focusing on their health characteristics, risk factors, and leisure activities. We performed a secondary analysis of the original data of the 2017 HBSC study to examine participation in bullying once and multiple times among school-age children in Serbia. For this purpose, a nationally representative sample of 3267 children from 64 primary and high schools in the Republic of Serbia was evaluated. The outcome variable of interest in our study was participation in bullying. Further groups of individual variables such as health characteristics, risk factors, and leisure activities were assessed. Multivariate regression analysis indicated that children who felt everyday stomach pain, irritability or bad mood, and nervousness were more likely to participate in bullying at least once compared with those who rarely or never had such symptoms by 1.46, 1.58, and 1.58 times, respectively. School-age children who reported being drunk two to three times, and four or more times in life were more likely to participate in bullying than those who reported never being drunk by 1.53 and 1.74 times, respectively. Children who reported to watch TV or other media for five or more hours per day were 2.34 times more likely to be involved in bullying at least once. Multiple regression analysis showed that students with daily stomach pain, back pain, nervousness, and dizziness were more likely to be involved in multiple bullying by 1.16, 1.62, 1.82, and 1.70 times, respectively. Students who had nightly meetings or reported being drunk four or more times in the last 30 days were more likely to be involved in multiple bullying by 2.54 and 3.47, respectively. Students who reported playing games five or more times per day were 2.70 times more likely to be involved in this multiple bullying. This study highlights the importance of professional and family education programmes for early identification of specific health symptoms in the pediatric population, as well as integration with interventions aimed at reducing alcohol abuse among school-age children.

Validation of a Bullying Scale in Peruvian Adolescents and Gender-Specific Differences

The objective of the study was to evaluate the psychometric properties of the European Bullying Intervention Project Questionnaire (EBIPQ) inPeruvian adolescents and to determine gender-specific differences. The sample comprised 532 students in sixth grade of elementary school to third grade of high school. To validate the instrument, we requested an expert judgement and conducted a pilot test. Subsequently, we performed the exploratory factorial analysis, which showed that all the questions were correctly loaded in both components, an aspect that explained the 48.6%variance. We determined the reliability by means of the internal-consistency method using the Cronbach's alfa (αtotal= .856;αvictimization= .807;αaggression= .828). We found gender-specific differences in bullying roles(p<.001). In conclusion, the factorial structure of the EBIPQ in Peruvian adolescents is similar to the original questionnaire and presents high reliability and construct validity.

Line of care for the attention to morbimortality from external causes in adolescents and young people

OBJECTIVES

to describe the development and modeling of a line of care for the prevention and attention of morbimortality from external causes in adolescents and young people within the scope of the municipal management of the Unified Health System.

METHODS

methodological study operationalized in three stages: situational analysis; literature review; development, and modeling. Descriptive statistical analysis and content analysis of the thematic type were used to produce evidence and support the development of the line of care.

RESULTS

by upholding the evidence of the study, it was elaborated a line of care, whose theoretical and methodological proposal included: 1) conceptual matrix, 2) educative matrix, 3) assistance matrix, and 4) operative matrix.

FINAL CONSIDERATIONS

the lines of care are strong tools for articulating the levels of health care, being a resolute and feasible proposal given its cost-effectiveness for complex health demands such as the morbimortality of adolescents and young people from external causes.

Urban-Rural Differences in Depression Literacy Among High School Teachers in the Kingdom of Eswatini

BACKGROUND

Concerns have been raised over teachers' mental health literacy in low-income countries and lower- and middle-income countries wherein pediatric mental health resources are limited. This study aims to investigate adolescent depression literacy among teachers in Eswatini and to explore the role of urbanicity.

METHODS

We conducted a cross-sectional survey in 59 public high schools in Eswatini in 2019-2020. Data were collected by a paper-and-pencil questionnaire; depression literacy was assessed by the 17-item Adolescent Depression Knowledge Questionnaire.

RESULTS

Teachers' adolescent depression literacy item-level correct rates fell between 27 and 80%. Although the multivariate response models indicated that teaching in urban areas was slightly associated with having higher depression literacy in general (adjusted odds ratio [aOR] = 1.46; 95% confidence interval = 1.00-2.12), such urban-rural differences did not manifest homogeneously across all items: urban teaching was significantly linked with reduced correct responses toward certain items concerning depression etiology and treatment, including "depression runs in some families," "major stress as a necessary cause," and "a curable illness" (aOR = 0.57 ∼ 0.68).

CONCLUSION

Urban-rural differences in teachers' depression literacy were manifested at both scale- and item-levels. A critical need exists for urban/rural areas-tailored intervention on teachers' literacy toward mental disorders in the resource-limited regions to better improve health and developmental outcomes of students.

The Association between Participation in Fights and Bullying and the Perception of School, Teachers, and Peers among School-Age Children in Serbia

Participating in physical fighting and bullying can be a cause of severe injury and death among school-age children. Research evidence can support school and health actors' efforts to improve school-age children's development and health capacity for life. The study aims to assess the prevalence of school-age children's participation in fights and bullying in Serbia, and to examine the relevance of students' socio-demographic characteristics and perceptions of school and relations with other students and professors for participation in fights and bullying. A secondary analysis is also performed on the original data of the 2017 HBSC study, which was conducted on 3267 students in a nationally representative sample of primary and high schools in Serbia. We sought to investigate the relationship between eight socio-demographic characteristics and nine school-related perceptions, with two outcome variables: taking part in fights and taking part in bullying, examined by using univariate and multivariate logistic regression. The main results show that 50.8% of boys and 17.1% of girls have taken part in fights, while 17.7% boys and 10.4% of girls have taken part in bullying. Students who felt a large and very large burden of school obligations were 1.43 times more likely to participate in bullying at least once, while they were 1.38 and 2.12 times more likely to participate in multiple fights and 4.04, 1.24, and 2.78 times more likely to participate multiple times in bullying. Multiple participation in fights and in bullying is significantly negatively associated with female gender, younger age years, good and very good perception of family financial status and quality of life, and positive perceptions of school and relations they have with other students and professors. Fights among school-age children are significantly positively associated with living with relatives/legal guardians and poor quality of life. In conclusion, the prevalence of participating in at least one fight/bullying is higher than in multiple fights/bullying. These associations suggest a necessity to enhance the monitoring and control of peer behavior among school-age children. The findings of the study imply key enablers of protection, such as building relationships based on team spirit and work, friendly behavior, empathy, and help, which should be included in the value system of school and family activities in programs to combat fights and bullying in school-age children.

Linha de cuidado para a atenção à morbimortalidade por causas externas em adolescentes e jovens

RESUMO Objetivos: descrever o desenvolvimento e modelagem de uma linha de cuidado para a prevenção e atenção à morbimortalidade por causas externas em adolescentes e jovens, no âmbito da gestão municipal do Sistema Único de Saúde. Métodos: estudo metodológico operacionalizado em três etapas: análise situacional; revisão de literatura; desenvolvimento e modelagem. Análise estatística descritiva e de conteúdo do tipo temática foram utilizadas para produzir evidências e embasar a elaboração da linha de cuidado. Resultados: apoiando-se nas evidências do estudo, elaborou-se uma linha de cuidado, cuja proposta teórico-metodológica contemplou: 1) matriz conceitual, 2) matriz educativa, 3) matriz assistencial e 4) matriz operativa. Considerações Finais: as linhas de cuidado são instrumentos potentes para a articulação dos níveis de atenção à saúde, sendo uma proposta resolutiva e exequível haja vista seu custo-efetividade para demandas complexas em saúde como a morbimortalidade de adolescentes e jovens por causas externas.

Prevalence and Correlates of Serious Injuries among Adolescents in Mauritius

Introduction

Injuries are a major global health problem that affects teenagers in many countries. Though several studies have been done in many countries, little is known among adolescents in Mauritius. Therefore, our paper explored the prevalence and correlates of serious injuries among adolescents in Mauritius.

Methods

We analysed the 2017 Global School-Based Student Health Survey (GSHS) data from Mauritius, using the Chi-square test and binomial logistic regression analysis with adjusted odds ratio (AOR) at 95% confidence interval (CI).

Results

The prevalence of serious injuries among adolescents in Mauritius stood at 39.0%. Also, the predictors of serious injuries included sex (AOR = 0.70, CI = 0.58–0.81), physical attack (AOR = 0.47, CI = 0.39–0.57), being bullied (AOR = 0.48, CI = 0.48–0.70), suicide ideation (AOR = 0.65, CI = 0.49–0.85), hunger (AOR = 0.65, CI = 0.48–0.86), truancy from school (AOR = 0.77, CI = 0.63–0.93), marijuana use (AOR = 0.54, CI = 0.39–0.76), alcohol consumption (AOR = 0.64, CI = 0.70–0.98), and parental neglect (AOR = 0.83, CI = 0.70–0.98).

Conclusion

The rate of injury among adolescents in Mauritius is moderately high, with sex, suicidal thought, hunger, truancy, drug use, and parental neglect as correlates. There is an urgent need for health promotion interventions at family, community, and school levels to deal with this level of serious injuries and the factors influencing such occurrences among these adolescents in Mauritius.

The association of parental involvement with adolescents' well-being in Oman: evidence from the 2015 Global School Health Survey

BACKGROUND

The parent-adolescent relationship plays a key role in adolescent development, including behaviour, physical health, and mental health outcomes. Studies on the parental factors that contribute to an adolescent's dietary habits, exercise, mental health, physical harm and substance use are limited in the Middle East and North Africa region, with none in Oman. This study aims to investigate the association between parental involvement and adolescent well-being in Oman.

METHODS

Cross-sectional data from the 2015 Global School Health Survey for Oman was analysed. The dataset consisted of 3468 adolescents. Adolescents reported on their parental involvement (checking to see if they did their homework, understanding their problems, knowing what they are doing in their free time and not going through their things without permission). Parental involvement was scored on a 20-point scale. Associations with the following dependent variables: nutrition, exercise, hygiene, physical harm, bullying, substance use, tobacco use and mental health well-being were done using Spearman's correlations, linear and logistic regressions.

RESULTS

The surveyed population was 48% male, 65% aged 15 to 17 years old and 5% reported that they "most of the time or always" went hungry. Parental involvement was positively correlated with each of the dependent variables. Adolescents with higher parental involvement had significantly higher odds of good nutrition (1.391), hygiene (1.823) and exercise (1.531) and lower odds of physical harm (0.648), being bullied (0.628), poor mental health (0.415), tobacco use (0.496) and substance use (0.229).

CONCLUSIONS

Parental involvement plays a positive role in all aspects of adolescents' well-being in Oman. Awareness campaigns and interventions aimed to help improve the well-being of adolescents should incorporate such positive role in their designs.

Grade repetition and bullying victimization in adolescents: A global cross-sectional study of the Program for International Student Assessment (PISA) data from 2018

BACKGROUND

Grade repetition is practiced worldwide and varies considerably across the globe. Globally, around 32.2 million students repeated a grade at the primary education level in 2010. Although a large body of research has documented grade repetition's academic and non-academic effects, the limited evidence on associations between grade repetition and school bullying is inconsistent and ambiguous. This study aimed to investigate the global association of grade repetition with bullying victimization in a large-scale school-based cross-sectional study.

METHODS AND FINDINGS

We used the latest global data from the Program for International Student Assessment (PISA) 2018. PISA 2018 was conducted between March and August 2018 in 80 countries and economies among students aged 15-16 years attending secondary education. The students reported their experiences of repeating a grade at any time point before the survey and of being bullied in the past 12 months. The outcome measures were 6 types of bullying victimization. We accounted for the complex survey design and used multivariate logistic regression models to estimate the odds ratios (ORs) with 95% confidence intervals (CIs) of grade repetition with bullying victimization after adjusting for potential confounders (sex; age group; migrant status; school type; economic, social, and cultural status; and parental emotional support). This study included 465,146 students (234,218 girls and 230,928 boys) with complete data on grade repetition and bullying victimization in 74 countries and economies. The lifetime prevalence of grade repetition was 12.26%, and 30.32% of students experienced bullying at least a few times a month during the past 12 months. Grade repetition was statistically significantly associated with each type of bullying victimization. The OR (95% CI) of overall bullying victimization for grade repeaters compared with their promoted peers was 1.42 (95% CI 1.32-1.52, p < 0.001). The sex-specific analysis produced similar results in both boys and girls. Furthermore, girls who repeated a grade had higher risks of being made fun of, being threatened, having possessions taken away, and being pushed around than boys. The major limitation is that this study only included students attending schools and therefore may be subject to possible selection bias. In addition, the cross-sectional design hinders us from establishing causality between grade repetition and bullying victimization.

CONCLUSIONS

In this study, we observed that, globally, both boys and girls who repeat a grade are at increased risk of being bullied compared with promoted peers, but girls may experience higher risks than boys of specific types of bullying associated with repeating a grade. These findings provide evidence for the association of grade repetition with bullying victimization. Sex differences in risk of experiencing some types of bullying suggest that tailored interventions for girls who repeat a grade may be warranted.

Violence and non-fatal injuries among Vietnamese in-school adolescents: national prevalence estimates and associated factors

School violence and injury are major public health problems worldwide. The data of this study were from the Viet Nam Global School-based Student Health Survey (GSHS) - a nationally representative survey conducted in 2019, with a sample size of 7690 students aged 13-17 years old. We found the prevalence of violence and non-fatal injury to be 14.5% and 21.4%, respectively. Factors related to higher odds of violence and non-fatal injuries in both sexes included smoking cigarettes, drinking alcohol, having mental health problems (loneliness, worrying and suicidal thinking), and truancy. In contrast, parental monitoring was associated with lower odds of violence, and parental respect was a protective factor of both violence and non-fatal injuries. Students who experienced violence had a higher likelihood of having non-fatal injuries in both sexes. Future policies should consider individual factors and parent-child bonding, to mitigate the burden of violence and injury among in-school adolescents in Viet Nam.

Prevalence and Correlates of Unintentional Injuries among In-School Adolescents in Ghana

Injuries among adolescents pose significant public health problems. Unintentional injuries are the leading cause of adolescents’ mortality and disability with the largest burden in low-and middle-income countries. Yet, there is paucity of data in Ghana on adolescent injuries. The present study aimed to determine the prevalence and correlates of unintentional injuries among in-school adolescents in Ghana using data from the Global School-Based Health Survey. Cross-sectional data on 2058 adolescents in junior and senior high schools who randomly participated in the 2012 Global School-Based Health Survey were analyzed. Descriptive statistics were performed to determine the prevalence of unintentional injuriesacross the background characteristics of in-school adolescents. Binary logistic regression was employed to determine the factors associated with unintentional injuries. The results were presented as crude and adjusted odds ratios at a 95% confidence interval. The prevalence of one or more serious injuries in the past 12 months was 57.0%. The most commonly reported type and cause of injuries were “I had a cut or stab wound” (15.2%) and “I fell” (13.1%), respectively. In the adjusted regression, in-school adolescents aged 14–16 (aOR = 1.60, CI = 1.12–2.28) were more likely to report one or more serious injuries compared to their counterparts aged 13 or younger. In-school adolescents who participated in physical education (aOR = 1.27, CI = 1.03–1.58) had higher odds of reporting one or more serious injuries. The odds of being injured was higher among adolescents who were truant at school compared to those who were not truant (aOR = 1.42, CI = 1.14–1.77) In-school adolescents who were bullied were more likely to report being injured one or multiple times compared to their counterparts who were not bullied (aOR = 2.16, CI = 1.75–2.65). In addition, the odds of being injured once or multiple times were higher among adolescents who were physically attacked (aOR = 2.21, CI = 1.78–2.75), those that engaged in physical fighting (aOR = 1.94, CI = 1.54–2.45), and those who reported high psychological distress (aOR = 2.00, CI = 1.52–2.63) compared to their counterparts who were not. Conversely, adolescents in senior high schools were 39% less likely to be injured once or multiple times compared to those in junior high schools (aOR = 0.61, CI = 0.47–0.79). A relatively high prevalence of unintentional injuries was found among in-school adolescents in the study. The numerous factors identified in this study could be integrated into health promotion and injury prevention activities to help reduce the occurrence of injuries among in-school adolescents. Moreover, students who are susceptible to unintended injuries such as older adolescents, victims of bullying, those who participate in physical education, those who are often involved in fights, truants, and those who have psychological distress should be sensitized to take measures that will reduce their level of susceptibility. First aid treatment services should also be made available in schools to treat victims of unintended injuries.

Trends of 20 Health Risk Behaviours Among Adolescents in Morocco: Results of Three National Cross-Sectional School Surveys of 2006, 2010 and 2016

Background

This study aimed to estimate the trends of 20 health risk behaviours among adolescents in Morocco.

Methods

Cross-sectional data from 13,109 adolescents (14 years median age) that took part in three waves (2006, 2010, and 2016) of the “Morocco Global School-Based Student Health Survey (GSHS)” were analysed.

Results

Among both boys and girls, five health risk behaviours (being physically attacked, annual injury, passive smoking, zero days walking or biking to school, and poor hand hygiene after toilet use) significantly declined over time, as well as among boys the involvement in physical fighting. Inadequate fruit intake and current tobacco use increased among both boys and girls over time, and among girls bullying victimization and among boys poor hand hygiene prior to eating increased over time.

Conclusion

More health risk behaviours decreased than increased in this study of three cross-sectional surveys over a period of 10 years. Additional school health promotion is needed.

From fathers to peers: Association between paternal violence victimization and peer violence perpetration among youth in Malawi, Nigeria, and Zambia

Interpersonal violence against children and youth, including parental violence and peer violence, are major global health concerns. However, the majority of the parental violence and peer violence literature examines each separately from one another. In this study, we specifically investigate the role of fathers and whether paternal violence victimization is associated with peer violence perpetration, above and beyond maternal violence victimization. We used nationally-representative data from three sub-Saharan African country surveys of the Violence Against Children Surveys, which comprised a pooled sample of 8184 youth aged 13-24 years in Malawi (conducted in 2013), Nigeria (2014), and Zambia (2014). We used multivariable logistic regression models to estimate the association between paternal violence victimization and peer violence perpetration, controlling for maternal violence victimization, witnessing violence, and other covariates. We also tested a structural equation model to determine whether the direct association between paternal violence victimization and peer violence perpetration was mediated through youth mental distress or alcohol use, controlling for other violence exposures and covariates. In the pooled sample, 22.8% of youth reported paternal violence victimization, and 18.8% of youth reported peer violence perpetration in their lifetime. Youth who experienced paternal violence had a greater odds of perpetrating peer violence (OR = 1.74, 95% CI: 1.50-2.02), compared with youth who did not experience paternal violence and after controlling for maternal violence victimization and other covariates. Structural equation model results revealed that approximately a quarter of the total association between paternal violence victimization and peer violence perpetration was mediated by youth mental distress and alcohol use. Our study underscores the role of fathers in the context of parental violence against youth and highlights the need for multicomponent and two-generation violence prevention interventions that address paternal violence and support youth psychosocial wellbeing to prevent cycles of violence perpetration against youth in sub-Saharan Africa.

Prevalence and correlates of single and multiple unintentional non-fatal injuries among school-going adolescents in Liberia

OBJECTIVE

This investigation aims to report on single and multiple unintentional nonfatal injuries among in-school adolescents in Liberia.

METHODS

Nationally representative cross-sectional data were statistically analysed from 2,744 adolescents (median age=18 years) that participated in the 2017 Liberia Global School-Based Student Health Survey (GSHS).

RESULTS

The prevalence of single or multiple serious injuries (past 12 months) was 71.6% (31.8% once and 39.7% two or more times). Struck or hit by an object (10.6%), fall (9.0%), and motor vehicle crashes (8.6%) were the most frequent causes of injury, and cuts or open wounds (13.6%), fractures or dislocation (8.2%), and concussion (5.0%) were the most prevalent types of injury. In adjusted multinomial logistic regression analysis, experience of hunger (or food insecurity), passive smoking, frequent school truancy, psychological distress, and current cannabis use were associated with multiple and/or single injury. In addition, in unadjusted analysis, current tobacco use, ever drunk, ever amphetamine use, physically inactive and sedentary and walking and biking to school were associated with single and/or multiple injuries. In a separate multinomial logistic regression model, victims of physically assault, involvement in physical fighting, and bullying victimization were associated with both single and multiple injuries.

CONCLUSION

A high prevalence of unintentional single and multiple injuries was discovered and several factors were found that can be utilized in targeting programmes aimed at injury prevention among adolescents.

Factors associated with physical and sexual violence among school-going adolescents in Nepal: Findings from Global School-based Student Health Survey

Background

Globally violence is a matter of public health concern with severe physical and mental health implications and social consequences. Evidence suggest that adolescents have an elevated risk of exposure to physical and sexual violence. However, there is a lack of nationally representative research on violence and its associated factors in Nepal to inform interventions. This paper attempts to find the factors associated with various forms of physical and sexual violence among school-going adolescents in Nepal.

Methods

We analysed the cross-sectional data from the Global School-based Student Health Survey (GSHS) 2015. The GSHS survey applied a two-stage cluster sampling process to select a representative sample of 7 to 11 grade students from 74 schools across the country. We applied logistic regression analysis to identify the factors associated with physical and sexual violence.

Results

Out of the total 6,529 participants, 45.24% of them faced a physical attack, 39.25% were involved in a physical fight, and 11.65% were victims of sexual violence in the survey administered between 7 August 2015 to 14 March 2016. In a multiple regression analysis, the age of participants, parental supervision, feeling unsafe at school, and the number of close friends were found to be associated with a physical attack. Participants who were bullied, had multiple sex partners, and had received corporal punishment in school had a higher engagement in a physical fight. Likewise, school grade, having parents who understand the problems, having multiple sex partners, and corporal punishment at school were associated with instances of sexual violence.

Conclusion

The study identified multiple factors associated with experiences of physical attacks, involvement in a physical fight, and sexual violence among school-going adolescents. This study results can have important implications for school administration, parents, and policymakers alike to plan appropriate anti-violence strategies and interventions. Since various forms of violence share some common risk factors, a comprehensive strategy could be worth considering to prevent such acts of violence.

The prevalence of suicidal behaviors and their mental risk factors among young adolescents in 46 low- and middle-income countries

BACKGROUND

To describe the prevalence of suicidal behaviors (ideation, planning, and attempt) and their associated factors in young adolescents in low- and middle-income countries (LMICs).

METHODS

We used the latest data from the Global School-Based Health Survey (GSHS) for adolescents aged 12-15 years during 2009-2015. The weighted prevalence and 95% confidential intervals (CIs) of suicidal behaviors were calculated using a random-effects model. The factors associated with suicidal behaviors were examined using logistic regression analysis.

RESULTS

Data from 130,488 adolescents (48.13% boys) in 46 LMICs were included in the study. Across all countries, the pooled 12-month prevalence of suicidal ideation, planning, and attempt were 14.5%, 14.6%, and 12.7%, respectively. The highest prevalence of suicidal ideation, planning, and attempt were all in Africa (16.7%, 19.3% and 17.0%), and the lowest prevalence were all in South-East Asia (8.2%, 10.5% and 7.4%). The overall prevalence of three suicidal behaviors were higher in girls (all P < 0.001). Suicidal ideation and planning were more common in the 14-15 age group than 12-13 age group (both P < 0.001). The factors associated with suicidal behaviors were being female, older age, loneliness, anxiety, a lack of close friends, and having family supportive (all P < 0.001).

LIMITATIONS

The GSHS data were obtained from a self-report questionnaire and the participants included in the GSHS were adolescents in school.

CONCLUSIONS

The prevalence of suicidal behaviors remains high among young adolescents in LMICs, especially in Africa. These countries should be intervention priorities.

Associations of number of victimizations with mental health indicators and health-risk behaviours among a nationally representative sample of in-school adolescents in Curaçao

PURPOSE

The study aimed to estimate the association of experiencing a higher number of victimizations with mental health and health-risk behaviours among adolescents in the 2015 Curaçao Global School-Based Student Health Survey (GSHS).

METHODS

In all, 2,765 in-school adolescents with a median age of 15 years from Curaçao responded to the cross-sectional GSHS.

RESULTS

Results indicate that from six forms of victimization (bullied, parental physical victimization, physically attacked, physical intimate partner violence victimization, forced sex and violent injury) assessed, 29.6 % reported one type of victimization, 11.3 % two types and 4.9 % three or more types of victimization. In adjusted logistic regression analyses, PV was associated with four poor mental health indicators (worry-induced sleep disturbance, suicidal ideation, loneliness, and suicide attempt) and eleven health-risk behaviours (current tobacco use, current alcohol use, current cannabis use, early sexual debut, sex among students who were drunk, multiple sexual partners, non-condom use at last sex, school truancy, carrying a weapon, short sleep and skipping breakfast).

CONCLUSION

Almost one in six students reported poly-victimization (≥2 types). Higher frequency of victimization was positively associated with four poor mental health indicators and eleven health-risk behaviours.

Serious non-fatal unintentional injuries among in-school adolescents in Sri Lanka: results from the 2016 Sri Lankan global school-based health survey

BACKGROUND

Unintentional injuries among adolescents is a major public health problem the world over. A great majority of the annual deaths among adolescents is due to unintentional injuries; it is also the leading cause of death among adolescents in the world. The aim of this study was to estimate the incidence of injuries and their associated factors among school going adolescents aged 13-17 years using data from the most recent Global School-Based Health Survey (GSHS) conducted in Sri Lanka.

METHODS

A cross-sectional survey was conducted using a self-administered questionnaire, among 3262 adolescents attending government schools. The sample was selected through a two-staged cluster sampling technique. In the first stage, 40 schools were selected using probabilities proportional to school enrollment size, from all schools in the country that have classes in grades 8-12. Then, from the selected schools, classes were selected using systematic equal probability sampling with a random start. The weighted prevalence was calculated, and logistic regression analysis was conducted in order to determine the correlates.

RESULTS

During the 12 months before the survey, 35.8% (95% CI-30.7 - 41.1) of the students reported being seriously injured one or more times. The injuries were more common among males, but were equally common among the two different age groups (13-15 age group vs 16-17 age group). The most common type of injury was cut or stab wounds (5.5%), followed by broken bones/dislocated joints (5.3%). Multivariable analysis revealed that only a few factors were associated with injury, such as being of the male sex, being bullied, being physically attacked, and/or being in a physical fight.

CONCLUSION

This study demonstrated that the prevalence of serious unintentional injuries among school going adolescents is a major public health problem in Sri Lanka. This timely and comprehensive survey would help policy makers and researchers identify the unmet needs related to adolescent injuries. Furthermore, evidence generated form the study should be given due consideration when designing school-based interventions to prevent adolescent injuries.

Trends of Alcohol Use, Dietary Behaviour, Interpersonal Violence, Mental Health, Oral and Hand Hygiene Behaviour among Adolescents in Lebanon: Cross-Sectional National School Surveys from 2005, 2011 and 2017

Health risk behaviours during adolescence can have long-term negative consequences. Little is known, however, about the recent health risk behaviour trends in adolescents in Lebanon. This investigation aimed to report the trends in the prevalence of various health risk behaviours, such as alcohol use, dietary behaviour, interpersonal violence, mental health, oral and hand hygiene, among adolescents in Lebanon. Cross-sectional nationally representative data were analysed from 13,109 adolescents (14 years median age) that participated in three waves (2005, 2011 and 2017) of the “Lebanon Global School-Based Student Health Survey (GSHS)”. Results indicate that significant improvements were found among both boys and girls in the decline in interpersonal violence (bulling victimization, being physically attack and involvement in physical fighting), poor washing of hands after using the toilet, and suicide planning, and among girls only loneliness, worry-induced sleep disturbance and suicidal ideation. Significant increases were found among both boys and girls in the prevalence of inadequate fruit consumption, and among boys only unintentional injury and not always washing hands before eating. In conclusion, several decreases but also increases in health risk behaviours were found over three assessment points during a period of 12 years calling for continued health enhancing activities in this adolescent population.

Global variation in the prevalence of bullying victimisation amongst adolescents: Role of peer and parental supports

BACKGROUND

Bullying victimisation is a global public health problem that has been predominantly studied in high income countries. This study aimed to estimate the population level prevalence of bullying victimisation and its association with peer and parental supports amongst adolescents across low and middle income to high income countries (LMIC-HICs).

METHODS

Data were drawn from the Global School-based Student Health Survey of school children aged 12-17 years, between 2003 and 2015, in 83 LMIC-HICs in the six World Health Organization (WHO) regions. We estimated the weighted prevalence of bullying victimisation at country, region and global level. We used multiple binary logistic regression models to estimate the adjusted association of age, gender, socioeconomic status, and parental support and peer support, and country level variables (GDP and government expenditure on education) with adolescent bullying victimisation.

FINDINGS

Of the 317,869 adolescents studied, 151,036 (48%) were males, and 166,833 (52%) females. The pooled prevalence of bullying victimisation on one or more days in the past 30 days amongst adolescents aged 12-17 years was 30·5% (95% CI: 30·2-31·0%). The highest prevalence was observed in the Eastern Mediterranean Region (45·1%, 44·3-46·0%) and African region (43·5%, 43·0-44·3%), and the lowest in Europe (8·4%, 8·0-9·0%). Bullying victimisation was associated with male gender (OR: 1·21; 1·11-1·32), below average socio-economic status (OR: 1·47, 1·35-1·61), and younger age (OR: 1·11, 1·0-1·24). Higher levels of peer support (0·51, 0·46-0·57), higher levels of parental support (e.g., understanding children's problems (OR: 0·85, 0·77-0·95), and knowing the importance of free time spent with children (OR: 0·77, 0·70-0·85)), were significantly associated with a reduced risk of bullying victimisation.

INTERPRETATIONS

Bullying victimisation is prevalent amongst adolescents globally, particularly in the Eastern Mediterranean and African regions. Parental and peer supports are protective factors against bullying victimisation. A reduction in bullying victimisation may be facilitated by family and peer based interventions aimed at increasing social connectedness of adolescents.

Physical Fighting among School-Attending Adolescents in Pakistan: Associated Factors and Contextual Influences

BACKGROUND

Adolescent physical fighting is a problem of public health importance, with varied consequences in the form of school absenteeism, injury, and, in some cases, death. Although research on risk and protective factors exists, most has been conducted in high-income countries.

METHODS

The 2009 Pakistan Global School-based Health Survey (GSHS) data were used. Logistic regression models were used to determine the associations. Five independent variables were investigated at the individual level (anxiety, suicide planning, truancy, physical activity, and bullying victimization) and four independent variables at the social level (presence of supportive parental figures, presence of helpful peers, extent of social network, and food insecurity).

RESULTS

Among adolescents in this study (N = 5177), 20% reported being involved in two or more physical fights, most of whom were males (79.9%). The factors associated with physical fighting were: being male (OR = 2.78); bullying victimization (OR = 3.14); truancy (OR = 1.63), loneliness (OR = 1.44); and suicidality, as evidenced by having a suicide plan (OR = 1.75). Having few close friends (0-2) as opposed to more (>3) was found to be protective against engaging in physical fighting.

CONCLUSION

Risk factors for physical fighting among adolescents in South Asia seem to corroborate with previously-identified risk factors using samples in high-income countries, while protective factors seemed to differ. More research needs to be conducted to understand why certain factors do not have the same protective effect among South Asian adolescents.

AIM

The aim of this study was to examine demographic and contextual factors associated with physical fighting among a nationally representative sample in a rapidly developing South Asian context.