Self-rated health during adolescence: stability and predictors of change (Young-HUNT study, Norway)

The experience of adolescence process among French teenager pregnancies: a mixed-methods study

PURPOSE

Teenage pregnancy remains a significant global public health concern worldwide. However, it presents a complex phenomenon in developed countries, carrying potential short- and long-term consequences for both mothers and children.

METHODS

This mixed method study used data from the French cross-sectional study "Portraits of adolescents", which included 6000 girls aged between 13 and 17 years. The quantitative approach involved comparisons between a subgroup with an history of pregnancy and their peers, examining their lived-experience and mental health. The qualitative approach investigated the question "What does being a teenager mean for you?" specifically for the girls who reported an history of pregnancy.

RESULTS

Teenage pregnancies presented elevated rates of mental health disorders, including dark thoughts, depression, self-harm, participating in dangerous games, attempting suicide and increased use of psychoactive substances. With limited support, in comparison to their peers. The qualitative approach revealed three major themes: "being in action", "a way of feeling", and "quality of relationship".

CONCLUSION

This vulnerable subgroup of adolescents suggests the need for a coordinated multidisciplinary healthcare approach, given their limited parental and friend support, with a high risk of experiencing poor mental health. Additionally, these findings portray a "silent sufferer" population characterized by difficulties recognizing or managing emotions due to difficulties in expressing their emotional distress.

Childhood and Adolescent Depression Symptoms and Young Adult Mental Health and Psychosocial Outcomes

Importance

Depression is a leading cause of disability. The timing and persistence of depression may be differentially associated with long-term mental health and psychosocial outcomes.

Objective

To examine if depression symptoms during early and middle childhood and adolescence and persistent depression symptoms are associated with impaired young adult outcomes independent of early risk factors.

Design, Setting, and Participants

Data for this prospective, longitudinal cohort study were from the Québec Longitudinal Study of Child Development, a representative population-based Canadian birth cohort. The cohort consists of infants born from October 1, 1997, to July 31, 1998. This is an ongoing study; data are collected annually or every 2 years and include those ages 5 months to 21 years. The end date for the data in this study was June 30, 2019, and data analyses were performed from October 4, 2022, to January 3, 2024.

Exposures

Depression symptoms were assessed using maternal reports in early childhood (ages 1.5 to 6 years) from 1999 to 2004, teacher reports in middle childhood (ages 7 to 12 years) from 2005 to 2010, and self-reports in adolescence (ages 13 to 17 years) from 2011 to 2015.

Main Outcomes and Measures

The primary outcome was depression symptoms at age 20 years, and secondary outcomes were indicators of psychosocial functioning (binge drinking; perceived stress; not being in education, employment, or training; social support; and experiencing online harrasment) at age 21 years. All outcomes were self-reported. Adult outcomes were reported by participants at ages 20 and 21 years from 2017 to 2019. Risk factors assessed when children were aged 5 months old were considered as covariates to assess the independent associations of childhood and adolescent depression symptoms with adult outcomes.

Results

The cohort consisted of 2120 infants. The analytic sample size varied from 1118 to 1254 participants across outcomes (56.85% to 57.96% female). Concerning the primary outcome, adjusting for early risk factors and multiple testing, depression symptoms during adolescence were associated with higher levels of depression symptoms (β, 1.08 [95% CI, 0.84-1.32]; P < .001 unadjusted and Bonferroni adjusted) in young adulthood. Concerning the secondary outcomes, depression symptoms in adolescence were only associated with perceived stress (β, 3.63 [95% CI, 2.66-4.60]; P < .001 unadjusted and Bonferroni adjusted), while both middle-childhood (β, -1.58 [95% CI, -2.65 to -0.51]; P = .003 unadjusted and P < .001 Bonferroni adjusted) and adolescent (β, -1.97 [95% CI, -2.53 to -1.41]; P < .001 unadjusted and Bonferroni adjusted) depression symptoms were associated with lower levels of social support. There were no associations for binge drinking; not being in education, employment, or training; or experiencing online harrasment.

Conclusions and Relevance

In this cohort study of Canadian children and adolescents, childhood and adolescent depression symptoms were associated with impaired adult psychosocial functioning. Interventions should aim to screen and monitor children and adolescents for depression to inform policymaking regarding young adult mental health and psychosocial outcomes.

The associations of physical activity and sedentary behavior with self-rated health in Chinese children and adolescents

OBJECTIVE

The study aimed to analyze the independent and joint associations of physical activity (PA) and sedentary behavior (SB) with self-rated health (SRH) among Chinese children and adolescents.

METHODS

Cross-sectional data on moderate-to-vigorous physical activity (MVPA), school-based PA, extracurricular physical activity (EPA), screen time (ST), homework time, and SRH were assessed through a self-report questionnaire in the sample of 4227 Chinese children and adolescents aged 13.04 ± 2.62 years. Binary logistic regression was used to compare gender differences in PA, SB, and SRH among children and adolescents, and analyses were adjusted for age and ethnicity.

RESULTS

In independent associations, boys and girls engaging in ≥60 min/day of MVPA and >1 hour/day of EPA reported optimal SRH. Only boys who participated in >1 hour/day of school-based PA were significantly more likely to have optimal SRH (OR = 1.49, 95%CI = 1.19-1.86). Only girls who had ≤2 hours/day of ST were significantly associated with optimal SRH (weekdays: OR = 1.38, 95%CI = 1.10-1.74; weekends: OR = 1.40, 95%CI = 1.14-1.71; whole week: OR = 1.42, 95%CI = 1.16-1.73). In joint associations, regardless of SB recommendation, meeting PA recommendation was significantly associated with optimal SRH in both boys (meet PA and SB recommendations, OR = 1.61, 95%CI = 1.03-2.50; meet PA but not SB recommendations, OR = 2.40, 95%CI = 1.57-3.65) and girls (meet PA and SB recommendations, OR = 3.72, 95%CI = 2.08-6.65; meet PA but not SB recommendation, OR = 4.27, 95%CI = 2.09-8.75).

CONCLUSION

Increased PA and reduced SB were positively associated with optimal SRH in Chinese children and adolescents. Notably, lower ST positively influenced only girls' SRH. Meeting PA recommendation is more impactful than meeting SB recommendation for improving SRH in Chinese children and adolescents. Future studies could explore these associations using objective measures of PA and SB in China.

Poorer self-reported mental health and general health among first year upper secondary school students do not predict school dropout: a five-year prospective study

Introduction

Education is important for socioeconomic, work and health status; thus, dropping out of secondary school is of major concern. In Norway, 1 out of 5 is dropping out from upper secondary education. Academic performance is a known predictor for dropout, but the role of mental and general health status is studied less.

Methods

By use of student data collected during the first school year we examined the accumulated risk of school dropout over 5 years. Students entering upper secondary school in a North-Norwegian region (Troms County) completed a comprehensive questionnaire during August 2010 (N = 1,676, 69% response rate). The contribution of mental and general health problems in predicting five-year dropout was of primary interest, adjusted for demographics and academic performance.

Results

One-third of the students had dropped out after 5 years. A logistic regression analysis showed no significant effect of mental and general health problems on dropout. Among the covariates, higher grades from lower secondary education reduced the chance of dropping out (OR = 0.31; p < 0.001). Subgroup analyses showed that students in the vocational track reported poorer mental and general health, compared to students in the general track, but this difference was not related to dropout. General track students were also less likely to drop out than vocational track students (OR for dropout 0.66; p < 0.05).

Discussion

In conclusion, lower grades from lower secondary education represented a warning flag for school dropout during upper secondary education whereas mental health issues were not.

Physical activity and sedentary time after lifestyle interventions at the Norwegian Healthy Life Centres

AIMS

This study evaluates long-term changes in physical activity and its associations with various predictors after a behavior change program at the Norwegian Healthy Life Centers.

BACKGROUND

Physical activity is recommended and is part of public health strategies to prevent noncommunicable diseases.

METHODS

This longitudinal cohort, based on a controlled randomized trial, studies a population of 116 Healthy Life Center participants in South-Western Norway who wore SenseWear Armbands to measure time spent in moderate to vigorous physical activity and sedentary time based on metabolic equivalents. The measurements were obtained at baseline, immediately post-intervention, and 24 months after baseline. Linear mixed model analyses were performed to assess predictors for change in physical activity and sedentary time.

FINDINGS

High physical activity levels at baseline were maintained during the 24-month study period. Young, male participants with good self-rated health, utilizing local PA facilities were most active, and young participants utilizing local facilities were also less sedentary. The participants with higher levels of education were less active initially but caught up with the difference during follow-up. A high degree of controlled regulation, characterized by bad conscience and external pressure, predicted more sedentary behavior and a trend toward being less physically active. Autonomous motivation was associated with less time spent on sedentary behaviors. People with high self-efficacy for physical activity were more sedentary initially but showed a reduction in their sedentary behavior.The study supports the importance of attending local training facilities and adopting motivation for behavioral change that is not based on guilt and external rewards. Interventions aimed at improving physical activity among people at risk for noncommunicable diseases benefit from habitual use of local training facilities, strengthening their self-perceived health and the development of internalized motivation. However, it has not been shown to mitigate social health disparities.

Primary school children's health and its association with physical fitness development and health-related factors

The health status (HS) of children is influenced by a variety of factors, including physical fitness (PF) or social and environmental characteristics. We present a 4-year longitudinal study carried out with 263 primary school children. PF was assessed yearly using the German Motor Performance Test 6-18. Demographic data, leisure time behavior and socioeconomic factors were collected using questionnaires for children and parents. Based on parents' ratings in year 4, children were categorized as either "very good health status" (VGHS) or "good health status or below" (GHSB). Children with VGHS (73%) showed a larger improvement of global PF (p < 0.001), a significantly higher proportion of being/playing outside (p < 0.001), significantly lower proportions of overweight (p < 0.001), of media availability in the bedroom (p = 0.011) and of daily media consumption > 2 h (p = 0.033) compared to children with GHSB. Regarding socio-economic factors, children with VGHS revealed significantly fewer parents with lower education (p = 0.002), lower physical activity levels (p = 0.030) and lower migration background (p < 0.001). Physical fitness (p = 0.019) and outdoors exercising (p = 0.050) were the only variables to provide significantly higher chances of perceiving one's own health as very good when tested within a complex model including all the variables studied in this work. Considering the little focus on PF in the current Austrian physical education curriculum and the favorable environmental features of the Tyrolean region, more emphasis should be given to promoting didactical and pedagogical approaches that allow schoolers to be active in the nature.

Help overcoming pain early, a brief person-centred intervention for adolescents with chronic pain in a school setting, may improve symptoms of insomnia

Introduction and aims

Chronic pain and symptoms of insomnia affect large numbers of adolescents and early interventions are prioritized. The aim of the current study was to evaluate potential secondary effects of the intervention, Help Overcoming Pain Early (HOPE), on symptoms of insomnia and self-rated health.

Methods

The study included non-randomized aggregated data from the active and control conditions in a previously conducted randomized controlled trial evaluating the efficacy of HOPE, after the participants in the control condition also had received the intervention. Symptoms of insomnia were assessed with the Minimal Insomnia Symptom Scale and self-rated health was assessed with one item, at the start of the intervention, post intervention, and at a six-month follow-up. Baseline variables included age, gender, pain localization, pain impact, school absence and symptoms of depression (assessed with the Center for Epidemiological Studies Depression Scale for Children). Inferential analyzes were performed using Linear Mixed Models (LMM). Effect sizes were evaluated by calculating Cohen's d.

Results

There were statistically significant improvements in symptoms of insomnia at the six-month follow-up, and statistically significant improvements in self-rated health at the end of the intervention and at the six-month follow-up. Effect sizes were small across outcomes and assessments.

Discussion and conclusion

Results illustrated significant but small improvements in symptoms of insomnia and self-rated health in adolescents with chronic pain following the HOPE intervention. Although caution is needed when assessing the findings, results illustrate the potential utility of an accessible brief early intervention in a school context.

Health and Lifestyle Issues among Youth: A Record Analysis of Contributing Factors among Beneficiaries Attending Youth Mental Health Promotion Clinics (Yuva Spandana Kendras) in Karnataka, India

Background

Youth are consideren to be most vulnerable to health and lifestyle issues (HLS) in India. The current study aims to investigate the factors that contribute to health and lifestyle issues among youth attending mental health promotion clinics (YMHP) in Karnataka.

Method

Three-year first-visit data from beneficiaries (aged 15-35 years) attending YMHP clinics in Karnataka between 2017 and 2020 were analyzed. Multivariable logistic regression analysis included beneficiaries reporting any HLS issue as the outcome and a host of 57 hypothesized variables as exposures.

Results

Overall, 2,615 (25%) beneficiaries reported HLS issues. Years of schooling (AOR 5-7 years = 0.89; 95% confidence interval [CI] =0.60-1.31), (AOR 8-10 years = 0.65; 95% CI = 0.46-0.91), (AOR >10 years = 0.67; 95% CI = 0.49-0.93)], unemployed youth (AOR = 0.52; 95% CI = 0.45-0.61) business and salaried workers (AOR = 1.69; 95% CI = 1.33-2.13), and other occupations (AOR = 2.11; 95% CI = 1.73-2.56), junk food consumption (AOR = 0.76;95% CI = 0.68-0.84), having issues related to relationships with parents (AOR = 3.01; 95% CI = 2.47-3.68) and intergenerational issues (AOR = 1.71; 95% CI = 1.19-2.45), self-development issues (AOR low-self-awareness = 1.57; 95% CI = 1.33-1.85), (AOR low-self-esteem = 1.29; 95% CI = 1.062-1.57), (AOR emotional issues = 1.57; 95% CI = 1.31-1.89), education and academics (AOR = 1.23; 95% CI = 1.09-1.39), safety issues (AOR = 4.11; 95% CI = 3.07-5.50), gender sex and sexuality issues (AOR = 2.44; 95% CI = 1.43-4.15), suicidal ideation (AOR = 1.91; 95% CI = 1.44-2.54), substance use (AOR tobacco chewing = 1.45; 95% CI = 1.09-1.93), (AOR tobacco-smoking = 1.66; 95% CI = 1.18-2.32), (AOR smoking = 4.94; 95% CI = 3.52-6.93) and experiencing emotions (AOR feel anxious = 1.63; 95% CI = 1.41-1.88), (AOR forgetfulness = 1.50; 95% CI = 1.41-1.98), (AOR difficulty in concentration = 1.37; 95% CI = 1.035-1.81), (AOR anger = 1.61; 95% CI = 1.25-2.07), (AOR feel worthless = 2.21; 95% CI = 1.71-2.86) were associated with HLS issues among beneficiaries.

Conclusion

This analysis addresses an important but neglected component of HLS issues among youth highlighting the importance of early intervention among youth to prevent the development of diseases later in life. The study has important implications for youth health promotion in India and countries such as India.

Health and Lifestyle Issues Among Youth

A record analysis of contributing factors among beneficiaries attending Youth Mental Health promotion clinics (Yuva Spandana Kendras) in Karnataka, India.

To Make and Keep Friends: The Role of Health Status in Adolescent Network Tie Formation and Persistence

Health status may shape network structure through network dynamics (tie formation and persistence) and direction (sent and received ties), net of typical network processes. We apply Separable Temporal Exponential Random Graph Models (STERGMs) to National Longitudinal Study of Adolescent to Adult Health survey data (n = 1,779) to differentiate how health status shapes network sent and received tie formation and persistence. Results indicate that networks are shaped by withdrawal of adolescents experiencing poor health, highlighting the importance of separating distinct and directed processes of friendship formation and persistence when considering how health relates to adolescent social life.

Trends in health and health inequality during the Japanese economic stagnation: Implications for a healthy planet

Introduction

Human health and wellbeing may depend on economic growth, the implication being that policymakers need to choose between population health and the health of ecosystems. Over two decades of low economic growth, Japan's life expectancy grew. Here we assess the temporal changes of subjective health and health inequality during the long-term low economic growth period.

Methods

Eight triennial cross-sectional nationally representative surveys in Japan over the period of economic stagnation from 1992 to 2013 were used (n = 625,262). Health is defined positively as wellbeing, and negatively as poor health, based on self-rated health. We used Slope and Relative Indices of Inequality to model inequalities in self-rated health based on household income. Temporal changes in health and health inequalities over time were examined separately for children/adolescents, working-age adults, young-old and old-old.

Results

At the end of the period of economic stagnation (2013), compared to the beginning (1992), the overall prevalence of wellbeing declined slightly in all age groups. However, poor health was stable or declined in the young-old and old-old, respectively, and increased only in working-age adults (Prevalence ratio: 1.14, 95% CI 1.08, 1.20, <0.001). Over time, inequality in wellbeing and poor self-rated health were observed in adults but less consistently for children, but the inequalities did not widen in any age group between the start and end of the stagnation period.

Conclusions

Although this study was a case study of one country, Japan, and inference to other countries cannot be made with certainty, the findings provide evidence that low economic growth over two decades did not inevitably translate to unfavourable population health. Japanese health inequalities according to income were stable during the study period. Therefore, this study highlighted the possibility that for high-income countries, low economic growth may be compatible with good population health.

The longitudinal development of students' well-being in adolescence: The role of perceived teacher autonomy support

Although a decline in adolescents' well-being has repeatedly been reported, longitudinal evidence for this development is rare and time-varying factors like teacher autonomy support that could be associated with this trend have sparsely been investigated. Therefore, the present study examined how the temporal development of perceived autonomy support from their German language arts teachers is related to changes in four different facets of students' well-being. Longitudinal data from 3446 adolescents from Germany (N_Schools  = 178) on five measurement points (Grades 5-9) were analyzed using latent growth curve models. Satisfaction with school, enjoyment of school, and self-rated health decreased over time, while social integration remained stable. Perceived teacher autonomy support also declined between Grades 5 and 9. Furthermore, baseline levels of perceived teacher autonomy support and facets of well-being were positively related. Finally and most importantly, our results indicated that changes in perceived teacher autonomy support were positively associated with the development of satisfaction with school, enjoyment of school, and self-rated health, but not social integration. The findings suggest that perceived teacher autonomy support plays an important role in the development of students' well-being in adolescence.

Associations Between Children's Depressive Symptoms, Life Events, and Family Factors Among School-Aged Children

BACKGROUND

About 20-30% of children worldwide report depressive symptoms. This study examined associations between children's depressive symptoms, life events, and family factors.

METHODS

Nationally representative data (n = 95,725) were drawn from the 2017 School Health Promotion Study in Finland. The respondents were 4th and 5th grade pupils (aged 10-12) in primary schools and their parents/guardians (n = 33,726). Data were analyzed for child-parent dyads (n = 32,181). Associations were studied using cross tabulation and logistic regression models.

RESULTS

Children's reports of poor self-rated health, problems with family interactions, and the accumulation of life events were statistically significantly associated with depressive symptoms, also when controlling for sociodemographic factors. Financial situation and parent's depressed mood, both reported by parents, were associated with children's depressive symptoms when both were included in the regression model. However, this association disappeared when other predictors were added to the model.

CONCLUSION

The results make apparent the complex associations between children's depressive symptoms and family factors. Further research is needed on the discrepancies between parent and child experiences.

Reliability and validity of the positive mental health literacy scale in Chinese adolescents

Background and aim

Mental health literacy (MHL) is not only the necessary knowledge and ability to promote mental health, but also an important determinant of mental health. Traditionally, the MHL Scale focuses on measuring knowledge and beliefs about mental disorders. In China, there are very few scales for assessing positive MHL. The present study aimed to evaluate the reliability and validity of a Chinese version of the Positive MHL Scale (MHPK-10) in Chinese adolescents.

Methods

Chinese adolescents (n = 1,247) completed the MHPK-10 online. The validation included the translation and cultural adaptation of the MHPK-10 original version into Chinese and assessment of its psychometric properties: reliability-test-retest and internal consistency, construct validity and criterion validity.

Results

Participant's mean score on the revised positive MHL scale was 3.75 (SD = 0.69) which was a unidimensional scale. The correlation coefficients between each item and the total score were between 0.639 and 0.753. Scale item loadings ranged between 0.635 and 0.760 based on confirmatory factor analysis. Cronbach's α coefficient of the scale was 0.869, and the test-retest intraclass correlation coefficient was 0.721 (p < 0.01). Criterion validity was assessed by comparing results of the revised MHPK-10 against those of other validated scales and resulting correlations ranged between 0.342 and 0.615.

Conclusion

The revised Chinese version of the MHPK-10 has sound reliability and validity and can be used to measure Chinese adolescents' positive MHL.

The inter-relatedness and demographic predictors of physical activity, self-rated health, and mental well-being: A three-wave study in secondary school children

INTRODUCTION

The World Health Organisation recommends that children and adolescents engage in at least 60 min of moderate-to-vigorous physical activity per day. Previous research has shown that physical activity is related to other constructs such as mental well-being and self-rated health. This study examined the inter-relatedness of these constructs in Northern Irish school children.

METHODS

This study was a secondary analysis of data gathered as part of a longitudinal study. Participants were n = 1791 adolescents in their final years of secondary (high) school (age range 15-18; female = 64.6%). Data were gathered on three occasions over a 2-year period on self-rated health, physical activity, mental well-being, heavy episodic drinking, lifetime smoking, psychological and somatic symptoms, as well as a range of socio-demographic measures.

RESULTS

Descriptive results showed extremely low levels of self-reported physical activity within the past week, with <6% of the sample attaining the WHO guidelines at each wave of data collection. There were significant gender differences on all variables assessed. Results further showed a small-sized relationship (statistically significant for girls only) between physical activity and mental well-being. There was also a small-sized relationship between physical activity and self-rated health. Notably, effect sizes for the relationship between self-rated health and both physical activity and mental well-being were higher. In terms of socio-demographic predictors of lower physical activity, being female, lifetime cigarette smoking, and higher somatic and psychological symptoms were all statistically significant factors.

CONCLUSION

Self-rated health emerged as the most important predictor of physical activity among adolescents.

Factors associated with self-rated health in primary care in the South-Western health zone of Malawi

Background

Self-rated health (SRH) is a single-item measure of current health, which is often used in community surveys and has been associated with various objective health outcomes. The prevalence and factors associated with SRH in Sub-Saharan Africa remain largely unknown. This study sought to investigate: (1) the prevalence of poor SRH, (2) possible associations between SRH, and socio-demographic and clinical parameters, and (3) associations between SRH and the patients’ assessment of the quality of primary care.

Methods

A cross-sectional study was conducted in 12 primary care facilities in Blantyre, Neno, and Thyolo districts of Malawi among 962 participants who sought care in these facilities. An interviewer-administered questionnaire containing the Malawian primary care assessment tool, and questions on socio-demographic characteristics and self-rated health was used for data collection. Descriptive statistics were used to determine the distribution of variables of interest and binary logistic regression was used to determine factors associated with poor SRH.

Results

Poor SRH was associated with female sex, increasing age, decreasing education, frequent health care attendance, and with reported disability. Patients content with the service provided and who reported higher scores of relational continuity from their health care providers reported better SRH as compared with others.

Conclusion

This study reports findings from a context where SRH is scarcely examined. The prevalence of poor SRH in Malawi is in line with findings from clinical populations in other countries. The associations between poor SRH and socio-demographic factors are also known from other populations. SRH might be improved by emphasizing continuity of care in primary care services.

Self-perceived weight and self-rated health have distinct relationships according to body mass index in Korean teenagers

It was hypothesized that adolescents who perceived themselves as underweight or overweight would be positively associated with poor self-rated health (SRH), regardless of their actual weight status, and that the SRH would be varied depending on the combination of their actual weight and their perceived weight. The study aimed to evaluate associations of self-perceived weight and body mass index (BMI)-based weight status with SRH in Korean adolescents. A cross-sectional study was conducted in 1658 female and 1888 male adolescents aged 10 to 18 years based on the Korea National Health and Nutrition Examination Survey using complex-samples logistic regression. Weight estimation was determined by comparing BMI-based weight and self-perceived body shape. Age, family affluence, and health status were confounders. In sex-specific analysis, the odds for poor SRH were higher in males who accurately estimated underweight or overweight and those who were normal weight, but overestimated weight compared with those who accurately self-perceived as being normal weight. In females, the odds for poor SRH were higher in those with normal weight but underestimated or overestimated weight compared with a female comparison group. In the overall analysis, males who accurately perceived their weight as underweight, males and females who perceived their weight as overweight despite being normal weight or overweight, and females who perceived weight as underweight despite being normal weight had higher odds for poor SRH compared with a female comparison group. In conclusion, as the hypothesis of this study, self-perceived overweight and underweight in adolescents were associated with poor SRH regardless of BMI, and the association differed by BMI in Korean adolescents.

Vigorous physical activity and self-rated health during adolescence: A cross-sectional survey

Background

Despite the positive relationship between self-rated health and general physical activity, very little research has touched upon the relationship between self-rated health and vigorous physical activity. Such research will help to promote self-rated health among adolescents by addressing the close relationship between self-rated health and the components of physical activity.

Purpose

In this study, the relationship between self-rated health and vigorous physical activity among Chinese adolescents were analyzed.

Methods

The current study was based on a collaborative survey conducted by the WHO in several nations, and the data generated by Health Behavior in School-aged Children every 4 years on health behavior were adopted. The school class was taken as a basic unit for sampling. Cluster sampling was performed systematically, and the possibility was proportional to the population. The sampling was conducted to collect typical cases. The class teachers were informed of the sampling activities, and they were to collect data on the students by distributing the questionnaires.

Results

The research included 116,828 respondents from 36 countries. Among them, 51.82% were girls and 48.18% were boys. A total of 98.54% of the respondents considered their health status as fair or above when completing the questionnaire, while 1.46% believed that their health status was poor. Moreover, more than 86% of the respondents participated in vigorous exercise more than weekly, and better self-health ratings were found among respondents who exercised more than weekly (once a week: OR = 1.95, CI: 1.86-2.04; two or three times a week: OR = 1.69, CIL: 1.63-1.76; four or six times a week: OR = 1.30, CI: 1.25-1.35). Certain respondents reported better results for self-rated health (4-6 h every week: OR = 1.36, CI: 1.30-1.43; 2 or 3 h every week: OR = 1.48, CI: 1.42-1.55; 1 h every week: OR = 1.64, CI: 1.57-1.72).

Conclusion

In this study, empirical evidence is provided for the relationship between self-rated health and vigorous physical activity among adolescents. From the results, it can be observed that there is a positive relationship between self-rated health and vigorous physical activity among adolescents.

Independent and joint effects of sleep duration and sleep quality on suboptimal self-rated health in medical students: A cross-sectional study

Objective

Studies on the association between sleep behavior and health often ignored the confounding effects of biorhythm-related factors. This study aims to explore the independent and joint effects of sleep duration and sleep quality on suboptimal self-rated health (SRH) in medical students.

Methods

Cross-sectional study. Proportional stratified cluster sampling was used to randomly recruit students from various medical specialties at a medical university in eastern China. Our questionnaire mainly included information on basic demographic characteristics, SRH, sleep behavior, and biorhythm-related factors. The independent and joint effects of sleep duration and sleep quality on suboptimal SRH were assessed by logistic regression after controlling for potential confounders.

Results

Of 1,524 medical students (mean age = 19.9 years, SD = 1.2 years; 59.1% female), 652 (42.8%) had suboptimal SRH. Most medical students (51.5%) slept for 7 h/night, followed by ≥8 (29.1%) and ≤ 6 h (19.4%). After adjusting for basic demographic characteristics and biorhythm-related factors, compared with students who slept for ≥8 h/night, the adjusted ORs (95%CI) for those who slept 7 and ≤ 6 h/night were 1.36 (1.03, 1.81) and 2.28 (1.60, 3.26), respectively (P < 0.001 for trend); compared with those who had good sleep quality, the adjusted ORs (95%CI) for those who had fair and poor sleep quality were 4.12 (3.11, 5.45) and 11.60 (6.57, 20.46), respectively (P < 0.001 for trend). Further, compared with those who slept for ≥8 h/night and good sleep quality, those who slept ≤ 6 h and poor sleep quality had the highest odds of suboptimal SRH (OR 24.25, 95%CI 8.73, 67.34).

Conclusions

Short sleep and poor sleep quality were independently and jointly associated with higher odds of suboptimal SRH among medical students.

Socioeconomic inequality in violent behaviors, life dissatisfaction, and self-rated health in pediatric population: the CASPIAN-V study

BACKGROUND

Bullying, being a victim of violent behaviors, life satisfaction (LS) and self-rated health (SRH) in children and adolescents, all have consistently been recognized as vital factors in school performance and future individual life.

METHODS

This cross-sectional data secondary study was a part of the fifth Childhood and Adolescence Surveillance and Prevention of Adult Non-communicable disease (CASPIAN-V) in 2015. A total of 14,400 students 7-18 years and their parents living in 30 provinces in Iran were studied. A validated questionnaire of the World Health Organization on Global School-based Health Survey (WHO-GSHS) was used to measure the outcomes and socioeconomic variables. Family's socioeconomic status (SES) was determined using principal component analysis (PCA). The crude and adjusted odds ratios (95% confidence interval (CI)) were estimated using multiple logistic regressions for each outcome.

RESULTS

A total of 14,274 students completed the study, of whom 50.6% were boys. Overall, the prevalence of bullying, being a victim, life dissatisfaction (LDS), and poor SRH among students was 35.6, 21.4, 21.1, and 19.0%, respectively. In multiple-logistic regression analysis (Adjusted OR, (95%CI), students with an illiterate father and mother (1.60, (1.25-2.04), 1.28, (1.03-1.61), unemployed father (1.58, (1.29-1.81)), and one-parent family (1.32, (1.05 - 1.64) had a higher odd of Poor-SRH. Besides, a family size larger than four members (1.14, (1.03-1.25), and low-SES (1.35, (1.15-1.56), and illiteracy of the mother (1.64, (1.30-2.08) had a direct association with LDS. Mother illiteracy also increased the odds of bullying (1.77, (1.45-2.16) and being a victim (1.58, (1.26-1.98).

CONCLUSIONS

Some socioeconomic variables can be proposed as the statistically significant attribution of bullying and being a victim, LDS, and Poor-SRH in children and adolescents.

Association between simultaneity of health-risk behaviours and self-rated health in Brazilian adolescents

Introduction

This study examined the association between simultaneity of four health-risk behaviours, namely, low levels of moderate-to-vigorous physical activity (insufficient MVPA: <420 min/week), tobacco use, alcohol consumption, and excessive television (TV)–(>2 h/d of TV viewing) and self-rated health (SRH) in Brazilian adolescents.

Methods

We used data of 100,551 adolescents from the National School Health Survey, a national cross-sectional study carried out in 2015. Association between simultaneity of health risk behaviours (i.e. the ratio between observed and expected prevalence rates) and SRH was examined using logistic regression models.

Results

The majority of the participants were female (51.9%) and 14 years of age (50.6%), and 26% of the participants’ SRH ranged from ’average’ to ’extremely poor’. Those who engaged in the following combinations of health-risk behaviours had higher odds of worse SRH than their healthier counterparts: insufficient MVPA and tobacco use (odds ratio—OR: 2.0, 95% confidence interval [CI]: 1.4 to 3.0); insufficient MVPA and alcohol consumption (OR: 1.6, 95%CI: 1.3 to 1.9); insufficient MVPA and >2 h/day of TV viewing (OR: 1.3, 95%CI: 1.1 to 1.6); insufficient MVPA, tobacco use and alcohol consumption (OR: 2.1, 95%CI: 1.7, to 2.7); and insufficient MVPA, alcohol consumption and >2 h/day of TV viewing (OR: 1.6, 95%CI: 1.4 to 2.0).

Conclusions

Insufficient MVPA, alcohol consumption, and other health-risk behaviours were associated with worse SRH in Brazilian adolescents.

Pathways to healthy aging - Exploring the determinants of self-rated health in older adults

OBJECTIVE

The decade 2021-2030 has been declared the Decade of Healthy Aging by the United Nations General Assembly, underlining that health is central to the experience of older age and the opportunities that aging brings. Self-rated health (SRH) appears consistent with the state of objective health, and therefore can serve as a simple core indicator of healthy aging. SRH can be affected by psychological and lifestyle factors, and by the developmental and sociodemographic context, which can directly and indirectly influence subjective health status. The aim of the present study was to establish the structure of the relationships between SRH, health-related behavior, subjective wellbeing, developmental tasks attainment and sociodemographic factors in the late-life period.

METHODS

The study group consisted of 340 Polish retired seniors, aged 61 to 94 (M = 70.75, SD = 6.48): 88 men (25.9 %) and 252 women (74.1 %). The respondents completed the following measures: 10-point numerical scale for SRH, Health-Related Questionnaire for Seniors, Satisfaction with Life Scale, Developmental Tasks Questionnaire for Seniors and a sociodemographic survey.

RESULTS

The group demonstrated a medium level of SRH and other variables. SHR was positively correlated with health-related behavior, wellbeing, developmental tasks attainment and perceived economic status, and negatively with age. Structural equation model revealed that health-related behavior, wellbeing, age and economic status have a direct influence on SRH. Developmental tasks attainment was found to predict health behavior, although no direct relationship with SRH was found.

CONCLUSIONS

A broader understanding of healthy aging is achieved by considering the context of its factors. Psychological interventions should promote a healthy lifestyle and adapt it to the late life period to promote health among seniors.

Factors related to self-rated health: a survey among patients and their general practitioners

OBJECTIVE

To explore associations between general practice patients' SRH and symptoms, diagnoses, chronic conditions, unexplained conditions, and life stressors.

DESIGN

A cross-sectional study. Data were collected from GP and patient questionnaires.

SETTING

General practices in Southeast Norway.

SUBJECTS

47 general practitioners (GPs) who included 866 consecutive patients.

MAIN OUTCOME MEASURES

SRH was measured with a single question from the COOP-WONCA overall health chart and dichotomized into good/poor SRH. Binary logistic regression models were used in the analyses.

RESULTS

Poor SRH was reported by 48% of the patients in the past week. A higher prevalence of poor SRH was found for women, middle-aged, recipients of social security grants, patients diagnosed with asthenia, lower back pain, and depression/anxiety, and for patients with reported life stressors and unexplained conditions. We found an almost linear association between the number of symptoms and the likelihood of reporting poor SRH. The probability of reporting poor SRH increased along with an increasing number of symptoms for common diagnoses. In a multivariate analysis, the only number of symptoms, being in receipt of social security grants and being retired was associated with poor SRH.

CONCLUSION

The likelihood of reporting poor SRH increased with an increasing number of symptoms, partly independent of the diagnosis given by GPs. This result coincides with our previous findings of a strong association between the number of symptoms, function, and health. The symptom burden thus appears to be an important factor for SRH among patients in general practice.KEY POINTSThere is a high prevalence of poor SRH in general practice patients.The likelihood of reporting poor SRH is partly independent of the diagnosis given.The number of symptoms was the factor strongest associated with poor SRH.

Factors associated with self-rated health in primary care in the South-Western health zone of Malawi

BACKGROUND

Self-rated health (SRH) is a single-item measure of current health, which is often used in community surveys and has been associated with various objective health outcomes. The prevalence and factors associated with SRH in Sub-Saharan Africa remain largely unknown. This study sought to investigate: (1) the prevalence of poor SRH, (2) possible associations between SRH, and socio-demographic and clinical parameters, and (3) associations between SRH and the patients' assessment of the quality of primary care.

METHODS

A cross-sectional study was conducted in 12 primary care facilities in Blantyre, Neno, and Thyolo districts of Malawi among 962 participants who sought care in these facilities. An interviewer-administered questionnaire containing the Malawian primary care assessment tool, and questions on socio-demographic characteristics and self-rated health was used for data collection. Descriptive statistics were used to determine the distribution of variables of interest and binary logistic regression was used to determine factors associated with poor SRH.

RESULTS

Poor SRH was associated with female sex, increasing age, decreasing education, frequent health care attendance, and with reported disability. Patients content with the service provided and who reported higher scores of relational continuity from their health care providers reported better SRH as compared with others.

CONCLUSION

This study reports findings from a context where SRH is scarcely examined. The prevalence of poor SRH in Malawi is in line with findings from clinical populations in other countries. The associations between poor SRH and socio-demographic factors are also known from other populations. SRH might be improved by emphasizing continuity of care in primary care services.

Health Status and Association With Interpersonal Relationships Among Chinese Children From Urban Migrant to Rural Left-Behind

Background

To date, numerous studies have examined the health status of Chinese left-behind children and migrant children. However, the impact of children's diverse migration/left-behind experiences on their health is still unclear.

Methods

A cross-sectional survey was conducted in 2020 in Nanling country (Anhui province) and Kaihua country (Zhejiang province) in China. School children from grade 5 to 8 reported their socio-demographic, interpersonal relationships, self-rated health, suicidal ideation, and depression. Participants were divided into four groups based on their migrant patterns, namely rural left-behind children with previous migration experience (ME-LBC), rural children with previous migration experience (ME-NLBC), rural left-behind children without migration experience (LBC), and rural children without migration experience (NLBC).

Results

Among 2,323 participants included in the present study, there were 336 ME-LBC (14.5%), 283 ME-NLBC (12.2%), 561 LBC (24.1%) and 1,143 NLBC (49.2%). Compared with NLBC, ME-LBC reported significantly poorer self-rated health (OR = 0.72, 95% CI [0.53-0.97], p < 0.05), higher risk of depression (β = 0.90, 95% CI [0.02-1.77], p < 0.05) with adjustment of socio-demographic and interpersonal relationships. There was no significant difference in suicidal ideation among different groups of children. The better interpersonal relationship was associated with a better self-rated health, and lower prevalence of depression and suicidal intention.

Conclusions

Compared to ordinary rural children, ME-LBC tended to experience higher levels of depression and poorer self-rated health. These research findings imply developing intervention programs about psychological adjustment tailored to different migrant patterns of Chinese rural children. The keys might be to strengthen the relationships with peer and teacher in school and improve the quality of parent-child communication in family for LBC.

Trends in gender and socioeconomic inequalities in adolescent health over 16 years (2002-2018): findings from the Canadian Health Behaviour in School-aged Children study

INTRODUCTION

Monitoring health inequalities in adolescents informs policy approaches to reducing these inequalities early in the life course. The purpose of this study was to investigate trends in gender and socioeconomic inequalities in six health domains.

METHODS

Data were from five quadrennial survey cycles of the Health Behaviour in School-aged Children (HBSC) study in Canada (pooled n = 94 887 participants). Differences in health between socioeconomic groups (based on material deprivation) and between genders were assessed using slope and relative indices of inequality in six health domains: daily physical activity, excess body weight, frequent physical symptoms, frequent psychological symptoms, low life satisfaction, and fair or poor self-rated health.

RESULTS

Over a 16-year period, adolescents in Canada reported progressively worse health in four health domains, with those at the lowest socioeconomic position showing the steepest declines. Socioeconomic differences increased in excess body weight, physical symptoms, low life satisfaction, and fair or poor health. Gender differences also increased. Females showed poorer health than males in all domains except excess body weight, and gender differences increased over time in physical symptoms, psychological symptoms and low life satisfaction.

CONCLUSION

Socioeconomic and gender inequalities in health are persistent and widening among adolescents in Canada. Policies that address material and social factors that contribute to health disparities in adolescence are warranted.

Family-Rated Pediatric Health Status Is Associated With Unplanned Health Services Use

OBJECTIVE

Self-rated health is a common self-reported health measure associated with morbidity, mortality, and health care use. The objective was to investigate the association of family-rated health status (FRH) in pediatric care with administrative indicators, patient and respondent features, and unplanned health services use.

PATIENTS AND METHODS

Data were taken from Child-Hospital Consumer Assessment of Healthcare Providers and Systems surveys collected between 2015 and 2019 in Alberta, Canada and linked with administrative health records. Three analyses were performed: correlation to assess association between administrative indicators of health status and FRH, logistic regression to assess respondent and patient characteristics associated with FRH, and automated logistic regression to assess the association between FRH and unplanned health services use within 90 days of discharge.

RESULTS

A total of 6236 linked surveys were analyzed. FRH had small but significant associations with administrative indicators. Models of FRH had better fit with patient and respondent features. Respondent relationship to child, child age, previous hospitalizations, and number of comorbidities were significantly associated with ratings of FRH. Automated models of unplanned services use included FRH as a feature, and poor ratings of health were associated with increased odds of emergency department visits (adjusted odds ratio: 2.15, 95% confidence interval: 1.62-2.85) and readmission (adjusted odds ratio: 2.48, 95% confidence interval: 1.62-2.85).

CONCLUSION

FRH is a simple, single-item global rating of health for pediatric populations that provides accessible and useful information about pediatric health care needs. The results of this article serve as a reminder that family members are valuable sources of information that can improve care and potentially prevent unplanned health services use.

Physical fitness of children and youth with asthma in comparison to the reference population : Cross-sectional results of the population-based MoMo study in Germany

BACKGROUND

Physical fitness is an essential marker of health. The literature regarding the question of whether individuals with asthma have reduced physical fitness compared to their non-asthmatic peers is inconsistent and focuses on the cardiorespiratory endurance dimension. This study provides a comparison of different dimensions of physical fitness in individuals with and without asthma on the basis of the German population-based study "KiGGS" (German Health Interview and Examination Survey for Children and Adolescents) and its in-depth study "MoMo" (2009-2012: wave 1 and 2014-2017: wave 2).

METHODS

In total, 7731 individuals aged 6-30 years were included in this cross-sectional analysis at two measurement waves, including 353 individuals with and 7378 without asthma. The 12-month prevalence of physician-diagnosed asthma was assessed by interview. Physical fitness was measured by six test items of the MoMo test profile. "Cardiorespiratory endurance" was measured by an ergometric test, "muscular strength" by standing long jump, push-ups and sit-ups and "coordination" by jumping sideways and balancing backwards. Because of the broad age range of the sample, age- and sex-specific percentiles were used. Physical activity, age, gender and general state of health were assessed by questionnaire.

RESULTS

The individuals with asthma reported a poorer general state of health at both measurement waves. However, the results of the fitness tests indicated that they were as physically fit as their peers without asthma in relation to cardiorespiratory endurance and muscular strength. The mean percentiles were all within the same range. The results of the comparisons of coordination performance were inconsistent. At wave 1 they were within the same range, at wave 2 individuals with asthma showed a poorer coordination performance (p = 0.041; HL = 4.125, CI of HL 0.155-8.125).

CONCLUSIONS

To the best of our knowledge, this is the first study to compare the physical fitness of individuals with and without asthma by considering several dimensions of physical fitness. The study demonstrates that cardiorespiratory endurance and muscular strength are not reduced in individuals with asthma. The results of the comparisons at the two measurement waves were remarkably stable.

Pre-vaccination vulnerability and suspected adverse events following HPV vaccination. A case-control study nested in the Danish national birth cohort

Previous studies have indicated that girls experiencing suspected adverse events (AE) following HPV vaccination were more vulnerable prior to vaccination. However, no study has previously investigated differences in vulnerability using prospectively collected self-reported measures of vulnerability. The objective of this study therefore was to describe the distribution of biological and psychosocial indicators of vulnerability in girls referred to a hospital setting due to suspected adverse events and compare it with a sample of non-referred HPV vaccinated girls. The study was conducted as a case control study based within the Danish National Birth Cohort. Cases were defined as HPV vaccinated girls referred to a hospital setting between 2015 and 2017 due to suspected adverse events (n = 80), and 5 controls were randomly selected from the remaining source population, matched to cases on age at vaccination, region of residence and year of vaccination. The final study population consisted of 480 girls. Prior exposures were based on information gathered from an 11 year follow up of the DNBC and included information on self-rated health, frequent health complaints, medication use, bullying, stressful life events and physical activity. Conditional logistic regression analysis was used to estimate the association between each exposure and referral. The percentage of individuals in the exposed category of each exposure was generally higher for cases than controls. Particularly, the odds of being referred were higher for those with low self-rated health compared to high (OR [95%-CI] 2.43 [1.07-5.5]1), those being bullied (OR 3.19 [1.17-8.73]), and those who had taken medication (OR 2.22 [1.32-3.67]). Overall, these results indicated that girls experiencing suspected AE following HPV vaccination were more vulnerable prior to vaccination.

Patients want their doctors' help to increase physical activity: a cross sectional study in general practice

BACKGROUND

Inactivity is prevalent in patients presenting in general practice, and the health benefits of increased physical activity (PA) are well known. Few studies have explored whether patients want their general practitioner's (GPs) contribution in facilitating a lifestyle change.

OBJECTIVE

To identify the characteristics of patients who expect help from their doctor in increasing levels of PA.

DESIGN

We collected data via questionnaires for this cross-sectional study from general practices.

SETTING

General practices in Norway, during Spring 2019.

SUBJECTS

A total of 2104 consecutive patients (response rate 75%) participated.

MAIN OUTCOME MEASURES

The questionnaire included questions about self-rated health, level of physical activity, the desire to become more physically active, and questions about the role of the GP in increasing the level of physical activity in their patients. We analysed our data using Pearson chi-square and binary logistic regression.

RESULTS

Female patients were less active, but their motivation to increase activity and their expectations of receiving help from their doctor were similar to males. Younger patients were more motivated for increased activity, and to manage without help from their doctors. Impaired self-rated health (SRH) was associated with inactivity and, at the same time, with the motivation to become more active with help from general practitioners.

CONCLUSION

Most patients in the GPs' office are physically inactive. This study revealed an important message for GPs: in clinical work, emphasise physical activity for health gains, especially for patients with impaired SRH.Key PointsFour out of five patients attending Norwegian general practice are inactiveMore than 85% of these patients want to increase their physical activity levelMore than 50% would like help from their GP to achieve this goal.

Lower thriving among females with hearing impairment than males - a cross-sectional study of 185 primary and secondary students in Greenland

The prevalence of ear infections and hearing i mpairment among Greenlandic children is amajor public health problem, and studies investigating the association between hearing impairment and thriving among Greenlandic children are scarce. The aim of this study was to examine the association between hearing impairment and thriving in asample of school-children in Sisimiut, Greenland. This cross-sectional study included children from 5^th to 10^th grade from two schools in Sisimiut and two schools located in nearby settlements. Participants filled out aquestionnaire and underwent ear examination and audiometry. Binary logistic regression examined the associations of hearing impairment and thriving variables defined as self-rated health, headache and school satisfaction. 179 children participated from schools in Sisimiut, and 6 children were from schools in settlements. The prevalence of hearing impairment was 10% among school-children in Sisimiut. There was atendency among girls with hearing impairment to have higher odds ratios for low self-rated health, often headache and low school-satisfaction. This study indicates that girls with hearing impairment are more susceptible to low thriving compared to girls with normal hearing. Interventions targeting the thriving of hearing impairment among children in Greenland should take gender differences into account.

Changes over time in mental health symptoms among adolescents in Tampere, Finland

Background:

Mental health problems are common in adolescence and seeking help for them is becoming more common. Referrals to adolescent mental healthcare have recently increased in Finland.

Objective:

To examine time trends in internalizing and externalizing mental health symptoms among Finnish adolescents.

Method:

A time-trend school survey was conducted among 9^th graders (15-year-olds) in Tampere, Finland, in three time periods: 2002–03, 2012–13 and 2018–19 (N = 4,162).

Results:

Compared to the period 2002–03, prevalence of externalizing symptoms decreased in the period 2012–13 and further in 2018–19. The prevalence of internalizing symptoms did not change significantly between 2002–03 and 2012–13; however, in 2018–19, depression, social anxiety, general anxiety, poor subjective health, stress symptoms among boys, and poor self-esteem increased compared to earlier time periods. The increases were more marked among girls. However, suicidal ideation did not increase in 2018–19 compared to earlier time periods.

Conclusion:

Whereas the prevalence of externalizing symptoms decreased among Finnish adolescents between 2002–03 and 2018–19, the prevalence of internalizing symptoms increased between 2012–13 and 2018–19. To help to understand the causes of these increases and to prevent internalizing problems, further research on the underlying causes is needed.

Factors Predicting Physical Activity and Sports Participation in Adolescence

Physical activity is important for children's health and wellbeing, yet participation declines across teenage years. It is important to understand the mechanisms that could support adolescents to maintain physical activity participation. The aim of this study was firstly to examine change in sports and nonsports activities over two years during adolescence. Secondly, we explored possible predictors of physical activity and sports participation after two years. Method. A longitudinal cohort study was conducted between 2011 and 2013. Our data were collected from 1225 Norwegian adolescents who were followed over a two-year period, from 6th to 8th grade (11 to 13 years) and from 8th to 10th grade (13 to 15 years). We examined the relations between physical activity and predictors such as peer support, parent support, socioeconomic status (SES), attitude towards physical education, active transportation to school, self-rated health, body image, and change of nonsports activities. We used linear regression analyses and binary logistic regression to explore possible predictors of physical activity and sports participation after two years. Results. We found a significant reduction in sports participation during early adolescence, most pronounced, from 8th to 10th grade (from 13 to 15 years). Factors which predicted physical activity after two years were a positive attitude towards physical education, perceived support from parents, if the student travelled to school in an active way (by walk or bicycle) and also how the student rated his/her own health. The last three factors also predicted improvements of physical activity during the two years. Possible predictors of persisting or starting doing sports were increasing levels of self-rated health, increasing socioeconomic status, whereas increasing engagement in nonsports activities predicted reduced participation in sports. Conclusion. Health promotive efforts aiming at increasing active school transportation, parental support, and subjective health seem important for maintenance of physical activity and sports participation during adolescence. Attitudes may improve by adapting physical education to individual needs and interests and can function as an additional promotive factor.

Maternal depression and non-specific health complaints in the offspring: a cross-sectional study in Danish primary care

Background

Maternal depression has been linked to adverse outcomes in the offspring. Existing literature is mainly based on parental reports, which can be an unreliable source when the parent has depression.

Aim

To explore if maternal depression was associated with daily health complaints and low self-assessed health (SAH) in the offspring.

Design and setting

Participants were 45 727 children from the Danish National Birth Cohort recruited between 1996 and 2002. At 11-year follow-up, mothers and their children were invited to complete a questionnaire. Maternal depression was categorised into: no depression, first-time treatment, continued treatment, post-treatment, and relapse.

Method

Binomial regression was used to estimate the adjusted prevalence proportion ratio (aPPR) of frequent health complaints and low SAH in children of mothers with depression compared to children of mothers without depression.

Results

The prevalence of any daily health complaint was 11.4%, daily somatic complaints 4.1%, daily mental complaints 8.9%, both daily mental and somatic complaints 1.5%, and low SAH 5.3%. Children of mothers with depression (any category) were more likely to report a daily health complaint: first-time treatment aPPR 1.35 (95% confidence interval [CI] = 0.96 to 1.85), continued treatment aPPR 1.59 (95% CI = 1.37 to 1.85), post-treatment aPPR 1.30 (95% CI = 1.20 to 1.41), and relapse aPPR 1.56 (95% CI = 1.35 to 1.79). Children of mothers with depression were also more likely to report low SAH: first-time treatment aPPR 1.58 (95% CI = 0.99 to 2.54), continued treatment aPPR 1.86 (95% CI = 1.51 to 2.28), post-treatment aPPR 1.34 (95% CI = 1.19 to 1.50), and relapse aPPR 1.56 (95% CI = 1.26 to 1.93). Girls had a higher prevalence of mental and somatic health complaints and more often reported low SAH compared to boys.

Conclusion

Treatment of maternal depression was associated with higher prevalence of daily health complaints and low SAH in the offspring at age 11 years. The association was strongest for children of mothers with continued depression or relapse.

Correlates of psychological distress and self-rated health among Palestinian citizens of Israel: findings from the health and environment survey (HESPI)

OBJECTIVES

Psychological distress is a problem strongly associated with socio-economic conditions. This study aims to assess rates of psychological distress and 'poor' self-rated health among Palestinian citizens of Israel, who constitute 21% of the population and nearly 50% live in poverty, and compare their psychological distress scores with those of the general Israeli population.

DESIGN

The Health and Environment Survey among Palestinian citizens of Israel (HESPI-2015), included a representative sample of this minority; 2018 individuals aged ≥18 were interviewed. The questionnaire included socio-demographic and health-related information, the General Health Questionnaire-12, (GHQ-12) and Self-rating of health (SRH).

RESULTS

Subjects with GHQ-12 global scores of ≥17 were considered to have high distress. Low education, female gender, obesity and the presence of chronic diseases were significantly associated with high psychological distress over and above the effect of the other variables. Poor SRH was strongly associated with having a chronic disease and additional risk factors were older age group, low education and high psychological distress. Comparing psychological distress scores of Arabs in Israel with those of the general population showed that 30% of the former were classified as asymptomatic, as compared to 75% in the general population while the proportion of symptomatic or highly symptomatic was 14% in the latter as compared with 45% in the former.

CONCLUSIONS

It appears that the burden of poverty, chronic disease and low education in this population, which suffers from multiple stressors, is disproportionate and should be addressed by the authorities, together with concrete plans to improve the education of the younger generations. Clearly, the association between discriminating policies and deprivation with psychological distress is not unique to the case of the Palestinian minority in Israel and therefore this study will allow for the examination and generalization of the current findings to other discriminated and disadvantaged minorities.

Adolescent abuse victims displayed physical health complaints and trauma symptoms during post disclosure interviews

AIM

We investigated whether adolescents who had recently disclosed sexual abuse or family violence displayed more psychological trauma symptoms and physical health complaints than unaffected controls. We also investigated to what degree physical health complaints were associated with trauma symptoms in these abuse victims.

METHODS

Abuse, trauma symptoms and physical health complaints were assessed during face-to-face interviews with 40 sexual abuse victims and 35 family violence victims aged 10-18 years. They had all attended forensic interviews at the Barnehus in Oslo, a specialised Norwegian police unit where evidence is gathered in adolescent-friendly surroundings, from October 2016 to November 2018. Their symptoms were compared with 41 controls from the general population. Linear regression analyses investigated associations between trauma symptoms and physical health complaints.

RESULTS

Sexually abused adolescents displayed higher levels of post-traumatic stress reactions, depression, dissociation and physical health complaints than unaffected controls. Family violence victims displayed higher levels of post-traumatic stress reactions. Trauma symptoms were associated with physical health complaints, and these were most prominent in the adolescents with the highest burden of symptoms.

CONCLUSION

Based on the high burden of symptoms revealed, clinical examinations of abused adolescents should include a systematic assessment of trauma symptoms and physical health complaints.

Associations between physical activity, sedentary behaviour and self-rated health among the general population of children and adolescents: a systematic review and meta-analysis

Background

Self-rated health (SRH) is an indicator that captures a person’s perception of their overall health status. The relationship between physical activity (PA), sedentary behaviour (SB) and SRH has been investigated in systematic reviews among adult and elderly populations. No systematic review to date has synthesized the relationship between PA, SB and SRH among children and adolescents. The purpose of this systematic review and meta-analysis was to synthesize the associations between PA, SB and SRH in the general population of children and adolescents and to investigate the dose-response relationship between PA, SB and SRH.

Methods

We conducted a computer search for English language studies in the databases of MEDLINE, EMBASE and PSYCINFO that were published between 1946 and 2019. We searched PubMed, Google Scholar, and the references of the identified publications for additional studies. A meta-analysis was employed to synthesize the associations between PA, SB respectively and SRH. The dose-response association was tested using a random effects meta-regression model. The review was reported following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines.

Results

Sixty-eight published articles were included in the final review, including 59 cross-sectional and nine longitudinal studies. We found evidence that PA was associated with better SRH, and SB was associated with lower SRH among children and adolescents. A dose-response relationship between PA and SRH was observed, where a higher level of PA was associated with better SRH than a lower level of PA. The relationship between PA, SB and SRH was observed in both boys and girls, and did not show a significant gender difference.

Conclusions

The findings in the systematic review suggest that health intervention programmes targeting promoting PA and reducing SB among children and adolescents may enhance their overall health status. Future research is needed to expand prospective cohort and intervention studies to address directionality and causality in the relationships between PA, SB and SRH among children and youth.

Trial registration

PROSPERO - CRD42019142244. Registered on October 18, 2019.

Association of Early Menarche with Adolescent Health in the Setting of Rapidly Decreasing Age at Menarche

STUDY OBJECTIVE

This study aimed to investigate the association between age at menarche (AAM) and adverse health indicators in adolescent girls.

DESIGN

A retrospective cohort study.

SETTING

Population-based survey data.

PARTICIPANTS

A total of 319,437 female participants aged 12-18 years from the Korea Youth Risk Behaviour Web-based Survey.

INTERVENTIONS AND MAIN OUTCOME MEASURES

We assessed associations between AAM (categorized as ≤10, 11, and ≥12) and health indicators (poor self-rated health, high psychological stress, unhappiness, sexual initiation, and pregnancy). Covariates were individual-level (bodyweight, living with family, parent's education, household wealth, and presence of parents and siblings) and community-level factors (year of birth, single-sex education and level of school, urbanization level of school area, year of survey, and regional deprivation). Odds ratios (ORs) for each adverse health indicator were examined by each AAM group using multivariable regression analyses. For pregnancy, we calculated relative risks (RRs) using a log-binomial regression model.

RESULTS

Age at menarche was <12 in 42% of our study population. Nearly one-half of the girls born in the early 2000s went through menarche before the age of 12 years, whereas only one-third of girls born in the early 1990s went through menarche before the age of 12 years. Girls who experienced menarche at age ≤10 or age 11 years were more likely to show self-rated poor health (AAM ≤ 10: OR, 1.28; 95% confidence intervals [CI], 1.22-1.34; AAM = 11: OR, 1.16; 95% CI, 1.12-1.21), high stress (OR, 1.19; 95% CI, 1.14-1.23, and OR, 1.10; 95% CI, 1.06-1.14), and sexual initiation (OR, 2.21; 95% CI, 2.05-2.38, and OR, 1.32; 95% CI, 1.23-1.41) compared to those with AAM ≥12 years when data were adjusted for all covariates. AAM ≤10 years was associated with consistently higher odds for poor health than AAM ≥12 years. The ORs of sexual initiation increased with earlier AAM. Risk of pregnancy was similar across AAM groups when individual- and community-level covariates were controlled for.

CONCLUSION

Early menarche, defined as <12 years, can be still a useful indicator in adolescent health interventions to identify high-risk groups in the setting of declining AAM.

Self-rated health in adolescence as a predictor of 'multi-illness' in early adulthood: A prospective registry-based Norwegian HUNT study

Self-rated health (SRH) is a marker of future health and a possible predictor of future multimorbidity, which is a major challenge for population health and health care. There is a lack of studies on adolescent SRH and patterns of health problems across the transitional period from adolescence to early adulthood. Therefore, this study aimed to identify groups of people with similar health problems in early adulthood and explore the predictive value of adolescent SRH on the group classification after a period of 10–19 years. Data from 8828 adolescents participating in the Young HUNT-1 survey (1995–1997) were linked to the Norwegian registry of general practitioner (GP) claims, which includes diagnoses recorded in GP consultations in 2006–2014. We used latent class analysis (LCA) to identify groups of patients with similar health problems in early adulthood and explored SRH as a predictor of class membership using latent class regression, adjusting for baseline chronic disease, frequency of health care attendance, sex and age. The mean age at baseline was 16 years, and 50% of the participants were female. SRH was reported as very good by 28%, good by 61% and not good by 11%. We identified five groups of patient classification (classes): Healthy (35%), Infections and general problems (26%), Musculoskeletal problems (21%), Psychological problems (6%) and Multi-illness (13%). We found a gradual increase in the probability of belonging to the Healthy class with better SRH, and an inverse pattern for the Psychological and Multi-illness classes. This pattern remained after adjusting for baseline variables. In conclusion, there is a clear association between adolescent SRH and the risk of having multi-illness in early adulthood, seen as a proxy for later multimorbidity. This finding warrants greater attention to SRH in adolescence as a possible indicator in targeted prevention of future health problems.

•

Adolescent self-rated health (SRH) predicted health problems 10–19 years later.

•

Patients were classified into five groups with similar patterns of health problems.

•

Better SRH increased the probability of adults belonging to the healthiest group.

•

Not good SRH tripled the risk for multi-illness compared to very good SRH.

•

Low SRH in adolescence is a possible predictor of multimorbidity in adulthood.

Sense of Coherence in Association with Stress Experience and Health in Adolescents

This study investigated the associations between sex, age, socio-economic status, stress, sense of coherence (SOC), and health (mental wellbeing, depressive symptoms, self-rated health, and subjective health complaints) in Norwegian adolescents aged 13–19 years. Furthermore, the study investigated the potential protective or compensatory role from SOC on the association between stress and health. Methods: The study was based on a cross-sectional sample of 1233 adolescents. Data were analyzed with descriptive, comparative, and multiple linear regression analyses. Results: Girls reported significantly higher scores on depressive symptoms and subjective health complaints than boys. Stress was significantly and positively associated with depressive symptoms. SOC associated significantly with all outcome variables; and especially with mental wellbeing and depressive symptoms. Significant interaction effects of sex in combination with stress and SOC were found in association with depression and mental wellbeing. Associations were strongest for girls. Conclusion: The findings provided support for the significant role of SOC as a coping resource, especially in relation to adolescents’ mental health; weaker associations were found with subjective health complains and self-rated health. The findings also mainly supported a compensatory role of SOC on the association between stress and health during adolescence.

Adolescent internalizing symptoms: The importance of multi-informant assessments in childhood

BACKGROUND

Childhood internalizing symptoms can be associated with adolescent internalizing symptoms, but only a small proportion of symptomatic children are at long-term risk. Our objectives were to (1) distinguish between typical and atypical levels of internalizing symptoms using mother- and teacher-assessments and (2) test the association between childhood internalizing symptoms and adolescent generalized anxiety, depression, and social phobia symptoms in boys and girls.

METHODS

Multi-trajectory models were used to estimate the evolution of mother- and teacher-reported internalizing symptoms across childhood (1.5 to 12 years) in a large population-based cohort (n = 1431). Multiple linear regression models were implemented to estimate the association between childhood group membership of internalizing symptoms and self-reported specific internalizing symptoms at 15 years by sex.

RESULTS

Five groups of childhood internalizing symptoms were identified: Mother & teacher low (22.6%), Mother moderate/teacher low (37.9%), Mother moderate/teacher high (18.3%), Mother high/teacher low (11.8%) and Mother & teacher high (9.5%). Multiple linear regression models showed that compared to the low group, (1) boys in the high group reported higher social phobia symptoms (p = 0.04), (2) girls in the high group reported higher depression (p = 0.01) and generalized anxiety (p < 0.01) symptoms, and (3) girls in the moderate/high group reported higher generalized anxiety symptoms (p = 0.02) in adolescence.

LIMITATIONS

The main limitation is that mothers' and teachers' assessments mostly covered different developmental periods.

CONCLUSIONS

A multi-informant assessment of childhood internalizing symptoms improves adolescent specific internalizing symptoms identification in a general population sample over reliance on a single informant.

Active Travel of Czech and Polish Adolescents in Relation to Their Well-Being: Support for Physical Activity and Health

The adoption of active travel (AT) habits in adolescence, supported by positive emotions, increases the chances of a lifelong positive attitude towards AT. The aim of this study was to assess the associations between active travel and well-being (WB), and to estimate the share of AT in weekly physical activity (PA) and its contribution to meeting the weekly PA recommendations in adolescents. The International Physical Activity Questionnaire-long form and the WHO-5 questionnaire were used to assess the level of AT, weekly PA and well-being of 2805 adolescents from 36 Czech and 39 Polish schools. A higher rate of AT is only significantly associated with higher well-being in girls. However, meeting AT recommendations in combination with higher WB increased the likelihood of meeting the weekly PA recommendations in both girls and boys. AT accounts for 22.5% of weekly PA of Czech (Polish 24.2%) boys. Concerning girls, it accounts for 24.9% of weekly PA in the Czech Republic and 24.5% in Poland. Meeting AT recommendations should be part of comprehensive school-based PA programs. State, school and municipal policies in the Central European region should pay more attention to the improvement of WB and the built environment for AT in secondary school adolescents.

Non-specific Health complaints and self-rated health in pre-adolescents; impact on primary health care use

The objective of the present study was to explore past and future primary health care use in preadolescents reporting frequent non-specific health complaints or a low self-rated health compared to that of preadolescents with no frequent health complaints or with good self-rated health. The study was conducted as a cohort study based within the Danish National Birth Cohort (1996–2002). Information on non-specific health complaints and self-rated health was obtained by an 11-year follow-up questionnaire. Information about number of general practitioner (GP) contacts was obtained from the Health Insurance Service Register. A total of 44,877 pre-adolescents gave complete exposure information. Pre-adolescents who reported frequent non-specific health complaints had a higher use of GP compared to pre-adolescents without complaints across the five years following the index date (somatic complaints: IRR = (1.46 [1.38; 1.55], mental complaints: IRR = 1.16 [1.12; 1.19], both complaints: IRR = 1.58 [1.47; 1.69]). The same pattern was found for the association between low self-rated health and number of GP contacts (IRR = 1.41 (1.36; 1.46)). Non-specific health complaints and a poor self-rated health in pre-adolescents was associated with a higher past and future use of GP, indicating a need for development of early interventions with help for symptom management.

Why Do Japan and South Korea Record Very Low Levels of Perceived Health Despite Having Very High Life Expectancies?

Japan and Korea follow a unique trend in which, despite reporting two of the highest life expectancies (LEs) among the Organization for Economic Co-operation and Development (OECD) countries, the proportion of people with good self-rated health (SRH) is disproportionately low. We sought to explain this high-LE-low-SRH paradox by examining associations among LE, the prevalence of good SRH, and healthcare utilization. Our hypothesis was that countries with more frequent healthcare use would demonstrate poorer SRH and that SRH would not show a meaningful association with LE among developed countries. This study extracted data from Health at a Glance 2017 by the OECD for 26 countries with valid and comparable information on LE, SRH, and the number of doctor consultations per capita. Correlations among LE, good SRH, and number of doctor consultations per capita were analyzed. The number of annual doctor consultations per capita and the prevalence of good SRH were closely correlated (correlation coefficient=-0.610); excluding outliers produced a higher correlation coefficient (-0.839). Similar patterns were observed when we replaced good SRH with poor SRH. Meanwhile, the correlation coefficient between annual per capita doctor consultations and LE was quite low (-0.216). Although good SRH is closely related to better LE at the individual level, this was not true at the national level. Frequent use of healthcare in Japan and Korea was strongly correlated with poorer SRH, without any meaningful correlation with LE.

Behavioural factors as predictors of self-rated health among polish adolescent girls

OBJECTIVE

Introduction: Self-rated health (SRH), an indicator which is extensively used in population studies, constitutes a measure of health closely linked to morbidity, mortality and overall health status and enjoys popularity in surveys monitoring adolescents. Most studies show that at puberty girls assess their health as worse than boys do, and the difference widens with age. Moreover, puberty is a crucial period for health, since it is the time when health risk behaviours are often initiated or become established. Aim: To analyse the associations between high scores on self-rated health among 15-year-old girls, participants of the Healthy Me programme, and their selected health behaviours.

PATIENTS AND METHODS

Material and methods: The study covered a group of 1173 second-grade female students from 48 lower secondary schools located in rural and urban areas of 16 voivodeships all over Poland. The participants answered questions about chronic diseases or disability, self-rated health, diet, leisure activities, physical activity and health risk behaviours. In the statistical analysis, the association between self-rated health and individual indicators of health behaviour was examined using logistic regression.

RESULTS

Results: Two thirds of the girls assessed their health as excellent or good. Only approximately 5% of the respondents made the "extreme negative" assessment. In the final multivariate analysis, five factors remained important predictors of high self-rated health scores: regular participation in physical education classes, vigorous physical activity, daily breakfast consumption, consumption of fruit at least once a day and sleep for at least 8 hours a day.

CONCLUSION

Conclusions: Regular participation in physical education classes, vigorous physical activity, consumption of breakfast and fruit every day, as well as sleep for at least 8 hours a day are powerful predictors of high scores on self-rated health of 15-year-old adolescent girls. Public health activities aimed at adolescents should focus on the positive aspects of health and a lifestyle paying special attention on pro health behaviours.

Is self-esteem associated with self-rated health among French college students? A longitudinal epidemiological study: the i-Share cohort

OBJECTIVES

The aim of the study was to estimate the association between self-esteem and subsequent self-rated health during college years, taking into account a wide range of potential confounders.

DESIGN

Prospective longitudinal study.

SETTING

The French i-Share cohort.

PARTICIPANTS

The sample consisted of 1011 college students.

PRIMARY AND SECONDARY OUTCOME MEASURES

The association between self-esteem and later self-rated health was evaluated using multivariate modelling.Data regarding self-rated health, global self-esteem and demographic, educational, social, behavioural, environmental and financial characteristics were collected through an internet-based questionnaire.

RESULTS

The 1011 participants had a median age of 21.9 years and 79% (795/1011) were females. Self-rated health was assessed a median of 8 months after the self-esteem measurement. Twenty per cent of the students declared average to very poor health (203/1011). Students with higher levels of self-esteem were more likely to declare good or very good self-rated health (adjusted OR=1.40, 95% CI 1.15 to 1.72, p value=0.001). Other factors associated with good or very good self-rated health were low body mass index, a comfortable financial situation during childhood and three personality traits (low persistence and harm avoidance and high cooperativeness).

CONCLUSIONS

This study offers novel findings on the impact of self-esteem on self-rated health among college students. Interventions targeting self-esteem should be experimented during university years in order to improve health outcomes.

Is the association of weight disorders with perceived health status and life satisfaction independent of physical activity in children and adolescents? The CASPIAN-IV Study

BACKGROUND

Physical activity (PA) and weight status have been suggested as predictors of life satisfaction (LS) and perceived health status (PHS). Therefore the present study aims to investigate and compare the impacts of body mass index (BMI) and PA on LS and PHS in a population of Iranian children and adolescents.

MATERIAL AND METHODS

This study was conducted in 2011-12 as a nationwide population-based study among 14 880 students of age 6-18 years. Students were selected via a multistage cluster sampling method from 30 provinces of Iran. Information on demographics, PA, PHS and LS was obtained using the World Health Organization Global School-based Student Health Survey (WHO-GSHS) questionnaire. PA values were considered as low (<2 /week), moderate (2-4 h/week) and high (>2 h/week).

RESULTS

The current study has a participation rate of 90.6% (50.8% boys). PA was significantly associated with both LS and PHS [odds ratio (OR), 1.37 in both), while in BMI, this association was significant for only PHS (in underweight: OR, 0.65; 95% CI, 0.57-0.75; in excess weight: OR, 0.82; 95% CI, 0.73-0.93). In the combined group of BMI-PA, the influence of PA prevailed over the impact of BMI on PHS and LS, and therefore, PA was found to be the stronger factor.

CONCLUSION

Although BMI and PA could both significantly impact LS and PHS, the stronger influence of PA on LS and PHS suggests that upgrading the 'activity level' of children and adolescents should be underscored and included on the agenda, rather than merely focusing on their BMI and weight status.