Well-being in 15-year-old adolescents: a matter of relationship with school

School climate and school identification as determinants of smoking conventional cigarettes or vaping among adolescents in China: Stress-coping mediation mechanisms

INTRODUCTION

Smoking conventional cigarettes or vaping (SV) poses significant health threats to adolescents. School climate and school identification are key elements of the school environment and potential factors of SV. Based on the Stress Coping Theory, the mediations between school climate/school identification and SV, via perceived stress/active coping, were examined.

METHODS

A cross-sectional survey was conducted among secondary school students from February to March 2022 in Taizhou, China. Structural equation modeling was used.

RESULTS

The prevalence of SV among the 7526 participants was 4.7% (singular use of conventional cigarettes: 3.2%; singular use of electronic cigarettes: 3.6%; dual use: 2.1%). School climate, school identification, and active coping were positively, and perceived stress (family stress, academic stress, and peer-related stress) were negatively associated with SV. The association between school climate and SV was fully mediated via: 1) school climate → perceived stress → SV; 2) school climate → active coping → SV; and 3) school climate → perceived stress → active coping → SV. The effect sizes were 52.1%, 43.8%, and 6.3%, respectively. Similar partial mediation mechanisms were found between school identification and SV, with relatively small effect sizes (<10%).

CONCLUSIONS

This study observed the prevalence of SV among Chinese secondary school students. School climate and school identification had both significant direct and indirect (via perceived stress/active coping) effects on SV. Positive school environments may reduce students' stress and promote active coping. The stress coping mechanisms explained the association between school climate and SV better than between school identification and SV.

The wellbeing of adolescents and the role of greenness: A cross-sectional study among Italian students

Introduction

Adolescence is a critical period of life, and the level of wellbeing acquired during this stage might have an influence on health status in adulthood. The wellbeing of adolescents is associated with both biological and environmental determinants. To date, few studies have evaluated the effect of exposure to urban green spaces (i.e., greenness) on adolescents' wellbeing. Therefore, the aim of this study is to assess the association between exposure to greenness and the wellbeing of adolescents, accounting for the level of urbanization surrounding schools.

Methods

In the frame of the 2018 Italian Health Behaviour in School-aged Children (HBSC), we analyzed cross-sectional data from the Piedmont Region. Exposure to greenness was quantified by the Normalized Difference Vegetation Index (NDVI). Schools were geocoded, and a fixed buffer (radius 1,500 m) centered on each school was then built to enable average NDVI calculations. Adolescents' wellbeing was assessed by self-reported psychological, somatic, and psychosomatic health complaints as follows. Respondents were asked how often, in the last 6 months, they had experienced: (a) headache, (b) stomachache, (c) backache, (d) dizziness, (e) feeling low, (f) irritability or bad temper, (g) feeling nervous, and (h) difficulties getting to sleep using the HBSC Symptom Checklist (HBSC-SCL), an eight-item tool. Multivariable, multilevel logistic regression models tested the association between exposure to NDVI and psychosomatic, somatic, and psychological health complaints, one at a time, using schools as a random intercept.

Results

In total, 2065 subjects (47.6% girls) aged 11 (48.4%) and 13 (51.6%) years were involved. Greenness was found to be inversely associated with reported psychosomatic (OR 0.72, 95% CI: 0.53-0.98) and psychological health complaints (OR 0.67, 95% CI: 0.49-0.92) in boys only, adjusting for age, urbanization level, and socioeconomic status, and stratifying by gender.

Discussion

Our results support the implementation of future policies for urban environmental design supporting the increase of green spaces, as suggested by the United Nations Sustainable Development Goals. Further studies are needed to confirm our findings.

The Mental Well-Being of Italian Adolescents in the Last Decade through the Lens of the Dual Factor Model

(1) Background: In Italy, the components of adolescents' mental well-being (psychological symptomatology and cognitive perception of life satisfaction) showed different temporal trends, suggesting the adoption of a multidimensional conceptualization. We aimed to assess temporal patterns and provide additional insights into Italian adolescents' mental well-being in the last decade by adopting the Dual Factor Model; (2) Methods: We used nationally representative samples of Italian students (n = 165,000) aged 11, 13, and 15 years across the three more recent Italian Health Behaviour in School-aged Children (HBSC) surveys. Two measures of mental well-being were used: life satisfaction (LS, indicator of positive subjective well-being) and psychological health complaints (PHC, indicator of mental illness); (3) Results: Our study showed that the overall sample has been moving from a Complete Mental Health (Flourishing) to an Incomplete Mental Illness (Struggling) condition. Among 13- and 15-year-old girls, a jump from one to the other mental condition was observed in the 2014-2018 and 2010-2014 time periods, respectively; (4) Conclusions: Our findings suggest that Italian adolescents, especially older girls, have been shifting from Complete Mental Health to Incomplete Mental Illness in the last decade. Further research is needed to investigate this breaking up of the connection between psychological symptomatology and cognitive perception of life satisfaction.

Adolescents' Mental Health at School: The Mediating Role of Life Satisfaction

In this study, we further developed prior research on risk and protective factors in adolescents' mental health. More specifically, we used structural equation modelling to assess whether relationships at school with teachers and peers, and life satisfaction predicted mental health in a large sample of adolescents, while also testing for age and gender invariance. The sample comprised 3,895 adolescents (M age = 16.7, SD = 1.5, 41.3% girls), who completed self-report instruments assessing their perceived life satisfaction, student-teacher relationship, school connectedness and mental health. Overall, the results suggested that life satisfaction acted as a mediator between adolescents' positive school relations and their mental health. Outcomes were invariant across genders, while quality of school relations and mental health declined with age. Limitations of the study and futures lines in mental health research among adolescents are briefly discussed.

Sources of academic stress among Iranian adolescents: a multilevel study from Qazvin City, Iran

Background

Academic stress can cause mental and physical problems and affect adolescents’ healthy development. This study aimed to estimate academic stress and explore its sources at the individual- and school levels among school-going adolescents in the city of Qazvin, Iran.

Results

This cross-sectional study used a stratified cluster sampling to recruit 1724 students aged 12–19 years from 53 schools in Qazvin City. Data were collected using a validated self-administered questionnaire. The mean academic stress score was 45.7 (95% CI 45.2, 46.3). The stress level was statistically higher among older 47.5 (95% CI 46.7, 48.3) than younger 44.1 (95% CI 43.4, 44.9) adolescents. The main academic stressors included: future uncertainty 69.7 (95% CI 68.8, 70.7), academic competition 58.5 (95% CI 57.3, 59.6), and interaction with teachers 56.1 (95% CI 55.3, 56.9). Gender, educational period, school type, family socioeconomic status, and father’s education were associated with academic stress.

Conclusions

We conducted a multilevel study using a random sample of male and female students in the city of Qazvin, Iran. Results indicated moderate levels of stress among Iranian adolescents. The academic stress was associated with several individual and school-level variables. Students and their families and teachers need education on stress prevention methods and coping mechanisms. Future research should focus on developing and testing multilevel policies and interventions to improve students’ mental health and academic performance.

Connectedness as a protective factor in immigrant youth: results from the Health Behaviours in School-aged Children (HBSC) Italian study

OBJECTIVES

The aim of this work was to study whether and to what extent selected connectedness variables (perceived family, peer, and school support) are protective factors against low life satisfaction and high health complaints in immigrant youth with different ethnic backgrounds, while also taking into account the effect of socioeconomic status (SES).

METHODS

A representative sample of 47,799 students (15% immigrants, among whom 4980 were from non-Western countries) aged 11, 13, and 15 years were recruited from schools throughout Italy within the framework of the Italian 2013/2014 Health Behaviour in School-aged Children study. Bayesian network analyses were used to assess the association between connectedness variables, and low life satisfaction and high health complaints.

RESULTS

The connectedness variables family and school support were strong protective factors against both low life satisfaction and high health complaints (99% probability of relative risk < 1 in all subgroup comparisons). This protective role was still present when subgroups with high SES were compared. Peer support also showed a protective effect, though it was weaker.

CONCLUSIONS

Our results show that, among immigrant youth, perceived high support can act as a moderator on the effect of environmental stressors. In line with international guidelines, these results confirm that public health professionals should create school interventions that foster a culture of inclusiveness, promote a supportive school environment, and engage families of immigrant youth.

High-School Satisfaction Scale (H-Sat Scale): Evaluation of Contextual Satisfaction in Relation to High-School Students' Life Satisfaction

Recent literature on positive psychology underlines the crucial role of schools to create a psychologically healthy environment and to set programs and strategies fostering adolescents’ well-being. The aim of the present study is to validate a scale that measures scholastic satisfaction since a scientific evaluation and interventions on school satisfaction can help professionals to support adolescents’ positive development and school adjustment. We adapted the College Satisfaction Scale (CSS) and confirmed the previous five-dimensional structure also in a high school students’ sample (n = 792). The High-school Satisfaction Scale (H-Sat Scale) evaluates five dimensions of school satisfaction: appropriateness of choice (CH), quality of school services (SE), relationships with classmates (RE), effectiveness of study habits (ST) and usefulness for a future career (CA). The questionnaire consists of 20 items; it showed good psychometric features and, consistent with previous literature, confirmed its validity in relation to life satisfaction and quality of life of high school students. Compared with previous scales, the H-Sat evaluates two innovative areas of school satisfaction since it gives a measure of satisfaction in career path (appropriateness of choice and usefulness for future career) could help school counsellors to set interventions in this field.

School-level factors associated with teacher connectedness: a multilevel analysis of the structural and relational school determinants of young people's health

Background

Conducting research on the antecedents of teacher connectedness (TC) is key to inform intervention and policy that can leverage the public health potential of teachers for young people’s well-being. As part of the EU-funded Teacher Connectedness Project, this study aims to examine the contribution of a variety of school-level factors (including type of school, school size, student–teacher ratio, students per class and teacher gender).

Methods

Sample consisted of 5335 adolescents aged 11, 13 and 15 years that had participated in the HBSC study in England. Multilevel multinomial regression was used to examine the contributions of sociodemographic and school-level factors to TC.

Results

TC was lower in older adolescents and those from less affluent families, but similar in boys and girls. Regarding school-level factors, it was not the size of the school but the ratio of students per teacher which was significantly associated to TC, with higher student–teacher ratio being significantly associated with lower odds of medium-to-high TC. Some differences between mixed and all-girls schools were also found.

Conclusions

Health promotion strategies targeting student–teacher relationships need to consider how TC changes by age and SES and give attention to school-level factors, in particular the student–teacher ratio.

"What being healthy means to me": A qualitative analysis uncovering the core categories of adolescents' perception of health

Background

Studies exploring adolescents’ perception of health are still scarce in the international literature. Through a qualitative analysis, this study aims to explore the core categories or themes evoked when adolescents describe what it means to be healthy and unhealthy.

Methods

A convenience purposive sample of 34 15-year-old students from three different upper secondary schools took part in a 2-hour group discussion session. During the session, two conceptual projective techniques, the collage creation and the think-aloud technique, were used to elicit perceptions and descriptions of the typical healthy and unhealthy adolescent. Perceptions and descriptions voiced by adolescents were analysed through content analysis, and the key concepts that emerged were grouped so that core categories or themes could be identified.

Results

The analysis revealed five core categories that adolescents used to describe what being healthy or unhealthy meant to them: physical appearance, personal commitment and goals, possessions and space, use of free time, and social belonging.

Conclusions

Instead of those approaches that focuses solely on the avoidance of risk, the identified core categories or themes might be the basics around which health promotion programmes in adolescence should be built. Engaging students in planning for their future and assisting them in mapping out crucial steps to meet their personal goals, including life, academic, and career goals, is a suitable way to address issues that are meaningful to adolescent health.

Application of the Human Well-Being Index to Sensitive Population Divisions: A Children's Well-Being Index Development

The assessment of community well-being is critical as an end-point measure that will facilitate decision support and assist in the identification of sustainable solutions to address persistent problems. While the overall measure is important, it is equally vital to distinguish variations among groups within the population who may be impacted in a different manner. The U.S. Environmental Protection Agency (US EPA) developed the Human Well-Being Index (HWBI), as a way of measuring these outcomes and assessing community characteristics. The HWBI approach produces a suite of indicators, domains and a final composite index appropriate for characterizing well-being of a population. While generalized approaches are needed, it is important to also recognize variations in well-being across community enclaves. This paper presents an adaption of the HWBI for child populations to test the applicability of the index framework to specific community enclaves. First, an extensive literature review was completed to ensure the theoretical integrity of metric and indicator substitutions from the original HWBI framework. Metric data were then collected, refined, imputed where necessary and evaluated to confirm temporal and spatial availability. A Children's Well-Being Index (CWBI) value, representing the same indicators and domains of well-being as the original HWBI, was calculated for the population under age 18 across all US counties for 2011. Implications of this research point to an effective, holistic end-point measure that can be tracked over time. Similarly, there is great potential for the application of the original HWBI method to other statistical population segments within the greater US population. These adaptations could help identify and close gaps in equity of resource distribution among these groups.

School and community physical activity characteristics and moderate-to-vigorous physical activity among Chinese school-aged children: A multilevel path model analysis

PURPOSE

The purpose of this study was to examine the association between school and community physical activity (PA) characteristics and levels of moderate-to-vigorous physical activity (MVPA) among Chinese school children.

METHODS

Data were obtained from the 2016 Physical Activity and Fitness in China-The Youth Study project. Participants were 80,928 school children (Grades 4-12; 39,747 boys, 41,181 girls; mean age = 13 years) and 935 physical education (PE) teachers who completed a study survey. Independent variables included both school-related factors (school-level PA support, availability of and access to PA facilities, and the duration of school PE classes) and community-related factors (the frequency of sports events, sports training opportunities, availability of sports clubs and organizations, and access to PA facilities). The dependent variable was the children's self-reported participation in MVPA. The data were analyzed, in 2017, via multilevel modeling.

RESULTS

PA support from school administrators was the only school-level factor significantly related to children's participation in MVPA. Children's perceptions of the frequency of community-sponsored sports events, availability of sports clubs and organizations, and convenient access to PA facilities were associated with a high level of MVPA participation. In regard to residency in urban and rural areas, children attending urban schools who perceived high availability of PA facilities were associated with a low level of participation in MVPA.

CONCLUSION

School support for PA and community PA resources are associated with MVPA among Chinese school children. School PA facilities appear underutilized among urban schools as evidenced by low levels of MVPA among school children.

Quality of life in anxious adolescents

PURPOSE

To examine associations between health-related quality of life (HRQoL) and anxiety symptoms across anxiety domains (obsessions/compulsions, social anxiety, panic disorder, agoraphobia, separation anxiety, physical injury fears, generalised anxiety, and posttraumatic stress) in a general adolescent population. Expanded knowledge about these associations can provide valuable information for improving interventions and prevention strategies for adolescent anxiety.

METHODS

Cross-sectional data about anxiety were collected via a school survey from a community sample of Norwegian adolescents aged 12-17 (N = 1719). Based on scores from the Spence Children's Anxiety Scale (SCAS), each adolescent was categorized as reporting a low, medium, or high level of anxiety. Each adolescent's HRQoL was then measured using the Questionnaire for Measuring Health-Related Quality of Life in Children and Adolescents Revised Version (KINDL-R). Hierarchical regression analyses were performed to determine any relationship between anxiety symptoms and HRQoL.

RESULTS

Across domains of anxiety, anxiety symptoms were inversely associated with overall HRQoL. All HRQoL-dimensions were inversely associated with overall level of anxiety symptoms. In adolescents with medium and high anxiety symptoms, poor HRQoL was documented in all HRQoL dimensions with the exception of the family dimension.

CONCLUSIONS

The strong association between elevated levels of anxiety symptoms and poor HRQoL demonstrate the importance of improved mental health interventions and prevention initiatives targeting anxious adolescents.

Unhealthy food consumption in adolescence: role of sedentary behaviours and modifiers in 11-, 13- and 15-year-old Italians

BACKGROUNDS AND AIM

Unhealthy eating behaviours increase with age and have been associated with adverse health consequences in adulthood. We examined the influence of screen-based sedentary behaviours (SBs) on unhealthy food consumption, such as energy-dense foods and sweetened drinks, among a representative sample of nearly 60 000 adolescents and assessed the role of possible modifiers.

METHODS

Data come from the Italian 2009-10 Health Behaviour in School-aged Children (HBSC) survey. Data on Eating patterns, SBs, physical activity, peers network, BMI and socio-economic status (SES) were collected following the HBSC study protocol. Hierarchical logistic regression models were used.

RESULTS

Unhealthy food consumption was significantly associated with a lower intake of fruit and vegetables and with the increase of SBs in both sexes and in all ages. The risk was interestingly higher in normal weight adolescents, in those with wider relationships with peers and in low SES children.

CONCLUSIONS

This study adds evidence to support the importance of investing more resources in educational initiatives both to increase parents' awareness to support adolescents on dietary choices and on time spent in screen-based behaviours, independently of their adiposity status; and to develop youth's ability to access and appropriately use media and technologies. Policy makers should also increase their attention on introducing regulatory policies on television food advertising to which youth are exposed.