The use of parental occupation in adolescent health surveys. An application of ISCO-based measures of occupational status

Health Literacy and Its Association with the Adoption of the Mediterranean Diet: A Cross-Sectional Study

Health literacy (HL) is a crucial factor influencing health-related decisions, including dietary patterns. The Mediterranean diet is widely recognized as one of the healthiest eating patterns. This study aims to explore the association between HL levels among adults in socially vulnerable contexts and their adoption of the Mediterranean diet. Conducted as part of a cluster-randomized trial in primary schools, the research involved 557 parents of children aged 6 to 10 who consented to participate. HL was assessed using the HLS questionnaire, while adoption of the Mediterranean diet was evaluated using the MEDAS questionnaire. Participants also provided anthropometric and sociodemographic data via a questionnaire, from which BMI was calculated (weight/height2). Education level was categorized as higher education or lower and professional status was classified based on occupational categories. Generalized linear models and logistic regression were employed for analysis. The findings indicate a direct association between HL level and adoption of the Mediterranean diet (B = 0.022, 95% CI 0.010-0.035, p < 0.001), underscoring the influence of HL on dietary choices. Specifically, the healthcare dimension of HL emerges as pivotal in shaping dietary behaviors, particularly towards the Mediterranean diet. These results underscore the importance of policies and programs aimed at enhancing HL, especially among socially vulnerable populations. Prioritizing public health interventions to improve HL is critical for promoting better dietary decision-making.

Country-level sociocultural context and socioeconomic inequalities in adolescent dietary behaviours: A multilevel analysis in 21 European countries

Studies to date have predominantly focused on countries' socioeconomic conditions (e.g., income inequality) to explain cross-national differences in socioeconomic inequalities in adolescent health (behaviours). However, the potential explanatory role of sociocultural contexts at country-level remains underexamined. This study examined whether the country-level sociocultural context and changes thereof were associated with adolescent socioeconomic inequalities in dietary behaviours. International comparative data of 344,352 adolescents living in 21 countries participating in 2002, 2006, 2010 and 2014 waves of the Health Behaviour in School-aged Children (HBSC) survey were combined with aggregated levels of openness-to-change from the European Social Survey (ESS). Four dietary behaviours (i.e., fruit, vegetable, sweets and soft drink consumption) and two measures of socioeconomic status (SES) on the individual level (i.e., family affluence scale [FAS] and occupational social class [OSC]) were studied. Multilevel logistic regression analyses returned contrasting results for the two SES measures used. In countries with higher levels of openness-to-change, smaller FAS inequalities in daily fruit, sweets and soft drink consumption were observed, but no such inequalities were found for vegetable consumption. Conversely, in these countries, larger OSC inequalities in soft drink consumption were found. Country-specific changes in openness-to-change over time were not associated with the magnitude of adolescent dietary inequalities. Findings underscore the importance of including country-level sociocultural contexts to improve the understanding of cross-national differences in socioeconomic inequalities in adolescents' diets. Future studies, spanning a longer timeframe, are required to examine whether such associations exist within countries over time since our timeframe might have been too small to capture these long-term trends.

Bullying at School, Cyberbullying, and Loneliness: National Representative Study of Adolescents in Denmark

AIMS

The aim was to examine how loneliness was associated with bullying victimization at school and online.

METHODS

We used data from the Danish arm of the international Health Behavior in School-aged Children (HBSC) study from 2022. The study population was a nationally representative sample of 11-15-year-olds who completed the internationally standardized HBSC questionnaire at school, n = 5382. Multilevel logistic regression was applied to study the associations between bullying victimization and loneliness.

RESULTS

The prevalence of reporting loneliness often or very often was 9.0%; 6.3% of the sample experienced habitual bullying victimization at school, and 4.8% incurred cyberbullying. There was a strong and graded association between loneliness and bullying victimization at school and cyberbullying. The associations were significant for boys and girls, and the association between exposure to bullying at school and loneliness was steeper for boys than girls. The gradients were steeper for physical bullying than for cyberbullying. Students exposed to habitual bullying in both contexts had an adjusted OR (95% CI) of 11.21 (6.99-17.98) for loneliness.

CONCLUSION

Exposure to bullying at school and cyberbullying are strongly associated with loneliness. It is important to reduce bullying at school and on the internet and to promote effective interventions to reduce continuing loneliness.

Recurrent headache, stomachache, and backpain among adolescents: association with exposure to bullying and parents' socioeconomic status

OBJECTIVES

Recurrent pain is a prevalent and severe public health problem among adolescents and is associated with several negative health outcomes. In a representative sample of adolescents this study examined 1) whether exposure to bullying and low socioeconomic status (SES) were associated with recurrent headache, stomachache and backpain, 2) the combined effect of exposure to bullying and low SES on recurrent pain and 3) whether SES modified the association between bullying and recurrent pain.

METHODS

Data derived from the Danish contribution to the international collaborative study Health Behaviour in School-aged Children (HBSC). The study population was students in three age groups, 11-, 13- and 15-year-olds from nationally representative samples of schools. We pooled participants from the surveys in 2010, 2014 and 2018, n=10,738.

RESULTS

The prevalence of recurrent pain defined as pain 'more than once a week' was high: 11.7 % reported recurrent headache, 6.1 % stomachache, and 12.1 % backpain. The proportion who reported at least one of these pains 'almost every day' was 9.8 %. Pain was significantly associated with exposure to bullying at school and low parental SES. The adjusted odds ratio (AOR, 95 % CI) for recurrent headache when exposed to both bullying and low SES was 2.69 (1.75-4.10). Equivalent estimates for recurrent stomachache were 5.80 (3.69-9.12), for backpain 3.79 (2.58-5.55), and for any recurrent pain 4.81 (3.25-7.11).

CONCLUSIONS

Recurrent pain increased with exposure to bullying in all socioeconomic strata. Students with double exposure, i.e., to bullying and low SES, had the highest OR for recurrent pain. SES did not modify the association between bullying and recurrent pain.

Preventing Stress among High School Students in Denmark through the Multicomponent Healthy High School Intervention-The Effectiveness at First Follow-Up

Stress is a widespread phenomenon and young people especially are experiencing high levels of stress. School-related factors are the most frequently self-reported stressors among adolescents, but few interventions have targeted the school environment. This study evaluated the effectiveness of the Healthy High School (HHS) intervention on stress at a 9-month follow-up. The study included 5201 first-year high school students (~16 years) in Denmark. Participating schools were randomized into the HHS intervention (N = 15) or control group (N = 15). Baseline measurements were conducted in August 2016 and the follow-up was conducted in May 2017. The intervention was designed to promote well-being (primary outcome) by focusing on physical activity, meals, sleep, sense of security, and stress (secondary outcomes). The intervention comprised: structural initiatives at the school level; a teaching material; peer-led innovation workshops; and a smartphone app. The 10-item Perceived Stress Scale was used to measure stress. Intervention effects on perceived stress were estimated using an intention-to-treat approach with multiple imputations of missing data and multilevel general linear regression modelling. A total of 4577 students answered the baseline questionnaire. No statistically significant difference was found in stress between students at intervention and control schools at the follow-up (mean score: 16.7 versus 16.7, adjusted b = 0.42, 95% CI: -0.16;1.00). The HHS Study is one of the first large randomized controlled trials targeting school environmental stressors. Potential implementation failures and the failures of the program theory are discussed.

Underweight among adolescents in Denmark: prevalence, trends (1998-2018), and association of underweight with socioeconomic status

BACKGROUND

Underweight among adolescents is an important clinical and public health issue. It is associated with adverse health outcomes throughout the life-span and may reflect food poverty, unhealthy eating habits, or some underlying health conditions.

OBJECTIVE

To study prevalence and trends in underweight among adolescents 1998-2018, to examine social inequality in underweight, and whether social inequality changed over time.

METHODS

Data were derived from 6 cross-sectional school surveys from The Health Behaviour in School-aged Children study in Denmark. The study included 11-, 13-, and 15-year-old schoolchildren in random samples of schools in 1998, 2002, 2006, 2010, 2014, and 2018 (n = 22,177). Underweight was determined by body mass index-for-age thinness grade 2-3 (the Cole and Lobstein method). Socioeconomic status was determined using occupational social class (the Danish OSC Measurement).

RESULTS

The overall prevalence of underweight was 3.1% among boys and 5.3% among girls (P < 0.0001) and decreased by age (P < 0.0001) among both boys and girls. The prevalence of underweight was almost stable from 1998 to 2018. There was no observed absolute or relative social inequality in the prevalence of underweight among boys or girls.

CONCLUSION

The prevalence of underweight in 11- to 15-year-olds was significantly higher among girls than boys. The prevalence remained stable from 1998 to 2018. There was no significant association between SES and prevalence of underweight. It is important to elucidate the underlying causes of underweight such as malnutrition, eating disorders, eating problems, loss of appetite, chronic diseases, insufficient knowledge of nutrients effects on bodily functions, and persistent pain.

Trends in material and non-material inequalities in adolescent health and health behaviours: A 12-year study in 23 European countries

Information on trends in adolescent health inequalities is scarce but the available evidence suggests that inequalities are increasing. Prior studies describe associations between material resources of socioeconomic status (SES) and health, while information on non-material SES resources and inequalities in health behaviours is lacking. To improve current understandings of evolutions in adolescent health inequalities, we examined how material and non-material SES resources were associated with changes in selected health outcomes (life satisfaction, physical and psychological symptoms) and health behaviours (physical activity, screen time, breakfast, fruit, vegetables, sweets and soft drinks consumption and alcohol and tobacco use) over a 12-year period. Repeated cross-sectional data came from the 2002, 2006, 2010 and 2014 waves of the Health Behaviour in School-aged Children (HBSC) survey from 23 European countries (n = 480,386). Measures of family affluence and occupational social class were used as indicators of material and non-material SES resources respectively. Regression-based slope indices of inequality indicated that absolute material and non-material inequalities remained stable from 2002 to 2014 in all health outcomes, except for life satisfaction for which a decrease in material inequalities was found between the highest and lowest affluence group (0.81 to 0.68 difference; p < 0.001). In terms of health behaviours, material inequalities decreased in screen time between highest and lowest affluence groups (0.53 to 0.34 h/day difference; p < 0.001), fruit (odds ratio [OR] 1.89 to 1.72 lower odds; p = 0.0088) and soft drinks consumption (OR 1.36 to 1.13 lower odds; p < 0.001) and remained stable in all others. Non-material inequalities increased in all health behaviours (except for sweets consumption) between highest and lowest occupational social class groups: physical activity (0.16 to 0.24 h/day difference; p = 0.0071), screen time (-0.41 to -0.58 h/day difference; p < 0.001), breakfast (0.21 to 0.51 day/week difference; p < 0.001), fruit (OR 1.23 to 1.48 higher odds; p < 0.001), vegetables (OR 1.39 to 1.74 higher odds; p < 0.001) and soft drinks consumption (OR 0.59 to 0.43 lower odds; p < 0.001) and alcohol (OR 0.99 to 0.85 lower odds; p = 0.0420) and tobacco use (OR 0.71 to 0.59 lower odds; p = 0.0183). In summary, non-material inequalities in most health behaviours increased, whereas material inequalities in adolescent health and health behaviours remain stable or decreased. Policies and interventions may consider non-material SES components as these can help in reducing future health inequalities.

Parental Illness and Life Satisfaction among Young People: A Cross-Sectional Study of the Importance of School Factors

Background: The aim of this study was to examine the relationship between parental illness and life satisfaction among Danish adolescents and the potential modifying effect of positive school experiences. Moreover, we describe the use of student counsellor services among adolescents with and without ill parents. Methods: Data included 9565 adolescents primarily aged 13–19 years, who participated in the cross-sectional Well-being Despite Study. Multilevel logistic regression models including joint effect analyses were performed. Results: Parental illness was strongly associated with life satisfaction. Negative school experiences were more frequent among adolescents with ill parents and strongly associated with low life satisfaction for all students. However, joint effect analyses did not show effect modification by school-related variables. The odds ratio of having talked to a student counsellor was highest for adolescents with multiple ill parents, compared to no ill parents. Conclusions: Parental illness is a strong predictor of low life satisfaction among adolescents; the impact depends on number of ill parents, whether parental illness is physical or mental, and their level of impairment. Positive school experiences were less frequent in adolescents of ill parents and did not counteract the effect of parental illness on life satisfaction.

Chronic backpain among adolescents in Denmark: trends 1991-2018 and association with socioeconomic status

Chronic backpain among adolescents is important because the prevalence is high, above 10%, and more than 10% of all adolescents experience impacts on important day-to-day activities. Chronic backpain tracks into adulthood and is associated with several health problems. The objective was to study trends in the prevalence of chronic backpain among adolescents 1991-2018, to examine the association with socioeconomic status (SES), and whether this association changed over time. The study used data from eight comparable cross-sectional school surveys of nationally representative samples of 11-15-year-olds in 1991, 1994, 1998, 2002, 2006, 2010, 2014, and 2018, which constitute the Danish arm of the international Health Behaviour in School-aged Children (HBSC) study. The participation rate was 74.6% of the eligible study population, n = 29,952. Chronic backpain was defined as self-reported backpain daily or several days a week during the last 6 months. The prevalence of chronic backpain was 11.1%, significantly increasing from 8.9% in 1991 to 11.7% in 2018. The OR for chronic backpain was 1.20 (95% CI: 1.10-1.31) in middle, and 1.56 (95% CI: 1.41-1.73) in low compared to high SES. Sensitivity analyses with two other cut-points for backpain frequency showed similar associations.Conclusion: Chronic backpain is common among adolescents and the prevalence increased from 1991 to 2018. The prevalence was highest in lower SES families. We recommend increased efforts to prevent chronic backpain. What is Known: • Chronic backpain among adolescents is common, has a high burden of disability, is associated with several health problems, and tracks into adulthood. What is New: • The prevalence of chronic backpain among adolescents in Denmark increased from 8.9% in 1991 to 11.7% in 2018. • The prevalence was highest among adolescents from lower SES families.

Positive Youth Development and Mental Well-Being in Late Adolescence: The Role of Body Appreciation. Findings From a Prospective Study in Norway

Although a vulnerable period, adolescence is a time of great potential for healthy development. Understanding factors that contribute to mental well-being in this period is of great importance to facilitate for healthy development. During the adolescence period the body goes through rapid and considerable changes, and the focus on body appearance and perfection is substantial at societal, media, and peer level. In this study, we investigated the association between dimensions characterizing positive youth development, and mental well-being among Norwegian adolescents 16-17 years 1 year later, and whether this association was mediated by degree of body appreciation. We further tested whether the indirect and direct paths between positive youth development dimensions and mental well-being were moderated by gender. We used data from the first and second follow-up of the control arm of the COMPLETE study, a cluster randomized controlled trial in upper secondary schools in Norway. Findings showed that positive youth development in grade 1, as measured by both a combined global PYD and the dimensions competence, and connection were significantly associated with mental well-being in grade 2 in models adjusted for mental well-being in grade 1, gender and perceived family affluence. Also, body appreciation in grade 1 significantly predicted mental well-being in grade 2 in models including each of global PYD, competence, connection, character, and caring dimensions. Contrary to our hypothesis, no mediating effects of body appreciation were observed, and no moderation of indirect effects by gender were observed.

Poverty and the prediction of health status in adolescents from low-income families in Taiwan

BACKGROUND

A comparison of the performance between monetary and an asset-based socioeconomic position (SEP) index in predicting adolescents' health outcomes was conducted only in low-income countries. Our study aims to compare these two indices among adolescents from low-income families in a high-income country.

METHODS

Data of adolescents aged 12-18 years was used from the Taiwan Database of Children and Youth in Poverty (n = 2529). The asset-based index was based on a set of weighted self-reported household conditions using principal components analysis. Multivariable logistic regression was conducted to examine the association between these two indices and the mental and physical health outcomes among adolescents.

RESULTS

Health outcomes were significantly associated with the asset-based SEP index but not with the monetary index. An increased trend was shown in mental illness symptoms, infections, injuries, allergies and dental problems when the regression was performed in the asset-based SEP index (P < 0.05) but not in the monetary SEP index.

CONCLUSIONS

An asset-based SEP index serves as a better index associated with a social gradient in health inequality. To prioritize giving care to people in need, healthcare policymakers should consider including an assessment of household assets and resources, supplementary to the conventional monetary index.

Parental socioeconomic status and adolescent health in Japan

There is no consensus on which parental socioeconomic indicators should be used to define adolescents’ socioeconomic status (SES). Utilising the data for 3154 parent-adolescent pairs obtained from the sample of the Survey of Lifestyle Value of Parents and Children 2011 conducted by the Cabinet Office in Japan, the associations between adolescent’s subjective economic status, parental SES (i.e. education, occupation, and household income), and child health-related outcomes (i.e. self-rated health, dietary and oral health behaviours) were analysed using multilevel mixed-effects ordered logistic regression to investigate heterogeneity in these relationships across SES indicators and health outcome measures. Results demonstrated that income was the strongest predictor of adolescent health outcomes, suggesting that adolescents in the middle- or high-income groups tended to report better health status compared to the low-income group, have a higher frequency of having breakfast, and more likely to regularly brush their teeth by 24% (OR 1.24, 95% CI [1.06–1.46]) to 66% (OR 1.66, 95% CI [1.30–2.12]). Parental education was also related to child health-related behaviours, with higher levels of habitual healthy behaviours being observed in the middle- and high-education groups than in the low-education group by 15% (OR 1.15, 95% CI [1.01–1.32]) to 63% (OR 1.63, 95% CI [1.31–2.03]). Future studies regarding health disparities among children/adolescents should carefully choose an SES indicator, taking multiple pathways between each SES indicator and health/health behaviours into consideration.

Recurrent abdominal pain among adolescents: trends and social inequality 1991-2018

OBJECTIVES

The association between socioeconomic status and recurrent abdominal pain (RAP) among adolescents is an understudied issue. No study has examined whether such an association changes over time. The aim was to examine trends in RAP among adolescents in Denmark from 1991 to 2018, to examine whether there was social inequality in RAP and whether this inequality varied over time.

METHODS

The study used data from the Danish part of the international Health Behaviour in School-aged Children (HBSC) study of nationally representative samples of 11-, 13- and 15-year-olds. This study pooled data from eight comparable surveys from 1991 to 2018, overall participation rate 88.0%, n=30,048. The definition of RAP was self-reported stomach-ache daily or several days per week during the past six months. We reported absolute inequality as prevalence difference in RAP between low and high socioeconomic status and relative inequality as odds ratio for RAP by socioeconomic status.

RESULTS

In the entire study population, 5.6% reported RAP, 3.1% among boys and 7.8% among girls. There was a significant increase in RAP from 1991 to 2018 among boys and girls, test for trend, p<0.0001. The prevalence of RAP was significantly higher in low than high socioeconomic status, OR=1.63 (95% CI: 1.42-1.87). The absolute social inequality in RAP fluctuated with no consistent increasing or decreasing pattern.

CONCLUSIONS

The prevalence of RAP increased from 1991 to 2018. The prevalence was significantly higher among girls than among boys, and significantly higher in low socioeconomic status families. Professionals should be aware of RAP as common and potentially serious health problems among children and adolescents. In addition to clinical examination it is important to focus on improving the child's quality of life, reduce parents' and children's concerns about the seriousness of the condition, and consider supplements to medicine use.

Occupational categories and cardiovascular diseases incidences: a cohort study in Iranian population

Introduction

In spite of traditional cardiovascular risk factor, the different occupations can play an important role in cardiovascular disease (CVDs) incidence. We aimed to assess the correlation between the occupational classes, based on the International Standard Classification of Occupation (ISCO), and CVDs in Iran as a developing country.

Methods

We followed the 2440 men, aged 35-65 years and without history of CVDs over fourteen years; 2001 to 2015 during the Isfahan Cohort Study. ISCO was used to classify occupations into 10 categories. Incidence rates of ischemic heart diseases and stroke were recorded. Socioeconomic demographic data including marital state, income and place of living and metabolic risk factors were also recorded.

Results

The mean age was 46.97 ± 8.31 years old. 272 cardiovascular events (CVEs) were recorded that unstable angina was the highest recorded with 49% prevalence and the fatal stroke had the lowest outbreak (1%). The unemployed/jobless group and elementary occupations (9th ISCO category) had higher and lower relative frequency in CVEs respectively. There was non-significant decrease in CVEs in all of categories except of 4^th (clerical support workers) and 10th (armed forces) groups in comparison to unemployed/jobless subjects (P > 0.05). After considering of the group 7 as a reference group (most absolute CVEs frequency), in fully adjustment analysis group 4 had significant risk for CVEs (P = 0.04).

Conclusions

This study indicates that working as clerical support workers (4^th ISCO category) is associated with higher significant risk for IHD and stroke incidence in comparison to craft and related trades workers (7^th group of ISCO).

Self-Control Outdoes Fluid Reasoning in Explaining Vocational and Academic Performance-But Does It?

Trait self-control, the ability to interrupt undesired behavioral tendencies and to refrain from acting on them, is one of the most important socio-emotional skills. There had been some evidence that it outperforms intelligence in predicting students' achievement measured as both school grades and standardized achievement tests. However, recent research has shown that the relationships between trait self-control and measures of achievement are more equivocal, emphasizing the importance of the respective outcome of the test to the individual. On the one hand, high-stakes school achievement measures such as GPA repeatedly showed strong relationships with trait self-control. On the other hand, findings on the relationships between trait self-control and performance in mostly low-stakes standardized achievement tests were more heterogeneous. The substantial positive relationship between intelligence and both achievement measures is uncontested. However, the incremental value of trait self-control beyond intelligence when investigating their relationships with achievement remains uncertain. To investigate the relationships of self-control with school achievement and two standardized achievement tests (school mathematics and physics) beyond fluid reasoning, we drew on a large heterogeneous sample of adults in vocational training (N = 3,146). Results show differential patterns of results for fluid reasoning and trait self-control and the achievement measures. Trait self-control and fluid reasoning showed similar relationships with school achievement, whereas only fluid reasoning was significantly associated with standardized achievement test scores. For both achievement measures, no significant interaction effects between trait self-control and fluid reasoning were found. The results highlight the utility of trait self-control for performance in high-stakes school assessment beyond fluid reasoning, but set limits to the overall value of trait self-control for achievement in standardized assessments-at least in low-stakes testing situations.

Trends in social inequality in overweight and obesity among adolescents in Denmark 1998-2018

OBJECTIVES

The aim was to analyze trends in overweight and obesity in relation to socioeconomic position among Danish adolescents in the 20-year period 1998-2018.

METHODS

The study used data on self-reported height and weight and parents' occupational social class (OSC) from 11-, 13- and 15-year-old schoolchildren in 1998, 2002, 2006, 2010, 2014 and 2018, n = 22,177. The analyses included absolute social inequality in overweight/obesity (prevalence difference between low and high OSC) and relative social inequality (OR for overweight/obesity).

RESULTS

In the total sample, the prevalence of overweight and obesity was 9.7% and 1.4%, respectively, with significantly higher prevalence in low than high OSC. There were significantly increasing trends in both overweight and obesity 1998-2018 in low OSC and no significant increase in high OSC. The OR for overweight was 1.59 (1.42-1.74) in middle and 2.16 (1.89-2.46) in low OSC, OR for obesity 1.74 (1.29-2.34) in middle and 2.97 (2.15-4.11) in low OSC. Associations were not modified by survey year.

CONCLUSIONS

There was a persistent absolute and relative social inequality in overweight and obesity 1998-2018 among Danish adolescents.

Equality of opportunity is linked to lower mortality in Europe

Background

This study investigates if intergenerational equality of opportunity is linked to mortality in 30 European countries. Equality of opportunity may lead to greater returns on health investments and, consequently, improved health outcomes. In turn, a perceived lack of fairness in the distribution of life chances and limited possibilities for upward intergenerational mobility can cause anxiety among individuals and gradually compromise their health.

Methods

We used information on 163 467 individuals’ and their parents’ Socio-Economic Index of Occupational Status from a large survey data set—the European Social Survey—to generate three complementary measures of equality of opportunity. We then linked these to administrative data on total, gender-specific and cause-specific mortality rates assembled by Eurostat from the national statistical offices.

Results

We found that lower equality of opportunity, measured by the attainment of individuals from the lowest and highest quartiles of socioeconomic status and by the overall intergenerational correlation in socioeconomic status, was related to higher mortality rates, particularly in relation to diseases of the nervous system and the sense organs, diseases of the respiratory system and external causes of mortality. Our measures of equality of opportunity were more consistently linked with mortality of men than women.

Conclusion

Equality of opportunity may be an important explanation of mortality that warrants further research. Measures that aim at facilitating intergenerational social mobility can be justified not only via normative considerations of equality of opportunity but also in terms of individuals’ chances to enjoy healthy lives.

Accuracy of Body Weight Estimation Among Palestinian Refugee Adolescents Living in Jordan: A Cross-Sectional Study

PURPOSE

We aimed to examine the prevalence of obesity among adolescents living in a refugee camp in Jordan and analyze the factors influencing their weight perceptions.

DESIGN

Cross-sectional survey.

METHODS

We examined the body weight perception, and the influence of psychological, cultural, and social factors, among Palestinian refugee adolescents living in Jordan using a cross-sectional survey. Univariate, bivariate, and multiple logistic regression analyses were used to investigate the relationships between body weight status, weight perception, satisfaction with weight, screen time, and depression status of these adolescents.

RESULTS

A total of 620 adolescents participated in the study, of which 24% were either overweight or obese. Overweight or obese adolescents were more likely to underestimate their weight (p < .001), while those with depressive symptoms (Patient Health Questionnaire for Adolescents score > 14), were more likely to overestimate their body weight (p = .021). Having symptoms indicative of depression (adjusted odds ratio [AOR] = 1.70; 95% confidence interval [CI] = 1.16-2.50) and having a body mass index in the overweight/obese range (AOR = 4.16; 95% CI = 2.73-6.35) were predictors of discordant weight perception.

CONCLUSIONS

This study showed that excess body weight is a significant issue among Palestinian refugee adolescents living in a refugee camp in Jordan. Underlying depression is an important factor in excess weight and distorted weight perceptions especially among this vulnerable group.

CLINICAL RELEVANCE

The study highlights the importance of addressing discordant body weight perception and depression in weight management in nursing interventions for vulnerable adolescent groups.

Adolescent Socioeconomic Status and Mental Health Inequalities in the Netherlands, 2001-2017

Even in wealthy countries there are substantial socioeconomic inequalities in adolescent mental health. Socioeconomic status (SES) indicators-parental SES, adolescent subjective SES and adolescent educational level-are negatively associated with adolescent mental health problems, but little is known about the interplay between these SES indicators and whether associations have changed over time. Using data from the Dutch Health Behaviour in School-Aged Children (HBSC) studies (n = 27,020) between 2001 and 2017, we examined associations between three SES indicators and six indicators of adolescent mental health problems. Linear regressions revealed that adolescent subjective SES and adolescent educational level were independently negatively associated with adolescent mental health problems and positively associated with adolescent life satisfaction, but parental SES had negligible independent associations with adolescent mental health problems and life satisfaction. However, when interactions between SES indicators were considered, high adolescent subjective SES was shown to buffer the negative association between parental SES and adolescent mental health problems and the positive association between parental SES and life satisfaction. Despite societal changes between 2001 and 2017, socioeconomic inequalities in adolescent mental health were stable during this period. Findings suggest that all three SES indicators-parental SES, adolescent subjective SES and adolescent educational level-are important for studying socioeconomic inequalities in adolescent mental health.

Short report: persistent social inequality in poor self-rated health among adolescents in Denmark 1991-2014

The aim was to examine trends in social inequality in poor self-rated health (SRH) among adolescents in Denmark 1991-2014. The analysis included 18 996 11-15-year-old school children from the cross-sectional Health Behaviour in School-aged Children studies in 1991, 2002, 2006, 2010 and 2014. Across the five surveys, the prevalence of poor SRH was 14.2%, remaining almost unchanged from 1991 to 2014. The proportion with poor SRH was 12.2% in high, 14.3% in middle and 17.6% in low occupational social class. This social inequality in poor SRH was persistent during the entire study period, both in terms of absolute and relative social inequality.

Trends in socioeconomic differences in daily smoking among 15-year-old Danes 1991–2014

Aim: To examine trends in socioeconomic differences in daily smoking among 15-year-old Danes between 1991–2014, using occupational social class as indicator of socioeconomic status. Methods: The study included 15-year-olds participating in seven Danish Health Behaviour in School-aged Children studies between 1991–2014, n = 8,641. The analyses focused on absolute socioeconomic differences (prevalence difference between low and high occupational social class) and relative socioeconomic differences communicated by odds ratio for daily smoking. Results: The prevalence of daily smoking declined from 18.6% in 1991 to 4.5% in 2014. Across all surveys, the prevalence was 8.9% in high, 12.8% in middle and 16.5% in low occupational social classes ( p < 0.0001). The absolute socioeconomic differences increased from 1991 to 2006 and declined thereafter. Across all survey years, the odds ratio (95% confidence interval) for daily smoking was 1.40 (1.19–1.65) in middle and 1.90 (1.56-2.32) in low versus high occupational social classes. The statistical interaction between occupational social class and survey year was significant ( p = 0.0404), suggesting increasing relative socioeconomic differences from 1991 to 2014. Conclusions: There was a substantial decline in daily smoking among 15-year-olds between 1991–2014 in all occupational social class groups. The prevalence of daily smoking was highest in the low occupational social class during the entire period. The absolute socioeconomic differences in daily smoking increased between 1991–2006 and declined thereafter. The relative socioeconomic differences increased over 1991–2014. Studies of change in socioeconomic differences over time should address both absolute and relative socioeconomic differences as they may result in different conclusions and because important improvement in prevalence patterns may be disguised by exclusive focus on changes in relative socioeconomic differences.

Direct and Indirect Influences of Objective Socioeconomic Position on Adolescent Health: The Mediating Roles of Subjective Socioeconomic Status and Lifestyles

The use of composite indices and subjective measures to evaluate socioeconomic position, taking into account the effect of inequalities on adolescent health-related behaviors, can contribute to understanding the effect of inequalities on health during adolescence. The aim of this study was to examine the direct and indirect contribution of objective and subjective socioeconomic factors in a broad range of health and lifestyles outcomes. The data come from a representative sample of adolescents (N = 15,340; M age = 13.69) of the Health Behavior in School-aged Children study in Spain. Structural equation modeling was used for data analysis. A global index for evaluating objective socioeconomic position predicted both health and healthy lifestyles. Subjective socioeconomic status mediated the relationship between objective socioeconomic position and health but did not have a significant effect on healthy lifestyles when objective indicators were considered. Lastly, fit indices of the multiple-mediator model—including the direct effect of objective socioeconomic position on health and its indirect effects through the subjective perception of wealth and lifestyles—explained 28.7% of global health variance. Interventions aimed at reducing the impact of health inequalities should address, in addition to material deprivation, the psychological and behavioral consequences of feeling poor.

Socioeconomic position and occupational social class and their association with risky alcohol consumption among adolescents

OBJECTIVES

To compare different measures of socioeconomic position (SEP) and occupational social class (OSC) and to evaluate their association with risky alcohol consumption among adolescents attending the last mandatory secondary school (ages 15-17 years).

METHODS

This was a cross-sectional study. 1268 adolescents in Catalonia (Spain) participated in the study. Family affluence scale (FAS), parents' OSC, parents' level of education and monthly familiar income were used to compare socioeconomic indicators. Logistic regression analyses were conducted to evaluate socioeconomic variables and missing associated factors, and to observe the relation between each SEP variable and OSC adjusting by sociodemographic variables.

RESULTS

Familiar income had more than 30% of missing values. OSC had the fewest missing values associated factors. Being immigrant was associated with all SEP missing values. All SEP measures were positively associated with risky alcohol consumption, yet the strength of these associations diminished after adjustment for sociodemographic variables. Weekly available money was the variable with the strongest association with risky alcohol consumption.

CONCLUSIONS

OSC seems to be as good as the other indicators to assess adolescents' SEP. Adolescents with high SEP and those belonging to upper social classes reported higher levels of risky alcohol consumption.

Occupational Class Groups as a Risk Factor for Gastrointestinal Cancer: A Case-Control Study

BACKGROUND

Cancer has a high mortality rate in both developing and developed countries. 11%-15% of cancers are attributable to occupational risk factors.

OBJECTIVE

To determine if specific occupational classes, based on the International Standard for Classification of Occupations 2008 (ISCO-08), are risk factors for gastrointestinal (GI) cancer.

METHODS

In this case-control study, 834 cancer patients were interviewed by a single physician. Cases included patients with GI cancer. Age-matched controls were selected from non-GI cancer patients. Each year of working, up until 5 years before the diagnosis, was questioned and categorized by the ISCO classification.

RESULTS

243 GI cancer cases and 243 non-GI cancer patients (486 in total) were studied. Working in ISCO class 8 (plant and machine operators, and assemblers) was significantly associated with higher risk of GI cancer (OR 1.63, 95% CI 1.05 to 2.52). Working in ISCO class 6 (skilled agricultural, forestry and fishery workers) and 9 (elementary occupations) were also associated with higher incidence of GI cancers.

CONCLUSION

Working in ISCO classes of 8, 6, and 9, which are usually associated with low socio-economic status, can be considered a risk factor for GI cancers.

The role of community social capital in the relationship between socioeconomic status and adolescent life satisfaction: mediating or moderating? Evidence from Czech data

BACKGROUND

The concept of social capital has been extensively used to explain the relationship between socioeconomic status (SES) and adolescent health and well-being. Much less is known about the specific mechanism through which social capital impacts the relationship. This paper investigates whether an individual's perception of community social capital moderates or mediates the association between SES and life satisfaction.

METHODS

This study employs cross-sectional data from the 2009-2010 Czech Health Behaviour in School-Aged Children survey: a WHO Collaborative Cross-National Study (HBSC). A sample of 4425 adolescents from the 5^th, 7^th and 9^th grade (94.5% school response rate, 87% student response) was used to perform multilevel analysis.

RESULTS

We found that pupils' life satisfaction was positively related to both family affluence and perceived wealth. Moreover, we found the cognitive component of social capital to be positively associated with life satisfaction. Additionally, a significant interaction was found, such that the social gradient in life satisfaction was flattened when pupils reported high levels of perceived community social capital.

CONCLUSIONS

The present findings suggest that community social capital acts as an unequal health resource for adolescents, but could potentially represent opportunities for public health policy to close the gap in socioeconomic disparities.

Relative deprivation and risk factors for obesity in Canadian adolescents

Research on socioeconomic differences in overweight and obesity and on the ecological association between income inequality and obesity prevalence suggests that relative deprivation may contribute to lifestyle risk factors for obesity independently of absolute affluence. We tested this hypothesis using data on 25,980 adolescents (11-15 years) in the 2010 Canadian Health Behaviour in School-aged Children (HBSC) study. The Yitzhaki index of relative deprivation was applied to the HBSC Family Affluence Scale, an index of common material assets, with more affluent schoolmates representing the comparative reference group. Regression analysis tested the associations between relative deprivation and four obesity risk factors (skipping breakfasts, physical activity, and healthful and unhealthful food choices) plus dietary restraint. Relative deprivation uniquely related to skipping breakfasts, less physical activity, fewer healthful food choices (e.g., fruits, vegetables, whole grain breads), and a lower likelihood of dieting to lose weight. Consistent with Runciman's (1966) theory of relative deprivation and with psychosocial interpretations of the health consequences of income inequality, the results indicate that having mostly better off schoolmates can contribute to poorer health behaviours independently of school-level affluence and subjective social status. We discuss the implications of these findings for understanding the social origins of obesity and targeting health interventions.

Psychometric Validation of the Revised Family Affluence Scale: a Latent Variable Approach

The aim was to develop and test a brief revised version of the family affluence scale. A total of 7120 students from Denmark, Greenland, Italy, Norway, Poland, Romania, Scotland and Slovakia reported on a list of 16 potential indicators of affluence. Responses were subject to item screening and test of dimensionality. Bifactor analysis revealed a strong general factor of affluence in all countries, but with additional specific factors in all countries. The specific factors mainly reflected overlapping item content. Item screening was conducted to eliminate items with low discrimination and local dependence, reducing the number of items from sixteen to six: Number of computers, number of cars, own bedroom, holidays abroad, dishwasher, and bathroom. The six-item version was estimated with Samejima's graded response model, and tested for differential item functioning by country. Three of the six items were invariant across countries, thus anchoring the scale to a common metric across countries. The six-item scale correlated with parental reported income groups in six out of eight countries. Findings support a revision to six items in the family affluence scale.

Trends in social inequalities in adolescent health complaints from 1994 to 2010 in Europe, North America and Israel: The HBSC study

BACKGROUND

Studies have shown constant or increasing health inequalities in adulthood in the last decades, but less is known about trends in health inequalities among adolescents. The aim is to analyse changes in socioeconomic differences in subjective health complaints from 1994 to 2010 among 11- to 15-year-olds in Europe, North America and Israel.

METHODS

Data were obtained from the international 'Health Behaviour in School-aged Children' (HBSC) survey. Analyses were based on the HBSC surveys conducted in 1994 (19 countries), 1998 (25 countries), 2002 (32 countries), 2006 (37 countries) and 2010 (36 countries) covering a time period of up to 16 years. Log binomial regression models were used to assess inequalities in multiple health complaints. Socioeconomic position was measured using perceived family wealth.

RESULTS

Inequalities in multiple health complaints emerged in almost all countries, in particular since 2002 (RR 1.1-1.7). Trend analyses showed stable (29 countries), increased (5 countries), decreased (one country) and no social inequalities (2 countries) in adolescent health complaints.

CONCLUSION

In almost all countries, social inequalities in health complaints remained constant over a period of up to 16 years. Our findings suggest a need to intensify efforts in social and health policy to tackle existing inequalities.