Online health information-seeking behaviour and mental well-being among Finnish higher education students during COVID-19

Online health information-seeking behaviour has increased since the World Health Organization declared COVID-19 a global pandemic in March 2020. This study examined whether health-related information on COVID-19 searched on the internet was associated with mental well-being among higher education students. A cross-sectional internet survey was conducted among 18- to 34-year-old students in Finland (N = 2976; mean age 24.61 years and median 24) in the spring of 2020. The data were analysed using descriptive statistics, Pearson's chi-square tests, Kruskal-Wallis nonparametric H tests, and a two-way ANOVA. The results indicated that most students (86% of females, 82% of males) used the internet to search for information on COVID-19. Students' self-perceived abilities to determine the relevance of online information on COVID-19 were associated with mental well-being.

A Chronic Disease in Adolescence and Selection to an Educational Path-A Longitudinal Study

Chronic disease may affect adolescents' educational success. We study whether adolescents with a somatic chronic condition have lower school performance, lower odds for academic education, and a delayed start of upper-secondary studies. Seventh graders and ninth graders in the Helsinki Metropolitan Region, Finland, were invited to participate in a school survey in 2011 and 2014, respectively. The respondents (2011, N = 8960; 2014, N = 7394) were followed using a national application registry until 2017. The chronic conditions were asthma, diabetes, and epilepsy. Outcomes were grade point average (GPA), study place in an academic school, and delayed start of secondary education. Adolescents with a chronic disease needing medication had lower GPAs in both grades. Chronic disease with medication in the seventh grade predicted higher odds for the non-academic track (OR = 1.3) and the delayed start (OR = 1.4). In the ninth grade, chronic disease predicted non-academic studies univariately (OR = 1.2) and was not associated with the delayed start. The somatic chronic condition with medication, particularly epilepsy, slightly lowers students' school performance, which is a mediator between the chronic condition and selection into educational paths. Compared to gender and parents' education, and particularly to GPA, the role of chronic conditions on educational outcomes is small.

A qualitative study on multisector activities to prevent childhood obesity in the municipality of Seinäjoki, Finland

Background

Multisector activities are needed to prevent childhood obesity due to its multifactorial background. The first aim was to identify the activities that had been undertaken for obesity prevention and deduce their main targets. Second, we analyzed the public health policy approaches (upstream, midstream, and downstream) which were followed. Finally, we studied the perception of interviewees regarding their sectors’ roles in implementing the local obesity program.

Methods

Deductive content analysis was used to analyze semi-structured interviews with 34 key professionals (from seven administrative sectors) who had participated in multisector health promotion during 2009–2016 and five representatives of other core parties.

Results

Several midstream and upstream activities were targeted at making physical activity (PA) and healthy eating (HE) integral parts of children’s lifestyle. One long-term strategy was to create environments for PA accessible to every inhabitant and build and renovate the interiors and yards of schools and day-care centers. The healthiness of meals was increased progressively. In addition to midstream and upstream activities, as a downstream activity, an intervention targeting children at risk of obesity was implemented. The impact of management on the activities was considerable; childhood obesity prevention was included in the city strategy and systematically coordinated at the highest managerial level. Altogether, various sectors operated efficiently to promote obesity-preventing lifestyles; however, not all (important) sectors recognized their role in the multisector process.

Conclusion

Most of the activities to guide children towards obesity-preventing lifestyles were either at the midstream or upstream level. Among the latter, considerable work is aimed at creating opportunities to practice PA and making it a natural part of the daily life. The aim of familiarizing children with lifestyles that include PA and HE was shared across sectors, including sectors that had not yet acknowledged their role in obesity prevention. Strong support from city management and systematic coordination of the activity are important factors that contribute to the engagement of several administrative sectors in working towards a shared aim, such as the prevention of childhood obesity.

Digital health literacy and information behaviour in university students in Finland

Background

During the COVID-19 pandemic, Internet and social media became important and fast sources of health information, leading to overabundance of both valid and invalid information. Digital health literacy (DHL) is a core competency for navigating web- and social media based COVID-19 information. This study is part of the global COVID-HL survey assessing DHL among university students.

Methods

Six universities from Eastern, Northern, Southern, and Western Finland participated in an online survey in May 2020. Five subscales from the DHL Instrument (DHLI), adapted to the context of the COVID-19 pandemic, were used. The data were analyzed using univariate and bivariate analyses.

Results

Mean age of the students (N = 3771) was 28 y. (females n = 2720). Students had searched information from the Internet for themselves and others (85,2%). Females had searched more than male, and the probability of searches increased with age. Majority of students (90,4%) considered information easy to find and 83,2% of students found it easy to use the information in decisions related to their health, males easier than female or diverse gender. The greatest difficulty was in assessing the reliability of information (24,0%). The sources for information seeking often were news sites, search engines, and websites of public bodies (64,8%, 50,5% and 44,1%, respectively). The topics that were most searched were spread of the coronavirus (90,1%), its symptoms (88,0%) and restrictions (87,7%). 86,3% of students considered the verified information very important.

Conclusions

Finnish students were rather confident in their DHL skills. However, almost every fourth had difficulties in assessing the reliability of the information, a key competence of DHL in the context of overabundance of information. This suggests that DHL, especially the competence of critically evaluate health related information, need to be strengthen among university students in Finland across different study subjects.

Relationship between screen time and sleep among Finnish preschool children: results from the DAGIS study

STUDY OBJECTIVES

To examine the associations between screen time, the time spent on different screen devices, and sleep in a sample of Finnish preschool children.

METHODS

The current study analyzed cross-sectional data from the DAGIS study carried out in Finland in 2015-2016 on 736 children aged 3-6 years. Parents reported in a 7-day diary the durations the child used screen devices daily, with separate details about watching TV or DVDs, using tablets or smartphones, and using computers. In addition, parents reported children's bedtimes and wake-up times, which were further used in calculating sleep duration. Parents answered questions regarding their child's sleep consistency. Statistical analyses included adjusted general linear modeling.

RESULTS

An hourly increase in total screen time was associated with 11 min later bedtime (p < 0.001) and 10 min shorter sleep duration (p < 0.001). More TV/DVD watching was associated with later bedtimes (p = 0.016) and a shorter sleep duration (p = 0.001). More smartphone/tablet use was associated with later bedtimes (p = 0.005), later wake-up times (p = 0.038), and weaker sleep consistency (p = 0.024). More computer use was associated with later bedtimes (p = 0.046). Results did not differ between genders.

CONCLUSIONS

Increased screen time was associated with later bedtimes and shorter sleep duration among preschool children. Adverse associations with sleep outcomes were found for each screen device. Attention should be paid to promoting balanced use of screens and regular sleep habits in young children.

Health and socioeconomic circumstances over three generations as predictors of youth unemployment trajectories

BACKGROUND

Youth unemployment is a critical life event, which may trigger other labour market-related disadvantages and detrimental health implications. To better understand the processes causing unemployment, we study how socioeconomic circumstances of successive generations and familial and health factors in adolescence predict youth unemployment trajectories between ages 16 and 28 in Finland from 2000 to 2009.

METHODS

We used survey data from 1979 to 1997 on 12- to 18-year-old Finns (n = 43 238) linked with 1970-2009 registry-based data of their grandparents, parents and themselves. Growth mixture modelling and multivariate logistic regression analyses were used.

RESULTS

Three latent youth unemployment trajectories emerged; low (46%), decreasing (38%) and high (16%) risk groups. Of adolescent factors, low school achievement was the most important predictor of youth unemployment followed by smoking, stress symptoms and poor self-rated health. Grandparents' education predicted their grandchildren's unemployment but the effects of other grandparental socioeconomic circumstances mediated through parents' socioeconomic status (SES). Parents' low SES and education, and long-term unemployment increased the risk of the child's unemployment. Youth unemployment was related to low education at the age of 29.

CONCLUSION

Grandparents' education, family socioeconomic circumstances and adolescents' health and school achievement predict the developmental trajectory of youth unemployment. Youth unemployment is also related to low education in early adulthood. Our findings suggest that the health selection of unemployment works already in adolescence.

How does reserve capacity influences transition into upper secondary school among adolescent Finns?

Background

Educational inequalities occur when differences in educational outcomes are more strongly related to students' background than their own academic efforts. During adolescence, psychosocial resources such as social support and self-efficacy, collectively termed “reserve capacity” may serve as a pathway to educational transitions and help reduce educational inequalities. We study how reserve capacity affects transition of adolescents into upper secondary school in terms of non-placement or placement into vocational or academic track.

Methods

We use data from 9th graders in 128 schools at the 14 municipalities of Helsinki Metropolitan region who participated in the MetLoFin follow-up survey in 2014 (n = 7,344 students). The data were linked with the national Joint Application Registry containing information on whether student was placed in academic (65%) or vocational (32%) track or had no placement (3%) for upper secondary schools. Multinomial logistic regression models, adjusted for sex and school, were fitted to analyse the effect of students' background and reserve capacity on type of educational placement.

Results

Students whose parents had low education were more likely to be in vocational than academic track compared to those whose parents had high education (OR = 2.5 95% CI: 2.1-3.0). Having a foreign background increased the risk of having no placement than academic placement (OR = 1.5 95% CI: 1.1-2.2) compared to native students. Low social support and low self-efficacy predicted vocational placement of students relative to academic track but not no placement compared to academic placement. Academic grades remained strongest predictor of placement.

Conclusions

Students' background still determine educational outcomes, but psychosocial resources could likely reduce educational inequalities and ensure successful educational transitions in adolescence.

Key messages

Social backgrounds impact adolescents’ educational transitions. Adding students’ psychosocial resources could reduce educational inequalities.

Multisector prevention of childhood obesity in a Finnish municipality - factors perceived as crucial

Background

Obesity among children threatens health and life expectancy. Risk factors interact in complex ways on individual, household, and community levels. Interventions on lifestyle factors have been targeted at children. Although some have impacted weight gain positively, environment and policy approaches by multiple actors across the society, especially when integrated in everyday life could have longer lasting effects. In Finland, multisector collaboration is enabled by several institutional structures, such as child welfare clinics and student welfare services. We studied in a municipality how administrative sectors and some key NGOs contributed to the prevention of childhood obesity, and particularly, which were the factors seen as potentially crucial.

Methods

The informants were purposely selected, being those, who had operated in the process of health promotion in the City of Seinäjoki (Finland) in 2009-2016. They represented several administrative sectors, either as office holders at the managerial level or as working at the operational level or in NGOs. In total, 37 participated (1 refusal) the semi-structured interviews, which were recorded, transcribed verbatim (355 pages), anonymized, and analyzed with deductive content analysis.

Results

There emerged six entities of factors crucial for obesity prevention: strong and long-term commitment to health promotion both at the administrative and executive levels; activity aiming at well-being of all inhabitants; a shared view of the importance of preventive work and multiprofessional collaboration; competent and development minded personnel, appropriate administrative structure and the strong leadership role of the health promotion coordinator; the light administrative structure of the Finnish municipality; convenient size of the municipality.

Conclusions

There was a shared opinion among the interviewees about the crucial elements of multisectoral collaboration for obesity prevention.

Key messages

Multisectoral collaboration and strong commitment to long-term activity both at the administrative and executive levels form key elements in the prevention of childhood obesity. A supportive administrative structure in a municipality together with strong coordination of health promotion are important prerequisites for the prevention of childhood obesity.

Does long-term disease in adolescence predict educational career?

Background

Serious long-term diseases like asthma, diabetes or epilepsy in adolescence means extra efforts to cope everyday life in school, hobbies or at home. These also set extra challenges on adolescents to go through the developmental tasks of that age. We study here, if adolescents with a long-term disease have lower chances for an academic education compared to those without a long-term disease.

Methods

In 2011, all 7th graders in the Helsinki Metropolitan area, Finland were invited to the MetLoFin survey (8946 students from 128 schools answered). In 2014, all 9th graders, representing the same cohort were invited in the end of the lower secondary school (7629; 127). The data were linked with the national Joint Application Registry for the upper secondary schools. Serious diseases were asthma, diabetes, epilepsy and some other individual diseases (6%).

Results

At the 7th grade, the OR for continuing in vocational track or not having got a study place instead of academic track was 1.2 for those with the long-term disease. The difference stayed after adjusting for parents' education and sex but disappeared after adjusting for GPA. At 9th grade, results were similar, but the association disappeared after adjusting for parents' education and sex.

Conclusions

Even in a country like Finland, with high quality health services for children, a long-term disease can compromise educational career, even if the effect is small. The effect mediates mainly through GPA, which is the main selection criteria for upper secondary school.

Key messages

A long-term disease in adolescence can lower chances for academic educational career, even though the effect is small. The effect is mainly mediating through poorer GPA.

Late start of upper secondary education and health-compromising behaviours among Finnish adolescents-a follow-up study

Background

The Finnish government has emphasized the need to expedite educational transitions. We study if a late start of upper secondary education is related to health-related selection, namely health-compromising behaviours in adolescence.

Methods

A large cohort of adolescents from the seventh (12–13 years) and ninth (15–16 years) grades answered online classroom surveys (total n = 10 873). They were followed to the start of upper secondary education, obtained from the Joint Application Registry. We compared those who continued studies directly from the ninth grade with later starters. We measured late bedtime, breakfast not every school day, tooth brushing less than twice-a-day, monthly alcohol consumption, weekly smoking, daily energy drinks, physical activity <6 days/week and excessive screen time. Multilevel logistic regressions and latent class analyses were conducted.

Results

In gender and school adjusted models in the seventh grade, all behaviours except physical activity predicted the late start. The strongest predictor was smoking, OR = 2.96 (CI = 2.25–3.89). In the ninth grade, smoking, breakfast, tooth brushing and energy drinks, OR = 1.80, (CI = 1.36–2.39, strongest), were predictive. After controlling for sociodemographic background and academic achievement, associations for alcohol and screen time became non-significant in the seventh grade. In the ninth grade, only screen time remained significant, OR = 1.33 (CI = 1.04–1.71). Health-compromising behaviours formed clusters. Belonging to the unhealthy cluster predicted the late start in both grades, in adjusted models only in the seventh grade.

Conclusions

Students with health-compromising behaviours are less likely to start upper secondary education directly after the compulsory education. This may increase the risk for fragmentary educational trajectories and work careers.

Compliance with the 24-h movement guidelines and the relationship with anthropometry in Finnish preschoolers: the DAGIS study

Background

Recent 24-h movement guidelines for the early years established recommendations for physical activity (PA), screen time (ST), and sleep. To date, few studies have focused on compliance with meeting the guidelines and their associations with health outcomes. Thus, we aimed to investigate: 1) compliance with the 24-h movement guidelines, and 2) associations between compliance and anthropometry in Finnish preschoolers.

Methods

We utilized DAGIS survey data that were collected in 2015–2016 (N = 864). PA was assessed 24 h/day over 7 days using a waist-worn ActiGraph wGT3X-BT accelerometer. ST and sleep were reported by the parents during the same 7 days. Anthropometry was assessed using body mass index (BMI, kg/m²) and waist circumference (WC, cm). Children were classified as meeting the guidelines if they averaged ≥180 min/day of PA, which consisted of ≥60 min of moderate-to-vigorous intensity; ≤60 min/day of ST; and 10–13 h/day of sleep. In total, 778 children (51% boys, mean age: 4.7 ± 0.9 years) were included in the study. The compliance with meeting the 24-h movement guidelines was calculated for each behavior separately and in combinations. Adjusted linear regression analyses were applied to examine associations of compliance with BMI and WC.

Results

Children were physically active on average 390 (±46.2) min/day and spent 86 (±25.5) min/day in moderate-to-vigorous PA. They spent 76 (±37.4) min/day on ST and had on average 10:21 (±0:33) h:min/day of sleep. The compliance rate in meeting all three movement guidelines overall was 24%. The highest compliance rate was found for PA (85%), followed by sleep (76%) and ST (35%). Meeting guidelines separately for PA or sleep, or for both, were associated with lower WC (PA: B = -1.37, p < 0.001; Sleep: B = -0.72, p = 0.009; PA + Sleep: B = -1.03, p < 0.001). In addition, meeting guidelines for sleep or for both PA and sleep were associated with lower BMI (Sleep: B = -0.26, p = 0.027; PA + Sleep: B = -0.30, p = 0.007). There were no significant associations found regarding ST.

Conclusions

Meeting recommendations for PA and sleep may have an important role in supporting a healthy weight status in young children. However, there is still a need to improve compliance with the 24-h movement guidelines, especially for ST.

Health and educational aspirations in adolescence: a longitudinal study in Finland

Background

The health selection hypothesis suggests that poor health leads to low educational attainment during the life course. Adolescence is an important period as poor health might prevent students from making the best educational choices. We test if health in adolescence is associated with educational aspirations and whether these associations persist over and above sociodemographic background and academic achievement.

Methods

Using classroom surveys, a cohort of students (n = 5.614) from the Helsinki Metropolitan Region was followed from the 7th (12–13 years,) up to the 9th grade (15–16 years) when the choice between the academic and the vocational track is made in Finland. Health factors (Strengths and Difficulties Questionnaire (SDQ), self-rated health, daily health complaints, and long-term illness and medicine prescribed) and sociodemographic background were self-reported by the students. Students’ educational aspirations (applying for academic versus vocational track, or both) and their academic achievement were obtained from the Joint Application Registry held by the Finnish National Agency for Education. We conducted multilevel multinomial logistic regression analyses, taking into account that students are clustered within schools.

Results

All studied health factors were associated with adolescents’ educational aspirations. For the SDQ, daily health complaints, and self-rated health these associations persisted over and above sociodemographic background and academic achievement. Students with better health in adolescence were more likely to apply for the academic track, and those who were less healthy were more likely to apply for the vocational track. The health in the group of those students who had applied for both educational tracks was in between. Inconsistent results were observed for long-term illness. We also found robust associations between educational aspirations and worsening health from grade 7 to grade 9.

Conclusions

Our findings show that selection by health factors to different educational trajectories takes place at early teenage much before adolescents choose their educational track, thus supporting the health selection hypothesis in the creation of socioeconomic health inequalities. Our findings also show the importance of adolescence in this process. More studies are needed to reveal which measures would be effective in helping students with poor health to achieve their full educational potential.

Children’s food intake in relation to preschool-level facilitators and barriers of healthy nutrition

Background

Childcare is an important setting for young children’s food consumption as, in Finland, most children eat three meals a day in childcare. Thus, it is important to recognize determinants of children’s dietary intake in childcare. The aim of this study was to examine food-related factors at preschool and manager-level and their association with children’s fruit, vegetable and fibre intake at preschool.

Methods

The study was a part of the cross-sectional DAGIS survey conducted in 2015-2016. It aimed to examine 3-6-year-old preschoolers’ energy balance-related behaviors in Finland. Preschool managers from 58 preschools filled in a questionnaire on food and nutrition related factors at preschool such as kitchen type, food policies, food education, the manager’s possibilities to impact fruit and vegetable supply and cooperation challenges with the catering service. Preschool personnel kept food record for the children (n = 585) on two preschool days. Multilevel linear and logistic regression analyses were conducted with age, gender and municipality as confounders, preschool-level factors as independent variables and children’s vegetable (g/day) and fruit (yes vs. no) consumption, and fibre intake (g/MJ) as outcome variables.

Results

Having many written food policies in the preschool was associated with higher intake of vegetables (p = 0.01) and fibre (p = 0.03) among the children. Having at least 2 out of 3 different cooperation challenges with the catering service was associated with higher intake of fibre (0.03) and lower odds of eating fruits (p = 0.01).

Conclusions

Written food policies and manager-reported challenges with the catering service were associated with children’s vegetable, fruit and fiber intake at preschool. Factors that are relatively distal from the meal situations may impact children’s food intake at preschool and should be taken into account when promoting healthy food intake at preschool, but more studies are needed.

Key messages

Written food policies and good cooperation between the preschool and catering services may be of benefit to children’s healthy food intake at preschool. The relation between preschool and manager-level factors and children’s food intake are very little studied, and thus more studies are needed before conclusions can be made.

Transition into secondary education and health-compromising behaviours: A longitudinal study

Background

We studied the associations of health-compromising behaviours with a transition into secondary education by following a large cohort of Finnish adolescents. Students with a direct (successful) transition into secondary education after the 9th grade (73%) and those with a late transition (7%) were compared.

Methods

We analysed the following health behaviours in the 7th and 9th grades collected in school surveys in the Helsinki Metropolitan Area: late bed time, irregular breakfast pattern, tooth brushing less than twice a day, monthly alcohol consumption, smoking, regular energy drink consumption, physical activity level under recommendations, and excessive screen time, as well as clustering of these behaviours.

Results

In logistics regression models (adjusted for gender, school), in the 7th grade all health-compromising behaviors except physical inactivity were related to the late transition, and in the 9th grade energy drink, smoking, breakfast, tooth brushing and screen time. In multivariate models (controlled for academic achievement, immigrant status, language spoken at home, and parents’ education) only bed time was independently associated in both grades. Bed time, breakfast, tooth brushing, alcohol, smoking, and energy drink formed three behavioral clusters -healthy, mixed, and unhealthy lifestyles. The last two predicted the late start in both grades; in multivariate models unhealthy only. Change in academic achievement over time, but not in lifestyle, predicted the transition.

Conclusions

Students with unhealthy lifestyle are more likely to start secondary education later than those with healthy lifestyle meaning also postponing of their graduation and start of working life.

Key messages

The unhealthy lifestyle of those who start secondary education later than average, may be one of the mechanisms in the origin of socioeconomic health differences in later life. Healthy lifestyle as early as 13 years predicts successful educational paths.

Fruit, Vegetable, and Fibre Intake among Finnish Preschoolers in Relation to Preschool-Level Facilitators and Barriers to Healthy Nutrition

Preschool is a major factor affecting food consumption among young children in Finland, given that most preschoolers eat three meals a day in that setting. Thus, it is important to recognise the determinants of dietary intake at preschool. The aim of this study was to examine food-related factors at the preschool and manager level, and their association with the dietary intake of children in childcare. The study was a part of the cross-sectional DAGIS survey conducted in 2015 to 2016 in Finland. The managers of 58 preschools filled in a questionnaire related to food and nutrition at their preschools. Preschool personnel kept food records for the children (n = 585) on two preschool days. Multilevel linear and logistic regression analyses were conducted with age, gender, and municipality as covariates, preschool-level factors as independent variables, and children's vegetable (g/day) and fruit (yes vs. no) consumption and fibre intake (g/MJ) as outcome variables. Having many written food policies in the preschool was associated with a higher intake of vegetables (p = 0.01) and fibre (p = 0.03) among the children. Having at least two out of three cooperation-related challenges with the catering service was associated with a higher intake of fibre (p = 0.03) and lower odds of eating fruit (p = 0.01). Factors that are relatively distal from meal situations may have an effect, and should be taken into account in the promotion of healthy eating at preschool, but more studies are needed.

Social determinants of adolescent smoking over three generations

Aim: We studied how multigenerational socioeconomic circumstances influence adolescents' smoking. Previous studies have shown that low academic achievement as well as parents' low socioeconomic circumstances are associated with adolescents' smoking, but there are few studies on grandparents' influence on their grandchildren's smoking. For the chain of three generations, we hypothesised that high socioeconomic circumstances of both parents and grandparents decrease the probability of smoking and adolescents' own education and circumstances contribute to this association. We further investigated the role of intergenerational social mobility. Method: Survey data from 1979 to 1997 on 12- to 18-year-old Finns (n=54,487) were linked with 1970-2009 registry-based data of their grandparents, parents and themselves. Socioeconomic circumstances among parents and grandparents were measured by socioeconomic status, education and material resources and among adolescents by academic achievement, educational orientation, family structure and parental smoking. Logistic regression analysis was used to study the associations. Results: Associations of adolescent smoking with grandparental socioeconomic circumstances were weak and mediated through parental circumstances. Parental smoking and divorce and living in a non-intact family increased smoking. Adolescents' low academic achievement and orientation to low education level were the most important predictors of smoking. Upward intergenerational social mobility between fathers and children decreased the risk of smoking, whereas downward mobility increased it. Conclusions: The influence of grandparents' low socioeconomic circumstances on grandchildren's smoking is mediated through parents' socioeconomic circumstances. Low academic achievement in adolescence is a strong predictor of smoking and adolescents orient towards the group of their future education level, not that of their parents.

Neighborhood Socioeconomic Status and Feeding Practices in Finnish preschools

Aims: Certain feeding practices, such as role modeling healthy eating and encouragement are recommended to be used in preschools. Little is known about whether preschool characteristics are associated with the use of these feeding practices. Our aim was to examine whether the socioeconomic status (SES) of the preschool neighborhood is associated with the feeding practices in preschools. Methods: This study was part of the cross-sectional DAGIS study. We studied 66 municipal preschools and 378 early childhood educators (ECEs). Preschool neighborhood SES was assessed with map grid data. Feeding practices were assessed by questionnaires and lunchtime observation. Associations between preschool neighborhood SES and feeding practices were tested with logistic regression analyses adjusted for ECEs' educational level and municipal policies on ECEs' lunch prices, and on birthday foods. Results: The crude model showed that in high-SES neighborhood preschools ECEs were more likely to eat the same lunch as the children (OR 2.46, 95% CI 1.42-4.24) and to reward children with other food for eating vegetables (OR 2.48, 95% CI 1.40-4.41). Furthermore, in high-SES preschools it was less likely that birthday foods outside of the normal menu were available on birthdays (OR 0.29, 95% CI 0.12-0.71). In the adjusted model, rewarding with other food remained associated with preschool neighborhood SES (OR 2.13, 95% CI 1.12-4.07). Conclusions: After adjustments, preschool neighborhood SES was mostly unassociated with the feeding practices in preschools. Municipal policies may have a significant impact on feeding practices and ultimately on young children's food intake in Finland where most children attend municipal preschools.

Increased Health and Wellbeing in Preschools (DAGIS) Study-Differences in Children's Energy Balance-Related Behaviors (EBRBs) and in Long-Term Stress by Parental Educational Level

This paper describes the Increased Health and Wellbeing in Preschools (DAGIS) survey process and socioeconomic status (SES) differences in children's energy balance-related behaviors (EBRBs), meaning physical activity, sedentary and dietary behaviors, and long-term stress that serve as the basis for the intervention development. A cross-sectional survey was conducted during 2015⁻2016 in 66 Finnish preschools in eight municipalities involving 864 children (3⁻6 years old). Parents, preschool personnel, and principals assessed environmental factors at home and preschool with questionnaires. Measurement of children's EBRBs involved three-day food records, food frequency questionnaires (FFQ), seven-day accelerometer data, and seven-day sedentary behavior diaries. Children's long-term stress was measured by hair cortisol concentration. Parental educational level (PEL) served as an indicator of SES. Children with low PEL had more screen time, more frequent consumption of sugary beverages and lower consumption of vegetables, fruit, and berries (VFB) than those with high PEL. Children with middle PEL had a higher risk of consuming sugary everyday foods than children with high PEL. No PEL differences were found in children's physical activity, sedentary time, or long-term stress. The DAGIS intervention, aiming to diminish SES differences in preschool children's EBRBs, needs to have a special focus on screen time and consumption of sugary foods and beverages, and VFB.

Association of Self-Perceived Physical Competence and Leisure-Time Physical Activity in Childhood-A Follow-Up Study

BACKGROUND

The basis of self-perceived physical competence is built in childhood and school personnel have an important role in this developmental process. We investigated the association between initial self-perceived physical competence and reported leisure-time physical activity (LTPA) longitudinally in 10-, 12-, and 15-year-old children.

METHODS

This longitudinal follow-up study comprises pupils from an elementary school cohort (N = 1346) in the city of Turku, Finland (175,000 inhabitants). The self-perceived physical competence (fitness and appearance) and LTPA data were collected with questionnaires. The full longitudinal data were available from 571 pupils based on repeated studies at the ages of 10, 12, and 15 years in 2004, 2006, and 2010. We analyzed the association of self-perceived physical competence and LTPA using regression models.

RESULTS

Self-perceived physical competence was positively associated with LTPA at all ages (10 years p < .05, 12 years p < .0001, 15 years p < .0001). Increase in the self-perceived physical fitness scores was likely to associate with higher LTPA at each age point (10 years [odds ratio, OR] = 1.18, 95% confidence interval, CI: 1.09-1.27; 12 years [OR] = 1.27, 95% CI: 1.18-1.37; and 15 years [OR] = 1.28, 95% CI: 1.19-1.38).

CONCLUSIONS

Self-perceived physical competence is associated with LTPA in children and adolescents, and the association is strengthened with age.

Tobacco use and exposure to tobacco promoting and restraining factors among adolescents in a developing country

OBJECTIVE

With a long history of tobacco cultivation, adolescents in Ghana are at relatively high risk of the emerging tobacco epidemic in developing countries. This study explored exposure to tobacco promoting/restraining factors and their associations with smoking and tawa (traditional smokeless tobacco) use among 13-18-year-old Ghanaians.

METHODS

School-based representative data were collected in 2008 (n = 1165).

RESULTS

Prevalence rates of tobacco use, smoking and tawa use were 9.1% (11.5% boys and 6.4% girls), 6.6% (8.0% boys and 4.7% girls) and 5.7% (7.3% boys and 3.9% girls), respectively. Four percent of the respondents attended schools without a smoking ban, 66% had been taught about the harmful effects of smoking in the current school year, and 53% had been exposed to tobacco advertising. Fifty-three percent of adolescents who had tried to purchase tobacco products were not refused because of their age. Multivariate analyses found that attendance at a school where smoking was allowed, not having been taught about the harmful effects of smoking, exposure to tobacco advertising and parental smoking were positively associated with tobacco use, and knowledge that smoking is harmful to health and difficult to quit were negatively associated with tobacco use.

CONCLUSIONS

Both smoking and tawa use were relatively low among Ghanaian adolescents. Exposure to tobacco advertising was high. There is no tobacco legislation in Ghana, but societal norms or cultural values seem to restrict smoking in schools and access to tobacco products.

Socioeconomic differences in alcohol and drug use among Ghanaian adolescents

Socioeconomic differences in experimental alcohol use, drunkenness, marijuana use and other drug uses among adolescents in Ghana was investigated using multiple socioeconomic indicators. A school-based cross-sectional survey of a representative sample of 12-18-year-olds (N=1195, response rate=89.7%) was conducted in Ghana in 2008. Logistic regression analysis was applied to model the associations between substance use and socioeconomic status. Use of marijuana and drugs was associated with lower material affluence while experimental alcohol use was associated with higher material affluence. Living in non-nuclear family was predictive of other drug uses and drunkenness. Other drug uses were associated with lower paternal education and occupation while drunkenness was associated with lower paternal education. Individual anticipated future social position measured by plans after graduation was the strongest predictor of experimental alcohol use, drunkenness, marijuana and other drug uses. Interventions are need to prevent adolescence substance use especially among those in danger of discontinuing schooling and those in less affluence families.

Do socioeconomic differences in tobacco use exist also in developing countries? A study of Ghanaian adolescents

Background

In Western countries, tobacco use is most prevalent among adolescents in lower socioeconomic groups. The association between socioeconomic status (SES) and tobacco use among adolescents in developing countries is unexplored. Using multiple SES measures, we investigated this association among adolescents in Ghana.

Method

A school-based survey of a representative sample of 13-18-year-old Ghanaians (N = 1,165, response rate = 89.7%) was conducted in three regions, in 2008. Logistic regression analysis was used to evaluate the relationship of smoking, tawa (smokeless tobacco) use with familial SES (parental occupation and education, material affluence scale, family structure), an adolescent's individual social position (school performance, plans after graduation) and inter-generational social mobility (predicted by the differences of familial and individual positions).

Results

Socioeconomic differences existed in tobacco use whether measured by familial SES or individual social position with higher prevalence in lower socioeconomic groups. Low father's education and living in a non-nuclear family were associated with both forms of tobacco use while low material affluence was associated with tawa use only; individual social position measured by plans after graduation was the strongest predictor of both smoking and tawa use. Inter-generational downward social mobility and particularly staying in low SES was related to both forms of tobacco use.

Conclusions

Similar to Western countries, lower SES is related to an adolescent's tobacco use also in developing countries. Cumulative socioeconomic disadvantage over generations increases the probability of tobacco use.

Socioeconomic differences in smoking among Finnish adolescents from 1977 to 2007

PURPOSE

Persistence of socioeconomic differences in smoking among adolescents over time is unexplored. We investigated the changes in smoking among 12-18-year-old Finns from 1977 to 2007 using multiple indicators of socioeconomic status (SES) to determine whether differences between socioeconomic groups increase over time, with reduced smoking in higher socioeconomic groups.

METHODS

Nationwide biennial surveys were conducted since 1977 (response rate, 59%-88%; N = 96,747) using familial and individual social position (school performance/career) indicators. Associations between socioeconomic indicators and smoking were evaluated using logistic regression analysis.

RESULTS

Socioeconomic differences in smoking measured by familial SES or individual social position persisted over time, with higher rates in lower SES groups. Individual social position was more strongly related to smoking than familial SES. Differences between groups assessed by individual social position increased over time: the difference in smoking prevalence between groups with the lowest and highest individual social position among 12-14-year-old girls and boys, respectively, was 22% and 28% in 1977-1983, and 45% and 34% in 2001-2007; and in 16-18-year-old girls, 33% in 1977-1983 and 48% in 2001-2007. Smoking differences in relation to father's education increased over time: the difference in 12-14-year-old girls and boys, respectively, between the lowest and highest SES groups was 6% and 5% in 1977-1983 and 9% and 8.5% in 2001-2007; and in 16-18-year-old girls and boys, respectively, 7% and 10% in 1977-1983 and 13% and 14.5% in 2001-2007.

CONCLUSIONS

Differences between socioeconomic groups among Finnish adolescents persisted or increased over 30 years, and predict differences in smoking-related diseases between socioeconomic groups in adulthood.

Indicators for Measuring Material Affluence of Adolescents in Health Inequality Research in Developing Countries

The aim of the present study was to (i) develop a material affluence scale (MAS) for measuring adolescent SES in health inequality research in developing countries, (ii) compare the association of the MAS with the parental SES measures (parental occupation and education), and (iii) evaluate the association of parental SES and MAS with key health and health behaviour indicators. We used school-based cross-sectional survey conducted in thirty districts within three administrative regions in southern Ghana (a West African country) among adolescents ages 12-18-year old (N = 1,195) as an example. Principal Component Analysis (PCA) was used as the main statistical technique. MAS categorised adolescents into material affluence groups (MAS scores for the poorest, poor, average, affluent and most affluent were-1.679, -0.355, 0.354, 0.725 and 1.022 from the first principal component quintile respectively), it has adequate internal coherence (alpha = 0.622) and moderately correlates with parental SES (r = 0.39, p < 0.001). MAS and parental SES showed similar pattern of strength and direction of association with selected health and health behaviour indicators. MAS presents a viable alternative method for measuring adolescent's SES in health inequality research in developing countries and could be useful as well in western countries.

Sociodemographic factors and a secular trend of adolescent overweight in Finland

BACKGROUND AND AIM

The prevalence of overweight and obesity increased three-fold among Finnish adolescents during the past three decades. The aim of the present study was to evaluate whether this secular trend differed between sociodemographic subgroups of adolescents.

METHODS

Mailed surveys were conducted among nationally representative samples of 12-18 year olds biennially in 1979-2005 (N=3,105-8,390 per year, response rates 88%-66%). Body mass index was calculated from self-reported weight and height, and overweight (including obesity) was defined according to the IOTF reference for children. Associations between sociodemographic factors and secular trend in the prevalence of overweight were tested by logistic regression including interaction terms between survey year and sociodemographic variables.

RESULTS

Throughout the study period a higher prevalence of overweight, as compared with the respective reference groups, was observed among adolescents from rural areas, Western or Eastern Finland; or from lower socioeconomic status families (as measured by father's/guardian's education or occupational status or by mother's education); adolescents reporting lower school achievement, attending vocational school or not going to school at all; adolescents whose fathers were not employed outside home; and among girls living in non-nuclear families or whose mothers were unemployed/laid-off or retired/on long-lasting sick leave. The statistically significant interactions between survey year and sociodemographic variables on the prevalence of overweight were few and inconsistent.

CONCLUSION

The prevalence of overweight varied across sociodemographic subgroups of adolescents but in general no sociodemographic differences in the trends over time were observed. These results suggest that factors underlying the increasing trend of overweight have affected the entire adolescent population.

Attitudes towards and perceptions about contraceptive use among married refugee women of Somali descent living in Finland

OBJECTIVES

To assess attitudes towards and perceptions about contraceptive use among married refugee women of Somali descent living in Finland.

METHOD

A sample of 100 married refugee women of Somali descent (18-50 years of age) were invited to participate in a study on contraceptive use in Finland (30 women refused). Qualitative and quantitative methods were used to collect the data. Questionnaire of the first data set was written in the Somali language. Interviews were conducted in the Somali language.

RESULTS

The attitudes and opinions of these women towards contraceptive use (73% did not use contraceptives, 27% did use them) were connected with religious beliefs and issues involving marital relations. Religious or gender issues did not seem to influence those who used contraception.

CONCLUSIONS

The findings indicated that the majority of the married refugee women of Somali descent living in Finland did not use contraception. The process of starting the use of contraception was possible because of an access to good reproductive health care and family planning services, changes in life situations, and adaptations to Finnish social and cultural norms.

Early risk factors for lumbar discectomy: an 11-year follow-up of 57,408 adolescents

There is a lack of longitudinal studies on the risk factors of lumbar discectomy. Using combined population survey and hospital discharge register data in a prospective longitudinal design, we investigated the association between adolescent risk factors and lumbar discectomy until early middle age. A prospective cohort of health survey respondents (n = 57,408) aged 14-18 years was followed for 651,000 person-years (average follow-up, 11.3 years). Study endpoints were lumbar discectomy, death or end of follow-up. Participants' mean age at the end of follow-up was 27 years. In multivariate Cox's regression analysis, the significant risk factor for lumbar discectomy among male respondents was daily smoking, HR being 1.5 (95% CI 1.1-2.2). In females, frequent participation in sports clubs (HR 2.7, 95% CI 1.1-6.3) and overweight (HR 2.1; 95% CI 1.1-4.1) were significantly associated with an increased risk of lumbar discectomy. Daily smoking in males and frequent participation in sports clubs and overweight in females measured at adolescence were statistically associated with lumbar discectomy at an 11-year follow-up, although the hazard ratios were relatively small. Further study of these common risk factors and their modifications may lead to a better understanding of the causes of lumbar disc herniation.

Health related quality of life in 10-year-old schoolchildren

OBJECTIVE

The purpose of this study was to investigate the health related quality of life (HRQL) in a total cohort of general school children.

METHODS

The study population consisted of the children starting 4th grade (age 9-10) in Finnish primary schools in autumn 2004 (n = 1,346) and their parents in a city of 175,000 inhabitants. Pediatric Quality of Life Inventory 4.0 (PedsQL 4.0) was used for assessment of HRQL. The response rate was 81% for the children (n = 1,091). Most children had parents who participated (n = 999).

RESULTS

The children reported highest HRQL mean values in physical (85.00, SD 10.95) and social (84.71, SD 14.28), and lowest in school (78.89, SD 14.53) and emotional (75.43, SD 15.67), functioning scales. Girls reported significantly lower emotional (t = -2.43, P = 0.02) functioning than boys. Child self reports show lower social (t = -2.57, P = 0.01) and school (t = -3.44, P = 0.0006) functioning, and higher emotional (t = 5.82, P < 0.0001) and physical (t = 4.79, P < 0.0001) functioning than their parent-proxy assessments.

CONCLUSIONS

Interventions aiming at supporting the emotional and school functioning of the school children are recommended. Parents may overestimate the social and school functioning and underestimate the physical and emotional functioning compared to their children's own perceptions.

Predictors of low back pain hospitalization--a prospective follow-up of 57,408 adolescents

Low back pain (LBP) is common among adolescents and it has been estimated that one-fifth of adolescents suffer from recurrent severe LBP. However, longitudinal studies describing the risk factors of LBP are scarce. The purpose of this study was to investigate whether health, physical activity and other health behaviors, socio-demographic background and school success predict LBP hospitalization until early middle age. A cohort of 72,378 adolescents (57,408 respondents, response rate 79%) aged 14-18 years participating in a population survey between 1979 and 1997 was followed for an average of 11.1 years through the national hospital discharge register. We identified 810 (1.1%) persons with LBP hospitalization, 620 males (1.7% of the whole male cohort) and 190 (0.5%) females (HR 3.2; 95% CI: 2.7-3.7). In multivariate Cox's analysis, the strongest risk factors for LBP hospitalization for the whole cohort were weekly health complaints (HR 1.5; 95% CI: 1.2-1.9), daily smoking (HR 1.4; 95% CI: 1.1-1.7), and poor school success (HR 1.4; 95% CI: 1.1-1.9). Late puberty decreased the risk in males (HR 0.7; 95% CI: 0.5-0.9). Among females, participation in organized sports (HR 1.7; 95% CI: 1.1-2.5) was associated with an increased risk for LBP hospitalization. The associations between the risk factors and LBP hospitalization persisted into adulthood. Efforts to reduce adolescent smoking may decrease LBP-related morbidity in males. Coaches should pay special attention to the nature of physical training and personal exercises in females, and physiotherapists and sports physicians to the prevention of LBP hospitalization.

Participation in sports clubs is a strong predictor of injury hospitalization: a prospective cohort study

The aim of this prospective cohort study was to investigate the nature and risk factors of injuries leading to hospitalization. A cohort of 57 407 Finns aged 14-18 years was followed in the Hospital Discharge Register for an average of 10.6 years, totaling 608 990 person-years. We identified 5889 respondents (10.3%) with injury hospitalization. The most common anatomical location was the knee and shin (23.9%), followed by the head and neck (17.8%), and the ankle and foot (16.7%). Fractures (30.4%) and distortions (25.4%) were the most common injury types. The strongest risk factor for injury hospitalization was frequent participation in sports clubs [hazard ratio (HR) in males 1.8; 95% confidence interval (CI): 1.7-2.0 and in females 2.3; 95% CI: 1.9-2.7], followed by recurring drunkenness (HR 1.6; 95% CI: 1.4-2.7 in males and 1.4; 95% CI: 1.2-1.6 in females) and daily smoking (HR 1.4; 95% CI: 1.3-1.5 in males and 1.43 95% CI: 1.2-1.5 in females). The association between injuries and sports clubs participation remained after adjusting for sociodemographic background, health, and health behaviors. Health behavior in adolescence, particularly sports club activity, predicted injury hospitalization. Preventive interventions directed toward adolescents who participate in sports clubs may decrease injury occurrence.

Adolescents' health and health behaviour as predictors of injury death. A prospective cohort follow-up of 652,530 person-years

Background

Injuries represent an important cause of mortality among young adults. Longitudinal studies on risk factors are scarce. We studied associations between adolescents' perceived health and health behaviour and injury death.

Methods

A prospective cohort of 57,407 Finns aged 14 to 18 years was followed for an average of 11.4 years. The end-point of study was injury death or termination of follow-up in 2001. The relationships of eight health and health behaviour characteristics with injury death were studied with adjusted Cox's proportional hazard model.

Results

We identified 298 (0.5%) injury deaths, 232 (0.9%) in men and 66 (0.2%) in women. The mean age at death was 23.8 years. In the models adjusted for age, sex and socioeconomic background, the strongest risk factors for injury death were recurring drunkenness (HR 2.1; 95% CI: 1.4–3.1) and daily smoking (HR 1.7; 95% CI: 1.3–2.2). Poor health did not predict injury death. Unintentional and intentional injury deaths had similar health and health behavioural risk factors.

Conclusion

Health compromising behaviour adopted at adolescence has a clear impact on the risk of injury death in adulthood independent from socioeconomic background. On the other hand, poor health as such is not a significant predictor of injury death. Promotion of healthy lifestyle among adolescents as part of public health programmes would seem an appropriate way to contribute to adolescent injury prevention.

Alcohol use in families: a 15-year prospective follow-up study

AIMS

To study the prevalence of adolescents' problematic alcohol use and its parental predictors: drinking habits and socio-demographic factors.

DESIGN, SETTING, PARTICIPANTS AND MEASUREMENTS

Questionnaires were sent regularly to the same Finnish families (n = 1132) from the onset of pregnancy (in 1986-87) to the child's age of 15 years (in 2001-02) (n = 1028). There was a total of three follow-up points.

FINDINGS

At 15 years of age, 83% of girls and 79% of boys had used alcohol; 18% of boys and 14% of girls had been drunk more than once a month. The child's permanent separation from at least one biological parent was the strongest socio-demographic predictor of adolescents drinking. Fathers' present heavy drinking and parental early drinking were the best predictors of their children's problematic alcohol use at the age of 15.

CONCLUSIONS

Knowledge of fathers' alcohol use and its time of onset may be used to determine children who are at added risk of problematic alcohol use later in life. Special guidance, support and treatment can be targeted to these families.

Use of information and communication technology and prevalence of overweight and obesity among adolescents

BACKGROUND

The prevalence of overweight and obesity has increased among children and adolescents, as well as among adults, and television viewing has been suggested as one cause. Playing digital games (video, computer and console games), or using computer may be other sedentary behaviors related to the development of overweight and obesity.

OBJECTIVE

To study the relationships of times spent on viewing television, playing digital games and using computer to overweight among Finnish adolescents.

DESIGN

Mailed cross-sectional survey.

SUBJECTS

Nationally representative samples of 14-, 16-, and 18-y-old (N=6515, response rate 70%) in 2001.

METHODS

Overweight and obesity were assessed by body mass index (BMI). The respondents reported times spent daily on viewing television, playing digital games (video, computer and console games) and using computer (for e-mail, writing and surfing). Data on timing of biological maturation, intensity of weekly physical activity and family's socio economic status were taken into account in the statistical analyses.

RESULTS

Increased times spent on viewing television and using computer were associated with increased prevalence of overweight (obesity inclusive) among girls: compared to girls viewing television <1 h daily, the adjusted odds ratio (OR) for being overweight was 1.4 when spending 1-3 h, and 2.0 when spending > or =4 h daily on viewing television. In girls using computer > or =1 h daily, the OR for being overweight was 1.5 compared to girls using computer <1 h daily. The results were similar in boys, although not statistically significant. Time spent on playing digital games was not associated with overweight.

CONCLUSION

Overweight was associated with using information and communication technology (ICT), but only with certain forms of ICT. Increased use of ICT may be one factor explaining the increased prevalence of overweight and obesity at the population level, at least in girls. Playing digital games was not related to overweight, perhaps by virtue of game playing being less sedentary or related to a different lifestyle than viewing television and using computer.

Pubertal timing and educational careers: a longitudinal study

BACKGROUND

Pubertal timing is related to several dimensions of adolescent development. No studies concern its associations with educational careers.

AIM

To investigate whether pubertal timing predicts attained educational level and how school achievement, educational track and sociodemographic background in adolescence mediate this relationship.

SUBJECTS AND METHODS

Survey data (1981, 1983, 1985) from samples of 12-16-year-old Finns (n = 7674) were linked with the respondents' attained education in 1998 (ages 27-33). Ages of menarche and of first ejaculation were indicators of pubertal timing.

RESULTS

Among boys who by age 16 had experienced early, average or late pubertal timing, 13%, 12%, and 6% reached upper tertiary educational level, respectively. Boys with early or average puberty often came from high social strata and selected educational tracks with good prospects. In girls, sociodemographic factors rather than pubertal timing predicted attained educational level.

CONCLUSIONS

Early or average onset of puberty plays a role in dividing boys into educational tracks after compulsory schooling. Support should be given to boys, whose delayed pubertal development makes them immature to making appropriate educational decisions and to boys who may have experienced early puberty but fail to exploit educational opportunities available for them.

Health behaviours and health in adolescence as predictors of educational level in adulthood: a follow-up study from Finland

A longitudinal study design is used to find out whether health and health behaviours at age 12-16 predict educational level in early adulthood. The purpose is to study direct (based on health) and indirect (based on health behaviours) health-related selection mechanisms in adolescence. These mechanisms contribute to the allocation of people into various educational positions and thus to the creation of socio-economic health differences in adulthood. Baseline data at age 12-16 from the Adolescent Health and Lifestyle Survey (Finland) in 1981, 1983 and 1985 were linked with data on highest attained education at age 27-33, obtained from the Register of Completed Education in 1998. In the baseline surveys, all 12-, 14- and 16-year-olds born within a specified range of birth dates in July 1964, 1966, 1968, or 1970 were included in the samples (N=11149). The response rate in the mailed surveys varied between 74% and 88% in boys and between 85% and 92% in girls. Associations between baseline variables and attained educational level were assessed by polychotomous logistic regression analysis.Health-compromising behaviours and poor perceived health in adolescence predicted low educational level in adulthood. Several behaviours had independent associations with attained educational level, while associations between health and educational level were mostly accounted for by school achievement and sociodemographic background, which were strong and independent predictors of educational level. The study indicates that in adolescence, indirect selection based on health behaviours, rather than direct selection by perceived health, contributes to the production of socio-economic health differences.

Toothbrushing as part of the adolescent lifestyle predicts education level

Socio-economic differences in health and health behavior are well-known. Our hypothesis was that toothbrushing frequency in adolescents predicts their education level in adulthood. The aim was also to study the role of toothbrushing in adolescents' health-related lifestyle. Data from nationally representative samples of 12- to 16-year-olds (N = 11,149) were linked with register data on the highest level of education attained at age 27-33 years. Adolescents with a low toothbrushing frequency reached only the lowest education levels. School achievement or sociodemographic background only partly accounted for the association. Exploratory factor analysis found four dimensions of health behaviors. At age 12, a low toothbrushing frequency was loaded highly with "street-oriented" behaviors, concentrated around smoking and alcohol use. At ages 14 and 16, it was associated with a "traditional" lifestyle of the less-well-educated. Altogether, a low toothbrushing frequency indicated selection into the less-well-educated stratum of society. This is likely to be reflected in socio-economic health differences in adulthood.

Health related lifestyle in adolescence predicts adult educational level: a longitudinal study from Finland

OBJECTIVE

To assess the relative importance of perceived health and health related lifestyle in adolescence in the production of educational differences.

DESIGN

A longitudinal study: survey data from 1981 and 1985 linked with Educational Registry data from 1993.

SETTING

The whole of Finland.

PARTICIPANTS

A representative sample of 4761, 16 and 18 year olds. The follow up rate was 82%.

MEASUREMENTS AND MAIN RESULTS

The outcome variable was the attained educational level at age 24 to 30. Predictive variables described health related lifestyle and health at the age of 16 and 18. Those whose educational level was low at follow up, had in adolescence, a more health compromising lifestyle than those who had reached higher levels. They had placed less emphasis on health promoting behaviours like not smoking, physical exercise, good diet, and dental hygiene. Smoking was the outstanding predictor of attained educational level. Among the health variables, only psychosomatic symptoms predicted high educational levels in girls, and both psychosomatic symptoms and height in boys.

CONCLUSION

Those who reach a high level of education in adulthood, have had a health enhancing lifestyle already in adolescence, while those reaching only a low level, have had a health compromising lifestyle. Health plays only a small part in the prediction of adult educational level. The results suggest that a health compromising lifestyle, adopted already in adolescence, is an important mechanism from which educational health differences originate.

Teaching sociology of medicine: the group process

As a part of any curriculum reorganization, new instructional methods are also tested. When the University of Turku sociology of medicine course was found to need renovation, its goals and objectives, content and instructional methods were closely examined and modified, in order to strengthen institutional and multiprofessional relations and reinforce sociocultural issues in doctors' competence with the patient. This paper discuss this change, emphasizing teaching and learning methodology.

Health status: does it predict choice in further education?

STUDY OBJECTIVE

To study the significance of a young person's health to his or her choice of further education at age 16.

DESIGN

A cross sectional population survey

SETTING

The whole of Finland.

PARTICIPANTS

A representative sample of 2977 Finnish 16 year olds. The response rate was 83%.

MEASUREMENTS AND MAIN RESULTS

The three outcome variables reflected successive steps on the way to educational success: school attendance after the completion of compulsory schooling, the type of school, and school achievement for those at school. Continuing their education and choosing upper secondary school were most typical of young people from upper social classes. Female gender and living with both parents increased the probability of choosing to go on to upper secondary school. Over and above these background variables, some health factors had additional explanatory power. Continuing their education, attending upper secondary schools, and good achievement were typical of those who considered their health to be good. Chronically ill adolescents were more likely to continue their education than the healthy ones.

CONCLUSIONS

School imposes great demands on young people, thus revealing differences in personal health resources. Adaptation to the norms of a society in which education is highly valued is related to satisfying health status. In a welfare state that offers equal educational opportunities for everyone, however, chronically ill adolescents can add to their resources for coping through schooling. Health related selection thus works differently for various indicators of health and in various kinds of societies. Social class differences in health in the future may be more dependent on personally experienced health problems than on medically diagnosed diseases.