National-Level Schoolwork Pressure, Family Structure, Internet Use, and Obesity as Drivers of Time Trends in Adolescent Psychological Complaints Between 2002 and 2018

Little is known about societal processes that contribute to changes in adolescent mental health problems. This study aims to fill this gap using data from the Health Behavior in School-aged Children study between 2002 and 2018 (n_countries = 43, n_individuals = 680,269, M_age = 14.52 (SD = 1.06), 51.04% female), supplemented with other international data. National-level psychological complaints increased more strongly among girls than boys. National-level schoolwork pressure, single-parent households, time spent on internet, and obesity were generally rising. In both boys' and girls' samples, increases in national-level schoolwork pressure, obesity, and time spent on internet use were independently associated with increases national-level psychological complaints. However, national-level obesity and psychological complaints were more strongly related among girls than boys. Results highlight the potential impact of societal-level processes on adolescent mental health problems.

Sexual attraction-based disparities in adolescent mental health: The role of school norms

Purpose

Few researchers have explained disparities in mental health between sexual minority and heterosexual adolescents by focusing on structural forms of stigma as, for instance, heterosexist school or classroom norms. Addressing this gap, our paper aimed to study disparities in life satisfaction, psychosomatic complaints, and emotional problems between sexual minority and heterosexual adolescents and examine the moderating role of heterosexist norms in the classroom and school.

Methods

We used data from the 2013 and 2017 Dutch Health and Behaviour in School-Aged Children (HBSC) study (N = 12,756; M age = 14.02; SD = 1.54). Separate multi-level analyses for life satisfaction, psychosomatic complaints, and emotional problems were conducted in which cross-level interaction effects between sexual attraction and school and classroom-level heterosexist norms were estimated.

Results

Same-sex attracted, both-sex attracted, and adolescents unsure about their sexual attraction reported lower life satisfaction, more psychosomatic complaints (not for unsure adolescents), and more emotional problems than their other-sex attracted peers. Stronger school-level heterosexist norms were associated with higher life satisfaction and fewer psychosomatic complaints and fewer emotional problems. Stronger classroom-level heterosexist norms were associated with less emotional problems. Few moderating effects of classroom and school-level heterosexist norms were found. Contrary to expectations, disparities in life satisfaction between same-sex attracted and other-sex attracted adolescents decreased when classroom-level heterosexist norms were stronger.

Conclusions

Although our findings suggest pressing health disparities between heterosexual and sexual minority adolescents, heterosexist norms at the school- and classroom-level hardly contributed to these health disparities.

Country-level social mobility and inequalities in adolescent health behaviours in 32 countries

Background

Higher family affluence is associated with healthier behaviours in adolescents, but the strength of this association varies across countries. Differences in social mobility at the country-level, i.e. the extent to which adolescents develop a different socioeconomic status (SES) than their parents, may partially explain why the association between family affluence and adolescent health behaviours is stronger in some countries than in others.

Methods

Using data from adolescents aged 11-15 years from 32 different countries, participating in the 2017/2018 wave of the Health Behaviour in School-aged Children (HBSC) study (N = 185,086), we employed multilevel regression models with cross-level interactions to examine whether country-level social mobility moderates the association between family affluence and adolescent health behaviours (i.e. moderate-to-vigorous physical activity, vigorous physical activity, healthy foods consumed, unhealthy foods consumed, having breakfast regularly, weekly smoking).

Results

Higher family affluence was more strongly associated with higher levels of physical activity in countries characterized by high levels of social mobility (cross-level interaction linear regression coefficient 0.34; 95% CI 0.08 to 0.60; p = 0.009 for moderate-to-vigorous physical activity, and 0.31; 0.11 to 0.50; p = 0.002 for vigorous physical activity). No cross-level interactions were found for any of the other health behaviours.

Conclusions

Our findings suggest that differences in social mobility at the country-level may contribute to cross-national variations in socioeconomic inequalities in adolescent physical activity. Further research can shed light on the mechanisms linking country-level social mobility to inequalities in adolescent physical activity to identify targets for policy and interventions.

Key messages

• This is one of the first studies to investigate country-level social mobility in relation to health equity. Inequalities in adolescent physical activity were steeper in socially mobile countries.

• Stronger efforts to engage adolescents from low-affluent families in physical activity may be necessary in countries characterized by high levels of social mobility.

Educational level, attention problems, and externalizing behaviour in adolescence and early adulthood

Background

Social causation as well as health-related selection may contribute to educational gradients in adolescents' attention problems (AP) and externalizing behaviour (EB). From past studies it is unclear which of these mechanisms predominates, as AP and EB have the potential to disrupt adolescents' educational careers, but may also be affected by differences in their social environment. Furthermore, gradients in AP and EB may reflect ‘third variables' already present in childhood, such as parental socioeconomic status (SES) and IQ. We investigated social causation and health-related selection in the development of educational differences in EB and AP.

Methods

We used data from a Dutch population-based cohort (TRAILS Study; n = 2,229), including measurements of educational level, EB, and AP at ages around 14, 16, 19, 22, and 26 years. First, we evaluated the directionality in longitudinal associations between education, EB, and AP with cross-lagged panel models, with and without adjusting for pre-existing individual differences using fixed effects. Second, we assessed the role of parental SES and IQ in childhood both as confounders in longitudinal associations, and as predictors of AP, EB, and educational level around age 14.

Results

In fixed effects models, AP, but not EB, consistently predicted decreases in educational level throughout all of adolescence and young adulthood. Regarding social causation, differences in parental SES contributed to increases in EB amongst the lower educational tracks in mid-adolescence. Childhood IQ and parental SES strongly predicted education around age 14. Parental SES, but not IQ, also predicted early adolescent AP and EB.

Conclusions

We found health-related selection attributable to AP throughout all phases of adolescence and young adulthood. Further, our results highlight the role of social causation from parental SES in determining adolescent educational level, AP, and EB.

Key messages

AP have the potential to negatively impact adolescents’ educational careers and may trigger downward mobility in the educational system in all phases of adolescence and young adulthood. The results of this study call for actions to reduce the impact of AP on education. Further, it is essential to address the effects of insufficient economic resources on education and mental health.

National level wealth inequality and socioeconomic inequality in adolescent mental wellbeing

Background

Previous research established a positive association between national income inequality and socioeconomic inequalities in adolescent health, but little is known about the extent to which national level inequalities in accumulated financial resources (i.e. wealth) are associated with these health inequalities. Therefore, we examined the association between national wealth inequality and income inequality and socioeconomic inequalities in adolescent mental wellbeing.

Methods

Data were from 17 countries participating in three successive waves (2010, 2014 and 2018) of the cross-sectional Health Behaviour in School-aged Children (HBSC) study. We combined individual-level data on adolescents' life satisfaction, psychological and somatic symptoms and socioeconomic status (SES) with country-level data on income and wealth inequality (n = 244771). We performed time-series analysis on a pooled sample of 48 country/year groups.

Results

Higher levels of national wealth inequality were associated with fewer average psychological and somatic symptoms, while higher levels of national income inequality were associated with more psychological and somatic symptoms. No associations between either national wealth inequality or income inequality and life satisfaction were found. Smaller differences in somatic symptoms between higher and lower SES groups were found in countries with higher levels of national wealth inequality. In contrast, larger differences in psychological symptoms and life satisfaction (but not somatic symptoms) between higher and lower SES groups were found in countries with higher levels of national income inequality.

Conclusions

Although both national wealth and income inequality are associated with (socioeconomic inequalities in) adolescent mental wellbeing, associations are in opposite directions. Further research is warranted to gain better understanding in the role of national wealth inequality on (socioeconomic inequalities in) adolescent health.

Key messages

This is one of the first studies to examine if socioeconomic inequalities in adolescent mental wellbeing are associated with national wealth inequality independently from national income inequality. Opposing effects of national wealth inequality and income inequality on socioeconomic inequalities in adolescents’ mental wellbeing warrant further research before policy recommendations can be made.

Immigration background and adolescent mental health problems: the role of family affluence, adolescent educational level and gender

PURPOSE

European studies demonstrated that immigrant adolescents are at a higher risk for mental health problems than native adolescents, but little is known about the role of socioeconomic status (SES) and gender in this association. This study examined to what extent differences in the mental health problems of non-western immigrant and native Dutch adolescents were explained by adolescents' family affluence and educational level and differed with the adolescents' family affluence, educational level, and gender.

METHODS

Adolescents in a Dutch nationally representative sample of 11-16-year old native Dutch (n = 5283) and non-western immigrants (n = 1054) reported on their family affluence, own educational level, conduct problems, emotional symptoms, peer relationship problems, and hyperactivity-inattention problems.

RESULTS

Non-western immigrant adolescents were at a higher risk for conduct problems and peer relationship problems than native Dutch adolescents, but family affluence and educational level explained only a very small proportion of these differences. With two exceptions, differences in the mental health problems of non-western immigrants and natives were highly comparable for different family affluence levels, educational levels, and for boys and girls. Only for natives, a higher family SES was related to less conduct problems. Furthermore, only for non-western immigrants a high family SES related to more hyperactivity-inattention problems.

CONCLUSIONS

Our findings illustrate that the association between immigration background and adolescent mental health problems is largely independent of SES and gender. Future studies should include other factors to facilitate our understanding of the association between immigration background and adolescent mental health problems.

The decline in adolescent substance use across Europe and North America in the early twenty-first century: A result of the digital revolution?

Objectives

Increases in electronic media communication (EMC) and decreases in face-to-face peer contact in the evening (FTF) have been thought to explain the recent decline in adolescent substance use (alcohol, tobacco, cannabis). This study addresses this hypothesis, by examining associations between (time trends in) EMC, FTF, and substance use in more than 25 mainly European countries.

Methods

Using 2002–2014 data from the international Health Behaviour in School-aged Children (HBSC) study, we ran multilevel logistic regression analyses to investigate the above associations.

Results

National declines in substance use were associated with declines in FTF, but not with increases in EMC. At the individual level, both EMC and FTF related positively to substance use. For alcohol and cannabis use, the positive association with EMC was stronger in more recent years. Associations between EMC and substance use varied across countries, but this variation could not be explained by the proportion of young people using EMC within countries.

Conclusions

Our research suggests that the decrease in FTF, but not the increase in EMC, plays a role in the recent decrease in adolescent substance use.

Electronic supplementary material

The online version of this article (10.1007/s00038-018-1182-7) contains supplementary material, which is available to authorized users.

The Happiest Kids on Earth. Gender Equality and Adolescent Life Satisfaction in Europe and North America

Cross-national differences in adolescent life satisfaction in Europe and North America are consistent, but remain poorly understood. While previous studies have predominantly focused on the explanatory role of economic factors, such as national wealth and income equality, they revealed weak associations, at most. This study examines whether societal gender equality can explain the observed cross-national variability in adolescent life satisfaction. Based on the assumption that gender equality fosters a supportive social context, for example within families through a more equal involvement of fathers and mothers in child care tasks, adolescent life satisfaction was expected to be higher in more gender-equal countries. To test this hypothesis, national-level data of gender equality (i.e., women’s share in political participation, decision making power, economic participation and command over resources) were linked to data from 175,470 adolescents aged 11–16 years old (M_age = 13.6, SD = 1.64, 52% girls) from 34 European and North American countries involved in the 2009/10 Health Behaviour in School-aged Children (HBSC) study. Results of linear multilevel regression analyses indicate that adolescents in countries with relatively high levels of gender equality report higher life satisfaction than their peers in countries with lower levels of gender equality. The association between gender equality and adolescent life satisfaction remained significant after controlling for national wealth and income equality. It was equally strong for boys and girls. Moreover, the association between gender equality and life satisfaction was explained by social support in the family, peer and school context. This analysis suggests that gender equality fosters social support among members of a society, which in turn contributes to adolescent life satisfaction. Thus, promoting gender equality is likely to benefit all members of a society; not just by giving equal rights to women and girls, but also by fostering a supportive social climate for all.