Is BMI a Valid Indicator of Overweight and Obesity for Adolescents?

Background: Overweight and obesity are mostly monitored via the Body Mass Index (BMI), based on self-reported or measured height and weight. Previous studies have shown that BMI as a measure of obesity can introduce important misclassification problems. The aim of this study was to assess the validity of overweight and obesity classification based on self-reported and on measured height and weight versus the proportion of body fat as the criterion. Methods: We used data on 782 adolescents (mean age = 13.5, 55.8% boys) from the Health Behaviour in School-Aged Children (HBSC) study conducted in 2018 in Slovakia. We obtained self-reported (height and weight) and objective measures (height, weight) and the proportion of fat (as the criterion measure) measured via bioimpedance body composition analysis (BIA) with an InBody 230 from the adolescents. Results: Both measured and self-reported BMI indicated overweight and obesity with relatively low sensitivity (66-82%), but high specificity (90-92%). The superior accuracy of measured BMI in comparison to self-reported BMI was confirmed by the area under the curve (AUC) based on the receiver operating characteristics (ROC) curves (AUC measured/self-reported: 0.94/0.89; p < 0.001). The misclassification of overweight and obesity was significantly higher when using self-reported BMI than when using measured BMI. Conclusion: Both self-reported and measured BMI as indicators of overweight and obesity underestimate the prevalence of adolescents with overweight and obesity.

Is being a boy and feeling fat a barrier for physical activity? The association between body image, gender and physical activity among adolescents

Regular physical activity leads to physical and mental health benefits. Previous studies have shown physical activity to be associated with body image and gender. The aim of this cross-sectional study was to explore the associations of body image with physical activity of adolescents and whether gender modifies this association. We obtained data on body image and physical activity as part of the Health Behaviour in School-Aged Children study in 2010 from Slovakia (n = 8042, age 11–15 years, 49% boys, response rate: 79.5%). Adolescents answered questions about their body image and the frequency of their physical activity. Sufficient physical activity was more likely in adolescents perceiving themselves as fat (OR = 0.63, 95%CI 0.54–0.73) and in boys (OR = 2.15, 95%CI 1.92–2.42). A poor body image among girls was not associated with physical activity, whereas among boys it was associated with less physical activity. Gender seems to moderate the relationship between body image and physical activity in youths. Health promotion should be targeted in particular at boys with a negative body image, as they are at higher risk of physical inactivity.

Status and Trends of Physical Activity Surveillance, Policy, and Research in 164 Countries: Findings From the Global Observatory for Physical Activity-GoPA! 2015 and 2020 Surveys

BACKGROUND

Physical activity (PA) surveillance, policy, and research efforts need to be periodically appraised to gain insight into national and global capacities for PA promotion. The aim of this paper was to assess the status and trends in PA surveillance, policy, and research in 164 countries.

METHODS

We used data from the Global Observatory for Physical Activity (GoPA!) 2015 and 2020 surveys. Comprehensive searches were performed for each country to determine the level of development of their PA surveillance, policy, and research, and the findings were verified by the GoPA! Country Contacts. Trends were analyzed based on the data available for both survey years.

RESULTS

The global 5-year progress in all 3 indicators was modest, with most countries either improving or staying at the same level. PA surveillance, policy, and research improved or remained at a high level in 48.1%, 40.6%, and 42.1% of the countries, respectively. PA surveillance, policy, and research scores decreased or remained at a low level in 8.3%, 15.8%, and 28.6% of the countries, respectively. The highest capacity for PA promotion was found in Europe, the lowest in Africa and low- and lower-middle-income countries. Although a large percentage of the world's population benefit from at least some PA policy, surveillance, and research efforts in their countries, 49.6 million people are without PA surveillance, 629.4 million people are without PA policy, and 108.7 million live in countries without any PA research output. A total of 6.3 billion people or 88.2% of the world's population live in countries where PA promotion capacity should be significantly improved.

CONCLUSION

Despite PA is essential for health, there are large inequalities between countries and world regions in their capacity to promote PA. Coordinated efforts are needed to reduce the inequalities and improve the global capacity for PA promotion.

The Spiritual Well-Being Scale: Psychometric Evaluation of the Shortened Version in Czech Adolescents

The aim of this study was to psychometrically evaluate the shortened version of the Spiritual Well-Being Scale (SWBS) in Czech adolescents. A nationally representative sample of 4217 adolescents participated in the 2014 Health Behaviour in School-aged Children survey. The internal consistency of the SWBS was assessed using Cronbach's alpha (α) and Mean Inter-Item Correlation (MIIC) values. The factor structure was evaluated using principal component analyses. After adjustment, our new seven-item version of the scale supports a two-factorial model of the SWBS with satisfactory internal consistency (α = 0.814, MIIC = 0.379). This version of the SWBS is suitable for measuring spiritual well-being in a secularising environment.

After the bell: adolescents' organised leisure-time activities and well-being in the context of social and socioeconomic inequalities

BACKGROUND

Previous research has linked adolescents' participation in organised leisure-time activities (OLTAs) to better health and well-being. It remains unclear whether these associations can be observed consistently across social and socioeconomic strata and countries.

METHODS

The present study used nine nationally representative samples of adolescents aged 11, 13 and 15 years (total n=55 429) from the 2017/2018 Health Behaviour in School-aged Children survey from Europe and Canada. Regression models with mixed effects to account for nested nature of data were applied to estimate: (1) the associations of social and socioeconomic factors with OLTA participation; (2) strengths of the associations between breadth and pattern of OLTA participation with health and well-being indicators, after adjustment for the social and socioeconomic factors.

RESULTS

Rates of OLTA participation varied by age, sex and country of adolescents. Participants from lower socioeconomic classes and non-nuclear families were less likely to participate in OLTAs across each of the nine countries. Moreover, breadth of OLTA participation was associated with higher well-being independent of socioeconomic status or family structure. All of the participation patterns were associated with higher life satisfaction, but sports (either alone or in combination with a non-sport OLTA) were also associated with fewer psychological complaints and excellent self-rated health.

CONCLUSION

Adolescents' engagement in OLTAs was associated with adolescents' subjective well-being regardless of country, age, sex and variance in social and socioeconomic factors. Policies aimed at increasing adolescents' subjective well-being and OLTA participation should focus on adolescents from low socioeconomic classes and non-nuclear families.

Time trends in consumption of sugar-sweetened beverages and related socioeconomic differences among adolescents in Eastern Europe: signs of a nutrition transition?

BACKGROUND

High intake of sugar-sweetened beverages (SSBs) contributes to detrimental cardio-metabolic indicators in youth. Monitoring of SSB consumption is lacking in Eastern Europe.

OBJECTIVES

We assessed trends in the prevalence of adolescent daily consumption of SSBs in 14 Eastern European countries between 2002 and 2018, both overall and according to family material affluence.

METHODS

We used 2002, 2006, 2010, 2014, and 2018 data of the Health Behaviour in School-Aged Children school-based study (repeated cross-sectional). Nationally representative samples of adolescents aged 11, 13, and 15 years were included (n = 325,184; 51.2% girls). Adolescents completed a standardized questionnaire, including a question on SSB consumption frequency. We categorized adolescents into 3 socioeconomic groups based on the relative Family Affluence Scale (FAS). Adjusted prevalences of daily SSB consumption by survey year, as well as country-level time trends between 2002 and 2018, were computed using multilevel logistic models (overall and by FAS groups).

RESULTS

In 2018, the prevalence of adolescents consuming SSBs every day varied considerably between countries (range, 5.1%-28.1%). Between 2002 and 2018, the prevalence of daily SSB consumption declined in 10/14 countries (P for linear trends ≤ 0.004). The largest reductions were observed in Slovenia (OR, 0.48; 95% CI: 0.45-0.50) and the Russian Federation (OR, 0.67; 95% CI: 0.64-0.70). Daily SSB consumption was reduced at faster rates among the most affluent adolescents (who were larger consumers in 2002) than in the least affluent adolescents in 11/14 countries (P for linear trends ≤ 0.004). Thus, differences between FAS groups narrowed over time or even reversed, leading to larger proportions of daily consumers in the least affluent adolescents in 2018 in 5/14 countries (P ≤ 0.05).

CONCLUSIONS

Adolescent daily consumption of SSBs decreased between 2002 and 2018 in most Eastern European countries. Declines were larger among higher-affluence adolescents. These results are useful to evaluate and plan interventions promoting healthy childhood diets.

Typologies of Joint Family Activities and Associations With Mental Health and Wellbeing Among Adolescents From Four Countries

PURPOSE

This study aims to identify distinct typologies of joint family activities and the associations with mental health and wellbeing among adolescents across four countries from the World Health Organization European region.

METHODS

The 2017/2018 data from adolescents from Armenia (n = 3,977, M_age = 13.5 ± 1.6 years, 53.4% female), Czechia (n = 10,656, M_age = 13.4 ± 1.7, 50.1% female), Russia (n = 4,096, M_age = 13.8 ± 1.7, 52.4% female), and Slovakia (n = 3,282, M_age = 13.4 ± 1.5, 51.0% female) were collected in schools. The respondents self-reported their participation in joint family leisure-time activities, life satisfaction, psychological and somatic complaints, as well as a range of demographic and family situational factors. Stratified by countries, latent class analysis identified typologies of joint family activities, and logistic regression models explored cross-sectional associations with life satisfaction, and psychological and somatic complaints.

RESULTS

Three typologies were identified across each of the four countries, distinguished by low, moderate, and high levels of family engagement. Adolescents with higher family engagement generally reported greater life satisfaction and fewer psychological complaints compared to those with lower family engagement. Russian adolescents in the high family engagement typology reported fewer somatic complaints compared to those with low family engagement. In addition, adolescents from Czechia and Russia showing moderate family engagement also reported fewer psychological complaints compared to those in the low family engagement typology.

DISCUSSION

Our findings from four countries suggest that adolescents with high family engagement have greater life satisfaction and fewer psychological complaints, pointing toward a need for interventions to support family engagement among adolescents. Further research is needed to fully explore underlying mechanisms.

Cross-national variation in the association between family structure and overweight and obesity: Findings from the Health Behaviour in School-aged children (HBSC) study

Background

Trends of increased complexity in family structure have developed alongside increasing prevalence of overweight and obesity. This study examines cross-national variations in the likelihood of living with overweight and obesity among adolescents living with one parent versus two parents, as well as the influence of living with stepparents, grandparents and siblings. Furthermore, the study explores how these associations relate to age, gender and individual-level socioeconomic status (SES) and country-level SES. We hypothesised that adolescents living in one-parent versus two-parents families, were more likely to live with overweight and obesity.

Methods

The study is based on nationally representative data from 41 countries participating in the 2013/14 Health Behaviors in School-Aged Children study (n = 211.798). Multilevel logistic regression analysis was used to examine the associations between family structure and overweight and obesity by age, gender, SES, and geographic region, among adolescents aged 11, 13 and 15 years.

Results

Living with one versus two parent(s) was associated with a higher likelihood of overweight and obesity (ORadj.1.13, 95%CI 1.08,1.17). Age, gender, individual-level SES, and living with grandparents were also associated with a higher likelihood of overweight and obesity, whereas living with siblings was associated with a lower likelihood of overweight and obesity. The effect of family structure varied also by age and gender with no significant associations found between living with one parent and overweight and obesity in the 15-year-old age group. Some cross-national variation was observed, and this was partly explained by country-level SES. The effect of family structure increased by a factor 1.08 per one-unit change in country-level SES (OR 1.08, 95%CI1.03, 1.12).

Conclusion

The study indicates that living in a one-parent family, as well as living together with grandparents, are associated with overweight and obesity among adolescents, particularly in the Nordic European region. Existing welfare policies may be insufficient to eliminate inequalities related to family structure differences.

Gender-specific social and environmental correlates of active travel to school in four European countries: the HBSC Study

Introduction

Despite the health benefits, a large proportion of girls and boys in Europe do not travel to school actively. A better understanding of the correlates associated with this behavior could guide interventions. This study examines perceived social and environmental correlates of active travel to school (ACTS) from the 2017/18 Health Behavior in School-Aged Children (HBSC) survey in four European countries, with a special emphasis on gender differences (n = 22,023).

Methods

Logistic regression was conducted to analyze associations between the perceived importance of each correlate and ACTS behavior for 11-, 13-, and 15-year-old girls and boys from Germany, Czechia, Poland, and Slovakia. All models were adjusted for age, family affluence, and meeting World Health Organization recommendations for moderate-to-vigorous physical activity.

Results

Rates of ACTS significantly differed between girls and boys. In Czechia, 65% of girls and boys traveled to school actively, followed by Slovakia (61.4% girls and 58.4% boys), Poland (57.7% girls and 60.2% boys), and Germany (42.6% girls and 48.6% boys). Girls were less likely to actively travel to school compared to boys (odds ratio [OR]: 0.92, 95% confidence interval [CI]: 0.87-0.97). Increasing age (OR: 0.95, 95% CI: 0.93-0.97) and a greater distance to school index (OR: 0.89, 95% CI: 0.88-0.90) were both negatively associated with ACTS. The perceived importance of living closer to school and of road and neighborhood safety was positively associated with ACTS, with a stronger association in boys than in girls for neighborhood safety. On the contrary, the perceived importance of having people to walk with was negatively associated with ACTS, with a stronger association in girls (OR: 0.74, 95% CI: 0.65-0.84) than in boys (OR: 0.77, 95% CI: 0.66-0.88).

Discussion

This study provides insights into perceived social and environmental correlates associated with ACTS behavior. Future research should include gender-specific perceptions and more in-depth investigations of correlates encouraging ACTS, especially considering social aspects, safety issues, and the structuring of the environment in different cultural settings.

Does it fit better? Measures of physical activity among adolescents in relation to health indicators

BACKGROUND

Measuring physical activity (PA) is one of the pillars of successful health promotion; however, we struggle to find a tool enabling the identification of risk groups. The current standard approach of assessing moderate-to-vigorous physical activity (MVPA) every day does this inadequately. The aim of this study is to explore whether three other indicators of adolescents' PA can identify such risk groups in a better way.

METHODS

We used data on 888 11- to 15-year-old adolescents (mean age = 13.5, 56% boys) from the Health Behaviour in School-aged Children study conducted in 2018 in Slovakia. Sufficient PA was indicated by the following four indicators: (i) MVPA every day, (ii) MVPA 5-7 days a week, (iii) engagement in organized sports (team or individual) and (iv) combining MVPA 5-7 days a week and engagement in organized sports. We used binary logistic regression analysis to assess the association of various indicators of adolescents' PA with body composition, cardiovascular fitness and self-rated health (SRH), considering age and gender.

RESULTS

Being active based on various indicators was associated with better health outcomes, with the strongest associations for the indicator combining MVPA 5-7 days a week and engagement in organized sports. The only exceptions were the non-significant associations of active adolescents (being active 5-7 days per week or engaged in organized sports) with cardiovascular fitness and SRH.

CONCLUSIONS

Measuring PA using an indicator that combines MVPA 5-7 days a week and engagement in organized sports is the most valid using three health indicators as criteria.

Body image, body composition and environment: do they affect adolescents' physical activity?

BACKGROUND

Most adolescents are less physically active than recommended, despite the strong effort of various stakeholders to promote physical activity (PA). Body image and body composition may play an important role not only in directly facilitating adolescents' PA but also in enabling environment-related factors. As evidence is lacking, we aimed to assess the associations of adolescents' PA with body-related and environment-related factors, whether this differs by age and gender, and whether these factors interact.

METHODS

We used data on 888 11- to 15-year-old adolescents (mean age = 13.5, 56% boys) from the Health Behaviour in School-aged Children study conducted in 2018 in Slovakia. We used multinomial logistic regression analysis to assess the association of adolescents' PA with body-related factors (body image, body composition) and environment-related factors (PA-promoting environment, less leisure constraints), taking into account age and gender.

RESULTS

Adolescents who perceived their body as not too fat were more likely to be physically very active rather than inactive [odds ratios (ORs)/95% confidence interval (CI) 2.15/1.44-3.22], and similarly those who were not overweight/obese (3.24/2.09-5.01) and perceived less leisure constraints (1.74/1.44-2.11). In older adolescents and in girls, the association of adolescents' PA with body composition and environment-related factors was stronger. The association of adolescents' PA with perceiving less leisure constraints was stronger among adolescents who did not perceive their body as too fat (OR/95% CI 1.98/1.26-3.14), and for those who were not overweight/obese (OR/95% CI 1.62/1.01-2.57).

CONCLUSION

Adolescents' PA is associated with both body-related and environment-related factors. These associations are stronger in girls and older adolescents, if co-occurring.

Body Fat Mediates Association between Active Living and Health among Adolescents

The aim of this study was to explore the association of moderate-to-vigorous physical activity and organized leisure-time activities with self-rated health among adolescents and whether these associations are mediated by body fat percentage. We used data on 888 adolescents (mean age 12.97, SD 1.20, 56.0% boys) from the Health Behaviour in School-aged Children (HBSC) study conducted in 2018 in Slovakia. We used logistic regression models to examine associations within self-reported data (moderate-to-vigorous physical activity and organized leisure-time activities with self-rated health) and their mediation by anthropometric data (body fat percentage). The adolescents who were sufficiently physically active and with normal body fat were more likely to report good or excellent health (odds ratios-OR/95% confidence intervals-95% CI: 3.52/1.50-8.27 and 3.66/2.37-5.68). Similarly, the adolescents who were engaged in individual/team sport and with normal body fat were more likely to report good or excellent health (OR/95% CI: 2.04/1.31-3.17 and 3.66/2.37-5.68). Adjustment for body fat percentage reduced the association between moderate-to-vigorous physical activity and self-rated health by 27.6% and the association between leisure-time activities and self-rated health by 30.7%. Active living and normal body fat might contribute to better health in adolescence. Programs and efforts to increase physical activity and leisure-time activities in childhood and adolescence need to identify which aspects of these activities are important, effective, and crucial for the population of adolescents.

Family structure and the association with physical activity-Findings from 40 countries participating in the Health Behaviour in School-aged Children (HBSC) study

BACKGROUND

The family has been acknowledged as central to developing physical activity (PA) beliefs and behaviours. However, increased diversity in family structures has developed over the last decades. This study examines the association between family structure and PA among adolescents and cross-national variations in the associations.

METHODS

The data are from the 2013/14 Health Behaviours in School-Aged Children study, involving nationally representative samples of 11-, 13- and 15-year-olds (n = 211,798) from 40 countries. Multilevel Poisson regression analysis was used to examine the associations between family structure and moderate to vigorous physical activity (MVPA) and vigorous physical activity (VPA) by age, gender, socioeconomic status (SES), and geographic region.

RESULTS

Living with one versus two parents was associated with a reduced likelihood of daily 60 min MVPA for boys (IRR = 0.96, 95% CI: 0.92, 0.99) and ≥ 4 times/week VPA (IRR 0.93, 95% CI: 0.91, 0.95). This impact on MVPA differed across individual-level SES (high SES; IRR = 0.92, (p <0.05), low SES; IRR = 1.04, (ns)), and was for VPA only significant for those with siblings (IRR = 0.93, 95% CI: 0.91, 0.96). Cross-country variations in the association between living with one versus two parents were observed, most pronounced for VPA. These differences varied by region, primarily explained by country-level SES differences between regions. The likelihood of daily 60 min MVPA also increased with siblings in the main house (IRR 1.11, 95% CI: 1.07, 1.14), and ≥ 4 times/week VPA decreased with grandparents in the main house (IRR 0.91, 95% CI: 0.89,0.94).

CONCLUSIONS

Family structure correlated with PA, but cross-country differences exist. The findings are relevant for the development of policies and programs to facilitate PA, especially in countries where living with one versus two parents was unfavourable. Additional country-specific research is needed to identify challenges for engaging in PA related to family structure.

Sleep characteristics and adolescent physical activity-related injuries in sports clubs, leisure time and schools

OBJECTIVE

Sleep has been identified as an important factor in relation to physical activity-related injury (PARI) in adolescents. The study aimed to explore associations between sleep duration, sleep problems and PARI among Slovak adolescents in three different settings: sports clubs, leisure time and schools.

METHODS

We analysed data from the cross-sectional Health Behaviour in School-aged Children study conducted in 2022 on a representative sample of 10 163 Slovak adolescents aged from 10.5 to 18.3 (mean age 13.4 (SD=1.5); 50.9% boys). Data were collected through self-administered online questionnaires completed by respondents in schools during the classes. Multiple logistic regression models were used to assess associations between sleep duration during schooldays and weekends, sleep problems and PARI in sports clubs, leisure time and schools.

RESULTS

Adolescents with normal sleep duration during schooldays and those who reported no problems with falling asleep, waking up at night and day sleepiness had a higher chance of not being injured during PA in sports clubs, leisure time and schools compared with adolescents with short sleep duration and sleep problems. Sufficient sleep duration during the weekend increased the probability of not having PARI in leisure time and schools, with the strongest association between long sleep duration and PARI in leisure time.

CONCLUSION

Good sleep quality and sufficient sleep duration were found to play a protective role in relation to PARI in adolescents. The findings suggest implementing sleep interventions in PARI prevention programmes, which must be considered a key component of adolescent PA promotion.

Barriers and enablers for sufficient moderate-to-vigorous physical activity: The perspective of adolescents

BACKGROUND

Interventions to improve physical activity (PA) among adolescents continue to be a public health priority. To promote PA more effectively, we need to identify the main factors contributing to (not) engagement in PA in the perspective of adolescents themselves. Thus, we explored the barriers and enablers for sufficient moderate-to-vigorous physical activity (MVPA) in adolescents from their point of view.

METHODS

We used qualitative data collected as part of the international Health Behaviour in School-Aged Children study. We obtained data from 14-17 years old adolescents from the first year of Slovak high school. We conducted 11 online, semi-structured individual and group interviews with 24 participants in total (7 boys; mean age = 15.17, SD = 0.87) in Slovakia. We analysed the data using consensual qualitative research and thematic analysis.

RESULTS

In the statements of adolescents, four main themes were identified regarding factors contributing to (not) engagement in PA among adolescents. 'Myself as a source' represents the importance of adolescents' own efforts, knowledge, physical predispositions and PA experience. 'How PA can be done' represents school as an opportunity for PA, and PA teachers and sports coaches as specialists who can create an enabling environment for sports. 'Others as a source' represents the social circle that can set a positive sports example and can encourage adolescent's efforts in PA. 'Factors outside' represents other factors that can inspire adolescents, e.g. by giving them a comfortable space and time to exercise, or can be a barrier to PA.

CONCLUSION

The potential factors that include adolescents' perspectives can be more leveraged in designing supportive, inclusive, enjoyable, and skills-appropriate PA programmes.

Are adolescents' physical activity and body-related factors associated with medically attended injuries?

BACKGROUND

Injuries are the major cause of disability and death during adolescence, representing a significant public health burden among youth. Body-related factors such as body composition and cardiovascular fitness (CVF) may affect adolescents' vulnerability to injuries. As evidence is lacking, we aimed to explore the associations of medically attended injuries with adolescents' physical activity (PA) and body-related factors, and whether these associations are modified by age, gender and family affluence.

METHODS

We used data on 888 11- to 15-year-old adolescents (mean age = 13.5, 56% boys) from the Health Behaviour in School-aged Children study conducted in 2018 in Slovakia. We used binary logistic regression analysis to assess the association of medically attended injuries with adolescents' PA and body-related factors (body composition, CVF), considering age, gender and family affluence.

RESULTS

Adolescents were more likely to report medically attended injuries if they were physically very active (odds ratio/confidence interval OR/CI:2.76/1.83-4.15) or active (OR/CI:1.91/1.27-2.87) rather than inactive. Body-related factors were not associated with medically attended injuries among adolescents. Moreover, age, gender and family affluence did not modify the association of medically attended injuries with adolescents' PA and body-related factors. The only exception was the modifying effect of gender: the association of medically attended injuries with being very active was stronger in boys (OR/CI: 3.04/1.32-6.99).

CONCLUSION

Very physically active adolescent boys are the most vulnerable group of adolescents in terms of injuries. PA promotion programmes should further consider gender-specific strategies aimed at preventing injuries.