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(1) Background: The World Health Organization (WHO)-5 Well-Being Index has been used in many epidemiological studies to assess adolescent mental well-being. However, cross-country comparisons of this instrument among adolescents are scarce and, so far, no good-fitting, common invariant measurement model across countries has been reported. The present study aims to evaluate and establish a version of the WHO-5 Well-Being Index that allows for a valid cross-country comparison of adolescent self-reported mental well-being. (2) Methods: Using data from the 2018 Health Behaviour in School-aged Children study, we evaluated the measurement model and measurement invariance of the five items of the WHO-5 Well-Being Index. We used nationally representative samples of 11-, 13-, and 15-year-old adolescents ( N = 74,071) from fifteen countries and regions in Europe. Measurement invariance of the WHO-5 was assessed using a series (country, gender, and age) of multi-group confirmatory factor analyses. In addition, we evaluated the convergent validity of the measure by testing its correlations with psychosomatic complaints, life satisfaction, and self-rated health. (3) Results: We found that WHO-5 does not show good psychometric properties or good measurement invariance fit. However, by excluding the first item of the scale ("I have felt cheerful and in good spirits"), the WHO-4, consisting of the other four original items, had good psychometric properties, and demonstrated good suitability for cross-national comparisons (as well as age and gender) in adolescent mental well-being. (4) Conclusions: The present study introduces the WHO-4-a revised version of the WHO-5-, that allows for a valid comparison of mental well-being across fifteen countries and regions in Europe. The WHO-4 proved to be a reliable and valid instrument to assess mental well-being in the adolescent population.

The Guilt and Shame Experience Scale (GSES) is a new, brief self-report instrument for assessing experiences of guilt and shame. It includes two distinct scales: feelings of shame and feelings of guilt. The present report focuses on results from a final validation study using a nationally representative sample of 7899 adolescents (M age = 14.5 ± 1.1 years, 50.7% boys) who participated in the 2014 Health Behavior in School-aged Children study. For factor analysis, the dataset was divided into two groups. One group ( n = 3950) was used for the Exploratory Factor Analysis (EFA) and the second ( n = 3949) for the Confirmatory Factor Analysis (CFA). The EFA results in a one-factor model of the GSES scale, while the CFA suggests a two-factor solution mirroring two scales, feelings of shame and feelings of guilt. Both models have a good fit to the data, and the scale also showed high internal consistency (Cronbach's alpha = 0.89). A nonparametric comparison of different sociodemographic groups showed a higher disposition for experiencing guilt and shame among girls, students of the ninth grade, and religious respondents. A comparison of the results to previously published results obtained from adults indicates that adolescence is a developmental period involving low differentiation between moral emotions like guilt and shame compared with adulthood. Moreover, positive association with religious attendance shows a need of addressing these issues in a pastoral care setting.

The aim of this study was to investigate the test-retest reliability of the motives for undertaking physical activity (PA) items from the Health Behavior in School-Aged Children (HBSC) study questionnaire among Slovak and Czech adolescents and to determine whether this reliability differs by gender, age group and country. We obtained data from 580 students aged 11 and 15 years old (51.2% boys) who participated in a test and retest study with a four-week interval in 2013 via the Health Behavior in School-Aged Children cross-sectional study in the Czech Republic and Slovakia. We estimated the test-retest reliability of all 13 dichotomized motives by using Intraclass Correlation Coefficients (ICC) and Cohen's Kappa statistics, for continuous and dichotomized motives, respectively. Test-retest reliability showed moderate agreement for nine motives (ICC from 0.41 to 0.60) and fair agreement for four motives (ICC from 0.33 to 0.40). Kappa statistics were similarly moderate to large (0.33 to 0.61), except for three motives with small or trivial correlations. The motives "To improve my health" and "To enjoy the feeling of using my body" had consistently low Kappas and correlations. Overall, the results of this study suggest that most questions on motives for PA on the HBSC questionnaire have acceptable test-retest characteristics for use among adolescents.

(1) Background: There is a need for studies on population-level health literacy (HL) to identify the current state of HL within and between countries. We report comparative findings from 10 European countries (Austria, Belgium (Fl), Czechia, England, Estonia, Finland, Germany, Macedonia, Poland, and Slovakia) on adolescents' HL and its associations with gender, family affluence (FAS), and self-rated health (SRH). (2) Methods: Representative data (N = 14,590; age 15) were drawn from the HBSC (Health Behavior in School-Aged Children) study. The associations between HL, gender, FAS, and SRH were examined via path models. (3) Results: The countries exhibited differences in HL means and in the range of scores within countries. Positive associations were found between FAS and HL, and between HL and SRH in each country. Gender was associated with differences in HL in only three countries. HL acted as a mediator between gender and SRH in four countries, and between FAS and SRH in each country. (4) Conclusions: The findings confirm that there are differences in HL levels within and between European countries, and that HL does contribute to differences in SRH. HL should be taken into account when devising evidence-informed policies and interventions to promote the health of adolescents.

Research in some religious countries shows that religiosity and spirituality positively affect adolescent health. We studied whether religiosity and spirituality also have positive associations with adolescent health in a secular country. We tested the associations between religious attendance and spirituality and self-reported health and health complaints using a representative sample of Czech adolescents ( n = 4182, 14.4 ± 1.1 years, 48.6% boys) from the 2014 health behavior in school-aged children (HBSC) study. We used religious attendance, the adjusted shortened version of the spiritual well-being scale (SWBS), and its two components-religious well-being (RWB) and existential well-being (EWB)-as independent variables and the eight item "HBSC symptom checklist" and self-reported overall health as dependent variables. A higher level of spirituality was associated with lower chances of health complaints and self-reported health, ranging from a 9% to 30% decrease in odd ratios (OR). Religious attendance was not associated with any of the observed variables. The EWB showed a negative association with all of the observed variables, with associations ranging from a 19% to 47% decrease. The RWB was associated with a higher risk of nervousness (OR = 1.12), while other associations were not significant. Non-spiritual but attending respondents were more likely to report a higher occurrence of stomachache (OR = 2.20) and had significantly worse overall health (OR = 2.38). In a largely secular country, we found that spirituality and the EWB (unlike religious attendance and the RWB) could have a significant influence on adolescent health.

The family environment is associated with religiosity and spirituality as well as many aspects of adolescent lives, including their health behaviour. Therefore, the aim of this study was to assess family environment associations with adolescent religious attendance (RA), i.e., weekly participation in religious services, and spirituality in a highly secular country. A nationally representative sample ( n = 4182, 14.4 ± 1.1 years, 48.6% boys) of Czech adolescents participated in the 2014 Health Behaviour in School-aged Children cross-sectional study. RA, spirituality and the family environment, i.e., family communication, perceived emotional support, and parental monitoring, were measured. Higher adolescent RA was associated with lower self-reported easiness of communication with mother (odds ratio (OR) = 0.68; 99% confidence interval (99% CI) = 0.47-0.99; p < 0.01). In contrast, spiritual respondents were more likely to report both easier communication with their father (OR per standard deviation (SD) change = 1.12, 99% CI 1.02-1.23; p < 0.01) and mother (OR per SD change = 1.38 (1.23-1.55); p < 0.001) and higher perceived emotional support (OR per SD change = 1.73 (1.55-1.92); p < 0.001). Parents of respondents who attended religious services at least once a week, as well as parents of spiritual respondents, were generally more likely to monitor adolescent behaviour. Thus, this study provides information for parents, mental health workers, and pastoral carers. Further research should assess the association of a lower easiness of family communication with dissonances in adolescent-parent religiosity/spirituality and with higher parental monitoring.

Socioeconomic inequalities in eating habits have a profound impact on the health of adolescents. The aim of the present study was to evaluate socioeconomic disparities in the eating habits of Czech adolescents and to compare their change between 2002 and 2014. The data from the Czech Health Behavior in School-aged Children (HBSC) study conducted in 2002 and 2014 was utilized. The Family Affluence Scale (FAS) was used to assess socioeconomic disparities. Higher odds of daily consumption of fruit (2002: OR = 1.67; 2014: OR = 1.70, p < 0.001) and vegetables (2002: OR = 1.54; 2014: OR = 1.48, p < 0.001) were associated with high FAS in both genders. Adolescents with higher FAS were less likely to consume sweets (2002: OR = 0.72, p < 0.05) and more likely to eat breakfast on weekdays (2014: OR = 1.19, p < 0.05). In 2002 and 2014, the data showed lower odds of daily consumption of soft drinks (Low: OR = 0.47; Medium: OR = 0.43; High: OR = 0.41, p < 0.001), fruit (Low: OR = 0.73; Medium: OR = 0.74, p < 0.001; High: OR = 0.75, p < 0.05), sweets (Low: OR = 0.71; Medium: OR = 0.79, p < 0.001) and breakfast on weekends (High: OR = 0.70, p < 0.05), and a higher likelihood of eating breakfast on weekdays (Low: OR = 1.26, p < 0.01; Medium: OR = 1.13, p < 0.05). These findings play an important role in future public measures to improve dietary habits and decrease social inequalities in youth., Competing Interests: The authors declare no conflict of interest.

Many children skip breakfast, consume soft drinks/sweets and do not eat the recommended amounts of fruit and vegetables. Poor eating habits in children tend to be carried over into adulthood. The changes in eating behaviours of Czech 11-, 13- and 15-year-old children were examined by frequency of breakfast (on weekdays and weekends), fruit, vegetable, sweet and soft drink consumption using data obtained from the Health Behaviour in School-aged Children (HBSC) surveys in 2002, 2006, 2010 and 2014. Logistic regression was used to analyze changes in eating behaviours. The findings showed a significant increase (only in girls, p ≤ 0.001) in prevalence of breakfast consumption (on weekdays) and a decrease in daily consumption of soft drinks (in boys and girls, p ≤ 0.001), sweets (in boys and girls, p ≤ 0.01) and fruit (in boys, p ≤ 0.01; in girls, p ≤ 0.001) between 2002 and 2014. Daily vegetable and breakfast on weekends consumption remained statistically unchanged over time. More frequent daily fruit, vegetable and breakfast (on weekends) consumption was reported by girls and younger children, whereas daily soft drink intake was more prevalent in boys and older children. There is a need for re-evaluation of current policies and new initiatives to improve the eating habits of Czech children.

This study examines trends in overweight and obesity, physical activity (PA) and screen time (ST) among Czech adolescents over a recent 12-year study period. Nationally representative samples consisted of 19,940 adolescents (9760 boys and 10,180 girls) aged 10.5-16.5 years from the Czech Health Behaviour in School-aged Children (HBSC) questionnaire-based surveys conducted in 2002, 2006, 2010 and 2014. Trends in the prevalence of overweight/obesity, meeting the recommendations for moderate-to-vigorous PA (MVPA) (≥60 min per day of MVPA) and excessive ST (>2 h per day) were estimated using logistic regression. Significant increases (p < 0.001) in the prevalence of overweight/obesity between the years 2002 and 2014 were evident for both adolescent boys (18.3%(2002)-24.8%(2014)) and girls (8.3%(2002)-11.9%(2014)). Compared to 2002, in 2014 significant decreases (p < 0.001) in meeting MVPA recommendations were observed among boys (32.2%(2002)-25.6%(2014)) and girls (23.2%(2002)-19.2%(2014)). Moreover, in boys we observed significant increases (p < 0.001) in excessive ST on weekdays (75.1%(2002)-88.8%(2014)), as well as on weekends (78.3%(2002)-91.9%(2014)) between the years 2002 and 2014. Increases in overweight/obesity with concomitant decreases in PA provide evidence in support of the current and upcoming efforts of government and commercial organizations in implementing interventions aimed at reducing excessive body weight among Czech adolescents.

Low levels of physical activity (PA) during adolescence contribute to obesity and poor health outcomes in adolescence, and these associations endure into adulthood. The aim of this study was to assess the associations between motives for PA and the level of PA among adolescent boys and girls. We obtained data regarding motives for PA and frequency of PA in 2010 via the Health Behavior in School-aged Children cross-sectional study in the Czech and Slovak Republics (n = 9018, mean age = 13.6, 49% boys). Respondents answered questions about their motives for PA and the frequency of their PA. Motives for PA were assessed using 13 items, which were structured in four groups. We explored the association between the motives for PA and sufficient PA using univariate and multivariate logistic regression models adjusted for age, and separately for boys and girls. "Good child" motives and Achievement motives were significantly associated with sufficient PA among both boys and girls. Health motives were associated with sufficient PA only among boys, and Social motives were associated with sufficient PA only among girls. Motives for PA were associated with the level of PA, and this association was partially gender dependent. These gender differences should be considered in interventions focusing on enhancement of PA.