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Background Physical activity (PA) is recognised as one of the leading and effective strategies to prevent non-communicable diseases that boosts the immune system to fight against diseases. Closures of schools, sport clubs and facilities because of COVID-19 reduced the opportunities to participate in PA. We aimed to examine physical activity levels of late adolescents, the contexts to be physical active and its changes during the spring 2020 lockdown. Methods A national representative sample of late adolescents in general upper secondary school (n = 2408, females = 64%, mean age = 17.2y, SD = 0.63) completed self-report online surveys on PA behaviours between March and June 2020. Multinominal logistic regression analyses were performed to identify correlates with PA, and decision tree analyses to ascertain the perceived changes on PA during lockdown based on sport club aspirations and levels of PA. Results Among the late adolescents, the distribution of PA frequency was 23% (0-2 days/week), 35% (3-4 days/week), 30% (5–6 days/week) and 12% (7 days/week), and differences between males and females were not statistically significant. Participation in both indoor and outdoor PA were 50 times more likely to report daily PA (OR = 54.28, CI = 15.16–194.37) than non-participation. A quarter of late adolescents were not part of a sports club, yet their PA levels increased. Although sports club members generally perceived they did less PA during lockdown, over a third of sport club members with competitive aspirations reported daily PA. Conclusions Overall, most late adolescents reported their PA levels decreased during lockdown. Findings from this study continue to demonstrate factors associated with PA in the context of the COVID-19 lockdown. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-12263-w.

Background The Symptom Checklist (SCL) developed by the Health Behaviour in School-aged Children (HBSC) study is a non-clinical measure of psychosomatic complaints (e.g., headache and feeling low) that has been used in numerous studies. Several studies have investigated the psychometric characteristics of this scale; however, some psychometric properties remain unclear, among them especially a) dimensionality, b) adequacy of the Graded Response Model (GRM), and c) measurement invariance across countries. Methods Data from 229,906 adolescents aged 11, 13 and 15 from 46 countries that participated in the 2018 HBSC survey were analyzed. Adolescents were selected using representative sampling and surveyed by questionnaire in the classroom. Dimensionality was investigated using exploratory graph analysis. In addition, we investigated whether the GRM provided an adequate description of the data. Reliability over the latent variable continuum and differential test functioning across countries were also examined. Results Exploratory graph analyses showed that SCL can be considered as one-dimensional in 16 countries. However, a comparison of the unidimensional with a post-hoc bifactor GRM showed that deviation from a hypothesized one-dimensional structure was negligible in most countries. Multigroup invariance analyses supported configural and metric invariance, but not scalar invariance across 32 countries. Alignment analysis showed non-invariance especially for the items irritability, feeling nervous/bad temper and feeling low. Conclusion HBSC-SCL appears to represent a consistent and reliable unidimensional instrument across most countries. This bodes well for population health analyses that rely on this scale as an early indicator of mental health status.

Purpose: The purpose of the study was to examine the trends between 2002 and 2018 in school pressure and school satisfaction among 15-year-old students, across countries and by gender, in the WHO European region and North America, and explore whether there are variations between countries and by gender in the co-occurrence of school pressure and school satisfaction. Methods: Data from the 32 countries that participated in the Health Behaviour in School-aged Children study (HBSC) study between 2002 and 2018 were used. Statistical analyses included ttests, binary logistic regression analyses, and chi-square tests, as required by each of the study aims. Results: School satisfaction tended to increase over the period 2002e2018 among boys, whereas school pressure increased among girls. Also, gender differences tended to dissipate in school satisfaction and generally increase in school pressure. The co-occurrence of school satisfaction and school pressure in 2017/2018 shows that the majority of students are found in the “not pressured enot highly satisfied” and “pressuredenot highly satisfied” groups. There were more boys in the former group and more girls in the latter group. Conclusion: Few students in the 32 countries belonged to the “not pressuredehighly satisfied” group, which from a public health perspective may be seen as the most desirable group. The increases in school pressure in girls from 2002 to 2018 and their overrepresentation in the pressured groups require further attention. Ministerio de Ciencia, Innovación y Universidades RYC-2017e 21626

Our study evaluated the relationship between adolescent health complaints and socioeconomic position in 45 countries. Data are from the 2017/2018 international Health Behaviour in School-aged Children survey which used proportionate sampling among adolescents aged 11 to 15 years old (n=228,979). Multilevel, multinomial regression analysis assessed the association between the multilevel latent classes with socioeconomic status (SES; at the household and country level). Three distinct latent classes were identified: No Complaints, Psychological Complaints, and a Physical and Psychological Complaints class; where, low household SES was highest for the physical and psychological complaints class. The findings suggest that health promotion policies and interventions among adolescents should consider the specific needs of adolescents living with low household SES as they report more subjective health complaints.

I den här studien utforskades ifall det förekommer sociodemografiska skillnader i upplevelse av psykiska besvär, socialt stöd och känsla av ensamhet bland finlandssvenska ungdomar. Det undersöktes även ifall ungdomarnas upplevelse av psykiska besvär kan förklaras med familje-, kamrat- och klasskamratstöd samt känsla av ensamhet. Utöver det utforskades ifall samband mellan socialt stöd och psykiska besvär kan förklaras med känsla av ensamhet. Som datamaterial användes WHO:s skolelevstudie (WHO-Koululaistutkimus) från 2018 med ett deltagarantal på 599 svenskspråkiga elever från årskurs 5, 7 och 9 (Målder = 11,9/14,0/15,9; svarsprocent 38 %). Som statistiska analysmetoder användes Pearsons chi2-test, envägs variansanalys, oberoende t-test, Spearmans rangkorrelationsanalys, multipel linjär regressionsanalys och medierande analys. Resultaten visade att flickor upplevde psykiska besvär och känsla av ensamhet i högre grad än pojkar. Elever i årskurs 7 och 9 upplevde nervositet i signifikant högre grad än eleverna i årskurs 5. De med högre upplevd socioekonomiska status upplevde i lägre grad psykiska besvär. Det förekom inte signifikanta skillnader i fråga om psykiska besvär, socialt stöd eller känsla av ensamhet mellan finlandssvenska ungdomar bosatta i stadsort och på landsbygden. Familjestöd och klasskamratstöd förklarade psykiska besvär signifikant och negativt, vilket innebar att lägre grad av familje- och klasskamratstöd associerades med högre grad av psykiska besvär. Känsla av ensamhet förklarade psykiska besvär signifikant och positivt, det vill säga högre grad av ensamhetskänslor associerades med högre grad av psykiska besvär. Kamratstöd förutsade inte psykiska besvär signifikant. Enligt resultaten kunde även samband mellan socialt stöd i form av familje-, kamrat- och klasskamratstöd och psykiska besvär delvis förklaras med känsla av ensamhet. Studien bidrar med ny kunskap om finlandssvenska ungdomars välmående och kan uppmuntra till hälsofrämjande verksamhet. För att få en djupare förståelse om lägre nivåer av socialt stöd och upplevelse av ensamhet i grundskoleålder kan vara riskfaktorer för utveckling av mental ohälsa behövs mer forskning, speciellt i form av longitudinella studier.

1) Background: The use of social media has become an integral part of adolescents’ daily lives. However, the intensive use of social media can develop into a health-threatening addiction, but unfavourable health consequences can occur even with less use. Social media user groups categorized as no-risk, moderate risk (of developing problematic behaviour), and problematic use were examined with reference to their prevalence, their associations with individual determinants and health, and the increased health risk between groups. (2) Methods: The Finnish nationally representative HBSC data (persons aged 11, 13, and 15, n = 3408) and descriptive and binary logistic regression analysis were applied. (3) Results: Problematic social media use (9.4%) was most common among older age groups, and among persons with moderate/low school achievement, low health literacy, and low parental monitoring. Belonging to a moderate risk group (33.5%) was most frequent among girls, and among adolescents with low/moderate parental monitoring and health literacy. All the negative health indicators systematically increased if the respondent belonged to a moderate risk or problematic use group. (4) Conclusions: The study confirmed the association between problematic social media use and negative health outcomes and highlighted the need to pay close attention to adolescents at moderate risk who exhibited negative health outcomes. peerReviewed

Aim: The first aim of this study was to explore the prevalence of loneliness and subjective health complaints (SHCs) among school-aged children in Finland. The second aim was to analyse to what extent perceived loneliness explains any variance in SHCs among school-aged children. Method: A representative sample of 5925 Finnish children and adolescents from grades 5 ( Mage=11.8 years), 7 ( Mage=13.8) and 9 ( Mage=15.8) completed the Health Behaviour in School-aged Children (HBSC) survey. Descriptive statistics were used to examine the prevalence of health complaints and loneliness. Structural equation modelling was used to test how strongly loneliness was associated with SHCs. Results: The prevalence of loneliness and SHCs was higher among girls and increased with age. Loneliness was a significant predictor of health complaints, especially of psychological symptoms among girls and among ninth grade students. Conclusions: The findings indicate that loneliness is a major risk to the health and well-being of school-aged children. The strong association between loneliness and SHCs highlights the importance of active preventive actions to reduce loneliness.

Introduction Straightlining, or identical responses across all items within a multi-item scale, is often taken as an indication that responses to all items in a questionnaire are of poor quality. The purpose of this study was to examine straightlining on two scales: The Sense of Unity Scale (SUS) and the short version of the Warwick-Edinburgh Mental Well-being Scale (SWEMWBS). Methods Data stem from the 2017–2018 data collections in four Nordic countries of the Health Behaviour in School-children study (HBSC) (15-year-old students only; 50.9% girls; n = 5928). Data were weighted to adjust for oversampling of Swedish-speaking Finnish students and to equalize sample size across countries. The main analyses were done with general linear modeling with adjustments for cluster effects (school classes). Results The proportion with straightlining on SUS was 22.8%, varying from 5.8% among Swedish girls to 46.4% among Finnish boys. The proportion with straightlining on SWEMWBS was 18.4%, varying from 5.2% among Norwegian girls to 46.0% among Finnish boys. Straightlining on one of the scales correlated with straightlining on the other one. Straightlining tended to inflate Cronbach's α values and reduce number of factors in factor analyses. Associations between the two scales and external variables tended to be lower among straightlining students. Associations between external variables (other than SUS/SWEMWBS) are on average slightly weaker among straightliners. Straightlining students obtained more favorable scores on several resource-related variables. Conclusion Although some problems have been identified, straightlining does not serve well as a general indicator of poor data quality. publishedVersion

LÄHTÖKOHDAT Yksinäisyys on merkittävä riski nuoren terveydelle. Selvitimme suomalaisnuorten kokeman yksinäisyyden yleisyyttä ja yhteyksiä psykosomaattiseen oireiluun sekä lääkkeiden käyttöön. MENETELMÄT Aineistona käytettiin kansallisesti edustavaa WHO-Koululaistutkimusta, johon vastasi 1 798 oppilasta 7. ja 9. luokilta keväällä 2018. Tilastollisina menetelminä käytettiin2-testiä ja 95 %:n luottamusvälitarkastelua. TULOKSET Yksinäisyys yleistyi yläkoulun aikana, ja lähes joka kuudes 15-vuotias tunsi itsensä vähintään melko usein yksinäiseksi. Yksinäiset nuoret raportoivat muita yleisemmin pää-, vatsa- ja selkäkipua sekä hermostuneisuutta ja nukahtamisvaikeuksia. He käyttivät niihin lääkkeitä jopa kolme kertaa yleisemmin kuin muut nuoret. PÄÄTELMÄT Nuorten yksinäisyyden kokemuksiin tulisi kiinnittää huomiota kotona ja koulussa. Ehkäisemiseen ja vähentämiseen on keinoja, mutta korjaavien toimenpiteiden käyttöönotto edellyttää, että yksinäisyys ja sen vaikutukset tunnistetaan. peerReviewed