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Adolescents belonging to minority or marginalized groups often experience discrimination, which may negatively affect their mental and physical health. Using the dataset of the 2018 Health Behaviour in School-Aged Children (HBSC) study, we analyzed perceived discrimination based on various grounds in four minority groups of schoolchildren in Ireland: sexual minority youth, youth living with a disability or chronic condition, immigrant youth, and youth belonging to the Traveller community. To minimize the potential confounding effect of psycho-social contextual factors, we used a case-control matching approach, comparing minority groups with their non-minority peers matched by gender, age group, and social class. Minority groups were significantly more likely than their matched non-minority counterparts to report discrimination, not only on the basis of their minority status but also on other grounds. These associations varied in their effect size. We discuss educational and policy implications of the findings for reducing discrimination and structural stigma in school settings.

Funding information: Grant funding for this analysis was provided by the: (1) Centre for Surveillance and Research, Public Health Agency of Canada (6D016-123071/001/SS); 2) Canadian Institutes of Health Research (Project Grant PJT 162237); 3) Polish National Science Centre (2013/09/B/HS6/03438). Corresponding author, Valerie F. Pagnotta, is supported by a CIHR Frederick Banting and Charles Best Canada Graduate Scholarship. Background Strong variations in injury rates have been documented cross-nationally. Historically, these have been attributed to contextual determinants, both social and physical. We explored an alternative, yet understudied, explanation for variations in adolescent injury reporting-that varying access to medical care is, in part, responsible for cross-national differences. Methods Age-specific and gender-specific rates of medically treated injury (any, serious, by type) were estimated by country using the 2013/2014 Health Behaviour in School-aged Children study (n=209 223). Available indicators of access to medical care included: (1) the Healthcare Access and Quality Index (HAQ; 39 countries); (2) the Universal Health Service Coverage Index (UHC; 37 countries) and (3) hospitals per 100 000 (30 countries) then physicians per 100 000 (36 countries). Ecological analyses were used to relate injury rates and indicators of access to medical care, and the proportion of between-country variation in reported injuries attributable to each indicator. Results Adolescent injury risks were substantial and varied by country and sociodemographically. There was little correlation observed between national level injury rates and the HAQ and UHC indices, but modest associations between serious injury and physicians and hospitals per 100 000. Individual indicators explained up to 9.1% of the total intercountry variation in medically treated injuries and 24.6% of the variation in serious injuries. Conclusions Cross-national variations in reported adolescent serious injury may, in part, be attributable to national differences in access to healthcare services. Interpretation of cross-national patterns of injury and their potential aetiology should therefore consider access to medical care as a plausible explanation. Postprint

Treatment advances over the past five decades have resulted in significant improvements in survival from childhood cancer. Although survival rates are relatively high, social disparities in outcomes have been sometimes observed. In a population-based study, we investigated social inequalities by sex and deprivation in treatment receipt in childhood cancer in Ireland. Cancers incident in people aged 0 to 19 during 1994 to 2012 and treatments received were abstracted from the National Cancer Registry Ireland. Multivariable modified Poisson regression with robust error variance (adjusting for age, and year) was used to assess associations between sex and deprivation category of area of residence at diagnosis and receipt of cancer-directed surgery, chemotherapy or radiotherapy. Three thousand seven hundred and four childhood cancers were included. Girls were significantly less likely than boys to receive radiotherapy for leukemia overall (relative risk [RR] = 0.70; 95% confidence interval [CI] = 0.50-0.98), and acute lymphoblastic leukemia specifically (RR = 0.54; 95% CI = 0.36-0.79), and surgery for central nervous system (CNS) overall (RR = 0.83; 95% CI = 0.74-0.93) and other CNS (RR = 0.76; 95% CI = 0.60-0.96). Girls were slightly less likely to receive chemotherapy for non-Hodgkin lymphoma and surgery for Hodgkin lymphoma (HL), but these results were not statistically significant. Children residing in more deprived areas were significantly less likely to receive chemotherapy for acute myeloid leukemia or surgery for lymphoma overall and HL, but more likely to receive chemotherapy for medulloblastoma. These results may suggest social inequalities in treatment receipt for childhood cancers. Further research is warranted to explore whether similar patterns are evident in other childhood cancer populations and to better understand the reasons for the findings.

This research explores service providers’ views on the barriers that prevent women in the sex work industry in Ireland from accessing co-ordinated health services. A purposive sample of eight service providers in the field of women’s health and social care in the West of Ireland were selected and interviewed for this study. The service providers were asked about their perception of the barriers of sex workers accessing health and social care services. Using thematic analysis, three key themes were identified: (1) lack of knowledge of women’s involvement in sex work; (2) identified barriers to health services; and (3) legislative and policy barriers to providing supportive services. While the service providers acknowledged that they do not knowingly provide services for sex workers, they all recognise that some of their service users are at risk of, and potentially are, involved in sex work. Yet, they were able to identify some of the barriers sex workers face when accessing their services. All these barriers were the result to the services’ limited capacity to support women engaging in sex work. At the time of data collection, the legislative context meant that selling sex under certain conditions was outside the law. This study highlights the consequences that criminalisation can have on the health of sex workers and the need for a paradigm shift in existing health and social care services. In this paper, we propose that a social justice rather than a criminal justice approach has the potential to address sex workers’ right to access appropriate health care. This paper gives due recognition to marginalised women, and advocates for better provision of services for women in the sex industry, while considering the new legislation of 2017.

This study explores recent cross-national trends over time (2002–2014) in the occurrence of victimization by bullying; then it documents the overlap between cybervictimization and traditional bullying in 2014 among adolescents in 37 countries. Data from four cycles (2002, 2006, 2010, and 2014) of the cross-national Health Behavior in School-Aged Children study were included (N = 764,518). Trends in traditional victimization were evaluated using logistic regression models in 37 countries. Prevalence of cybervictimization and the overlap between cybervictimization and traditional victimization were estimated. Linear decreases in bullying victimization were observed in 21 countries among boys, and in 12 countries among girls. The prevalence of cybervictimization was systematically lower than traditional victimization. Overall across all countries, 45.8% of those who reported cybervictimization also reported traditional victimization (46.5% for boys and 45.3% for girls), but wide country variations were observed. These indicate the need for a more holistic perspective to intervention and prevention that considers all expressions of bullying, traditional or online. Public health programs and policies could focus on addressing bullying more broadly, rather than focusing on behaviors that happen in a particular context.

Social patterns in bullying show consistent gender differences in adolescent perpetration and victimization with large cross-national variations. Previous research shows associations between societal gender inequality and gender differences in some violent behaviors in adolescents. Therefore, there is a need to go beyond individual associations and use a more social ecological perspective when examining gender differences in bullying behaviors. The aim of the present study was twofold: (1) to explore cross-national gender differences in bullying behaviors and (2) to examine whether national-level gender inequality relates to gender differences in adolescent bullying behaviors.Traditional bullying and cyberbullying were measured in 11-year-olds to 15-year-olds in the 2017/18 Health Behaviour in School-aged Children study (n = 200,423). We linked individual data to national gender inequality (Gender Inequality Index, 2018) in 46 countries and tested their association using mixed-effects (multilevel) logistic regression models.Large cross-national variations were observed in gender differences in bullying. Boys had higher odds of perpetrating both traditional and cyberbullying and victimization by traditional bullying than girls. Greater gender inequality at country level was associated with heightened gender differences in traditional bullying. In contrast, lower gender inequality was associated with larger gender differences for cyber victimization.Societal gender inequality relates to adolescents' involvement in bullying and gendered patterns in bullying. Public health policy should target societal factors that have an impact on young people's behavior.

BackgroundLittle is known about the impact of being a bystander to bullying. This study compared health outcomes among bullies, victims and bystanders, and investigated actions taken by bystanders when they saw bullying.MethodParticipants included 7522 students aged 12–18 years that completed self-report questionnaires in the 2013/2014 Health Behaviour in School-aged Children survey. Binary logistic regression models (controlled for bully, victim, bystander status and demographic variables) were used to investigate the associations between participation in bullying as a bully, victim and bystander and health outcomes.ResultsOverall, 13.3% of adolescents reported being a bully, 25.1% reported being a victim and 30.5% reported that they saw bullying, in the last couple of months. Bystanders were significantly more likely to experience psychological symptoms (OR 1.355), somatic symptoms (OR 1.392) and low life satisfaction (OR 1.268) than those who were not bystanders. Helping the victim was significantly associated with experiencing psychological symptoms (OR 1.240), somatic symptoms (OR 1.251) and low life satisfaction (OR 1.198). Being a bully was significantly associated with experiencing psychological symptoms (OR 1.382) and not having excellent health (OR 1.252). Victims were significantly more likely to experience psychological symptoms (OR 2.437), somatic symptoms (OR 2.364), low life satisfaction (OR 2.564) and not having excellent health (OR 1.559).ConclusionIn Ireland, being a bystander to bullying is more prevalent in schools than bullying perpetration or victimisation. The impact of being a bystander to bullying needs to be highlighted and included in intervention development.

Background Sport-related concussion is a significant public health issue, especially among children and adolescents. A growing body of evidence suggests that athletes who do not immediately report concussion and continue to play while concussed take longer to recover than their counterparts. Yet, many child and adolescent athletes do not immediately report concussion symptoms to a responsible adult. Aim This study examined the utility of the Theory of Planned Behavior (TPB) in predicting concussion reporting intentions and in-season reporting behaviors among high school, Gaelic Athletic Association (GAA) athletes in the Republic of Ireland. Methods High school GAA athletes aged 12-18 years completed surveys at baseline and at three-month follow-up. Concussion-related perceived behavioral control (PBC), attitudes, subjective norms, and reporting intentions were assessed at baseline. In-season concussion reporting behaviors were assessed at three-month follow-up. Hierarchical linear regression models were used to examine the relationship between the constructs of the TPB and baseline reporting intentions. Logistic regression models were used to examine the relationship between the constructs of the TPB and in-season reporting behaviors. All data were collected during the 2016–2017 academic year. Results A total of 153 adolescent athletes were included (n = 102 [66.7%] females; Mage = 14.4 years, [SD = 1.6]). Consistent with the TPB, results revealed that PBC and reporting intentions contributed to the prediction of in-season reporting behaviors. Reporting intentions, in turn, were strongly influenced by PBC, attitudes, and subjective norms. PBC was the strongest predictor of concussion reporting intentions and in-season reporting behaviors; the stronger the athletes’ PBC, the stronger their reporting intentions and the more likely they were to have reported concussion symptoms during the current season. Conclusion Although the findings from the current study must be interpreted cautiously given the small sample size, the findings suggest that the TPB has some utility in the prediction of concussion reporting intentions and reporting behaviors. However, our findings suggest that the TPB should not be used in isolation; other models that incorporate personal factors and environmental constraints may be needed to better our understanding of concussion reporting intentions and behaviors among high school athletes. Concussion education programs that include strategies to enhance PBC over concussion reporting may help improve concussion reporting behaviors among high school athletes.

Outcome 5 of the Irish Better Outcomes, Brighter Futures national youth policy framework (&ldquo, Connected, respected, and contributing to their world&rdquo, ) offers a suitable way to study psychosocial determinants of adolescent health. The present study (1) provides nationally representative data on how 15- to 17-year-olds score on these indicators, (2) compares sexual minority (same- and both-gender attracted youth) with their non-minority peers. We analyzed data from 3354 young people (aged 15.78 &plusmn, 0.78 years) participating in the Health Behaviour in School-aged Children (HBSC) study in Ireland. Age and social class were associated with the indicators only to a small extent, but girls were more likely than boys to report discrimination based on gender and age. Frequency of positive answers ranged from 67% (feeling comfortable with friends) to 12% (being involved in volunteer work). Sexual minority youth were more likely to feel discriminated based on sexual orientation, age, and gender. Both-gender attracted youth were less likely than the other groups to report positive outcomes. Same-gender attracted youth were twice as likely as non-minority youth to volunteer. The results indicate the importance of a comprehensive approach to psycho-social factors in youth health, and the need for inclusivity of sexual minority (especially bisexual) youth.

When HBSC Ireland data was first collected in 1998, very few data on children's health was available. HBSC was seen as an opportunity for Public Health Practitioners and policy-makers to move towards evidence-informed practice. Public health practitioners are invited to liaise with the research team on questionnaire content. HBSC Ireland collaborates to ensure scientifically appropriate measures that can also assist in meeting policy goals. In 2014 the researchers worked with the policy lead for Tobacco to assess children's exposure to tobacco smoke & their views of cigarette packaging. Findings were used to provide a rationale for new legislation on plain packaging for tobacco products and provide a baseline for policy evaluation. In 2018 we worked with the Health Research Board Evidence Centre to develop items on alcohol procurement and location of consumption. A partnership with the Institute of Public Health lead to the inclusion of new items on exposures to UV light and sun protection. This work is being used to develop public health messaging for children and parents by the national cancer control programme. A strategic partnership between HBSC Ireland and the Department of Children and Youth Affairs has enabled the extensive use of HBSC data in the monitoring of the Better Outcomes, Brighter Futures policy framework for children & young people. This has included adopting existing international survey items as indicators and developing new items to fill gaps in the available evidence base. The core principles of these initiatives include transparency; background conceptual & methodological materials are prepared & pilot studies are published. A key element of Knowledge Translation work is our helpdesk, providing analyses to public & community bodies for the purposes of practice, research or policy. More than 50 short reports have been provided as part of this service to the public health community in Ireland.

This paper examines the importance of understanding wellbeing in childhood and adolescence, and will present Ireland’s efforts to develop a set of national indicators of wellbeing that are published every two year in the State of the Nation’s Children Report. One of the main source of population based indicators of wellbeing in Ireland is the Irish Health Behaviour in School-Aged Children (HBSC). The HBSC Study in Ireland collects data from 10-18 year olds children since 1998, using a self-completion questionnaire. Data are collected every four years using standardised procedures for sampling and data collection. The same procedures are used since the initiation of the study in Ireland allowing for both cross-country comparison and time trend analysis. As part of the efforts to develop the Irish set of indicators of wellbeing, the HBSC group used a participatory research with children to identify what makes children happy, and the indicators identified by children are now routinely collected. The paper will present these indicators and how they were developed. Most recently, the HBSC study group was asked to develop indicators to the new National Policy framework for children and young people, Better Outcomes Brighter Future, to fill in the gaps in existing knowledge. This further expands the role that the HBSC study in Ireland has in informing policy and in providing data for assessing its success. The paper will present the indicators that are currently used for both national documents, as well as how these were developed.

Internationally, subjective health complaints have become increasingly prevalent in children. Thus, a comprehensive understanding of the determinants of health complaints is needed to inform effective policies and strategies. This study explores if meeting physical activity and total screen time (TST) recommendations are associated with the risk of reporting health complaints weekly or more. The 2014 Irish Health Behaviour in School-aged Children study collected questionnaire data from 10,474 10-17year olds. Children reported how often they experienced eight health complaints as less than weekly or weekly or more. Children who met moderate-to-vigorous physical activity recommendations were active for 60min/day in the past seven days. Three types of screen based activity were categorised to reflect if children met TST recommendations of ≤2h/day. Poisson regression examined the association between meeting recommendations and the risk of health complaints. The prevalence of individual health complaints ranged from 20.4-44.3% in girls and from 10.1-35.4% in boys. Overall, 5.1% (4.5-5.6%) of girls and 8.7% (7.8-9.5%) of boys met both (physical activity and TST) recommendations, while two thirds of girls (67.3%, 66.1-68.5%) and over half of boys (55.0%, 53.5-56.6%) met neither recommendation. Not meeting TST recommendations was significantly associated with the risk of reporting health complaints while associations with physical activity were less apparent. Children who did not meet either recommendation had a significantly increased risk for six of the health complaints when compared to those who met both recommendations. As health complaints and poor lifestyle behaviours were common in children, population level measures are warranted.

Body image concerns are prevalent among adolescents; however, a single item assessing what influences their body image does not exist. Thus, the aim of this study was to develop a survey item on the factors influencing adolescent body image for inclusion in a nationally representative health behaviour survey. This article describes the methodology used to develop a survey item and the results obtained through its inclusion in the survey. The research design included a literature review, consultation work with young people and data analyses of the new survey item included in the survey. Results from the current study revealed that a variety of factors influence adolescent body image, some of which have been overlooked in the traditional body image literature to date. This study demonstrates consultation with young people can contribute to the development of quantitative measures.

The relationship between cyberbullying and friendship dynamics on adolescent body dissatisfaction was examined. Data from the Irish contribution to the international cross-sectional 2013/2014 Health Behaviour in School-aged Children study were used. Results showed that girls were three times more likely than boys to report that their body is too fat, and adolescents who were cyberbullied were almost twice as likely as adolescents who were not cyberbullied to consider themselves too fat. Stronger friendship dynamics were associated with decreased levels of body dissatisfaction, and friendship dynamics were found to partially mediate the relationship between cyberbullying and body dissatisfaction.

IMPORTANCE: While the association between income inequality and interpersonal violence has been attributed to the psychosocial effects of inequality (eg, increased class anxiety, reduced social capital), longitudinal evidence for this pathway is limited by a reliance on small ecological studies and cross-sectional data. The developmental consequences of early-life inequality for subsequent involvement in violence have not been investigated. OBJECTIVE: To examine the association between income inequality during infancy and early childhood and adolescents’ involvement in bullying others, experiences of being bullied, or both. DESIGN, SETTING, AND PARTICIPANTS: The Health Behavior in School-aged Children survey study was conducted in European and North American schools. This analysis used individual data on bullying (being bullied, bullying others, or both) from 6 consecutive school-based surveys of 11-year-old to 15-year-old students carried out in 40 countries between February 1994 to March 2014. Data analysis occurred from March 2018 to January 2019. EXPOSURE: National Gini indices of income inequality for every year of life spanning a 35-year period (1979 to 2014). MAIN OUTCOMES AND MEASURES: Being bullied, bullying others, and both outcomes were measured using a common definition and questions adapted from the Bully-Victim Questionnaire and translated to many languages. RESULTS: The sample included 425 938 male students and 448 265 female students from 162 country–survey year groups in 29 196 schools. Linear regression coefficients indicated that early-life income inequality from birth to 4 years was positively associated with being bullied (male students: linear regression coefficient, 18.26 [95% CI, 11.04-25.47]; P

Molcho Michal. Une perspective internationale sur les enfants et le bien-être. In: Revue des politiques sociales et familiales, n°131-132, 2019. Le bien-être des enfants : un enjeu politique / Understanding children's well-being: A political issue. pp. 109-117.

This paper examines well-being in childhood in a historical context, and in the context of the family and school and relationships with parents, based on a large cross-sectional survey. The Health Behaviour in School-aged Children Study (HBSC) is an international survey that has collected data every four years since 1984 from children and adolescents in over 40 countries in Europe and North America. The HBSC study aims to gain new insights into, and increase our understanding of, young people's health and well-being, health behaviours and their social context in three critical points in the life of adolescents : 11, 13 and 15 years old. The study collects data on various aspects of adolescents’ lives, including their perceived health and wellbeing, and relationships with their parents. The findings from the HBSC study indicate that the gender gap in well-being and in communication with parents increases with age. If boys and girls report poorer well-being and communication with their parents as they grow older, these decreases are larger among girls than boys., Molcho Michal. Children and well-being from an international perspective. In: Revue des politiques sociales et familiales, n°131-132, 2019. Le bien-être des enfants : un enjeu politique / Understanding children's well-being: A political issue. pp. 231-238.

The benefits of physical activity for the physical health of individuals are well documented. Less is known about the benefits of physical activity for mental health. This paper explores the associations between physical activity and positive mental health and mental health problems. The paper utilises data collected from a representative sample of 10–17-year-old adolescents in Ireland. Physical activity in the study is measured using moderate-to-vigorous physical activity (MVPA) and vigorous physical activity (VPA). Mental health was measured using the Cantril Leader of Life Satisfaction, the WHO-5 index, Mental Health Inventory (MHI-5) and the Health Behaviour in School-Aged Children (HBSC) Symptom Checklist (HBSC-SCL). Data were analysed using bivariate (Pearson Correlation, t-test, one-way ANOVA) and multivariate (two-way ANOVA, ordinary least squares (OLS) regressions) analyses. In total, 8636 adolescents were included in this analysis. Higher participation in physical activity was associated with higher scores on the positive mental health indicators and lower scores on the mental health problems indicators. When modelled together, VPA was a stronger predictor of mental health than MVPA, especially in girls. For example, standardised beta coefficients for predicting MHI-5 were −0.09 for MVPA (p &lt, 0.001) and −0.13 for VPA (p &lt, 0.001) To our knowledge, this is the first study that looks at levels of physical activity as well as both positive mental health and mental health problems. The study highlights the need to encourage and enable adolescents, and especially girls, to participate in vigorous exercising as way of promoting positive mental health.

The aim of this study was to investigate how peers influence adolescent body image, and whether this influence was positive and/or negative from young peoples’ perspectives. One hundred and eleven adolescents aged 13 to 18 years from the Republic of Ireland participated in this study, in 17 focus groups. Data were analyzed using a thematic analysis approach. Findings demonstrated that peers have an overwhelming negative impact on adolescent body image, and consequently, health. Both boys and girls revealed that the peer environment is characterized by a significant pressure to conform to appearance expectations, and deviations from such expectations lead to negative peer experiences. Positive peer influences were also revealed but to a far lesser extent.

Aim We examined how sociodemographic, clinical and area-level factors are related to short-term prostate cancer mortality versus mortality from other causes, a crucial distinction for this disease that disproportionately affects men older than 60 years. Methods We applied competing risk survival models to administrative data from the Queensland Cancer Registry (Australia) for men diagnosed with prostate cancer between January 2005 and July 2007, including stratification by Gleason score. Results The men (n = 7393) in the study cohort had a median follow-up of 5 years 3 months. After adjustment, remoteness and area-level disadvantage were not significantly associated with prostate cancer mortality. However, area-level disadvantage had a significant negative relationship with hazard of death from a cause other than prostate cancer within 7 years; compared with those living in the most advantaged areas, the likelihood of mortality was higher for those in the most disadvantaged (subhazard ratio [SHR] = 1.39; 95% CI, 1.01–1.90; P = 0.041), disadvantaged (SHR = 1.51; 95% CI, 1.14–2.00; P = 0.004), middle (SHR = 1.34; 95% CI, 1.02–1.75; P = 0.034) and advantaged areas (SHR = 1.44; 95% CI, 1.09–1.89; P = 0.009). Those with Gleason score of 7 and higher had a lower hazard of prostate cancer mortality if they were living with a partner, whereas those with lower Gleason scores and living a partner had lower hazards of other-cause mortality. Conclusions Understanding why men living in more disadvantaged areas have higher risk of non-prostate cancer mortality should be a priority.

Introduction There are concerns that tobacco control policies may be less effective in reducing smoking among disadvantaged socioeconomic groups and thus may contribute to inequalities in adolescent smoking. This study examines how the association between tobacco control policies and smoking of 15-year-old boys and girls among 29 European countries varies according to socioeconomic group. Methods Data were used from the Health Behaviour in School-aged Children (HBSC) study conducted in 2005/2006 comprising 50,338 adolescents aged 15 years from 29 European countries. Multilevel logistic regression analyses were conducted to assess the association of weekly smoking with components of the Tobacco Control Scale (TCS), and to assess whether this association varied according to family affluence (FAS). Analyses were carried out per gender and adjusted for national wealth and general smoking rate. Results For boys, tobacco price was negatively associated with weekly smoking rates. This association did not significantly differ between low and high FAS. Levels of tobacco-dependence treatment were significantly associated with weekly smoking. This association varied between low and high FAS, with higher treatment levels associated with higher probability of smoking only for low FAS boys. For girls, no tobacco policy was significantly associated with weekly smoking, irrespective of the FAS. Conclusions Results indicated that most tobacco control policies are not clearly related to adolescent weekly smoking across European countries. Only tobacco price seemed to be adequate decreasing smoking prevalence among boys, irrespective of their socioeconomic status.

Background Advances in treatment mean that most children diagnosed with cancer during childhood survive. Therefore, it is increasingly important to examine the long‐term consequences of childhood cancer, including educational attainment. This systematic review investigated whether the educational attainment of childhood cancer survivors differ from the cancer‐free population. Design/methods We searched seven databases for articles published from January 2005 to August 2018. We identified full papers in English, reporting primary data on academic attainment of adult survivors of childhood cancer, compared to a control group. Quality appraisal was conducted using the Newcastle‐Ottawa Scale. Results Fourteen studies met the inclusion criteria. Nine papers included patients with various types of cancers, four focused on a single type of cancer, and one on patients who underwent stem cell transplantation. Of the 14 papers, 2 studies were considered good quality, 10 were considered adequate quality, and 2 were considered poor quality. Four studies reported more favorable educational attainment among survivors while six did not report significant differences. Less favorable attainment was consistently reported for CNS survivors in four studies. Conclusion The literature does not provide a clear pattern of the long‐term consequences of childhood cancer on education attainment. While this may suggest that there is no consistent difference between the education attainment of cancer survivors and controls, it may also be the result of limitations in the existing research. To better assess the education attainment of survivors, there is a need for high‐quality studies, with appropriate comparators, and standardized measures of education attainment across countries.

Background/aim Sport-related concussion is associated with various short- and long-term health consequences, especially among adolescent athletes. Yet, many concussions go unreported and/or unrecognised. The purpose of this study was to assess high school athletes’ concussion-related knowledge, attitudes, intentions and reporting behaviours, and to explore whether gender differences are evident. Methods A total of 435 high school athletes (52.2% female; mean age, 14.55 ± 1.67 years) participated in the survey. Questions assessed athletes’ knowledge, attitudes, reporting intention and reporting behaviours, in respect to sports-related concussion. Comparisons between male and female athletes were explored using Mann-Whitney tests and chi-squared (χ2) tests as appropriate. Results We found that 60% of the participants stated that they have played in practice or during a game (this season) with concussion symptoms. Males expressed more negative outcomes of concussion reporting and lower concussion reporting intention, compared to females. We found no significant gender differences in concussion-reporting behaviours. Conclusion Our findings suggest that knowledge, favourable attitudes towards reporting and reporting intention alone are not enough to create an environment that encourages the disclosure of concussion symptoms. Health promotion communication campaigns, coupled with concussion education and awareness programmes, should be utilised to further highlight the importance of timely concussion management, and to create a culture in which the reporting of concussion is considered normative.

ObjectiveTo investigate weight concerns among adolescent boys and relationships with health indicators and family factors.DesignAnalysis of the 2010 Health Behaviour in School-aged Children survey of 10–17-year-olds.SettingSchools in the Republic of Ireland.ResultsAmong 6187 boys, 25·1 % reported a desire to lose weight (weight ‘loss’ concern) and 7·7 % reported a desire to gain weight (weight ‘gain’ concern). Both types of weight concerns were associated with poor self-rated health, life satisfaction and happiness, and with more frequent emotional and physical symptoms. Family factors were associated with boys’ weight concerns. In adjusted analyses, the risk of weight ‘loss’ concerns decreased with daily family breakfasts (OR=0·80; 95 % CI 0·66, 0·97). The risk of weight ‘gain’ concerns decreased with frequent family evening meals (OR=0·77; 95 % CI 0·60, 0·99). Ease of communication with mother was associated with a decreased risk of weight ‘loss’ and weight ‘gain’ concerns among boys (OR=0·74; 95 % CI 0·60, 0·90 and OR=0·61; 95 % CI 0·44, 0·82, respectively). An open father–son relationship and having a father present in the home decreased the risk of weight ‘loss’ concerns (OR=0·69; 95 % CI 0·57, 0·82 and OR=0·81; 95 % CI 0·67, 0·98, respectively).ConclusionsBody weight concerns were reported by a sizeable minority of boys and were associated with negative health outcomes. The findings support the need to promote frequent family meals and facilitate open communication in families.

BACKGROUND: Bullying among children and adolescents is a public health concern; victimization is associated with psychological and physical health problems. The purpose of this study is to examine temporal trends in bullying victimization among school-aged children in Europe and North America. METHODS: Data were obtained from cross-sectional self-report surveys collected as part of the Health Behaviour in School-aged Children (HBSC) study from nationally representative samples of 11-, 13- and 15-year-olds, from 33 countries and regions which participated in the 2001-02, 2005-06 and 2009-10 surveys. Responses from 581 838 children were included in the analyses. Binary logistic regression was used for the data analyses. RESULTS: The binary logistic regression models showed significant decreasing trends in occasional and chronic victimization between 2001-02 and 2009-10 across both genders in a third of participating countries. One country reported significant increasing trends for both occasional and chronic victimization. Gender differences in trends were evident across many countries. CONCLUSION: Overall, while still common in many countries, bullying victimization is decreasing. The differences between countries highlight the need to further investigate measures undertaken in countries demonstrating a downward trend. Language: en

BACKGROUND: The aim was to examine temporal trends in injury mortality and morbidity across 30 countries in Europe and North America, and the impact of regional geography and adolescent risk behaviours (including substance use and physical fighting) on such trends. METHOD: s: Data were obtained for 30 countries in 2002, 2006 and 2010. Mortality data were obtained from the World Health Organization's (WHO) Health for all database. Trends over time were described by WHO Regions using standardized rates comparisons and Poisson regression analyses. RESULTS: Injury-related mortality, but not morbidity, declined over time across all countries (from 10 to 8 deaths per 100 000 between 2001 and 2010), with notable differences observed by Regions (e.g. from 48 to 39 deaths in Russia). Risk behaviours included in the models were consistently and significantly associated with injury morbidity, with substance increasing the risk for injury by 1.15 to 1.36 among girls, and physical fighting increasing the risk by 1.21 to 1.31 among boys across WHO Regions. Risk behaviours did not explain the observed temporal trends. CONCLUSIONS: Injury mortality and morbidity represent different health phenomena. Efforts that have been made to make societies safer for children have seemed to be successful in reducing injury morbidity. Language: en

This study aimed to explore the associations of traditional and cyberbullying victimisation with self-reported health and life satisfaction, and to examine whether involvement in risk behaviours contributes to these health outcomes.We asked questions on involvement in traditional and cyberbullying, risk behaviours, self-reported health and life satisfaction to school children. In total, 318 students aged from 15 to 18 years old in 8 post-primary schools in Ireland completed the survey.Children who were victims of bullying were more likely to report poor health, low life satisfaction and engaging in risky behaviours. Although not statistically significant, we found that cyber victimisation was positively associated with increased reporting of poor health and low life satisfaction.Traditional bullying is the most common type of bullying among school children in Ireland, and overall, seems to have a stronger association with poor health. However, a sizable proportion of children are victims of cyberbullying or of both cyberbullying and traditional bullying. It is, therefore, important to acknowledge, identify and address all types of bullying to improve the health outcomes of children.

Aims To examine the role of national wealth in the association between family affluence and adolescent weekly smoking, early smoking behaviour and weekly smoking among former experimenters. Design and Participants Data were used from the Health Behaviour in School-aged Children (HBSC) study conducted in 2005/2006 in 35 countries from Europe and North America that comprises 60 490 students aged 15 years. Multi-level logistic regression was conducted using Markov chain Monte Carlo methods (MCMC) to explore whether associations between family affluence and smoking outcomes were dependent upon national wealth. Measurement Family Affluence Scale (FAS) as an indicator for the socio-economic position of students. Current weekly smoking behaviour is defined as at least weekly smoking (dichotomous). Early smoking behaviour is measured by smoking more than a first puff before age 13 years (dichotomous). Weekly smoking among former experimenters is restricted to those who had tried a first puff in the past. Findings The logistic multi-level models indicated an association of family affluence with current weekly smoking [odds ratio (OR) = 1.088; 95% credible interval (CrI) = 1.055–1.121, P

Background The food environment within and surrounding schools may influence children's diets. This study explored if the internal and external school food environments were associated with intake of specific food groups among adolescents. Methods Participants were a subset of 5344 post-primary school students that took part in the Health Behaviour in School-aged Children (HBSC) survey. Four school-level variables were created: urban/rural, disadvantaged status, percentage fast food premises within one kilometer of the school and food sold in the school. Logistic regression models were used to examine school-level influences on daily food consumption controlling for individual and family food environmental factors. Results For students in disadvantaged schools, the odds of having soft drinks (OR 1.79, 95% CI 1.30–2.47) or chips (OR 1.82, 95% CI 1.17–2.83) daily were larger and the odds of consuming fruits (OR 0.79, 95% CI 0.62–0.99) or vegetables (OR 0.73, 95% CI 0.60–0.88) daily were smaller than for students at other schools. Girls and those from higher socioeconomic classes also had healthier eating habits. Attending a school where more than 10% of the food premises within one kilometer of the school were fast food outlets was associated with a 0.78 (95% CI 0.64 to 0.94) and a 0.79 (95% CI 0.66 to 0.93) decreased odds of daily fruit and vegetable intake, respectively. Conclusions Fast food environments around post-primary schools are associated with less fruit and vegetable intake. Children in disadvantaged schools and from lower social classes are more likely to report poorer dietary habits than children in other schools or from higher social classes, respectively. Multiple contexts influence diet, and children at an economic or social disadvantage are at most risk of poor dietary habits.

Concussion education is an important aspect of concussion prevention. The purpose of this study was to investigate the effect of a novel, theory of planned behavior (TPB)-driven concussion education program on secondary school athletes' concussion-reporting relevant cognitions immediately post-intervention and at 3 months follow-up. Data were collected from 428 secondary school athletes during the 2016-2017 academic year: 229 were assigned to an intervention group of which 59 (25.76%) completed assessments at all timepoints; 199 were assigned to a control group of which 153 (76.88%) completed assessments at all timepoints. Using repeated measures ANOVAs, we examined differences in athletes' concussion-reporting cognitions, by group and gender. The program had a significant positive effect on athletes' knowledge (P < 0.01), perceived behavioral control over concussion recognition and reporting (P < 0.01), and reporting intention (P < 0.01). These results were maintained at 3 months follow-up, with the exception of perceived behavioral control. The program did not have a significant effect on athletes' attitudes toward concussion reporting and subjective reporting norms. Results suggest that the TPB may be a useful framework to inform the development of more effective educational programs. There is a need for multi-layered interventions that aim to create sporting environments that encourage positive concussion care seeking behaviors.

Objective: Due to the importance of surveillance of injuries and accidents in the Czech Republic, the purpose. of this study was to report the temporal trends of injuries of Czech adolescents between 2002 and 2014. Methods: Adolescents (N = 20,038) from the Czech Republic, that took part in the 2002, 2006, 2010 and 2014 HBSC study, reported the frequency of medically attended injuries in the past 12 months. Repeated binary logistic regressions with different years as reference categories were performed. Results: Less than half (44.7%) of all Czech adolescents reported they had experienced at least one medically attended injuries in the past 12 months, with boys experiencing more injuries than girls (p < 0.001), and the injuries were more common in older adolescents. Fewer boys reported injury in 2014 when compared to 2002 (OR, CI: 0.81, 0.72-0.90), there was also a significant decrease in injuries among girls between 2014 and 2006 (OR, CI: 0.77, 0.69-0.86). Conclusions: The trend was not linear amongst boys. Along with improved safety promotion education, the rate of injuries decreased among adolescents between the years 2002 and 2014.

Purpose Patients with uveal melanoma (UM) undergo lifelong follow-up as metastases can occur more than 20 years after diagnosis. Little is known about the quality of life (QoL) of UM survivors over such an extended period. To investigate their QoL, we used various estimating factors. Methods A cohort of patients diagnosed and treated for UM with regularly scheduled follow-up visits was asked to fill in a European Organization for Research and Treatment of Cancer (EORTC) questionnaire comprised of the EORTC QLQ-C30 and EORTC QLQ-OPT30 modules. An additional open question examined other changes in the patients' lifestyle since diagnosis. Independent demographic and medical data were collected from patient records. Results Two hundred and thirty-two of 294 patients agreed to complete the questionnaire. General QoL correlated highly with the eye-related QoL. Statistically significant higher QoL was associated with tumours not involving the ciliary body, and with better best-corrected visual acuity (BCVA). A subgroup of 39% of the patients reported severe disability affecting eye-related tasks. Thirty-three per cent were highly concerned about various aspects of their future health. Patients who underwent enucleation reported lower eye-related QoL and described problems related to body image in response to the open question. Conclusion General QoL of UM patients is only slightly affected by their malignancy. However, body image and psychosocial adjustment are major issues involved in evaluating QoL. Continuous long-term psychosocial treatment is needed from the time of diagnosis in a subgroup of patients suffering from eye-related disabilities.

Distance from residence to hospital has been associated with clinical outcomes for colorectal cancer patients. However, little is known about the association of remoteness with quality of life (QoL) for colorectal cancer survivors. We examined the relationship between distance from hospital and colorectal cancer survivors’ QoL, with a specific focus on gender. Colorectal cancer survivors in Ireland who were more than 6-months postdiagnosis completed the European Organization for Research and Treatment of Cancer QLQ-C30, measuring global health status (GHS) and physical, role, cognitive, social, and emotional functioning. Bootstrap linear regression was used to evaluate the association between remoteness and QoL scales, controlling for demographic and clinical variables. Separate models were generated for the full sample, for women, and for men. The final analytical sample was 496 colorectal cancer survivors; 186 women and 310 men. Living remote from the treating hospital was associated with lower physical functioning (coefficient −4.38 [95 % confidence interval −8.13, −0.91]) and role functioning (coeff. −7.78 [−12.64, −2.66]) among all colorectal cancer survivors. In the separate gender models, remoteness was significantly associated with lower physical (coeff. −7.00 [−13.47, −1.49]) and role functioning (coeff. −11.50 [−19.66, −2.65]) for women, but not for men. Remoteness had a significant negative relationship to GHS (coeff. −4.31 [−8.46, −0.27]) for men. Aspects of QoL are lower among colorectal cancer survivors who live far from their treating hospital. There are gender differences in how remoteness is related to QoL domains. The results of this study suggest that policy makers, service providers, and health care professionals should consider the specific QoL needs of remote colorectal cancer survivors, and be attuned to and prepared to address the differing needs of men and women.

© 2014, Springer Science+Business Media New York. Purpose: This analysis describes the long-term workforce participation patterns of individuals diagnosed with head and neck cancer (HNC). Methods: Survivors of HNC (ICD10 C00-C14, C32) diagnosed at least 8 months previously were identified from the National Cancer Registry Ireland and sent a survey including questions about working arrangements before and since diagnosis. Descriptive statistics and multivariate logistic regression were used to examine the factors that influence workforce participation at 0, 1 and 5 years after diagnosis. Results: Two hundred sixty-four individuals employed at the time of diagnosis responded to the survey, an average 6 years post-diagnosis. Seventy-seven percent took time off work after diagnosis, with a mean work absence of 9 months (range 0–65 months). Fifty-two percent of participants reduced their working hours (mean reduction 15 h/week). The odds of workforce participation following HNC were increased by not being eligible for free medical care (OR 2.61, 95 % CI 1.15–5.94), having lip, mouth or salivary gland cancer (compared to cancer of the pharynx or cancer of the larynx, OR 2.79, 1.20–6.46), being self-employed (OR 2.01, 1.07–3.80), having private health insurance (OR 2.06, 1.11–3.85) and not receiving chemotherapy (OR 2.82, 1.31–6.06). After 5 years, only the effect of medical card remained (i.e., medical insurance) (OR 4.03, 1.69–9.62). Conclusions: Workforce participation patterns after HNC are complex and are influenced by cancer, treatment and employment factors. Implications for Cancer Survivors: Patients should be informed of the potential impacts of HNC on workforce participation, and clinicians, policy makers and employers should be aware of these potential longer-term effects and related variables.

Objective Urban-rural variation in cancer incidence, treatment, and clinical outcomes has been well researched. With the growing numbers and longer lifespan of cancer survivors, quality of life (QOL) is now a critical issue. The present study investigates the QOL of head and neck cancer (HNC) survivors in Ireland, paying special attention to urban and rural variation. Methods From the population-based National Cancer Registry Ireland, we identified 991 survivors of HNC (ICD10 C00-C14, C32), who were at least eight months post-diagnosis, and invited them to complete a postal survey. We used self-reported data and information from the Registry to create a composite variable classifying respondents' current area of residence as "urban" or "rural." Respondents self-reported QOL using the Functional Assessment for Cancer Therapy with Head and Neck module (FACT-HN). We used bootstrap linear regression to control for confounding variables, while estimating the association of urban and rural residence to FACT-HN domain scores. Results We obtained survey and Registry data from 583 HNC survivors. Controlling for demographic and clinical variables, rural survivors reported higher physical (coefficient 1.27, bias-corrected and accelerated 95% confidence interval 0.54, 2.43), emotional (coef. 0.99, 95% CI 0.21, 2.02), and HNC-specific (coef. 1.55, 95% CI 0.32, 3.54) QOL than their urban counterparts. Social and functional QOL did not differ significantly. Conclusions These findings add to growing evidence of important differences in life experiences of cancers survivors in urban and rural settings. Results such as these will allow health professionals, policy makers and service providers to better serve these populations. © 2014 Elsevier Ltd. All rights reserved.

The discovery of thousands of crocodile mummies during excavations in the Fayum town of Tebtunis has raised questions as to where they were produced and by whom, and whether they were produced in an organised manner as part of the local crocodile cults. This article examines the textual and archaeological evidence for the breeding of crocodiles for mummification as votive offerings, and offers a reconstruction of what this practice may have entailed. The textual evidence in both Greek and Demotic is fragmentary, and sources related to contemporary animal cults complement the picture and provide an insight as to how this cultic practice operated. A recently discovered crocodile nursery in the town of Narmouthis and the multitude of crocodile mummies discovered in crocodile cemeteries throughout the Fayum suggest that crocodile breeding may have been a large-scale enterprise. The examination of this evidence in the light of modern methods of crocodile and alligator breeding sheds new light on how breeding may have been carried out the in the crocodile cults of the Graeco-Roman Fayum.

Background Lung cancer is the leading cause of cancer death worldwide. Clinically appropriate cancerdirected surgery is an influential and significant prognostic factor. In a population-based study, we determined how urban/rural residence was related to surgery receipt for patients with non-small cell lung cancer. We assessed the relationship between relative survival and patients' area of residence, taking into account surgery receipt and area socioeconomic level. Methods We extracted data from the National Cancer Registry Ireland on patients with non-small cell lung cancer diagnosed during 1994-2011 and linked to arealevel data on socioeconomic indicators and urban/rural categories. We calculated ORs for receipt of cancerdirected surgery using logistic regression with postestimation of adjusted proportions. Relative survival estimates with follow-up to 31 December 2012 were calculated for all cases and stratified by surgery receipt, adjusting for clinical variables, area socioeconomic level and other sociodemographic characteristics. Results 15 031 people diagnosed with non-small cell lung cancer were included in the analysis. On the basis of the multiple logistic regression model, a significantly larger proportion of urban patients (adjusted proportion 23%) as compared with rural patients (adjusted proportion 21%) received surgery ( p

Aims To examine cross-national changes in frequent adolescent cannabis use (40+ times consumed over life-time at age15)overtimeandrelatethesetrendstosocietalwealth,familyaffluenceandgender.Design Datafromthreecycles (2002, 2006, 2010) of the Health Behaviour in School-aged Children (HBSC) Study were used for cross-sectional and trend analyses of adolescent cannabis use. Setting Representative surveys in 30 European and North American countries. Participants A total of 160 606 15-year-old students. Measurements Respondents' life-time cannabis use, demographics, family affluence (FAS) and frequency of peer contacts were measured individually. Indicators of wealth (gross domestic product per capita, GDP) and perceived availability of cannabis were obtained from national public data bases.Findings The frequency of life-time cannabis use decreased over time among adolescents in Europe and North America, particularly in western European countries and the United States (relative risk (RR) = 0.86: confidence interval (CI) 0.79-0.93). This trend was not observed consistently in rapidly developing countries in eastern, central and southern Europe. Over time (2002-10), cannabis use became: (i) less characteristic of high GDP countries in contrast to lower GDP countries (RR = 0.74: CI 0.57-0.95); (ii) less characteristic of youth from high FAS families in contrast to youth from low FAS families (RR = 0.83: CI 0.72-0.96); and (iii) characterized by an increasing gender gap, i.e. consumption was higher among males (RR 1.26: CI 1.04-1.53). Perceived availability of cannabis and peer contacts remained strong predictors of frequent cannabis use. Conclusions Among 30 European and North American countries, cannabis use appears to have 'trickled down' over time, with developing countries taking on the former (heavier) use pattern of richer countries, and less affluent youth taking on the former (heavier) use pattern of more affluent youth. Cannabis use continues to be more common among adolescent males than females.

Background: When individuals stop working due to cancer this represents a loss to society - the loss of productivity. The aim of this analysis was to estimate productivity losses associated with premature mortality from all adult cancers and from the 20 highest mortality adult cancers in Ireland in 2011, and project these losses until 2030. Methods: An incidence-based method was used to estimate the cost of cancer deaths between 2011 and 2030 using the Human Capital Approach. National data were used for cancer, population and economic inputs. Both paid work and unpaid household activities were included. Sensitivity analyses estimated the impact of assumptions around future cancer mortality rates, retirement ages, value of unpaid work, wage growth and discounting. Results: The 233,000 projected deaths from all invasive cancers in Ireland between 2011 and 2030 will result in lost productivity valued at (sic)73 billion; (sic)13 billion in paid work and (sic)60 billion in household activities. These losses represent approximately 1.4 % of Ireland's GDP annually. The most costly cancers are lung ((sic)14.4 billion), colorectal and breast cancer ((sic)8.3 billion each). However, when viewed as productivity losses per cancer death, testis ((sic)364,000 per death), cervix ((sic)155,000 per death) and brain cancer ((sic)136,000 per death) are most costly because they affect working age individuals. An annual 1 % reduction in mortality reduces productivity losses due to all invasive cancers by (sic)8.5 billion over 20 years. Conclusions: Society incurs substantial losses in productivity as a result of cancer-related mortality, particularly when household production is included. These estimates provide valuable evidence to inform resource allocation decisions in cancer prevention and control.

Background/Aim: Sports-related concussions are now recognized as a major public health concern. However, despite the association of concussion with short- and long-term health consequences, many young athletes still lack basic knowledge about concussion and seem to believe that concussions may be “toughed out” and do not require medical attention. This study assessed self-reported practice of playing in training or a match while concussed among Gaelic Athletic Association (GAA) athletes in Ireland aged 13–25 years old (M=19.19, SD=3.54). This study also assessed knowledge about and attitudes towards sports-related concussion in GAA players in Ireland. Methods: Using a self-report questionnaire, data were captured electronically on GAA athletes aged 13–25 years old (n=80) regarding knowledge about the detection, assessment and management of sports-related concussion, as well as participant’s attitudes towards concussion and self-reported practice of playing in training or a match while concussed. Data were collected from June to August 2013. Results: This study revealed that approximately one in four athletes reported having played while concussed in practice or during a match. Males were significantly more likely to play while concussed than females (40.9% and 17.2%, respectively). Results from this study indicated participants lack a complete understanding of concussion, as common misconceptions about concussion prevailed. Analyses revealed that participants generally have safe attitudes towards concussion and concussion management. Conclusion: Generating awareness of the potential short- and long-term health consequences of concussion, coupled with the promotion of safer attitudes towards this injury, could minimize the number of players who return-to-play pre-maturely and promote a more safety-conscious sports culture in Ireland.