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Aims: Loneliness is an important public health challenge for all ages. This study reports time trends of loneliness among adolescents over a 12-year period and analyses the strength of the associations between loneliness, health complaints, and medicine use. Methods: Data were derived from the cross-sectional Finnish Health Behaviour in School-aged Children study conducted in 2006, 2010, 2014, and 2018. The study population is based on a random sample of schools with 20,444 participants aged 11–15 years. The trends were analysed with a Mantel–Haenszel test, and the strength of the associations was evaluated by mixed-effects logistic and linear regressions. Results: An increasing prevalence in frequent loneliness (2006: 11%; 2018: 15%) was evident over the 12-year study period, especially in girls and 15-year-olds. Among all adolescents, loneliness was associated with a higher risk of recurrent health complaints and medicine use to treat the corresponding health issues, especially nervousness (odds ratio 5.8) and sleeping difficulties (odds ratio 7.6). Conclusions: Adolescence is a period of higher risk of frequent loneliness and associated health complaints. In this study, loneliness was common among adolescence and an increasing trend of loneliness was observed between 2006 and 2018. Also, psychosomatic health complaints and medicine use were strongly associated with loneliness. Persistent loneliness is a significant health risk and failure to resolve loneliness before entering adulthood may imply significant concerns for future well-being.

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.

(1) Background: Internet use has become an integral part of adolescents’ daily lives. It is important to understand how adolescents use the internet, and how this use is associated with demographic factors and health from a person-oriented perspective. (2) Methods: The study applied the Finnish nationally representative HBSC data (persons aged 11, 13, and 15, n = 3408), descriptive observation, latent class analysis, and multinomial logistic regression analysis. (3) Results: Entertainment activities (listening to music) and socially oriented activities (liking posts, talking online) were the most prevalent among adolescents, but gender differences emerged. Five different internet user profiles were identified (encompassing interest-driven, friendship-driven, abstinent, irregular, and excessive users). Interest-driven users participated in interest- and media-oriented activities. Adolescents in the interest-driven user group were more likely to be boys and participants with low academic achievement, high parental monitoring, and high problematic social media use. Friendship-driven users participated in socially oriented activities. Adolescents in the friendship-driven user group were more likely to be girls and participants aged 13 or 15, with high peer and family support. Abstinent users participated only in entertainment, while irregular users showed no particularly high involvement in any internet activity. Adolescents in the abstinent and irregular user groups were likely to be boys and participants aged 11 with high family support. Excessive users had high involvement in internet activities overall. Adolescents in the excessive user group were more likely to be participants with high problematic social media use and were most likely to feel low and tired on school mornings. (4) Conclusion: The study confirmed the prevalence of internet use. It identified five internet user profiles and differences between user profiles regarding individual and social factors and health outcomes.

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.

Sport has been promoted as a means of increasing the social inclusion of persons with intellectual disabilities. Suitable tools for evaluating this claim are not readily available. The aim of this study was to develop a self-report tool for use by people with intellectual disabilities regarding the social inclusion they experience in sport and in the community. A three-phase process was used. In the first phase an item bank of questionnaire items was created and field-tested with 111 participants. Initial factor analysis identified 42 items which were further evaluated in Phase 2 with 941 participants from six European countries. Construct validity was established first through Exploratory and then Confirmatory factor analysis. These analyses identified ten items relating to inclusion in sports and ten to inclusion in local communities. A third phase checked the usability and test-retest reliability of the short form with a further 228 participants. In all, 1280 athletes and non-disabled partners were involved from eight countries. This short social inclusion questionnaire has been shown to be a reliable and valid measure for use transnationally. Further psychometric properties remain to be tested, notably its sensitivity to change resulting from interventions aimed at promoting social inclusion.

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

At present there are different positions regarding trends in adolescent mental health. Can we trust trend data on the mental health among adolescents in the Nordic countries? Some question the trustworthiness of adolescent self-reports, which describe ordinary daily hassles as health complaints, which cannot be interpreted as signs of mental disorders. In addition, today there is a more open climate for talking about mental issues, which can lead to an overestimation of the prevalence of mental disorders. Statistics on mental health services statistics report increased psychopharmaceutic prescriptions as well as consumption of professional care. Such data argues for increased governmental investment in adolescent mental health services. Is this pattern due to increased availability of mental health services and/or increased prevalence of mental health problems in the adolescent population? A concern is that data availability influences policymaking and allocation of resources. If there is an emphasis on self-reported data from adolescents that may an increased risk of medicalization of young people's dealing with their daily lives. If on the other hand the reported problems among young people is disregarded, this would be against the UN Child Convention. The survey data has important qualities especially if the data is analysed and reported properly. The validation of survey measure has been done both regarding psychometric quality and content validity. Advanced analysis of the data can draw a more nuanced picture. Moreover, some screening instruments have been developed as a first step towards making diagnosis. Instead the HBSC surveys ask boys and girls about their health and well-being, social environment and health behaviours. HBSC uses findings at national and international levels to gain new insights into young people's health and wellbeing, understand the social determinants of health, and inform policy and practice to improve young people's lives.

Long-term trends in mental health of school-aged children can be analysed in the HBSC study. In Sweden the proportion of the children that report at least two weekly health complaints during the last six months has increased from the first data collection 1985/1985 to the latest 2017/2018 among all age groups for both girls and boys. Among the 11-year-old it reached 41 % among girls and 30 % boys, and among 15-year-old girls 62 % and boys 35 %. Can we trust this? The prevalence of two or more weekly health complaints showed large differences by country over time and especially in 2014, when Iceland and Sweden showed an almost 10%-point larger prevalence of multiple weekly symptoms (about 35%) than Denmark, Finland and Norway (about 25%). Norway was the only country to show a decline during 2002-2014. The prevalence of sleep difficulties has increased over the 12-year period in Denmark, Iceland, and Finland. In Sweden the prevalence fell from 26% to 21% from 2002 to 2006 but rose by 10% points from 2010 to 2014. Only Norway showed a positive development over the 12-year period; the prevalence declined in 2014 to 17% the lowest prevalence of sleep difficulties in any of the five Nordic countries. The trend of excellent self-rated health for Nordic adolescents indicates a small overall improvement between 2002 and 2006 but a stable trend in the following periods up until 2014. Finland and especially Sweden shows a decline in the prevalence of students having an excellent self-rated health. The only country to show a positive development in the prevalence of students having excellent self-rated health from 2002 to 2014, is Norway. The overall prevalence of adolescents having high life satisfaction has declined in most of the Nordic countries examined.

The aim is to discuss methodological challenges for research on adolescent positive mental health. A first consideration is which questions should the measurement instrument answer. In the clinical context it should have the properties of giving enough information for making a diagnosis of high quality. In the public health context, its objective may be to give information that enables the researcher to describe trends at the population level and provide guidance on areas of intervention. The HBSC study is monitoring the health and health behaviour of school-aged children in a public health context. It is a population survey, defined by the form of data collection and the method of analysis. The data is collected by questionnaire from a representative sample of school-aged children. It tries to answer descriptive questions (What, who, when?), but also tries to explore causal associations (Why?), given the limitations of the cross-sectional design. Surveys have advantages: Good for gathering descriptive data; Can cover a wide range of topics. Are relatively inexpensive to use; Can include large number of respondents; and Can be analysed using a variety of existing software. Among the disadvantages can be mentioned: Self-report may lead to biased reporting; Data may provide a general picture but lack depth; Difficult to obtain adequate information on context; and Differences in understanding: it is difficult to formulate questions in such a way that it will mean exactly same thing to each respondent. The choice of measurement tools or indicators involves both theoretical and practical issues. Multidisciplinary research teams may include different theoretical traditions, which is an asset but also make it necessary to be explicit regarding overall aims of the study. Most often the theoretical issues focus one of three topics: the value of the types of data; the relative scientific rigor of the data; or basic, underlying philosophies of evaluation.

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.

Increasingly, physical education teachers are expected to become the cog in an ever-expanding physical activity (PA) promotion wheel. This requires such teachers to be equipped with new knowledge a...

This study aimed to examine the validity and reliability of an instrument designed to measure student perceptions of curricular goals in physical education, the Curricular Goals in Physical Education Questionnaire. Participants were 879 Finnish students from grades 7 to 9 (412 girls, 467 boys; mean age 13.81). An exploratory factor analysis was performed on Sample 1 (n = 287), revealing a four-factor solution and suggesting that factor structure be cross-validated with confirmatory factor analysis in Sample 2 (n = 592). Confirmatory factor analysis demonstrated an acceptable fit and supported the four-factor model. Tests for gender invariance supported configural, metric, and scalar invariance. Analyses of factor mean differences indicated that girls attributed more importance than boys to physical education’s health-related goals, social and emotional learning, and motor skill development. This study confirmed the validity of the Curricular Goals in Physical Education Questionnaire to assess student pers...

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

Background Previous research established a positive association between national income inequality and socioeconomic inequalities in adolescent health, but little is known about the extent to which national level inequalities in accumulated financial resources (i.e. wealth) are associated with these health inequalities. Therefore, we examined the association between national wealth inequality and income inequality and socioeconomic inequalities in adolescent mental wellbeing. Methods Data were from 17 countries participating in three successive waves (2010, 2014 and 2018) of the cross-sectional Health Behaviour in School-aged Children (HBSC) study. We combined individual-level data on adolescents' life satisfaction, psychological and somatic symptoms and socioeconomic status (SES) with country-level data on income and wealth inequality (n = 244771). We performed time-series analysis on a pooled sample of 48 country/year groups. Results Higher levels of national wealth inequality were associated with fewer average psychological and somatic symptoms, while higher levels of national income inequality were associated with more psychological and somatic symptoms. No associations between either national wealth inequality or income inequality and life satisfaction were found. Smaller differences in somatic symptoms between higher and lower SES groups were found in countries with higher levels of national wealth inequality. In contrast, larger differences in psychological symptoms and life satisfaction (but not somatic symptoms) between higher and lower SES groups were found in countries with higher levels of national income inequality. Conclusions Although both national wealth and income inequality are associated with (socioeconomic inequalities in) adolescent mental wellbeing, associations are in opposite directions. Further research is warranted to gain better understanding in the role of national wealth inequality on (socioeconomic inequalities in) adolescent health. Key messages This is one of the first studies to examine if socioeconomic inequalities in adolescent mental wellbeing are associated with national wealth inequality independently from national income inequality. Opposing effects of national wealth inequality and income inequality on socioeconomic inequalities in adolescents’ mental wellbeing warrant further research before policy recommendations can be made.

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