Veronika Ottová-Jordan1, Otto R F Smith2, Lilly Augustine3, Inese Gobina4, Katharina Rathmann5, Torbjørn Torsheim6, Joanna Mazur7, Raili Välimaa8, Franco Cavallo9, Helena Jericek Klanscek10, Wilma Vollebergh11, Charlotte Meilstrup12, Matthias Richter5, Irene Moor5, Ulrike Ravens-Sieberer13. 1. 1 Department of Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany v.ottova-jordan@uke.de. 2. 2 Department of Health Promotion and Development, University of Bergen, Bergen, Norway 3 Department of Public Mental Health, Division of Mental Health, Norwegian Institute of Public Health, Oslo, Norway. 3. 4 Public Health Agency of Sweden, Holna, Sweden 5 Department of Human Sciences, Kristianstad University, Kristianstad, Sweden. 4. 6 Department of Public Health and Epidemiology, Riga Stradins University, Riga, Latvia. 5. 7 Institute of Medical Sociology, Medical Faculty, Martin-Luther University Halle-Wittenberg, Halle, Germany. 6. 8 Department of Psychosocial Science, University of Bergen, Bergen, Norway. 7. 9 Department of Child and Adolescent Health, Institute of Mother and Child, Warsaw, Poland. 8. 10 Department of Health Sciences, University of Jyväskylä, Jyväskylä, Finland. 9. 11 Department of Public Health and Pediatrics, University of Turin, Turin, Italy. 10. 12 National Institute of Public Health, Ljubljiana, Slovenia. 11. 13 Faculty of Social and Behavioral Sciences, Department of Interdisciplinary Social Science, University of Utrecht, Utrecht, Netherlands. 12. 14 National institute of Public Health, University of Southern Denmark, Copenhagen, Denmark. 13. 1 Department of Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Abstract
BACKGROUND: This article describes trends and stability over time in health complaints in adolescents from 2002 to 2010 and investigates associations between health complaints, behavioural and social contextual factors at individual level and economic factors at macro-level. METHODS: Comprising N = 510 876 11-, 13- and 15-year-old children and adolescents in Europe, North America and Israel, data came from three survey cycles of the international Health Behaviour in School-aged Children (HBSC) study. Age- and gender-adjusted trends in health complaints were examined in each country by means of linear regression. By using the country as the random effects variable, we tested to what extent individual and contextual variables were associated with health complaints. RESULTS: Significant associations are stronger for individual level determinants (e.g. being bullied, smoking) than for determinants at macro-level (e.g. GDP, Gini), as can be seen by the small effect sizes (less than 5% for different trends). Health complaints are fairly stable over time in most countries, and no clear international trend in health complaints can be observed between 2002 and 2010. The most prominent stable determinants were being female, being bullied, school pressure and smoking. CONCLUSION: Factors associated with health complaints are more related to the proximal environment than to distal macro-level factors. This points towards intensifying targeted interventions, (e.g. for bullying) and also targeting specific risk groups. The comparably small effect size at country-level indicates that country-level factors have an impact on health and should not be ignored.
BACKGROUND: This article describes trends and stability over time in health complaints in adolescents from 2002 to 2010 and investigates associations between health complaints, behavioural and social contextual factors at individual level and economic factors at macro-level. METHODS: Comprising N = 510 876 11-, 13- and 15-year-old children and adolescents in Europe, North America and Israel, data came from three survey cycles of the international Health Behaviour in School-aged Children (HBSC) study. Age- and gender-adjusted trends in health complaints were examined in each country by means of linear regression. By using the country as the random effects variable, we tested to what extent individual and contextual variables were associated with health complaints. RESULTS: Significant associations are stronger for individual level determinants (e.g. being bullied, smoking) than for determinants at macro-level (e.g. GDP, Gini), as can be seen by the small effect sizes (less than 5% for different trends). Health complaints are fairly stable over time in most countries, and no clear international trend in health complaints can be observed between 2002 and 2010. The most prominent stable determinants were being female, being bullied, school pressure and smoking. CONCLUSION: Factors associated with health complaints are more related to the proximal environment than to distal macro-level factors. This points towards intensifying targeted interventions, (e.g. for bullying) and also targeting specific risk groups. The comparably small effect size at country-level indicates that country-level factors have an impact on health and should not be ignored.