Inequalities in health complaints: 20-year trends among adolescents in Scotland, 1998-2018.

This study examined trends in inequalities in health complaints among early adolescents in Scotland from 1998 to 2018. We analysed data from the Health Behaviour in School-aged Children (HBSC) survey conducted in Scotland in 1998, 2002, 2006, 2010, 2014 and 2018. A self-report questionnaire was administered in schools to a nationally representative sample of 11-, 13-, and 15-year-olds (n = 29,250). Health complaints were measured using a scale comprising four psychological symptoms (feeling low, feeling nervous, irritability and sleep difficulties) and four somatic symptoms (headache, backache, stomachache and dizziness). Socio-economic status was measured using the Family Affluence Scale. Between 1998 and 2018, there were significant increases in the proportion of girls and boys reporting feeling low, feeling nervous, sleep difficulties and backache. Prevalence of the eight individual health complaints was higher among girls and adolescents from lower affluence families. Socio-economic inequalities increased over time, such that declines in mental health were greatest among low affluence adolescents. The data show worsening trends in health complaints among Scottish adolescents between 1998 and 2018, particularly for girls and adolescents from low affluence families. Increasing inequalities in mental health highlight the need to address the underlying social and structural determinants of adolescent mental health.

The association between MPOWER tobacco control policies and adolescent smoking across 36 countries: An ecological study over time (2006-2014).

OBJECTIVE: To examine associations over time between national tobacco control policies and adolescent smoking prevalence in Europe and Canada. DESIGN: In this ecological study, national tobacco control policies (MPOWER measures, as derived from WHO data) in 36 countries and their changes over time were related to national-level adolescent smoking rates (as derived from the Health Behaviour in School-aged Children study, 2006-2014). MPOWER measures included were: Protecting people from tobacco smoke (P), offering help to quit tobacco use (O), warning about the dangers of tobacco (W), enforcing bans on advertising, promotion and sponsorship (E) and raising taxes on tobacco (R). RESULTS: Across countries, adolescent weekly smoking decreased from 17.7% in 2006 to 11.6% in 2014. It decreased most strongly between 2010 and 2014. Although baseline MPOWER policies were not directly associated with differences in average rates of adolescent smoking between countries, countries with higher baseline smoke-free policies (P) showed faster rates of change in smoking over the time period. Moreover, countries that adopted increasingly strict policies regarding warning labels (W) over time, faced stronger declines over time in adolescent weekly smoking. CONCLUSION: A decade after the introduction of the WHO MPOWER package, we observed that, in our sample of European countries and Canada, measures targeting social norms around smoking (i.e., smoke-free policies in public places and policies related to warning people about the dangers of tobacco) are most strongly related to declines in adolescent smoking.

Do social support and eating family meals together play a role in promoting resilience to bullying and cyberbullying in Scottish school children?

This study investigates if cyberbullying is associated with wellbeing independently of traditional bullying and if social support and eating family meals together promotes resilience by buffering adolescents against the consequences of both types of bullying. Data for 5286 eleven, thirteen and fifteen year olds participating in the cross-sectional 2018 Scottish Health Behaviour in School-aged Children study were analysed. Adolescent self-report measures were used to assess traditional bullying, cyberbullying, classmate and teacher support and frequency of family meals together. Psychological wellbeing was assessed with the 5-item World Health Organization Wellbeing index. Analyses were conducted separately by gender with multilevel models, adjusting for sociodemographic factors. Resilience to bullying and cyberbullying was operationalised using statistical interactions. For both genders, cyberbullying and traditional bullying measures were associated with reduced wellbeing and all social support indicators were associated with increased wellbeing. In models containing both bullying measures, frequent traditional bullying victimisation was associated with a 7.2 (95% CI: 3.4-10.1) reduction in wellbeing score for boys and a 7.2 (95% CI: 4.5-10.0) reduction for girls, while cyberbullying was associated with 10.5 (95% CI: 5.8-15.1) reduction in wellbeing score for boys and 11.1 (95% CI: 6.7-15.5) reduction for girls. For both genders adjusting for classmate support explained away the relationships between traditional bullying and wellbeing, but cyberbullying was associated negatively with wellbeing independent of social support. Only one of 12 interaction tests provided any evidence of resilience. Cyberbullying was associated with a 7.8 (95% CI: 0.2-15.4) reduction in wellbeing score for girls who ate with their family every day, and 17.3 (95% CI: 10.5-24.1) reduction for girls who ate with their families less than weekly. In conclusion, cyberbullying is a strong, albeit rare, threat to adolescent wellbeing. Social support is important for wellbeing, but its ability to buffer adolescents against the consequences of bullying may be limited.

Is obesity at individual and national level associated with lower age at menarche? Evidence from 34 countries in the Health Behaviour in School-aged Children Study.

PURPOSE: A unique standardized international data set from adolescent girls in 34 countries in Europe and North America participating in the Health Behaviour in School-aged Children Study (HBSC) is used to investigate the contribution of body mass index (BMI) at individual and country level to cross-national differences in age at menarche. METHODS: Two independent nationally representative survey data sets from 15-year-olds (n = 27,878, in 34 countries, year = 2005/2006) and 11-year-olds (n = 18,101, in 29 countries, year = 2001/2002) were analyzed. The survey instrument is a self-report questionnaire. Median age at menarche and 95% confidence intervals (CIs) were estimated using Kaplan-Meier analysis. Hierarchical models were used to assess the relationship between BMI and age at menarche (months). "Country-level obesity" was measured by prevalence of overweight/obesity (%) in each country. RESULTS: Country-level median age at menarche ranged between 12 years and 5 months and 13 years and 5 months. Country-level prevalence of overweight among 15-year-old girls ranged from 4% to 28%. Age at menarche was inversely associated with individual BMI (unstandardized regression coefficient beta = -1.01; 95% CI, -1.09 to -.94) and country-level aggregate overweight at age 11 (unstandardized regression coefficient beta = -.25; 95% CI, -.43 to -.08). Individual- and country-level measures of BMI account for 40% of the country-level variance in age at menarche. CONCLUSIONS: The findings add to the evidence that obesity in childhood is a risk factor for early puberty in girls and accounts for much of the cross-national variation in age at menarche. Future HBSC surveys can track this relationship in the wake of the obesity "epidemic."

Socioeconomic differences in second-hand smoke exposure among children in Scotland after introduction of the smoke-free legislation.

BACKGROUND: To examine the impact of the Scottish smoke-free legislation on social inequalities in secondhand smoke (SHS) exposure among primary school children. METHODS: Comparison of nationally representative, cross-sectional, class-based surveys carried out in the same schools before and after legislation. Participants were 2532 primary school children (primary 7; aged around 11 y) surveyed in January 2006 (before legislation) and 2389 in January 2007 (after legislation). Outcome measures were salivary cotinine concentrations, self-reported family socioeconomic classification (family SEC) and family affluence scale (FAS). RESULTS: After adjusting for number of smoking parents, mean cotinine concentration varied significantly across both family SEC and FAS groups, and increased significantly stepwise from high to low family SEC/FAS. Mean cotinine fell in all family SEC/FAS groups after legislation. The relative drop in mean cotinine was equal across all family SEC/FAS groups. Adding an interaction term between survey-year and family SEC/FAS to the model showed an increase in inequalities over time, but was only significant at the 93% level using FAS and 73% using family SEC. CONCLUSION: Inequalities in SHS exposure exist among 11-year-old children in Scotland. Smoke-free legislation has reduced exposure to SHS among all children. Although the greatest absolute reduction in cotinine is observed in the lowest SEC/FAS group, cotinine levels remain highest for this group and there is a suggestion of possible increases in inequalities, which may warrant longer-term monitoring.

Changes in child exposure to environmental tobacco smoke (CHETS) study after implementation of smoke-free legislation in Scotland: national cross sectional survey.

OBJECTIVE: To detect any change in exposure to secondhand smoke among primary schoolchildren after implementation of smoke-free legislation in Scotland in March 2006. DESIGN: Comparison of nationally representative, cross sectional, class based surveys carried out in the same schools before and after legislation. SETTING: Scotland. PARTICIPANTS: 2559 primary schoolchildren (primary 7; mean age 11.4 years) surveyed in January 2006 (before smoke-free legislation) and 2424 in January 2007 (after legislation). OUTCOME MEASURES: Salivary cotinine concentrations, reports of parental smoking, and exposure to tobacco smoke in public and private places before and after legislation. RESULTS: The geometric mean salivary cotinine concentration in non-smoking children fell from 0.36 (95% confidence interval 0.32 to 0.40) ng/ml to 0.22 (0.19 to 0.25) ng/ml after the introduction of smoke-free legislation in Scotland-a 39% reduction. The extent of the fall in cotinine concentration varied according to the number of parent figures in the home who smoked but was statistically significant only among pupils living in households in which neither parent figure smoked (51% fall, from 0.14 (0.13 to 0.16) ng/ml to 0.07 (0.06 to 0.08) ng/ml) and among pupils living in households in which only the father figure smoked (44% fall, from 0.57 (0.47 to 0.70) ng/ml to 0.32 (0.25 to 0.42) ng/ml). Little change occurred in reported exposure to secondhand smoke in pupils' own homes or in cars, but a small decrease in exposure in other people's homes was reported. Pupils reported lower exposure in cafes and restaurants and in public transport after legislation. CONCLUSIONS: The Scottish smoke-free legislation has reduced exposure to secondhand smoke among young people in Scotland, particularly among groups with lower exposure in the home. We found no evidence of increased secondhand smoke exposure in young people associated with displacement of parental smoking into the home. The Scottish smoke-free legislation has thus had a positive short term impact on young people's health, but further efforts are needed to promote both smoke-free homes and smoking cessation.

Persistent socio-demographic differences in physical activity among Scottish schoolchildren 1990-2002.

BACKGROUND: Regular participation in physical activity can have significant health gains in terms of physical and psychological wellbeing but there is evidence to suggest that many young people are not sufficiently active to benefit their health. This paper examines the socio-demographic patterning of leisure-time vigorous physical activity among Scottish schoolchildren between 1990 and 2002. METHODS: The Health Behaviour in School-Aged Children survey of 11-, 13- and 15-year-old schoolchildren has been carried out in Scotland since 1990 at four-yearly intervals. Levels of vigorous physical activity were measured in relation to gender, age and socio-economic status (SES). RESULTS: Girls reported lower levels of vigorous physical activity than boys and this gender difference persisted throughout the four survey years, irrespective of changes in overall levels of physical activity. Vigorous physical activity was also consistently lower among lower SES groups and older adolescents. The effect of gender was greatest, with high-SES girls reporting lower levels of vigorous activity than low-SES boys, and low-SES girls being the least active overall. CONCLUSION: Scottish adolescent females, especially those from low SES groups, may be at particular risk of the adverse health effects associated with low levels of physical activity. Health promotion programmes to promote physical activity need to address these persistent gender and socio-economic inequalities.