1.1 Health behaviours

Background: Cardiovascular diseases (CVDs) are the number one cause of death globally and among other reasons, are due to the inability to control modifiable lifestyle CVDs risk factors.

Objective: To analyze different profiles of adolescents according to their modifiable lifestyle CVDs risk factors (overweight/obesity, physical activity, smoking, and alcohol consumption).

Method: The sample consisted of 26,110 adolescents (52.3% girls) aged 11, 13, and 15 years old who participated in the Health Behavior in School-aged Children (HBSC) survey in 2018 in seven Mediterranean countries. Sociodemographic characteristics (sex, age, residence country, and socioeconomic status) and modifiable lifestyle CVDs risk factors (overweight/obesity, physical activity, smoking, and alcohol consumption) were recorded. A two-step cluster analysis, one-way analysis of variance, and Chi-squared test were performed.

Results: Four different cluster groups were identified: two low-risk groups (64.46%) in which there was only risk in low physical activity level; a moderate risk group (14.83%) in which there were two risk factors: unhealthy weight and low physical level; and a high risk group (20.7%) which presented risk in all modifiable lifestyle CVDs risk factors assessed. Males and adolescents with high socioeconomic status were overrepresented in the low risk group. Older adolescents reported higher likelihood of being in the high-risk group. In all seven countries, the most prevalent groups were those with the lower risk.

Conclusions: Given that the adolescence period constitutes an important time for interventions aimed at CVDs prevention, identifying profiles of moderate and high-risk adolescents is crucial.

Background: Although it is known that health behaviours, socio-demographic variables and outcomes correlate, it is rarely investigated if there are typical patterns of these variables among the research subjects.

Objectives: To find out whether the students can be divided into distinct groups based on their health behaviour and whether these groups differ in other ways (outcomes and socio-demographics).

Method: In step 1, a hierarchical cluster analysis was carried out to determine the number of groups and to identify the cluster centres. In step 2, this information was entered as the initial values of a cluster centre analysis. In step 3, the clusters were characterised using additional variables.

Results: The 8065 students surveyed could be divided into 5 distinct groups based on their data on smoking, drinking, soft drinks, exercising, fighting and bullying, with cluster 1 and cluster 5 representing the strongest contrast. Cluster 1 comprises students whose health behaviour is generally positive. It is the largest cluster with 49.5% of students. Cluster 5 comprises students whose behaviour is consistently negative. It is the smallest cluster with 7.1% of students. Students in cluster 2 are close to average on many variables, but their dental health is problematic because they frequently consume soft drinks and rarely brush their teeth. Students in cluster 3 are physically inactive, their mental health is poor, but they are also rarely injured. The students in cluster 4 stand out because of their aggressive behaviour.

Conclusion: With the help of cluster analysis, it is possible to categorise the students into a small number of groups based on their health behaviour. These groups are coherent in terms of health behaviour, many outcome variables and socio-demographic variables.

Background: Energy drink consumption among adolescents has become a notable global phenomenon, and has been associated with numerous negative health outcomes.

Objective(s): We examined how prevalent energy drink consumption is among Finnish adolescents, and has there been any change in consumption patterns between 2014 and 2018. Moreover, we identified which background factors, individual resources, and family factors are associated with weekly energy drink consumption.

Method: The data were drawn from the Health Behaviour in School-aged Children (HBSC) surveys (2014 and 2018), each comprising 13- and 15-year-old Finnish adolescents (n = 7405). Descriptive and multilevel mixed-effect binary logistic regression analysis were applied. Complex methods and the WLSMV estimator was used to obtain the standardized regression coefficients and unbiased standard errors.

Results: Weekly energy drink consumption increased among Finnish adolescents between 2014 (18.2%) and 2018 (24.4%), especially among girls. In 2018, boys typically consumed more than girls, and 15-year-olds more than 13-year-olds. Moreover, in 2018, weekly energy drink consumption was more prevalent among 15-year-old adolescents with a non-academic educational aspiration (46.0%) than among adolescents with an academic aspiration (18.3%). Gender (boys more than girls), older age (only in 2018), less parental monitoring, lower school achievement, and a lower level of health literacy explained around 28% of the variance in weekly energy drink consumption in both years.

Conclusions: According to the findings, interventions to decrease the energy drink consumption, should be targeted at all adolescents, but especially at those with fewer individual resources. The interventions should also pay attention to family-level factors.

Introduction: In the Mediterranean diet meals represent spaces for socialization and communication. This study compared “what they eat”, and other lifestyles and health indicators among adolescents who eat family meals everyday with those who did not in eight Mediterranean countries (Turkey, Spain, Greece, Israel, Italy, Macedonia, Malta, and Portugal).

Methods: The sample comprised 39,247 students (11-, 13-, and 15-years old) who participated in the 2017/18 edition of the HBSC study. Sociodemographic characteristics (sex, age, family affluence, and parental employment), lifestyles (frequency of breakfast, fruit, vegetables, and sugary soft-drinks consumption; tooth brushing; physical activity; and electronic media communication –intensity and problematic use–), BMI, body image, and well-being indicators (self-rated health, life satisfaction, and feeling low) were included. Binary logistic regression was performed.

Results and conclusion: Adjusting for sex, age, and family affluence, adolescents having an everyday family meal showed feeling healthier, having higher life satisfaction and better body image; showing higher consumption of breakfast, fruits, vegetables, and soft drinks; brushing their teeth more frequently; presenting electronic media communication almost all the time throughout the day with close friends, and people other than friends, and had lower problematic media use when compared to those adolescents not having an everyday family meal. One unexpected finding was the possible negative effect of having a high family affluence and both parents employed on family meals. Excluding increased soft drinks consumption, findings highlight the importance of considering Mediterranean conviviality of meals when promoting not only healthy eating habits, but also healthier lifestyles, socialization, and overall adolescent health and wellbeing.