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Aims: We examined the relationship between loneliness and health among young adolescents. We also investigated the validity of a single-item measure of loneliness by comparing this to a composite score. Methods: The current data come from a nationally representative sample of 11- to 15-year-old adolescents (N=3305; F=52%) from Denmark collected in 2014 as part of the Health Behaviour in School-aged Children (HBSC) collaborative cross-national survey. Results: A series of binary logistic regressions showed that higher loneliness among adolescents, whether measured using the single- or multi-item measurement, was associated with poorer self-rated health, higher frequency of headache, stomach ache, backache, difficulties sleeping, greater sleep disturbance and more instances of feeling tired in the morning. Those associations were relatively consistent across sex and age groups. Conclusions: Loneliness is associated with poorer self-reported health and sleep problems among young adolescents. Those findings are similar across two measures of loneliness, suggesting robust findings. The development of interventions and health-education efforts to fight loneliness in adolescence is important.

The Health Behaviour in School-aged Children (HBSC) study is a large cross-national research study, conducted in partnership with the World Health Organization (WHO). The study has surveyed young people aged 11, 13 and 15 years every 4 years since the mid-1980s and has grown to include 50 countries across Europe, North America, and Western-Central Asia. Over the past 40 years more than 1.6 million students have participated. HBSC aims to advance understanding of adolescent health behaviours, health and wellbeing within social contexts, inform national and international health promotion policies and practice, and foster collaboration among researchers, policymakers, and practitioners. In this paper we share the history and development of the HBSC study covering: i) theory-driven and novel research impact, ii) unique long-term trends in adolescent health behaviours and perceived health and wellbeing, iii) methodological rigor to allow cross-national comparison, and iv) embedding youth involvement and maximizing policy impact.

The headers in the first two rows in table three were off. TABLE 3 Overview of time trend patterns for psychological and somatic complaints by gender and country for 1994–2018 and 1994–2022 (Health Behaviour in School-aged Children study, 41 countries). Trend until 2018 Trend until 2022 Psychological complaints Somatic complaints Psychological complaints Somatic complaints Country/region Boys Girls Boys Girls Boys Girls Boys Girls Armeniae — — — Linear decrease — Quadratic—U-shaped* — Quadratic—U-shaped* Austriaa Linear increase Quadratic—U-shaped — Linear increase Quadratic—U-shaped* Quadratic—U-shaped Linear increase* Quadratic—U-shaped* Belgium—Flandersa — Linear increase Quadratic—inverted U-shaped Cubic Cubic* Cubic* Linear increase* Quadratic—U-shaped* Belgium—Walloniaa Quadratic—U-shaped Quadratic—U-shaped Quadratic—inverted U-shaped Linear increase Quadratic—U-shaped Cubic* —* Linear increase Bulgariad Quadratic—U-shaped Linear increase Quadratic—U-shaped — Cubic* Linear increase Linear increase* Cubic* Canadaa — Quadratic—U-shaped — Linear increase Quadratic—U-shaped* Quadratic—U-shaped — Quadratic—U-shaped* Croatiac — Quadratic—U-shaped — — — Quadratic—U-shaped — Quadratic—U-shaped* Czechia Linear increase Linear increase — Quadratic—inverted U-shaped Linear increase Quadratic—U-shaped* — Cubic* Denmarka Linear increase Linear increase Linear increase Linear increase Linear increase Cubic* Linear increase Cubic* Englandb Cubic Linear increase — Linear increase Quadratic—U-shaped* Cubic* Cubic* Cubic* Estoniaa — Cubic — Cubic Cubic* Cubic Cubic* Cubic Finlanda — Quadratic—U-shaped Linear increase Linear increase Linear increase* Quadratic—U-shaped —* Cubic* Francea Quadratic—U-shaped Quadratic—U-shaped Cubic Quadratic—inverted U-shaped Quadratic—U-shaped Quadratic—U-shaped Linear increase* Cubic* Germanya — Quadratic—U-shaped — Linear increase Cubic* Cubic* Linear increase* Quadratic—U-shaped* Greeceb Linear decrease Cubic — — Cubic* Cubic Quadratic—U-shaped* Cubic* Greenlanda — Linear increase Linear increase Linear increase Linear increase* Linear increase Linear increase Linear increase Hungarya — Cubic Linear increase Linear increase Quadratic—U-shaped* Cubic Linear increase Cubic* Icelandd — Linear increase — Cubic Quadratic—U-shaped* Quadratic—U-shaped* / Quadratic—U-shaped* Irelandb — Linear increase — Linear increase Quadratic—U-shaped* Quadratic—U-shaped* Linear increase* Linear increase Israela Linear decrease — — — —* Cubic* Quadratic–inverted U-shaped* Cubic* Italyc — Linear increase — Linear increase Linear increase* Quadratic—U-shaped* / Linear increase Latviaa Linear increase Linear increase Linear increase Linear increase Quadratic—U-shaped* Cubic* Linear increase Quadratic—U-shaped* Lithuaniaa — Cubic Quadratic - inverted U-shaped — Cubic* Cubic Quadratic-inverted U-shaped Cubic* Luxembourgd — Cubic — — Linear increase* Quadratic—U-shaped* — — North-Macedoniac — Quadratic—U-shaped — — Linear increase* Quadratic—U-shaped Linear increase* Linear increase* Maltac — Linear increase Linear increase Linear increase — Linear increase Linear increase Linear increase Netherlandsc — Linear increase — Cubic Quadratic—U-shaped* Quadratic—U-shaped* Linear increase* Linear increase* Norwaya — Linear increase — — Cubic* Linear increase — Linear increase* Polanda Cubic Cubic Quadratic—inverted U-shaped Linear increase Cubic Cubic Linear increase* Cubic* Portugalb Quadratic—U-shaped Quadratic—U-shaped — — Quadratic—U-shaped Quadratic—U-shaped / Quadratic—U-shaped* Romaniad —/ Quadratic - U-shaped — — Quadratic—U-shaped* Quadratic—U-shaped / Cubic* Russiaa — — Quadratic—inverted U-shaped Linear increase — — — — Scotlanda Quadratic—U-shaped Quadratic—U-shaped — Quadratic—U-shaped Quadratic—U-shaped Quadratic—U-shaped Linear increase* Quadratic—U-shaped Slovakiaa Linear increase — Linear increase Linear increase Cubic* Cubic* Linear increase Quadratic—U-shaped* Sloveniac Quadratic—U-shaped Cubic — Linear increase Quadratic—U-shaped Cubic Linear increase* Linear increase Spainc Linear decrease Linear decrease — Linear decrease Linear decrease Quadratic—U-shaped* — Linear decrease Swedena Linear increase Linear increase — Linear increase Cubic* Cubic* Linear increase* Cubic* Switzerlandb — Quadratic—U-shaped — Linear increase Linear increase* Cubic* Linear increase* Cubic* Ukrainec Quadratic—U-shaped Cubic Cubic — — — — — USAb Linear decrease Cubic — — — — — — Walesa Cubic Quadratic—U-shaped — Linear increase Quadratic—U-shaped* Quadratic—U-shaped Quadratic—U-shaped* Cubic* Total number of countries with Linear decrease 4 1 0 2 1 0 0 1 Linear increase 6 14 7 20 8 4 19 9 Quadratic—inverted U-shaped 0 0 5 2 0 0 2 0 Quadratic—U-shaped 7 13 1 1 15 18 2 11 Cubic 3 9 2 4 10 16 2 16 None (—) 21 4 26 12 4 0 13 1 * = Different trend pattern for 1994–2018 and 1994–2022; a Data since 1994. b Data since 1998. c Data since 2002. d Data since 2006. e Data since 2010.

The aim was to develop and test a brief revised version of the family affluence scale. A total of 7120 students from Denmark, Greenland, Italy, Norway, Poland, Romania, Scotland and Slovakia reported on a list of 16 potential indicators of affluence. Responses were subject to item screening and test of dimensionality. Bifactor analysis revealed a strong general factor of affluence in all countries, but with additional specific factors in all countries. The specific factors mainly reflected overlapping item content. Item screening was conducted to eliminate items with low discrimination and local dependence, reducing the number of items from sixteen to six: Number of computers, number of cars, own bedroom, holidays abroad, dishwasher, and bathroom. The six-item version was estimated with Samejima’s graded response model, and tested for differential item functioning by country. Three of the six items were invariant across countries, thus anchoring the scale to a common metric across countries. The six-item scale correlated with parental reported income groups in six out of eight countries. Findings support a revision to six items in the family affluence scale.

Background An overarching objective in research comparing different sample groups is to ensure that the reported differences in outcomes are not affected by differences between groups in the functioning of the measurement instruments, i.e. the items have to work in the same way for the different sample groups to be compared. Lack of invariance across sample groups are commonly called Differential Item Functioning (DIF). There is a sense in which the DIF of an item can be taken account of by resolving (splitting) the item into group specific items, rather than deleting the item. Resolving improves fit, retains the reliability and content provided by the item, and compensates for the DIF in estimation of person parameters on the scale of the instrument. However, it destroys invariance of the item’s parameter value among the groups. Whether or not a DIF item should be resolved depends on whether the source of the DIF is relevant or irrelevant for the content of the variable. The present paper shows how external information can be used to investigate if the gender DIF found in the item “Stomach ache” in a psychosomatic symptoms scale used among adolescents may reflect abdominal pain because of a biological factor, the girls’ menstrual periods. Methods Swedish data from the international Health Behaviour in School-aged Children study (HBSC) collected in 2005/06, 2009/10 and 2013/14 were used, comprising a total of 18,983 students in grades 5, 7 and 9. A composite measure of eight items of psychosomatic problems was analysed for DIF with respect to gender and menstrual periods using the Rasch model. Results The results support the hypothesis that the source of the gender DIF for the item “Stomach ache” is a gender specific biological factor. In that case the DIF should be resolved if the psychosomatic measure is not intended to tap information about abdominal pain caused by a gender specific biological factor. In contrast, if the measure is intended to tap such information, the DIF should not be resolved. Conclusions The conceptualisation of the measure governs whether the item showing DIF should be resolved or not.

Aim To examine the external validity of the Family Affluence Scale (FAS) among adolescents in Sweden by using register data for parental earned income, level of education and occupational status. Methods Data from the baseline (2015–2019) of the Study of Adolescence Resilience and Stress (STARS), comprising 2283 13-year-olds in the region of Västra Götaland, were used. The FAS III consists of six items: unshared bedroom, car ownership, computer/tablet ownership, dishwasher, number of bathrooms and number of holidays abroad. Register data regarding earned income, educational level and occupational status from Statistics Sweden (2014–2018) were linked to adolescents. In total, survey data were available for 2280 adolescents, and register data were available for 2258 mothers and 2204 fathers. Results Total parental earned income was moderately correlated with adolescents’ scoring on FAS (0.31 <  r  < 0.48, p  < 0.001), depending on examination year. The low FAS group mainly comprised low-income households, and the high FAS group mainly comprised high-income households. Correlations between mothers’ and fathers’ educational level and adolescents’ scoring on FAS were low ( r  = 0.19 and r =  0.21, respectively, p  < 0.001). FAS was higher among adolescents whose parents were working, but the correlation between parents’ occupational status and FAS was low ( r =  0.22, p  < 0.001). Conclusions The FAS can mainly identify low- and high-income households in Sweden. It may be used as an alternative measure of parental earned income in studies using self-reported socioeconomic status among adolescents.

Little is known about societal processes that contribute to changes in adolescent mental health problems. This study aims to fill this gap using data from the Health Behavior in School-aged Children study between 2002 and 2018 (ncountries = 43, nindividuals = 680,269, Mage = 14.52 (SD = 1.06), 51.04% female), supplemented with other international data. National-level psychological complaints increased more strongly among girls than boys. National-level schoolwork pressure, single-parent households, time spent on internet, and obesity were generally rising. In both boys’ and girls’ samples, increases in national-level schoolwork pressure, obesity, and time spent on internet use were independently associated with increases national-level psychological complaints. However, national-level obesity and psychological complaints were more strongly related among girls than boys. Results highlight the potential impact of societal-level processes on adolescent mental health problems.

Using waste wood to prepare recycled wood fiber (RWF) and using it to enhance low-carbon cement-based materials can achieve the recycling utilization of waste resources, which meets the needs of green and sustainable development strategy. In this study, the performance of high-belite sulfoaluminate cement (HBSC) composites reinforced with recycled wood fibers (RWFs) derived from construction waste wood was investigated. The effects of RWF content and water-to-cement ratio on mechanical properties, hydration characteristics, thermal conductivity, and micro-structure were systematically evaluated. Increasing RWF content resulted in an initial increase followed by a decrease in the mechanical properties of HBSC-based materials. A 20% RWF incorporation simultaneously optimized flexural and compressive strength while mitigating crack propagation. The addition of RWF decreased the dry density of HBSC. Thermal conductivity exhibited a linear correlation with dry density and decreased with higher water-cement ratios. At 20% RWF content and a water-cement ratio of 0.45, the microstructure of the HBSC composite became denser (or more refined in pore structure), resulting in the optimal comprehensive performance.

(1) Background: The World Health Organization (WHO)-5 Well-Being Index has been used in many epidemiological studies to assess adolescent mental well-being. However, cross-country comparisons of this instrument among adolescents are scarce and, so far, no good-fitting, common invariant measurement model across countries has been reported. The present study aims to evaluate and establish a version of the WHO-5 Well-Being Index that allows for a valid cross-country comparison of adolescent self-reported mental well-being. (2) Methods: Using data from the 2018 Health Behaviour in School-aged Children study, we evaluated the measurement model and measurement invariance of the five items of the WHO-5 Well-Being Index. We used nationally representative samples of 11-, 13-, and 15-year-old adolescents (N = 74,071) from fifteen countries and regions in Europe. Measurement invariance of the WHO-5 was assessed using a series (country, gender, and age) of multi-group confirmatory factor analyses. In addition, we evaluated the convergent validity of the measure by testing its correlations with psychosomatic complaints, life satisfaction, and self-rated health. (3) Results: We found that WHO-5 does not show good psychometric properties or good measurement invariance fit. However, by excluding the first item of the scale (“I have felt cheerful and in good spirits”), the WHO-4, consisting of the other four original items, had good psychometric properties, and demonstrated good suitability for cross-national comparisons (as well as age and gender) in adolescent mental well-being. (4) Conclusions: The present study introduces the WHO-4—a revised version of the WHO-5—, that allows for a valid comparison of mental well-being across fifteen countries and regions in Europe. The WHO-4 proved to be a reliable and valid instrument to assess mental well-being in the adolescent population.

The perception of one’s own body image is an important determinant of adolescent health. While positive body image is associated with health-promoting behaviours, negative body image may be related to engagement in health-compromising risk behaviours. Hypothetically, an adolescent’s perceived body image may also be influenced by racial/cultural ideals and related gendered expectations, governed by social norms within distinct cultural groups. Variations in perceived body image by race/ethnicity remain largely unexplored in Canada, even descriptively. A descriptive, cross-sectional study was employed using data from the 2017–2018 cycle of the Canadian Health Behaviour in School-aged Children (HBSC) study (weighted n = 18,766 participants). Self-perceptions of body image were described for Canadian adolescents, stratified by race/ethnicity and gender (boys vs. girls). There were two main findings. First , variations in perceptions of body image mainly varied by gender. Boys were more likely to report feeling ‘too thin’ while a higher proportion of girls reported feeling ‘too fat’. These trends were observed across different races/ethnicities. Second , there was little variation in patterns of self-reported body image by race/ethnicity, while the gendered variations remained within all major racial/ethnic groups. Existing research on adolescent body image typically focuses on gender norms, overlooking the potential of racial and ethnic influences on body image perceptions. Our study confirms that adolescent body image does not appear to vary substantially on racial/ethnic lines among Canadian adolescents, consistent with existing studies that highlight the strong influence of gender norms on adolescent body image.