Study Of Health Behavior In School Children

学龄儿童健康行为（HBSC）研究是与世界卫生组织（世卫组织）欧洲区域办事处合作进行的一项跨国研究调查。HBSC旨在获得新的见解，并增加我们对年轻人的健康和福祉，健康行为和他们的社会背景的理解。1982年在三个国家发起，目前已有超过35个国家和地区参与。第一次跨国调查是在1983/84年进行的，第二次是在1985/86年进行的，之后每四年进行一次，使用一项共同的研究方案。美国自1993/94年起加入HBSC，自1997/98年起成为正式成员。最近的二零零一至零二年度调查刚刚完成。除了参与国际调查外，美国还同时进行了一项具有全国代表性的基于学校的调查，调查对象是6-10年级的约15,000名学生，使用相同的数据收集方法。1997/98年调查的最近主要研究集中在暴力、欺凌行为和伤害的流行、模式、决定因素和影响、青少年抑郁的流行病学、超重和青春期的时间。在欺凌方面，作为欺凌者、受害者，或作为欺凌者和受害者的参与，从包括美国在内的25个国家的113,200名平均年龄为11岁、13岁和15岁的学生的全国代表性样本中进行了评估。参与欺凌的国家差异很大，从9-54%不等，与较差的心理社会适应有关。在所有或几乎所有国家，欺凌者、受害者和被欺凌者报告的健康问题更严重，情绪和社会适应能力更差。受害者和被欺凌者一致报告与同学的关系较差，而欺凌者和被欺凌者报告更多的酒精使用和携带武器。对携带武器、在学校携带武器、身体打架和在身体打架中受伤的自我报告也进行了调查，发现参与每一种暴力相关行为的男孩比例为13-23%，女孩比例为4-11%。欺负别人比被欺负的几率更大，在校外发生的欺负比在学校发生的更大。携带武器与每周在学校被欺负相关的调整后的赔率为1.5；在学校欺凌他人2.6；4.1 .被学校欺负；以及欺负别人离开学校的行为。因此，在美国，欺凌通常是更严重的暴力行为的标志，包括携带武器、频繁打架和打架相关的伤害。关于超重和青春期成熟的时间，利用1997/98年的数据，比较了15个国家和/或地区的29,242名13岁和15岁的男孩和女孩自我报告的身高和体重体重指数（BMI, kg/m2）以及BMI≥(=>)85百分位和BMI => 95百分位（超重）的患病率。超重患病率最高的是美国，最低的是立陶宛。根据研究参考标准，美国13岁男孩超重患病率为12.6%，13岁女孩超重患病率为10.8%，15岁男孩超重患病率为13.9%，15岁女孩超重患病率为15.1%，均远远超过95百分位或大于95百分位的预期5%。各国之间的相对排名表明，与欧洲和以色列青少年相比，美国青少年报告的BMI => 85百分位和BMI => 95百分位（超重）的比例最高。使用2001/02年数据的后续研究观察了青春期成熟的时间与美国青少年体型增加的关系。尤其是女孩，早熟与较高的身体质量指数和超重有关。由于其他成熟模式，尤其是冒险行为，也可能与青春期发育有关，美国HBSC研究了这种关系。检查的危险行为包括青少年是否曾经吸烟或过量饮酒（喝醉）。男孩的青春期状态由上唇毛发的出现（在Tanner阴毛阶段4周围）和女孩的月经初潮（在Tanner阴毛阶段3和4之间）来表示。在青春期高峰期的各个年龄段，越成熟的青少年的身高和体重均显著增加，危险行为的报告频率随年龄和成熟程度的增加而增加。调整年龄、种族差异、居住地和对家庭富裕程度的看法后，更成熟、有胡须的男孩和月经来潮后的女孩吸烟或酗酒的可能性几乎是前者的两倍。因此，青春期成熟的时间不仅是青少年超重发展的一个因素，也是危险行为发展的一个因素。

The Health Behaviour in School-aged Children (HBSC) study is a cross-national research survey conducted in collaboration with the World Health Organization (WHO) Regional Office for Europe. The HBSC aims to gain new insight into, and increase our understanding of young people's health and well-being, health behaviors and their social context. Initiated in 1982 in three countries, there are now over 35 participating countries and regions. The first cross-national survey was conducted in 1983/84, the second in 1985/86, and subsequently every four years using a common research protocol. The U.S. has been associated with the HBSC since 1993/94 and a fully participating member since 1997/98. The most recent survey was just completed for 2001/02. Besides contributing to the international survey, the U.S. simultaneously mounts a nationally representative school-based survey of ~15,000 students in grades 6-10 using identical data collection methods. Recent major studies from the 1997/98 survey have focused on the prevalence, patterns, determinants, and effects of violence, bullying behaviors, and injury, the epidemiology of depression among young adolescents, and overweight and the timing of puberty. With respect to bullying, involvement as bully, victim, or both bully and victim was assessed from nationally representative samples of 113,200 students at averages ages of 11, 13, and 15 from 25 countries, including the U.S. Involvement in bullying varied dramatically across countries, ranging from 9-54%, and was associated with poorer psychosocial adjustment. In all or nearly all countries, bullies, victims, and bully-victims reported greater health problems and poorer emotional and social adjustment. Victims and bully-victims consistently reported poorer relationships with classmates, while bullies and bully-victims reported greater alcohol use and weapon-carrying. Self-report of weapon-carrying, weapon-carrying in school, physical fighting, and being injured in a physical fight was also examined for the U.S. sample with the finding that involvement in each of the violence-related behaviors ranged from 13-23% of boys and 4-11% of girls. Greater odds of involvement occurred with bullying others than being bullied and with bullying that took place away from school than that occurring in school. The adjusted odds for weapon carrying associated with being bullied in school weekly was 1.5; for bullying others in school 2.6; for being bullied away from school 4.1; and for bullying others away from school 5.9. Thus, bullying in the U.S. is generally a marker for more serious violent behaviors, including weapon-carrying, frequent fighting, and fighting-related injury. With respect to overweight and timing of pubertal maturation, using the 1997/98 data, body mass index (BMI, kg/m2) from self-reported height and weight and the prevalence of BMI at or greater than (=>) 85th centile, and BMI => 95th centile (overweight) in 29,242 boys and girls, ages 13 and 15 years, in 15 countries and/or regions were compared. The highest prevalence of overweight was found in the U.S. and lowest in Lithuania. Based on the study reference standard, prevalence of overweight in the U.S. was 12.6% in 13-year-old boys, 10.8% in 13-year-old girls, 13.9% in 15-year-old boys, and 15.1% in 15-year-old girls, all far exceeding the 5% expected at or greater than the 95th centile. Relative rankings among countries indicated that U.S. adolescents report the highest rates of BMI => 85th centile and BMI => 95th centile (overweight) compared with European and Israeli adolescents. Follow-up studies using the 2001/02 data have looked at the timing of pubertal maturation in association with the increased body size of U.S. adolescents. In girls particularly, early maturation is associated with a higher BMI and overweight. Since other maturational patterns, especially risk-taking behavior, may also be associated with pubertal development, this relationship was investigated in the U.S. HBSC. Examples of risk behaviors examined included whether the adolescent had ever smoked tobacco or drunk alcohol to excess (got drunk). Boys' pubertal status was indicated by the appearance of hair on the upper lip (around Tanner pubic hair stage 4) and girls' by menarche (between Tanner pubic hair stages 3 and 4). At every age during peak pubertal periods, more mature adolescents were significantly taller and heavier, and the reported frequency of risk behaviors increased with age and maturational status. Adjusting for age, ethnic differences, residence and perception of family affluence, more mature boys with facial hair and post-menarcheal girls were almost twice as likely to have ever smoked or reported getting drunk. Thus, not only is the timing of pubertal maturation a factor in the development of adolescent overweight, but also in the development of risk behaviors.