Study Of Health Behavior In School Children

学龄儿童健康行为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家研究调查。HBSC旨在对年轻人的健康和福祉、健康行为和他们的社会背景进行新的洞察和理解。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，随后每四年使用一项共同的研究方案。美国自1993/94年以来一直与HBSC联系在一起，自1997/98年以来一直是全面参与的成员。最近一次的统计调查刚完成2001/02年度。除了对国际调查做出贡献外，美国还利用相同的数据收集方法，同时对约1.5万名6-10年级的学生进行了一项具有全国代表性的基于学校的调查。1997/98年调查的最新主要研究集中在暴力、欺凌行为和伤害的流行率、模式、决定因素和影响，青少年抑郁症的流行病学，以及超重和青春期的时间。关于欺凌行为，参与欺凌行为是从来自25个国家的113,200名具有全国代表性的学生中进行评估的，这些学生的平均年龄分别为11岁、13岁和15岁。参与欺凌行为的国家差异很大，从9%到54%不等，而且与较差的心理社会适应能力有关。在所有或几乎所有国家，欺凌者、受害者和欺凌受害者报告的健康问题更严重，情绪和社会适应能力更差。受害者和欺凌受害者总是报告与同学的关系较差，而欺凌受害者和欺凌受害者报告说更多地使用酒精和携带武器。美国样本还检查了携带武器、在学校携带武器、肢体打斗和在肢体打斗中受伤的自我报告，发现每种与暴力相关的行为都涉及13%-23%的男孩和4%-11%的女孩。欺凌他人的几率比被欺负的几率大，发生在学校以外的欺凌行为的几率比在学校发生的要大。携带武器与每周在学校受到欺凌有关的调整后的比数为1.5；在学校欺负他人的比数为2.6；在学校被欺负的比数为4.1；在学校欺负他人的比数为5.9。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、频繁打架和与打架有关的伤害。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岁的男孩和女孩的体重指数(BMI，kg/m2)、体重指数(BMI)和体重指数(BMI)。超重率最高的是美国，最低的是立陶宛。根据研究参考标准，美国13岁男孩的超重率为12.6%，13岁女孩的超重率为10.8%，15岁男孩的超重率为13.9%，15岁女孩的超重率为15.1%，都远远超过或高于第95个百分位数的5%的预期。各国之间的相对排名表明，与欧洲和以色列的青少年相比，美国青少年报告的BMI=85百分位和BMI=95百分位(超重)的比率最高。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，早熟与更高的BMI和超重有关。由于其他成熟模式，特别是冒险行为，也可能与青春期发育有关，美国HBSC对这种关系进行了调查。被检查的危险行为的例子包括青少年是否曾过度吸烟或酗酒(喝醉)。男孩的青春期状态是通过上嘴唇上的毛发(坦纳阴毛阶段4)和女孩的初潮(坦纳阴毛阶段3和4之间)来表示的。在青春期高峰期的每个年龄段，更成熟的青少年明显更高、更重，报告的危险行为频率随着年龄和成熟状态的增加而增加。根据年龄、种族差异、居住地和对家庭富裕的看法进行调整后，留着胡须的成熟男孩和初潮后的女孩吸烟或报告喝醉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，而且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.