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Adolescent self-reported health in relation to school factors: a multilevel analysis
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. (Arcum)ORCID iD: 0000-0002-1773-6896
Umeå University, Faculty of Social Sciences, Department of Social Work.
2014 (English)In: Journal of School Nursing, ISSN 1059-8405, E-ISSN 1546-8364, Vol. 30, no 2, 114-122 p.Article in journal (Refereed) Published
Abstract [en]

The aim of the study was to examine school-related determinants of self-reported health among adolescents. Questionnaire survey data comprising 4,972 students, Grades 7 through 9, from 20 schools in northern Sweden were used. Also, complimentary data about each school were collected from the Swedish National Agency for Education. Using multilevel logistic regression analyses, results showed that most variation in self-reported health was explained by individual-level differences. Truancy, bullying, and poor relations with teachers significantly increased the odds ratio of reporting poor general health, for boys and for girls. Most variables at the school level, for example, school size and student-teacher ratio, did not render significant associations with students' self-reported health. In conclusion, this study indicates that health promotion at school, including school health services, may benefit from focusing primarily on individual-level determinants of health, that is, students' relations to peers and teachers, without ignoring that bullying and weak student-teacher relationships also may induce school-level interventions.

Place, publisher, year, edition, pages
Sage Publications, 2014. Vol. 30, no 2, 114-122 p.
Keyword [en]
adolescent health, compulsory school, logistic regression, multilevel modeling
National Category
Family Medicine
Identifiers
URN: urn:nbn:se:umu:diva-71408DOI: 10.1177/1059840513489709ISI: 000332846700005PubMedID: 23674554Scopus ID: 2-s2.0-84896262537OAI: oai:DiVA.org:umu-71408DiVA: diva2:623721
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2007-0595
Available from: 2013-05-28 Created: 2013-05-28 Last updated: 2017-12-06Bibliographically approved
In thesis
1. Adolescent self-reported health in the Umeå region: Associations with behavioral, parental and school factors
Open this publication in new window or tab >>Adolescent self-reported health in the Umeå region: Associations with behavioral, parental and school factors
2012 (English)Doctoral thesis, comprehensive summary (Other academic)
Alternative title[sv]
Självrapporterad hälsa hos ungdomar i Umeåregionen, och dess samband med normrelaterat beteende samt med föräldra- och skolfaktorer
Abstract [en]

This thesis consists of a quantitative and a qualitative study. The quantitative study (articles I-III) aimed to examine how self-reported health in adolescence is associated with behavioral, parental, and school factors. Through a survey directed at all adolescents in grades 7-9, data were collected in 2005 in a region in northern Sweden (n=5060). Statistical methods were used to analyze the survey data: chi2tests, multivariate logistic regressions and multilevel logistic regressions. Results showed that even though most adolescents reported good health, there were also rather large proportions of adolescents who reported headaches, stomach aches and feelings of stress. Girls reported poor health to a higher extent than boys, a difference that was larger in grade 9 than in grade 7. The results also showed that being norm compliant was associated with good self-reported health. Furthermore, perceiving relations and communication with parents as poor was associated with poor self-reported health; however, this relationship could not explain gender differences in self-reported health. Continuing on, analyses showed that there exist greater variations in self-reported health between students (within a school) than between different schools. On an individual level, poor relations to teachers, bullying and truancy were associated with poor general health. The qualitative study  (article IV) sought to examine barriers to and facilitators of utilization of local school survey results within a school setting. In 2011, 21 school district managers and principals within a Swedish municipality were interviewed. Analyses were performed using a qualitative content analysis. The results from the qualitative study showed that the dissemination and utilization of school survey results appeared as two interrelated phases in one process. Barriers and facilitators differed qualitatively depending on the phase, dissemination or utilization.

In conclusion, professionals as well as researchers need to consider the complexity of adolescent health and its social determinants. Adolescent health is a concern for multiple sectors in society, which highlights the need for further development of collaborations between professionals in relevant fields, such as health care, school and social services.

Abstract [sv]

Den här avhandlingen består av en kvantitativ och en kvalitativ studie. Syftet med den kvantitativa studien (artikel I-III) var att undersöka sambandet mellan ungdomars självrapporterade hälsa och deras normrelaterade beteende samt föräldra- och skolfaktorer. Data samlades in under 2005, genom en enkät som riktade sig till alla ungdomar i årskurs 7-9 i en region i norra Sverige (n=5060). De statistiska metoder som användes i den kvantitativa studien var bland annat chi2- test, logistisk regression samt flernivåanalys. Resultaten visade att även om de flesta ungdomar rapporterade en god allmän hälsa, så var det också en relativt stor andel som rapporterade huvudvärk, magont samt upplevelser av stress. Flickor rapporterade sämre hälsa än pojkar, en skillnad som var större i åk 9 jämfört med åk 7. Resultaten visade också att normföljsamhet hade ett signifikant samband med god självrapporterad hälsa. De ungdomar som upplevde relationen och kommunikationen med sina föräldrar som dålig, rapporterade också dålig hälsa i högre utsträckning än övriga. Sambandet mellan självrapporterad hälsa och föräldrarelationer kunde inte förklara skillnaderna i ohälsa mellan pojkar och flickor. Vidare, analyser visade att det fanns större variationer i självrapporterad hälsa mellan ungdomar (inom en skola) än mellan olika skolor. Dåliga relationer med lärare, skolk, samt att bli utsatt för mobbning hade ett signifikant samband med dålig självrapporterad hälsa, på en individuell nivå.

Syftet med den kvalitativa studien (artikel IV) var att undersöka vilka faktorer inom skolan som möjliggör och som utgör barriärer för användningen av enkätresultaten från en lokal skolenkät. 2011 genomfördes 21 intervjuer med skolområdeschefer och rektorer inom en kommun i Sverige. Analyser av intervjumaterialet genomfördes med hjälp av kvalitativ innehållsanalys. Resultaten från denna studie visade att spridningen och användningen av resultaten från skolenkäten kan beskrivas som två relaterade faser i en process. De faktorer som underlättade samt utgjorde barriärer för spridningen och användningen av enkätresultaten var kvalitativt olika varandra beroende på vilken fas i processen respondenterna hänvisade till.

Dessa resultat illustrerar den mångfacetterade komplexitet som inryms i ungdomars hälsa och dess sociala determinanter, en komplexitet som både forskare och professionella behöver ta hänsyn till. Ungdomars hälsa angår ett flertal samhällssektorer, vilket visar på betydelsen av en fortsatt utveckling av samverkan mellan professionella inom exempelvis hälso- och sjukvården, skolan och socialtjänsten.

Place, publisher, year, edition, pages
Umeå: Umeå universitet, 2012
Series
Studier i socialt arbete vid Umeå universitet : avhandlings- och skriftserie, ISSN 0283-300X ; 71
Keyword
adolescence, school survey, self-reported health, somatic complaints, stress, norm compliance, parent-adolescent relations, compulsory school, school managers, research utilization, ungdomar, skolenkät, självrapporterad hälsa, somatiska besvär, stress, normföljsamhet, föräldrarelationer, skola, skolområdeschefer, forskningsanvändning
National Category
Social Work
Identifiers
urn:nbn:se:umu:diva-54177 (URN)978-91-7459-377-8 (ISBN)
Public defence
2012-05-11, Samhällsvetarhuset, Hörsal C, Umeå universitet, Umeå, 10:15
Opponent
Supervisors
Available from: 2012-04-20 Created: 2012-04-18 Last updated: 2015-04-29Bibliographically approved

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