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Objectives: This study examined (non-)monotonic time trends in psychological and somatic complaints among adolescents, along with gender differences., Methods: Repeated cross-sectional Health Behaviour in School-aged Children (HBSC) data from 1994 to 2022 covering 15-year-old adolescents from 41 countries (N = 470,797) were analysed. Three polynomial logistic regression models (linear, quadratic, cubic) were tested for best fit, including separate analyses by gender and health complaints dimension., Results: Time trend patterns varied by gender and health complaints dimension. Increases were found in 82.3% of cases (linear 25%, quadratic U-shaped 28.7%, cubic 28.7%), while 14% showed no clear trend, and 3.7% decreased. Boys typically showed linear increases or no clear trend over time, whereas girls generally showed cubic or U-shaped trends. Psychological complaints often displayed U-shaped or cubic patterns, whereas somatic complaints mostly showed linear increases., Conclusion: Psychological and somatic complaints demonstrated diverse time trend patterns across countries, with non-monotonic patterns (U-shaped and cubic) frequently observed alongside linear increases. These findings highlight the complexity of changes within countries over three decades, suggesting that linear modelling may not effectively capture this heterogeneity., Competing Interests: The authors declare that they do not have any conflicts of interest., (Copyright © 2024 Schrijvers, Cosma, Potrebny, Thorsteinsson, Catunda, Reiss, Hulbert, Kostičová, Melkumova, Bersia, Klanšček, Gaspar and Dierckens.)

Purpose: Building on research suggesting that the COVID-19 pandemic may have led to an exacerbation of deteriorating trends in mental health among adolescents, this paper examined trends in adolescents' psychological and somatic complaints across 35 countries from 2010 to 2022, and tested trends in sociodemographic inequalities in these outcomes between 2018 and 2022., Methods: Using data from 792,606 adolescents from 35 countries (51% girls; mean age = 13.5; standard deviation 1.6) across four Health Behaviour in School-aged Children surveys (2010, 2014, 2018, 2022), hierarchical multilevel models estimated cross-national trends in adolescent psychological and somatic complaints. We tested whether observed values in 2022 were in line with predicted values based on 2010-2018 linear trends. Finally, moderation effects of age, family affluence, and family structures on the outcomes were tested (2018-2022)., Results: Both girls and boys showed substantially higher levels of psychological complaints in 2022 compared with the predicted values. For somatic complaints, higher levels than predicted in 2022 were observed only in girls. Moderation analyses revealed an increase from 2018 to 2022 in age gaps and a narrowing in the socioeconomic gap for both outcomes. Also, there was a widening gap between adolescents living with 2 parents and those living in a single parent household in 2022 compared to 2018., Discussion: Cross-national increases in adolescent psychological and somatic complaints were higher than expected in 2022, based on previous trends. Magnitudes of change varied across different sociodemographics groups, with implications for pre-existing mental health inequalities., (Copyright © 2024 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)

The health of children, adolescents, and young adults is a primary global concern. In 2021, there were 2.1 million deaths among children and adolescents. Injuries, violence, communicable diseases, nutritional deficiencies, substance use, non-communicable diseases, and mental health disorders are among the leading causes of death in this age group. Background/objectives: This scoping review aims to identify and describe health promotion and healthy lifestyle programs developed worldwide targeting adolescents and young adults. Methods: A total of 106 programs were included, of which 8 were selected through scientific databases and 98 through other research methods (e.g., government websites and other online sources). Results: The results show that Europe, North America, New Zealand, and the United States of America are the continents and countries with the highest number of programs. Most programs originated before 2020 and are aimed at children, adolescents, and young adults. Mental health, substance and non-substance dependencies, and sexual and reproductive health were the most frequent areas among the available youth programs. Most programs do not mention evaluating or monitoring the services provided. Conclusions: This work allows for a deeper understanding of the programs available for adolescents and young adults, providing an overview of their characteristics. Moreover, it emphasizes the importance of increasing the number of available programs, especially in countries with higher morbidity and mortality rates among the young population. The programs must be based on population studies to better meet their needs. Lastly, programs should become sustainable and integrated into national public policies, accompanied by ongoing training, supervision, and intervision of professionals working in these contexts.

The experience of living with a chronic condition (CC) impacts adolescents' psychological and social adjustment and overall functioning. Considering the increased risk of psychosocial challenges among adolescents with CC, this study aimed to enhance our understanding of the psychological and social factors that impact their quality of life. It also compared the psychological and social variables among (a) adolescents with and without CC and (b) adolescents with CC who are and who are not victims of bullying. The results demonstrated that adolescents with CC showed more psychosocial difficulties than their peers, as they more frequently reported involvement in situations of violence, and demonstrated more difficulties at a psychological and emotional level. Further, being victims of bullying increased the psychosocial vulnerabilities of these adolescents. A better quality of life was associated with the following psychosocial factors: not being a victim of bullying or cyberbullying, having less anxiety and fewer depressive symptoms, liking school, receiving more support from family and friends, having better relationships with peers, and having fewer physical and psychological symptoms. These findings are significant for helping schools develop tools and strategies to address violence and support students with CC, who are at a higher risk of being involved in such situations and require a targeted response., Competing Interests: The authors have no competing interests to declare., (Copyright: © 2024 The Author(s).)

Background: Aging is a process inherent to the human condition that is characterized by various biological, psychological, and social changes that can lead to certain mental health problems., Objective: This study aimed to understand and characterize how biological, psychological, and social factors influence mental health symptoms and neuropsychological function in the aging process., Methods: A sample consisting of 616 participants (73.8% female) aged between 50 and 90 years, (mean [SD]: 69.6 [17.2] years). Data collection involved a neuropsychological assessment carried out by a psychologist in a clinical interview session and the self-completion of a questionnaire., Results: Regression models revealed that depressive symptoms are explained by anxiety, psychological and environmental quality of life, and sleep habits. Anxiety symptoms are explained by depression, physical quality of life, and sleep habits. Statistically significant differences were identified between participants with and without anxiety in neuropsychological terms at the level of agnosia and praxis. Statistically significant differences were identified between participants with and without depression in neuropsychological terms at the level of memory, language, agnosia and praxis, and executive function (eg, prefrontal tests)., Conclusions: Depression and anxiety symptoms are associated and could negatively influence the aging process. Aging should be understood in an ecological way taking into account the action of biological, psychological, social, and environmental factors, as well as the relationship and influence between the different levels and factors. This knowledge is important for diagnosis, for clinical practice, and for the development and definition of public policies to promote healthy aging., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Screen time and the use of social networks is the most frequent form of leisure time occupation and socializing for adolescents. The present study is aimed at understanding and characterizing, from an ecological perspective, what distinguishes healthy and less healthy or even dependent use of social media in young people and the influence on adolescents' well-being. This paper is based on the Health Behaviour in School-aged Children (HBSC) from 2022, a survey carried out every 4 years, in collaboration with the World Health Organisation (WHO), following an international protocol. A total of 7643 students from the 6th, 8th, 10th, and 12th school grades responded, of which 53.9% were female, with an average age of 15.05 ( SD = 2.36). The sample is representative of the school grades under study. The results allow us to study and identify similarities and differences between three groups related to the level of healthiness in the use of social networks and its relations to well-being from an ecological perspective. What distinguishes adolescents with less healthy use of social networks is that they are more often female, older, have more self-injurious behaviour, higher alcohol consumption, and a worse relationship with teachers. The adolescents with the highest level of dependence on social networks are those who have a higher perception of lack of safety at school and in their area of residence, as well as a higher use of screen time as a leisure activity. The well-being of adolescents using social media in a healthy way is explained by fewer psychological symptoms, better stress management strategies, better body awareness, more physical activity, less time online with friends, and better relationships with family and teachers. Technologies and social networks are important for the well-being of adolescents; it is essential to promote a healthy, critical and balanced use with other "screen-free" activities and to promote socio-emotional skills, a lack of which seems to be one of the biggest risk factors associated with the healthy use of technologies.

The United Nations Convention on the Rights of the Child emphasizes the importance of allowing children and adolescents to influence decisions that are important to them following their age and maturity. This paper explores the principles, practices, and implications around using parental versus child/adolescent consent when participating in social science research and policy development. Experiences from two studies are presented: The Confronting Obesity: Co-creating policy with youth (CO-CREATE) and the Health Behaviour in School-aged Children (HBSC) study, a World Health Organization (WHO) Collaborative Cross-National study. Although parental consent may be an important gatekeeper for protecting children and adolescents from potentially harmful research participation, it may also be considered an obstacle to the empowerment of children and adolescents in case they want to share their views and experiences directly. This paper argues that evaluation of possible harm should be left to ethics committees and that, if no harm related to the research participation processes is identified and the project has a clear perspective on collaborating with the target group, adolescents from the age of 12 years should be granted the legal capacity to give consent to participate in the research project. Collaboration with adolescents in the development of the research project is encouraged., (© 2023 The Authors. Obesity Reviews published by John Wiley & Sons Ltd on behalf of World Obesity Federation.)

(1) Background: The aim of the present study is to analyze subjective happiness in relation to leisure time in 10-year-old boys and girls from Brazil, Chile and Spain and to determine which leisure time activity has a greater effect on their subjective happiness and whether there are differences according to gender. (2) Methods: Data from the third wave of the Children's Worlds Project was used, which was collected by administering self-report measures to representative samples in each country. The sample was composed of 4008 early adolescents from Brazil (22.1%, n = 886), Chile (22.8%, n = 913) and Spain (55.1%, n = 2209). The mean age of the sample was 10.17 years (SD = 0.57), and 51.7% were girls. (3) Results: In terms of subjective happiness, moderate to high means were observed, with higher scores in boys and the Spanish sample. The results showed some differences in leisure time activities among children from Brazil, Chile and Spain. Furthermore, the results highlighted the importance of relaxation time with the family to promote happiness in pre-adolescence across genders and countries. Additionally, playing outdoors and doing homework were also found to be protective factors for subjective happiness. (4) Conclusions: In Brazil, Chile and Spain the most consistent result was the positive effect of spending time relaxing with the family on subjective happiness.

During and in the aftermath of the COVID-19 pandemic, several works reflected on young people's physical and psychological health. The Dual Factor Model, which we refer to as the quadripartite model, is useful for understanding children's and adolescents' psychological health and differentiating them regarding their attitude toward the effects of the COVID-19 pandemic. In this investigation, students from the fifth to twelfth year of schooling enrolled in the DGEEC study "Psychological Health and Wellbeing in Portuguese schools" were considered. Four groups were created based on life satisfaction (low or high) and psychological distress (with or without symptoms). The study included 4444 students (M = 13.39 years ± 2.41), of whom 47.8% were male. Of the participants, 27.2% were in the second cycle of primary education, and 72.8% were in lower and upper secondary education. Differences in gender and education level (as a proxy for age) were observed. Additionally, when considering students' perceptions of changes in their lives following the COVID-19 pandemic (stayed the same, became worse, became better), these three groups were compared concerning personal and contextual variables, revealing significant differences at both the individual and contextual levels. Finally, the study discusses the influence of education and health professionals and the need for friendly public policies.

The study aimed to characterize and understand the difficulties experienced by informal caregivers from a bio-psychosocial and environmental perspective, taking into account the socio-demographic and health characteristics of the informal caregiver and the person cared for, quality of life, perceived burden, social support, and the impact of the COVID-19 pandemic on the informal caregiver and the person cared for. The participants were 371 informal primary caregivers, 80.9% female, aged between 25 and 85 years, mean 53.17 (SD = 11.45) years. Only 16.4% of the informal caregivers benefited from monitoring and training for informal caregiver skills; 34.8% received information on the rights of the person being cared for; 7.8% received advice or guidance on the rights and duties of the informal caregiver; 11.9% of the caregivers benefited from psychological support; and 5.7% participated in self-help groups. A convenience sample was used, and data were collected via an online questionnaire. The main findings show that the major difficulties experienced by caregivers are related to social constraints, the demands of caring, and the reactions of the person cared for. The results reveal that the burden of the main informal caregivers is explained by the level of education, quality of life, level of dependence of the person cared for, level of difficulties, and social support. The COVID-19 pandemic impacted caregiving by increasing the perceived difficulty of accessing support services, such as consultations, services, and support; causing distress feelings in the caregiver, such as, anxiety and worry; increasing the needs and symptoms of the person cared for; and increasing the degree of isolation, for both, the informal caregiver and the person cared for.

The quality of the school environment is associated with greater school involvement and academic success and improved levels of well-being/quality of life. In this sense, this study intends to explore the relationship between the quality of life of Portuguese adolescents and school. 8215 adolescents participated in this study, 52.7% of which were female, aged between 10 and 22 years and an average age of 14.36 years ( SD  = 2.28). The sample was collected as part of the Health Behavior in School-aged Children (HBSC) study. The results show that girls like school, teachers, school breaks (between classes) and classes more than boys and present less concerns/difficulties with school. Compared to boys, they report more pressure with the schoolwork and a better perception of safety at school. On the other hand, boys have a better relationship with their peers and teachers, miss more classes on purpose and report a higher perception of quality of life. An above-average QoL is statistically and significantly related with liking school, peers, teachers, school breaks (between classes) and classes. It is also related with feeling less pressure with the schoolwork, a better perception of school success and of safety in the school environment. Additionally, having an above-average QoL is statistically significantly associated with having a better relationship with peers and teachers and less concerns/difficulties with school. This is an important message for the reorganization of schools in terms of their practices and curricula. The need to develop strategies to promote greater identification of students with school is reinforced., Competing Interests: Compliance with Ethical StandardsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. Fábio Botelho Guedes has a scholarship from the Foundation for Science and Technology (SFRH/BD/148299/2019). Ana Cerqueira has a scholarship from the Foundation for Science and Technology (SFRH/BD/148403/2019)., (© The Author(s), under exclusive licence to Springer Nature B.V. 2023, Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.)

Rationale: The associations between the number of COVID-19 cases/deaths and subsequent uptake of protective behaviors may reflect cognitive and behavioral responses to threat-relevant information., Objective: Applying protection motivation theory (PMT), this study explored whether the number of total COVID-19 cases/deaths and general anxiety were associated with cross-situational handwashing adherence and whether these associations were mediated by PMT-specific self-regulatory cognitions (threat appraisal: perceived vulnerability, perceived illness severity; coping appraisal: self-efficacy, response efficacy, response costs)., Method: The study (#NCT04367337) was conducted in March-September 2020 among 1256 adults residing in 14 countries. Self-reports on baseline general anxiety levels, handwashing adherence across 12 situations, and PMT-related constructs were collected using an online survey at two points in time, four weeks apart. Values of COVID-19 cases and deaths were retrieved twice for each country (one week prior to the individual data collection)., Results: Across countries and time, levels of adherence to handwashing guidelines were high. Path analysis indicated that smaller numbers of COVID-19 cases/deaths (Time 0; T0) were related to stronger self-efficacy (T1), which in turn was associated with higher handwashing adherence (T3). Lower general anxiety (T1) was related to better adherence (T3), with this effect mediated by higher response efficacy (T1, T3) and lower response cost (T3). However, higher general anxiety (T1) was related to better adherence via higher illness severity (T1, T3). General anxiety was unrelated to COVID-19 indicators., Conclusions: We found a complex pattern of associations between the numbers of COVID-19 cases/deaths, general anxiety, PMT variables, and handwashing adherence at the early stages of the pandemic. Higher general anxiety may enable threat appraisal (perceived illness severity), but it may hinder coping appraisal (response efficacy and response costs). The indicators of the trajectory of the pandemic (i.e., the smaller number of COVID-19 cases) may be indirectly associated with higher handwashing adherence via stronger self-efficacy., Competing Interests: Declaration of competing interest None., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Variables associated with lifestyle can constitute either risk or protective factors for the development and progression of chronic conditions (CC). This study intends to explore the differences between adolescents with and without CC and between adolescents whose school participation is affected/not affected by the existing CC with regard to variables related to lifestyle (i.e., sleep, physical activity, BMI, and leisure). In addition, it also intends to analyze the influence of these variables (i.e., CC and lifestyle) regarding the adolescents' quality of life (QoL). This work is part of the Portuguese HBSC 2018 study. A total of 8215 adolescents participated (52.7% female), with an average age of 14.36 years ( SD = 2.28). The results showed that the adolescents with CC and whose school attendance and participation are affected by their CC exhibit more sleep difficulties (i.e., they experience lower sleep quality and have a higher degree of sleepiness), higher BMI levels (i.e., higher values of overweight and obesity), less participation in leisure activities, and a lower perception of QoL. A higher perception of QoL is associated with school participation unaffected by the existing CC, sleeping well, a low level of sleepiness, a more frequent practice of physical activity, a lower BMI, and a greater involvement in leisure activities. Adolescent health and well-being are a prominent issue in terms of public policies, with behavior and lifestyle playing a significant role in this domain. This message needs to be reinforced in regard to families, educators, healthcare professionals, and public sector policies, particularly concerning students with CC.

Students with chronic conditions (CC) tend to experience several barriers in terms of their school participation and performance. Therefore, the present study aims to explore the factors related to the time of diagnosis of CC (recent/non-recent), the barriers to participation and academic success (health condition, people's attitude towards CC and school physical environment), the physical and mental health (physical/psychological symptoms and concerns) and school-related variables (relationship with teachers and peers), regarding the school participation of first-year students with CC. This work is part of the HOUSE-Colégio F3 Project, University of Lisbon, which includes 1143 first-year university students from 17 Faculties and Institutes of the University of Lisbon. In this specific study, only the subsample of 207 students with CC was considered, 72.4% of which were female, aged between 18 and 54 years ( M = 20.00; SD = 4.83). The results showed that students with a recent diagnosis of CC and students with school participation affected by the CC were those who presented more negative indicators regarding barriers to school participation, physical and mental health, and school-related variables. A greater impact of CC in terms of school participation was associated with having a recent diagnosis, with people's attitude towards CC and with the health condition as barriers, with more psychological symptoms and worse relationships with teachers and peers. This is a relevant message for the organization of health services for students with CC at the beginning of their university studies, especially since they are often displaced from home and managing their health conditions alone (in many cases, for the first time).

Background: Happiness is becoming increasingly relevant in recent research, including adolescents. Many studies are using the single-item measure for adolescent happiness, however, its validity is not well known. We aimed to examine the validity of this measure among adolescents in three countries from distinct European regions - Eastern (Lithuania), Southern (Portugal), and Western (Scotland)., Materials and Methods: The analysis included data from Health Behaviour in School-aged Children (HBSC) study from three countries and three last surveys (2009/10, 2013/14, and 2017/18). The total sample comprised 47,439 schoolchildren. For validity, the indicators reflecting subjective health, life satisfaction, quality of life, well-being, social support, health complaints, bullying, and self-directed violence were assessed. The calculations were conducted in the total sample and by gender, age, survey year, and country., Results: The different indicators of concurrent and convergent validity revealed consistent correlations with happiness, with better well-being, health, and subjective perceptions being related to higher happiness. Meanwhile, health complaints, bullying behaviors, and self-directed violence were related to lower happiness. The subgroup differences were consistent across gender, age groups, countries, and survey rounds. The extent of differences was more expressed among girls., Conclusion: The single item for adolescent happiness measurement features a consistent pattern of validity concerning indicators of concurrent and convergent validity. Higher self-reported happiness is associated with better mental and physical health and well-being, and less expressed negative factors (complaints, bullying, and self-directed violence). In addition, among girls the correlations tend to be stronger than boys., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Lukoševičiūtė, Gariepy, Mabelis, Gaspar, Joffė-Luinienė and Šmigelskas.)

Background: The COVID-19 pandemic has had a disproportionately hard impact on refugees and other migrants who are often exposed to the virus with limited means to protect themselves. We tested the hypothesis that during the COVID-19 pandemic, refugees and other migrants have suffered a negative impact on mental health and have been unjustly discriminated for spreading the disease in Europe (data collection from April to November 2020)., Methods: Participants in the ApartTogether Survey (N = 8297, after listwise deletion of missing items final N = 3940) provided data regarding to their difficulties to adhere to preventive recommendations against COVID-19 infection (CARE), self-perceived stigmatization (SS), and psychological distress (PD). Structural Equation Modeling was used to investigate PD as a mediator in the pathway linking CARE to SS, while adjusting for the housing and residence status. To improve confidence in the findings, single hold-out sample cross-validation was performed using a train/test split ratio of 0.8/0.2., Results: In the exploratory set (N = 3159) SS was associated with both CARE (B = 0.200, p < 0.001) and PD (B = 0.455, p < 0.001). Moreover, PD was also associated with CARE (B = 0.094, p = 0.001) and mediated the effect of CARE on SS (proportion mediated = 17.7%, p = 0.001). The results were successfully replicated in the confirmation set (N = 781; total effect = 0.417, p < 0.001; proportion mediated = 29.7%, p < 0.001). Follow-up analyses also found evidence for an opposite effect (i.e., from SS to CARE, B = 0.132; p < 0.001), suggesting that there might be a vicious circle between the self-perceived stigmatization and the access to health care and the use of preventive measures against COVID-19 infection., Conclusions: Refugees and other migrants who had more difficulties in accessing health care and preventive measures against COVID-19 infection experienced worse mental health and increased discrimination. These negative effects appeared to be stronger for those with more insecure housing and residence status, highlighting from one side the specific risk of insecure housing in the impact of COVID-19 upon mental health and infection protection, and for another side the need to proper housing as a strategy to prevent both COVID-19 and mental distress., (© 2022. The Author(s).)

Background: Patterns of protective health behaviors, such as handwashing and sanitizing during the COVID-19 pandemic, may be predicted by macro-level variables, such as regulations specified by public health policies. Health behavior patterns may also be predicted by micro-level variables, such as self-regulatory cognitions specified by health behavior models, including the Health Action Process Approach (HAPA)., Purpose: This study explored whether strictness of containment and health policies was related to handwashing adherence and whether such associations were mediated by HAPA-specified self-regulatory cognitions., Methods: The study (NCT04367337) was conducted among 1,256 adults from Australia, Canada, China, France, Gambia, Germany, Israel, Italy, Malaysia, Poland, Portugal, Romania, Singapore, and Switzerland. Self-report data on cross-situational handwashing adherence were collected using an online survey at two time points, 4 weeks apart. Values of the index of strictness of containment and health policies, obtained from the Oxford COVID-19 Government Response Tracker database, were retrieved twice for each country (1 week prior to individual data collection)., Results: Across countries and time, levels of handwashing adherence and strictness of policies were high. Path analysis indicated that stricter containment and health policies were indirectly related to lower handwashing adherence via lower self-efficacy and self-monitoring. Less strict policies were indirectly related to higher handwashing adherence via higher self-efficacy and self-monitoring., Conclusions: When policies are less strict, exposure to the SARS-CoV-2 virus might be higher, triggering more self-regulation and, consequently, more handwashing adherence. Very strict policies may need to be accompanied by enhanced information dissemination or psychosocial interventions to ensure appropriate levels of self-regulation., (© The Author(s) 2021. Published by Oxford University Press on behalf of the Society of Behavioral Medicine.)

Background: The UN has recognised well-being as a main goal of The Global Strategy for Women's, Children's and Adolescents' Health (2016-2030)., Objective: The aim was to identify the areas of mental health that are the most significant to teenagers., Material and Methods: The mixed-method approach was applied. Quantitative research included adolescents aged 11-15 years (6,026 in Portugal; 4,545 in Poland). HBSC study results (2013/2014) were analysed in terms of the following variables: self-rated health, life satisfaction (Cantril Ladder, KIDSCREEN-10 Index), and psychosomatic complaints (SCL scale). Focus workshops took place in 2018, with 72 teenagers aged 14 to 16., Results: 16.6% of the Polish participants and 12.7% of the Portuguese participants were concerned about their health. Polish participants were less satisfied with their life [KIDSCREEN score: 25.48 for Poland (SD=6.39), and 29.96 (SD=6.03) for Portugal]. Both nations associated mental health (MH) with the family setting and relationships with friends. An additional association among Portuguese teenagers involved social issues, whereas Polish adolescents were more focussed on relationships with various people in their environment, as well as on experiencing issues at school and in the family., Conclusions: Adolescent MH is determined by stress, environmental pressure and high expectations. The viewpoints of adolescents are the most valuable source of knowledge for specialists, researchers and youth institutions, who can benefit greatly from taking advantage of this resource., (© 2021 Dorota Kleszczewska et al., published by Sciendo.)

Background: A healthy and supportive family environment leads to more positive results regarding adolescents' development. The main objective of this study was to explore and analyze the relationship between adolescents' quality of life (QoL) and their family environment/relationship., Method: The sample was collected as part of the Health Behavior in School-aged Children 2018 study, which included 8215 adolescents, 52.7% female, with a mean age of 14.36 years ( SD = 2.28)., Results: Girls are more involved in family activities (such as family meals), report being treated with fairness by their parents and feel less parental pressure to get good grades. Boys have a higher perception regarding their family affluence, better family relationships and support and better QoL. Having an above-average QoL is significantly related to high family affluence, better communication with both parents, greater involvement in family activities, greater perception of help from parents regarding decision-making, greater perception of being treated with fairness by parents and less pressure from parents to get good grades, as well as a better family relationship/support., Conclusion: It is important to determine the impact that parental divorce/separation or a weak parent-child relationship can have on adolescents. It is also necessary to consider the family relationship and structure when devising strategies and public policies related to the promotion of adolescents' health and well-being.

Background: The COVID-19 pandemic has affected people's engagement in health behaviors, especially those that protect individuals from SARS-CoV-2 transmission, such as handwashing/sanitizing. This study investigated whether adherence to the World Health Organization's (WHO) handwashing guidelines (the outcome variable) was associated with the trajectory of the COVID-19 pandemic, as measured by the following 6 indicators: (i) the number of new cases of COVID-19 morbidity/mortality (a country-level mean calculated for the 14 days prior to data collection), (ii) total cases of COVID-19 morbidity/mortality accumulated since the onset of the pandemic, and (iii) changes in recent cases of COVID-19 morbidity/mortality (a difference between country-level COVID-19 morbidity/mortality in the previous 14 days compared to cases recorded 14-28 days earlier)., Methods: The observational study (#NCT04367337) enrolled 6064 adults residing in Australia, Canada, China, France, Gambia, Germany, Israel, Italy, Malaysia, Poland, Portugal, Romania, Singapore, and Switzerland. Data on handwashing adherence across 8 situations (indicated in the WHO guidelines) were collected via an online survey (March-July 2020). Individual-level handwashing data were matched with the date- and country-specific values of the 6 indices of the trajectory of COVID-19 pandemic, obtained from the WHO daily reports., Results: Multilevel regression models indicated a negative association between both accumulation of the total cases of COVID-19 morbidity (B = -.041, SE = .013, p = .013) and mortality (B = -.036, SE = .014 p = .002) and handwashing. Higher levels of total COVID-related morbidity and mortality were related to lower handwashing adherence. However, increases in recent cases of COVID-19 morbidity (B = .014, SE = .007, p = .035) and mortality (B = .022, SE = .009, p = .015) were associated with higher levels of handwashing adherence. Analyses controlled for participants' COVID-19-related situation (their exposure to information about handwashing, being a healthcare professional), sociodemographic characteristics (gender, age, marital status), and country-level variables (strictness of containment and health policies, human development index). The models explained 14-20% of the variance in handwashing adherence., Conclusions: To better explain levels of protective behaviors such as handwashing, future research should account for indicators of the trajectory of the COVID-19 pandemic., Trial Registration: Clinical Trials.Gov, # NCT04367337., (© 2021. The Author(s).)

The present study intends to (1) analyze the differences regarding the quality of life between young foreigners and young Portuguese adolescents; (2) understand the relationship between variables related to the school context and the quality of life of foreign adolescents living in Portugal. In all, 8215 adolescents participated in this study, and only the sub-sample of 578 foreigners was considered. 50.3% are boys, aged between 10 and 22 years old. Foreign students in Portugal have a lower well-being index than Portuguese students and a worse relationship with peers and teachers. Foreign girls like school more than boys, have less difficulties in school and have a higher perception of security at this context. On the other hand, they have a lower perceived academic competence and a worse relationship with peers. The importance of developing programs to promote socioemotional skills, empowering teachers and educators, and promoting the adoption of an inclusive model in schools is highlighted., (© 2021 Wiley Periodicals LLC.)

Adolescents' mental health determines their general health and their mental health as adults. Improve the Youth project (ITY) was created and implemented among Polish and Portuguese adolescents. The aim of the project was to investigate the well-being of Portuguese and Polish adolescents, and to evaluate differences between them in self-rated health, life satisfaction and perceived psychosomatic health. A mixed-method approach was applied. The quantitative part was based on Health Behaviour in School-aged Children (HBSC) 2014 data, including adolescents aged 11-15 years (6026 in Portugal; 4545 in Poland). This study meets the issues raised by the HBSC results, regarding mental health in adolescence, and it is aimed to improve adolescents' social participation and active citizenship. In most study areas, findings in Poland were less favourable than in Portugal. The qualitative part was developed to recognize the main threats for adolescent's well-being. In this, they emphasised that every opportunity to talk about their feelings and needs resulted in improvement of their mental health. Elevated levels of stress were connected to environmental pressure and high expectations that they were often unable to cope with. Nervousness, perceiving that it was impossible to meet expectations, the desire to keep up with their peers, fatigue, and uncertainty of the future increased the feelings of frustration. The differences found between countries may be due to cultural roots, surfacing the relevance of assessing adolescents' mental health needs in the social context of family, school and peers. This study also aims to raise awareness among educators and stakeholders to the importance of youth engagement., (© 2021 Wiley Periodicals LLC.)

Objective: The main objective is to understand and characterize the impact of Covid-19 pandemic on mental health and psychosocial risks at work in professionally active adults., Methods: This specific work includes 4708 professionally active participants from all over the country, of which 3354 are women (71.2%), aged between 19 and 86 years, with an average age of 45.8 years (SD = 12.56)., Results: The global impact of Covid-19 is explained by socio-demographic factors (sex, age, and education), by work-related and volume of work and health that is reflected in most symptoms. We found sex, age, education level, and professional area differences related to global impact of Covid-19., Conclusion: The Covid-19 pandemic accounts for the challenge to identify the important factors to promote resilience of citizens, professionals, and organizations., Competing Interests: Matos have no relationships/conditions/circumstances that present potential conflict of interest., (Copyright © 2021 American College of Occupational and Environmental Medicine.)

Purpose: Insufficient and poor sleep patterns are common among adolescents worldwide. Up to now, the evidence on adolescent sleep has been mostly informed by country-specific studies that used different measures and age groups, making direct comparisons difficult. Cross-national data on adolescent sleep that could inform nations and international discussions are lacking. We examined the sleep patterns of adolescents across 24 countries and by gender, age, and affluence groups., Methods: We obtained sleep data on 165,793 adolescents (mean age 13.5 years; 50.5% girls) in 24 European and North American countries from the recent cross-sectional Health Behaviour in School-aged Children surveys (2013-2014 and 2017-2018). For each country, we calculated the age-standardized mean in sleep duration, timing, and consistency and the proportions meeting sleep recommendations on school and nonschool days from self-reported bedtimes and wake times. We conducted stratified analyses by gender, age, and family affluence group., Results: Adolescent sleep patterns varied cross-nationally. The average sleep duration ranged between 7:47 and 9:07 hours on school days and between 9:31 and 10:22 hours on nonschool days, and the proportion of adolescents meeting sleep recommendations ranged between 32% and 86% on school days and between 79% and 92% on nonschool days. Sleep patterns by gender and affluence groups were largely similar, but older adolescents slept less and went to bed later on school days than younger adolescents in all countries., Conclusions: The sleep patterns of adolescents vary across countries and sociodemographic groups. Insufficient sleep on school days is common in many countries. Public health and policy efforts to promote healthy adolescent sleep are encouraged., (Copyright © 2020. Published by Elsevier Inc.)

During middle adolescence, elevated stress and a greater presence of psychological disorders have been documented. The research has paid little attention to the regulation of positive affective states. Fredrickson's broaden-and-build theory suggests that cultivating positive emotions helps to build resources that boost well-being. The current research aimed to examine the longitudinal associations between responses to positive affect (emotion-focused positive rumination, self-focused positive rumination, and dampening) and psychological adjustment (self-esteem and life satisfaction) during middle adolescence. A longitudinal study with two waves separated by one year was conducted, assessing 977 adolescents (M = 13.81, SD = 0.79; 51.5% boys) with self-report measures. A cross-lagged panel analysis was performed by including within the same model the relationships between all of the variables in the two assessment points. The results indicated cross-lagged positive relationships of self-focused positive rumination with both self-esteem and life satisfaction, while dampening showed a negative cross-lagged relationship with self-esteem. Moreover, higher self-esteem predicted more emotion-focused positive rumination, and more dampening predicted lower life satisfaction. Thus, the use of adaptive responses to positive affect and a better psychological adjustment were found to be prospectively interrelated at the one-year follow-up during middle adolescence. The discussion argues for the need to implement programmes to promote more adaptive responses to positive affect to enhance psychological adjustment in the adolescent transition to adulthood., (© 2018 Scandinavian Psychological Associations and John Wiley & Sons Ltd.)

The main objective is to study the relation and impact of Socioeconomic Status (SES) on the subjective well-being in children and adolescents and the role of social and personal factors in this relation. Data was collected in 16 schools; 8 in the North and 8 in the Lisbon Region of Portugal. The questionnaires were filled out by 1,181 youths, 51.5% of which were female. Ages ranged between 8 and 17, the girl's average age being 9.8 years (SD = 1.32) and the boy's average age being 10.0 (SD = 1.53); 2.6% of young people had special educational needs, and 3% did not use the Portuguese language at home; 12.2% had repeated a grade; 27.1% had a high SES; 64.2% had medium/low SES and 8.7% were unemployed. Three adequate regression models were built. Model 1 established the association between SES and subjective well-being. This association turned out to be not significant with the effect of personal and social factors, which were strongly associated with subjective wellbeing. It was revealed that the impact of SES on subjective well-being is mitigated by the presence of social and personal factors. The promotion of personal and social skills appears to be an effective way to avoid the negative effects of low SES in child and adolescent development.

Background: Effective interventions promoting healthier eating behavior among adolescents are urgently needed. One factor that has been shown to impact effectiveness is whether the target population accepts the intervention. While previous research has assessed adults' acceptance of eating-related interventions, research on the opinion of adolescents is lacking. The current study addressed this gap in the literature., Methods: Two thousand seven hundred sixty four adolescents (aged 10-17 years) from four European countries answered questions about individual characteristics (socio-demographics, anthropometrics, and average daily intake of healthy and unhealthy foods) and the acceptability of ten eating-related intervention strategies. These strategies varied in type (either promoting healthy eating or discouraging unhealthy eating), level of intrusiveness, setting (home, school, broader out-of-home environment), and change agent (parents, teacher, policy makers)., Results: Based on adolescents' acceptability ratings, strategies could be clustered into two categories, those promoting healthy eating and those discouraging unhealthy eating, with acceptability rated significantly higher for the former. Acceptability of intervention strategies was rated moderate on average, but higher among girls, younger, overweight and immigrant adolescents, and those reporting healthier eating. Polish and Portuguese adolescents were overall more accepting of strategies than UK and Dutch adolescents., Conclusions: Adolescents preferred intervention strategies that promote healthy eating over strategies that discourage unhealthy eating. Level of intrusiveness affected acceptability ratings for the latter type of strategies only. Various individual and behavioral characteristics were associated with acceptability. These findings provide practical guidance for the selection of acceptable intervention strategies to improve adolescents' eating behavior.

The impact of the social environment on healthy eating awareness results from complex interactions among physical, economic, cultural, interpersonal and individual characteristics. This study investigated the impact of social support and social influence on healthy eating awareness, controlling for socio-economic status, gender and age. Additionally, the mediating effect of self-regulation strategies was examined. A total of 2764 children and adolescents aged 10-17 from four European countries completed self-report measures on healthy eating awareness, social influence and the use of self-regulation strategies. Healthy eating awareness and the use of self-regulation strategies were more likely to occur among younger participants. An interaction between gender and age was related to the use of some self-regulation strategies; compared to girls, boys decreased the use of self-regulation strategies more from pre-adolescence to adolescence. Peer social influence was associated with more unhealthy eating in older participants. Results suggest a need to promote self-regulatory competences among young people in order to assist them with regulating their eating behaviours, especially in the presence of peers. Both school-based interventions and family-based interventions, focusing on self-regulation cognitions and social (peer) influence, could help children and adolescents to use self-regulatory strategies which are essential to eat healthier.

Objectives: The aim is to evaluate the mutual influences between sleep duration/sleep deprivation (SD) and the sleep stealers/adolescent risk behaviours., Methods: The national survey is a component of the Health Behaviour in School-Aged Children (HBSC) study, it is based on a school-based self-completed questionnaire; 3476 students were randomly selected from 139 randomly chosen Portuguese schools using as an unit the class, 53.8% were girls; 45.9% attended the 8th grade and 54.1% the 10th grade; the mean age was 14.9 years. The measured variables were: 1) gender and age; 2) sociodemographics; 3) sleep duration during the week and during weekends and computed SD; 4) screen time (computer use during the week and during the week end (PC use); watching TV and mobile phone use; 5) earlier sexual behaviour; 6) violent behaviours: fights, use of weapons; 7) use of tobacco, alcohol and drugs. The statistical analysis included Pearson chi-square tests and logistic regression., Results: Excessive use of mobile phone, of computer use during weekdays, and internet facilities; substance use; violence and earlier sexual relations had significantly higher prevalence in sleep deprived adolescents. By logistic regression only using PC during weekdays, tobacco, drugs and weapons were associated to SD, while SD was associated to PC use during weekdays, tobacco use and drugs' use. Computer uses tend to be associated among themselves. Mobile phone is associated with computer practices and with alcohol and tobacco use. Tobacco is associated with most risk behaviours. Alcohol use is associated with other substance use, computer use and violent behaviours. Violence behaviours, earlier sex and drugs use tend to be associated among themselves., Conclusions: Sleep stealers use and risk behaviours are more prevalent in sleep deprived adolescents, but, in spite of significant individual associations, models of risk behaviours are still lacking.

Objectives: The present study aimed to evaluate the influences of sleep duration, sleep deprivation, and weekend variability of sleep upon other adolescents' features, namely those related to health and health-related quality of life., Methods: The Health Behaviour in School-Aged Children (HBSC) survey is based on a self-completed questionnaire. The participants in the present study were 3476 students (53.8% were girls) in the 8th and 10th grades at school; the mean age was 14.9 years (range 12.5-19.0). Subjective sleep duration during the weeknights and weekends was collected; sleep deprivation (SD) was considered whenever the difference was greater than 3 h. Health complaint frequency and health-related quality of life (with the Kidscreen 10) were collected., Results: Sleep deprivation was present in 18.9% of the students. It was negatively correlated with sleep duration on weeknights. There were no gender differences, but SD increased with age and grade. Higher school grades were mainly associated with fatigue. A considerable number of adolescents had sleep problems (37.2%); 25.5% had difficulties in sleep initiation, which was more prevalent in adolescents with SD. The sleep duration on weeknights was decreased in the SD group. The average health-related quality of life was reduced in adolescents with SD. The frequency of health complaint was higher is adolescents with SD. Girls had significantly more health complaints than boys, with special focus on headaches., Conclusions: Sleep deprivation is associated with the perception of health-related quality of life and perceived physical and mental health., (Copyright © 2014. Published by Elsevier B.V.)

Background: Overweight epidemics, including among children and adolescents, are fuelled by contemporary obesogenic environments. Recent research and theory highlight the importance of socio-cultural factors in mitigating adverse impacts of the abundance of food in high-income countries. The current study examines whether family meal culture shapes young people's eating behaviors and self-regulation., Methods: Young people aged 10-17 years were recruited through schools in four European countries: the Netherlands, Poland, Portugal and the United Kingdom. A total of 2,764 participants (mean age 13.2 years; 49.1% girls) completed a self-report questionnaire in class, providing information on healthy and unhealthy eating, joint family meals and communal meal values and use of eating-related self-regulation strategies., Results: Path analysis found that family meal culture variables were significantly associated with young people's eating behaviors, as was self-regulation. Significant indirect effects of family meal culture were also found, through self-regulation., Conclusions: Results confirm that family meal culture, encompassing values as well as practices, shapes young people's eating behaviors. Findings extend and link previously separate lines of enquiry by showing how food cultures can play out in the home environment. Importantly, the study contributes novel evidence suggesting that self-regulation is shaped by the home environment and mediates its influence., (© 2014 The International Association of Applied Psychology.)

Background: Applying self-regulation strategies have proven important in eating behaviors, but it remains subject to investigation what strategies adolescents report to use to ensure healthy eating, and adequate measures are lacking. Therefore, we developed and validated a self-regulation questionnaire applied to eating (TESQ-E) for adolescents., Methods: Study 1 reports a four-step approach to develop the TESQ-E questionnaire (n = 1097). Study 2 was a cross-sectional survey among adolescents from nine European countries (n = 11,392) that assessed the TESQ-E, eating-related behaviors, dietary intake and background characteristics. In study 3, the TESQ-E was administered twice within four weeks to evaluate test-retest reliability (n = 140). Study 4 was a cross-sectional survey (n = 93) that assessed the TESQ-E and related psychological constructs (e.g., motivation, autonomy, self-control). All participants were aged between 10 and 17 years., Results: Study 1 resulted in a 24-item questionnaire assessing adolescent-reported use of six specific strategies for healthy eating that represent three general self-regulation approaches. Study 2 showed that the easy-to-administer theory-based TESQ-E has a clear factor structure and good subscale reliabilities. The questionnaire was related to eating-related behaviors and dietary intake, indicating predictive validity. Study 3 showed good test-retest reliabilities for the TESQ-E. Study 4 indicated that TESQ-E was related to but also distinguishable from general self-regulation and motivation measures., Conclusions: The TESQ-E provides a reliable and valid measure to assess six theory-based self-regulation strategies that adolescents may use to ensure their healthy eating.

Complex relationships exist between eating behaviour and personal and environmental factors. Rural and urban geographic contexts seem to play a role in eating behaviour, and therefore deserve a deeper study. A healthy eating behaviour and the conditions that promote it are a major issue in the promotion of adolescent health. The study aims to investigate the associations between the area of residence (urban vs. rural), self-regulation strategies (TESQ-E) and eating behaviours among children and adolescents. A total of 11,820 adolescents (50.6% girls) participated in the study, with a mean age of 13.30 years (SD= 2.13). Nine countries (The Netherlands, United Kingdom, Poland, Portugal, Denmark, Romania, Germany, Finland and Belgium) completed a questionnaire in the school context, asking about the use of self-regulation strategies, eating behaviour awareness/care and sociodemographic questions such as age, gender and residential area. Both areas of residence (urban vs. rural) are associated with eating awareness/care in Romania and Portugal, controlling for age, gender and self-regulation strategies. In some European countries at least, and most probably around the world, health promotion should focus on an ecological approach that includes the understanding of the effect of both environmental factors and personal skills on eating behaviour/awareness., (© 2014 International Union of Psychological Science.)

Obesity-related behaviors, such as intake of snacks and sweetened beverages (SSB), are assumed to result from the interplay between environmental factors and adolescents' ability to self-regulate their eating behaviors. The empirical evidence supporting this assumption is missing. This study investigated the relationships between perceptions of at-home and out-of-home food environment (including SSB accessibility, parental, and peers' social pressure to reduce intake of SSB), nutrition self-regulatory strategies (controlling temptations and suppression), and SSB intake. In particular, we hypothesized that these associations would differ across the stages of preadolescence, early and mid-adolescence. Self-reported data were collected from 2,764 adolescents (10-17 years old; 49 % girls) from 24 schools in the Netherlands, Poland, Portugal, and the United Kingdom. Path analysis indicated that direct associations between peers' social influence and SSB intake increased with age. Direct negative associations between at-home and out-of-home accessibility and SSB intake as well as direct positive associations between parental pressure and intake become significantly weaker with age. Accessibility was related negatively to self-regulation, whereas higher social pressure was associated with higher self-regulation. The effects of the environmental factors were mediated by self-regulation. Quantitative and qualitative differences in self-regulation were observed across the stages of adolescence. The associations between the use of self-regulatory strategies and lower SSB intake become significantly stronger with age. In preadolescence, SSB intake was regulated by means of strategies that aimed at direct actions toward tempting food. In contrast, early and mid-adolescents controlled their SSB intake by means of a combination of self-regulatory strategies focusing on direct actions toward tempting food and strategies focusing on changing the psychological meaning of tempting food.

Purpose: Easy access to unhealthy foods is believed to contribute to the current overweight epidemic. It remains unclear, however, how access to unhealthy foods is related to self-regulation of food intake. This study tests the hypothesis that using self-regulation strategies buffers the negative influences of easy access to unhealthy foods., Methods: Cross-sectional survey data from 2764 adolescents aged 10-17 years from four European countries (The Netherlands, UK, Poland and Portugal) about use of self-regulation strategies, access to unhealthy foods and intake of unhealthy foods (sweet and salty snacks and sugar-sweetened beverages) were used., Results: Both access to unhealthy foods and use of self-regulation strategies were independently, but in opposing directions, related to intake of unhealthy foods. Easy access to unhealthy food products was associated with higher consumption, but this effect could be attenuated by use of self-regulation strategies to facilitate healthy eating even when the food environment tempts one to do otherwise., Conclusions: Health promotion policy and programs should not only address the food environment but could also teach young people better strategies to deal with it.

The main objective of this study was to build a model, which includes personal and social factors, that helps to highlight factors that promote health-related quality of Life (HRQoL) in children and in adolescents. A sample of 3195 children and adolescents was acquired from 5th and 7th graders from all five Portuguese regions. In this study three independent latent variables were specified--Physical, Psychological and Social and two dependent latent variables were measured: Health behavior and Quality of Life. The integrative model was composed by different components: (1) health-related quality of life, integrated by 8 dimensions from KIDSCREEN-52; (2) health behavior, (3) variables related to physical health; (4) variables related to social health; (5) variables related to psychological health. As results were found strong correlation between psychological dimensions and self-esteem and other factors and a structural equation model was developed. The model presented a RMSEA index of .08. Similarly, adjustment levels for the CFI, NFI and IFI vary above or around .90, which suggests a good adjustment for the hypothesized model. The model presented significant qui-square. This study showed that in all the samples studied, the psychological variables were those that contributed at a superior level to HRQoL.

This umbrella review analyzed the relationships between social and physical micro-environmental (neighborhood, school) characteristics as predictors of child and adolescent diet, physical activity, and body weight. Eight systematic reviews, discussing 132 original studies (97% correlational, 3% experimental) yielded 98 social, physical, and socio-economic characteristics, as categorized in the original reviews. Among micro-environmental predictors stronger support (i.e., replicated results) was obtained for 12 out of 98 original micro-environmental variables, with physical activity as the outcome in 10 out of 12 cases. In particular, replicated significant relationships were found for several physical activity-specific neighborhood and school characteristics (e.g., community opportunities to exercise, lower costs of physical activity facilities, physical activity build environment) and adolescent physical activity. Among more general (i.e., not behavior-specific) micro-environmental characteristics, stronger support was found for low crime level, school type, and child/adolescent physical activity.

This umbrella review analyzed the effectiveness of school-based interventions, applying body weight or behavioral outcomes. Twelve systematic reviews and five meta-analyses (examining 196 trials) were included. Results indicated that the effectiveness was usually referred to body weight or BMI change, with 1/3 of trials (per review) indicating significant changes in BMI or obesity prevalence. Meta-analyses yielded mixed effects (three showed significant changes in weight, BMI, or obesity). Interventions were more effective if they aimed at a reduction of sedentary behaviors, incorporated moderate-to-vigorous physical activity, and parental involvement. The inclusion of a nutrition component moderated the long-term effects of interventions. More efficient interventions lasted at least 3 months, did not aim solely at environmental changes, and were implemented in general population. Female and younger participants may benefit more from the interventions. The role of psychological theories and behavioral or cognitive mediators was rarely investigated.

The main objective of this study was to develop a brief version of the Escala de Satisfação com o Suporte Social for children and adolescents (Ribeiro, 1999). A representative sample of 3195 children and adolescents was obtained from 5th and 7th graders throughout all five Portuguese regions. The results showed a good internal consistency for the social support satisfaction factor, alpha = 0.84; acceptable for the necessity for activities connected to social support factor, alpha = 0.69. By using ANOVA, gender, age and socioeconomic status related differences were identified. A confirmatory factorial analysis was done and an adjusted model was found by taking off item 5. The concurrent validity was inspected with measures related to social support, such as optimism, self-worth and perceptions of health related quality of life. With this analysis, we verified that women and younger participants (< 12 years) showed a higher social support satisfaction. Medium-high socioeconomic status participants showed a higher negative social support satisfaction. These results suggest the validity of the scale in assesing perceptions of social support.

The aims of this study are to determine the influence of migrant status on sexual behavior and communication about "safer sex" and to identify ethnic-specific prevention issues. Data were obtained from a special administration of the Health Behavior in School-Aged Children Survey in a special sample of Portuguese schools located in low-income Lisbon neighborhoods with large proportions of African migrants.Survey participants included 919 6th, 8th and 10th graders (52.3% female), of whom 19.2% were migrant foreigners from African Portuguese-speaking countries, including Cape Verde (60.8%), Mozambique (1.6%), Angola (16.8%), S. Tomé (8%), and Guinea-Bissau (14.8%). Subsequently, four focus groups were held with adolescent who had participated in the survey (n = 45), three focus group with health and education professionals (n = 25), and one focus group with parents (n = 6).Compared with Portuguese adolescents, African migrant teens reported initial sexual intercourse at earlier ages, less frequent condom use, and less frequent and less comfortable communications with parents about sexual issues.Implications for selective prevention of STD are discussed and recommendations are made.