Skip to main navigation menu Skip to main content Skip to site footer
##common.pageHeaderLogo.altText##

Original article

Vol. 153 No. 5 (2023)

Adolescents’ self-reported health status, behaviours and health issues addressed during routine school doctor consultations in Switzerland: an observational study

  • Yael Rachamin
  • Sofia Elena Nerlich
  • Levy Jäger
  • Saskia Maria De Gani
  • Olivier Favre
  • Oliver Senn
DOI
https://doi.org/10.57187/smw.2023.40078
Cite this as:
Swiss Med Wkly. 2023;153:40078
Published
15.05.2023

Summary

BACKGROUND: We aimed to investigate the self-reported health status and behaviours of 7th-grade adolescents, associations with gender and educational track, as well as health issues addressed during routine school doctor consultations in Switzerland.

METHODS: Data on health status and behaviours, specifically general well-being, stimulant and addictive substance use, bullying/violence, exercise, nutrition and health protection, and puberty/sexuality, were drawn from routinely collected self-assessment questionnaires from 1076 (of a total of 1126) students from 14 schools in the Swiss canton of Zug in 2020. Data on health issues addressed in school doctor consultations were collected by nine school doctors (for 595 individual consultations). Multilevel logistic regression analyses were used to investigate the association of gender and educational track with unfavourable health status or behaviours.

RESULTS: Although 92% (n = 989) of the students reported being happy or satisfied overall, 21% (n = 215) often or almost always felt sad, and 5-10% had repeatedly been seriously physically hurt (n = 67), sexually harassed with words (n = 88) or experienced uncomfortable physical contact (n = 60). Female gender and a lower educational track were associated with unfavourable health status. In 90% (n = 533) of the school doctor consultations, at least one topic of disease prevention or health promotion was addressed, whereby the topics addressed depended strongly on the individual school doctors.

CONCLUSIONS: Our findings revealed that unfavourable health status and behaviours were prevalent among adolescents but the health topics addressed in school doctor consultations were not tailored to students’ self-reported health issues. A school-based approach that strengthens adolescents’ health literacy and provides opportunities for patient-centred counselling has the potential to improve the current and future health of adolescents and, ultimately, adults. To realise this potential, it is essential for school doctors to be sensitised and trained to address students’ health concerns. Emphasis should be placed on the importance of patient-centred counselling, the high prevalence of bullying, and gender and educational differences.

References

  1. Sawyer SM, Afifi RA, Bearinger LH, Blakemore SJ, Dick B, Ezeh AC, et al. Adolescence: a foundation for future health. Lancet. 2012 Apr;():1630–40. 10.1016/S0140-6736(12)60072-5 DOI: https://doi.org/10.1016/S0140-6736(12)60072-5
  2. Forrest CB, Riley AW. Childhood origins of adult health: a basis for life-course health policy. Health Aff (Millwood). 2004;():155–64. 10.1377/hlthaff.23.5.155 DOI: https://doi.org/10.1377/hlthaff.23.5.155
  3. Harris SK, Aalsma MC, Weitzman ER, Garcia-Huidobro D, Wong C, Hadland SE, et al. Research on Clinical Preventive Services for Adolescents and Young Adults: Where Are We and Where Do We Need to Go? J Adolesc Health. 2017 Mar;():249–60. 10.1016/j.jadohealth.2016.10.005 DOI: https://doi.org/10.1016/j.jadohealth.2016.10.005
  4. Wieber F, von Wyl A, Crameri A, Dratva J, Passalacqua S, et al. Psychische Gesundheit in der kinder- und hausärztlichen Versorgungspraxis. ZHAW; 2020.
  5. UNICEF Data. Mental health 2021 [Available from: https://data.unicef.org/topic/child-health/mental-health/#_edn1
  6. Jeannin A, Narring F, Tschumper A, Bonivento LI, Addor V, Bütikofer A, et al. Self-reported health needs and use of primary health care services by adolescents enrolled in post-mandatory schools or vocational training programmes in Switzerland. Swiss Med Wkly. 2005 Jan;():11–8.
  7. Mohler-Kuo M, Schnyder U, Dermota P, Wei W, Milos G. The prevalence, correlates, and help-seeking of eating disorders in Switzerland. Psychol Med. 2016 Oct;():2749–58. 10.1017/s0033291716001136 10.1017/S0033291716001136 DOI: https://doi.org/10.1017/S0033291716001136
  8. Collins L, Smiley SL, Moore RA, Graham AL, Villanti AC. Physician tobacco screening and advice to quit among U.S. adolescents - National Survey on Drug Use and Health, 2013. Tob Induc Dis. 2017 Jan;():2. 10.1186/s12971-016-0107-6 DOI: https://doi.org/10.1186/s12971-016-0107-6
  9. Langford R, Bonell C, Jones H, Pouliou T, Murphy S, Waters E, et al. The World Health Organization’s Health Promoting Schools framework: a Cochrane systematic review and meta-analysis. BMC Public Health. 2015 Feb;():130. 10.1186/s12889-015-1360-y DOI: https://doi.org/10.1186/s12889-015-1360-y
  10. Alemán-Díaz AY, Backhaus S, Siebers LL, Chukwujama O, Fenski F, Henking CN, et al. Child and adolescent health in Europe: monitoring implementation of policies and provision of services. Lancet Child Adolesc Health. 2018 Dec;():891–904. 10.1016/S2352-4642(18)30286-4 DOI: https://doi.org/10.1016/S2352-4642(18)30286-4
  11. Denny S, Howie H, Grant S, Galbreath R, Utter J, Fleming T, et al. Characteristics of school-based health services associated with students’ mental health. J Health Serv Res Policy. 2018 Jan;():7–14. 10.1177/1355819617716196 DOI: https://doi.org/10.1177/1355819617716196
  12. Lüthi F, Balthasar A, Laubereau B. Organisation der schulärztlichen Untersuchungen in der Schweiz - Versuch einer Systematisierung kantonaler Modelle. Schweiz Arzteztg. 2019;():686–9. 10.4414/saez.2019.17871 DOI: https://doi.org/10.4414/saez.2019.17871
  13. Gesundheit und Geschlecht Neuchâtel, Switzerland: Federal Statistical Office; 2020 [Available from: https://www.bfs.admin.ch/bfs/de/home/statistiken/kataloge-datenbanken/publikationen.assetdetail.15284969.html
  14. International Standard Classification of Education (ISCED). UNESCO Institute for Statistics; [cited 2021 5.11.2021]. Available from: http://uis.unesco.org/en/topic/international-standard-classification-education-isced
  15. R Core Team. R: A language and environment for statistical computing. Vienna, Austria: R Foundation for Statistical Computing; 2020.
  16. Bates D, Mächler M, Bolker B, Walker S. Fitting Linear Mixed-Effects Models Using lme4. J Stat Softw. 2015;():1–48. 10.18637/jss.v067.i01 DOI: https://doi.org/10.18637/jss.v067.i01
  17. Hothorn T, Bretz F, Westfall P. Simultaneous inference in general parametric models. Biom J. 2008 Jun;():346–63. 10.1002/bimj.200810425 DOI: https://doi.org/10.1002/bimj.200810425
  18. Ambord S, Eichenberger Y, Delgrande Jordan M. Gesundheit und Wohlbefinden der 11- bis 15-jährigen Jugendlichen in der Schweiz im Jahr 2018 und zeitliche Entwicklung - Resultate der Studie “Health Behaviour in School-aged Children” (HBSC) (Forschungsbericht Nr. 113). Lausanne, Switzerland: Sucht Schweiz; 2020.
  19. OECD. PISA 2018 Results (Volume III) 2019.
  20. Konsortium PISA.ch. PISA 2018: Schülerinnen und Schüler der Schweiz im internationalen Vergleich. Bern und Genf: SBFI/EDK und Konsortium PISA.ch; 2019.
  21. Wolke D, Lereya ST. Long-term effects of bullying. Arch Dis Child. 2015 Sep;():879–85. 10.1136/archdischild-2014-306667 DOI: https://doi.org/10.1136/archdischild-2014-306667
  22. Kaess M. Bullying: peer-to-peer maltreatment with severe consequences for child and adolescent mental health. Eur Child Adolesc Psychiatry. 2018 Aug;():945–7. 10.1007/s00787-018-1201-5 DOI: https://doi.org/10.1007/s00787-018-1201-5
  23. Lereya ST, Copeland WE, Costello EJ, Wolke D. Adult mental health consequences of peer bullying and maltreatment in childhood: two cohorts in two countries. Lancet Psychiatry. 2015 Jun;():524–31. 10.1016/S2215-0366(15)00165-0 DOI: https://doi.org/10.1016/S2215-0366(15)00165-0
  24. World Health Organization. Key findings. Regional Office for E. Spotlight on adolescent health and well-being. Findings from the 2017/2018 Health Behaviour in School-aged Children (HBSC) survey in Europe and Canada. International report. . Copenhagen: World Health Organization. Regional Office for Europe; 2020.
  25. Selbst wahrgenommener Gesundheitszustand nach Geschlecht, Alter, Bildungsniveau, Sprachgebiet Neuchâtel, Switzerland: Federal Statistical Office; 2017 [Available from: https://www.bfs.admin.ch/asset/de/6466030
  26. Eisner-Fellay T, Akre C, Auderset D, Barrense-Dias Y, Suris JC. Far from acceptable: youth-reported risk behaviour screening by primary care physicians. Fam Pract. 2020 Nov;():759–65. 10.1093/fampra/cmaa068 DOI: https://doi.org/10.1093/fampra/cmaa068
  27. Boerma T, Hosseinpoor AR, Verdes E, Chatterji S. A global assessment of the gender gap in self-reported health with survey data from 59 countries. BMC Public Health. 2016 Jul;():675. 10.1186/s12889-016-3352-y DOI: https://doi.org/10.1186/s12889-016-3352-y
  28. Dey M, Jorm AF, Mackinnon AJ. Cross-sectional time trends in psychological and somatic health complaints among adolescents: a structural equation modelling analysis of ‘Health Behaviour in School-aged Children’ data from Switzerland. Soc Psychiatry Psychiatr Epidemiol. 2015 Aug;():1189–98. 10.1007/s00127-015-1040-3 DOI: https://doi.org/10.1007/s00127-015-1040-3
  29. O’Neil A, Russell JD, Thompson K, Martinson ML, Peters SA. The impact of socioeconomic position (SEP) on women’s health over the lifetime. Maturitas. 2020 Oct;:1–7. 10.1016/j.maturitas.2020.06.001 DOI: https://doi.org/10.1016/j.maturitas.2020.06.001
  30. Phillips SP, Hamberg K. Women's relative immunity to the socio-economic health gradient: artifact or real? Global health action. 2015;8:27259-. doi: 10.3402/gha.v8.27259. DOI: https://doi.org/10.3402/gha.v8.27259
  31. Kaul P, Irwin CE Jr. Serving the Underserved: The Health and Well-Being of Adolescent and Young Adult Males. J Adolesc Health. 2018 Mar;( 3s):S1–2. 10.1016/j.jadohealth.2017.12.008 DOI: https://doi.org/10.1016/j.jadohealth.2017.12.008
  32. Flannery KM, Vannucci A, Ohannessian CM. Using Time-Varying Effect Modeling to Examine Age-Varying Gender Differences in Coping Throughout Adolescence and Emerging Adulthood. J Adolesc Health. 2018 Mar;( Supplement):S27–34. 10.1016/j.jadohealth.2017.09.027 DOI: https://doi.org/10.1016/j.jadohealth.2017.09.027
  33. Östlin P, Eckermann E, Mishra US, Nkowane M, Wallstam E. Gender and health promotion: a multisectoral policy approach. Health Promot Int. 2006 Dec; Suppl 1:25–35. 10.1093/heapro/dal048 DOI: https://doi.org/10.1093/heapro/dal048
  34. Lynch L, Long M, Moorhead A. Young Men, Help-Seeking, and Mental Health Services: Exploring Barriers and Solutions. Am J Men Health. 2018 Jan;():138–49. 10.1177/1557988315619469 DOI: https://doi.org/10.1177/1557988315619469
  35. Rutishauser C, Esslinger A, Bond L, Sennhauser FH. Consultations with adolescents: the gap between their expectations and their experiences. Acta Paediatr. 2003 Nov;():1322–6. 10.1111/j.1651-2227.2003.tb00503.x DOI: https://doi.org/10.1111/j.1651-2227.2003.tb00503.x
  36. Turner L, Spencer L, Strugnell J, Di Tommaso I, Tate M, Allen P, et al. Young people have their say: what makes a youth-friendly general practice? Aust Fam Physician. 2017;():70–4.
  37. Klein JD, Wilson KM. Delivering quality care: adolescents’ discussion of health risks with their providers. J Adolesc Health. 2002 ;():190–5. 10.1016/S1054-139X(01)00342-1 DOI: https://doi.org/10.1016/S1054-139X(01)00342-1
  38. Cheng TL, DeWitt TG, Savageau JA, O’Connor KG. Determinants of counseling in primary care pediatric practice: physician attitudes about time, money, and health issues. Arch Pediatr Adolesc Med. 1999 Jun;():629–35. 10.1001/archpedi.153.6.629 DOI: https://doi.org/10.1001/archpedi.153.6.629
  39. Trein P. Switzerland implements a national strategy to prevent non-communicable diseases. European Social Policy Network (ESPN) - European Comission; 2017.
  40. National Strategy for the Prevention of Noncommunicable Diseases (NCD strategy): Federal Office of Public Health; [cited 2021 23.11.2021]. Available from: https://www.bag.admin.ch/bag/en/home/strategie-und-politik/nationale-gesundheitsstrategien/strategie-nicht-uebertragbare-krankheiten.html
  41. Abel T, Hofmann K, Ackermann S, Bucher S, Sakarya S. Health literacy among young adults: a short survey tool for public health and health promotion research. Health Promot Int. 2015 Sep;():725–35. 10.1093/heapro/dat096 DOI: https://doi.org/10.1093/heapro/dat096
  42. Fleary SA, Joseph P, Pappagianopoulos JE. Adolescent health literacy and health behaviors: A systematic review. J Adolesc. 2018 Jan;():116–27. 10.1016/j.adolescence.2017.11.010 DOI: https://doi.org/10.1016/j.adolescence.2017.11.010
  43. Alderman EM. AMA Guidelines for Adolescent Preventive Services (GAPS): recommendations and rationale. JAMA. 1994;():980–1. 10.1001/jama.1994.03520120090040 DOI: https://doi.org/10.1001/jama.1994.03520120090040
  44. Bieri U, Kocher JP, Gauch C, Tschöpe S, Venetz A, et al. Bevölkerungsbefragung "Erhebung Gesundheitskompetenz 2015" [Population survey "Health literacy survey 2015"]. Bern, Switzerland: gfs.bern; 2016.
  45. Smetana JG, Villalobos M, Tasopoulos-Chan M, Gettman DC, Campione-Barr N. Early and middle adolescents’ disclosure to parents about activities in different domains. J Adolesc. 2009 Jun;():693–713. 10.1016/j.adolescence.2008.06.010 DOI: https://doi.org/10.1016/j.adolescence.2008.06.010
  46. Racine N, McArthur BA, Cooke JE, Eirich R, Zhu J, Madigan S. Global Prevalence of Depressive and Anxiety Symptoms in Children and Adolescents During COVID-19: A Meta-analysis. JAMA Pediatr. 2021 Nov;():1142–50. 10.1001/jamapediatrics.2021.2482 DOI: https://doi.org/10.1001/jamapediatrics.2021.2482
  47. Kantonsvergleich: Gesundheitsdirektion Kanton Zug, Fachstelle für Statistik; [cited 2021 25.11.2021]. Available from: https://www.zg.ch/behoerden/gesundheitsdirektion/statistikfachstelle/zug-im-vergleich?chart=04-01&order=asc

Most read articles by the same author(s)

1 2 > >>