Psychosocial school environment and health risk behaviours of adolescents in Bulgaria: results from multilevel analysis
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ORIGINAL ARTICLE
Psychosocial school environment and health risk behaviours of adolescents in Bulgaria: results from multilevel analysis Elitsa Dimitrova1,2 • Tatyana Kotzeva1,3 • Anna Alexandrova-Karamanova1 Received: 30 April 2020 / Revised: 26 July 2020 / Accepted: 15 September 2020 / Published online: 17 October 2020 Swiss School of Public Health (SSPH+) 2020
Abstract Objectives The paper aims to study the relationships between psychosocial school environment and health risk behaviours (cigarette smoking, alcohol consumption, drunkenness, bullying perpetration and early start of sexual life) in a representative sample of Bulgarian adolescents. Methods We apply multilevel analysis, using data from the Bulgarian 2017/2018 ‘‘Health Behaviour in School-aged Children (HBSC)’’ Study. Results There is a significant variation between schools in Bulgaria in the proportions of students who smoke cigarettes, drink alcohol, get drunk and have an early start of sexual life. Lower school satisfaction is significantly associated with higher odds of smoking and drunkenness. The effect of school pressure differs for smoking and bullying perpetration. The effect of student support also differs for certain types of health risk behaviours. Higher student support is positively associated with frequent alcohol consumption and drunkenness. The relationship between teacher support and alcohol abuse is negative. Conclusions There is a significant association between characteristics of psychosocial school environment and Bulgarian adolescents’ risk health behaviours (cigarette smoking, alcohol consumption, drunkenness, bullying perpetration). Comprehensive and effective health promotion policies in Bulgarian schools are needed in order to facilitate healthy lifestyles. Keywords Cigarette smoking Alcohol consumption Drunkenness Bullying perpetration Early start of sexual life Psychosocial school environment
Introduction School influences the intellectual and emotional growth of children, as well as their personal and social development (Pulkkinen et al. 2006). A supportive school environment
This article is part of the special issue ‘‘Adolescent health in Central and Eastern Europe’’.
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00038-020-01482-4) contains supplementary material, which is available to authorized users. & Elitsa Dimitrova [email protected] 1
Institute for Population and Human Studies at the Bulgarian Academy of Sciences, Sofia, Bulgaria
2
Plovdiv University Paisii Hilendarski, Plovdiv, Bulgaria
3
Burgas Free University, Burgas, Bulgaria
has been proven as a valuable resource for enhancing adolescents’ good physical and mental health, while stress and discomfort at school are found to be associated with health risk behaviours (HRBs) and increased psycho-somatic complaints (Bond et al. 2007). School-related stress has been associated with self-reported illness and symptoms, as well as with anxiety, depression and poor wellbeing (Pascoe et al. 2
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