title: Trends in health complaints from 2002 to 2010 in 34 countries and their association with health behaviours and social context factors at individual and macro-level.
abstract: BACKGROUND
  This article describes trends and stability over time in health complaints in adolescents from 2002 to 2010 and investigates associations between health complaints, behavioural and social contextual factors at individual level and economic factors at macro-level.
  
  
  METHODS
  Comprising N = 510 876 11-, 13- and 15-year-old children and adolescents in Europe, North America and Israel, data came from three survey cycles of the international Health Behaviour in School-aged Children (HBSC) study. Age- and gender-adjusted trends in health complaints were examined in each country by means of linear regression. By using the country as the random effects variable, we tested to what extent individual and contextual variables were associated with health complaints.
  
  
  RESULTS
  Significant associations are stronger for individual level determinants (e.g. being bullied, smoking) than for determinants at macro-level (e.g. GDP, Gini), as can be seen by the small effect sizes (less than 5% for different trends). Health complaints are fairly stable over time in most countries, and no clear international trend in health complaints can be observed between 2002 and 2010. The most prominent stable determinants were being female, being bullied, school pressure and smoking.
  
  
  CONCLUSIONS
  Factors associated with health complaints are more related to the proximal environment than to distal macro-level factors. This points towards intensifying targeted interventions, (e.g. for bullying) and also targeting specific risk groups. The comparably small effect size at country-level indicates that country-level factors have an impact on health and should not be ignored.
authors: 1 Department of Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany v.ottova-jordan@uke.de.
authors: Veronika
authors: V
authors: Ottová-Jordan
authors: 2 Department of Health Promotion and Development, University of Bergen, Bergen, Norway 3 Department of Public Mental Health, Division of Mental Health, Norwegian Institute of Public Health, Oslo, Norway.
authors: Otto R F
authors: OR
authors: Smith
authors: 4 Public Health Agency of Sweden, Holna, Sweden 5 Department of Human Sciences, Kristianstad University, Kristianstad, Sweden.
authors: Lilly
authors: L
authors: Augustine
authors: 6 Department of Public Health and Epidemiology, Riga Stradins University, Riga, Latvia.
authors: Inese
authors: I
authors: Gobina
authors: 7 Institute of Medical Sociology, Medical Faculty, Martin-Luther University Halle-Wittenberg, Halle, Germany.
authors: Katharina
authors: K
authors: Rathmann
authors: 8 Department of Psychosocial Science, University of Bergen, Bergen, Norway.
authors: Torbjørn
authors: T
authors: Torsheim
authors: 9 Department of Child and Adolescent Health, Institute of Mother and Child, Warsaw, Poland.
authors: Joanna
authors: J
authors: Mazur
authors: 10 Department of Health Sciences, University of Jyväskylä, Jyväskylä, Finland.
authors: Raili
authors: R
authors: Välimaa
authors: 11 Department of Public Health and Pediatrics, University of Turin, Turin, Italy.
authors: Franco
authors: F
authors: Cavallo
authors: 12 National Institute of Public Health, Ljubljiana, Slovenia.
authors: Helena
authors: H
authors: Jericek Klanscek
authors: 13 Faculty of Social and Behavioral Sciences, Department of Interdisciplinary Social Science, University of Utrecht, Utrecht, Netherlands.
authors: Wilma
authors: W
authors: Vollebergh
authors: 14 National institute of Public Health, University of Southern Denmark, Copenhagen, Denmark.
authors: Charlotte
authors: C
authors: Meilstrup
authors: 7 Institute of Medical Sociology, Medical Faculty, Martin-Luther University Halle-Wittenberg, Halle, Germany.
authors: Matthias
authors: M
authors: Richter
authors: 7 Institute of Medical Sociology, Medical Faculty, Martin-Luther University Halle-Wittenberg, Halle, Germany.
authors: Irene
authors: I
authors: Moor
authors: 1 Department of Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors: Ulrike
authors: U
authors: Ravens-Sieberer
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior; D002648:Child; D005060:Europe; D005260:Female; D015438:Health Behavior; D006305:Health Status Indicators; D006306:Health Surveys; D006801:Humans; D007557:Israel; D008297:Male; D009656:North America; D064890:Social Determinants of Health