Multidimensional Poverty Among Adolescents in 38 Countries: Evidence from the Health Behaviour in School-aged Children (HBSC) 2013/14 Study

Depósi o de In es igación de la Uni e sidad de Se illa h ps://idus.us.es/ This e sion o he a icle has been accep ed o publica ion, a e pee e iew and is subjec o Sp inge Na u e’s AM e ms o use, bu is no he Ve sion o Reco d and does no e lec pos -accep ance imp o emen s, o any co ec ions. The Ve sion o Reco d is a ailable online a : h ps://doi.o g/10.1007/s12187-017-9489-0 Child Indica o s Resea ch Mul idimensional dep i a ion among adolescen s in 39 coun ies: e idence om he Heal h Beha iou in School-Aged Child en (HBSC) 2013/14 s udy --Manusc ip D a -- Manusc ip Numbe : ISCI-D-16-00082 Full Ti le: Mul idimensional dep i a ion among adolescen s in 39 coun ies: e idence om he Heal h Beha iou in School-Aged Child en (HBSC) 2013/14 s udy A icle Type: O iginal esea ch Keywo ds: mul idimensional dep i a ion; adolescen well-being; Heal h Beha iou in School-aged Child en S udy; Sus ainable De elopmen Goals Co esponding Au ho : Zla a B uckau UNICEF O ice o Resea ch-Innocen i ITALY Co esponding Au ho Seconda y In o ma ion: Co esponding Au ho 's Ins i u ion: UNICEF O ice o Resea ch-Innocen i Co esponding Au ho 's Seconda y Ins i u ion: Fi s Au ho : Yeka e ina Chzhen Fi s Au ho Seconda y In o ma ion: O de o Au ho s: Yeka e ina Chzhen Zla a B uckau Emilia Toczydlowska F ank Elga Concepción Mo eno-Maldonado Gonneke S e ens Dagma Sigmundo á Gene iè e Ga iépy O de o Au ho s Seconda y In o ma ion: Funding In o ma ion: Agencia de Inno ación y Desa ollo de Andalucía (SEJ 08007) MSc Concepción Mo eno-Maldonado Abs ac : This s udy in es iga ed he applica ion o UNICEF's Mul iple O e lapping Dep i a ion Analysis (MODA) amewo k o 40 Eu opean egions and Canada using da a on adolescen s aged 11, 13 and 15 om he 2013/14 Heal h Beha iou in School-aged Child en su ey. I is he i s applica ion o MODA ha is based en i ely on da a collec ed om adolescen s hemsel es a he han om household e e ence pe sons on hei behal . Unlike o he MODA s udies, he p esen analysis mos ly ocuses on non-ma e ial, ela ional aspec s o child dep i a ion. Al hough he e is subs an ial c oss-coun y a ia ion in he p e alence o adolescen dep i a ions ega ding nu i ion, pe cei ed heal h, school en i onmen , p o ec ion om pee iolence, amily en i onmen and in o ma ion access, ou indings unde line ha hese mo e subjec i e single dimensions o dep i a ion ha dly a y wi h na ional weal h and income inequali y Howe e , when ocusing on dep i a ion on a leas h ee dimensions (i.e., mul idimensional dep i a ion), esul s showed ha wi h inc easing na ional le el income inequali y, sha es o adolescen s dep i ed in h ee o mo e ou o six dimensions also inc eased. In he majo i y o coun ies. gi ls we e a a highe isk o mul idimensional dep i a ion han boys. In addi ion, adolescen s no li ing wi h bo h pa en s in he household and hose epo ing lowe le els o amily weal h we e Powe ed by Edi o ial Manage ® and P oduXion Manage ® om A ies Sys ems Co po a ion consis en ly mo e dep i ed han o he adolescen s, bo h ega ding single and mul idimensional dep i a ion. The esul s o his s udy show he in e connec edness o social ( amily, school suppo ) and psychological (heal h and iolence) dep i a ions o adolescen s h oughou Eu ope, e.g. child en dep i ed in he domain o amily and school en i onmen a e likely o be also dep i ed in he pe cei ed heal h and p o ec ion om pee iolence. Powe ed by Edi o ial Manage ® and P oduXion Manage ® om A ies Sys ems Co po a ion Mul idimensional dep i a ion among adolescen s in 39 coun ies: e idence om he Heal h Beha iou in School-Aged Child en (HBSC) 2013/14 s udy Chzhen, Y1., B uckau , Z.1, Toczydlowska, E.1, Elga , F.2, Mo eno-Maldonado, C.3, S e ens, GW.J.M..4, Sigmundo á, D.5 and Ga iépy, G.6 1 UNICEF O ice o Resea ch-Innocen i, Piazza SS Annunzia a, 12, 50122 Flo ence, I aly 2 Ins i u e o Heal h and Social Policy and Douglas Ins i u e, McGill Uni e si y, 1130 Pine A enue Wes , Mon eal, QC H3A 1A3, Canada 3 Depa men o De elopmen al and Educa ional Psychology, Uni e si y o Se ille, C/ Camilo José Cela, s/n, 41018 Se ille, Spain 4 U ech Cen e o Child and Adolescen S udies, U ech Uni e si y, P.O. Box 80140, 3508 TC U ech , The Ne he lands 5Facul y o Physical Cul u e, Palacký Uni e si y Olomouc, Tř. Mí u 117, 77111 Olomouc, Czech Republic 6 Ins i u e o Heal h and Social Policy | McGill Uni e si y, 1130 Pine A e Wes , Mon eal, QC, H3A 1A3 Co esponding Au ho : Zla a B uckau . E-mail add ess: zb uckau @unice .o g. Tel: (+39) 055 20 330 Fax: (+39) 055 2033 220 Acknowledgemen s: The Heal h Beha iou in School-aged Child en (HBSC) s udy is a Wo ld Heal h O ganiza ion collabo a i e s udy and is suppo ed by each membe coun y o he HBSC ne wo k (www.hbsc.o g). The HBSC s udy is coo dina ed in e na ionally by D Joanna Inchley, Uni e si y o S . And ews, Sco land, wi h in e na ional da a coo dina ion pe o med by D Odd un Samdal, Uni e si y o Be gen, No way. Ti le Page 1 Mul idimensional dep i a ion among adolescen s in 39 coun ies: e idence om he Heal h Beha iou in School-Aged Child en (HBSC) 2013/14 s udy Abs ac This s udy in es iga ed he applica ion o UNICEF’s Mul iple O e lapping Dep i a ion Analysis (MODA) amewo k o 40 Eu opean egions and Canada using da a on adolescen s aged 11, 13 and 15 om he 2013/14 Heal h Beha iou in School-aged Child en su ey. I is he i s applica ion o MODA ha is based en i ely on da a collec ed om adolescen s hemsel es a he han om household e e ence pe sons on hei behal . Unlike o he MODA s udies, he p esen analysis mos ly ocuses on non-ma e ial, ela ional aspec s o child dep i a ion. Al hough he e is subs an ial c oss-coun y a ia ion in he p e alence o adolescen dep i a ions ega ding nu i ion, pe cei ed heal h, school en i onmen , p o ec ion om pee iolence, amily en i onmen and in o ma ion access, ou indings unde line ha hese mo e subjec i e single dimensions o dep i a ion ha dly a y wi h na ional weal h and income inequali y. Howe e , when ocusing on dep i a ion on a leas h ee dimensions (i.e., mul idimensional dep i a ion), esul s showed ha wi h inc easing na ional le el income inequali y, sha es o adolescen s dep i ed in h ee o mo e ou o six dimensions also inc eased. In he majo i y o coun ies, gi ls we e a a highe isk o mul idimensional dep i a ion han boys. In addi ion, adolescen s no li ing wi h bo h pa en s in he household and hose epo ing lowe le els o amily weal h we e consis en ly mo e dep i ed han o he adolescen s, bo h ega ding single and mul idimensional dep i a ion. The esul s o his s udy show he in e connec edness o social ( amily, school suppo ) and psychological (heal h and iolence) dep i a ions o adolescen s h oughou Eu ope. Child en dep i ed in he domain o amily and school en i onmen a e also likely o be dep i ed in he pe cei ed heal h and p o ec ion om pee iolence. Key wo ds: mul idimensional dep i a ion; adolescen well-being; Heal h Beha iou in School- Aged Child en S udy; Sus ainable De elopmen Goals. Blinded Manusc ip Click he e o iew linked Re e ences 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 2 1. In oduc ion I has been widely acknowledged ha child en ha e basic human igh s, such as a su icien supply o heal hy oods, access o heal h ca e, access o educa ion, and eedom o g ow up in a sa e en i onmen . These igh s a e undamen al o child wellbeing and ensh ined in he Uni ed Na ions’ 1989 Con en ion on he Righ s o he Child (CRC). UNICEF has de eloped he Mul iple O e lapping Dep i a ion Analysis (MODA) o acili a e esea ch and su eillance o child en and adolescen s who a e dep i ed o hese igh s. Like UNICEF’s Global S udy on Child Po e y and Dispa i ies (Go don e al. 2003; UNICEF 2007), MODA uses child- ele an indica o s o measu e dep i a ions in dimensions oo ed in he CRC bu wi h a g ea e emphasis on o e lapping dimensions and age-app op ia e cons uc s o child en and you h (see de Neubou g e al. 2012). The aim o his s udy was o apply he MODA oolki o pu o wa d a new measu e o mul idimensional dep i a ion among adolescen s in high- and middle-income coun ies in Eu ope and Canada using da a om he WHO Heal h Beha iou in School-aged Child en (HBSC) s udy 2013/14. This s udy sough o con ibu e o he li e a u e on mul idimensional child dep i a ion and o illus a e how da a ha we e collec ed di ec ly om adolescen s could be used o assess p og ess owa ds he new uni e sal Sus ainable De elopmen Goals.1 I is he i s s udy o mul idimensional child dep i a ion ha is based en i ely on da a collec ed om child en hemsel es a he han om household e e ence pe sons on behal o child en (e.g. Chzhen e al. 2016a; Chzhen and Fe one 2016; de Milliano and Handa 2014; de Milliano and Pla go 2014). Unlike p e ious MODA s udies, he p esen analysis mos ly ocused on non- ma e ial, ela ional aspec s o child dep i a ion. Resea ch ques ions and hypo heses Child po e y is con en ionally measu ed in mone a y e ms, as a sha e o child en li ing in households wi h income o consump ion below a ce ain po e y line. Howe e , his app oach assumes ha child en ecei e a ai po ion o household esou ces and can con ol hei sha e o amily esou ces, including social, educa ional, and cul u al capi al (Chzhen and Fe one 2016). Di ec measu es o child dep i a ion ha e been ound o complemen household-based mone a y indica o s o dep i a ion (de Neubou g e al. 2014; Guio e al. 2012; Main and B adshaw 2012). While ce ain household-le el dep i a ions (e.g. housing condi ions) a ec 1 SDG Ta ge 1.2 calls o “ educing a leas by hal he p opo ion o men, women and child en o all ages li ing in po e y in all i s dimensions acco ding o na ional de ini ions” by 2030. See h ps://sus ainablede elopmen .un.o g/sdg1. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 3 child en and you h (Chzhen e al. 2016a; Guio e al. 2012), i is use ul o collec a leas some in o ma ion om child en hemsel es. Sel - epo s a e especially use ul o measu ing child en’s exposu e o iolence ou side he home, school expe iences, and access o in o ma ion. Un il now, he consequences o dep i a ion o adolescen s a e discussed less han o o he age g oups (Vine e al. 2012). This may be an impo an omission in he li e a u e, as adolescence is a o ma i e li e s age in which disad an ages ha e las ing impac s on he li e cou se (Alemán-Díaz e al. 2016; B ene e al. 2013; Hanson and Chen 2007; Woodwa d e al. 2003; Dmi ie a 2013). Al hough high-income Wes e n Eu opean wel a e s a es ha e achie ed an unp eceden ed le el o ma e ial weal h, s udying adolescen dep i a ion in hese con ex s is s ill c ucial (Mackenbach 2012). Social and economic changes in hese s a es ha e inc eased he isk o poo heal h – no jus o economically disad an aged amilies bu o mo e middle- class amilies and amilies wi h young child en as well (Li e al. 2008). In s udying adolescen dep i a ion, he use o mul idimensional domains may be o i al impo ance as di e en expe iences end o co-exis (E ans and Kim 2010). Fo ins ance, a ecen s udy o adolescen s based on HBSC da a ound ha a clus e o isk beha io s (smoking, d inking, igh ing, physical inju ies, and bullying o he s) ela ed o psychosoma ic symp oms and consump ion o suga y d inks and swee s (Walsh e al. 2016). The HBSC s udy collec s heal h in o ma ion om adolescen s aged 11, 13 and 15 yea s ac oss mo e han 40 coun ies in Eu ope and No h Ame ica.2 The HBSC does no collec in o ma ion on household income and al hough i collec s some socio-economic in o ma ion such as pa en al occupa ion o educa ion, hese da a a e o en subjec o inaccu a e o missing esponses (Ridol o and Mai land 2011; Rich e e al. 2012). Howe e , in addi ion o in o ma ion on common ma e ial asse s in he home (e.g. ca s, compu e s), he HBSC su ey collec s a weal h o in o ma ion on non-ma e ial aspec s o child well-being, such as heal h, isk beha iou s, pee and amily ela ionships, and pee iolence (Cu ie e al. 2014). Le e aging hese ich da a in a c oss-coun y compa a i e con ex , he speci ic objec i es o his s udy we e o: (1) examine c oss-na ional di e ences in he p opo ion o mul idimensional adolescen dep i a ion in 39 coun ies (and 41 egions) ha pa icipa ed in he 2013/14 HBSC s udy,3 including associa ions be ween dep i a ion a es, egion weal h and income inequali y; (2) analyze di e ences in mul iple dep i a ion owing o indi idual cha ac e is ics such as age, 2 See www.hbsc.o g. 3 We excluded G eenland om he analysis. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 4 gende , amily s uc u e and pe cei ed amily weal h; and (3) iden i y g oups o child en in mul iple dimensions o dep i a ion and cons ella ions o mul iple dep i a ions ha end o co- occu . P e ious c oss-na ional s udies ha e ound ha he mos obus s uc u al de e minan s o adolescen heal h and wellbeing a e na ional weal h (i.e. na ional GDP pe capi a) and income inequali y (Vine e al. 2012; Elga e al. 2015a; Elga e al. 2015b). Based on his e idence and o he indings om MODA analyses in low and middle income coun ies (de Milliano and Pla go 2014), we expec ed o ind ha low coun y weal h and high inequali y bo h ela e o mo e dep i a ion in adolescen s in single and in mul iple dimensions. Based on known social inequali ies in adolescen heal h be ween gende g oups and le els o socioeconomic posi ion (Inchley e al. 2016), we expec ed o ind mo e dep i a ion in emales han in males and in lowe socioeconomic g oups (pa icula ly in he heal h dimension). Fu he mo e, gi en he obus con ibu ion o amily and pee suppo on adolescen heal h and wellbeing (Inchley e al. 2016), we expec ed o ind he highes deg ees o dep i a ion o e lap among he dimensions oo ed in heal h and amily and pee ela ionships. 2. Da a and me hods The 2013/14 HBSC s udy ec ui ed nea ly 220,000 adolescen s aged 11, 13 and 15 yea s ac oss 39 coun ies (42 egional uni s). We had sub-na ional in o ma ion o wo coun ies: Belgium (Flande s and Wallonia) and G ea B i ain (England, Sco land and Wales). We e e o all coun ies and sub-na ional uni s as egions in he emainde o his pape . S a i ied samples o schools ha ep esen he egional, economic, and public-p i a e dis ibu ion o schools in each egional uni we e ec ui ed using a common p o ocol (Inchley e al. 2016). Schools we e sampled wi h eplacemen as needed wi hin each s a um o ensu e consis en sample composi ion be ween coun ies. The HBSC p o ocol s ipula ed a s anda d ques ionnai e o ma , i em o de , and es ing condi ions. Teache s o ained in e iewe s dis ibu ed he ques ionnai es in class oom se ings. Each membe coun y ob ained e hics clea ance o conduc he su ey om a uni e si y-based e iew boa d o equi alen egula o y body. You h in p i a e and special needs schools and s ee and inca ce a ed you h we e excluded. 2.1.Indica o s and dimensions The HBSC ques ionnai e ocuses on heal h ou comes, well-being, heal h- ela ed beha iou s and social en i onmen s (Inchley e al. 2016). The da a a e sui ed o he s udy o adolescen mul idimensional dep i a ion using UNICEF’s MODA amewo k because hey co e many 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 5 o he child igh s dimensions embedded in he CRC (Uni ed Na ions 1989) “ ha a e essen ial o any child’s de elopmen i espec i e o hei coun y o esidence, socio-economic s a us, o cul u e” (de Neubou g e al. 2012, pp.14-15). The CRC has been a i ied by all coun ies excep he Uni ed S a es. We iden i ied six dimensions in he HBSC da a: nu i ion, pe cei ed heal h, school en i onmen , p o ec ion om pee iolence, amily en i onmen , and access o in o ma ion. Table 1 classi ies HBSC a iables in o indica o s and dimensions o child dep i a ion. Each o he six dimensions is ep esen ed by wo indica o s. The ole o hese indica o s is o ope a ionalize he igh s-based dimensions using he bes da a a ailable (Chzhen e al. 2016a). Fo ins ance, gi ing all adolescen s compu e s would no necessa ily e adica e he unde lying dep i a ion in in o ma ion access, bu no ha ing a compu e a home sugges s lowe access o in o ma ion. Indica o s a e agg ega ed in o dimensions using he union app oach: i a child is dep i ed on jus one indica o ou o he wo, hey a e coun ed as dep i ed in he espec i e dimension. Al hough his esul s in a highe dep i a ion headcoun han i dep i a ion in bo h indica o s we e equi ed (i.e., he in e sec ion app oach), he union app oach is mo e consis en wi h he child igh s amewo k: he absence o dep i a ion in one indica o does no make up o dep i a ion in ano he . Table 1 Child dep i a ion indica o s, dimensions and h esholds Dimension Indica o Indica o h eshold: de p i ed i Nu i ion B eak as on weekda y s Ne e ea s b eak as on weekda y s. Consump ion o ui s and e g e ables Consumes ui s o ege ables less han once a week. Pe cei ed heal h Sel - a ed heal h Fai o p oo sel - a ed heal h. Heal h complain s Repo s wo o mo e ou o eigh heal h s y m p oms e e y da y . School en i onmen S uden suppo No classma e suppo . Disag ees o s ongly disag ees wi h a leas one o he ollowing s a emen s: “ he s uden s in my class enjoy being oge he ”, “mos o he s uden s in my class a e kind and help ul” and “o he s uden s acce p me as I am”. Teache suppo No eache suppo . Disag ees o s ongly disag ees wi h a leas one o he ollowing s a emen s: “I eel ha my eache s accep me as I am”, “I eel ha my eache s ca e abou me as a pe son” and “I eel a lo o us in m y eache s”. P o ec ion om pee iolence Bullied Being bullied a school a leas once in he pas couple o mon hs. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 12 widesp ead o consis en as in heal h dep i a ion. Gi ls we e mo e likely o be dep i ed in classma e o eache suppo in se en egions ou o 41, wi h he la ges di e ences o 6 and 7 poin s in Li huania and Es onia, espec i ely. In con as , boys we e a a g ea e isk in Ge many (4 poin s), Is ael (3 poin s) and Slo enia (3 poin s). Figu e 4 anks egions by he a e o dep i a ion in p o ec ion om pee iolence, anging om a low o 15% in A menia o a high o 61% in Li huania. Jus o e hal o adolescen s (51%) we e dep i ed in his dimension in Wallonia (Belgium), Russia, La ia and Li huania. Again, p e alence a es did no a y signi ican ly wi h mac o-economic ac o s. Ac oss he wo indica o s, he a es o dep i a ion we e highe o bullying han o cybe - bullying. Boys we e mo e likely o epo he o me , while gi ls we e mo e likely o epo he la e . Boys we e mo e likely o be dep i ed in he o e all iolence dimension in 13 egions ou o 41, wi h he la ges di e ence o 16 poin s in Is ael, while gi ls we e a a g ea e isk in nine egions, wi h he la ges gaps o 7-10 poin s ound in Canada, Wales, England, Sco land and I eland. Incidence o dep i a ion in amily en i onmen anged om 16-17% in Sweden, Finland, No way and Denma k o 41-45% in Russia and Bulga ia (Figu e 5), bu he e we e no signi ican associa ions wi h mac o-economic indica o s. A he lowe end o he dep i a ion anking, poo e egions like Li huania and Uk aine had one in i e adolescen s dep i ed in his dimension, compa ed wi h a leas one in h ee in iche egions like I eland, Iceland and F ance a he highe end o he anking. Gende di e ences wi hin egions we e mixed: gi ls we e mo e likely o be dep i ed in nine egions (wi h he la ges gap o 7 poin s in Flande s) and boys in ano he eigh (wi h he la ges gap o 6 poin s in Moldo a). Figu e 6 demons a es ha dep i a ion p opo ion in in o ma ion access was gene ally lowe han in o he dimensions, anging om one in wen y adolescen s in he Ne he lands, Wales, Sco land and Finland o a ound one in i e (21-23%) in A menia and Moldo a and o e one in h ee (35%) in Albania. In con as o he o he dimensions, dep i a ion in in o ma ion access a ied signi ican ly wi h economic de elopmen (GDP pe capi a; =-0.46; p<0.01) and income inequali y (Gini coe icien ; =0.41; p<0.05).9 Ac oss he wo indica o s, p opo ions o adolescen s wi h no compu e a home we e below 10% (excep in Albania, A menia and Moldo a), which was consis en ly lowe han he sha e o adolescen s who did no use compu e s on weekdays. Boys and gi ls we e as likely o ha e a compu e a home (excep in 9 The e ec o income inequali y appea s o be spu ious because when he in o ma ion dep i a ion a e is eg essed on bo h GDP pe capi a (PPP) and he Gini coe icien , he e ec o he la e is no longe signi ican . 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 13 Albania whe e gi ls we e mo e dep i ed on his indica o ), bu boys we e mo e likely o no use compu e s on weekdays (excep in Albania and A menia). This p oduced signi ican ly highe dep i a ion a es in in o ma ion access among boys in 18 egions, wi h he la ges gende gap o 5 poin s in Bulga ia. Meanwhile, he dep i a ion a e was 3 poin s and 11 poin s highe o gi ls in A menia and Albania, espec i ely. Ac oss all six dimensions, adolescen s no li ing wi h bo h pa en s in he household and hose epo ing lowe le els o amily weal h we e consis en ly mo e dep i ed. Olde adolescen s we e mo e likely o be dep i ed in each dimension excep iolence10 and in o ma ion access. Ne gende e ec s in dep i a ion a es emained e en when adjus ed o age, amily s uc u e and amily weal h, since hese cha ac e is ics we e dis ibu ed equally ac oss boys and gi ls. In he wo coun ies o which we had sub-na ional in o ma ion, di e ences be ween egions we e some imes s a k. Adolescen s in Wallonia we e subs an ially mo e likely o be dep i ed han hei Flemish coun e pa s in e e y dimension excep amily en i onmen and in o ma ion access. Dep i a ion a es we e lowe in England han in Sco land and Wales in nu i ion, heal h and school en i onmen . 3.2.Mul idimensional dep i a ion The six dimensions o dep i a ion ended o o e lap in his s udy so ha e en in egions wi h lowe dep i a ion a es in single dimensions, a leas one in wo adolescen s we e dep i ed in one o mo e dimensions. This p opo ion anged om he low o 54% in Sweden o he high o 87% in Russia and Wallonia. D awing he cu -o a wo o mo e dimensions ou o six p oduced dep i a ion a es anging om 24% in Sweden o 61% in Bulga ia and Wallonia. In he emainde o hese analyses, we used he cu -o o h ee dimensions because i p oduced less ex eme headcoun a es han he cu -o o wo o mo e, while s ill main aining a high deg ee o a ia ion ac oss egions. Highe cu -o s (i.e. ou o mo e; i e o mo e) p oduced subs an ially lowe dep i a ion a es, wi h li le a ia ion ac oss egions, sugges ing ha mos di e ences lied in he sha es o adolescen s dep i ed in wo o h ee dimensions simul aneously. The choice o one cu -o o illus a i e pu poses is somewha a bi a y, bu due o space limi a ions we could no show he esul s o all possible cu -o s. Ou obus ness 10 Olde adolescen s we e consis en ly less likely o be bullied, bu in se e al coun ies hey we e a a highe isk o cybe bullying by pic u es o messages. Since he a es o cybe bullying end o be lowe , olde adolescen s appea ed o be less likely o be dep i ed in he p o ec ion om iolence dimension (es ima es a ailable on eques ). 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 14 checks show simila esul s when using wo o h ee ou o six dimensions as he cu -o (es ima es a ailable on eques ). Figu e 7 anks egions by he sha e o adolescen s dep i ed in a leas h ee ou o six dimensions. Ra es anged om one in en (9-10%) in No way and Sweden o abou one in h ee in Bulga ia, La ia, Russia and Wallonia (32-34%). Weal hie na ions ended o ha e lowe a es o mul idimensional dep i a ion ( =-0.31; p<0.10), bu his ela ionship appea s o ha e been d i en by income inequali y. Mo e income unequal coun ies had highe sha es o adolescen s dep i ed in h ee o mo e dimensions (Figu e 8), while iche egions ended o be mo e equal. I he mul idimensional dep i a ion a e was eg essed on bo h egion weal h and income inequali y hen he associa ion o egion weal h was no longe signi ican , while he e ec o income inequali y held. Gi ls we e mo e likely o be dep i ed in h ee o mo e dimensions han boys in 25 o 41 egions, wi h he la ges di e ence o 8 poin s in England. Boys we e mo e likely o be dep i ed han gi ls in Is ael (5 poin s). Olde child en we e mo e likely o be dep i ed in h ee o mo e dimensions in 21 egions, bu less likely o be dep i ed in ano he wo (Es onia and Uk aine). Child en li ing wi h one o no pa en and hose epo ing low amily weal h we e consis en ly mo e likely o be dep i ed in he majo i y o coun ies. The la ges di e ences by amily s uc u e we e ound in Canada (14 poin s) and I eland (16 poin s), while Es onia showed he g ea es ne e ec o pe cei ed amily weal h (35 poin s). 3.3.O e lap be ween dimensions To in es iga e which dimensions mainly d o e mul idimensional dep i a ion among he HBSC egions, we calcula ed he p opo ion o adolescen s dep i ed in h ee dimensions a a ime o each o he 20 unique combina ions o six dimensions. The h ee mos equen combina ions o h ee simul aneous dep i a ions we e: heal h, school en i onmen , and amily en i onmen ; heal h, school en i onmen , and p o ec ion om pee iolence; and school en i onmen , amily en i onmen , and p o ec ion om pee iolence. Each combina ion comp ised a ound 6% o adolescen s in he o e all sample. I is no able ha he same ou dimensions we e in ol ed in he op h ee combina ions. In ac , 3% o adolescen s on a e age ac oss egions we e dep i ed in all ou simul aneously. Figu e 9 shows he sha e o adolescen s dep i ed in heal h, school en i onmen , amily en i onmen and p o ec ion om pee iolence a once, sepa a ely by egion. Ra es anged om 1% in Albania, Sweden, Albania and No way o 6% in La ia, Russia, Wallonia and Wales. Gi ls we e mo e likely o be dep i ed in all ou dimensions a once in he majo i y o 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 15 he egions (29 o 41), wi h he la ges di e ence o six poin s in Wales. Boys we e mo e likely o be dep i ed in all ou dimensions in Is ael (by 1.5 poin s). Con olling o gende , amily s uc u e and pe cei ed amily weal h, olde adolescen s we e mo e likely o be dep i ed in hese ou dimensions in jus unde one-hal o he egions (16 o 41). In 26 o 41 egions, adolescen s om non- wo-pa en amilies we e signi ican ly mo e likely o be dep i ed in all ou dimensions. Adolescen s who epo ed ha hei amily was no e y/no a all well o we e mo e likely o be dep i ed in hese ou dimensions simul aneously in all bu wo egions (Albania and A menia), wi h he la ges di e ence o 15 poin s ound in Es onia and La ia. 4. Discussion and conclusion This s udy demons a ed he applica ion o he MODA amewo k o 40 Eu opean egions and Canada using da a on adolescen s aged 11, 13 and 15 om he HBSC s udy. I is he i s applica ion o MODA ha is based en i ely on da a collec ed om adolescen s hemsel es a he han om household e e ence pe sons on behal o adolescen s (e.g. de Milliano and Handa 2014; de Milliano and Pla go 2014; Chzhen e al. 2016a; Chzhen and Fe one 2016). Unlike o he MODA s udies, he p esen analysis mos ly ocuses on non-ma e ial, ela ional aspec s o child dep i a ion, co esponding closely o uni e sal child en’s igh s embedded in he CRC. As such, hese aspec s could be used o de elop na ionally ailo ed measu es o mul idimensional adolescen dep i a ion o moni o p og ess owa ds eaching sus ainable de elopmen goals (“SDGs”), goal 1, a ge 1.2 o his age g oup. All coun ies o he wo ld signed up o educe “a leas by hal he p opo ion o men, women and child en o all ages li ing in po e y in all i s dimensions acco ding o na ional de ini ions.” Mos coun ies a e ye o ag ee on he na ional de ini ions o mul idimensional po e y, so he p esen s udy illus a es he po en ial o de eloping an adolescen -speci ic mul idimensional measu e. The s udy highligh s subs an ial c oss- egion a ia ion in he p e alence o adolescen dep i a ions. No dic coun ies had he lowes le els o mul idimensional dep i a ions among adolescen s. Sweden, No way, Denma k, Finland and Iceland all had 15% o less o adolescen s dep i ed in h ee o mo e dimensions ou o six. Only he Ne he lands had compa ably low le els o mul iple dep i a ions. T adi ionally, hese a e coun ies wi h consis en ly be e ou comes in many indica o s o child well-being (Kame man e al. 2003; B adshaw and Richa dson 2009). Al hough Sweden ecen ly anked below a e age on inequali y o child ou comes ac oss 41 OECD and EU coun ies (UNICEF 2016), in ou s udy i had he lowes p opo ion o adolescen s dep i ed om a poo school en i onmen , poo amily en i onmen as well as mul iple dep i a ions ( h ee plus). The di e ence be ween ou 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 16 esul s and hose om UNICEF could be explained by he me hodological di e ences in measu es (ou comes s. social ela ionships). F ancophone egions (Wallonia and F ance) show a ela i ely high concen a ion o dep i a ion among adolescen s (bo h coun ies a e in he op 5 o egions wi h he highes pe cen ages o dep i a ion in h ee o mo e dimensions), compa able only o Bulga ia, La ia and Russia, coun ies wi h lowe le els o economic de elopmen . This is somewha in line wi h indings o he ecen UNICEF (2016) epo , which anked F ance and Belgium in 28 h and 29 h place ou o 41 coun ies on inequali y in all dimensions (income, educa ion, heal h and li e-sa is ac ion). Al hough he e we e limi s o c oss- egional compa abili y o he esul s due o cul u al di e ences and no ms ela ed o amily and pee ela ionships, ou indings unde line ha he mo e subjec i e single aspec s o child dep i a ion do no a y wi h na ional weal h and income inequali y. Howe e , mo e income unequal coun ies ended o ha e highe sha es o adolescen s dep i ed in h ee o mo e dimensions. This is an impo an inding in he ligh o pos -2015 SDG agenda o educing inequali y wi hin and among coun ies.11 Only o bo h indica o s o pe cei ed heal h, consis en gende di e ences we e ound in all coun ies, wi h gi ls being mo e dep i ed han boys. Fo he o he dimensions, esul s e ealed gende di e ences in only some o he coun ies (and o en in opposing di ec ions). These indings a e consis en wi h ea lie s udies showing ha gi ls ha e a poo e pe cep ion o hei heal h (Ca allo e al. 2006; Inchley e al. 2016; Chzhen e al. 2016b). Rema kably, mul idimensional dep i a ion ( h ee o mo e domains) was mo e common o gi ls han o boys in 60 pe cen o he coun ies, showing ha gi ls a e mo e ulne able o mul iple dep i a ions han boys. The isk o dep i a ion was no only la ge o gi ls bu also o adolescen s ha pe cei ed hei amily a luence as ela i ely low and hose om non- wo-pa en amilies. These links we e no only ound o all single dimensions o dep i a ion bu also o he likelihood o acing a leas h ee ypes o dep i a ion. Di e ences acco ding o pe cei ed amily weal h we e la ge han age and amily s uc u e ac oss all egions. Al hough he associa ions be ween amily backg ound and adolescen heal h beha io and ou comes a e well es ablished in he li e a u e (Cu ie e al. 2008; Elga e al. 2015b), his is he i s HBSC-based s udy o show ha ulne abili ies o adolescen s om lowe pe cei ed socio-economic s a us amilies go beyond indi idual aspec s o adolescen s’ li e o also explaining he mul idimensionali y o hese expe iences. 11 h ps://sus ainablede elopmen .un.o g/sdg10. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 17 The esul s o his s udy show he in e connec edness o speci ic psychological and social dep i a ions. Mo e speci ically, a lack o pe cei ed suppo in school and amily coincided mos o en wi h expe iences o being bullied and poo heal h, while nu i ion and in o ma ion access a e less likely o be in e connec ed wi h hese dimensions o dep i a ion. I migh be ha adolescen s who lack good communica ion and suppo a school and amily a e likely o become ic ims o bullying and su e om poo heal h. The e is no claim o causali y o di ec ion o hese associa ions, bu om policy pe spec i e hey d aw a en ion o a g oup o adolescen s who a e ma ginalised o excluded wi hin he school en i onmen as hese adolescen s and young people a e ulne able in all hei social ies and connec ions du ing hei adolescen li es. Re e ences Alemán-Díaz, A. Y., Toczydlowska, E., Mazu , J., F asquilho, D., Melkumo a, M., & Holmq is , G. (2016). Why income inequali ies ma e o young people’s heal h: A look a he e idence. Innocen i Wo king Pape 2016-06. Flo ence: UNICEF O ice o Resea ch. Bickham, D. S., Hswen, Y., & Rich, M. (2015). Media use and dep ession: exposu e, household ules, and symp oms among young adolescen s in he Uni ed S a es. In e na ional Jou nal o Public Heal h, 60(2), 147-155, doi:10.1007/s00038-014- 0647-6. Bobako a, D., Ham ik, Z., Badu a, P., Sigmundo a, D., Nalecz, H., & Kalman, M. (2015). Tes - e es eliabili y o selec ed physical ac i i y and seden a y beha iou HBSC i ems in he Czech Republic, Slo akia and Poland. In e na ional Jou nal o Public Heal h, 60(1), 59-67, doi:10.1007/s00038-014-0628-9. Boyce, W., Da ies, D., Gallupe, O., & Shelley, D. (2008). Adolescen isk aking, neighbo hood social capi al, and heal h. Jou nal o Adolescen Heal h, 43(3), 246- 252, doi:10.1016/j.jadoheal h.2008.01.014. B adshaw, J., & Richa dson, D. (2009). An index o child well-being in Eu ope. Child Indica o s Resea ch, 2(3), 319-351, doi:10.1007/s12187-009-9037-7. B ene , N., Kann, L., Shanklin, S., Kinchen, S., Ea on, D., Hawkins, J., e al. (2013). Me hodology o he you h isk beha io su eillance sys em. MMWR. Recommenda ions and Repo s: Mo bidi y and Mo ali y Weekly Repo . Recommenda ions and Repo s/Cen e s o Disease Con ol, 62(RR-1), 1-20. B indo a, D., Veselska, Z., Klein, D., Ham ik, Z., Sigmundo a, D., an Dijk, J., e al. (2015). Is he associa ion be ween sc een-based beha iou and heal h complain s among adolescen s mode a ed by physical ac i i y? In e na ional Jou nal o Public Heal h, 60(2), 139-145, doi:10.1007/s00038-014-0627-x. B ooks, F. M., Magnusson, J., Spence , N., & Mo gan, A. (2012). Adolescen mul iple isk beha iou : an asse app oach o he ole o amily, school and communi y. The Jou nal o Public Heal h, 34(suppl 1), i48-i56 doi:10.1093/pubmed/ ds001. Callaghan, M., Kelly, C., & Molcho, M. (2015). Explo ing adi ional and cybe bullying among I ish adolescen s. In e na ional Jou nal o Public Heal h, 60(2), 199-206, doi:10.1007/s00038-014-0638-7. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 18 Ca allo, F., Dalmasso, P., O o a -Jo dan, V., B ooks, F., Mazu , J., Välimaa, R., e al. (2015). T ends in sel - a ed heal h in Eu opean and No h-Ame ican adolescen s om 2002 o 2010 in 32 coun ies. The Eu opean Jou nal o Public Heal h, 25(suppl 2), 13–15, doi:10.1093/eu pub/ck 011. Ca allo, F., Zambon, A., Ra en-Siebe e , U., To sheim, T., Lemma, P., & HBSC Posi i e Heal h Focus G oup (2006). Gi ls g owing h ough adolescence ha e a highe isk o poo heal h. Quali y o Li e Resea ch: An In e na ional Jou nal o Quali y o Li e Aspec s o T ea men , Ca e and Rehabili a ion, 15(10), 1577-1585, doi:10.1007/s11136-006-0037-5. Collins, W. A., & Lau sen, B. (2004). Pa en -adolescen ela ionships and in luences. In R. M. Le ne , & L. S einbe g (Eds.), Handbook o adolescen psychology (Vol. 2, pp. 331-362). N.J.: Willey. Cu ie, C., Inchley, J., Molcho, M., Lenzi, M., Veselska, Z., & Wild, F. e. (2014). Heal h Beha iou in School-aged Child en (HBSC) s udy p o ocol: backg ound, me hodology and manda o y i ems o he 2013/14 Su ey. Edinbu gh: Child and Adolescen Heal h Resea ch Uni . Cu ie, C., Molcho, M., Boyce, W., Hols ein, B., To sheim, T., & Rich e , M. (2008). Resea ching heal h inequali ies in adolescen s: The de elopmen o he Heal h Beha iou in School-Aged Child en (HBSC) Family A luence Scale. Social Science & Medicine, 66(6), 1429-1436, doi:10.1016/j.socscimed.2007.11.024. Chzhen, Y., de Neubou g, C., de Milliano, M., & Pla go, I. (2016a). Child po e y in he eu opean union: The mul iple o e lapping dep i a ion analysis app oach (EU- MODA). Child Indica o s Resea ch, 9(2), 335-336, doi:10.1007/s12187-015-9321-7. Chzhen, Y., & Fe one, L. (2016). Mul idimensional child dep i a ion and po e y measu emen : Case s udy o Bosnia and He zego ina. Social Indica o s Resea ch, Online Fi s , doi:10.1007/s11205-016-1291-8. Chzhen, Y., Moo , I., Picke , W., Toczydlowska, E., & S e ens, G. (2016b). Family a luence and inequali y in adolescen heal h and li e sa is ac ion: E idence om he HBSC s udy 2002-2014. Innocen i Wo king Pape 2016-10. Flo ence: UNICEF O ice o Resea ch. de Milliano, M., & Handa, S. (2014). Child po e y and dep i a ion in Mali: The i s na ional es ima es. Innocen i Wo king Pape 2014-20. Flo ence: UNICEF O ice o Resea ch de Milliano, M., & Pla go, I. (2014). Analysing Child po e y and dep i a ion in sub- Saha an A ica: CC-MODA – C oss Coun y Mul iple O e lapping Dep i a ion Analysis. Innocen i Wo king Pape 2014-19. Flo ence: UNICEF O ice o Resea ch. de Neubou g, C., Chai, J., de Milliano, M., Pla go, I., & Wei, Z. (2012). S ep-by-S ep Guidelines o he Mul iple O e lapping Dep i a ion Analysis (MODA). Wo king Pape 2012-10. Flo ence: UNICEF O ice o Resea ch de Neubou g, C., de Milliano, M., & Pla go, I. (2014). Los (in) Dimensions: Consolida ing p og ess in mul idimensional po e y esea ch. Innocen i Wo king Pape 2014-04. Flo ence: UNICEF O ice o Resea ch. Dmi ie a, J. (2013). Socioeconomic in luences on heal h and heal h beha io in adolescen s. In W. T. O'Donohue, L. T. Benu o, & L. Woodwa d Tolle (Eds.), Handbook o adolescen heal h psychology (pp. 43-60). New Yo k: Sp inge . Due, P., Hols ein, B., Lynch, J., Dide ichsen, F., Gabhain, S., Scheid , P., e al. (2005). Bullying and symp oms among school-aged child en: in e na ional compa a i e c oss sec ional s udy in 28 coun ies. The Eu opean Jou nal o Public Heal h, 15(2), 128- 132, doi:10.1093/eu pub/cki105. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 19 Elga , F., McKinnon, B., Walsh, S., F eeman, J., D Donnelly, P., de Ma os, M., e al. (2015a). S uc u al de e minan s o you h bullying and igh ing in 79 coun ies. Jou nal o Adolescen Heal h, 57(6), 643-650. Elga , F., P ö ne , T.-K., Moo , I., De Cle cq, B., S e ens, G. W., & Cu ie, C. (2015b). Socioeconomic inequali ies in adolescen heal h 2002–2010: a ime-se ies analysis o 34 coun ies pa icipa ing in he Heal h Beha iou in School-aged Child en s udy. The Lance , 385(9982), 2088-2095, doi:10.1016/S0140-6736(14)61460-4. E ans, G. W., & Kim, P. (2010). Mul iple isk exposu e as a po en ial explana o y mechanism o he socioeconomic s a us-heal h g adien . Annals o he New Yo k Academy o Sciences, 1186(1), 174–189, doi:10.1111/j.1749-6632.2009.05336.x. Fai lie, R. W. (2012). The e ec s o home access o echnology on compu e skills: E idence om a ield expe imen . In o ma ion Economics and Policy, 24(3-4), 243-253, doi:10.1016/j.in oecopol.2012.06.001. Fai lie, R. W., Bel an, D. O., & Das, K. K. (2010). Home compu e s and educa ional ou comes: E idence om he NLSY97 and CPS. Economic Inqui y, 48(3), 771-792, doi:10.1111/j.1465-7295.2009.00218.x. Fle che , A. C., S einbe g, L., & Williams‐Wheele , M. (2004). Pa en al in luences on adolescen p oblem beha io : Re isi ing S a in and Ke . Child De elopmen , 75(3), 781-796, doi:10.1111/j.1467-8624.2004.00706.x. Ga iepy, G., Sen enac, M., McKinnon, B., & Elga , F. (2016). Validi y and eliabili y o a b ie symp om checklis o measu e psychological heal h in school-aged child en. Child Indica o s Resea ch, 9(2), 471-484, doi:10.1007/s12187-015-9326-2. Go don, D., Nandy, S., Pan azis, C., Pembe on, S., & Townsend, P. (2003). The dis ibu ion o child po e y in he de eloping wo ld. B is ol: Cen e o In e na ional Po e y Resea ch. Gue a, N., & Hanish, L. D. (2004). Agg essi e ic ims, passi e ic ims, and bullies: De elopmen al con inui y o de elopmen al change? Me ill-Palme Qua e ly, 50(1), 17-38, doi:10.1353/mpq.2004.0003. Guio, A.-C., Go don, D., & Ma lie , E. (2012). Measu ing ma e ial dep i a ion in he EU: Indica o s o he whole popula ion and child-speci ic indica o s. Eu os a Me hodologies and Wo king Pape s. Luxembou g: O ice o O icial Publica ions o he Eu opean Communi ies. Hanson, M., & Chen, E. (2007). Socioeconomic s a us and heal h beha io s in adolescence: a e iew o he li e a u e. Jou nal o Beha io al Medicine, 30(3), 263-285, doi:10.1007/s10865-007-9098-3. Ha el-Fisch, Y., Walsh, S. D., Fogel-G in ald, H., Ami ai, G., Picke , W., Molcho, M., e al. (2011). Nega i e school pe cep ions and in ol emen in school bullying: A uni e sal ela ionship ac oss 40 coun ies. Jou nal o Adolescence, 34(4), 639-652, doi:10.1016/j.adolescence.2010.09.008. Haugland, S., & Wold, B. (2001). Subjec i e heal h complain s in adolescence— eliabili y and alidi y o su ey me hods. Jou nal o Adolescence, 24(5), 611-624, doi:10.1006/jado.2000.0393. Haynie, D. L., Nansel, T., Ei el, P., C ump, A. D., Saylo , K., Yu, K., e al. (2001). Bullies, ic ims, and bully/ ic ims: Dis inc g oups o a - isk you h. Jou nal o Ea ly Adolescence, 21(1), 29-49, doi:10.1177/0272431601021001002. Hemphill, S., Ko e ski, A., & Hee de, J. (2015). Longi udinal associa ions be ween cybe - bullying pe pe a ion and ic imiza ion and p oblem beha io and men al heal h p oblems in young Aus alians. In e na ional Jou nal o Public Heal h, 60(2), 227- 237, doi:10.1007/s00038-014-0644-9. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 20 Hong, J. S., & Espelage, D. L. (2012). A e iew o esea ch on bullying and pee ic imiza ion in school: An ecological sys em analysis. Agg ession and Violen Beha io , 17(4), 311-322, doi:10.1016/j.a b.2012.03.003. Inchley, J., Cu ie, D., Young, T., Samdal, O., To sheim, T., Augus son, L., e al. (2016). G owing up unequal: gende and socioeconomic di e ences in young people’s heal h and well-being. Heal h Beha iou in School-aged Child en (HBSC) s udy: In e na ional epo om he 2013/2014 su ey. Heal h Policy o Child en and Adolescen s Copenhagen: WHO Regional O ice o Eu ope. In e na ional Mone a y Fund (2016). Wo ld Economic Ou look Da abase. h ps://www.im .o g/ex e nal/pubs/ /weo/2016/01/weoda a/index.aspx. Accessed 11 Ap il 2016 Kame man, S. B., Neuman, M., Wald ogel, J., & B ooks-Gunn, J. (2003). Social policies, amily ypes and child ou comes in selec ed OECD coun ies. OECD Social, Employmen and Mig a ion Wo king Pape s, No. 6: OECD Publishing. Kuhlemeie , H., & Hemke , B. (2007). The impac o compu e use a home on s uden s’ In e ne skills. Compu e s & Educa ion, 49(2), 460-480, doi:10.1016/j.compedu.2005.10.004. Lachy o a, M., Ka eniako a, Z., Mikula, P., & Nagyo a, I. (2015). Sel - a ed heal h in ela ion o men al heal h, physical ac i i y, seden a y beha iou in adolescen s. The Eu opean Jou nal o Public Heal h, 25(suppl 3), ck 171. 081, doi:10.1093/eu pub/ck 171.081. Lemma, P., Bo accino, A., Be chialla, P., Dalmasso, P., Cha ie , L., Vieno, A., e al. (2015). Well-being in 15-yea -old adolescen s: a ma e o ela ionship wi h school. The Jou nal o Public Heal h, 37(4), 573-580, doi:10.1093/pubmed/ du095. Le in, K. A., & Cu ie, C. (2010). Family s uc u e, mo he ‐child communica ion, a he ‐ child communica ion, and adolescen li e sa is ac ion: A c oss‐sec ional mul ile el analysis. Heal h Educa ion, 110(3), 152-168, doi:10.1108/09654281011038831. Li, J., McMu ay, A., & S anley, F. (2008). Mode ni y’s pa adox and he s uc u al de e minan s o child heal h and well-being. Heal h Sociology Re iew, 17(1), 64-77, doi:10.5172/hes .451.17.1.64. Liu, Y., Wang, M., Tynjälä, J., L , Y., Villbe g, J., Zhang, Z., e al. (2010). Tes - e es eliabili y o selec ed i ems o Heal h Beha iou in School-aged Child en (HBSC) su ey ques ionnai e in Beijing, China. BMC Medical Resea ch Me hodology, 10(1), 1-9, doi:10.1186/1471-2288-10-73. Mackenbach, J. P. (2012). The pe sis ence o heal h inequali ies in mode n wel a e s a es: he explana ion o a pa adox. Social Science & Medicine, 75(4), 761-769, doi:10.1016/j.socscimed.2012.02.031. Machado-Rod igues, A., Lei e, N., Coelho-e-Sil a, M., Enes, F., Fe nandes, R., Masca enhas, L., e al. (2015). Me abolic isk and ele ision ime in adolescen emales. In e na ional Jou nal o Public Heal h, 60(2), 157-165, doi:10.1007/s00038-014- 0625-z. Main, G., & B adshaw, J. (2012). A child ma e ial dep i a ion index. Child Indica o s Resea ch, 5(3), 503-521, doi:10.1007/s12187-012-9145-7. Mei eles, A., Xa ie , C., de Souza, A. A., P oie i, F., & Caia a, W. (2015). Sel - a ed heal h among u ban adolescen s: The oles o age, gende , and hei associa ed ac o s. Plos One, 10(7), e0132254, doi:10.1371/jou nal.pone.0132254. Mo eno, C., Muñoz-Tinoco, V., Pé ez, P., & Sánchez-Queija, I. (2006). Los adolescen es españoles y sus amilias: calidad en la comunicación con el pad e y con la mad e y conduc as de iesgo elacionadas con el consumo de sus ancias adic i as. Cul u a y Educación, 18(3-4), 345-362, doi:10.1174/113564006779172975. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 21 Mo eno, C., Sánchez-Queija, I., Muñoz-Tinoco, V., Ma os, M. G., Dallago, L., Bog , T. T., e al. (2009). C oss-na ional associa ions be ween pa en and pee communica ion and psychological complain s. In e na ional Jou nal o Public Heal h, 54(2), 235-242, doi:10.1007/s00038-009-5415-7. Nuu inen, T., Roos, E., Ray, C., Villbe g, J., Välimaa, R., Rasmussen, M., e al. (2014). Compu e use, sleep du a ion and heal h symp oms: a c oss-sec ional s udy o 15-yea olds in h ee coun ies. In e na ional Jou nal o Public Heal h, 59(4), 619-628, doi:10.1007/s00038-014-0561-y. Olweus, D. (1996). The e ised Olweus bully/ ic im ques ionnai e. Be gen: Uni e si y o Be gen. Pede sen, T. P., Meils up, C., Hols ein, B. E., & Rasmussen, M. (2012). F ui and ege able in ake is associa ed wi h equency o b eak as , lunch and e ening meal: c oss- sec ional s udy o 11-, 13-, and 15-yea -olds. The In e na ional Jou nal o Beha io al Nu i ion and Physical Ac i i y, 9(1), 9, doi:10.1186/1479-5868-9-9. Rampe saud, G., Pe ei a, M., Gi a d, B., Adams, J., & Me zl, J. (2005). B eak as habi s, nu i ional s a us, body weigh , and academic pe o mance in child en and adolescen s. Jou nal o he Ame ican Die e ic Associa ion, 105(5), 743-760, doi:10.1016/j.jada.2005.02.007. Rich e , M., Moo , I., & an Len he, F. J. (2012). Explaining socioeconomic di e ences in adolescen sel - a ed heal h: he con ibu ion o ma e ial, psychosocial and beha iou al ac o s. Jou nal o Epidemiology and Communi y Heal h, 66(8), 691-697, doi:10.1136/jech.2010.125500. Ridol o, H., & Mai land, A. (2011). Fac o s ha in luence he accu acy o adolescen p oxy epo ing o pa en al cha ac e is ics: A esea ch no e. Jou nal o Adolescence, 34(1), 95-103, doi:10.1016/j.adolescence.2010.01.008. Sigmund, E., Sigmundo á, D., Badu a, P., Kalman, M., Ham ik, Z., & Pa elka, J. (2015). Tempo al ends in o e weigh and obesi y, physical ac i i y and sc een ime among Czech adolescen s om 2002 o 2014: A na ional heal h beha iou in school-aged child en s udy. In e na ional Jou nal o En i onmen al Resea ch and Public Heal h, 12(9), 11848-11868, doi:10.3390/ije ph120911848. Sinclai , K., Bauman, S., Po ea , V., Koenig, B., & Russell, S. (2012). Cybe and bias-based ha assmen : associa ions wi h academic, subs ance use, and men al heal h p oblems. Jou nal o Adolescen Heal h, 50(5), 521-523, doi:10.1016/j.jadoheal h.2011.09.009. Smokowski, P. R., & Kopasz, K. H. (2005). Bullying in school: An o e iew o ypes, e ec s, amily cha ac e is ics, and in e en ion s a egies. Child en & Schools, 27(2), 101-110, doi:10.1093/cs/27.2.101. Sol , F. (2014). The S anda dized Wo ld Income Inequali y Da abase (SWIID) Ve sion 5.0., Ha a d Da a e se, V14. h ps://da a e se.ha a d.edu/da ase .xh ml?pe sis en Id=hdl:1902.1/11992. Accesed 05 July 2016. Sou ande , A., B uns ein, K. A., Ikonen, M., Lind oos, J., Lun amo, T., Koskelainen, M., e al. (2010). Psychosocial isk ac o s associa ed wi h cybe bullying among adolescen s: a popula ion-based s udy. A chi es o Gene al Psychia y, 67(7), 720- 728, doi:10.1001/a chgenpsychia y.2010.79. Spea s, B., Campbell, M. A., Tangen, D. J., Slee, P., & C oss, D. (2015). Aus alian p e- se ice eache s' knowledge and unde s anding o cybe bullying: Implica ions o school clima e. Les Dossie s des Sciences de l'Éduca ion, 33, 109-130. S einbe g, L., & Silk, J. S. (2002). Pa en ing adolescen s. In M. Bo ns ein (Ed.), Handbook o pa en ing, 1 (Vol. 1, pp. 103-133). Mahwah, N.J.: Law ence E lbaum Associa es, Publishe s. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65