Purpose Despite physical activity (PA)'s health benefits, few adolescents meet recommended levels. This review examined associations between adolescents’ self-reported PA and sedentary behaviours (SB) and their modifiable determinants, assessing interventions across settings (school, home, mixed). Methods Five databases were searched from 2010 to 2023. Eligible studies included experimental studies assessing adolescents’ self-reported PA/SB and modifiable determinants at pre- and post-intervention. Within a social-ecological framework, Robust-Bayesian-Meta-Analyses (RoBMA) were conducted per setting, assessing heterogeneity and publication-bias. Single-study outcomes were narratively reported. A holistic classification of determinant domains was then applied to map measured determinants and targeted intervention components across individual-psychological, individual-behavioural, interpersonal, and environmental domains. Risk of bias and evidence certainty were also evaluated. PROSPERO-ID: CRD42021282874. Results Twelve RCTs and two CTs (school n = 10, home n = 2, and school-home n = 2 settings) were included. Thirteen studies (93%) incorporated theory-based approaches, and 13 studies (93%) addressed multiple determinant domains, although only four (29%) showed high-integration multi-domain designs. Of the 67 unique modifiable determinants identified, 94% were classified within individual/interpersonal categories. In particular, RoBMAs showed minimal or no pooled effects on PA/SB or determinants, except for weak evidence suggesting a small positive effect on planning in school setting, including action and coping planning, implementation intentions, or commitment to a plan of action, with substantial heterogeneity across studies. Risk of bias was due mainly to randomization and outcome measurement issues. The level of certainty from the evidence ranged from very low to low. Discussion Existing interventions predominantly target individual-level factors, with limited coordinated integration across socio-ecological domains. High-quality future trials should test whether well-designed, integrated multilevel interventions can more consistently modify diverse determinants of adolescents' PA/SB across setting and co-occur with psychosocial benefits.

Background and aims: Persistent pain in adolescents is complex, prevalent, and linked to consequences such as school absenteeism and long-term health issues. Despite the urgent need for evidence-based guidelines and preventive measures, research often lacks early involvement of end-users, essential for targeted interventions. This study uses 'Future workshops' to gather insights from adolescents, healthcare providers, parents, and teachers, to inform the development of person-centered interventions for pain management. Method Three future workshops with adolescents with pain (n=13), healthcare providers and teachers (n=16), and parents (n=4) were conducted during January 2023 in Oslo, Norway. Workshops employed generative methods with critique, fantasy, and implementation phases. Case vignettes and inspiration cards facilitated discussions, fostering a participatory environment translating insights into actionable intervention visions. Results were analyzed separately using reflexive thematic analysis by Brown and Clarke. Results Future workshops yielded significant insights and solutions to enhance care for adolescents with persistent pain. These included more comprehensive interdisciplinary collaboration, early thorough assessments, dedicated coordination roles, pain management education, specialized adolescent-focused medical expertise, digital health solutions, school health service screening, and sustained support from school-based physiotherapists and psychologists. Conclusions Phase 1 of our ongoing project, featuring Future workshops, identified key strategies for developing person-centered interventions. Phase 2 will integrate these insights with relevant literature to refine proposed interventions. Phase 3 will further enhance solutions through additional workshops. This process aims to advance care and support strategies, translating collaborative insights and visions into actionable measures for adolescents managing persistent pain.

BACKGROUND AND OBJECTIVE:Persistent pain is common among adolescents, with significant consequences. School-based interventions have the potential to reach most adolescents, but there is a lack of systematic reviews addressing school-based pain interventions. This systematic review aimed to identify and evaluate the effectiveness of school-based interventions for reducing persistent pain and disability in adolescents compared to control interventions. DATABASES AND DATA TREATMENT:The PRISMA guidelines were followed (CRD42023477721). Searches in Medline, EMBASE, PEDro, CINAHL, Web of Science, Cochrane, AMED, PsycINFO, and Google Scholar identified 6651 studies. We included randomised controlled trials (RCTs) and controlled trials (CTs) of interventions conducted at schools involving adolescents aged 10-19 years with persistent pain lasting ≥ 3 months. Risk of bias was measured using the Cochrane RoB 2 tool for RCTs and ROBINS-I for CTs. Results were synthesised narratively. RESULTS:Sixteen studies met the inclusion criteria (n = 12 RCTs, n = 3 CTs, n = 1 pilot RCT) including 2873 participants. The identified interventions were relaxation, education, exercise, taping, and tailored pain management. Relaxation reduced headache activity in four out of five studies; exercise was effective for back and menstrual pain; education showed conflicting results; and person-centred care was not better than usual school health care for reducing pain. All included studies had a high risk of bias. CONCLUSION:Relaxation and exercise showed promising effectiveness on reducing persistent pain in adolescents, although with a high risk of bias. The need for higher-quality studies remains imperative to strengthen the evidence base and inform future interventions. SIGNIFICANCE STATEMENT:This systematic review highlights the potential of school-based interventions, particularly relaxation and exercise, in reducing persistent pain among adolescents, although in studies with a high risk of bias. These findings underscore the need for higher-quality studies to establish robust evidence and inform effective, equitable pain management strategies in school settings.

Bakgrunn Langvarige smerter blant ungdom er et utbredt og komplekst problem, ofte forbundet med skolefravær og andre helseplager. Tross behovet for kunnskapsbaserte retningslinjer og forebyggende tiltak, er det en mangel på tidlig involvering av sluttbrukere i forskningen, noe som er avgjørende for utviklingen av målrettede intervensjoner. Studien har som mål å identifisere utfordringer og barrierer i smertehåndteringen, sett fra perspektivene til ungdommer med langvarige smerter, foreldre, helsepersonell og lærere, samt å utforske deres visjoner for å utvikle en persontilpasset intervensjon. Metode I februar 2024 arrangerte vi workshops for tre grupper: 1) ungdommer med smerter (n=13), 2) helsepersonell og lærere (n=16), og 3) foreldre (n=4). Vi brukte generative metoder som besto av kritikk-, visjons- og implementeringsfaser. I tillegg ble casevignetter og inspirasjonskort brukt for å stimulere til diskusjon og skape et inkluderende miljø. Deltakerne omformet innsikter til visjoner for intervensjoner gjennom diskusjonene, som vi transkriberte. Deretter analyserte vi dataene ved hjelp av refleksiv tematisk analyse (Braun og Clarke). Resultat Barrierer i smertehåndteringen inkluderte vanskeligheter med å navigere i helsevesenet, mangel på tverrfaglig samarbeid med skolehelsetjenesten, og kommunikasjonsutfordringer mellom ungdommer, helsepersonell og foreldre. Alle workshop-gruppene anså skolen som en ideell og trygg arena for å igangsette intervensjoner. Visjonene omfattet tidlig helhetlig kartlegging og undersøkelser, med vektlegging av psykososiale faktorer og faktorer som opprettholder smertetilstanden. Videre ble det fremhevet behov for ekspertise rettet mot ungdom, dedikerte koordineringsroller, samt forslag om utvikling av en digital plattform for å tilby person-sentrert informasjon og ressurser for smertehåndtering. Konklusjon Studien avdekker flere tiltak for bedre oppfølging av ungdom med langvarige smerter, inkludert tidlig helhetlig kartlegging, styrket tverrfaglig samarbeid i skolehelsetjenesten, etablering av koordineringsroller og tilrettelegging for ungdomsrettet kompetanse. Involveringen av sluttbrukere har gitt oss verdifulle innsikter som kan sikre at fremtidige tiltak bedre reflekterer deres faktiske utfordringer og behov, og dermed kan ha større innvirkning.

INTRODUCTION:Long-lasting pain in adolescents may affect education, social interactions, and is associated with mental health challenges. Current interventions are often suboptimal due to insufficient understanding of the challenges faced by adolescents with long-lasting pain and those who support them. Understanding the management challenges experienced by adolescents with long-lasting pain, along with those faced by their parents, education professionals, and healthcare professionals (HCPs), is crucial for informing person-centered interventions and improving care and outcomes. OBJECTIVES:This study aimed to gather insights and visions from adolescents with long-lasting pain, along with their parents, HCPs, and teachers, to develop a person-centered intervention for managing pain. METHODS:We used a qualitative Action Research approach, employing three workshops with 1) adolescents with long-lasting pain, 2) HCPs and teachers, and 3) parents. Workshops incorporated case vignettes and design-card exercises to foster dialogue, knowledge construction and articulation of insights and visions to inform intervention design. Data were collected through audio recordings, participant artifacts, and field notes, then analyzed using Reflexive Thematic Analysis and matrix synthesis to create a conceptual model highlighting tension points for future interventions. RESULTS:In three separate workshops, 13 adolescents with long-lasting pain, 16 HCPs and teachers (four physiotherapists, four senior high school teachers, three psychologists, three school health nurses, and two General Practitioners), and four parents participated. Adolescents described pain's pervasive impact on their education, social lives, and self-identity. Barriers to improvement included limited coordination between healthcare and school, as well as a lack of communication. The school setting and school health services were identified as an ideal setting for interventions. Key visions for interventions included early holistic assessments, enhanced interdisciplinary collaboration with dedicated coordination roles, specialized adolescent-focused expertise, and the use of digital tools for personalized management. CONCLUSION:This study brought new insights into the development of a person-centered intervention for adolescents with long-lasting pain, highlighting the impact of pain on those affected and barriers to optimal care. It emphasized the need for including education professionals and school health services in interdisciplinary collaboration, holistic assessments, and improved expertise in adolescent pain management.

BACKGROUND:It is unclear whether lifestyle behaviours influence use of healthcare for musculoskeletal pain in young adults. This study examined if lifestyle behaviours among college/university students were associated with future healthcare utilisation for musculoskeletal pain. METHODS:Data from the Students' Health and Wellbeing Study (SHoT2018) were linked with the Norwegian Registry for Primary Health Care, comprising 31,358 college/university students. We analysed associations of physical activity level, sleep duration, alcohol consumption, smoking, illicit drug use and cumulative adverse lifestyle behaviours with healthcare utilisation for musculoskeletal pain over the following three years, including 'any use', 'high use' and for back and neck pain specifically. RESULTS:High physical activity levels, compared to recommended levels, were associated with a higher risk of 'any' healthcare utilisation for musculoskeletal pain (females: RR 1.14, 99% CI [1.04-1.25]; males: RR 1.20, 99% CI [1.07-1.36]); below recommended physical activity levels were associated with a lower risk (females: RR 0.90, 99% CI [0.85-0.96]; males: RR 0.84, 99% CI [0.76-0.93]). Illicit drug use was associated with a lower risk of healthcare utilisation for neck pain in females (RR 0.77, 99% CI [0.62-0.97]). Four or more adverse lifestyle behaviours, compared to ≤ 1, were associated with a lower risk of high healthcare utilisation for musculoskeletal pain (females: RR 0.66, 99% CI [0.48-0.90]; males: RR 0.68, 99% CI [0.48-0.97]) and a lower risk of healthcare utilisation for neck pain in females (RR 0.63, 99% CI [0.41-0.97]). CONCLUSIONS:Associations between college/university students' lifestyle behaviours and healthcare utilisation for musculoskeletal pain were identified, but with some unexpected patterns. Future research should explore long-term effects of these behaviours on healthcare utilisation for musculoskeletal pain. SIGNIFICANCE:High levels of physical activity among college and university students were associated with a greater risk of seeking healthcare for musculoskeletal pain within the following three years. Illicit drug use was associated with a lower risk of seeking healthcare for neck pain in females. Surprisingly, the presence of many adverse lifestyle behaviours appeared to be associated with a lower risk of healthcare utilisation for musculoskeletal pain, particularly healthcare contacts for neck pain in females and repeated healthcare contacts for musculoskeletal pain in general.

Abstract Background Although physical activity (PA) is associated with significant health benefits, only a small percentage of adolescents meet recommended PA levels. This systematic review with meta-analysis explored the modifiable determinants of adolescents’ device-based PA and/or sedentary behaviour (SB), evaluated in previous interventions and examined the associations between PA/SB and these determinants in settings. Methods A search was conducted on five electronic databases, including papers published from January 2010 to July 2023. Randomized Controlled Trials (RCTs) or Controlled Trials (CTs) measuring adolescents’ device-based PA/SB and their modifiable determinants at least at two time points: pre- and post-intervention were considered eligible. PA/SB and determinants were the main outcomes. Modifiable determinants were classified after data extraction adopting the social-ecological perspective. Robust Bayesian meta-analyses (RoBMA) were performed per each study setting. Outcomes identified in only one study were presented narratively. The risk of bias for each study and the certainty of the evidence for each meta-analysis were evaluated. The publication bias was also checked. PROSPERO ID: CRD42021282874. Results Fourteen RCTs (eight in school, three in school and family, and one in the family setting) and one CT (in the school setting) were included. Fifty-four modifiable determinants were identified and were combined into 33 broader determinants (21 individual–psychological, four individual–behavioural, seven interpersonal, and one institutional). RoBMAs revealed none or negligible pooled intervention effects on PA/SB or determinants in all settings. The certainty of the evidence of the impact of interventions on outcomes ranged from very low to low. Narratively, intervention effects in favour of the experimental group were detected in school setting for the determinants: knowledge of the environment for practicing PA, d = 1.84, 95%CI (1.48, 2.20), behaviour change techniques, d = 0.90, 95%CI (0.09, 1.70), choice provided, d = 0.70, 95%CI (0.36, 1.03), but no corresponding effects on PA or SB were found. Conclusions Weak to minimal evidence regarding the associations between the identified modifiable determinants and adolescents’ device-based PA/SB in settings were found, probably due to intervention ineffectiveness. Well-designed and well-implemented multicomponent interventions should further explore the variety of modifiable determinants of adolescents’ PA/SB, including policy and environmental variables.

Abstract Background Sleep plays a crucial role in the health and well-being of adolescents; however, inadequate sleep is frequently reported in numerous countries. This current paper aimed to describe sleep duration, factors impacting sleep, consequences of insufficient sleep and satisfaction with life in Norwegian adolescents, stratified by sex and by adherence to the 8-hour sleep recommendation, and to examine potential associations between adherence to the 8-hours sleep recommendation and satisfaction with life. Methods This is a cross-sectional study using data from the Norwegian Ungdata Survey, collected in 2021. Adolescents from five Norwegian counties were included, comprising a total of 32,161 upper secondary school students. Study variables were collected through an electronic questionnaire administered during school hours and all data are anonymous. Descriptive data of sleep patterns are presented, and linear regressions were conducted adjusting for SES, perceived stress, physical activity level, over-the-counter analgesics use, grade level and screen time. Results 73% of adolescents did not adhere to the 8-hours of sleep recommendation per night, with similar results for girls and boys. 64% reported tiredness at school (minimum 1–2 days weekly) and 62% reported that screen time negatively affected their ability to sleep. 23% reported that gaming affected their sleep, with a higher prevalence in boys than girls. Satisfaction with life score was 7.0 ± 1.9 points (out of 10) for the total sample, with higher scores for boys (7.3 ± 1.8 points) than girls (6.9 ± 1.9 points). Regressions revealed a positive association with satisfaction with life (B = 0.31, 95% [0.15 to 0.48]) in adolescents adhering to sleep recommendation of 8h compared to the ones not adhering to the sleep recommendation. Conclusions Most Norwegian adolescents fail to adhere to the 8-hours of sleep recommendation and the majority feel tired at school or during activities. More than half of adolescents reported that screen time negatively affected their ability to sleep. Adhering to the sleep recommendation was associated with higher life satisfaction. Our findings highlight the importance of sufficient sleep in adolescents, while future research is needed to examine other sleep related measures on adolescents´ satisfaction with life.

Abstract Background Perceived stress from schoolwork and perceived teacher care are shown to influence adolescents’ life satisfaction. However, there is a need to further explore how levels of perceived school stress affect life satisfaction of Norwegian adolescents across gender and school levels using nationwide data, and whether this association is moderated by perceived teacher care. Hence, this paper sought to: (1) describe perceived school stress, perceived teacher care and satisfaction with life in Norwegian adolescents stratified by gender and school level, (2) examine the association between perceived school stress and satisfaction with life by testing perceived teacher care as a possible moderator and (3) explore the association between perceived teacher care and adolescents’ satisfaction with life. Methods We utilized cross-sectional data from the Norwegian Ungdata Survey from 2021, encompassing adolescents from lower and upper secondary school. Two-thirds of all Norwegian adolescents participated in the Ungdata Survey from 2021. All data is anonymous. The study variables are presented according to lower and upper secondary school as well as gender. Linear regressions were conducted and adjusted for socioeconomic status (SES) by using SPSS. Results In total, 139,841 adolescents were included. Girls exhibited higher perceived school stress, lower perceived teacher care, and lower life satisfaction than boys in both lower and secondary school (all p < 0.01). Strong inverse associations on satisfaction with life were found in both genders in lower and upper secondary school among those who reported very frequent perceived school stress, with perceived teacher care moderating the relationship (B= -0.67; 95% CI [-0.70 to -0.65], P < 0.01]). Moreover, robust associations were unveiled between high and low levels of perceived teacher care and life satisfaction across gender and school level. Conclusions Higher perceived school stress was strongly inversely associated with life satisfaction in Norwegian adolescents, in both girls and boys, and in both lower and secondary school. Teacher care was identified as a moderator and seems to play a crucial part in the everyday life of Norwegian adolescents. These implications extend to teacher education, practice, and policy, which should be aware of the pivotal role of perceived teacher care on Norwegian school-based adolescents‘ life satisfaction.

Previous physical activity interventions for children (5-12yrs) have aimed to change determinants associated with self-report physical activity behaviour (PAB) and/or sedentary behaviour (SB), however, the associations between these determinants and PAB/SB in different settings are uncertain. The present study aimed to identify modifiable determinants targeted in previous PAB/SB interventions for children. Intervention effects on the determinants and their associations with self-report PAB/SB were assessed across settings. Search of relevant interventions from pre-defined databases was conducted up to July 2023. Randomized and non-randomized controlled trials with modifiable determinants were included. Data extraction and risk of bias assessments were conducted by two independent researchers. Where data could be pooled, we performed Robust Bayesian meta-analyses. Heterogeneity, publication bias and certainty of evidence were assessed. Fifteen studies were deemed eligible to be included. Thirty-seven unique determinants within four settings were identified-school, family, school with family/home, and community with(out) other settings. Ninety-eight percent of determinants belonged to individual/interpersonal determinant categories. Narratively, intervention effects on student perception of teachers' behaviour (school), self-management, perceived barriers, external motivation, exercise intention, parental modeling on SB (school with family/home) and MVPA expectations (community) were weak to strong, however, corresponding PAB/SB change was not evident. There were negligible effects for all other determinants and the corresponding PAB/SB. Meta-analyses on self-efficacy, attitude, subjective norm and parental practice and PAB/SB in two settings showed weak to strong evidence against intervention effect, while the effect on knowledge could not be determined. Similarly, publication bias and heterogeneity for most analyses could not be ascertained. We found no concrete evidence of association between the modifiable determinants and self-report PAB/SB in any settings. This is presumably due to intervention ineffectiveness. Design of future interventions should consider to follow the systems-based approach and identify determinants unique to the context of a setting, including policy and environmental determinants.

BackgroundThis study investigated the prevalence of pain, depressive symptoms, and their co-occurrence in Norwegian adolescents. Additionally, we investigated if perceived achievement pressure and coping with pressure were associated with pain, depressive symptoms and co-occurrent pain and depressive symptoms.MethodsCross-sectional data from the Norwegian Ungdata Survey (2017-2019) were analysed. Adolescents from across Norway completed an electronic questionnaire including questions on perceived achievement pressure, coping with pressure, pain, and depressive symptoms. Descriptive statistics presented prevalence rates, and multinominal regression reported in relative risk ratios (RR) was employed to estimate associations, adjusted for gender (boys/girls), school level, and socioeconomic status.ResultsThe analyses included 209,826 adolescents. The prevalence of pain was 33%, 3% for depressive symptoms, and 14% reported co-occurring pain and depressive symptoms. The prevalence of co-occurring symptoms was higher in girls (22%) than boys (6%). Significant associations were found between perceived achievement pressure and pain (RR 1.11, 95% CI 1.10-1.11), depressive symptoms (RR 1.27, 95% CI 1.27-1.28), and co-occurring symptoms (RR 1.34, 95% CI 1.33-1.34). Struggling to cope with pressure was associated with pain (RR 2.67 95% CI 2.53-2.81), depressive symptoms (RR 16.68, 95% CI 15.60-17.83), and co-occurring symptoms (RR 27.95, 95% CI 26.64-29.33).ConclusionThe prevalence of co-occurring pain and depressive symptoms is high among Norwegian adolescents. Perceived achievement pressure and struggling to cope with pressure were associated with isolated and, more strongly, co-occurring pain and depressive symptoms. Enhancing adolescents' ability to cope with pressure could be a crucial target in treating pain and depressive symptoms.

To combat the high prevalence of physical inactivity among children, there is an urgent need to develop and implement real-world interventions and policies that promote physical activity (PA) and reduce sedentary behaviour (SB). To inform policy makers, the current body of evidence for children’s PA/SB interventions needs to be translated. The current systematic review and meta-analysis aimed to identify modifiable determinants of device-measured PA and SB targeted in available intervention studies with randomized controlled trial (RCT) and controlled trial (CT) designs in children and early adolescents (5–12 years) and to quantify the effects of the interventions within their respective settings on the determinants of PA/SB and the outcomes PA and SB. A systematic search was conducted in MEDLINE, PsycINFO, Web of Science, SPORTDiscus and CENTRAL. Studies were considered if they were randomized controlled trials (RCTs) or controlled trials (CTs), included children and/or early adolescents (5–12 years; henceforth termed children), measured PA and/or SB using device-based methods and measured PA and/or SB and determinants of PA/SB at least at two timepoints. Risk of bias was assessed using the Cochrane Risk of Bias Tool for Randomised Trials (RoB2) for RCTs and Risk of Bias in Non-randomised Studies of Interventions (ROBINS-I) for CTs. The quality of the generated evidence was assessed using Grading of Recommendations Assessment, Development and Evaluation (GRADE). Robust Bayesian meta-analysis was conducted to quantify the effects of the interventions on the determinants of PA/SB, and the outcomes PA and SB, stratifying by study design, duration of PA/SB measurement, intervention setting and duration of follow-up measurement. Study characteristics and interventions were summarized. Thirty-eight studies were included with a total sample size of n = 14,258 (67

Objectives Health literacy (HL) related to musculoskeletal disorders (MSDs) in adolescents is a field with limited previous evidence. This study aimed to review and synthesise studies on MSDs and HL as well as various dimensions of HL in adolescents. Design Scoping review in accordance with Arksey and O’Malleys framework and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. Search strategy The search strategy was performed in the following databases in November 2021 (initial search) and December 2022 (updated search); Medline, EMBASE, PsychINFO, Cochrane, CINAHL, ERIC, Web of Science and Google Scholar. Eligible studies involving MSDs and HL or either of the HL dimensions related to finding, understanding, appraising or applying health information in adolescents were considered. Any dimension of HL studied, the outcome measure(s) used to assess HL and the type of MSD examined were charted, reviewed and synthesised. A directed content analysis was used for the subjective interpretation of text data. Results A total of 16 841 studies were identified and 33 were eligible for inclusion. Ten articles presented HL with a definition or description in the theoretical background. The remaining 23 studies involved finding, understanding, appraising or applying health information, without using the term ‘health literacy’. Most of the studies addressed how adolescents understand (n=32), and apply (n=23) health information, while few studies focused on how they find (n=11) and appraise (n=7) musculoskeletal health information. Conclusion Few studies have addressed HL and MSDs in adolescents explicitly, while most studies have considered dimensions of HL. Our findings suggest that there is important work to be done to align conceptual understandings with the measurement of HL in adolescents and that further research should be carried out to explore how HL is distributed among adolescents with MSDs and how adolescents living with MSDs report their HL.

Introduction Physical activity among children and adolescents remains insufficient, despite the substantial efforts made by researchers and policymakers. Identifying and furthering our understanding of potential modifiable determinants of physical activity behaviour (PAB) and sedentary behaviour (SB) is crucial for the development of interventions that promote a shift from SB to PAB. The current protocol details the process through which a series of systematic literature reviews and meta-analyses (MAs) will be conducted to produce a best-evidence statement (BESt) and inform policymakers. The overall aim is to identify modifiable determinants that are associated with changes in PAB and SB in children and adolescents (aged 5–19 years) and to quantify their effect on, or association with, PAB/SB. Methods and analysis A search will be performed in MEDLINE, SportDiscus, Web of Science, PsychINFO and Cochrane Central Register of Controlled Trials. Randomised controlled trials (RCTs) and controlled trials (CTs) that investigate the effect of interventions on PAB/SB and longitudinal studies that investigate the associations between modifiable determinants and PAB/SB at multiple time points will be sought. Risk of bias assessments will be performed using adapted versions of Cochrane’s RoB V.2.0 and ROBINS-I tools for RCTs and CTs, respectively, and an adapted version of the National Institute of Health’s tool for longitudinal studies. Data will be synthesised narratively and, where possible, MAs will be performed using frequentist and Bayesian statistics. Modifiable determinants will be discussed considering the settings in which they were investigated and the PAB/SB measurement methods used. Ethics and dissemination No ethical approval is needed as no primary data will be collected. The findings will be disseminated in peer-reviewed publications and academic conferences where possible. The BESt will also be shared with policy makers within the DE-PASS consortium in the first instance. Systematic review registration CRD42021282874.

There is limited knowledge on the association between lifestyle behaviour in adolescence and musculoskeletal pain in young adulthood. This study aimed to investigate whether an accumulation of adverse lifestyle behaviours in adolescents with and without musculoskeletal pain at baseline, was associated with persistent musculoskeletal pain (pain duration ≥3 consecutive months the last year) 11 years later. Longitudinal data from the Trøndelag Health Study in Norway including 1824 adolescents (13–19 years old) was analysed. The outcome was persistent musculoskeletal pain (≥3 months). The number of adverse lifestyle behaviours (low physical activity level, sleep problems, insufficient fruit/vegetables consumption, smoking, frequent alcohol intoxication [drunkenness] and/or illicit drug use) were summed up to comprise an ordinal variable and analysed with 0 or 1 adverse behaviours as the reference. Multiple logistic regression analyses, stratified by individuals with and without baseline musculoskeletal pain, were conducted. The results were expressed as odds ratios (ORs) with 95% confidence intervals (CIs). In adolescents with musculoskeletal pain at baseline, reporting ≥ four adverse lifestyle behaviours increased the odds of persistent musculoskeletal pain (OR 2.23, 95% CI 1.36, 3.66) 11 years later. Two and three adverse behaviours were not associated with future persistent musculoskeletal pain. In adolescents without musculoskeletal pain at baseline, an accumulation of adverse lifestyle behaviours was not associated with future persistent musculoskeletal pain. An accumulation of adverse lifestyle behaviours in adolescents with musculoskeletal pain at baseline was associated with persistent musculoskeletal pain 11 years later, but not in adolescents without musculoskeletal pain at baseline. An accumulation of four or more adverse lifestyle behaviours in adolescents with musculoskeletal pain was associated with persistent musculoskeletal pain in young adulthood. In future health care of adolescents with musculoskeletal pain, lifestyle behaviours should be assessed, with emphasis on accumulation of multiple adverse lifestyle behaviours. Focusing on an accumulation of multiple adverse lifestyle behaviours, rather than each individual behaviour, might provide a potential area for future research and interventions targeting musculoskeletal pain in youth.

Background Musculoskeletal pain has a high prevalence in adolescence and causes huge consequences for the individuals and the society. Little knowledge exists on social risk factors for musculoskeletal pain in adolescents. This study aimed to investigate if low social acceptance among peers during the first year of upper secondary school was associated with persistent and severe persistent musculoskeletal pain 2 years later and if psychological distress modified this association. Methods Longitudinal data from the Norwegian Fit Futures Study was used. Students in the first year of upper secondary school answered an electronic questionnaire, covering health status, pain, social acceptance among peers, and psychological distress. Persistent musculoskeletal pain was measured 2 years later. Multiple logistic regression analyses and moderation analyses were conducted adjusting for sex and chronic diseases. Main analyses were conducted on participants without persistent musculoskeletal pain at baseline, and secondary analyses were conducted on all participants with and without persistent musculoskeletal pain at baseline. Results Of 775 participants (52% females), 556 (71.7%) were pain-free at baseline and included in the main analyses. Significant associations between low social acceptance among peers and persistent musculoskeletal pain 2 years later were found in crude (Odds ratio (OR) = 1.8, 95%CI [1.0–3.1]) and adjusted analyses (OR = 1.8, 95%CI [1.0–3.2]). No statistically significant effect modification of psychological distress ( p = 0.89) on this association was found. A significant association between low social acceptance and persistent musculoskeletal pain was found in adjusted secondary analyses of all the students ( n = 692) (OR = 1.6, 95%CI [1.0–2.3]). Conclusions Our results indicate that low social acceptance among peers increases the risk of future persistent musculoskeletal pain in adolescents. Thus, interventions strengthening adolescent’s social arenas may be helpful to prevent persistent musculoskeletal pain. Trial registration Retrospective registered at clinicaltrials.org NCT04526522 .

Overt malformations do not always accompany behavioral changes resulting from perinatal exposure to certain drugs. However, the central nervous system (CNS) is the anatomical substrate for behavior, and functional defects may be accompanied by more subtle, structural alterations of the brain. The purpose of this study was to determine if changes in the weights of certain brain regions occur in rats exposed prenatally and/or perinatally to propylthiouracil (PTU) which retards functional development of the brain. Pregnant rats were dosed with PTU during gestation and/or lactation, and on postnatal day 28, auditory startle responses were measured to determine if PTU altered functional development. The brains of all pups were then dissected into 10 separate regions, dried and individually weighed. Brain weights were expressed in absolute and relative (to total brain weight) terms. Pups that were exposed to PTU from days 10 to 21 of gestation grew normally, but their startle responses to auditory stimuli were significantly different (p less than 0.05) from controls. Thus, for the purpose of this experiment, PTU acted as a developmental neurotoxicant because it altered performance on a test of neuromuscular function without being overtly teratogenic. The weights of most brain regions in PTU-treated rats were statistically comparable to controls. However, relative cerebellar weight was significantly (p less than 0.05) different. Therefore, these data suggested that relative cerebellar weight might be used to predict functional defects that appear during development following prenatal or perinatal exposure to certain neurotoxicants. Although cerebellar weight and auditory startle responses were altered by PTU, this study does not establish a causal relationship between the anatomical and functional changes that occurred.(ABSTRACT TRUNCATED AT 250 WORDS)

There is limited knowledge on the association between different health complaints and the development of persistent musculoskeletal pain in adolescents. The aims of this study were to assess whether specific health complaints, and an accumulation of health complaints, in the first year of upper-secondary school, were associated with persistent musculoskeletal pain 2 years later. We used data from a population-based cohort study (the Fit Futures Study in Norway), including 551 adolescents without persistent musculoskeletal pain at baseline. The outcome was persistent musculoskeletal pain (≥3 months) 2 years after inclusion. The following self-reported health complaints were investigated as individual exposures at baseline: asthma, allergic rhinitis, atopic eczema, headache, abdominal pain and psychological distress. We also investigated the association between the accumulated number of self-reported health complaints and persistent musculoskeletal pain 2 years later. Logistic regression analyses estimated adjusted odds ratios (ORs) with 95% confidence intervals (CIs). At the 2-year follow-up, 13.8% (95% CI [11.2–16.9]) reported persistent musculoskeletal pain. Baseline abdominal pain was associated with persistent musculoskeletal pain 2 years later (OR 2.33, 95% CI [1.29–4.19], p = 0.01). Our analyses showed no statistically significant associations between asthma, allergic rhinitis, atopic eczema, headache or psychological distress and persistent musculoskeletal pain at the 2-year follow-up. For the accumulated number of health complaints, a higher odds of persistent musculoskeletal pain at the 2-year follow-up was observed for each additional health complaint at baseline (OR 1.33, 95% CI [1.07–1.66], p = 0.01). Health care providers might need to take preventive actions in adolescents with abdominal pain and in adolescents with an accumulation of health complaints to prevent development of persistent musculoskeletal pain. The potential multimorbidity perspective of adolescent musculoskeletal pain is an important topic for future research to understand the underlying patterns of persistent pain conditions in adolescents.

BACKGROUND:No previous studies have investigated the prevalence of co-occurring neck/shoulder pain, other musculoskeletal pain, headache and depressive symptoms in adolescents. This study aimed to describe the prevalence of isolated neck/shoulder pain and the co-occurrence of neck/shoulder pain with other musculoskeletal pain, headache and depressive symptoms in Norwegian adolescents.METHODS:This is a cross-sectional study using data from the Norwegian Ungdata survey (2017-2019). Adolescents from almost all municipalities in Norway answered a comprehensive questionnaire, including physical complaints. We investigated the prevalence of self-reported neck/shoulder pain in isolation and neck/shoulder pain in combination with other musculoskeletal pain, headache and depressive symptoms. The results were presented with per cent and stratified by school level and sex.RESULTS:In total, 253,968 adolescents (50% girls) participated in the study, of which 56.5% were from lower secondary school. The total prevalence of neck/shoulder pain was 24%, but only 5% reported isolated neck/shoulder pain. Among students reporting neck/shoulder pain, half of them also reported other musculoskeletal pain, and 50% of the boys and 70% of the girls reported co-occurring headache. Depressive symptoms were reported in 28% of the boys and 45% of the girls with neck/shoulder pain.CONCLUSION:Neck/shoulder pain in adolescents is seldom isolated, but seems to co-occur with headache, other musculoskeletal pain and depressive symptoms. Researchers and clinicians should keep a broader health perspective in mind when approaching adolescents with neck/shoulder pain.SIGNIFICANCE:One in five adolescents reported neck/shoulder pain in this large population-based study of Norwegian adolescents. A majority of adolescents reported neck/shoulder pain in co-occurrence with other musculoskeletal pain, headache and depression. Researchers and clinicians should assess these comorbidities when assessing adolescents with neck/shoulder pain.

The objective was to investigate risk factors and risk profiles associated with neck pain in young adults using longitudinal data from the North-Trøndelag Health Study (HUNT). Risk factors were collected from adolescents (13–19 years of age), and neck pain was measured 11 years later. The sample was divided into two: Sample I included all participants (n = 1433), and Sample II (n = 832) included only participants who reported no neck/shoulder pain in adolescence. In multiple regression analyses in Sample I, female sex (OR = 1.9, 95% CI [1.3–2.9]), low physical activity level (OR = 1.6, 95% CI [1.0–2.5]), loneliness (OR = 2.0, 95% CI [1.2–3.5]), headache/migraine (OR = 1.7, 95% CI [1.2–2.6]), back pain (OR = 1.5, 95% CI [1.0–2.4]) and neck/shoulder pain (OR = 2.0, 95% [CI 1.3–3.0]) were associated with neck pain at the 11-year follow-up. Those with a risk profile including all these risk factors had the highest probability of neck pain of 67% in girls and 50% in boys. In Sample II, multiple regression analyses revealed that female sex (OR = 2.2, 95% CI [1.3–3.7]) and perceived low family income (OR = 2.4, 95% CI [1.1–5.1]) were associated with neck pain at the 11-year follow-up. Girls and boys with a perceived low family income had a 29% and 17% higher probability of neck pain than adolescents with a perceived high family income. The risk profiles in both samples showed that co-occurrence of risk factors, such as headache/migraine, neck/shoulder pain, back pain, low physical activity level, loneliness, and perceived low family income cumulatively increased the probability of neck pain in young adulthood. These results underline the importance of taking a broad perspective when studying, treating, and preventing neck pain in adolescents.