Menarche is an important period in a female’s life; its time of onset may depend on various factors and could correlate with the development of diseases in adulthood. Our study aims to investigate the relationship between body mass index and age at onset of menarche; We used a unique standardized national dataset on adolescent girls participating in the Italian Health Behaviour in School-aged Children Study. Two independent nationally representative survey datasets: one on 15-year-olds (n = 6505, year 2017/2018) and one on 11-year-olds (n = 6548, year 2013/2014) were analysed. The survey instrument was the self-report questionnaire. Median age at menarche and 95

Background:Overweight has been associated with several social and phycological problems and is perceived as one of the major health care challenges to focus on in the future. The purpose of the study is to investigate the correlations among nutritional status, assessed by the Body Mass Index, the perception of one's own health status and Life Satisfaction, detected in Italian adolescents living in Tuscany Region, and to investigate the influence of gender on them.Methods:A statistically representative sample of 2760 Tuscan adolescents aged 11, 13 and 15 was involved in the 2018 Health Behaviours at School-aged Children survey. The participants were divided into three nutritional status class: underweight, normal weight and overweight (overweight + obese).Results:The results show that there is a statistically significant difference in all categories between boys and girls aged 13 and 15 years; in girls aged 11 and 13 years, the Life Satisfaction of the overweight group is statistically lower than that of normal and underweight groups; Self-Rated Health is statistically lower in all age groups for overweight individuals compared to normal weight children, except for 11-year-old females.Conclusions:Viewing the psychosocial problems related to overweight, more attention and care must be placed on adolescents to ensure their healthier development.

Background/Objectives: Adolescence is an important period of psychophysical development. In this phase of life people acquire greater self-awareness and adopt behaviors that will later shape their lifestyle in adulthood. This study aimed to assess whether family structure can influence adolescents’ eating habits. Methods: Data were acquired from a survey titled ‘Italian Health Behaviour in School-aged Children’ (HBSC) given to a representative sample of Tuscan adolescents aged 11, 13, 15 and 17 years of age. Participants (3210) filled out a validated questionnaire answering questions about their eating habits and family structure. After adjusting for covariates, some interesting trends were highlighted in the survey results. Results: Adolescents living in single-mother families reported a lower intake of fruits (OR 0.68, 95% CI = 0.55–0.83) and vegetables (OR 0.66, 95% CI = 0.53–0.81) and a higher intake of sugar-added soft drinks (OR 1.33, 95% CI = 1.08–1.64). Living in a mother and stepfather family was associated with a higher intake of sugar-added soft drinks (OR 1.53, 95% CI = 1.02–2.28), whereas living in a father and stepmother family was associated only with a lower intake of fruits (OR 0.48, 95% CI = 0.26–0.87). Participants living with other family types reported a lower intake of vegetables (OR 0.68, 95% CI = 0.47–0.98). Conclusions: The results of this study show a correlation between family structure and adolescents’ eating habits.

Adolescence is a critical moment in life; people become individuals, create new relationships, develop social skills and learn behaviours that they will use for the rest of their lives. During this phase, adolescents establish patterns of behaviour that can protect their health. This study aims to 1. assess the presence of psychological disorders in adolescents of both genders, 2. determine their relation to socio-economic differences based on the Family Affluence Scale (FAS), and 3. assess trends from 2006 to 2018. Data were collected from the Italian Health Behaviour in School-aged Children survey given to a representative sample of Tuscan adolescents aged 11–15 years. Participants (n. 12,550) filled out questionnaires to assess whether psychological symptoms such as feeling low, irritability, nervousness, or sleeping difficulties manifested weekly or more often over the past six months. For the study we utilized a cross-sectional survey method and linear regression to examine the association between psychological symptoms (dependent variable measured on an interval scale (0–16)), gender and FAS. We conducted similar analyses using logistic regressions for each of the four symptoms. An increase in psychological symptoms in both genders was revealed between 2006 and 2018, with a statistically significant presence in females: 0.29 (95% Confidence Interval [CI], 0.17 to 0.41), 1.43 (95% CI, 1.37 to 1.48) and 1.43 (95% CI, 1.34 to 1.52) in low-, medium- and high-affluence families, respectively; whereas males presented 0.14 (95% CI, 0.01 to 0.27), 0.71 (95% CI, 0.65 to 0.77) and 0.31 (95% CI, 0.22 to 0.39), respectively. The probability of a predictive episode of psychological symptoms (feeling low, irritability, nervousness, sleeping difficulties) occurring weekly, or more, often was greatly increased in females of all socioeconomic classes. These findings suggest that the increase in psychological disorders in adolescents should be considered a public health problem and further investigated through longitudinal studies and continuous monitoring of health trends.

Background: The prevention of overweight is a high-priority public health task. The perception that parents have of their children's nutritional status is a well recognized risk factor for obesity in children, so the aim of our study was to evaluate mothers' perceptions of their children's nutritional status. Methods: We conducted, in 2016, a cross-sectional study enrolling1710 children (third grade of all primary schools) in Tuscany, as well as their mothers. Mothers' information were collected through a self-administered questionnaire, while children (weighed and measured) filled a questionnaire under the supervision of qualified personnel. Results: 1449 children completed the questionnaire. 74.12% of mothers were able to correctly identify children BMI. The non correct classification tends to significantly decrease in presence of a high educational level compared to low educational level. Mothers' BMI seems to not be associated with misclassification. The non correct classification was significantly associated with mothers' opinion about their children's eating habit. Conclusion: Our data confirmed that, in Tuscany, a limited percentage of mothers tend to misclassify the nutritional state of their children, but in order to maintain these encouraging results, further efforts should be done in order to make all mothers able to correctly evaluate their children. Statements: Authors declare no conflict of interest. The study was conducted according to the criteria set by the declaration of Helsinki and each subject signed an informed consent before participating to the study. Approval of the protocol was obtained from the institutional review board of the National Institute of Health, including the use of opt-out consent; that is, parents could refuse participation but the lack of a returned form was taken to imply consent to their child's participation

BACKGROUND:The prevalence of adolescent pain varies considerably across epidemiological studies, and little information is available on pain-related behaviours among adolescents, including medicine use. The aims of this study were: [1] to examine the prevalence of recurrent pain among 15-year-old adolescents in Italy; [2] to investigate the association between recurrent pain and medicine use among boys and girls; and [3] to evaluate the consistency of these associations across Regions.METHODS:The World Health Organization (WHO) collaborative International Health Behaviour in School-aged Children 2013/2014 study collected self-reported data on pain and medicine use from 13611 15-year-old adolescents in 21 Italian Regions. We used multi-level multivariate logistic regression, stratified by gender, to analyse the association between recurrent pain and medicine use for headache, stomachache, nervousness and difficulties in getting to sleep.RESULTS:On average, across all Regions, almost 45% of adolescents reported recurrent headache, more than 30% reported recurrent backache and approximately 30% reported recurrent stomachache. Although the prevalence of both pain and medicine use was much higher among girls, the association between pain and medicine use was similarly strong in adolescents of both genders. Adolescents with recurrent pain proved more likely to use medicines also for non-corresponding pain, nervousness and difficulties in getting to sleep. The association between recurrent pain and medicine use was consistent across Regions despite large inter-regional differences in the prevalence of both phenomena.CONCLUSIONS:Recurrent pain in adolescence is common nationwide. Adolescents with recurrent pain are more likely to use medicines in general. Recurrent pain and medicine use should be addressed by adolescent health policies.

BACKGROUND:The prevalence of overweight and obesity among children is rapidly increasing in many countries. For this reason we decided to investigate the eating habits of 8-9 years old Tuscany children, by paying attention to the frequency of their meals per day and to their food choices, also in relation to children's Body Mass Index (BMI) classes. In addition, we considered some environmental factors that could affect children eating behaviors, such as parents' BMI.METHODS:Data from the 2014 Tuscany nutritional surveillance system (part of the national periodical survey) and collected from children, parents and teachers, have been linked to study of children's eating habits. Logistic regression analyses were used to investigate the association between incorrect dietary habits and the potential predictors of overweight and obesity.RESULTS:More than half of the 2,163 children (68.64% overall, 67.61% females, 69.56% males) reported to have eaten an appropriate breakfast in the morning, while 5.9% skipped breakfast and only 33.5% of children ate an appropriate mid-morning snack. Logistic regression showed that having breakfast and especially an adequate breakfast are protective factors against obesity (OR 0.57, p<0.01; OR 0.84; p=0.03 respectively).CONCLUSION:In Tuscany Region, unhealthy dietary habits are common among children. The identified deficiencies may be a harbinger of future public health problems.

OBJECTIVES to examine the prevalence and time trends in childhood overweight (including obesity) and obesity among children dwelling in Tuscany Region (Central Italy) in the period 2002-2016. DESIGN cross-sectional study at seven points (Tuscan Nutritional Surveillance System conducted in the years 2002, 2006, 2008, 2010, 2012, 2014, and 2016); height and weight of the subjects are directly measured by trained staff; body mass index was assessed by means of the International Obesity Task Force and of the World Health Organization cut-offs. SETTING AND PARTICIPANTS representative sample of children dwelling in Tuscany Region (No. 10,155) aged between 8 and 9 years (5,258 boys and 4,897 girls). RESULTS regarding the estimation of the absolute prevalence level of childhood overweight, a discrepancy was observed between the two criteria. In all surveys, more boys than girls were overweight (or obese). Trend analysis showed a significant decrease in the prevalence of overweight (including obesity) and obesity in Tuscan children in the period 2002-2016 (32.0% vs. 28.1%; p <0.001) and of 10.0% vs. 5.9% (p <0.001) for obesity. CONCLUSIONS the present study is the first report from an Italian region showing a significant decrease in childhood obesity and overweight in the last 14 years. This reduction is probably a result of regional and local actions that were performed in many areas of society. However, efforts should be made to further reduce prevalence of childhood obesity and overweight.

BACKGROUNDThe aim of this research is to update the trend in overweight (including obesity) prevalence among Italian adolescents, evaluating possible differences by age and gender, and analyzing their relationships with socioeconomic status, between 2002 and 2014.METHODSThe present study is based on data from the Italian HBSC study at four time points (2002, 2006, 2010 and 2014), which involved 15 035 adolescents, aged 11-13-15 (7540 boys and 7495 girls).RESULTSGender and age were associated with the occurrence of overweight. In all surveys, boys had a higher prevalence of excess weight compared to girls (p < 0.001), but only among girls there was a significant increasing trend (from 11.2% in 2002 to 13.3% in 2014). From 2002 to 2014, the risk of being overweight was inversely associated with the economic level of the family, for both genders and all age groups.CONCLUSIONSData collected between 2002 and 2014 in Italy showed a low overall increase in prevalence of obesity and overweight and an inverse association between SES and obesity in all age groups and in both genders. These findings suggest that concerted, multi-sectorial, efforts are needed in Italy, in combination with a sound political will, focused on reducing social inequality associate.

Background A huge amount of literature suggests that adolescents' health-related behaviors tend to occur in clusters, and the understanding of such behavioral clustering may have direct implications for the effective tailoring of health-promotion interventions. Despite the usefulness of analyzing clustering, Italian data on this topic are scant. This study aimed to evaluate the clustering patterns of health-related behaviors. Methods The present study is based on data from the Health Behaviors in School-aged Children (HBSC) study conducted in Tuscany in 2010, which involved 3291 11-, 13-and 15-year olds. To aggregate students' data on 22 health-related behaviors, factor analysis and subsequent cluster analysis were performed. Results Factor analysis revealed eight factors, which were dubbed in accordance with their main traits: 'Alcohol drinking', 'Smoking', 'Physical activity', 'Screen time', 'Signs & symptoms', 'Healthy eating', 'Violence' and 'Sweet tooth'. These factors explained 67% of variance and underwent cluster analysis. A six-cluster.-means solution was established with a 93.8% level of classification validity. The between-cluster differences in both mean age and gender distribution were highly statistically significant. Conclusions Health-compromising behaviors are common among Tuscan teens and occur in distinct clusters. These results may be used by schools, health-promotion authorities and other stakeholders to design and implement tailored preventive interventions in Tuscany.

Abstract Objective The aim of the present study was to examine the prevalence and time trends in childhood overweight including obesity and obesity among Tuscan children from 2002 to 2012. Design Cross-sectional study at five time points (Tuscan Nutritional Surveillance Surveys conducted in the years of 2002, 2006, 2008, 2010 and 2012). Trained personnel directly measured the height and weight of the subjects. BMI was assessed by means of the International Obesity Task Force (IOTF) and WHO cut-offs. Setting Representative sample of children in the Tuscany region (Italy). Subjects Children (n 7183) aged between 7·5 and 9·5 years (3711 boys and 3472 girls). Results With respect to the estimation of the absolute prevalence level of childhood overweight, a discrepancy was observed between the two criteria. In all surveys, more boys than girls were overweight (including obesity). Trend analysis showed a significant decrease in the prevalence of overweight including obesity and obesity in Tuscan children from 2002 to 2012 (32·0 % v. 25·8 %, P<0·001 on using IOTF criteria and 37·7 % v. 34·3 %, P<0·001 on using WHO criteria for overweight including obesity; and 10·0 % v. 6·7 %, P<0·001 on using IOTF criteria and 12·5 % v. 11·3 %, P=0·035 on using WHO criteria for obesity). Conclusions The present study is the first report from an Italian region showing a significant decrease in childhood obesity and overweight in the last 10 years. This reduction is probably a result of regional and local actions that have taken place in many sectors of society. However, efforts should be made to lower the prevalence of childhood obesity and overweight further.

Background We aimed to determine the extent to which three core variables (school environment, peer group and family affluence) were associated with unhealthy behaviours and health outcomes among Tuscan adolescents. The unhealthy behaviours considered were smoking, alcohol consumption, sedentary lifestyle and irregular breakfast consumption; health outcomes were classified as self-reported health, multiple health complaints and life satisfaction. School environment was measured in terms of liking school, school pressure, academic achievement and classmate support; peer groups were evaluated in terms of the number of peers and frequency of peer contact. Family affluence was measured on a socioeconomic scale. Methods Data were taken from the Tuscan 2009/10 survey of "Health Behaviour in School-aged Children", a WHO cross-national survey. A binary logistic multiple regression (95% confidence intervals) was implemented. Results The total sample comprised 3291 school students: 1135 11-year-olds, 1255 13-year-olds and 901 15-year-olds. Peer group and school environment were associated with unhealthy behaviours such as smoking, alcohol consumption and sedentary lifestyle. Family affluence proved to have less impact on unhealthy behaviours, except in the case of adolescents living in low-income families. Poor health outcomes were directly related to a negative school environment. Regarding the influence of family affluence, the results showed higher odds of life dissatisfaction and poor self-reported health status in medium-income families, while low-income families had higher odds only with regard to life dissatisfaction. A consistent pattern of gender differences was found in terms of both unhealthy behaviours and health outcomes. Conclusions Unhealthy behaviours are strongly related to the school environment and peer group. A negative school environment proved to have the strongest relation with poor health outcomes.

Background This study aims to examine the influence of family affluence, school environment and peer group on unhealthy behaviours (irregular breakfast consumption, alcohol consumption, smoking, and sedentary lifestyle) and health outcomes (self-reported health, multiple health complaints and life satisfaction) within adolescent in an italian region. Methods The data from Health Behaviour in School-aged Children 2009/10 (HBSC), a WHO cross-National Survey, were used on a regional basis. The 3291 …

Background: The …e vai con la frutta (let’s go with fruit) project was designed to respond to the worrying low consumption of fruits and vegetable in the large portion of population, especially in youth. The main objective was to increase fruit and vegetable consumptions at school level. Methods: In 2010/11, we randomly selected subjects from middle and high schools in five Italian regions. The subjects were randomly divided into two groups: intervention (I) and control (C). A questionnaire on fruits and vegetables consumption was administered, at the baseline as well as at end of the period. The sample size was evaluated on the expected frequency of 0.5 for a binomial random variable, of ± 1.54% with IC of 95%. Results: These results confirmed that adolescent students at baseline survey eat less than the amount of fruits and vegetables consumption recommended by the International guidelines. After the intervention time, we observed an increment in fruits and vegetables consumptions both in middle and high school students. Regarding the impact of the intervention on the factors like knowledge, attitudes and behaviour, there was a positive change in the behaviour only in the intervention group, in coherence with the consumption variations examined. Conclusions: This study is the first time that fruits and vegetables were offered at such a large scale through vending machines at schools in five regions. Several vending companies under this project agreed to revise the list of healthy snacks offered to eliminate those clearly classified as junk foods.

Background There are very few studies on the frequency of breakfast and snack consumption and its relation to fruit and vegetable intake. This study aims to fill that gap by exploring the relation between irregular breakfast habits and snack consumption and fruit and vegetable intake in Tuscan adolescents. Separate analyses were conducted with an emphasis on the potentially modifying factors of sex and age. Methods Data was obtained from the 2010 Tuscan sample of the Health Behaviour in School-aged Children (HBSC) study. The HBSC study is a cross-sectional survey of 11-, 13- and 15-year-old students (n = 3291), selected from a random sample of schools. Multivariate logistic regression was used for analyzing the food-frequency questionnaire. Results A significant relation was found between low fruit and vegetable intake and irregular breakfast habits. Similarly, low fruit intake was associated with irregular snack consumption, whereas vegetable intake did not prove to be directly related to irregular snack consumption. Different patterns emerged when gender and age were considered as modifying factors in the analyses. A statistically significant relation emerged only among female students for irregular breakfast habits and fruit and vegetable intake. Generally, older female participants with irregular breakfast habits demonstrated a higher risk of low fruit and vegetable intake. Age pattern varied between genders, and between fruit and vegetable consumption. Conclusions Results suggest that for those adolescents who have an irregular consumption of breakfast and snacks, fruit intake occurs with a lower frequency. Lower vegetable consumption was associated with irregular breakfast consumption. Gender and age were shown to be moderators and this indicated the importance of analyzing fruit and vegetable intake and meal types separately. This study also confirmed that health-promotion campaigns that aim to promote regular meal consumption and consumption of fruits and vegetables need to take into account gender and age differences in designing promotional strategies. Future research should identify evidence-based interventions to facilitate the achievement of the Italian guidelines for a healthy diet for fruit, vegetables and meals intake.

INTRODUCTION The latest increase in childhood obesity focused attention on the important consequences that this phenomenon may have on public health in relationship to the increasing risk that an obese child may become an obese adult. To deal with this problem, there is necessary to assess systematically the distribution of childhood nutritional status at different levels: international, regional and local. In this paper are presented data on underweight, overweight and obesity prevalence in third grade primary school children, aged 8/9 years in Tuscany (2008) and its distribution in relationship to the demographic breadth of their place of residence. METHODS Data from statistic sample of 2109 (1.091 males, 1.018 females), 8/9 years school-children were collected; weight and height were measured using standardised personnel and instruments. Exact month age was calculated between the data of measurement and that of birth. Body Mass Index (BMI) classes were calculated using Cole et al.'s epidemiologic cut-off for children and adolescents. Residence areas were divided into four classes based on the number of inhabitants (< 10.000; 10.000-50.000; > 50.000; > 50.000 metropolitan). RESULTS The prevalence of underweight was 0.88% (0.76% in males and 1.01% in females), the prevalence of overweight was 23.43% (22.33% in males and 24.65% in females), the prevalence of obese was 7.95% (9.08% in males, 6.70% in females). The lowest prevalence of obese (6.46%) was found in towns with over 50.000 residents (metropolitan). CONCLUSION The obesity prevalence in Tuscany children is still lower than that of the Italian National Survey, while the overweight prevalence it's the same. Obesity prevalence (10.71%) is higher in municipalities with low residents number (< 10.000).