- Email: [email protected]
Sense of Community, Unfairness, and Psychosomatic Symptoms: A Multilevel Analysis of Italian Schools
Journal of Adolescent Health 53 (2013) 142e145
www.jahonline.org Adolescent health brief
Sense of Community, Unfairness, and Psychosomatic Symptoms: A Multilevel Analysis of Italian Schools Alessio Vieno, Ph.D. a, *, Michela Lenzi, Ph.D. a, Massimo Santinello, M.S. a, and Luca Scacchi, M.S. b a b
University of Padova, Padova, Italy University of Aosta, Aosta, Italy
Article history: Received June 19, 2012; Accepted February 20, 2013 Keywords: School context; Connectedness; Social justice; Adolescence; Health
A B S T R A C T
Purpose: This study examines the role of school sense of community and school unfairness in predicting psychosomatic symptoms among Italian early adolescents. The study used hierarchical linear modeling to examine the relations between individual and school characteristics, and students’ psychosomatic symptoms. Methods: Data were analyzed using a two-level model based on 22,552 students (49.8% boys; M age ¼ 15.70, SD ¼ .69) nested within 1,111 schools. A questionnaire devised by the Health Behavior in School-aged Children (HBSC) international group was used. Results: Sense of community and procedural unfairness in the school at the individual level showed a significant association with students’ psychosomatic symptoms. School characteristics predicted between-school variation in psychosomatic symptoms, in that procedural unfairness at the school level increased the risk for psychosomatic symptoms and a sense of community in the school protected students. Conclusions: The present study suggests that the quality-of-school context may have a key role in predicting students’ psychosomatic symptoms. Ó 2013 Society for Adolescent Health and Medicine. All rights reserved.
Although schools are a primary social context for adolescents, much of what we know in the etiology of health problems is connected to the role of school structure, organization, and practices (e.g., school socioeconomic status (SES) or prevention programs) [1,2]. One aspect of the school context that is potentially important for rates of health symptoms is the extent to which the school is a functional community (i.e., an environment characterized by caring and supportive interpersonal relationships, opportunities to participate, shared norms, goals, and values). By adopting a multilevel perspective, the aim of this
IMPLICATIONS AND CONTRIBUTION
Our findings show that adolescents’ psychosomatic symptoms also vary as a function of school climate. This validates the emphasis of current prevention efforts on working with teachers and peers to change the school and classroom environments, for example, through changes in their classroom management techniques or communicative styles.
study is to identify the characteristics of school settings that predict students’ psychosomatic symptoms. Specifically, we test whether students’ sense of community (as a protective factor) and perception of schools’ procedural unfairness (as a risk factor), measured at both the individual and the school level may predict adolescents’ psychosomatic symptoms.
Methods Setting and sampling
Approval to conduct the survey and related research was obtained from the ethics review board of the Faculty of Psychology, University of Padova. The international HBSC protocol was approved by the World Health Organization Europe. * Address correspondence to: Alessio Vieno, Ph.D., University of Padova, via Belzoni, 80, 35121 Padova, Italy. E-mail address: [email protected] (A. Vieno).
This study was conducted with a sample of Italian secondary school students drawn from a research project that is part of the “Health Behavior in School-aged Children” 2009/2010 (HBSC; for details see http://www.hbsc.org) [3].
1054-139X/$ e see front matter Ó 2013 Society for Adolescent Health and Medicine. All rights reserved. http://dx.doi.org/10.1016/j.jadohealth.2013.02.019
A. Vieno et al. / Journal of Adolescent Health 53 (2013) 142e145
143
Table 1 Descriptive univariate information and correlations among variables at both individual and school levels on the 2010 Italy data sample used for the analytical multilevel models
Individual level 1 Psychosomatic symptoms 2 Gender (male) 3 Age 4 FASa 5 School sense of community 6 School procedural unfairness 7 School demand 8 Bullying victimization School level 1 Mean FASa 2 Mean school sense of community 3 Mean procedural unfairness * ** a
1
2
e .30** .05** .06** .21** .16** .30** .09**
e .05** .06** .02* .02** .11** .07**
e .03 .07**
e .50**
3
e .09** .07** .08** .08** .02**
4
e .06** .01 .04** .05**
5
6
e .37** .15** .14**
e .14** .03**
7
N
Mean (SD) or %
e .05**
22,615 22,652 22,652 22,264 22,566 22,372 22,483 22,451
2.37 (.79) 49.8% 15.70 (.69) 2.38 (.68) 3.72 (.69) 2.37 (1.06) 2.60 (.90) 1.12 (.52)
1,111 1,111 1,111
2.35 (.27) 3.72 (.27) 2.64 (.40)
Range 1e5 0e1 14e19.92 1e3 1e5 1e5 1e4 1e5 1.55e3 1.27e4.10 1.60e4.19
p < .050. p < .001. FAS ¼ Family Affluence Scale.
Participants Within each region of the country, samples were stratified to represent the distribution of students in grade 10 and to be representative of the school student population. Of the schools selected for the study, 95.29% agreed to participate. The students’ response rate was 87.4%. The questionnaire was completed by a total of 22,552 students from 1,111 secondary schools. The average age was 15.70 (SD ¼ .69) years (N ¼ 11,281; 49.8% boys).
Psychosomatic symptoms ¼ g00 þ g10 ðgenderÞ þ g20 ðageÞ þ g30 ðFAS*Þ þ g40 ðSchool sense of community*Þ þ g50 ðschool procedural unfairness*Þ þ g60 ðschool demandÞ þ g70 ðbullying victimizationÞ þ g01 ðMEAN FASÞ þ g02 ðMEAN school sense of communityÞ þ g03 ðMEAN school procedural unfairnessÞ þ u0 þ r
Measures Data were collected through a self-report questionnaire devised by the HBSC international group. Psychosomatic symptoms. Psychosomatic symptoms are a nonclinical measure of mental health composed of an eight-item scale (part of the HBSC Symptom Checklist; e.g. headache, nervousness) [4]. Cronbach’s alpha for the eight-item scale was .79. Sense of community in the school. Students’ sense of community in the school was assessed by a six-item scale [5]. The Cronbach’s alpha for the six-item overall scale was .72. School unfairness. School unfairness was based on the students’ perceptions concerning whether the rules in the school are fair, and was assessed by a single item [6]. Control variables. School demands, bullying victimization, and demographics (sex, age, and Family Affluence Scale [FAS]) were introduced as control variables. Data at the school level were obtained by aggregating FAS and both indication of school sense of community and procedural unfairness, as reported by student respondents. Statistical analysis We examined the predictors of psychosomatic symptoms discriminating between the independent variables lying at the individual and at the school level by means of the multilevel regression technique of hierarchical linear modeling (HLM) [7]. The final model was as follows:
*group-mean centered. These variables were group-mean centered, because we are in a case of compositional effect (occurs when the aggregate of a person-level characteristic is related to the outcome even after controlling for the effect of the individual characteristic; see Raudenbush & Bryk [7]). When group-mean centering is chosen, the relationship between X and Y is directly decomposed into its within- and between-group components.
Results Descriptive statistics Descriptive statistics for the variables on each level and bivariate correlations among variables are shown in Table 1. In our sample, 6.5% of the variation in psychosomatic symptoms was at the school level, c2 (1,110) ¼ 2,672.52, p < .001, with a random level-1 coefficient reliability of .561. The HLM model for individuals’ psychosomatic symptoms at the school level is shown in Table 2. The variables we included in the model explained 19.6% of the variation of our dependent variable at the individual level. Consistent with our hypothesis, participants’ perceptions of being not adequately included in the school (low school-sense of community) and treated in an unfair manner were positively related to participants’ psychosomatic symptoms. Moreover, consistent with our hypothesis, being in a school with a high sense of community and where the rules were fairer decreased the level of psychosomatic symptoms. These variables explained nearly half (47.5%) of our dependent variable’s variability across schools.
144
A. Vieno et al. / Journal of Adolescent Health 53 (2013) 142e145
Table 2 Multilevel correlates of “Psychosomatic Symptoms” Unconditional model
Intercept g00 Individual level Gender (male) Age FASa,b School sense of communityb School procedural unfairnessb School demand Bullying victimization School level Mean FASa Mean school sense of community Mean procedural unfairness Variance components T
s2y Chi sq % variance explained within school % variance explained between school a b
Final model
b (s.e.)
t ratio
p
b (s.e.)
2.37 (.01)
295.28
<.001
1.48 (.13)
<.001
(.01) (.01) (.01) (.01) (.01) (.01) (.01)
43.98 7.76 2.31 19.64 14.63 35.63 10.67
<.001 <.001 .021 <.001 <.001 <.001 <.001
.07 (.03) .17 (.03) .05 (.02)
2.37 5.35 2.58
.018 <.001 .010
.021 .472 2,083.11 19.6% 47.5%
<.001
p
11.61
.48 .06 .02 .17 .08 .22 .13
.040 .587 2,672.52
t ratio
<.001
FAS ¼ Family Affluence Scale. Group mean-centered.
Discussion The principal aim of the study was to identify some characteristics of the school setting that predict students’ psychosomatic symptoms. By adopting a multilevel approach, our results demonstrated that students’ sense of community (as a protective factor) and perception of schools’ procedural unfairness (as a risk factor), measured at both the individualand the school-level are connected to adolescents’ psychosomatic symptoms. Previous research on school-related support and stress has emphasized the importance of an individual appraisal process. These results build on the idea that school environments that are perceived as a community can increase the sense of success, competence, and control, which in turn lead to better wellbeing [1,2]; moreover, this research is based on a transactional model of stress [8]. Confirming previous findings [6], lower levels of perceived sense of community in the school and higher perceived procedural unfairness are associated with higher levels of psychosomatic symptoms. While confirming the importance of individual-level differences, the present study demonstrates that psychosomatic symptoms varied as a function of school-membership. This effect was to a discrete extent accounted for by the school-level sense of community (as a protective factor) and school-level procedural unfairness (as a risk factor). These findings confirm that when controlling for individual factors there still remains a main effect of shared context [9]. Limitations and strengths The cross-sectional design of the study did not allow us to determine clearly the direction of the relationships among the study variables; longitudinal designs might help determine the direction of these relationships in future research projects. Moreover, in considering the results we have to take into account the possibility that other important school
characteristics can be connected to students’ sense of community, such as prevention programs aimed at improving school climate and social cohesion [5]. The strengths of the study include the use of a large and representative Italian sample, as well as a design that nests students within schools, which allows us to use multilevel analysis to gauge the simultaneous and separate influences of individual and school factors on psychosomatic symptoms. Implications Notwithstanding the limitations presented, these findings add new insight to the emerging evidence of a link between a school’s sense of community and perceived school unfairness, on one hand, and adolescent health, on the other, thus advancing the evidence of school climate as a correlate and predictor of adolescent psychosomatic symptoms. These results confirm how a school’s ecological and social environment dynamically and reciprocally interacts with adolescents to satisfy their innate need for autonomy, competence, and relatedness, as well as to meet their evolving developmental needs and improve developmental health outcomes [10]. Acknowledgments Data are from the administration of the World Health Organization’s “Health Behavior of School-Aged Children” survey in Italy. The international coordinator for the 2009/2010 study was Candace Currie, Edinburgh University. The data bank manager was Bente Wold, Bergen University. In Italy, in 2009/2010, the study has been carried out with the coordination of the University of Torino, Padova e Siena, the National Institute of Health and the Ministry of Health, under the leadership of Professor Franco Cavallo (Principal Investigator for Italy). It is part of the project “Sistema di indagini sui rischi comportamentali in età 6-17 anni” promoted and financed by the Ministry of Health (capitolo 4393/ 2005-CCM).
A. Vieno et al. / Journal of Adolescent Health 53 (2013) 142e145
The survey in Italy has been conducted in collaboration with the HBSC-Italy Group 2010 (Gruppo HBSC-Italia 2010): Franco Cavallo (Principal Investigator), Patrizia Lemma, Paola Dalmasso, Paola Berchialla, Sabina Colombini, Alessio Zambon, Lorena Charrier, Alberto Borraccino (Università di Torino); Mariano Giacchi, Giacomo Lazzeri, Valentina Pilato, Stefania Rossi, Andrea Pammolli (Università of Siena); Massimo Santinello, Alessio Vieno, Francesca Chieco, Michela Lenzi (Università di Padova); Angela Spinelli, Giovanni Baglio, Anna Lamberti, Paola Nardone (Istituto Superiore di Sanità); Daniela Galeone, Lorenzo Spizzichino, Maria Teresa Menzano, Maria Teresa Scotti (Ministero della Salute); and Maria Teresa Silani e Silvana Teti (Coordinamento Nazionale Uffici Scolastici Regionali). References [1] Bond L, Butler H, Thomas L, et al. Social and school connectedness in early secondary school as predictors of late teenage substance use, mental health, and academic outcomes. J Adolesc Health 2007;40:357.e9e357.e18.
145
[2] Saab H, Klinger DA. School differences in adolescent health and wellbeing: Findings from the Canadian Health Behaviour in School-aged Children study. Soc Sci Med 2010;70:850e8. [3] Currie C, Nic Gabhainn S, Godeau E, and the International HBSC Network Coordinating Committee. The Health Behaviour in School-aged Children: WHO Collaborative Cross-National (HBSC) Study: Origins, concept, history and development 1982e2008. Int J Public Health 2009;54:131e9. [4] Haugland S, Wold B. Subjective health complaints in adolescence. Reliability and validity of survey methods. J Adolesc 2001;24:611e24. [5] Vieno A, Perkins DD, Smith TM, Santinello M. Democratic school climate and sense of community in school: A multilevel analysis. Am J Community Psychol 2005;36:327e41. [6] Santinello M, Vieno A, De Vogli R. Primary headache in Italian early adolescents: The role of perceived teacher unfairness. Headache 2009;49:366e74. [7] Raudenbush SW, Bryk AS. Hierarchical linear models. 2nd ed. London: Sage; 2002. [8] Lazarus RS, Folkman S. Stress, appraisal, and coping. New York: Springer; 1984. [9] Torsheim T, Wold B. School-related stress, school support, and somatic complaints: A general population study. J Adolescent Res 2001;16: 293e303. [10] Waters SK, Cross DS, Runions K. Social and ecological structures supporting adolescent connectedness to school: A theoretical model. J Sch Health 2009;79:516e24.
www.jahonline.org Adolescent health brief
Sense of Community, Unfairness, and Psychosomatic Symptoms: A Multilevel Analysis of Italian Schools Alessio Vieno, Ph.D. a, *, Michela Lenzi, Ph.D. a, Massimo Santinello, M.S. a, and Luca Scacchi, M.S. b a b
University of Padova, Padova, Italy University of Aosta, Aosta, Italy
Article history: Received June 19, 2012; Accepted February 20, 2013 Keywords: School context; Connectedness; Social justice; Adolescence; Health
A B S T R A C T
Purpose: This study examines the role of school sense of community and school unfairness in predicting psychosomatic symptoms among Italian early adolescents. The study used hierarchical linear modeling to examine the relations between individual and school characteristics, and students’ psychosomatic symptoms. Methods: Data were analyzed using a two-level model based on 22,552 students (49.8% boys; M age ¼ 15.70, SD ¼ .69) nested within 1,111 schools. A questionnaire devised by the Health Behavior in School-aged Children (HBSC) international group was used. Results: Sense of community and procedural unfairness in the school at the individual level showed a significant association with students’ psychosomatic symptoms. School characteristics predicted between-school variation in psychosomatic symptoms, in that procedural unfairness at the school level increased the risk for psychosomatic symptoms and a sense of community in the school protected students. Conclusions: The present study suggests that the quality-of-school context may have a key role in predicting students’ psychosomatic symptoms. Ó 2013 Society for Adolescent Health and Medicine. All rights reserved.
Although schools are a primary social context for adolescents, much of what we know in the etiology of health problems is connected to the role of school structure, organization, and practices (e.g., school socioeconomic status (SES) or prevention programs) [1,2]. One aspect of the school context that is potentially important for rates of health symptoms is the extent to which the school is a functional community (i.e., an environment characterized by caring and supportive interpersonal relationships, opportunities to participate, shared norms, goals, and values). By adopting a multilevel perspective, the aim of this
IMPLICATIONS AND CONTRIBUTION
Our findings show that adolescents’ psychosomatic symptoms also vary as a function of school climate. This validates the emphasis of current prevention efforts on working with teachers and peers to change the school and classroom environments, for example, through changes in their classroom management techniques or communicative styles.
study is to identify the characteristics of school settings that predict students’ psychosomatic symptoms. Specifically, we test whether students’ sense of community (as a protective factor) and perception of schools’ procedural unfairness (as a risk factor), measured at both the individual and the school level may predict adolescents’ psychosomatic symptoms.
Methods Setting and sampling
Approval to conduct the survey and related research was obtained from the ethics review board of the Faculty of Psychology, University of Padova. The international HBSC protocol was approved by the World Health Organization Europe. * Address correspondence to: Alessio Vieno, Ph.D., University of Padova, via Belzoni, 80, 35121 Padova, Italy. E-mail address: [email protected] (A. Vieno).
This study was conducted with a sample of Italian secondary school students drawn from a research project that is part of the “Health Behavior in School-aged Children” 2009/2010 (HBSC; for details see http://www.hbsc.org) [3].
1054-139X/$ e see front matter Ó 2013 Society for Adolescent Health and Medicine. All rights reserved. http://dx.doi.org/10.1016/j.jadohealth.2013.02.019
A. Vieno et al. / Journal of Adolescent Health 53 (2013) 142e145
143
Table 1 Descriptive univariate information and correlations among variables at both individual and school levels on the 2010 Italy data sample used for the analytical multilevel models
Individual level 1 Psychosomatic symptoms 2 Gender (male) 3 Age 4 FASa 5 School sense of community 6 School procedural unfairness 7 School demand 8 Bullying victimization School level 1 Mean FASa 2 Mean school sense of community 3 Mean procedural unfairness * ** a
1
2
e .30** .05** .06** .21** .16** .30** .09**
e .05** .06** .02* .02** .11** .07**
e .03 .07**
e .50**
3
e .09** .07** .08** .08** .02**
4
e .06** .01 .04** .05**
5
6
e .37** .15** .14**
e .14** .03**
7
N
Mean (SD) or %
e .05**
22,615 22,652 22,652 22,264 22,566 22,372 22,483 22,451
2.37 (.79) 49.8% 15.70 (.69) 2.38 (.68) 3.72 (.69) 2.37 (1.06) 2.60 (.90) 1.12 (.52)
1,111 1,111 1,111
2.35 (.27) 3.72 (.27) 2.64 (.40)
Range 1e5 0e1 14e19.92 1e3 1e5 1e5 1e4 1e5 1.55e3 1.27e4.10 1.60e4.19
p < .050. p < .001. FAS ¼ Family Affluence Scale.
Participants Within each region of the country, samples were stratified to represent the distribution of students in grade 10 and to be representative of the school student population. Of the schools selected for the study, 95.29% agreed to participate. The students’ response rate was 87.4%. The questionnaire was completed by a total of 22,552 students from 1,111 secondary schools. The average age was 15.70 (SD ¼ .69) years (N ¼ 11,281; 49.8% boys).
Psychosomatic symptoms ¼ g00 þ g10 ðgenderÞ þ g20 ðageÞ þ g30 ðFAS*Þ þ g40 ðSchool sense of community*Þ þ g50 ðschool procedural unfairness*Þ þ g60 ðschool demandÞ þ g70 ðbullying victimizationÞ þ g01 ðMEAN FASÞ þ g02 ðMEAN school sense of communityÞ þ g03 ðMEAN school procedural unfairnessÞ þ u0 þ r
Measures Data were collected through a self-report questionnaire devised by the HBSC international group. Psychosomatic symptoms. Psychosomatic symptoms are a nonclinical measure of mental health composed of an eight-item scale (part of the HBSC Symptom Checklist; e.g. headache, nervousness) [4]. Cronbach’s alpha for the eight-item scale was .79. Sense of community in the school. Students’ sense of community in the school was assessed by a six-item scale [5]. The Cronbach’s alpha for the six-item overall scale was .72. School unfairness. School unfairness was based on the students’ perceptions concerning whether the rules in the school are fair, and was assessed by a single item [6]. Control variables. School demands, bullying victimization, and demographics (sex, age, and Family Affluence Scale [FAS]) were introduced as control variables. Data at the school level were obtained by aggregating FAS and both indication of school sense of community and procedural unfairness, as reported by student respondents. Statistical analysis We examined the predictors of psychosomatic symptoms discriminating between the independent variables lying at the individual and at the school level by means of the multilevel regression technique of hierarchical linear modeling (HLM) [7]. The final model was as follows:
*group-mean centered. These variables were group-mean centered, because we are in a case of compositional effect (occurs when the aggregate of a person-level characteristic is related to the outcome even after controlling for the effect of the individual characteristic; see Raudenbush & Bryk [7]). When group-mean centering is chosen, the relationship between X and Y is directly decomposed into its within- and between-group components.
Results Descriptive statistics Descriptive statistics for the variables on each level and bivariate correlations among variables are shown in Table 1. In our sample, 6.5% of the variation in psychosomatic symptoms was at the school level, c2 (1,110) ¼ 2,672.52, p < .001, with a random level-1 coefficient reliability of .561. The HLM model for individuals’ psychosomatic symptoms at the school level is shown in Table 2. The variables we included in the model explained 19.6% of the variation of our dependent variable at the individual level. Consistent with our hypothesis, participants’ perceptions of being not adequately included in the school (low school-sense of community) and treated in an unfair manner were positively related to participants’ psychosomatic symptoms. Moreover, consistent with our hypothesis, being in a school with a high sense of community and where the rules were fairer decreased the level of psychosomatic symptoms. These variables explained nearly half (47.5%) of our dependent variable’s variability across schools.
144
A. Vieno et al. / Journal of Adolescent Health 53 (2013) 142e145
Table 2 Multilevel correlates of “Psychosomatic Symptoms” Unconditional model
Intercept g00 Individual level Gender (male) Age FASa,b School sense of communityb School procedural unfairnessb School demand Bullying victimization School level Mean FASa Mean school sense of community Mean procedural unfairness Variance components T
s2y Chi sq % variance explained within school % variance explained between school a b
Final model
b (s.e.)
t ratio
p
b (s.e.)
2.37 (.01)
295.28
<.001
1.48 (.13)
<.001
(.01) (.01) (.01) (.01) (.01) (.01) (.01)
43.98 7.76 2.31 19.64 14.63 35.63 10.67
<.001 <.001 .021 <.001 <.001 <.001 <.001
.07 (.03) .17 (.03) .05 (.02)
2.37 5.35 2.58
.018 <.001 .010
.021 .472 2,083.11 19.6% 47.5%
<.001
p
11.61
.48 .06 .02 .17 .08 .22 .13
.040 .587 2,672.52
t ratio
<.001
FAS ¼ Family Affluence Scale. Group mean-centered.
Discussion The principal aim of the study was to identify some characteristics of the school setting that predict students’ psychosomatic symptoms. By adopting a multilevel approach, our results demonstrated that students’ sense of community (as a protective factor) and perception of schools’ procedural unfairness (as a risk factor), measured at both the individualand the school-level are connected to adolescents’ psychosomatic symptoms. Previous research on school-related support and stress has emphasized the importance of an individual appraisal process. These results build on the idea that school environments that are perceived as a community can increase the sense of success, competence, and control, which in turn lead to better wellbeing [1,2]; moreover, this research is based on a transactional model of stress [8]. Confirming previous findings [6], lower levels of perceived sense of community in the school and higher perceived procedural unfairness are associated with higher levels of psychosomatic symptoms. While confirming the importance of individual-level differences, the present study demonstrates that psychosomatic symptoms varied as a function of school-membership. This effect was to a discrete extent accounted for by the school-level sense of community (as a protective factor) and school-level procedural unfairness (as a risk factor). These findings confirm that when controlling for individual factors there still remains a main effect of shared context [9]. Limitations and strengths The cross-sectional design of the study did not allow us to determine clearly the direction of the relationships among the study variables; longitudinal designs might help determine the direction of these relationships in future research projects. Moreover, in considering the results we have to take into account the possibility that other important school
characteristics can be connected to students’ sense of community, such as prevention programs aimed at improving school climate and social cohesion [5]. The strengths of the study include the use of a large and representative Italian sample, as well as a design that nests students within schools, which allows us to use multilevel analysis to gauge the simultaneous and separate influences of individual and school factors on psychosomatic symptoms. Implications Notwithstanding the limitations presented, these findings add new insight to the emerging evidence of a link between a school’s sense of community and perceived school unfairness, on one hand, and adolescent health, on the other, thus advancing the evidence of school climate as a correlate and predictor of adolescent psychosomatic symptoms. These results confirm how a school’s ecological and social environment dynamically and reciprocally interacts with adolescents to satisfy their innate need for autonomy, competence, and relatedness, as well as to meet their evolving developmental needs and improve developmental health outcomes [10]. Acknowledgments Data are from the administration of the World Health Organization’s “Health Behavior of School-Aged Children” survey in Italy. The international coordinator for the 2009/2010 study was Candace Currie, Edinburgh University. The data bank manager was Bente Wold, Bergen University. In Italy, in 2009/2010, the study has been carried out with the coordination of the University of Torino, Padova e Siena, the National Institute of Health and the Ministry of Health, under the leadership of Professor Franco Cavallo (Principal Investigator for Italy). It is part of the project “Sistema di indagini sui rischi comportamentali in età 6-17 anni” promoted and financed by the Ministry of Health (capitolo 4393/ 2005-CCM).
A. Vieno et al. / Journal of Adolescent Health 53 (2013) 142e145
The survey in Italy has been conducted in collaboration with the HBSC-Italy Group 2010 (Gruppo HBSC-Italia 2010): Franco Cavallo (Principal Investigator), Patrizia Lemma, Paola Dalmasso, Paola Berchialla, Sabina Colombini, Alessio Zambon, Lorena Charrier, Alberto Borraccino (Università di Torino); Mariano Giacchi, Giacomo Lazzeri, Valentina Pilato, Stefania Rossi, Andrea Pammolli (Università of Siena); Massimo Santinello, Alessio Vieno, Francesca Chieco, Michela Lenzi (Università di Padova); Angela Spinelli, Giovanni Baglio, Anna Lamberti, Paola Nardone (Istituto Superiore di Sanità); Daniela Galeone, Lorenzo Spizzichino, Maria Teresa Menzano, Maria Teresa Scotti (Ministero della Salute); and Maria Teresa Silani e Silvana Teti (Coordinamento Nazionale Uffici Scolastici Regionali). References [1] Bond L, Butler H, Thomas L, et al. Social and school connectedness in early secondary school as predictors of late teenage substance use, mental health, and academic outcomes. J Adolesc Health 2007;40:357.e9e357.e18.
145
[2] Saab H, Klinger DA. School differences in adolescent health and wellbeing: Findings from the Canadian Health Behaviour in School-aged Children study. Soc Sci Med 2010;70:850e8. [3] Currie C, Nic Gabhainn S, Godeau E, and the International HBSC Network Coordinating Committee. The Health Behaviour in School-aged Children: WHO Collaborative Cross-National (HBSC) Study: Origins, concept, history and development 1982e2008. Int J Public Health 2009;54:131e9. [4] Haugland S, Wold B. Subjective health complaints in adolescence. Reliability and validity of survey methods. J Adolesc 2001;24:611e24. [5] Vieno A, Perkins DD, Smith TM, Santinello M. Democratic school climate and sense of community in school: A multilevel analysis. Am J Community Psychol 2005;36:327e41. [6] Santinello M, Vieno A, De Vogli R. Primary headache in Italian early adolescents: The role of perceived teacher unfairness. Headache 2009;49:366e74. [7] Raudenbush SW, Bryk AS. Hierarchical linear models. 2nd ed. London: Sage; 2002. [8] Lazarus RS, Folkman S. Stress, appraisal, and coping. New York: Springer; 1984. [9] Torsheim T, Wold B. School-related stress, school support, and somatic complaints: A general population study. J Adolescent Res 2001;16: 293e303. [10] Waters SK, Cross DS, Runions K. Social and ecological structures supporting adolescent connectedness to school: A theoretical model. J Sch Health 2009;79:516e24.