Perceived health in Swedish school students : a longitudinal prevalence study

This thesis, with a national sample of Swedish school students, is part of a collaborate project between Karolinska Institutet, The Swedish School of Sport and Health Sciences and Stockholm Institute of Education carried out in 2001 and with a follow-up study in 2004.

The overall aim of the collaboration was to investigate the conditions and circumstances surrounding school children's physical activities, their physical capacity, and general health status, with special attention paid to changes over time and with increase in age. The main aim of this thesis was to study students' perceived health, pain and reported injuries sustained during physical activity, with a focus on gender and age/grade differences (Study I and II). The aim of the third study was to examine changes in perceived health with increasing age within the same individual as well as over time at grade level e.g. comparing the cohort of same school-grade with a three-year interval. In addition, the aim was to investigate if factors, such as gender, age (grade level), stress, and level of physical activity were related to perceived health (Study III). The aim of the fourth study was to compare agreement of answers, given by the students with those given by their parents, to questions addressing students' medical background, injuries and perceived health.

An independent random selection of Swedish schools (n=48) enrolling grades 3, 6 and 9 was performed. In 2001, a total of 1,908 students participated in Studies I and II. The subjects in Study III were those school-students (n=1,276) who participated in the base study (2001) and who subsequently answered a mailed-out questionnaire in 2004. The subjects in Study IV were recruited from eleven different schools and were a sub-sample of schools that participated in the base study. The students attended grade 6 during the base study and were at the time of the investigation attending grade 8. Their parents were, at the same time, contacted and 186 corresponding student-same parent answers were collected.

A special health and injury questionnaire was constructed for the purpose of the studies. Every sixth student (n=299 or 16 %) reported m injury during the recall period (Study I). The most common type of injury was a sprain, sustained through a fall or a twisting movement. The lower extremity was the most frequently injured body site. There was a gender difference in injuries reported during physical education class, an age difference during organized sports but no age or gender differences during leisure activities. Every other student (50 %) reported that they previously had injured the same body part.

Fifty percent of the students reported that they had experienced pain, either as headache, abdominal pain or musculoskeletal pain, within the recall period (Study II). Gender differences were especially noticeable for headaches. Cooccurrence among the variables was moderate. For the total of the seven variables, the perception of pain and health complaints decreased with age for boys from grade 3 to 9, while multiple complaints increased for girls.

Results from the follow-up study (2004) showed for girls a continuing increase of frequent complaints over the three year period (Study III). In contrast, boys reported a decrease with the exception of tiredness, which increased with age for both genders. More girls (12 %) than boys (4 %) reported frequent pain at both measurement periods. When comparing change in assessment at grade level most variables were rated the same as three years earlier. Prevalence as well as change in prevalence of frequent complaints of pain and perceived health were related to gender and increasing age.

Stress as an explanatory factor for pain and health complaints was especially significant for girls and the risk of complaints, was most evident for students who were characterized as being physically inactive in 2001 and remained inactive three years later. Once a child is in good health, in absence of disease, pain and injury, his or her assessment matches up with their parent (Study IV). Children and parents also showed agreement in cases of severe injuries and daily complaints of knee pain. Less frequent headaches, back- and musculoskeletal pain and other complaints of minor injuries and tiredness, were all underreported and under-rated by their parents. This suggests that when assessing the perceived health and well-being of students, their own expressions should be the basis for the data collection and analysis rather than relying entirely on parental reports.

List of scientific papers

I. Sundblad G, Saartok T, Engstrom LM, Renstrom P (2005). Injuries during physical activity in school children. Scand J Med Sci Sports. 15(5): 313-23.
https://pubmed.ncbi.nlm.nih.gov/16181255

II. Sundblad GM, Saartok T, Engstrom LM (2006). Prevalence and co-occurrence of self-rated pain and perceived health in school-children: Age and gender differences. Eur J Pain. [Accepted]
https://pubmed.ncbi.nlm.nih.gov/16542860

III. Gunilla Brun Sundblad, Anna Jansson, Tönu Saartok, Per Renström, Lars-Magnus Engström (2006). Self-rated pain and perceived health in relation to stress and physical activity among school-students; A 3-year follow-up. [Submitted]

IV. Gunilla Brun Sundblad, Tönu Saartok, Lars-Magnus Engström (2006). A valid question and a reliable answer, A child-parent agreement study. [Submitted]