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LITHUANIAN UNIVERSITY OF HEALTH SCIENCES

ACADEMY OF MEDICINE

PREVENTIVE MEDICINE OF PUBLIC HEALTH DEPARTMENT

Miguel Martínez Alós

Relationship between familial determinants and health

behavior among Spanish adolescents

Final Master‘s Thesis

Supervisor: Prof. PhD Apolinaras Zaborskis

KAUNAS, 2018

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Table of Content

1. Summary 3

2. Conflict of interest 5

3. Bioethics permission 6

4. Abbreviation and terms 7

5. Introduction 8

6. Aims and objectives 10

7. Literature review 11

8. Subjects and methods 18

9. Results 22

10. Discussion 41

11. Conclusions 47

12. References 48

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1. Summary

Author: Miguel Martínez Alós

Title: Relationship between familial determinants and health behavior among Spanish adolescents Scientific supervisor: Apolinaras Zaborskis, PhD, professor

Background: The adolescence is a crucial period in wich a very important part of the development

both physical and psychological of the boys and girls occur. It has been studied that the family plays

a very important role on this process and in this thesis it is investigated more about how family

structure and communication affects it

Aim: To study the relationship between familial determinants and health behaviour among Spanish

adolescents

Objectives:

1) To identify familial determinants

2) To identify health behaviour patterns

3) To analyze the relatioship between familial determinants and health behaviour

4) To compare these associations between lithuanian and spanish adolescents

Methods: Study done among 126 Spanish students aged 15 on high schools at Alicante County

using a HBSC survey as a mode, the students that participated were volunteers and answered

anonymously. Data analyses was done using the SPSS program

Results: Good health perception was among the students with structured families 80.9% and in

unstructured 75%, about high life satisfaction was 84.3% in structured families and 75% in

unstructured, smoking prevalence among students without a structured family was 9.3% higher than

the ones with a structured one, if good communication with both parents only 17.7% smoked while

if bad communication with both parents 55%. About drunkness the results showed that if in a

structured family adolescents were drunk at least 2 times in a 46.4% of the cases and the ones in an

unstructures were 43.8%, about alcohol intake in structured families the most common answer was,

not regular intake with 56.4% and the not structured 68.8%, the regular option was 22.7% for

structured and 18.8% for unstructured, the never was 20.9% for structured and 12.5% for

unstructured. Suicidal thought among the adolescents in structured homes was 20% and in

unstructured 37.5%.

Conclusions: It has been proven that the family structure, having both parents together at home,

and the communication with the parents as well play a very important role in the development of

the adolescent, specially the communication with the father, as if there is not a proper care of the

student and support given by both parents the risks of unhealthy behavior increases considerably.

Keywords: Adolescents, Health, Life satisfaction, Smoking, Alcohol, Suicidal ideation, HBSC,

Spain

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Santrauka

Autorius: Miguel Martínez Alós

Pavadinimas: Šeimos ir gyvensenos veiksnių sąsajos tarp Ispanijos paauglių

Mokslinis vadovas: Apolinaras Zaborskis, Habil.dr., Profesorius

Aktualumas: Paauglystė – svarbus žmogaus augimo ir brendimo amžiaus tarpsnis. Šeimos

vaidmuo šiame vystymosi procese yra labai reikšmingas. Todėl šis tyrimas yra paskirtas šeimos

vaidmens paauglio savijautai ir gyvensenai gilesniam nagrinėjimui, atkreipiant dėmesį į šeimos

struktūrą ir paauglio bendravimo su tėvais formas.

Tikslas: Ištirti šeimos ir gyvensenos veiksnių sąsajas tarp Ispanijos paauglių.

Uždaviniai:

1) Išnagrinėti šeimos veiksnius: šeimos struktūrą ir paauglio bendravimo su tėvais formas;

2) Identifikuoti elgesio, susijusio su sveikata, formas;

3) Išnagrinėti šeimos ir elgesio veiksnių tarpusavio ryšį;

4) Palyginti šio ryšio stiprumą tarp Lietuvos ir Ispanijos paauglių.

Metodai: Tyrimo duomenys buvo surinkti Ispanijoje, Alikante apygardoje, apklausus 126

penkiolikmečius vidurinių mokyklų mokinius. Taikyta HBSC tyrimo metodologija, mokiniai

apklausoje dalyvavo laisvu noru ir atsakinėjo į anketą anonimiškai. Duomenys analizuoti taikant

SPSS programą.

Rezultatai: Savo sveikatą gerai vertino 80,9 proc. paauglių, gyvenančių pilnose šeimose, ir 75

proc. paauglių, gyvenančių nepilnose šeimose. Patenkinti gyvenimu buvo atitinkamai 84,3 proc.

ir 75 proc. paauglių. Palyginti su nepažeistos struktūros šeimomis, rūkančių paauglių dalis buvo

9,3 proc. didesnė šeimose, kuriose nebuvo abiejų tėvų (28,2 proc. ir 37 proc. atitinkamai). Tik

17,7 proc. paauglių rūkė, kai jie lengvai bendravo su abiem tėvais, ir 55 proc. rūkė, kai sunkiai

bendravo su abiem tėvais. Paauglių, kurie prisipažino buvę apsvaigę nuo alkoholio 2 ir daugiau

kartų per gyvenimą, pilnose šeimose buvo 46,4 proc., nepilnose - 43,8 proc. Dauguma paauglių

prisipažino nereguliariai vartojantys alkoholinius gėrimus: gyvenančių pilnose šeimose tokių

paauglių buvo 56,4 proc., gyvenančių nepilnose šeimose - 68,8 proc. Reguliariai vartojančių

alkoholį buvo atitinkamai 22,7 proc. ir 18,8 proc., ir visai nevartojančių, atitinkamai 20,9 proc. ir

12,5 proc. Suicidinių minčių kildavo 20 proc. paauglių, gyvenančių pilnose šeimose, ir 37,5

proc. paauglių, gyvenančių nepilnose šeimose.

Išvados: Tyrimas parodė, kad šeimos struktūra, kai gyvenama kartu su abiem tėvais, ir lengvas

bendravimas su tėvu ir motina yra svarbūs veiksniai, kad paauglys jaustųsi sveikesnis ir

laimingesnis, kad mažiau turėtų žalingų įpročių ir rizikingos elgsenos. Buvo pastebėtas svarbus

tėvo vaidmuo, o kai vaikas nesulaukia tėvų pagalbos, sunkiai bendrauja su abiem tėvais,

neigiamo elgesio rizika labai išauga.

Raktažodžiai: Paaugliai, Sveikata, Laimingumas, Rūkymas, Alkoholio vartojimas, Suicidiškas

elgesys, HBSC, Ispanija.

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2. Conflicts of interest

There is no conflict of interests.

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3. Bioethics permission

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4. Abreviatures list and Terms

Abreviatures

HBCS Health Behavior in School aged Children

WHO World Health Oganization

p Statistical significance

df Degree of freedom

OR Odds Ratio

SES Socio-economic status

Terms

Health Behavior in School aged Children � It is an international alliance of researchers that

collaborate on the cross-national survey of school students: The HBSC collects data every four

years on 11-, 13- and 15-year-old boys' and girls' health and well-being, social environments and

health behaviours. These years mark a period of increased autonomy that can influence how their

health and health-related behaviours develop

Family� Family in Spain is considered traditionally as the union of a man and a woman plus the

children they could have, however actually the society has changed and it led to a wider definition

that includes several types including the monoparental and the homosexual as marriage between

people of the same gender was approved in Spain, being the first country in the world that did it,

several years ago

Father � In this thesis the term father just defines to the father itself not other caregivers or tutor

Mother� It only refers to the mother of the adolescent itself not other caregiver or tutor

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5.Introduction

Health is defined as the complete physical, mental and social well-being and for

achieving it several factors intervene and one of the most important is the life style, it has been

proved since the firsts researches were started that there are factors that can influence our health and

so our behavior plays an important role on it. Life style interferes with health as having bad habits

leads to an increased risk of morbidities, through time several studies have showed that factors such

high alcohol intake, smoking, obesity, hyperlipidemia, hypertension and more have an enormous

impact in our health, the risk of getting ill and worse outcomes. In this study it is going to be

analyzed how the family interferes with the bad habits of the adolescents and check how different

family structures play a role in the life style.

The family role and the society have a very important influence in forming the

adolescent health behavior and have received much attention recently. This study is focused on how

family relation of the school aged children on different countries as Lithuania and Spain has

interfered with the adolescent bad habits and a life-style with risk factors for the health.

Adolescents of school age were surveyed in Spain during the summer of 2017, a total

of 126 sample participated (47 boys and 79 girls) using the Health Behavior in School aged

Children (HBSC). HBSC international questionnaires were completed in the classroom

anonymously for obtaining information about health perception, life satisfaction, alcohol consume,

smoking, suicidal thoughts and family characteristics.

Alcohol is one of the most important ill health determinants in the EU and on the

global scale (1.2). In Spain it is the most consumed drug among the adolescents (3) ʺHarmful

drinking among adolescents is a major concern in many countries. It reduces self-control and

increases risky behaviours, such as unsafe sex or dangerous driving. It is a primary cause of injuries

(including those due to road traffic accidents), violence (especially by a partner) and premature

deaths. It can also lead to health problems in later life and affect life expectancy.ʺ (4) As

documented in the literature, the adolescents are particularly vulnerable to damage in their

development and physical integrity when they consume drugs like alcohol and tobacco (5) . Also

statistics show that the proportions of children living in a traditional nuclear family (with their

biological father and mother) have been decreasing (6) children in biological two-parent families

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show more positive examples of healthy behaviour than adolescents in single-mother, cohabiting

stepfather or other type of non-intact families (7).

Most of the smokers start this habit when they are adolescents, globally aproximately

the 10 % of the 13-15 aged children use tobacco but in some areas this level is much higher and its

prevalence seems to be decreasing in high income countries (4), with this study we will evaluate the

use at Lithuania and Spain . As documented in the literature, the adolescents are particularly

vulnerable to damage in their development and physical integrity when they consume drugs like

alcohol and tobacco(5) and it has been reported too that adolescent tobacco use is predictive of

psychiatric and psychological health problems like depression, substance consumption, as well as

personality disorders (8), previous studies found that family structure (like intact vs. stepfamilies) is

significantly associated with smoking and could be seen as a serious risk factor (9) and a study of

35 countries showed socioeconomic inequalities in adolescent smoking behaviour: boys and girls

from poorer families were more likely to be smokers, and this association was mediated by an

unequal distribution of family factors such as family structure and relationships with parents (10).

One of the major causes of death among the adolescents is the suicide (4), suicide rate

of adolescents aged between 15 and 19 increased faster than for other age groups (11.12) In

Lithuania, from early 1990s, the frequency of suicide increased amongst adults and young people

aged 15-19 years (12). However, suicide attempts as acts of intending to end one’s life are observed

much more frequently than completed suicides (13) Also there are evidences showing that diurnal

and circadian changes might have an influence on completed suicides (14) specially when it is

reported that Lithuania has been among the countries with the highest suicide rate for more than 20

recent years (15). The Health Behaviour in School-aged Children (HBSC), a World Health

Organization (WHO) cross national study, considers the family as one of the significant domains of

adolescent life (16.17.18) helping to understand the behaviour of the adolescents in health terms

related.

Observing all this facts I had the idea of studying how this parameters were where I

grew up and compare them with the Lithuanian as I have done all my studies here and therefore

lived here for some years, this would give us a better perspective of this health problems and how

they are related to the familal determinants showing the importance of a good social well being

during the growth of the adolescent

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6.Aim and objectives of the thesis

Aim

To study the relationship between familial determinants and health behaviour among Spanish

adolescents

Objectives

1) To dientify familial determinants

2) To identify health behaviour patterns

3) To analyze the relatioship between familial determinants and health behaviour

4) To compare these associations between Lithuanian and Spanish adolescents

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7.Literature review

Adolescence

It is the period of the maturation that occurs between 10 and 19 years, it is before early

adulthood and after the childhood. It is a time to develop knowledge and skills, manage emotions,

relationships and any change during this phase will have a very strong impact in the adolescent

health not only now but also during adulthood. During this period there are both physical and

neurodevelopmental changes influenced by the hormones this last ones occur firstly in the limbic

system wich is responsible for pleasure seeking, emotional responses and sleep regulation, later

changes on the pre frontal cortex that regulates the decision making, impulse and future planning

(19). Also in this period there is a development into social skills, sexual maturation, economic

independence, manage emotions, obtaining an identity and learn to play a role in the adult life.

Influencing this huge development there is the consume of drugs such as smoking tobacco and

alcohol drinking, the relationship with friends and parents among other factors wich are a real big

risk for the adolescent to affect their life not only at the time being but in the future too, it makes the

role of the parents a very important factor making their sons and daughters prevent the risks and

help them with their maturation (20).

During the previous decades the socio economic and cultural view of the way of living

has changes drastically it has made that in several societies families that were historically very

structured and with good communication changed. It has been an increase in the mono-parental

homes divorced families that had children this added up to the fact that parents have less time the

supervision and relationship between the parents and adolescents worsened.(21, 22)

Alcohol

It is the most available and consumed drug in the world among adults but among the

adolescents too although they consume less and usually in binge drinking commonly on weekends.

In Spain a study conducted showed that the surveyed students between 15 and 18 years old 93.3%

of them had tried an alcoholic drink.48.5% took part in street binge-drinking and consumption was

predominantly during the weekend, and 45.5% had got drunk at least once. Most of the answered

that their first contact with alcohol was with the family and not in other environment (3), in England

the results were that almost 40% had drunk more than a sip and that the rates of consumption were

increasing while aging being up to 90% when aged 17 years and it also showed that alcohol

consumption was related with tobacco smoking, lower life quality, alcohol abuse disorder,

hyperactivity, conduct problems and accidents (23). There is other studies showing a correlation

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between the alcohol intake and the memory impairments and how can it affect the adolescents

neurologically as they are in an important part of their development(24), it also affects the sleep,

alcohol has been demonstrated as a individual factor that alters the sleeping patterns and cause

insomnia and that parents, teachers and therapist should consider the insomnia as a marker for

alcohol use independent to to other factors(25)

Adolescencents experience and discover new acitivities, alcohol drinking is a common

act among adults that during adolescence starts, it is used for fulfilling personal needs and social too

as it might help with intimate and intesify contacts it has been related with early sexual relationships

and early pregnancies as adolescents that initiate sexual activity early are less likely to use

contraceptives (26) , this together with the lack of knowledge can lead to an overuse that can

severely affect their health now but specially in the future (27). The family itself and the

communication between parents and adolescents play an important role on the behavior and well

being of their children. However studies have demonstrated that teenagers that live in foster homes

consume less alcohol than the ones living in a structured family during life 47.3% of the adolescents

living at fosters homes compared to 61.9% of the ones at structured families and actually

consuming 9.1% compared to 38.3%, although it showed different results on the smoking and illicit

drugs use (28).

Smoking

Tobacco is a leading global disease risk factor, leading cause of preventable deaths

causing aproximately 6 milions people ans about 600.000 people from second hand smoking and it

is one of the most used drugs, hopefully in the last decades the general consume of tobacco has

been decreased being 31.1% among men and 6.2% in women (29). Tobacco prevalence in Lithuania

increased up to 2012 however since then the use decreased, the gender difference have been

reduced as the girls smokes more, the urban adolescents smoke more than the ones in rural areas the

study done by the HBSC survey showed that Lithuanian adolescets are in the group of the highest

prevalence of smokers in Europe (30). A study carried out across Europe showed that generally

among the adolescents with low socioeconomic status the prevalence of smoking is higher . Studies

have showed that smoking is a risk health habit that most commonly starts during the adolescence

(31) and from then on remains aggravating the problem during the adulthood as more comorbidities

can appear (32) and even after quitting the risk of relapses and resume smoking is the same as for

adults, even several years after stopping (33) and one of the most effective ways to prevent it

specially among the youngers are the taxes it disencourage the adolescents to purchase cigarretes as

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every rise of the price by $1 decreased the sells of tobacco among adolescents in 1.6% for 15 years

old (34)

Nowadays the studies done that prove the impact of cigarrete smoking on the health

and with new studies appearing investigating the relationship of the tobacco smoking with some

comorbidities such as atrial fibrillation and its effect during anesthesia and the possible

complications that can be faced during a procedure (35, 36). Even all this information only one of

each three young smokers will quit succesfully, as when they were young may not think about the

possible health damage and after starting smoking the body gets used to the nicotine and become

addicted keeping this habit into adulthood, most of the adult smokers aroun 88% started this habit

when they were under 18 years old so if initiation into smoking is prevented the risk of adulthood

smoke would be significally reduced improving the public health because from this adolescent

smokers near half of them will die prematurely due to conditions related or influenced by tobacco

smoking (37, 38)

Suicidal ideation

Suicide is on of the most common causes of death among adolescents between15 and

19 years old and nowadays is the cause of around 1 million deaths per year in the world (4, 39). It is

an actual severe problem for the public health as the numbers of attemps grow ever larger specially

among adolescents wich age group is the one with the fastest growth (11, 12).

A major concern is how to prevent it and studies showed that the preventive measures

should be avoiding interpersonal violence as well as substance abuse due to both of this factor

increase the rik of the adolescent to commit suicide or at least attempt it and also prevention should

promote safe environment for the teenagers, screening progams with therapists (40). Other study

showed that adolescents living not with both of their parents and those belonging to low

socioeconomic group have an elevated risk of suicide, plus this research observed that the mental

problems like depression, insomnia (41, 42) and stress are an important factor to add for the suicide

ideation risk, this study revealed too that the tobacco smoking, alcohol intake, illicit drugs use (43)

and early sexual activity were related to suicide (42), the nowadays big tendency among

adolescents of the bullying, sexting and other ways of virtual harrasment (43) also some of this

behavior or conditions are connected between them making a bigger chance for the adolescent to

attempt. This study made profiles of the most vulnerable teenagers so this groups should be the ones

most focused for prevention.

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It important to be mentioned too that there is a gender difference concerning the

suicides, boys have higher mortality rates for suicide compared to girls, however the girls have

more rates of presenting with suicidal ideation and non mortal behavior rather than boys (45)

Family

Family has been defined as the group of individual with genetic or legal bond but it

can be more extended than that as the family plays a huge role in the development and well being of

the adolescent. Specially during the last decades there has been a great change in the family

structures as the societies have been transformed, nowadays there are families with very different

structures, both parents or tutors wich can be mother and father or both of the same gender if are a

homosexual couples, mono-parental with either the mother or the father, in some cases aunts,

uncles, grandfathers, grandmothers or even older brothers or sisters can be the responsible for the

adolescent plus the ones living at a foster home (46). The family structure is one of the variables

that matter the most as it affects the adolescent in the way that he or she will feel and behave,

however some studies identified that the essence of the family structure influence relies on having

both parents at home but does not matter if both are men or women as it would be in homosexual

parents that adopted or if parents are a man and a woman. In this families with parents of the same

gender was showed that parenting was very positive and that children had less unhealthy behavior,

this is understandable as this families planned to have a children more than in other circumstances

plus the children was also much more wanted than in other families, this study revealed that the

number, sexual orientation, biological relatedness or the gender were not an important factor as this

influenced less the adolescent than factors as family relationship, environment, communication and

bonding where this children grow up (47).

The family structure also showed that affects gratly the unhealthy behavior but it

should not be the most relevant on intervention programs, the most important target should be the

communication and relationship with parents as a form for prevention of risk behavior as it is an

easier way to protect the adolescents because family structure is not possible to interfere with (48).

Despite the cultural background of the family the aim when they have a children in any case of the

previously mentioned families is that the adolescent grows healthy and happily. They play the most

important role because they took care of the teenager and look after him or her, this is what it can be

defined as parenting, the succes on this issues of providing a good environment, attention and

support ot the adolescent. Also their own behavior affects because the future habits and even the

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health problems that may occur are influenced by the relation that exist with the parents and how

they behave as if an adolescent observes that alcohol intake is an everyday routine the probabilities

that the child will have this same behavior increases (48).

The family plays a role in matters such a dental hygiene, healthy diet, sports and

exercise activities, prevention of sedentarism, sexual education, illicit drugs, tobacco smoking and

alcohol intake. Smoking is a habit that the adolescent is more prone to do when within their family

the parents smoke, also if only one of them or any other family member exposed them to smoking

and it is easily preventable (49). Alcohol as well as smoking is greatly influenced by the family,

community support and the comprehension of the family (50).

One of the important variables among different families is the socio-economic status

wich plays a significant role on the healhty behavior of the adolescents, studies demonstrated that

families with high socio-economic status have dicreaseed risks of nutritional problems such as

obesity or overweight, while low socio-conomic status families had more prevalence of obesity and

overweight. The study also shows that monoparental families have more risk of these nutritional

problems as well as families with lower education levels (51). Other study evaluated the general

health perception among adolescents according the socio-economic level it demonstrated that low

SES during childhood increases the risks of a unhealthy life style, not only during adolescence but

thorugh life up to 31 years later into the adulthood, this provides an important information regarding

the strategies that can be carried to face this situation as it points the vulnerable group as the

adolscents living in a low income family have higher risks of unhealhty behavior as binge drinking,

smoking, lower physical exercise and poor diet showing that low SES adolescents eat less meat than

the ones with higher income all this evaluated characteristics were meant to evaluate the cardiologic

status of this adolescents when they grow up and it was showed that the unhealthy habits continued

through adulthood.

Also it should be considered that people of higher socio-economis status are more

aware of what a healthy life style is making a connection to the reason of this increased risk on

unhealthy beahvior due to education, as low SES families do not know well enough or do not have

such a healthy life style comparing with the families with higher income their children have a

higher risk of not living with a healhy life style (52).

Other important effect of the low socio-economic level of the families is that the ones

with lower incomes have an increased risk for drinking as mentioned early, however in this study it

is demonstrated that education among this adolescents plays a very important role too as among the

students that have lower educational aspirations the risk of excessive alcohol intake and drunkness

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is much increased targeting this group as the ones that should get interventions and help to prevent

the further use of acohol among them (53).

As it is said by the Spanish govenmental organization FAD (Fudation of Help against

Drug addiction) ʺThe most you fill your life with, the less space you let for the drugsʺ

Communication with paretns is also a really important variable, it is a potentially

modifiabl factor that can protect adolescents from unhelthy behavior, in a study evaluating the

adolescent relationship with his or her parents by aking about the support given by both father and

mother, the parental caring and the bonding between them was showed that family good

relationship is inversely proportional to unhealthy habits plus emotional problems such as

depression, lower self steem, drug use, suicide attempts and nutritional disorders as anorexia or

bulimia. This paper also showed that the students appreciate more the opinion of their parents

rather than the ones given by their peers, here the mother adolescent bonding was emphasized as

one of the strongest factors it was also mentioned that in case that the mother would suffer from

depression the chances of her sons or daugthers to suffer from the same disorder increase and also

the chronicity and severity, for adolescents wich may have their relations with his or her mother

restrained due to any cause, it is a possibility to get a benefit out of making the adolescence have a

better relationship with a female role model such as other relative lik an aunt, grand mother,

cousins, community leaders or sisters. Also there is the possibility to help the adolescent regarding

this matter with a Big sister program wich will allow him or her to have a good and positive relation

with a female role. There has been studies that demonstrated that an adolescent that experience a

lack or deficit in a relationship within the family may be able to compensate such problem with the

creation of a positive relation with other people.

In this study it was also encouraged to promote both relationship mother-adolescent

and father-adolescent as it can make the teenager have a healthier life not only physically but also

psychologically and this should be emphasized by the family therapist, family doctors and school

counselors, encouraging the parents to spend more time with their son or daughter doing some

activies, al least having meals together what has been proved to be associated to a lower risk for

substance abuse, depression and suicidal ideation (54).

Parentig is a clue determinant on the adolescent development and influences the future

as a lack or deficit of it makes the teenager to have greater risk of unhealhty behavior and more

problems related to it while good parentig and caring of the son or daughter encourages the

adolescent to have a healtier life style, more educational ambition and a heathy development thoguh

this years and in the future (55).

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Another study demonstrated that the parentig affects even more fields of the

adolescent life, not only the ones already mention of healhty behavior such as alcohol intake,

specially binge drinking and drunkness, tobacco smoking, physical exercise, healthy nutrition and

drugs abuse, also about emotional and educational as self-esteem, independence, academic

achievement, number of friends and school conectedness. It is more clear now the so much

important place that parenting and having good communication, relationship and bonding with the

sons and daughters has on the adolescent life making a substantial difference if there is either good

or bad both leading to a very separated outcomes. It makes the parenting and relations a clue factor

pay attention and so the main focus of prevention to protect the newer generations and give the

actual adolescents and childs a better life, not only during childhoor or adolescence but also during

the rest of their lifes as what happens to them now will change their future and if they become

parents their sons and daughters too (56).

Also the family can contribute to the prevention of unhealthy behavior or increase the

risk if not given the proper attention to the child. However it can change if the adolescent suffers a

disease, in a study has analysed how was the family environment of the affected adolescents and it

found that the homes of the bipolar adolescents had lower levels of bonding, expresiveness, cultural

and intellctual interests, and higher conflict rates compared to other families that were

demographically a match. This differences were aggravated when one or both parents were

diagnosed with some mood disorders and if so the sons or daughter of these people have a higher

risk to develop a more severe phenotype of the disease with presence of maniac episodes, psychotic

symptoms, hospitalizations and other comormidities. However it could not be determined that these

factors contributed to the illness although is has been demonstrated that children with troublesome

emotional and behavior problems are usually born in families with a less than ideal family

environment (57).

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8. Subjects and Methods

8.1 Subjects and study design

The data presented in this thesis is data from a survey distributed to two high schools,

the IES Manel Broseta in Banyeres de Mariola (with a population of 7102) and the IES Pare

Arques in Cocentaina (population 11436) located in rural areas of the county of Alicante (Spain)

using as a form the survey the Health Behavior in School-aged Children (HBSC) that was

completed in 2013 and 2014 in 42 different european countries it was distributed by their teachers

in their classroom ensuring that it was anonymous and ID was not asked neither writing their names

on the survey.

As the questionnaire was completed by students only aged 15 that volunteered at the

end of June in 2017when the academic year of the high schools ended the amount of participants

did not meet the expected number as it was a sample of 300 and the sample size variated on both

high schools, previous HBSC surveys recommended at least 1500 participants so the study would

have a good confidence interval. The data was collected by self report standardized questionnaires.

The sample was anonymous, participated voluntarily and participated 126 students (47 boys and 79

girls) aged 15 years old

8.2 Ethics

The HBSC study conformed the principles outlined in the Declaration of Helsinki.

National and local educational institutions agreed upon the study protocol. Ethical approval was

obtained for each national survey according to the national guidance and regulations at the time of

data collection. Researchers strictly followed the standardized international research protocol to

ensure consistency in survey instruments, data collection and processing procedures. In my study

there is a ethic agreement also with the university and I followed the same protocols.

8.3 Measures

I used a HBSC questionnaire that I personally translated from English into Spanish for

its distribution in the high schools that agreed to participate and then back to English. The

questionnaire consists of a section for characteristics of the surveyed, eating habits, health

perception, life satisfaction, health perception, physical activity, smoking, alcohol and illicit drugs,

19

sexual life, family, home environment, peers, school, bullying, leisure time, injuries and other

accidents, suicidal ideations and help.

In this thesis were focused the variables about life satisfaction, health perception,

smoking, alcohol, family, home environment and suicidal ideation. These variables were assessed

during the respective part of the questionnaire. Analysis were controlled according gender, family

structure and parents communication.

Health. Students were asked. How would you describe your health? Possible answers were:

(1) Excellent, (2) Good, (3) Satisfactory and (4) Poor. For the study answers 1 and 2 were observed

as good health and 3 and 4 as bad health

Life satisfaction. Question was On the top of the ladder are 10 – the best possible life for

you; on the bottom is 0 – the worst possible life for you. Please tick the box that best describes your

condition. Possible answers were from 0 up to 10. For the study the it was selected answer

0,1,2,3,4,5,6 as low life satisfaction and 7,8,9,10 as high life satisfaction

Happiness. Was asked In general, how do you feel about your life at the moment? Possible

answers were (1) Very happy, (2) Happy, (3) Unhappy and (4) Very unhappy. For the study it was

distributed answers 1 and 2 into happy and 3 and 4 to unhappy

Smoking. Students were asked: How often do you smoke tobacco at present? Possible

answers were: (1) Every day; (2) At least once a week, but not every day; (3) Less than once a

week; (4) I do not smoke. For the purposes of our study, we grouped them into smokers and non-

smokers. For that we took 1, 2, and 3 as smokers and 4 as non-smokers and combined them. Also if

was asked two more questions Have you ever smoked? If yes, so how many days? Asking about last

month and during all life Possible answers were: (1) Never, (2) 1-2 days, (3) 3-5 days, (4) 6-9 days,

(5) 10-19 days, (6) 20-29) and (7) 30 days or more

Alcohol. Adolescents were asked Have you ever drunk alcohol? If so, how many days

Possible answers were (1) Never, (2) 1-2 days, (3) 3-5 days, (4) 6-9 days, (5) 10-19 days, (6) 20-29)

and (7) 30 days or more . For the purposes answers were grouped 1 and 2 as never, 3 and 4 as not

regular and 5, 6 and 7 as regular at least weekly. Also was asked Have you ever had so much

alcoholic beverage that you were dizzy? Possible answers were (1) Never, (2) Once, (3) 2-3 times,

(4) 4-5 times and (5) More than 10 times. For the purposes of the study it was grouped answers 1

and 2 as less than 2 times and 3, 4 and 5 as more than 2 times

Suicidal ideation. Participants answered several questions regarding this topic, the

questions were During the past 12 months, did you ever feel so sad or hopeless almost every day for

20

two weeks or more that you stopped doing some usual activities? Possible answers were (1) Yes

and (2) No, next question was, During the past 12 months, did you ever seriously think about

suicide? Possible answers were (1) Yes and (2) No, During the past 12 months, did you ever make

a suicide plan? Possible answers were (1) Yes and (2) No, During the past 12 months, did you

attempt suicide? Possible answers were (1) Yes and (2) No and last question If you attempted

suicide during the past 12 months, did any attempt result in an injury, poisoning or other, that had

to be treated by a doctor? Possible answers were (1) Did not attempt suicide, (2) Yes and (3) No

Family structure. Question was Which of the following descriptions best describes your

current family situation? a list of people who may live with them (father, step-father, mother, step-

mother). Adolescents who answered both 'father' and 'mother' were included in the group of

adolescents living with both parents, while the rest of students were considered adolescents living in

families without at least one parent, which included single parent families, stepfamilies or

reconstituted families, and foster homes

Parents communication. Students answered to question Is it easy for you to talk to the

following persons about things that are very important for you and worry you? About Father and

Mother individually. Possible answers (1) Very easy, (2) Easy, (3) Difficult and (4) Very difficult.

For the study it was grouped in two groups answers 1 and 2 was grouped as Easy communication

and answers 3 and 4 grouped as Difficult communication. In the study it was also made a

combination of both values if the students answered 1 or 2 for both Mother and Father it was

classified as easy communication with both parents, if 1 or 2 in Father and 3 or 4 in Mother it was

Father easy, Mother difficult, if 3 or 4 Father and 1 or 2 Mother was Father difficult, Mother easy

and if both answers were 3 or 4 it was classified as difficult communication with both parents

8.4 Statistical analysis

Statistical analysis was conducted on the 126 participants. The analysis was not

stratified according high schools but all together.

Data was analyzed using the SPSS software (version 20; Inc. Chicago, IL, 2011). To

sum up the procedures done in this thesis, it was produced descriptive statistics such as percentages

and frequencies including variables of interest. To evaluate if there was significant difference

between the students that participated in the students that were made was calculated Chi-square test.

To test the association between the gender and familial determinants as family structure and

communication with parents there was conducted binary logistic regressions analyzing the impact

of gender and family variable on health, life satisfaction, smoking prevalence, drunkness and times

21

that the adolescents felt sad and stopped doing activities during last year. Interactions between

characteristics was tested by using the rule that if p<0.05 the difference was considered as

statistically significant. The results of the study are showed in this thesis as graphs and tables

under whose it is written theis Chi-square value and p.

22

9. Results

9.1 Demography of the survey sample

In this part it is commented the demographic characteristics of the sample that was

surveyed

Figure 9.1.1 Distribution of gender of sample

Participants on the survey were boys girls mostly 62.7% and less boys 37.3%

Figure 9.1.2 Distribution of communication with parents according to gender

Most of the students showed that communication with father is mostly easy with

87.3% for boys and 87.4% for girls and communication with mother is also mostly easy with 63.8%

for boys and 55.7% for girls

37%

63%

Boys Girls

87,3

12,7

63,8

36,2

87,4

12,6

55,7

44,3

0

10

20

30

40

50

60

70

80

90

100

Talk to father

easy

Talk to father

difficult

Talk to mother

easy

Talk to mother

difficult

Boys

Girls

23

Figure 9.1.3 Distribution of family structure according to gender Here it can be seen that the structured families are more common in a 91.5% of cases

for boys and 85% of cases for girls

9.2 General perception of the sample

In this chapter it is showed how the students considered their health and how they feel

about their life satisfaction

χ2 = 0.097 ; df=1; p=0.755

Figure 9.2.1 Distribution of screened health perception among Spanish students surveyed

As we can see in the figure the most of the students considered their health as good

being a 73% of all the answers while only 0.8% manifested that their health was poor. There is no

significant difference

91,5

8,5

85

15

0

20

40

60

80

100

Both parents No both parents

Boys

Girls

7,1

73

19

0,8

0

10

20

30

40

50

60

70

80

excellent good satisfactory poor

Health %

24

χ2 = 0.097 ; df=1; p=0.755

Figure 9.2.2 Distribution of health perception comparing gender

In the general perception of health there was very good with only a difference of 2.3%

better for girls. There is no significant difference

χ2 = 0.096; df=1; p=0.757

Figure 9.2.3 Distribution of life satisfaction (LS) among surveyed Spanish students.

The prevalence of High LS (7 or more in the survey from 0 up to 10) predominated

among boys and girls but specially in boys with a difference of 2.1%. There is no significant

difference

78,7 81

21,3 19

0

10

20

30

40

50

60

70

80

90

Good Health

Boys

Good Health

Girls

Poor Health

Boys

Poor Health

Girls

Health Perception %

84,4

15,6

82,3

17,7

0

10

20

30

40

50

60

70

80

90

High LS (% ) Low LS (% )

Boys

Girls

25

χ2 = 8.752a; df=1; p=0.003

Figure 9.2.4 Distribution of happiness among the students

Here it is shown that most students are describe themselves as happy most among the

girls that manifested that they were happy 100% but instead the boys showed that 10.6% of them

were actually unhappy. It is a significant difference

9.3 Smoking habits

In this chapter it is showed the prevalence of smoking among Spanish adolescents, its

correlation with the gender, how much does students smoked during last month, in its life and how

is the correlation between the smoking in the last month with the smoked during all life

Prevalence of smoking among Spanish students

In this part could be observed that most of the adolescents do not smoke 70,6%

although a 29.4% does

χ2 = 1.674a; df=1; p=0.196

Figure 9.3.1 Prevalence of smoking according gender

89,4

10,6

100

00

20

40

60

80

100

120

Happy (% ) Unhappy (% )

Boys

Girls

36,2

63,8

25,3

74,7

0

10

20

30

40

50

60

70

80

Yes (%) No (%)

Boys

Girls

26

In the graph it is showed that most of the students do not smoke specially girls who

only smoke 25.3% and boys 36.2%. It demonstrate that the majority do not smoke with less

consumption by the girls with a difference of 10.9% compared to the boys. There is no significant

difference.

9.4 Alcohol intake

In this chapter of the thesis it is showed the alcohol consumption among adolescents

by checking if they never drink at all, if it is a no regular intake and if regular at least weekly. Also

it is showed the same criteria but according to the gender and how many times the students were

drunk if at least 2 times or more according gender

χ2 =0.739a; df=2; p=0.691

Figure 9.4.1 Distribution of alcohol intake according to gender

Here can be observed that mostly among Spanish students the consume of alcohol is

not regular, most of the adolescents that do not drink are boys with 21.3% and the ones that

consume alcohol regularly are also boys 25.5%. There is no significant difference

21,3

53,2

25,5

19

60,8

20,3

0

10

20

30

40

50

60

70

Never Not Regular Regular

Boys (%)

Girls (%)

27

χ2 =0.764a; df=1; p=0.382

Figure 9.4.2 Distribution of times that adolescents have been drunk according to gender

It can be seen that among the boys they mostly have been drunk 2 or more times

51.1% while girls mostly have not been drunk 2 or more times 57%. There is no significant

difference

9.5 Suicide and suicidal thoughts

In this part of the thesis it is showed if the students stopped activities during last year,

thought about suicide, make suicide plans, attempted suicide and if so if they needed medical help

Distribution if last year students stopped doing activities due to being sad

Most of the students did not stopped their usuals activities 72.2% and the ones who

stopped were the 27.8%

Distribution of thought about suicide

Can be observed that most of them did not think about it 77.8% and 22.2% not

Distribution of suicidal plan formig

Most of the students did not make a suicide plan 93.7% and only 6.3% made a plan

Distribution of suicide attempt

Most did not attempt 96% and only 4% tried from those any of them needed medical

help

51,1

43

48,9

57

0

10

20

30

40

50

60

Boys (%) Girls (%)

Drunk 2 or more times

Not drunk 2 or more

times

28

9.6 Family and the role it plays

In this chapter the family structure is checked and its relevance on the life style and behaviour

among the adolescents

χ2 =0.967a; df=2; p=0.617

Figure 9.6.1 Distribution of alcohol intake according family structure

In this graph it is represented as previously that there is not a regular consume but

also. Here it is showed that students in families with both parents the never consume is lower 20.9%

compared with the 12.5% of the ones with no both parents, then the not regular consume if there is

both parents 56.4% also lower compared to the ones without both parents 68.8% and the last group

regular intake that if both parents are with the adolescent it is higher 22.7% compared to the

students without both parents 18.8%. There is no significant difference

χ2 =0.038a; df=1; p=0.845

20,9

56,4

22,7

12,5

68,8

18,8

0

10

20

30

40

50

60

70

80

Never Not regular Regular

Both parents (%)

No both parents (%)

46,4

53,6

43,8

56,3

0

10

20

30

40

50

60

Drunk 2 or more times No drunk 2 or more

times

Both parents (%)

No both parents (%)

29

Figure 9.6.2 Distribution of how many times adolescents were drunk according to the family

structure

Most of the students were not drunk 2 or more time,also it can be seen that in families

with both parents there is more adolescents that were drunk 2 or more times 46.4% with a

difference of 2.6%. There is no significant difference

χ2 =0.585a; df=1; p=0.444

Figure 9.6.3 Distribution of smoking prevalence according family structure

In this graph it can be observed that adolescents that have both parents have less

prevalence 28.2% with a difference of 9.3% compared to the ones without 37.5%. There is no

significant difference

χ2 =0.307a; df=1; p=0.580

71,8

28,2

62,5

37,5

0

10

20

30

40

50

60

70

80

No Yes

Both parents (%)

No both parents (%)

80,9

19,1

75

25

0

10

20

30

40

50

60

70

80

90

Good Poor

Both parents (%)

No both parents (%)

30

Figure 9.6.4 Distribution of general health perception according to family structure

It can be observed that the group of students with both parents have a better perception

of health 80.9% compared to the ones with no both parents 75% with a difference of 5.9%. There is

no significant difference

χ2 =0.849a; df=1; p=0.357

Figure 9.6.5 Distribution of life satisfaction according to family structure

It can be observed that in high life satisfaction among the adolescents is the most

prevalent specially with both parents there is 84.3% compared to those with not 75% making a

difference of 9.3%. There is no significant difference

χ2 =3.501a; df=1; p=0.061

84,3

15,7

75

25

0

10

20

30

40

50

60

70

80

90

High LS Low LS

Both parents (%)

No both parents (%)

97,3

2,7

87,5

12,5

0

20

40

60

80

100

120

Happy Unhappy

Both parents (%)

No both parents (%)

31

Figure 9.6.6 Distribution of happiness according to family structure

As showed previously most of the students are happy, the graph also shows a higher

level of happines among the adolescents with both parents at home 97.3% compared to the ones

without them 87.5% having a difference of 9.8%. There is no significant difference

χ2 =7.406a; df=1; p=0.007

Figure 9.6.7 Distribution of adolescents that stopped doing activities due to sadness according to

family structure

Here it can be seen how students with no both parents at home stopped activities in a

56.3% of cases a difference of 32.7% compared with the ones that had both parents who only

stopped a 23.6%. There is a significant statistical difference

χ2 =2.475a; df=1; p=0.116

23,6

76,4

56,3

43,8

0

10

20

30

40

50

60

70

80

90

Stopped activities Not stopped activities

Both parents (%)

No both parents (%)

20

80

37,5

62,5

0

10

20

30

40

50

60

70

80

90

Yes No

Both parents (%)

No both parents (%)

32

Figure 9.6.8 Distribution of suicidal thought among students according to the family structure

The graph shows that most students did no thought about suicide and the 37.5% of

adolescents without both parents thought about suicide while only 20% from the ones with both

parents, that is a difference of 17.5%. There is no significant difference

Did you make a suicide plan? Total

No Yes

Both parents (N) and (%) 103 93.6% 7 6.4% 110 100%

No both parents (N) and (%) 15 93.8% 1 6.3% 16 100%

Total (N) and (%) 118 93.7% 8 6.3% 126 100%

χ2 =0.000a; df=1; p=0.986

Figure 9.6.9 Distribution of suicide plan according family structure

It is showed that difference between adolescents with parents or without are very

similar with only a 0.2% difference

Did you attempt to suicide? Total

Never Once

Both parents (N) and (%)

106 96.4% 4 3.6% 110 100%

No both parents (N)

and (%)

15 93.8% 1 6.3% 16 100%

Total (N) and (%) 121 96% 5 4% 126 100%

χ2 =0.250a; df=1; p=0.617

Figure 9.6.10 Distribution of suicide attempt according family structure

The graph shows the group of adolescents with both parents at home attempted less

3.6% than the group without both parents 6.3% showing a difference of 2.7%

33

9.7 Importance of communication in risky health behaviour

χ2 =2.817a; df=3; p=0.421

Figure 9.7.1 Distribution of communication with parents according gender

In this graph can be observed that most of the students have both easy communication

with their parents 48.9% and 49.4%, also it shows that the boys have found communication with

father more easy 14.9% rather than girls 6.3% while girls have better relation with their mothers

24.8 % while boys 21.3%. There is no significant difference

χ2 =3.806a; df=3; p=0.283

Figure 9.7.2 Distribution of Life satisfaction according family communication

Here can be seen that most of the adolescents have high life satisfactio and that the

communication plays an important role as people who has good communication with both parents

14,9

21,3

14,9

48,9

16,5

24,8

6,3

49,4

0

10

20

30

40

50

60

Both difficult Father difficult,

Mother easy

Father easy,

Mother difficult

Both easy

Boys

Girls

70

81,3 81,8

88,5

30

18,8 18,2

11,5

0

10

20

30

40

50

60

70

80

90

100

Both difficult Father difficult,

Mother easy

Father easy,

Mother difficult

Both easy

High LS %

Low LS %

34

have high satisfaction 88.5% while the students with difficult communication have high satisfaction

only the 70%. There is no significant difference

χ2 =10.853a; df=3; p=0.013

Figure 9.7.3 Distribution of smoking prevalence according family communication

It shows that most student do not smoke but specially among the ones with good

communication with both parents 82.3% while only 17.7% smoked, also the ones with worse

communication smoke on the 55% of cases. It is a significant difference

χ2 =8.849a; df=6; p=0.182

45

65,6 66,7

82,3

55

34,3 33,3

17,7

0

10

20

30

40

50

60

70

80

90

Both difficult Father difficult,

Mother easy

Father easy,

Mother difficult

Both easy

No %

Yes %

25

12,58,3

24,2

35

65,6

75

58,1

40

21,9

16,7 17,7

0

10

20

30

40

50

60

70

80

Both difficult Father difficult,

Mother easy

Father easy,

Mother difficult

Both easy

Never %

Not regular %

Regular at least weekly %

35

Figure 9.7.4 Distribution of alcohol consumption according family communication

The graph shows that most students have a not regular intake, also it shows that the

group that have good communication have a regular intake the 17.7% while the adolescents with

difficult communication consume alcohol regularly 40%. There is no significant difference

χ2 =4.654a; df=3; p=0.199

Figure 9.7.5 Distribution of suicidal thought according family communication

Here it is showed that most students did not have any suicidal thought, specially

among the group of adolescents in which families there is bad communication 40% and among the

ones with better communication only 17.7% thought about it. There is no significant difference

60

81,375

82,3

40

18,825

17,7

0

10

20

30

40

50

60

70

80

90

Both difficult Father difficult,

Mother easy

Father easy,

Mother difficult

Both easy

No %

Yes %

36

Binary logistic regression

In this part of the results it is going to be showed how influences each variable both demographic

and familial

Health B P OR 95% C.I.for EXP(B)

Lower Upper

1.Gender

Boys (ref)

1

Girls -0.198 0.676 0.821 0.325 2.072

2. Family

Structure

Both parents (ref)

1

No both parents 0.131 0.839 1.140 0.322 4.041

3. Talk to Father

Easy (ref)

1

Difficult 0.870 0.07 2.388 0.932 6.118

4. Talk to Mother

Easy (ref)

1

Difficult 0.398 0.427 1.49 0.557 3.984

Constant -1.227 0 0.293

Figure 9.8.1 Impact of Family variables and gender on Health (results from multivariable binary

logistic regression)

In this table it can be observed that the factor that matters the most is the

communication with father, if there is a difficult communication the risk of considereing health as

poor is 2.388 times greater, the next most important factor is communication with mother, then

family structure and girls are healthier than boys.

37

Life satisfaction B P OR 95% C.I.for EXP(B)

Lower Upper

1.Gender

Boys (ref)

1

Girls 0.176 0.736 1.192 0.430 3.309

2. Family

Structure

Both parents (ref)

1

No both parents 0.444 0.495 1.558 0.436 5.571

3. Talk to Father

Easy (ref)

1

Difficult 0.538 0.294 1.713 0.627 4.679

4. Talk to Mother

Easy (ref)

1

Difficult 0.612 0.250 1.844 0.649 5.238

Constant -1.328 0 0.265

Figure 9.8.2 Impact of Family variables and gender on Life satisfaction (results from multivariable

binary logistic regression)

In the table it is showed that the most important factor is the communication with the

mother, if it is difficult it is going to be 1.844 times more probable that the life satisfaction is low,

the next mos important is the father communication, then the family structure and last the gender

being girls the ones with less life satisfaction.

38

Smoking B P OR 95% C.I.for EXP(B)

Lower Upper

1.Gender

Boys (ref)

1

Girls -0.594 0.162 0.552 0.240 1.270

2. Family

Structure

Both parents (ref)

1

No both parents 0.194 0.744 1.214 0.379 3.895

3. Talk to Father

Easy (ref)

1

Difficult 0.955 0.026 2.559 1.120 6.032

4. Talk to Mother

Easy (ref)

1

Difficult 0.794 0.078 2.213 0.915 5.354

Constant -0.546 0.078 0.579

Figure 9.8.3 Impact of Family variables and gender on Smoking (results from multivariable binary

logistic regression)

Here the most important variable is the communication with father, if it is difficult the

options of smoking increases 2.599 times, the next one the mother communication, then family

structure and girls smoked less than boys.

39

Drunkness B P OR 95% C.I.for EXP(B)

Lower Upper

1.Gender

Boys (ref)

1

Girls -0.342 0.361 0.710 0.341 1.48

2. Family

Structure

Both parents (ref)

1

No both parents -0.187 0.734 0.829 0.282 2.438

3. Talk to Father

Easy (ref)

1

Difficult 0.298 0.438 1.347 0.634 2.859

4. Talk to Mother

Easy (ref)

1

Difficult 0.0108 0.8 1.115 0.482 2.576

Constant -0.135 0.642 0.874

Figure 9.8.4 Impact of Family variables and gender on drunkness (results from multivariable binary

logistic regression)

The table shows that the most important factor is the communication with father, if

having a difficult communication the risk of being 2 or more increases in 1.347 times, next variable

is communication with mother, family structure if both parents are at home the risk of being drunk 2

or more times is reduced, and also girls risk of drunkness is reduced.

40

Sadness B P OR 95% C.I.for EXP(B)

Lower Upper

1.Gender

Boys (ref)

1

Girls 0.148 0.736 1.16 0.49 2.744

2. Family

Structure

Both parents (ref)

1

No both parents 1.282 0.023 3.604 1.193 10.884

3. Talk to Father

Easy (ref)

1

Difficult 0.719 0.097 2.053 0.878 4.797

4. Talk to Mother

Easy (ref)

1

Difficult 0.211 0.656 1.235 0.488 3.129

Constant -0.453 0.134 0.636

Figure 9.8.5 Impact of Family variables and gender on sadness and stopped activities during last 12

months (results from multivariable binary logistic regression)

The table shows that the most important varible is the family structure if the adolescents lives in a

home without one of their parents the risk of sadness increases 3.604 times, next most important is

communication to father, then communication to mother and girls were sadder than boys.

41

10.Discussion

Family

In this part it is going to be evaluated the influence of family structure with the previous

mentioned characteristics, the first one was the alcohol intake that showed that adolescents with

both parents at home mostly had not regular consume as well as the ones with out both parents with

a 56.4% and 68.8% respectively, the next most common answer was the regular intake with 22.7%

and 18.8% and the one with lowest answers the not drinking with 20.9% and 12.5%. In this the p

value was 0.617 so there is no statistical difference.

About the times that the students were drunk 2 or more times, for the ones that had both

parents at home the most answered option was that they were not drunk 2 or more times with 53.6%

and the ones without 56.3%. This shows that not living with both parents is a protective factor. Here

the p values is 0.845 so there is no statistical significance.

In Lithuania it was stablished that a family that is non structured, where both parents are not

at home, and week communication and relatioship between parents and sons or daughters increase

the alcohol intake by the adolescents (60).

Next teenagers were asked about the smoking prevalence, the ones that had both parents at

home did not smoke in the 71.8% of cases and the ones without both parents at home the 62.5%

answered no. This shows that having both parents is a preventive factor. Here the p value is 0.444

so there is not statistical difference.

In Lithuania other study showed that weak parental support and not intact families increased

the prevalence of smoking among the 15 years old students in a study performed at 2014 (61).

The next value evaluated was the influence of family structure on health perception with

results showing that most students answered 80.9% if had both answers and 75% if not, so here as

well as in smoking having both parents increase the health perception, the p value was 0.580 so

there is not statistical diffence. Also were asked about life satisfaction most answered they had high

life satisfaction the ones with both parents at home 84.3% and the ones without both 75%, as

previously having a structured family increased the life satisfaction among the students, here the p

value was 0.357 so there is no statistical difference. The happiness was also evaluated according the

family structure and most of the adolescents answered 97.3% the one with both parents and 87.5%

if not, as well as in the previous having a structured family increased the possibilities of being

happy. The p value is 0.061 still there is not statistical difference.

In Lithuania life satisfaction was showed that it is significantlly influenced by the family

structure and the relationship between parents and adolescents in boys 38% and girls 39%. About

42

the health rating it was also very influenced bieng a difference of 10% if there was good family

communication and structured family (58).

About suicidal ideation, the firs question about if there was sadness and stopped activities

during last year due to that if both families 23.6% and if not 56.3% showing a difference of 32.7%.

Here the family also influences as prevent the sadness and stopping of activities, p value is 0.007 so

it shows a statistical difference. Next was evaluated the suicidal ideation, among the students with

both parents at home the most answered option was no with 80% and the ones without both parents

62.5% being the family a protective factor here p value is 0.116. Also were asked about the suicide

plan making and the adolescents with a structured family answered no in a 93.6% and the ones

without both parents 93.8%, there is a minimal difference of 0.2%, here the p value is 0.986. Last

question was if the adolescents commited suicide the ones with both parents 96.4% and if not

93.8%, the p value is 0.617 shows that there is no statistical difference.

In Lithuania non intact families and weak relation between adolescent and parents with a

bad communication result in an increased risk of mental health problems such as suicides (59).

Communication with parents

First was described how was the communication according to the gender, boys mostly

answered that with both parents was easy 48.9% and girls to the same question 49.4%, the next

most answered for boys was mother easy, father difficult with 21.3%, the next most answered for

girls was the same mother easy and father difficult 24.8%. The p value was 0.421 there is no

statistical difference.

In Lithuania boys communication was easy with both parents 69.4%, 20.5% more than with

the Spanish, and for girls communication easy with both parents 54.03%, 4.63% more difference

with the Spaniards (62).

Was evaluated the previous characteristics but checking the influence of the family

communication, firstly was life satisfaction it showed that the ones that asnwered as high

satisfaction were the one with both easy communication 88.5% and then lowering if had problems

to communicate with one of the parents, if problems with mother 81.8% and if with father 81.3%

and if both difficult 70%. Showing that the good communication is a protection. The p value is

0.283

The smoking prevalence was evaluated and shows that if the students have both good

communication 82.3% do not smoke, if problem with mother only 66.7% do not smoke, if problems

only with father 65.5% and if problems with both 45%, it shows that good family communication

protects against smoking. The p value is 0.013 showing that there is a statistical difference.

43

In Lithuania the smoking prevalence was checked to observe if there was a relationship

between the family communication and smoking and it revealed that week families with low

support to their child and not structured families had greater prevalence (61).

Alcohol consumption question checking the influence of the family communication with it

showed that the most common answer for good communication with both parent 58.1%, and

problem with only one parent either mother 75% or father 65.6% was the not regular intake,

however in the both difficult communication the most common answer was regular at least weekly

40%. The p value here was 0.182 showig that there is not statistical difference.

In Lithuania was relationed the weak communication and support plus the no structured

family with the consumption of alcohol (60).

The last evaluated characteristic was the suicidal thought according the family

communication showed that if both easy communication they did not thought about it in the 82.3%

of cases, if problem with only mother the adolescents thought about suicide in a 75% of cases, if

only problems with the father they did not thought about suicide in 81.3% of cases and if both

difficult 60%. It demonstrates that the good communication prevents the suicidal ideation. Here the

p value is 0.199 showing that there is no statistical difference.

It Lithuania a study showed that the relation between family and adolescents, the support

given and the structure of family plays an important role and having a non structured family and not

good relation with parents increase the risk of suicide attempt (59).

Finally the binary logistic regression showed that the most important varible overall was the

communication with the father as was the most determinant on the healht perception, smoking and

drunkness, the communication with the mother played the most important role on life satisfaction

while the family structure was the most important for the sadness and stop doing activities the last

12 months.

The goal of this thesis was to analyze the influence of the familial determinants with the

harmful behavior regarding health issues as it has been demonstrated in multiple studies carried on

different countries. In this thesis the focus has been the family structure and communication with

parents among Spanish adolescents aged 15. The study was performed by collecting data from two

different high schools in Alicante county (Spain), the survey used was a translation from the

questionnaire that was used by the HBSC 2014 in wich participated a total of 126 students. In this

paper the main characteristics that have been evaluated are the following.

44

Health

The survey showed that among 15 year old Spaniards the health perception is good as

boys and girls described their health it in the 78.7% and 81% of cases respectively, but as the p

value is 0.755 there is no statistical difference between gender.

In Lithuania the results were that girls rated their health as good in 75% of cases and

boys in 90% of cases, 6% less girls rated theirself as having good health and boys did it 11.3% more

compared to the Spanish. The HBSC survey showed that in Spain the girls were happy in the 15%

of cases and boys in 8% (58).

Life satisfaction

It was answered that as well as health most of the adolescents calified their life as

satisfactory giving a score of 7 or above in a question were they could evaluate their life satisfaction

from 0 to 10, the boys answered that they had a high life satisfaction in the 84.4% of cases while the

girls in a 82.3%, here the p values is 0.757 so there is no statistical difference according gender.

In the question about happiness the postive answers were even more predominant that

in the previous characteristics, in this the boys answered that they were happy in the 89.4% of cases

and the girls in all the cases 100%, in this p value is 0.003 showing that girls are statistically happier

than boys.

In Lithuania the result was that boys considered themselves with high life satisfaction in

90% of cases and girls in 78%, 5.6% more boys rated their life satisfaction as high and girls 4.3%

less. The HBSC questionnaire among the Spanish showed that boys had high life satisfaction in

87% of cases and girls in 81% (58).

Smoking

The question about current smoking prevalence showed that most of the students do

not smoke, only 36.2% of boys and 25.3% of girls here the p value is 0.196 so there is no statistical

difference although the difference is 10.9%

The questions about consume of tobacco in the last month and during the last year

demonstrated that adolescents that have smoked 30 days or more in their life 47.4% still smoked the

last month if not daily almost so they consume tobacco as a routine, 15.8% smoked only 6-9 days

other 15.8% only 1-2 days showing that they are smoking very rarely, 5.3% smoked 3-5 days like

once per week and other 5.3% did not smoke at all the last month so only 5.3% of the ones that

were everyday or almost every day smokers achieved quitting.

45

In Lithuania 20% of boys smoke at least once a week and girls in the 12% of cases, so

boys smoke 16.2% less and girls 13.3% less compared to the Spaniards. The HBSC study shows

that among the Spaniards 8% boys and 10 girls% answered that they smoke (58).

Alcohol

The survey showed that most of the adolescents have a not regular consume of alcohol

drinks with 53.2% boys and 60.8% girls, the next option was the regular at least weekly consume

with answers of 25.5% and 20.3% of boys and girls respectively, the last option was the never use

with 21.3% of boys and 19% of girls. Here the p value was 0.691 so there is no statistical difference

The next question was about how many times the students had been drunk if 2 or more

or not, the boys answered that most of them 51.1% were drunk 2 or more time while girls chose the

opposite answer mostly with a 57%. In this case the p value was 0.382 so there is not a statistical

difference according gender about the times that the adolescents were drunk.

In Lithuania boys consume alcohol at least weekly boys 13% and girls 6%, it shows a

difference compared to the Spanish of 12.5% less in boys and 14.3% in girls. The HBSC showed

that among the Spaniards the boys were 11% and girls 8%. About how many times the adolescents

were drunk 2 or more times the Lithuanian boys answered it 41% and girls 33%, with a difference

of 10.1% less in boys and 10% less in girls. HBSC showed that Spanish teenagers were 2 or more

times drunk in 21% both boys and girls (58).

Suicidal though

The first question was about sadness and if they felt it during the last 12 months the

answers showed that 27.8% were sad and stopped doing usual activities during the last year

The next question ideation of suicide, if they thought about it during the last 12 months and

the students answered that 22.2% of them though about suicide

Then was asked if they made a suicide plan in the last 12 months and they answered that

only 6.3% actually thought about it, showing a decrease of 15.9% compared with the ideation of

suicide

The following question was if they attempted to commit suicide in the last 12 months and in

this question they only answered affirmatively 4% of the adolescents, showing a decrease of 2.3%

from those who made a plan to commit it. The last question was about medical help in case the

attempted, in this all the answers were that they did not need any health care help after they attempt.

In Lithuania 43% of the students reported sadness and stopping of doing activities due to it,

15.2% more than among the Spanish, about suicide ideation 23.8% thought about it, 1.6% more

46

than the Spaniards, about making a suicide plan 13.7%, 7.4% more than at Spain, about suicide

attempt 13.2%, while in Spain it was 9.2% less, and last about medical help if attempted suicide

4.1% needed while in Spain any of the surveyed answered that they need help (59).

47

11. Conclusions

1) To identify familial determinants

� About communication with parents, talking to father was easy for boys in 87.3% and

girls in 87.4%, communication with mother was easy for boys in 63.8% of cases and girls in

55.7%. Having a structured family where all live together in the same house is also a very

important factor among the adolescents, boys lives with both parents in 91.5% and girls in

85%.

2) To identify health behaviour patterns

� The study showed that among Spanish students smoking prevalence is 29.4%, the most

pattern of alcohol consumption is a not regular one 53.2% of boys and 60.8% of girls, next

more common pattern was regular with 25.5% boys and 20.3% girls and the last pattern

never with 21.3% of boys and 19% girls, drunkness at least twice was 51.1% in boys and

43% in girls, about suicide ideation 22.2% of cases the students thought about it , plan

making only 6.3% or attempting just 4%.

3) To analyze the relatioship between familial determinants and health behaviour

� It has been showed that lacking of good relationship with both parents affects negatively

as well as living in a not structured family the health behavior among the adolescents,

increasing the risk of smoking, alcohol consume and suicide ideation.

4) To compare these associations between Lithuanian and Spanish adolescents

� From the data obtained in the survey carried at Spain and the results from the HBSC

survey carried at Lithuania it can be observed that the Lithuanian adolescents have greater

health perception among boys, life satisfaction among boys, sadness that led to stop

activities, suicide thought, suicide plan making, suicide attempting and medical care after

suicide attempt. Also shows that Lithuanians adolescents have lower health perception

among girls, life satisfaction among girls, smoking prevalence both boys and girls and

alcohol intake both boys and girls.

48

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