The trends in perceived health, well-being, and risk behaviours among high school students in Finnmark, Norway, compared to the national average

ABSTRACT

This study examines trends in health, well-being, and risk behaviours among high school students in Finnmark, Norway, and compares them with the national average. Data were drawn from the Ungdata survey, covering three waves between 2014 and 2023. The sample included 6,084 high school students in Finnmark and 254,048 students nationwide. MANOVA with polynomial contrasts assessed linear trends among students in Finnmark, and MANOVA with difference contrast tested pairwise differences between Finnmark and national samples. Trend analysis revealed that 26 out of 63 variables, including digital use, school-related variables, antisocial behaviours, and depressive thoughts, increased over time, while 25 variables, such as physical activities, local environment, and bullying remained unchanged. Relationships with parents and substance use improved. Pairwise comparisons showed worse outcomes for Finnmark students in 43 and 41 out of 63 variables across waves, except for substance use and antisocial behaviours. This study indicates limited improvement in health and risk behaviours among high school students in Finnmark. Public health policies tailored to adolescents in Finnmark should focus on mental health services, promoting physical activity, and reducing antisocial behaviours and bullying. Further research should explore Finnmark’s multiethnic context, including the Sámi and Kven populations.

Background

The well-being and risk behaviours of adolescents are crucial components of public health, as adolescence is a critical developmental period during which habits related to physical activity, substance use, and mental health begin to form and potentially persist into adulthood [1,2]. Since trends in adolescent health and behaviours often reflect those in broader society, examining these trends is essential for establishing effective public health strategies that address the specific challenges faced by adolescents.

In the context of high-income countries like Norway, research has demonstrated that while there are common patterns of health challenges among adolescents [2], geographic, cultural, and socio-economic factors play significant roles in shaping the specific trends observed in different regions [1]. Multiple studies in Norway have examined the health, well-being, and risk behaviours of adolescents using national or international data collection methods such as the Ungdata Survey [3], Health Behaviour in School-aged Children survey (HBSC) [4], Young in Norway (YiN), and the Trøndelag Health Study (Young-HUNT). A meta-analysis of 35 cross-sectional data collections conducted between 1992 and 2019 revealed an increase in self-reported mental health problems among young adolescent girls since the early 1990s, although trends were less significant for adolescent boys [5]. Another study examining the trend of mental health complaints using Young-HUNT showed an increase in mental distress among adolescents aged 13–19 years in Nord-Trøndelag County, mid-Norway [6]. A study using HBSC data between 1994 and 2014 with adolescents aged 11 to 16 years olds found an increase in psychological and somatic health complaints among Norwegian adolescents [7]. While most studies have shown negative trends in mental health, a study comparing the temporal trends of self-rated health (SRH) among adolescents aged 11–15 years in five Nordic countries – Denmark, Finland, Iceland, Norway, and Sweden – showed an increase in excellent SRH rates in Norway. In contrast, Finland and Sweden saw a deteriorating trend, with only minor changes observed in Denmark and Iceland [8]. Another study conducted in Finland, Norway, and Sweden examined the relationship between a decline in drinking and smoking behaviours. It found that a reduction in daily smoking among adolescents, along with decreased perceived access to alcohol, and greater parental control, was linked to a decrease in heavy episodic drinking [9]. However, those studies mainly examined the trends of self-rated mental health or health complaints, but not the trends of risk behaviours and the factors influencing those behaviours. While various studies have investigated the impact of environmental factors on adolescent health and risk behaviours [10–13], they are all cross-sectional and do not provide information on temporal trends.

In Northern Norway, although studies focused on temporal trends are lacking, several studies have explored the influence of environmental factors on risk behaviours, mental health, and well-being among adolescents. The North Norwegian Youth Study (NNYS) is one such study – a longitudinal epidemiological study conducted in the three northernmost provinces of Norway between 1994–1995 and 1997–1998. Literatures from this study found that non-Sámi adolescents engaged in more drinking behaviour, while Sámi adolescents reported greater concerns from friends and family about their drinking [14,15]. Another study investigating ethnic differences in abstinence, drinking frequency, and context found that religious factors partially explained the association between Sámi ethnicity and drinking behaviour [16]. A study on predictors of smoking behaviour among Sámi and non-Sámi adolescents found a strong association between regular smoking and risk-taking behaviours, such as substance use and delinquency, across both ethnic groups, although ethnicity did not significantly influence smoking behaviours [17]. Additionally, weaker Sámi cultural orientation, reflected by favouring assimilation and residing in assimilated ethnic contexts, was associated with increased substance use, more often in late adolescence than in young adulthood [18]. The Norwegian Arctic Adolescent Health Study (NAAHS), conducted in the same region as NNYS from 2003–2005, found that among Sami adolescents, having suicidal thoughts was strongly associated with poorer self-reported health [19]. The study also found that family and peer relations are important factors for suicidal behaviours [20]. However, these studies targeted the whole of Northern Norway, not solely Finnmark County.

Finnmark County has distinct sociocultural and multiethnic contexts that differ from those in middle and southern Norway. The region is home to the Sámi people, who speak the Sámi language and inhabit the Sápmi region, and the Kven people, who are descendants of those who migrated to Northern Norway from Northern Finland and Northern Sweden in the 18th and 19th centuries. Additionally, people from Northern Finland, Northern Sweden, and Russia also reside in the region, and inter-marriage between these groups is common [21]. This unique multiethnic context adds another layer of complexity to the understanding of adolescent health. Studies conducted in other circumpolar regions, such as Alaska and northern Canada, have highlighted similar patterns, where indigenous youth are disproportionately affected by mental health issues like depression, anxiety, and suicide ideation [22]. In Finnmark, the interaction between cultural identity, social support, and mental health outcomes is an area requiring further exploration.

Thus, the temporal analysis of adolescent health trends in Finnmark becomes crucial, not only for addressing local disparities but also for contributing to a broader understanding of how geographic, cultural, and socio-economic factors intersect to influence adolescent well-being globally. This study fills a gap in the literature by focusing specifically on Finnmark and comparing its trends to national averages, offering valuable insights for public health initiatives in rural and indigenous communities worldwide.

From a theoretical perspective, this study draws on the social-ecological model, which emphasises the interaction between individual behaviours and broader environmental influences, such as family, school, and community [23]. In Finnmark, the study of trends across multiple waves allows for a more dynamic understanding of how these environmental factors serve as protective or risk factors in shaping adolescent health behaviours. By framing the research within this theoretical model, it becomes possible to explore interventions that target not only individual behaviour changes, but also structural and community-level improvements aimed at enhancing adolescent well-being in Finnmark and similar regions.

Given these contextual and theoretical frameworks, this study explores the temporal trends in self-reported health, environment factors surrounding adolescents, such as family, peers, school and local environment, and risk behaviours among high school students in Finnmark. Additionally, the study compared these factors with the national average in Norway.

Methods

Data sources and samples

This study used cross-sectional data from the Ungdata survey, a national data collection programme that focuses on the health, well-being, and risk behaviours of adolescents in Norway (Ungdatasenteret, n.d.-b). The Norwegian Social Research (NOVA) oversees the overall coordination of the programme, while the Regional Drug and Alcohol Competence Centers (KoRus) conduct the surveys at the municipal level. The survey is conducted every three years (Wave 0: 2010–2013, Wave 1: 2014–2016, Wave 2: 2017–2019, and Wave 3: 2020–2023) in both junior high and high schools throughout Norway, except for Wave 0 (2010–2013), which was conducted only in junior high schools, but included some high schools in 2013. The questionnaire includes a set of questions consistent across all survey waves, as well as optional questions chosen by municipalities based on their specific interests and needs. The online questionnaires are administered anonymously during school hours. For further information on Ungdata, refer to their website (Ungdatasenteret, n.d.-b).

This study used data from high school students from Wave 1 to Wave 3. A total of 324,720 high school students completed the survey, with response rates ranging from 65% to 73% [24–31]. Non-response was primarily due to either absence from school during the survey period or a lack of interest in participating. While all three waves from Finnmark data were used for analysis, Wave 1 data (2014–2016) from Norway overall was excluded. This was due to several municipalities in central Norway not being included in Wave 1, leading to a significant discrepancy in student number between Waves 1 and 2 —Wave 1 had 70,676 students, while Wave 2 had 128,543 students. Overall, the study used data from 6,084 high school students from Finnmark in the three survey waves and 254,048 students from Norway overall across the two waves. Table 1 presents the characteristics of participants by survey year. The data used for this study were obtained from the Survey Bank of the Norwegian Agency for Shared Services in Education and Research [32].).

Table 1.

Characteristics of participants by survey year.

		Finnmark (nf = 6084)			Norway (nn = 254 048)
		2014-2016	2017-2019	2020-2023	2017-2019	2020-2023
Gender	Males	916	1 049	1 000	61 936	59 762
		(50.3%)	(50.2%)	(48.0%)	(49.9%)	(48.6%)
	Females	905	1 042	1 085	62 275	63 210
		(49.7%)	(49.8%)	(52.0%)	(50.1%)	(51.4%)
	Missing	13	30	44	4 332	2 533
		(0.7%)	(1.4%)	(2.1%)	(3.4%)	(2.0%)
Grade level	10th	821	797	936	55 334	52 418
		(45.1%)	(38.8%)	(44.2%)	(43.5%)	(42.0%)
	11th	696	789	749	43 869	44 346
		(38.3%)	(38.5%)	(35.3%)	(34.5%)	(35.5%)
	12th	302	466	434	28 079	28 075
		(16.6%)	(22.7%)	(20.5%)	(22.1%)	(22.5%)
	Missing	15	69	10	1 261	666
		(0.8%)	(3.3%)	(0.5%)	(1.0%)	(0.5%)
Total		1 834	2 121	2 129	128 543	125 505

Measurement

This study utilised the questions from the core module, which were consistent across all survey waves and comprised about 100 questions [33]. The core questions covers various aspects of adolescents’ lives, including their free-time activities, physical activity levels, social media use, environmental factors (such as family, friends, school, and local community), substance use, antisocial behaviours, depressive thoughts, and future outlook. Questions that were not asked to all grades, particularly those not administered to the 10th-grade students, and questions with more than 10% missing values among students in Finnmark were excluded. A total of 65 variables were used for data analysis. The Appendix provides the exact wording of each question used to create the variables.

This study employed reverse coding, with higher scores indicating undesirable content or phenomena. For instance, a variable measuring school attendance was categorised into four levels, where the statement “I often don’t want to go to” was rated on a scale from 1 to 4. “Totally agree” was assigned a value of 4, and “totally do not agree” was assigned a value of 1, with 1 being considered undesirable.

Data analysis

The study used Multivariate Analysis of Variance (MANOVA) with polynomial contrasts to assess linear trends among high school students in Finnmark, adjusting for any changes in gender and grade prevalence. MANOVA with difference contrast was used to determine pairwise differences between students in Finnmark and the national average in Norway, with gender and grade as weighted factors.

Given that multiple hypotheses are simultaneously tested, this study applies Benjamini-Hochberg (BH) adjustment, a method for controlling the false discovery rate (FDR) to address Type I error of multiple comparisons [34]. A significance threshold of q < 0.05 was set, where the q-value represents the BH-adjusted p-value. Data analysis was conducted using SPSS Statistics 28 (IBM Corp., Armonk, N.Y., USA).

Ethics

The study used anonymised databases from the Ungdata survey, which had been approved by the Norwegian Centre for Research Data and conducted in accordance with the Declaration of Helsinki. Participation in the survey was voluntary, and informed consent was obtained from all students prior to the survey. Ethical concerns were addressed by the institutions conducting the survey, and a separate ethics approval for this study was not required.

Results

Trend analysis among high school students in Finnmark

Table 2 presents trends in selected variables among high school students in Finnmark. The results indicate that out of 63 variables, 26 worsened over time, particularly regarding depression and future outlook. Meanwhile, 25 variables, including physical activities and bullying, remained unchanged. Twelve variables, mostly related to relationships with parents and substance use, showed improvement over time.

Table 2.

Trends in selected variables among high school students in Finnmark (n = 6084).

factor	variables	mean			p	q	ηp2	T
		w1	w2	w3
free time	spent most of the evening out with friends/mates	2.24	2.11	2.18	.004	.007	.004	LR
	spent the whole evening at home	2.82	2.93	3.05	.000	.000	.013	LW
	spent most of the evening playing online games	1.77	1.84	1.90	.000	.000	.299	LW
	spent most of the evening socializing on the internet	3.01	3.13	3.08	.017	.026	.013	Q
	a member of any organizations, clubs, societies or associations?	1.71	1.69	1.73	.576	.615	.001	S
media use	watching TV	2.77	2.31	2.27	.000	.000	.027	LR
	reading books (not school-related)	5.44	5.51	5.49	.193	.238	.007	S
	playing computer games/video games	2.69	2.70	2.82	.000	.000	.371	LW
	playing games on your mobile/table	2.57	2.48	2.50	.268	.319	.008	S
	social media (Facebook, Instagram, etc.)	4.29	4.61	4.84	.000	.000	.105	LW
	time to spend on activities that involve looking at a screen each day	4.93	5.22	5.57	.000	.000	.037	LW
physical activity	physical activity which gets you out of breath or makes you sweaty	2.62	2.66	2.60	.213	.258	.006	S
	train or keep fit independently (running, swimming, cycling, walking)	5.57	5.57	5.69	.001	.002	.004	LW
	other kinds of organized physical activity (dance, martial arts, etc.)	4.06	4.08	4.01	.177	.228	.016	S
parentes	my parents usually know where I am, and who I’m with,	1.82	1.73	1.59	.000	.000	.047	LR
	my parents know most of the friends I hang out with in my free time	1.81	1.76	1.65	.000	.000	.019	LR
	financially, has your family been well off over the past two years?	2.11	2.08	1.92	.000	.000	.010	LR
	how happy or unhappy are you with your parents?	1.71	1.62	1.59	.048	.072	.002	S
friends	number of friends who you trust completely and who you can tell anything	1.48	1.49	1.57	.000	.000	.005	LW
	how happy or unhappy are you with your friends?	1.67	1.70	1.75	.189	.238	.002	S
school	I enjoy school	1.42	1.53	1.71	.000	.000	.027	LW
	my teachers care about me	1.68	1.80	1.86	.000	.000	.026	LR
	I feel that I fit in with the students at my school	1.62	1.73	1.85	.000	.000	.021	LW
	I´m bored at school	2.68	2.81	2.85	.000	.000	.008	LW
	I often don´t want to go to school	1.77	1.82	1.87	.127	.174	.008	S
	how long do you spend on homework and other schoolwork?	5.23	5.27	5.16	.174	.228	.071	S
	the school you go to	2.26	2.35	2.33	.288	.330	.018	S
local environment	places for meeting other young people in your free time	3.13	3.13	3.26	.141	.189	.010	S
	sports facilities	2.33	2.33	2.40	.373	.405	.001	S
	culture (cinemas, concert veneus, libraries, etc.)	2.52	2.47	2.68	.000	.000	.026	LW
	public transport (buses, trains, trams, etc.)	3.43	3.49	3.51	.977	.977	.007	S
	when you are out in the evening, do you feel safe in the local area?	1.39	1.50	1.51	.000	.000	.044	LW
	the local community where you live	2.43	2.56	2.55	.006	.011	.013	LW
bullying	take part in teasing, threatening og freezing out other young people?	1.28	1.30	1.28	.672	.706	.023	S
	sometimes teased, threatened or frozen out by other young people?	1.62	1.61	1.52	.086	.123	.005	S
antisocial behavior	take something from a shop without paying	1.10	1.12	1.15	.013	.022	.016	LW
	deliberately damaged or broken windowpanes, bus seats, etc.	1.05	1.07	1.10	.014	.023	.026	LW
	illegally spray-painted or tagged walls, buildings, trains, buses, etc.	1.02	1.04	1.04	.125	.174	.005	S
	not paid for the cinema, sporting events, bus and train tickets, etc.	1.29	1.33	1.57	.000	.000	.024	LW
	spent the whole night away from home without your parents knowing	1.72	1.67	1.65	.080	.117	.014	S
	skipped school	2.12	1.82	1.88	.000	.000	.035	LR
substance use	do you smoke?	1.73	1.64	1.58	.000	.000	.020	LR
	do you use snus (tobacco that you put under your lip)?	2.20	1.84	1.73	.000	.000	.026	LR
	do you ever drink any kinds of alcoholic drinks?	2.96	2.85	2.79	.001	.002	.119	LR
	do your parents allow you to drink alcohol?	2.24	2.20	2.13	.003	.006	.285	LR
	had so much to drink that you felt clearly intoxicated	2.77	2.52	2.57	.000	.000	.102	LR
	used hash/maijuana/cannabis	1.13	1.17	1.14	.329	.364	.013	S
	used other drugs	1.05	1.07	1.08	.275	.321	.007	S
	over the past 12 months, have you been offered cannabis?	1.98	1.99	1.99	.919	.949	.002	S
health	how many times have you had headache?	2.11	2.28	2.23	.000	.000	.108	LW
	how often have you used over-the-counter medicines?	2.01	2.05	1.95	.013	.022	.062	Q
	your health	2.43	2.52	2.46	.328	.364	.014	S
	your appearance	2.63	2.64	2.64	.965	.977	.044	S
depression	felt that everything is a struggle	2.25	2.53	2.44	.000	.000	.112	LW
	had sleep problems	1.97	2.14	2.25	.000	.000	.026	LW
	felt unhappy, sad or depressed	1.90	2.13	2.19	.000	.000	.065	LW
	felt hopelesness about the future	1.96	2.17	2.10	.000	.000	.062	LW
	felt stiff or tense	1.94	2.08	2.20	.000	.000	.08	LW
	worried to much about things	2.25	2.61	2.57	.000	.000	.139	LW
	felt lonely	1.87	2.04	2.06	.000	.000	.041	LW
future	will be unemployed at some point in your life?	1.64	1.77	1.73	.000	.000	.019	LW
	will study at a university or university college?	1.52	1.58	1.54	.016	.025	.109	Q
	will have a good, happy life?	1.30	1.42	1.37	.000	.000	.009	LW

Finn: Finnmark; w1: 2014–2016; w2: 2017–2019; w3: 2020–2023; q: Benjamini-Hochberg adjusted p-value; ηp²: Partial Eta Squared; T: overall trend.

A significance threshold of q < .05 was used.

Q-values in bold indicate significance.

Trend descriptions: LR = linear trend in the right direction, LW = linear trend in the wrong direction, Q = quadratic trend, S = stable.

Free time use (free time, media, physical activity)

Three variables related to physical activity either displayed negative trends or showed no significant change over time. “Spending most evenings at home” or “playing online games” exhibited negative trends (q = .000, ηp² = .013, and q = .000, ηp² = .299, respectively), whereas “spending the evenings with friends” demonstrated positive trends (q = .007, ηp² = .004). Similarly, “social media usage” and “playing computer games” displayed negative trends (q = .000, ηp² = .105, and q = .000, ηp² = .371, respectively), while no change was observed in “reading books” (q = .238, ηp² = .007). However, “the average time spent watching TV” decreased over time (q = .000, ηp² = .027).

Environment factors (parents, friends, school, and local environment)

Negative trends were observed in “the number of trustworthy friends” (q = .000, ηp² = .005) and school-related factors, such as “I enjoy school” (q = .000, ηp² = .027), “I feel that I fit in with the students at my school” (q = .000, ηp² = .021), and “I’m bored at school” (q = .000, ηp² = .008). Negative trends were also noted in variables related to the local environment, such as “satisfaction with cultural facilities” (q = .000, ηp² = .026), “satisfaction with local communities” (q = .011, ηp² = .013), and “feeling safe in the local areas” (q = .000, ηp² = .044). Seven out of 19 variables (36.9%) did not show significant trend over time, including the quality of local facilities where youth can meet each other, and satisfaction with parents, school, friends, and public transportation. In contrast, three out of four variables related to parents, such as “my parents usually know where I am and who I’m with” (q = .000, ηp² = .048), “my parents know most of my friends” (q = .000, ηp² = .019), and “my family has been financially stable” (q = .000, ηp² = .010).

Risk behaviors

Smoking (q = .000, ηp² = .020), snus use (q = .000, ηp² = .026), and three variables related to drinking (q = .002, ηp² = .119; q = .006, ηp² = .285; and q = .000, ηp² = .102, respectively) decreased over time, while three variables associated with cannabis and other drug use have shown no significant change. Of the six variables on antisocial behaviour, three showed negative trends: “deliberately damaging objects” (q = .023, ηp² = .026) and behaviours related to not paying at shops (q = .022, ηp² = .016), and public transportation (q = .002, ηp² = .024). Variables related to bullying did not show any significant trend over time.

Depressive thoughts and own health

Negative trends were observed in all seven variables related to depressive thoughts and two out of three variables related to future outlook. These negative trends included “feelings of loneliness” (q = .000, ηp² = .041), “worried too much about things” (q = .000, ηp² = .139), and “a lack of hope for a good life” (q = .000, ηp² = .041). Additionally, the prevalence of headaches increased (q = .000, ηp² = .108). No change was observed in satisfaction levels related to health and appearance.

Pairwise comparison between students in Finnmark and the national average

Table 3 provides a comparison of high school students in Finnmark and the national average in Norway over two survey waves (Wave 2: 2017–2019 and Wave 3: 2020–2023). The results showed that out of 63 variables, 43 and 41 variables had higher mean scores, indicating less desirable in Finnmark than in Norway during both survey waves, respectively. Variables related to physical activity, media use, bullying, relationships with parents, friends, and school were less desirable in Finnmark. However, the prevalence of substance use was lower in Finnmark compared to Norway.

Table 3.

Pairwise comparison of selected variables among high school students in Finnmark (n_f = 6084) and Norway overall (n_n = 254 048) by survey year.

		Mean score
Factor	Variables	Norway	Finn.	p	q	ηp2
Wave 2: 2017-2019
free time	spent most of the evening out with friends/mates	2.12	2.11	.355	.379	.002
	spent the whole evening at home	2.87	2.93	.000	.000	.001
	spent most of the evening playing online games	1.73	1.84	.000	.000	.304
	spent most of the evening socializing on the internet	3.09	3.13	.041	.050	.018
	a member of any organizations, clubs, societies or associations?	1.62	1.69	.000	.000	.004
media use	watching TV	2.31	2.31	.671	.671	.002
	reading books (not school-related)	5.50	5.52	.471	.486	.011
	playing computer games/video games	2.50	2.70	.000	.000	.365
	playing games on your mobile/table	2.38	2.48	.000	.000	.006
	social media (Facebook, Instagram, etc.)	4.37	4.61	.000	.000	.084
	time to spend on activities that involve looking at a screen	4.99	5.22	.000	.000	.009
physical activity	physical activity which gets you out of breath	2.53	2.66	.000	.000	.017
	train or keep fit independently (running, swimming, walking)	5.46	5.57	.070	.083	.008
	other kinds of organized physical activity (dance, martial arts)	4.04	4.08	.000	.000	.010
parentes	my parents usually know where I am, and who I’m with	1.49	1.73	.000	.000	.018
	my parents know most of the friends I hang out with	1.71	1.76	.000	.000	.012
	financially, has your family been well off over the past 2 years?	1.91	2.08	.000	.000	.005
	how happy or unhappy are you with your parents?	1.59	1.62	.005	.006	.001
friends	friend who you trust completely and who you can tell anything	1.42	1.49	.000	.000	.003
	how happy or unhappy are you with your friends?	1.57	1.70	.000	.000	.002
school	I enjoy school	1.46	1.53	.000	.000	.003
	my teachers care about me	1.74	1.80	.000	.000	.009
	I feel that I fit in with the students at my school	1.66	1.73	.000	.000	.014
	I´m bored at school	2.76	2.81	.000	.000	.002
	I often don´t want to go to school	1.74	1.82	.000	.000	.008
	how long do you spend on homework and other schoolwork?	5.13	5.27	.000	.000	.086
	how happy or unhappy are you with the school you go to	2.13	2.35	.000	.000	.009
local environment	places for meeting other young people in your free time	3.11	3.13	.073	.085	.012
	sports facilities	2.18	2.33	.000	.000	.002
	culture (cinemas, concert veneus, libraries, etc.)	2.46	2.47	.335	.364	.000
	public transport (buses, trains, trams, etc.)	2.76	3.49	.000	.000	.016
	when in the evening, do you feel safe in the local area?	1.59	1.50	.000	.000	.073
	how happy or unhappy are you with the local community	2.23	2.56	.000	.000	.012
bullying	take part in teasing, threatening other young people?	1.27	1.30	.000	.000	.025
	sometimes teased, threatened by other young people?	1.52	1.61	.000	.000	.003
antisocial behavior	take something from a shop without paying	1.15	1.12	.009	.011	.017
	deliberately damaged or broken window panes, bus seats, etc	1.11	1.07	.000	.000	.033
	illegally spray-painted or tagged walls, buildings, buses, etc.	1.04	1.04	.402	.422	.005
	not paid for the cinema, sporting events, bus and train tickets, etc.	1.65	1.33	.000	.000	.007
	spent the whole night away from home without knowing	1.44	1.67	.000	.000	.017
	skipped school	1.77	1.82	.005	.006	.018
substance use	do you smoke?	1.57	1.64	.000	.000	.018
	do you use snus (tobacco that you put under your lip)?	1.80	1.84	.575	.584	.019
	do you ever drink any kinds of alcoholic drinks?	2.96	2.85	.000	.000	.100
	do your parents allow you to drink alcohol?	2.21	2.20	.000	.000	.265
	had so much to drink that you felt clearly intoxicated	2.52	2.52	.082	.094	.094
	used hash/maijuana/cannabis	1.28	1.17	.000	.000	.022
	used other drugs	1.08	1.07	.001	.000	.006
	over the past 12 months, have you been offered cannabis?	2.04	1.99	.000	.000	.008
health	how many times have you had headache?	2.23	2.28	.000	.000	.100
	how often have you used over-the-counter medicines?	1.97	2.05	.000	.000	.055
	how happy or unhappy are you with your health	2.31	2.52	.000	.000	.022
	how happy or unhappy are you with your appearance	2.55	2.64	.000	.000	.062
depression	felt that everything is a struggle	2.40	2.53	.000	.000	.106
	had sleep problems	2.15	2.14	.142	.160	.023
	felt unhappy, sad or depressed	2.07	2.13	.000	.000	.057
	felt hopelesness about the future	2.07	2.17	.000	.000	.059
	felt stiff or tense	2.08	2.08	.153	.169	.099
	worried to much about things	2.53	2.61	.000	.000	.136
	felt lonely	1.95	2.04	.000	.000	.041
future	will be unemployed at some point in your life?	1.73	1.77	.000	.000	.008
	will study at a university or university college?	1.42	1.58	.000	.000	.079
	will have a good, happy life?	1.36	1.42	.000	.000	.003
Wave 3: 2020-2023
free time	spent most of the evening out with friends/mates	2.16	2.18	.537	.573	.001
	spent the whole evening at home	3.02	3.05	.006	.008	.000
	spent most of the evening playing online games	1.79	1.90	.000	.000	.286
	spent most of the evening socializing on the internet	3.03	3.08	.001	.000	.010
	a member of any organizations, clubs, societies or associations?	1.65	1.73	.000	.000	.003
media use	watching TV	2.36	2.27	.000	.000	.004
	reading books (not school-related)	5.45	5.49	.022	.027	.013
	playing computer games/video games	2.57	2.82	.000	.000	.355
	playing games on your mobile/table	2.41	2.50	.000	.000	.008
	social media (Facebook, Instagram, etc.)	4.66	4.84	.000	.000	.069
	time to spend on activities that involve looking at a screen	5.34	5.57	.000	.000	.002
physical activity	physical activity which gets you out of breath	2.51	2.60	.000	.000	.025
	train or keep fit independently (running, swimming, walking)	5.60	5.69	.000	.000	.010
	other kinds of organized physical activity (dance, martial arts)	4.03	4.01	.001	.000	.008
parentes	my parents usually know where I am, and who I’m with	1.46	1.59	.000	.000	.016
	my parents know most of the friends I hang out with	1.66	1.65	.486	.528	.009
	financially, has your family been well off over the past 2 years?	1.82	1.92	.000	.000	.003
	how happy or unhappy are you with your parents?	1.54	1.59	.000	.000	.004
friends	friend who you trust completely and who you can tell anything	1.46	1.57	.000	.000	.004
	how happy or unhappy are you with your friends?	1.59	1.75	.000	.000	.002
school	I enjoy school	1.61	1.71	.000	.000	.003
	my teachers care about me	1.84	1.86	.633	.654	.008
	I feel that I fit in with the students at my school	1.76	1.85	.000	.000	.010
	I´m bored at school	2.84	2.85	.150	.178	.001
	I often don´t want to go to school	1.81	1.87	.000	.000	.013
	how long do you spend on homework and other schoolwork?	5.11	5.16	.006	.008	.076
	how happy or unhappy are you with the school you go to	2.05	2.33	.000	.000	.008
local environment	places for meeting other young people in your free time	3.06	3.26	.000	.000	.015
	sports facilities	2.10	2.40	.000	.000	.003
	culture (cinemas, concert veneus, libraries, etc.)	2.52	2.68	.000	.000	.000
	public transport (buses, trains, trams, etc.)	2.55	3.51	.000	.000	.017
	when in the evening, do you feel safe in the local area?	1.61	1.51	.000	.000	.065
	how happy or unhappy are you with the local community	2.15	2.55	.000	.000	.015
bullying	take part in teasing, threatening other young people?	1.23	1.28	.000	.000	.026
	sometimes teased, threatened by other young people?	1.40	1.52	.000	.000	.002
antisocial behavior	take something from a shop without paying	1.17	1.15	.039	.047	.010
	deliberately damaged or broken windowpanes, bus seats, etc	1.09	1.10	.715	.715	.030
	illegally spray-painted or tagged walls, buildings, buses, etc.	1.05	1.04	.165	.193	.006
	not paid for the cinema, sporting events, bus and train tickets, etc.	1.77	1.57	.000	.000	.009
	spent the whole night away from home without knowing	1.43	1.65	.000	.000	.009
	skipped school	1.85	1.88	.008	.010	.031
substance use	do you smoke?	1.57	1.58	.590	.619	.009
	do you use snus (tobacco that you put under your lip)?	1.76	1.73	.000	.000	.016
	do you ever drink any kinds of alcoholic drinks?	2.93	2.79	.000	.000	.087
	do your parents allow you to drink alcohol?	2.21	2.13	.000	.000	.245
	had so much to drink that you felt clearly intoxicated	2.58	2.57	.706	.715	.079
	used hash/maijuana/cannabis	1.32	1.14	.000	.000	.017
	used other drugs	1.12	1.08	.000	.000	.009
	over the past 12 months, have you been offered cannabis?	2.06	1.99	.000	.000	.010
health	how many times have you had headache?	2.21	2.23	.283	.313	.106
	how often have you used over-the-counter medicines?	1.94	1.95	.227	.255	.078
	how happy or unhappy are you with your health	2.27	2.46	.000	.000	.027
	how happy or unhappy are you with your appearance	2.49	2.64	.000	.000	.053
depression	felt that everything is a struggle	2.36	2.44	.000	.000	.093
	had sleep problems	2.15	2.25	.000	.000	.016
	felt unhappy, sad or depressed	2.08	2.19	.000	.000	.049
	felt hopelesness about the future	2.05	2.10	.003	.004	.049
	felt stiff or tense	2.13	2.20	.000	.000	.094
	worried too much about things	2.50	2.57	.000	.000	.117
	felt lonely	1.94	2.06	.000	.000	.027
future	will be unemployed at some point in your life?	1.71	1.73	.206	.236	.010
	will study at a university or university college?	1.40	1.54	.000	.000	.096
	will have a good, happy life?	1.33	1.37	.000	.000	.002

Finn.: Finnmark; q: Benjamini-Hochberg adjusted p-value; ηp²: Partial Eta Squared.

A significance threshold of q < .05 was used.

Q-values in bold indicate significance.

Mean values with bold and italics indicate those that are better in Finnmark than in Norway.

Free Time Use (free time, media, physical activity)

High school students in Finnmark had higher scores in 10 and 11 out of 14 variables compared to the national average in Norway in Waves 2 and 3 respectively. These variables include “spent most of the evening playing online games” (Wave 2: q = .000, ηp² = .304; Wave 3: q = .000, ηp² = .286) and “playing online games using computers” (Wave 2: q = .000, ηp² = .365; Wave 3: q = .000, ηp² = .355), as well as “social media use” (Wave 2: q = .000, ηp² = .084; Wave 3: q = .000, ηp² = .069). No difference was found in “spending most of the evening out with friends or mates” in either wave. The score for “participating in organised physical activities such as dance and martial arts” was higher in Finnmark than the national average in Wave 2 (Norway = 4.04, Finnmark = 4.08, q = .000, ηp² = .010) but lower in Wave 3 (Norway = 4.03, Finnmark = 4.01, q = .000, ηp² = .008).

Environment factors (parents, friends, school, and local environment)

In both waves, students in Finnmark showed higher scores in all variables related to relationships with friends compared to the national average in Norway, such as “friend who you trust completely” (Wave 2: q = .000, ηp² = .003; Wave 3: q = .000, ηp² = .004) and “being happy with friends” (Wave 2: q = .000, ηp² = .002; Wave 3: q = .000, ηp² = .002). All ten variables related to parents and school were significantly higher scores among students in Finnmark than the national average in Wave 2, including “parents knowing where I am” (q = .000, ηp² = .018) and “spending on homework and other schoolwork” (q = .000, ηp² = .086). However, variables like “parents knowing my friends” (Wave 2: q = .000, ηp² = .012; Wave 3: q = .528, ηp² = .009), “whether teachers care about them” (Wave 2: q = .000, ηp² = .009; Wave 3: q = .654, ηp² = .008), and “being bored at school” (Wave 2: q = .000, ηp² = .008; Wave 3: q = .178, ηp² = .001) did not show a significant difference in Wave 3. Variables related to the local environment indicated that Finnmark students had higher satisfaction in both waves for factors such as such as “public transportation” (Wave 2: q = .000, ηp² = .016; Wave 3: q = .000, ηp² = .017) and “being happy with local communities” (Wave 2: q = .000, ηp² = .012; Wave 3: q = .000, ηp² = .015). However, Finnmark students reported lower scores in “feeling safe in the local area” (Wave 2: Norway = 1.59, Finnmark = 1.50, q = .000, ηp² = .073; Wave 3: Norway = 1.61, Finnmark = 1.51, q = .000, ηp² = .065).

Risk behaviors

The scores for all eight substance use variables were either low or not significantly different among students in Finnmark when compared to the national average in Norway in both waves, except in “smoking” in Wave 2 (Norway = 1.57, Finnmark = 1.64, q = .000, ηp² = .018). Substance use variables that had lower scores among students in Finnmark include “having drunk any kinds of alcohol” (Wave 2: Norway = 2.96, Finnmark = 2.85, q = .000, ηp² = .100; Wave 3: Norway = 2.93, Finnmark = 2.79, q = .000, ηp² = .087), “parents allowing to them to drink” (Wave 2: Norway = 2.21, Finnmark = 2.20, q = .000, ηp² = .265; Wave 3: Norway = 2.21, Finnmark = 2.13, q = .000, ηp² = .245), and three variables related to drug use, such as “being offered cannabis in the past 12 months” (Wave 2: Norway = 2.04, Finnmark = 1.99, q = .000, ηp² = .008; Wave 3: Norway = 2.06, Finnmark = 1.99, q = .000, ηp² = .010).

In terms of antisocial behaviours, two variables – “spent the whole night out without parents knowing” (Wave 2: q = .000, ηp² = .017; Wave 3: q = .000, ηp² = .009) and “skipped school” (Wave 2: q = .006, ηp² = .018; Wave 3: q = .010, ηp² = .031) – had higher scores among students in Finnmark in both waves. Meanwhile, the variable “not paying at shops and other places” had lower scores in both waves (Wave 2: Norway = 1.15, Finnmark = 1.12, q = .011, ηp² = .017; Wave 3: Norway = 1.17, Finnmark = 1.15, q = .047, ηp² = .010). Variables related to bullying had higher scores among students in Finnmark compared to the national average, including “take part in teasing, threatening other young people” (Wave 2: q = .000, ηp² = .025; Wave 3: q = .000, ηp² = .026).

Depressive thoughts and own health

Five out of seven variables on depressive thoughts and symptoms had higher values among students in Finnmark in Wave 2, while all variables had higher values in Wave 3. This includes statement such as “felt that everything is a struggle” (Wave 2: q = .000, ηp² = .106; Wave 3: q = .000, ηp² = .093), “felt hopelessness about the future” (Wave 2: q = .000, ηp² = .059; Wave 3: q = .004, ηp² = .049), and “worried too much about things” (Wave 2: q = .000, ηp² = .136; Wave 3: q = .000, ηp² = .117).

Regarding the variables related to own health and future outlook, four out of seven variables had higher values among the students in Finnmark in both waves. For Wave 2, no significant differences were found in three variables, including “being happy with my health” (Wave 2: q = .000, ηp² = .022; Wave 3: q = .000, ηp² = .027), “being happy with my appearance” (Wave 2: q = .000, ηp² = .062; Wave 3: q = .000, ηp² = .053), and “planning to study at university or college” (Wave 2: q = .000, ηp² = .079; Wave 3: q = .000, ηp² = .096).

Discussion

This study aimed to assess trends of well-being, factors surrounding adolescents, and risk behaviours of high school students in Finnmark, and compare them with the national average in Norway by using Ungdata, a database designed for adolescent health. The study used multivariate analysis of variance (MANOVA) with polynomial contrasts to assess linear trends among high school students in Finnmark, and MANOVA with difference contrast to determine pairwise differences between the students in Finnmark and the national average in Norway. Trend analysis showed that out of 63 variables, 26 deteriorated over time, particularly depressive thoughts and outlook on the future. Meanwhile, 25 variables, such as physical activities and bullying, remained unchanged. This suggests that over 80% of the indicators among high school students in Finnmark did not improve between 2014 and 2023. In contrast, 13 variables showed improvement over time, particularly variables related to relationships with parents and substance use. Pairwise comparisons showed that more than half of the variables had lower values in Finnmark than in Norway in all two waves. These variables include physical activity, media use, bullying, relationships with parents and friends, school connectedness, and satisfaction. While substance use decreased, depression increased more significantly in Finnmark than in Norway over time.

Free time use (free time, media, physical activity)

Trend analysis revealed that high school students in Finnmark spend more time on digital devices, such as social media and online games, while the time spent for physical activities like walking and jogging has declined. Comparisons with the national average in Norway show that students in Finnmark spend more time on digital devices at home and less time for physical training. While there has been no change in the amount of time they spend on organisational activities, students in Finnmark participate in these activities less frequently than the national average. These results indicate that students in Finnmark have become more inactive over time and are less active than the national average.

In Norway, 79% of male and 89% of female adolescents aged 11–17 did not meet the World Health Organization’s recommended levels of physical activity in 2022 [35]. Additionally, 97% of young people aged 16–24 had used social media in the last three months [36]. Given the study’s results, which indicate that students in Finnmark were less active and spent more time on digital devices, one possible solution is to encourage them to join youth clubs for sports, music, and other social activities. However, due to COVID-19, participation rates in Northern Norway were lower in 2022 compared to other regions in the country [37]. Additionally, due to the population decline in most municipalities in Finnmark County [38], many youth clubs and culture schools (municipality-owned after-school schemes that provide music and visual art classes) are facing downsizing or closure.

Environment factors (parents, friends, school, and local environment)

Relationship with friends, school connectedness, and satisfaction with the local area and facilities either worsened or remained unchanged over time for high school students in Finnmark. It also showed that students in Finnmark feel less satisfied or worse than the national average in Norway. Specifically, they reported having fewer friends they could trust, not enjoying school, and are not satisfied with cultural facilities such as libraries and public transportation. However, students in Finnmark reported feeling safer in their local area and more satisfied with their teachers than the national average. Although the relationship with parents improved over time, they did so less significantly than the national average in both waves.

Factors such as parental relationships, school connectedness, peer relationships, and the local environment can either be protective or risk factors for adolescent health and risk-taking behaviours [1,2]. Several studies have examined the impact of various factors on the mental health and risk-taking behaviour of adolescents in Norway. These factors include family cohesion and school climate, which have been linked to mental well-being [6]; parental socioeconomic status, which has been associated with high school dropout rates [39]; and parental control, which has been found to affect drinking behaviour [9]. Similarly, studies conducted in Northern Norway have shown that factors like relationships with parents, stepparent families, and friends can influence suicidal thoughts and attempts [20], while family conflict and connectedness have been linked to self-reported internalising symptoms among Sámi youth [40]. Therefore, understanding these factors is crucial for creating effective public health policies, especially for adolescents.

Risk behaviors

Smoking, snus, and drinking behaviours have declined over time among high school students in Finnmark, while cannabis and other drug use remained unchanged. Conversely, antisocial behaviours, such as deliberately damaging property and evading payments in shops or on public transportation have increased over time. Despite these trends, both substance use, and antisocial behaviours are less common among students in Finnmark compared to the national average in Norway. However, bullying or being bullied has remained unchanged over time and is more frequent among students in Finnmark than the national average.

The decline in alcohol and smoking use among adolescents is recognised as an international trend [9], and this pattern is also observed among students in Finnmark County. The prevalence of antisocial behaviours among students in Finnmark has increased over time, although it remains lower than the national average in Norway. Several factors influence antisocial behaviours, including parenting patterns, peer influence, school well-being, self-control, depressive thoughts, living environment, socio-economic conditions, and smartphone use intensity [41,42]. The results of this study show that many of these factors worsened or did not improve, except for the relationship with parents, which indicated an increase in anti-social behaviours among students in Finnmark.

Although the prevalence of bullying has remained unchanged over time, Finnmark County still has a higher prevalence than the national average. This is a major concern in Northern Norway [43,44], including Finnmark. Cyberbullying, which takes place over digital devices like computers and tablets, has increased in recent years [45].). Since digital device usage has also increased in Finnmark, it’s necessary to strengthen measures to prevent and protect against cyberbullying. Several studies have shown that Sámi youth face more discrimination than non-Sámi [46,47], which might explain why there’s a higher incidence of bullying among students in Finnmark than the national average. Although this study did not include ethnicity indicators, it is possible that ethnic-cultural bullying is also contributing to the issue.

Depressive thoughts and own health

Results showed that high school students in Finnmark had a higher prevalence of depressive thoughts and symptoms, as well as negative thoughts about the future, compared to the national average in Norway. This aligns with reports of increasing rates of depression and dissatisfaction among Norwegian adolescents [48,49]. It is well-documented that mental health challenges disproportionately affect Arctic populations, as evidenced by several studies. These studies demonstrate the prevalence of mental health issues among young people of diverse ethnic groups in Arctic regions such as Alaska, northern Canada, and Greenland [50], as well as disparities in suicidal thoughts and alcohol-related disorders between Arctic and non-Arctic populations in the US [51]. Other studies have shown the prevalence of mental health issues and youth suicide among Alaskan Arctic populations [22] and health disparities in five circumpolar communities, namely Alaskan Yup’ik, Alaskan Inupiaq, Canadian Inuit, Norwegian Sámi, and Siberian Eveny [52].

In Finnmark County, distinct factors may be contributing to the higher prevalence of depression among adolescents. For instance, this study revealed that students in Finnmark are less satisfied with their health and their environment, including school, friends, and neighbours. These factors could be influencing the negative trends of depressive thoughts and the higher prevalence of depression among students in Finnmark. Thus, it is critical to establish strategies to improve these factors and reduce depressive thoughts and symptoms.

Lessons for others and future implications

The study’s findings from Finnmark offer crucial insights into adolescent health trends in geographically isolated and sparsely populated regions, particularly within the circumpolar North. Finnmark’s trends in physical inactivity, digital device use, and depressive symptoms align with global concerns surrounding adolescent well-being. However, the distinctive sociocultural context of Finnmark, including the multiethnic composition such as Sámi and Kven populations, adds a layer of complexity that can inform health strategies in similar contexts globally. These factors highlight the importance of culturally sensitive and geographically tailored public health interventions.

In comparison with other circumpolar regions, similar challenges related to mental health disparities and physical inactivity have been identified, further emphasising the need for region-specific approaches. For example, mental health issues among adolescents in Alaska, northern Canada, and Greenland mirror those found in Finnmark, with isolation, harsh climate, and limited access to mental health resources contributing to these disparities. Additionally, the sharp decline in physical activity in Finnmark compared to national averages underscores the influence of environmental factors, which are common challenges in other Arctic regions as well. The rise in antisocial behaviours in Finnmark highlights a divergence from other regions in Norway and possibly other countries, suggesting a local or regional issue that requires further exploration into community and family dynamics.

The study’s recommendations point to the need for enhanced mental health services, the promotion of physical activity through culturally and climatically adapted programmes, and stronger interventions to address antisocial behaviours and bullying. Future research should focus on multiethnic and indigenous contexts, particularly the Sámi and Kven populations, and involve longitudinal studies to evaluate the long-term effectiveness of public health policies. These insights are critical for developing health strategies that are responsive to the unique sociocultural and environmental challenges faced by adolescents in Finnmark and similar regions.

Limitation

The present study had several limitations that should considered. First, the Ungdata survey is school based, which excludes students who have dropped out of school. Second, the response rate of high school students was lower than that of junior high students, with only around 66–68% of high school students responding, compared to 80–83% of junior high students. This lower response rate may have introduced some bias in the results.

Additionally, the survey used cross-sectional data, preventing the establishment of causal inferences or temporal relationships between the studied variables. Some questions were answered retrospectively, making them susceptible to recall bias and memory lapses.

The study should also consider limitations inherent to longitudinal research, such as the effects of time and period, including changes in the broader social and policy landscape. For instance, during Wave 3 data collection, the challenges faced by students due to COVID-19 May have influenced their responses.

Another limitation is the inconsistency in the time frames used to assess variables. Free time was measured over the past 7 days, media use had no specific time frame, antisocial behaviour and drug use were assessed over the past year, and depression was measured over the past week. The timing of data collection, such as during exams or emotionally stressful periods, may have influenced results, especially for variables like depression, which are assessed over shorter time frames.

Both trend and comparison analyses showed small effect sizes, so the findings should be interpreted with caution. The small effect sizes are partially due to the large sample size and different sample sizes between students in Finnmark and those throughout Norway. However, despite small effect sizes, the results provided meaningful insights for public health policy regarding adolescents in Finnmark, including recommendations for mental health services, promoting physical activity, and reducing antisocial behaviours and bullying. While the statistical significance suggests the observed effects are unlikely due to chance, it is important to note the small effect sizes.

Lastly, the survey did not include indicators related to ethnicity. Given the distinct socio-cultural and multi-ethnic contexts of Finnmark County, particularly the presence of the Sámi and Kven people, as well as individuals from Northern Finland, Northern Sweden, and Russia, and the inter-marriage of these groups, the diversity within these populations may have influenced factors affecting adolescents, such as family, social networks, health, and risk behaviours [20]; [53]; [16]. Different cultures and different group of people shape individuals’ behavioural decisions in various ways. Social norms – such as perceptions of what others do and expect – vary across cultural and social networks, affecting perceived health and well-being and risk behaviours [54,55]. Future studies should include ethnicity-related factors, such as ethnic identity, to better understand these issues.

Conclusion

This study has found that there has been limited improvement in perceived health, well-being, and risk behaviours among high school students in Finnmark over the past decade. The findings indicate minimal progress with some areas showing, a decline in physical activity, increased digital use, and depressive thoughts. Additionally, satisfaction with peers, school, and the local environment, along with antisocial behaviours, have not improved. Only the relationship with parents and substance use showed positive trends. The study also found that only 13% of variables were better than the national average in Norway, primarily those related to substance use.

Compared to other regions in Norway, Finnmark County has a small, isolated, and dispersed population, which may lead to a decrease in the quality of living environment. In smaller towns and communities located in the circumpolar North, including Arctic indigenous communities, young people are valuable resources who can contribute to making these cities more appealing as livable places [52,56]. Therefore, it is crucial for Finnmark County to take an action to develop public health policies for adolescents that that addresses mental health services, promote physical activity, and reduce antisocial behaviours and bullying. These measures can improve their well-being and create a better living environment for all.

The significance of this study lies in its contribution to local health policy in Finnmark. Until now, there has been insufficient evidence-based information, particularly regarding temporal trends in adolescent health. This lack of data has hindered efforts to address local disparities and to contribute to a broader understanding of how geographic, cultural, and socio-economic factors intersect to influence adolescent well-being. By offering targeted recommendations, this research can directly inform and enhance public health strategies in Finnmark, a region that has been underserved in terms of health data.

Given that Finnmark has a distinct sociocultural and multiethnic context, including the Sámi and Kven, further studies should consider these contexts for a more comprehensive understanding of the situation.

Appendix. Description of study variables

Factor	Questions	Response options (coding scheme)
Gender	Are you a boy or a girl?	boy, girl
Grade	In what grade are you?	year 1 (10th), year 2 (11th), year 3 (12th)
free time	Below we have listed various activities that you can do in your free time. Think about the last week (last 7 days). How many times have you … ?
	spent most of the evening out with friends/mates	1=never, 2 = 1 time, 3 = 2-5 times, 4 = 6 or more
	spent the whole evening at home	1=never, 2 = 1 time, 3 = 2-5 times, 4 = 6 or more
	spent most of the evening playing online games	1=never, 2 = 1 time, 3 = 2-5 times, 4 = 6 or more
	spent most of the evening socialising on the Internet or by mobile phone (talking, etc)	1=never, 2 = 1 time, 3 = 2-5 times, 4 = 6 or more
	Are you currently a member of any organisations, clubs, societies or associations, or have you previously been a member of one since you were 10?	1 =yes, I am currently a member, 2 = I´m not a member now, but I used to be, 3 = no, I have not been a member at any time since I was 10.
media use	Think about what you do on a normal day. How much time to you spend on the following things:
	watching TV	1 = no time, 2 = less than 30 minutes, 3 = 30 minutes − 1 hour, 4 = 1-2 hours, 5 = 2-3 hours, 6 = more than 3 hours
	reading books (not school-related)	1 = more than 3 hours, 2 = 2-3 hours, 3 = 1-2 hours, 4 = 30 minutes − 1 hour, 5 = less than 30 minutes, 6 = no time
	playing computer games/video games	1 = no time, 2 = less than 30 minutes, 3 = 30 minutes − 1 hour, 4 = 1-2 hours, 5 = 2-3 hours, 6 = more than 3 hours
	playing games on your mobile/table	1 = no time, 2 = less than 30 minutes, 3 = 30 minutes − 1 hour, 4 = 1-2 hours, 5 = 2-3 hours, 6 = more than 3 hours
	social media (Facebook, Instagram, etc.)	1 = no time, 2 = less than 30 minutes, 3 = 30 minutes − 1 hour, 4 = 1-2 hours, 5 = 2-3 hours, 6 = more than 3 hours
	Outside school, how much time do you normally spend on activities that involve looking at a screen (TV, computer, tablet, mobile) each day?	1 = no time, 2 = less than 1 hour, 3 = 1-2 hours, 4 = 2-3 hours, 5 = 3-4 hours, 6 = 4-6 hours, 7 = more than 6 hours
physical activity	How often do you do physical activity whack gets you out of breath or makes you sweaty?	1 = at least 5 times a week, 2 = 3-4 times a week, 3 = 1-2 times a week, 4 = 1-2 times a month, 5 = rarely, 6 = never
	How often do you train or keep fit independently (running, swimming, cycling, walking)?	1 = at least 5 times a week, 2 = 3-4 times a week, 3 = 1-2 times a week, 4 = 1-2 times a month, 5 = rarely, 6 = never
	How often do you participate in other kinds of organised physical activity (dance, martial arts, etc.)?	1 = at least 5 times a week, 2 = 3-4 times a week, 3 = 1-2 times a week, 4 = 1-2 times a month, 5 = rarely, 6 = never
Parents	My parents usually know where I am, and who I’m with, in my free time	1 = very true, 2 = quite true, 3 = not very true, 4 = not at all true
	My parents know most of the friends I hang out with in my free time	1 = very true, 2 = quite true, 3 = not very true, 4 = not at all true
	Financially, has your family been well off, or badly off, over the past two years?	1 = we have been well off the whole time, 2 = we have generally been well off, 3 = we have neither been well off nor badly off, 4 = we have generally been badly off, 5 = we have been badly off the whole time
	How happy or unhappy are you with your parents?	1 = very happy, 2 = slightly happy, 3 = neither happy nor unhappy, 4 = slightly unhappy, 5 = very unhappy
Friends	Do you have at least one friend who you trust completely and who you can tell absolutely anything?	1 = Yes, definitely, 2 = Yes, I think so, 3 = I don´t think so, 4 = There´s nobody I would call a friend at the moment
	How happy or unhappy are you with your friends	1 = very happy, 2 = slightly happy, 3 = neither happy nor unhappy, 4 = slightly unhappy, 5 = very unhappy
School	I enjoy school	1 = totally agree, 2 = somewhat agree, 3 = somewhat disagree, 4 = totally disagree
	My teachers care about me	1 = totally agree, 2 = somewhat agree, 3 = somewhat disagree, 4 = totally disagree
	I feel that I fit in with the students at my school	1 = totally agree, 2 = somewhat agree, 3 = somewhat disagree, 4 = totally disagree
	I´m bored at school	1 = totally disagree, 2 = somewhat disagree, 3 = somewhat agree, 4 = totally agree
	I often don´t want to go to school	1 = totally disagree, 2 = somewhat disagree, 3 = somewhat agree, 4 = totally agree
	On an average day, how long do you spend on homework and other schoolwork (outside the school day)?	1 = more than 4 hours, 2 = 3-4 hours, 3 = 2-3 hours, 4 = 1-2 hours, 5 = ½-1 hour, 6 = less than half an hour, 7 = never/almost never do any homework
	How happy or unhappy are you with the school you go to	1 = very happy, 2 = slightly happy, 3 = neither happy nor unhappy, 4 = slightly unhappy, 5 = very unhappy
local environment	think about the areas around where you live. how good do you think that services for young people are on:
	places for meeting other young people in your free time (after-school club, youth centre, etc.)	1 = very good, 2 = quite good, 3 = neither good nor bad, 4 = quite bad, 5 = don´t like it at all
	sports facilities	1 = very good, 2 = quite good, 3 = neither good nor bad, 4 = quite bad, 5 = don´t like it at all
	culture (cinemas, concert veneus, libraries, etc.)	1 = very good, 2 = quite good, 3 = neither good nor bad, 4 = quite bad, 5 = don´t like it at all
	public transport (buses, trains, trams, etc.)	1 = very good, 2 = quite good, 3 = neither good nor bad, 4 = quite bad, 5 = don´t like it at all
	When you are out in the evening, do you feel safe in the local area where you live?	1 = yes, very safe, 2 = yes, quite safe, 3 = not sure, 4 = no, don´t feel safe
	How happy or unhappy are you with the local community where you live?	1 = very happy, 2 = slightly happy, 3 = neither happy nor unhappy, 4 = slightly unhappy, 5 = very unhappy
bullying	Do you sometimes take part in teasing, threatening og freezing out other young people at school or in your free time?	1 = never, 2 = almost never, 3 = yes, around once a month, 4 = yes, around once a fortnight, 5 = yes, around once a week, 6 = yes, several times a week
	Are you sometimes teased, threatened or frozen out by other young people at school or in your free time?	1 = never, 2 = almost never, 3 = yes, around once a month, 4 = yes, around once a fortnight, 5 = yes, around once a week, 6 = yes, several times a week
antisocial behaviour	how many times have you done any of the following things over the past year (the past 12 months)?
	take something from a shop without paying	1 = never, 2 = once, 3 = 2-5 times, 4 = 6-10 times, 5 = 11 or more
	deliberately damaged or broken window panes, bus seats, post boxes, etc. (carried out vandalism)	1 = never, 2 = once, 3 = 2-5 times, 4 = 6-10 times, 5 = 11 or more
	illegally spray-painted or tagged walls, buildings, trains, buses, etc.	1 = never, 2 = once, 3 = 2-5 times, 4 = 6-10 times, 5 = 11 or more
	not paid for the cinema, sporting events, bus and train tickets, etc. when you should have paid	1 = never, 2 = once, 3 = 2-5 times, 4 = 6-10 times, 5 = 11 or more
	spent the whole night away from home without your parents knowing where you were	1 = never, 2 = once, 3 = 2-5 times, 4 = 6-10 times, 5 = 11 or more
	skipped school	1 = never, 2 = once, 3 = 2-5 times, 4 = 6-10 times, 5 = 11 or more
substance use	how many times have you done any of the following things over the past year (the past 12 months)?
	had so much to drink that you felt clearly intoxicated	1 = never, 2 = once, 3 = 2-5 times, 4 = 6-10 times, 5 = 11 or more
	used hash/marijuana/cannabis	1 = never, 2 = once, 3 = 2-5 times, 4 = 6-10 times, 5 = 11 or more
	used other drugs	1 = never, 2 = once, 3 = 2-5 times, 4 = 6-10 times, 5 = 11 or more
	Do you smoke?	1 = never, 2 = I used to, but I’ve stopped completely now, 3 = less than once a week, 4 = every week, but not every day, 5 = every day
	Do you use snus (tobacco that you put under your lip)?	1 = never, 2 = I used to, but I’ve stopped completely now, 3 = less than once a week, 4 = every week, but not every day, 5 = every day
	Do you ever drink any kinds of alcoholic drinks?	1 = never, 2 = I’ve just tried tasting them a few times, 3 = occasionally, but less than once a month, 4 = generally 1-3 times a month, 5 = every week
	Do your parents allow you to drink alcohol?	1 = no, 2 = don´t know, 3 = yes
	Over the past year (the past 12 months), have you been offered cannabis (hash or marijuana)?	1 = never, 2 = yes, once, 3 = yes, several times
health	Over the past month (past 30 days), how many times have you had headache?	1 = never, 2 = a few times, 3 = many times, 4 = daily
	How often have you used over-the-counter medicines (paracetamol, ibuprofen, etc.) over the past month?	1 = never, 2 = less than once a week, 3 = at least once a week, 4 = several times a week, 5 = daily
	How happy or unhappy are you with your health?	1 = very happy, 2 = slightly happy, 3 = neither happy nor unhappy, 4 = slightly unhappy, 5 = very unhappy
	How happy or unhappy are you with your appearance?	1 = very happy, 2 = slightly happy, 3 = neither happy nor unhappy, 4 = slightly unhappy, 5 = very unhappy
depression	During the past week, have you been affected by any of the following issues
	felt that everything is a struggle	1 = been affected a great deal, 2 = been affected quite a lot, 3 = not been affected much, 4 = not been affected at all
	had sleep problems	1 = been affected a great deal, 2 = been affected quite a lot, 3 = not been affected much, 4 = not been affected at all
	felt unhappy, sad or depressed	1 = been affected a great deal, 2 = been affected quite a lot, 3 = not been affected much, 4 = not been affected at all
	felt hopelessness about the future	1 = been affected a great deal, 2 = been affected quite a lot, 3 = not been affected much, 4 = not been affected at all
	felt stiff or tense	1 = been affected a great deal, 2 = been affected quite a lot, 3 = not been affected much, 4 = not been affected at all
	worried to much about things	1 = been affected a great deal, 2 = been affected quite a lot, 3 = not been affected much, 4 = not been affected at all
	felt lonely	1 = been affected a great deal, 2 = been affected quite a lot, 3 = not been affected much, 4 = not been affected at all
future	What do you think your future will be like? Do you think that you?
	will be unemployed at some point in your life?	1 =no, 2 = don´t know, 3 = yes
	will study at a university or university college?	1 = yes, 2 = don´t know, 3 =no
	will have a good, happy life?	1 = yes, 2 = don´t know, 3 =no

Disclosure statement

No potential conflict of interest was reported by the author(s).