Suicidal ideation among adolescents

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INTERNATIONAL PUBLIC HEALTH JOURNAL Special Issue Suicidal Ideation among School-Going Adolescents Edited by Mazyanga L Mazaba, Seter Siziya, and Joav Merrick Volume 9, Number 4, 2017 TABLE OF CONTENTS EDITORIAL Suicidal ideation among adolescents Mazyanga L Mazaba, Seter Siziya, and Joav Merrick

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ORIGINAL ARTICLES Factors associated with suicidal ideation among in-school adolescents, Uruguay Eric M Njunju, Mwenya Kwangu, David Mulenga, Mazyanga L Mazaba, and Seter Siziya

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Prevalence and factors for suicide ideation among adolescents attending school in Ghana Mwenya Kwangu, David Mulenga, Mazyanga L Mazaba, Eric M Njunju, and Seter Siziya

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Prevalence and correlates for suicidal ideation among adolescents in school in Gaza strip David Mulenga, Mazyanga L Mazaba, Mwenya Kwangu, Eric M Njunju, and Seter Siziya

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Prevalence and correlates of suicidal ideation among school-going adolescents in Oman Mwenya Kwangu, Eric M Njunju, David Mulenga, Mazyanga L Mazaba, and Seter Siziya

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Factors associated with suicidal ideation among adolescents attending school in Philippines Mwenya Kwangu, David Mulenga, Mazyanga L Mazaba, Eric M Njunju, and Seter Siziya

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Correlates of suicidal ideation among school-going adolescents in Bahamas Mwenya Kwangu, Seter Siziya, David Mulenga, Mazyanga L Mazaba, and Eric M Njunju

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Suicidal ideation prevalence and its associated factors among school-going adolescents in Pakistan Mwenya Kwangu, Eric M Njunju, David Mulenga, Seter Siziya, and Mazyanga L Mazaba

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Suicidal ideation in Jamaica: Prevalence and its correlates among school-going adolescents in a global school health-based survey Seter Siziya, Eric M Njunju, Mwenya Kwangu, David Mulenga, and Mazyanga L Mazaba

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Suicidal ideation in Guyana: Prevalence and its associated factors among adolescents in a global school health-based survey Seter Siziya, Mazyanga L Mazaba, Eric M Njunju, Mwenya Kwangu, and David Mulenga

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Factors associated with suicidal ideation among adolescents attending school in Samoa Seter Siziya, Aseel M Almansour, David Mulenga, Mazyanga L Mazaba, Eric M Njunju, and Mwenya Kwangu

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Prevalence and correlates for suicidal ideation among school-going adolescents in Iraq David Mulenga, Mwenya Kwangu, Eric M Njunju, Mazyanga L Mazaba, and Seter Siziya

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Correlates of suicidal ideation among in-school adolescents in Trinidad and Tobago David Mulenga, Seter Siziya, Mazyanga L Mazaba, Mwenya Kwangu, and Eric M Njunju

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Factors associated with suicidal ideation among adolescents attending school in Kuwait Mazyanga L Mazaba, Seter Siziya, David Mulenga, Eric M Njunju, and Mwenya Kwangu

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Suicidal ideation in Fiji: Prevalence and its correlates among school-going adolescents in a global school health-based survey Mazyanga L Mazaba, Eric M Njunju, Mwenya Kwangu, David Mulenga, and Seter Siziya

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Prevalence and correlates for suicidal ideation among adolescents in school in West Bank Mazyanga L Mazaba, David Mulenga, Mwenya Kwangu, Eric M Njunju, and Seter Siziya

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Suicidal ideation prevalence and its associated factors among in-school adolescents in Morocco David Mulenga, Mwenya Kwangu, Eric M Njunju, Seter Siziya, and Mazyanga L Mazaba

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Suicidal ideation in Vietnam: Prevalence and its associated factors among adolescents in a global school health-based survey Mazyanga L Mazaba, Seter Siziya, Eric M Njunju, Mwenya Kwangu, and David Mulenga Prevalence and correlates for suicidal ideation among adolescents in school in Bolivia Eric M Njunju, David Mulenga, Mazyanga L Mazaba, Mwenya Kwangu, and Seter Siziya Factors associated with suicidal ideation among adolescents attending junior high school in Suriname Eric M Njunju, Mazyanga L Mazaba, David Mulenga, Seter Siziya, and Mwenya Kwangu Correlates of suicidal ideation among in-school adolescents in Myanmar Eric M Njunju, Mwenya Kwangu, Seter Siziya, David Mulenga, and Mazyanga L Mazaba

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International Public Health Journal The International Public Health Journal is a peer-reviewed Journal aimed at the scientific community interested in the broad area of public health. This Journal provides an international multidisciplinary forum with a holistic approach to public health issues, health and medicine, health and social policy, service aspects, developmental aspects, epidemiology, rehabilitation, family and social issues, quality of life, and all other aspects of public health over the whole age spectrum. Literature will be published in the form of review articles, original articles, case reports, short communications, letters to the Editor, and book reviews.

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Editor-in-Chief Professor Joav Merrick, MD, MMedSci, DMSc, Medical Director, Ministry of Social Affairs, Jerusalem, Israel; Director, National Institute of Child Health and Human Development, Israel; Professor of Pediatrics, Hadassah Hebrew University Medical Center, Jerusalem, Israel; Kentucky Children’s Hospital, University of Kentucky, Lexington, Kentucky, United States; Professor of Public Health, School of Public Health, Georgia State University, Atlanta, Georgia, United States. E-mail: [email protected]

Associate Editor Mohammed Morad, MD, FRCP(Edinburgh), MRCPS(Glasgow), Professor, Clalit Health Services and Division of Community Health, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel. Email: [email protected] Editorial Board Daniel Chemtob, MD, MPH, DEA, Director, Department of Tuberculosis and AIDS, Ministry of Health, Jerusalem, Israel Itamar Grotto, MD, MPH, PhD, Professor and Director, Public Health Services, Jerusalem, Israel Morten Grønbæk, MD, PhD, DMSc, Professor, Centre for Alcohol Research and Director of Research, National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark Joan Earle Hahn, PhD, RN/APRN, CGNP, CGCNS, CNL, CDDN, Advanced Practice Nurse Consultant, Aging and Disability, New Hampshire, USA Bruce David Kirkcaldy, MA, PhD, FBPsS, Director, International Centre for the Study of Occupational and Mental Health, Düsseldorf, Germany Professor Lucie Laflamme, MSc, PhD, Chair of the Department of Public Health Sciences, Karolinska Institutet, Division of International Health, Stockholm, Sweden Bengt Lindström, MD, PhD, DrPH, Professor, Department of Public Health and Nursing, NTNU-Norwegian University of Science and Technology, Trondheim, Norway John R Lutzker, PhD, Professor of Public Health, Director, Center for Healthy Development SafeCare/UCEDD Centers, Georgia State University, Atlanta, Georgia, USA Frank Mo, PhD, MD, Medical Research Scientist, Chronic Disease Management Division, Centre for Chronic Disease Prevention and Control, Health Promotion and Chronic Disease Prevention Branch, Public Health Agency of Canada, Ottawa, Ontario Canada Professor Hatim A Omar, MD Director, Division of Adolescent Medicine, Kentucky Children’s Hospital, University of Kentucky Lexington, Kentucky, USA Teodor T Postolache, MD, Professor of Psychiatry, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, Maryland, USA I Leslie Rubin, MD, Associate Professor, Department of Pediatrics, Morehouse School of Medicine, Codirector, Southeast Pediatric Environmental Health Unit (PEHSU), Department of Pediatrics, Emory University, Medical Director, Developmental Pediatric Specialists, Founder Emeritus, Innovative Solutions for Disadvantage and Disability (ISDD), Atlanta, Georgia, USA Patricia Schofield, RGN, PhD, PGDipEd, DipN, Professor and Deputy Dean for Research and Income Generation, Faculty of Health, Social Care and Education, Anglia Ruskin University, London, United Kingdom Daniel TL Shek, PhD, FHKPS, BBS, SBS, JP, Associate Vice President (Undergraduate Programme) and Chair Professor, Department of Applied Social Sciences, The Hong Kong Polytechnic University, Hunghom, Kowloon, Hong Kong, PR China Professor Seter Siziya, BA(Ed), MSc, PhD, DLSHTM, CStat, CSci, FRSS, Michael Chilufya Sata School of Medicine, Copperbelt University, Ndola, Zambia

EDITORIAL

Int Public Health J 2017;9(4):351-353

ISSN: 1947-4989 © Nova Science Publishers, Inc.

Suicidal ideation among adolescents Mazyanga L Mazaba1,, BSc, MSc, Seter Siziya2, BA(Ed), MSc, PhD, and Joav Merrick3-7, MD, MMedSci, DMSc 1

The Health Press, Zambia National Public Health Institute, Ministry of Health, Lusaka, Zambia 2 Michael Chilufya Sata School of Medicine, Copperbelt University, Ndola, Zambia 3 National Institute of Child Health and Human Development, Jerusalem, Israel 4 Office of the Medical Director, Health Services, Division for Intellectual and Developmental Disabilities, Ministry of Social Affairs and Social Services, Jerusalem, Israel 5 Division of Pediatrics, Hadassah Hebrew University Medical Center, Mt Scopus Campus, Jerusalem, Israel 6 Kentucky Children’s Hospital, University of Kentucky College of Medicine, Lexington, Kentucky, USA 7 Center for Healthy Development, School of Public Health, Georgia State University, Atlanta, Georgia, USA

Introduction Suicidal ideation also referred to as suicidal thoughts where a person is preoccupied with unusual thoughts about suicide is a major global public health concern and more especially among the youth. Suicidal ideation is a major problem among youth in both the developed and developing world leading to 6% of death among youths globally. In countries considered to have low suicidal behavioral issues such as the Americas, 5,000 lives are lost through suicide (1). There are various levels of ideation including fleeting thoughts, extensive thoughts, detailed planning and role playing. Although not all those that have suicidal thoughts actualize it, it is a risk factor for suicide (2). Suicidal ideation which includes thoughts of harming or killing oneself is an important factor within suicidal behavior and an important precursor to suicide attempts (3, 4). Gliatto (2) in his evaluation of patients with suicidal ideation indicates that suicidal ideation is actually more common than suicidal attempts or completed suicide. Suicidal ideation has been documented to emerge in adolescence more between the ages of 10 and 24 years particularly higher among females in this age group (5). The WHO reports that more than 800,000 people die by suicide every year with more than 70% occurring in low and middle-income countries.

Statistics



Correspondence: Mazyanga L Mazaba, BSc, MSc, The Health Press, Zambia National Public Health Institute, Ministry of Health, Lusaka, Zambia. E-mail: [email protected]

The global statistics indicate highest rates of suicide among those above 70 years; however, it is notable that it is also the second leading cause of death among young persons between 15 and 29 years (6). The prevalence of suicidal ideation is similar between the high income and the low/medium income regions. However, prevalence of adolescent suicidal

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behaviours and in the magnitude of gender differences varies between countries and regions. The variation may be due to differences in the meaning of suicidal thoughts and normative attitudes towards suicide across diverse cultural, religious and economic settings according to McKinnon et al. (6). A study between 2008 and 2009 in the US indicated an estimated 2.2 million people having reported suicidal ideation in the past year; a nationwide high school survey in the US revealed 16% considered suicide with 13% creating a plan and 8% actualizing it (7). Another study on comparing suicidal behaviour among 17 European countries in 2012 indicated the lifetime prevalence of ideation among students aged 15–16 years ranging from 15% (Armenia) to 31.5% (Hungary); while another study in 2013, across 49 low- and middle-income countries revealed that suicidal ideation occurred in 15.3% of adolescents aged 13–15 years in the past year (6). Despite this phenomenon of suicidal behaviour being a large public health problem, by September 2014, only 28 countries worldwide had evidence of national suicide prevention strategies. The WHO Eastern Mediterranean region scores generally lower suicidal rates than other WHO regions. However further analysis reveals relatively higher rates among particular age groups including men and women between 15 and 29 years of age and those above 60 years (8).

Risk factors It is documented that several risk factors act cumulatively to increase a person’s vulnerability to suicidal behaviour. It is believed that the causes and risk factors for suicidal ideation encompass genetic disposition, physical and environmental factors in combination or otherwise. Genetic disposition include family history of mental illness or suicidal thoughts increasing the risk. Environmental related experiences such as difficulties in accessing help or care, substance abuse, discrimination, constant physical or mental abuse among others are sited as contributing factors to suicidal ideation (9). Persons in constant experience or exposure to major negative events are at high risk for suicide ideation that may eventually be actualized. Generally, factors including sex, age,

bullying, hunger, close friendship and parental understanding among others have been known to be associated with suicidal ideation (6). A study on suicidal behaviour among 32 low to medium income countries indicated an overlap in risk factors with those established in high income countries (6). Some studies have shown that suicidal ideation is significantly more common among adolescents who had experienced some form of victimization. Most common factors established include physical and sexual abuse, mental disorders and depressive symptoms substance use and weak family and social relationships (10-15). Turner et al. (16) showed that adolescents who experienced peer victimization within the past year were almost 2.5 times more likely to think about killing themselves than those who had not been victimized by peers. The findings also showed a substantial independent effect of sexual assault on suicide ideation, consistent with past research on the traumatic, stigmatizing, and shameproducing qualities of this form of victimization (16).

A worldview The papers in this issue are based on analysis of data from the most recent Global School-based Health Survey (GSHS). The GSHS has been conducted in over 86 countries in all the World Health organization regions (17) and this special issue aims to provide comparable data on the mental health of adolescents in 20 countries. The dependent variable used is suicidal ideation, while the independent factors included age, gender, food security, anxiety, loneliness, close friends, truancy, bullied, attached, in a fight, smoking cigarettes or marijuana, alcohol use or abuse and parental understanding.

References [1]

[2]

Stein DJ, Chiu WT, Hwang I, Kessler RC, Sampson N, Alonso J, et al. Cross-national analysis of the associations between traumatic events and suicidal behavior: findings from the WHO World Mental Health Surveys. PloS One 2010;5:e10574. Gliatto MF, Rai AK. Evaluation and treatment of patients with suicidal ideation. Am Fam Physician 1999;59:1500–6.

Editorial [3]

[4]

[5]

[6]

[7]

[8]

[9] [10]

Centers for Disease Control and Prevention. Suicide: definitions. URL: http://www.cdc.gov/ViolencePrevent ion/suicide/definitions.html. Bridge JA, Goldstein TR, Brent DA. Adolescent suicide and suicidal behavior. J Child Psychol Psychiatry 2006;47:372-94. Nock MK, Borges G, Bromet EJ, Cha CB, Kessler RC, Lee S. Suicide and suicidal behavior. Epidemiologic reviews. Oxford: Oxford University Press, 2008:133– 54. McKinnon B, Gariépy G, Sentenac M, Elgar FJ. Adolescent suicidal behaviours in 32 low- and middleincome countries. Bull World Health Organ 2016;94: 340-350F. In suicide. What are the most recent teen suicide statistics? URL: https://nobullying.com/teen-suicidestatistics/. World Health Organization. URL: https://www.who.int/ mediacentre/news/releases/2014/suicide-preventionreport/en/. Hawton K, Saunders KE, O'Connor RC. Self-harm and suicide in adolescents. Lancet 2012;379:2373–82. Swahn MH, Bossarte RM. Gender, early alcohol use, and suicide ideation and attempts: findings from the 2005 youth risk behavior survey. J Adolesc Health 2007;41:175–81.

[11]

[12]

[13]

[14]

[15]

[16]

[17]

353 Holt MK, Vivolo-Kantor AM, Polanin JR, Holland KM, DeGue S, Matjasko JL, et al. Bullying and suicidal ideation and behaviors: a meta-analysis. Pediatrics 2015;135:e496–509. Brown DW, Riley L, Butchart A, Meddings DR, Kann L, Harvey AP. Exposure to physical and sexual violence and adverse health behaviours in African children: results from the Global School-based Student Health Survey. Bull World Health Organ 2009;87:447–55. Pillai A, Andrews T, Patel V. Violence, psychological distress and the risk of suicidal behaviour in young people in India. Int J Epidemiol 2009;38:459–69. Randall JR, Doku D, Wilson ML, Peltzer K. Suicidal behaviour and related risk factors among School-aged youth in the republic of Benin. PLoS One 2014;9: e88233. Wilson ML, Dunlavy AC, Viswanathan B, Bovet P. Suicidal expression among school-attending adolescents in a middle-income sub-Saharan country. Int J Environ Res Public Health 2012;9:4122–34. Turner HA, Finkelhor D, Shattuck A, Hamby S. Recent victimization exposure and suicidal ideation in adolescents. Arch Pediatr Adolesc Med 2012;166:114954. World Health Organization. Chronic diseases and health promotion. Global school-based student health survey (GSHS). URL: http://www.who.int/chp/gshs/datasets/en

ORIGINAL ARTICLES

Int Public Health J 2017;9(4):357-364

ISSN: 1947-4989 © Nova Science Publishers, Inc.

Factors associated with suicidal ideation among in-school adolescents, Uruguay Eric M Njunju1,, BSc, MSc, Mwenya Kwangu1, BVM, MSc, David Mulenga2, BSc, MPH, Mazyanga L Mazaba3, BSc, MSc, and Seter Siziya2, BA(Ed), MSc, PhD 1

Department of Basic Sciences, Michael Chilufya Sata School of Medicine, Copperbelt University, Ndola, Zambia 2 Department of Clinical Sciences, Michael Chilufya Sata School of Medicine, Copperbelt University, Ndola, Zambia 3 The Health Press, Zambia National Public Health Institute, Ministry of Health, Lusaka, Zambia

Abstract The study examined the prevalence of suicidal ideation and associated factors among students in Uruguay in grades 2 CB, 3 CB and 1BD in 2012 in a Global School-based Student Health Survey. Both bi-variate and multi-variate logistic regression analyses at 95% confidence level were conducted to assess associations between relevant predictor variables and suicidal ideation within the previous twelve months. Out of a total of 3,524 students who participated in the survey, 3,480 of them responded to the question on suicidal ideation among other questions. Overall, 12.3% of the students reported having had suicidal ideation in the previous 12 months (7.2% among males and 16.6% among females). Being anxious, lonely, having no close friends, bullied, physically attacked or involved in a physical fight just like smoking cigarettes or marijuana, alcohol consumption and abuse were all significantly associated with suicidal ideation. Having parents or guardians who did not understand the adolescent’s problems and worries was also significantly associated with suicidal ideation. Interventions that address issues of violence against students, fighting with peers, initiation of smoking, alcohol and illicit drug use and those that encourage supportive roles of parents may reduce the risk of suicidal ideation. Keywords: Suicidal ideation, prevalence, associated factors, Uruguay

Introduction



Correspondence: Eric M Njunju, BSc, MSc, Department of Basic Sciences, Michael Chilufya Sata School of Medicine, Copperbelt University, Ndola, Zambia. E-mail: [email protected]

Suicide is a global public concern as more than 800,000 people commit it every year and for every suicide there are many more who attempt it (1). A prior suicide attempt is the single most important risk factor for suicide in the general population (1). In 2012, suicide was the second leading cause of death among 15-29 year olds worldwide and occurs throughout the life span (1, 2). The Global Burden of Disease Study in 2004 estimated that suicide contributes to 6% of all deaths among young people

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aged 10-24 years worldwide (3). Suicide does not just occur in high-income countries, but is a global phenomenon in all regions of the world (1). Notably, in 2012, 75% of global suicides occurred in low and middle income countries (1, 2). Previously, suicide rates were found to be low in Latin American countries, but that has been expected to change (4, 5). In Uruguay, literature on suicide or suicidal ideation is scarce (6.7). Suicide is preventable with timely, evidence-based and often low-cost interventions (1, 8). Suicidal ideation is both a strong risk factor and a stage in the suicidal process from planning to committing suicide (9, 10). Although not all suicidal ideation materialize into suicide attempts or suicide, it is the first step on to the path to suicide (11). A 60% rate of transition has been observed from suicidal ideation to first suicide attempt within the first year of ideation on-set (12). Hence, prevention of suicidal ideation may in turn prevent suicide. To date, several environmental, psychosocial and behavioural factors

Source: http://uruguaymap.facts.co/. Figure 1. Uruguay and its neighbouring countries.

have been associated with suicidal ideation, suicidal attempts and suicide. Physical, sexual and emotional abuses have also been associated with adolescent suicidal ideation and attempts (8, 12, 13). In Brazil, the prevalence of suicidal ideation was observed to be 14.0% and was associated with violent behaviour, smoking and alcohol consumption (14). Bullying of students was found to be common in Chile and was associated with suicidal ideation (14). Family problems, social pressure, economic struggle, racism and violence introduce constant emotional stresses and challenges among Peruvian adolescents (14). In addition, a strong association was observed between peer victimization and emotional, and mental stress among adolescents in Peru (14) may lead to having suicidal thoughts. The prevalence of suicidal ideation and its associated factors among junior high school students in Uruguay is unknown. Therefore, the objective of this study was to estimate the prevalence of suicidal ideation as well as identify factors associated with this phenomenon.

Suicidal ideation in Uruguay

Methods The study was conducted in Uruguay (see Figure 1), a country on the east coast of South America, and south of Brazil and east of Argentina. The country consists of a low, rolling plain in the south and a low plateau in the north. Uruguay is a high-income country with a gross national income per capita of US$ 16,810 in 2014 and there is no extreme poverty (15). The Global School based Health Survey (GSHS) was developed by the World Health Organization (WHO) in collaboration with UNICEF, UNESCO and UNAIDS with technical assistance from Centers for Diseases Control and Prevention, Atlanta, Georgia, United States with the aim of providing data on health and social behaviours among school-going adolescent students. This paper presents results of a secondary analysis of the data obtained from the GSHS conducted in 2012 students in Uruguay. The survey measured alcohol use; dietary behaviours; drug use; hygiene; mental health; physical activity; protective

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factors; sexual behaviours; tobacco use; violence and unintentional injury. The Uruguay GSHS used a two-stage cluster sampling design, in which in the first stage, schools were selected with probability proportional to enrolment size. In the second stage, classes were randomly selected and all students in selected classes were eligible to participate. The school response rate was 100%, the student response rate was 77% and the overall response rate was 77%. A total of 3,524 students participated in this survey. Students selfreported their responses to each question on a computer-scannable answer sheet. Variables that were used for our analysis included socio-demographic characteristics, having seriously considered attempting suicide, smoking, loneliness, parental understanding, involvement in a fight, truancy, anxiety, close friendship and food security. Assessments of associations were conducted using both bi-variate and multivariate logistic regression analyses with 95% confidence intervals using SPSS Version 16.0.0.

Table 1. Distribution of factors considered in the analysis by gender among students in the Uruguay 2012 Global School-based Health Survey

Factor Age