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Eur J Public Health. 2015 Apr;25 Suppl 2:7-12. doi: 10.1093/eurpub/ckv010.

Trend analyses in the health behaviour in school-aged children study: methodological considerations and recommendations.

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1 Section of Social Medicine, University of Copenhagen, Copenhagen, Denmark
2 School of Health Sciences, NUI Galway, Galway, Ireland.
3 National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark.
4 Department of Psychosocial Science, Faculty of Psychology, University of Bergen, Bergen, Norway.
5 Department of Interdisciplinary Social Sciences, Utrecht University, Utrecht, The Netherlands.
6 NSH Greater Glasgow & Clyde, Public Health Directorate, Glasgow, UK.
7 Knowledge and Analytical Services, Welsh Government, Cardiff, UK.
8 INSERM UMR, Université Toulouse, Toulouse, France.
9 Department of Public Health and Paediatrics, University of Turin, Turin, Italy.



This article presents the scope and development of the Health Behaviour in School-aged Children (HBSC) study, reviews trend papers published on international HBSC data up to 2012 and discusses the efforts made to produce reliable trend analyses.


The major goal of this article is to present the statistical procedures and analytical strategies for upholding high data quality, as well as reflections from the authors of this article on how to produce reliable trends based on an international study of the magnitude of the HBSC study. HBSC is an international cross-sectional study collecting data from adolescents aged 11-15 years, on a broad variety of health determinants and health behaviours.


A number of methodological challenges have stemmed from the growth of the HBSC-study, in particular given that the study has a focus on monitoring trends. Some of those challenges are considered. When analysing trends, researchers must be able to assess whether a change in prevalence is an expression of an actual change in the observed outcome, whether it is a result of methodological artefacts, or whether it is due to changes in the conceptualization of the outcome by the respondents.


The article present recommendations to take a number of the considerations into account. The considerations imply methodological challenges, which are core issues in undertaking trend analyses.

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