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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Adolescence is a transition period characterized by changes in physical&#44; cognitive&#44; emotional&#44; and social features making this period a crucial and critical stage in adolescents&#8217; development&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">At this stage&#44; behavior and lifestyles development patterns might affect the future health and well-being of youths&#46; In recent decades healthy lifestyles in this age period have been abandoned&#46; Moreover&#44; much evidence has been established reporting that these healthy lifestyles could be strong predictors of better mental health status among adolescents&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">1</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Spain tops the ranking of childhood obesity prevalence in the European Union&#46; Childhood obesity is closely related to free time exposure to screens&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">2</span></a> A consistent association between sedentarism or screens use and poor mental health has been observed&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">3</span></a> This fact is important when one third of our adolescents spends more than 3<span class="elsevierStyleHsp" style=""></span>hours per day connected to social networks&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">4</span></a> Excessive use of social networks or watching television&#44; insufficient physical activity level or inadequate sleeping patterns are considered risk factors for psychopathology development&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">5</span></a> Concerning toxic consumption&#44; according to the ESTUDES Survey <span class="elsevierStyleItalic">&#40;Spanish National survey on drug use in Secondary Education&#41;&#44;</span> more than 50&#37; of adolescents aged 14-18 years report binge drinking in the last 12 months and one in every four-last month&#46; Several studies have demonstrated that the use of cannabis during adolescence increases the risk of psychosis and schizophrenia accompanied by genetic<span class="elsevierStyleCrossOut">s</span> factors&#44; among others&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">6</span></a> On the other hand&#44; adverse life events during childhood&#44; especially adult abuse and bullying by peers<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">7</span></a> are important predictors of impaired social development and mental disorder&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">8</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">In Spain&#44; suicide is the first cause of death between 15 and 24 years&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">9</span></a> Non-suicidal self-harm&#44; beginning between 11-15 years of age and present in 13-23&#37; of the general population&#44; is an indicator of emotional dysregulation and an important risk factor for suicide attempts&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">10</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">In Spain&#44; no cohort studies have been carried out in the adolescent population with the objective to ascertain the relationship between lifestyles and psychosocial factors and risk of physical illnesses and mental disorders&#46; Given the priority to carry out specific preventive efforts and public health policies in this crucial transition period&#44; it is essential to describe the prevalence of healthy and risk behaviors&#44; as well as psychiatric symptoms&#44; and to establish possible associations between the prevalence of these behaviors and the risk of developing physical and mental disorders&#46; This is the main objective of the SESSAMO cohort study&#46; This project aims to&#58; 1&#41; assess the association between lifestyle and physical and mental health&#59; 2&#41; assess to in which extent self-concept and stressful life events can modulate these associations&#59; and 3&#41; establish the role of social determinants both in the lifestyle and in adolescents&#8217; health&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Method</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Design</span><p id="par0030" class="elsevierStylePara elsevierViewall">SESSAMO Project &#40;<span class="elsevierStyleItalic">Seguimiento de Estudiantes de Secundaria para valorar Salud Mental y Obesidad</span> &#91;Follow-up of secondary students to assess mental health and obesity&#93;&#41; is a multicentric prospective cohort study developed in Spain&#46; The collection of baseline data of the participants is carried out at schools through on-line&#44; validated&#44; self-administered questionnaires included in a data collection platform specifically designed for this project&#46; Starting at 14&#44; every three years&#44; up to the age of 25&#44; participants will be contacted again through a mobile application to update their information&#46; The follow-up questionnaires will include questions regarding habits and changes in lifestyle and psychosocial or physical variables&#44; and new medical or psychiatric diagnoses&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Participants</span><p id="par0035" class="elsevierStylePara elsevierViewall">All public&#44; concerted and private upper schools from Canary Islands&#44; Navarre and the Basque Country participate in the study&#46; After schools&#8217; acceptance to participate&#44; all the students aged from 14 to 16 years &#40;from 2nd to 4th of ESO - grades 2 through 4&#41; and their parents or legal guardians are invited to take part of the study&#46; We estimate a final sample of 4000 participants&#46; Exclusion criteria are&#58; the non-participation of the school center&#44; poor knowledge of the two languages in which the study is developed&#58; Spanish or Basque language&#59; the non-participation acceptation by parents or legal guardians&#59; the non-participation assent by the student despite the consent of the parents or guardians&#59; and students with cognitive or visual impairment&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Tools and materials for data collection</span><p id="par0040" class="elsevierStylePara elsevierViewall">Baseline information is collected through on-line&#44; validated&#44; self-administered questionnaires included in a data collection platform specifically designed for this project &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; Variables related to lifestyles&#44; stressful events&#44; personality and mental health are collected&#46; The Oviedo Response Infrequency Scale<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">11</span></a> is included to detect random responses&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">After parents or legal guardians fulfill the informed consents&#44; adolescent&#8217; height and weight are measured&#46; Likewise&#44; by means of another specific informed consent&#44; the technician collects an oral sample obtained rubbing a specific collector for genetic determinations &#40;ORAcollet DNA OCR-100 Kit&#41;&#44; non-invasive technique and without health risk&#46; These samples are kept in a biobank until analysis and will be destroyed once the project has finished&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">SESSAMO includes an optical questionnaire for parents inquiring about several physical and mental diseases and health conditions of their children&#46; COVID-19 impact is included&#46; This questionnaire is completed in paper format and only at baseline&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Statistical analyses</span><p id="par0055" class="elsevierStylePara elsevierViewall">The association between lifestyle variables and the presence of stressful life events and the prevalence or incidence of physical and mental pathology will be carried out through logistic regression models&#46; Cox regression models will be used for longitudinal analysis with more than 2 years of follow-up&#46; Likewise&#44; in the case that the different mental health indicators are collected quantitatively generalized linear models or generalized estimation equation models will be applied&#46; In all cases&#44; the models will be adjusted for possible confounding variables&#46; The possible interaction between personality traits or the presence of stressful events and different lifestyles in their effect on mental health will be analyzed including interaction terms in the regression models&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Confidentiality and ethical aspects</span><p id="par0060" class="elsevierStylePara elsevierViewall">The Research Ethics Committees at each Spanish autonomous community implicated in the project approved the protocol&#46; All participants and their parents or legal guardians receive a study information sheet and a graphical summary of the protocol &#40;see <a class="elsevierStyleCrossRef" href="#sec0085">online Appendix A</a>&#41;&#44; as well as individual informed consents&#46; Together with the consent of the parents&#47;legal guardians&#44; the assent of the minor is included&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Data storage is carried out in two independent databases&#46; One of them contains participants&#8217; identification data and the other clinical conditions&#46; The use of independent databases guarantees the confidentiality of the data&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">All information is treated in a completely confidential manner and is used exclusively for research purposes&#44; according to the Spanish Organic Law 15&#47;1999 on data protection and Law 3&#47;2018 on data protection and guarantee of digital rights &#40;LOPD&#41;&#46;</p></span></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Discussion</span><p id="par0075" class="elsevierStylePara elsevierViewall">SESSAMO Project is the first Spanish study whose aim is to prospectively assess the association between lifestyle and social determinants with physical and mental health in adolescents&#46; Data from SESSAMO will permit to ascertain adolescents&#8217; lifestyle and the main health problems associated to them&#46; To establish the role that these lifestyles have on adolescents&#8217; health is essential to design and implement preventive actions to change these habits and improve first adolescents&#8217; and later adults&#8217; physical and mental health&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Due to the importance of early intervention in the development of possible psychopathologies&#44; the research team informs the parents or guardians if a suspicious case of mental disorder is detected&#46; Finally&#44; each participating school receives a global results report&#46; This information will make it easier for schools to develop lines of action and implementation of specific programs that address issues such as emotional management&#44; suicidal ideation&#44; mental health&#44; and lifestyles&#44; among others&#46; The participation of different Spanish regions and types of schools increases study power and its ability to extrapolate its results&#46;</p><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Limitations</span><p id="par0085" class="elsevierStylePara elsevierViewall">Although the adolescents will be accompanied by a technician during the baseline evaluation who can resolve their doubts and all the questionnaires used to early detection of mental disorders have been validated in adolescent samples a non-differential misclassification bias cannot be ruled out&#46; In order to avoid a possible bias in answering questionnaires&#44; as quality control analysis&#44; a specific scale has been introduced in the platform to eliminate those participants who report random responses&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Another limitation is that the platform is not accessible to students with visual disabilities&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">An important challenge of this study is&#44; firstly&#44; to get the involvement of schools&#44; and secondly family&#39;s participation&#46; For that reason&#44; our team is involved in all the process starting with the first approach to school authorities and counseling departments&#44; and finally getting access to parents&#8217; associations and families providing all the information they request&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Related articles</span><p id="par0100" class="elsevierStylePara elsevierViewall">No other publications containing the results of this study have already been published or submitted to any journal&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Study status</span><p id="par0105" class="elsevierStylePara elsevierViewall">At the time of this submission participant recruitment was not completed&#46;</p></span></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Editor in charge</span><p id="par0110" class="elsevierStylePara elsevierViewall">Salvador Peir&#243;&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Authorship contributions</span><p id="par0115" class="elsevierStylePara elsevierViewall">A&#46; S&#225;nchez-Villegas and A&#46; Go&#241;i-Sarri&#233;s performed the literature review and conceived and designed the study&#46; G&#46; P&#237;rez&#44; N&#46; Y&#225;rnoz-Go&#241;i&#44; F&#46; Lahortiga-Ramos&#44; A&#46; Iruin&#44; A&#46; D&#237;ez-Su&#225;rez&#44; I&#46; Zorrilla&#44; L&#46; Morata-Sampaio&#44; M&#46;J&#46; Oliver and A&#46; Gonz&#225;lez-Pinto designed the data collection tools and will conduct the recruitment and the evaluation of the subjects in the different Spanish regions&#46; A&#46; S&#225;nchez-Villegas and A&#46; Go&#241;i-Sarri&#233;s drafted the manuscript&#46; A&#46; S&#225;nchez-Villegas will manage data&#46; All authors have reviewed the manuscript and approved the final version of the protocol&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Acknowledgements</span><p id="par0120" class="elsevierStylePara elsevierViewall">The authors wish to thank all adolescents&#44; their families&#44; teachers and management teams from educational centers involved in the SESSAMO Project&#46;</p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Funding</span><p id="par0125" class="elsevierStylePara elsevierViewall">This study has been funded by the Spanish Ministry of Science and Innovation &#40;Spanish National Institute of Health&#44; European Regional Development Fund&#41; and the Instituto de Salud Carlos III&#44; PI20&#47;00133&#46;</p></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0190">Conflicts of interest</span><p id="par0130" class="elsevierStylePara elsevierViewall">A&#46; S&#225;nchez-Villegas&#58; Instituto de Salud Carlos III&#44; Grant PI20&#47;00133&#46; I&#46; Zorrilla&#58; Otsuka and Janssen conference support&#46; A&#46; Gonz&#225;lez-Pinto&#58; Grants of Cibersam&#44; Spanish Ministry of Science and Basque Government&#59; provided funding&#44; consulting fees and conference support of Janssen&#44; Angelini and Rovi&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">During last decades&#44; a departure from health-related lifestyles has been observed among adolescents&#46; Evidence reports that healthy lifestyles could be predictors of better mental health status&#46; The aims of the SESSAMO Project are&#58; 1&#41; to assess the association between lifestyles and physical and mental health&#59; 2&#41; to assess how self-concept and stressful life events can modulate these associations&#59; and 3&#41; to establish the role of social determinants in the lifestyle and in adolescents&#8217; health&#46; The SESSAMO Project is a prospective cohort carried out in Spain&#46; Students aged 14-16 years &#40;2nd-4th ESO&#41; and their parents are invited to participate&#46; Baseline data are collected through on-line&#44; validated&#44; self-administered questionnaires through a digital platform&#46; Information on lifestyles&#44; stressful life events and self-concept are collected&#46; Screening of depression&#44; anxiety&#44; eating disorders&#44; suicide risk&#44; psychotic experiences and COVID impact is assessed&#46; Every three years&#44; up to age of 25&#44; participants will be contacted again to update relevant information&#46;</p></span>"
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        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">En las &#250;ltimas d&#233;cadas se ha producido un alejamiento de los estilos de vida saludables en adolescentes&#46; Los h&#225;bitos saludables pueden predecir una mejor salud mental&#46; El proyecto SESSAMO tiene como objetivos&#58; 1&#41; determinar la asociaci&#243;n entre el estilo de vida y la salud f&#237;sica y mental&#59; 2&#41; determinar c&#243;mo el autoconcepto y los acontecimientos vitales estresantes pueden modular dichas asociaciones&#59; y 3&#41; establecer el papel de los determinantes sociales en el estilo de vida y en la salud de los adolescentes&#46; Se trata de un estudio de cohortes prospectivo&#44; dirigido a estudiantes de secundaria de 14-16 a&#241;os y a sus padres&#46; Los datos basales se recogen con cuestionarios validados y autoadministrados en una plataforma <span class="elsevierStyleItalic">on-line&#46;</span> Se realiza un cribado de depresi&#243;n&#44; ansiedad&#44; trastornos alimentarios&#44; riesgo de suicidio&#44; experiencias psic&#243;ticas e impacto de la COVID-19&#46; Cada 3 a&#241;os&#44; hasta la edad de 25 a&#241;os&#44; se les volver&#225; a contactar para actualizar la informaci&#243;n relevante&#46;</p></span>"
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                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Instruments of measurement&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Diet&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Food Frequency Questionnaire &#40;FFQ&#41;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">12</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Physical activity&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">Physical Activity Questionnaire for Adolescents &#40;PAQ-A&#41;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">13</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Hobbies&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Questions from ESTUDES<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">14</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Toxic habits&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">Questions from ESTUDES<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">14</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">Pittsburgh Sleep Quality Index &#40;PSQI&#41;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">15</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Videogames&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Game Addiction Scale for Adolescents &#40;GASA-Short&#41;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">16</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Internet problematic use&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Problematic Internet Use Scale in adolescents &#40;PIUS-a&#41;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">17</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Bullying and cyberbullying&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">Olweus Bully Victim Questionnaire &#40;OBVQ&#41;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">18</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Stressful life events&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Stressful Life Events Inventory<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">19</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Inventory of Adverse Childhood Experiences &#40;IACE&#41;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">20</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Self-concept Form 5 &#40;AF-5&#41;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">21</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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Protocolo
SESSAMO, follow-up of secondary students to assess mental health and obesity: a cohort study
SESSAMO, seguimiento de estudiantes de secundaria para valorar salud mental y obesidad: estudio de cohortes
Adriana Goñi-Sarriésa,b, Guillermo Pírezc, Nora Yárnoz-Goñid, Francisca Lahortiga-Ramosb,e, Álvaro Iruinf,g, Azucena Díez-Suárezb,h, Iñaki Zorrillai, Leticia Morata-Sampaioj, M. Jesús Oliverk, Ana González-Pintoi, Almudena Sánchez-Villegasb,l,m,
Autor para correspondencia
almudena.sanchez@unavarra.es

Corresponding author.
a Red de Salud Mental de Navarra, Servicio Navarro de Salud-Osasunbidea, Pamplona, Spain
b Instituto de Investigación Sanitaria de Navarra, Pamplona, Spain
c Servicio de Psiquiatría, Complejo Hospitalario Universitario Insular-Materno Infantil, Servicio Canario de la Salud, Las Palmas de Gran Canaria, Spain
d Servicio de Psiquiatría, Hospital Clínico Universitario Lozano Blesa, Servicio Aragonés de Salud, Zaragoza, Spain
e Departamento de Psiquiatría y Psicología Médica, Universidad de Navarra, Pamplona, Spain
f Biodonostia Health Research Institute, Donostia-San Sebastián, Spain
g Red de Salud Mental de Gipuzkoa, Osakidetza, Spain
h Unidad de Psiquiatría Infantil y Adolescente, Departamento de Psiquiatría y Psicología Médica, Clínica Universidad de Navarra, Pamplona, Spain
i OSI Araba, Osakidetza, Vitoria-Gasteiz, Spain
j Departamento de Psicología y Sociología, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
k Research Institute of Biomedical and Health Sciencies, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
l Centro de Investigación Biomédica en Red de la Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Spain
m Institute for Innovation & Sustainable Development in Food Chain, Universidad Pública de Navarra, Pamplona, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Adolescence is a transition period characterized by changes in physical&#44; cognitive&#44; emotional&#44; and social features making this period a crucial and critical stage in adolescents&#8217; development&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">At this stage&#44; behavior and lifestyles development patterns might affect the future health and well-being of youths&#46; In recent decades healthy lifestyles in this age period have been abandoned&#46; Moreover&#44; much evidence has been established reporting that these healthy lifestyles could be strong predictors of better mental health status among adolescents&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">1</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Spain tops the ranking of childhood obesity prevalence in the European Union&#46; Childhood obesity is closely related to free time exposure to screens&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">2</span></a> A consistent association between sedentarism or screens use and poor mental health has been observed&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">3</span></a> This fact is important when one third of our adolescents spends more than 3<span class="elsevierStyleHsp" style=""></span>hours per day connected to social networks&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">4</span></a> Excessive use of social networks or watching television&#44; insufficient physical activity level or inadequate sleeping patterns are considered risk factors for psychopathology development&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">5</span></a> Concerning toxic consumption&#44; according to the ESTUDES Survey <span class="elsevierStyleItalic">&#40;Spanish National survey on drug use in Secondary Education&#41;&#44;</span> more than 50&#37; of adolescents aged 14-18 years report binge drinking in the last 12 months and one in every four-last month&#46; Several studies have demonstrated that the use of cannabis during adolescence increases the risk of psychosis and schizophrenia accompanied by genetic<span class="elsevierStyleCrossOut">s</span> factors&#44; among others&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">6</span></a> On the other hand&#44; adverse life events during childhood&#44; especially adult abuse and bullying by peers<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">7</span></a> are important predictors of impaired social development and mental disorder&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">8</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">In Spain&#44; suicide is the first cause of death between 15 and 24 years&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">9</span></a> Non-suicidal self-harm&#44; beginning between 11-15 years of age and present in 13-23&#37; of the general population&#44; is an indicator of emotional dysregulation and an important risk factor for suicide attempts&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">10</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">In Spain&#44; no cohort studies have been carried out in the adolescent population with the objective to ascertain the relationship between lifestyles and psychosocial factors and risk of physical illnesses and mental disorders&#46; Given the priority to carry out specific preventive efforts and public health policies in this crucial transition period&#44; it is essential to describe the prevalence of healthy and risk behaviors&#44; as well as psychiatric symptoms&#44; and to establish possible associations between the prevalence of these behaviors and the risk of developing physical and mental disorders&#46; This is the main objective of the SESSAMO cohort study&#46; This project aims to&#58; 1&#41; assess the association between lifestyle and physical and mental health&#59; 2&#41; assess to in which extent self-concept and stressful life events can modulate these associations&#59; and 3&#41; establish the role of social determinants both in the lifestyle and in adolescents&#8217; health&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Method</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Design</span><p id="par0030" class="elsevierStylePara elsevierViewall">SESSAMO Project &#40;<span class="elsevierStyleItalic">Seguimiento de Estudiantes de Secundaria para valorar Salud Mental y Obesidad</span> &#91;Follow-up of secondary students to assess mental health and obesity&#93;&#41; is a multicentric prospective cohort study developed in Spain&#46; The collection of baseline data of the participants is carried out at schools through on-line&#44; validated&#44; self-administered questionnaires included in a data collection platform specifically designed for this project&#46; Starting at 14&#44; every three years&#44; up to the age of 25&#44; participants will be contacted again through a mobile application to update their information&#46; The follow-up questionnaires will include questions regarding habits and changes in lifestyle and psychosocial or physical variables&#44; and new medical or psychiatric diagnoses&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Participants</span><p id="par0035" class="elsevierStylePara elsevierViewall">All public&#44; concerted and private upper schools from Canary Islands&#44; Navarre and the Basque Country participate in the study&#46; After schools&#8217; acceptance to participate&#44; all the students aged from 14 to 16 years &#40;from 2nd to 4th of ESO - grades 2 through 4&#41; and their parents or legal guardians are invited to take part of the study&#46; We estimate a final sample of 4000 participants&#46; Exclusion criteria are&#58; the non-participation of the school center&#44; poor knowledge of the two languages in which the study is developed&#58; Spanish or Basque language&#59; the non-participation acceptation by parents or legal guardians&#59; the non-participation assent by the student despite the consent of the parents or guardians&#59; and students with cognitive or visual impairment&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Tools and materials for data collection</span><p id="par0040" class="elsevierStylePara elsevierViewall">Baseline information is collected through on-line&#44; validated&#44; self-administered questionnaires included in a data collection platform specifically designed for this project &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; Variables related to lifestyles&#44; stressful events&#44; personality and mental health are collected&#46; The Oviedo Response Infrequency Scale<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">11</span></a> is included to detect random responses&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">After parents or legal guardians fulfill the informed consents&#44; adolescent&#8217; height and weight are measured&#46; Likewise&#44; by means of another specific informed consent&#44; the technician collects an oral sample obtained rubbing a specific collector for genetic determinations &#40;ORAcollet DNA OCR-100 Kit&#41;&#44; non-invasive technique and without health risk&#46; These samples are kept in a biobank until analysis and will be destroyed once the project has finished&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">SESSAMO includes an optical questionnaire for parents inquiring about several physical and mental diseases and health conditions of their children&#46; COVID-19 impact is included&#46; This questionnaire is completed in paper format and only at baseline&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Statistical analyses</span><p id="par0055" class="elsevierStylePara elsevierViewall">The association between lifestyle variables and the presence of stressful life events and the prevalence or incidence of physical and mental pathology will be carried out through logistic regression models&#46; Cox regression models will be used for longitudinal analysis with more than 2 years of follow-up&#46; Likewise&#44; in the case that the different mental health indicators are collected quantitatively generalized linear models or generalized estimation equation models will be applied&#46; In all cases&#44; the models will be adjusted for possible confounding variables&#46; The possible interaction between personality traits or the presence of stressful events and different lifestyles in their effect on mental health will be analyzed including interaction terms in the regression models&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Confidentiality and ethical aspects</span><p id="par0060" class="elsevierStylePara elsevierViewall">The Research Ethics Committees at each Spanish autonomous community implicated in the project approved the protocol&#46; All participants and their parents or legal guardians receive a study information sheet and a graphical summary of the protocol &#40;see <a class="elsevierStyleCrossRef" href="#sec0085">online Appendix A</a>&#41;&#44; as well as individual informed consents&#46; Together with the consent of the parents&#47;legal guardians&#44; the assent of the minor is included&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Data storage is carried out in two independent databases&#46; One of them contains participants&#8217; identification data and the other clinical conditions&#46; The use of independent databases guarantees the confidentiality of the data&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">All information is treated in a completely confidential manner and is used exclusively for research purposes&#44; according to the Spanish Organic Law 15&#47;1999 on data protection and Law 3&#47;2018 on data protection and guarantee of digital rights &#40;LOPD&#41;&#46;</p></span></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Discussion</span><p id="par0075" class="elsevierStylePara elsevierViewall">SESSAMO Project is the first Spanish study whose aim is to prospectively assess the association between lifestyle and social determinants with physical and mental health in adolescents&#46; Data from SESSAMO will permit to ascertain adolescents&#8217; lifestyle and the main health problems associated to them&#46; To establish the role that these lifestyles have on adolescents&#8217; health is essential to design and implement preventive actions to change these habits and improve first adolescents&#8217; and later adults&#8217; physical and mental health&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Due to the importance of early intervention in the development of possible psychopathologies&#44; the research team informs the parents or guardians if a suspicious case of mental disorder is detected&#46; Finally&#44; each participating school receives a global results report&#46; This information will make it easier for schools to develop lines of action and implementation of specific programs that address issues such as emotional management&#44; suicidal ideation&#44; mental health&#44; and lifestyles&#44; among others&#46; The participation of different Spanish regions and types of schools increases study power and its ability to extrapolate its results&#46;</p><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Limitations</span><p id="par0085" class="elsevierStylePara elsevierViewall">Although the adolescents will be accompanied by a technician during the baseline evaluation who can resolve their doubts and all the questionnaires used to early detection of mental disorders have been validated in adolescent samples a non-differential misclassification bias cannot be ruled out&#46; In order to avoid a possible bias in answering questionnaires&#44; as quality control analysis&#44; a specific scale has been introduced in the platform to eliminate those participants who report random responses&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Another limitation is that the platform is not accessible to students with visual disabilities&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">An important challenge of this study is&#44; firstly&#44; to get the involvement of schools&#44; and secondly family&#39;s participation&#46; For that reason&#44; our team is involved in all the process starting with the first approach to school authorities and counseling departments&#44; and finally getting access to parents&#8217; associations and families providing all the information they request&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Related articles</span><p id="par0100" class="elsevierStylePara elsevierViewall">No other publications containing the results of this study have already been published or submitted to any journal&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Study status</span><p id="par0105" class="elsevierStylePara elsevierViewall">At the time of this submission participant recruitment was not completed&#46;</p></span></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Editor in charge</span><p id="par0110" class="elsevierStylePara elsevierViewall">Salvador Peir&#243;&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Authorship contributions</span><p id="par0115" class="elsevierStylePara elsevierViewall">A&#46; S&#225;nchez-Villegas and A&#46; Go&#241;i-Sarri&#233;s performed the literature review and conceived and designed the study&#46; G&#46; P&#237;rez&#44; N&#46; Y&#225;rnoz-Go&#241;i&#44; F&#46; Lahortiga-Ramos&#44; A&#46; Iruin&#44; A&#46; D&#237;ez-Su&#225;rez&#44; I&#46; Zorrilla&#44; L&#46; Morata-Sampaio&#44; M&#46;J&#46; Oliver and A&#46; Gonz&#225;lez-Pinto designed the data collection tools and will conduct the recruitment and the evaluation of the subjects in the different Spanish regions&#46; A&#46; S&#225;nchez-Villegas and A&#46; Go&#241;i-Sarri&#233;s drafted the manuscript&#46; A&#46; S&#225;nchez-Villegas will manage data&#46; All authors have reviewed the manuscript and approved the final version of the protocol&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Acknowledgements</span><p id="par0120" class="elsevierStylePara elsevierViewall">The authors wish to thank all adolescents&#44; their families&#44; teachers and management teams from educational centers involved in the SESSAMO Project&#46;</p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Funding</span><p id="par0125" class="elsevierStylePara elsevierViewall">This study has been funded by the Spanish Ministry of Science and Innovation &#40;Spanish National Institute of Health&#44; European Regional Development Fund&#41; and the Instituto de Salud Carlos III&#44; PI20&#47;00133&#46;</p></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0190">Conflicts of interest</span><p id="par0130" class="elsevierStylePara elsevierViewall">A&#46; S&#225;nchez-Villegas&#58; Instituto de Salud Carlos III&#44; Grant PI20&#47;00133&#46; I&#46; Zorrilla&#58; Otsuka and Janssen conference support&#46; A&#46; Gonz&#225;lez-Pinto&#58; Grants of Cibersam&#44; Spanish Ministry of Science and Basque Government&#59; provided funding&#44; consulting fees and conference support of Janssen&#44; Angelini and Rovi&#46;</p></span></span>"
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            0 => "Adolescentes"
            1 => "Estilos de vida"
            2 => "Salud mental"
            3 => "Cribado"
            4 => "Cohorte"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">During last decades&#44; a departure from health-related lifestyles has been observed among adolescents&#46; Evidence reports that healthy lifestyles could be predictors of better mental health status&#46; The aims of the SESSAMO Project are&#58; 1&#41; to assess the association between lifestyles and physical and mental health&#59; 2&#41; to assess how self-concept and stressful life events can modulate these associations&#59; and 3&#41; to establish the role of social determinants in the lifestyle and in adolescents&#8217; health&#46; The SESSAMO Project is a prospective cohort carried out in Spain&#46; Students aged 14-16 years &#40;2nd-4th ESO&#41; and their parents are invited to participate&#46; Baseline data are collected through on-line&#44; validated&#44; self-administered questionnaires through a digital platform&#46; Information on lifestyles&#44; stressful life events and self-concept are collected&#46; Screening of depression&#44; anxiety&#44; eating disorders&#44; suicide risk&#44; psychotic experiences and COVID impact is assessed&#46; Every three years&#44; up to age of 25&#44; participants will be contacted again to update relevant information&#46;</p></span>"
      ]
      "es" => array:2 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">En las &#250;ltimas d&#233;cadas se ha producido un alejamiento de los estilos de vida saludables en adolescentes&#46; Los h&#225;bitos saludables pueden predecir una mejor salud mental&#46; El proyecto SESSAMO tiene como objetivos&#58; 1&#41; determinar la asociaci&#243;n entre el estilo de vida y la salud f&#237;sica y mental&#59; 2&#41; determinar c&#243;mo el autoconcepto y los acontecimientos vitales estresantes pueden modular dichas asociaciones&#59; y 3&#41; establecer el papel de los determinantes sociales en el estilo de vida y en la salud de los adolescentes&#46; Se trata de un estudio de cohortes prospectivo&#44; dirigido a estudiantes de secundaria de 14-16 a&#241;os y a sus padres&#46; Los datos basales se recogen con cuestionarios validados y autoadministrados en una plataforma <span class="elsevierStyleItalic">on-line&#46;</span> Se realiza un cribado de depresi&#243;n&#44; ansiedad&#44; trastornos alimentarios&#44; riesgo de suicidio&#44; experiencias psic&#243;ticas e impacto de la COVID-19&#46; Cada 3 a&#241;os&#44; hasta la edad de 25 a&#241;os&#44; se les volver&#225; a contactar para actualizar la informaci&#243;n relevante&#46;</p></span>"
      ]
    ]
    "apendice" => array:1 [
      0 => array:1 [
        "seccion" => array:1 [
          0 => array:4 [
            "apendice" => "<p id="par0140" class="elsevierStylePara elsevierViewall"><elsevierMultimedia ident="upi0005"></elsevierMultimedia></p>"
            "etiqueta" => "Appendix A"
            "titulo" => "Supplementary data"
            "identificador" => "sec0090"
          ]
        ]
      ]
    ]
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      0 => array:8 [
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        "etiqueta" => "Table 1"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Variables&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Instruments of measurement&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Lifestyle and health</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Diet&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Food Frequency Questionnaire &#40;FFQ&#41;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">12</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Physical activity&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Physical Activity Questionnaire for Adolescents &#40;PAQ-A&#41;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">13</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Hobbies&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Questions from ESTUDES<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">14</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Toxic habits&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Questions from ESTUDES<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">14</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Sleep quality&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Pittsburgh Sleep Quality Index &#40;PSQI&#41;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">15</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Sexual behavior&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Questions from the 2019 Middle School Youth Risk Behavior Survey&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Videogames&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Game Addiction Scale for Adolescents &#40;GASA-Short&#41;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">16</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Internet problematic use&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Problematic Internet Use Scale in adolescents &#40;PIUS-a&#41;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">17</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Stressful events</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Bullying and cyberbullying&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Olweus Bully Victim Questionnaire &#40;OBVQ&#41;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">18</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Stressful life events&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Stressful Life Events Inventory<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">19</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Adverse experiences&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Inventory of Adverse Childhood Experiences &#40;IACE&#41;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">20</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Personality variables</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Self-concept&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Self-concept Form 5 &#40;AF-5&#41;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">21</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Mental health</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Strengths and Difficulties&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Strengths and Difficulties Questionnaire &#40;SDQ&#41;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">22</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Depression&#44; Anxiety and Stress&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Depression&#44; Anxiety and Stress Scale &#40;DASS-21&#41;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">23</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Suicide risk&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Columbia-Suicide Severity Rating Scale &#40;C-SSRS&#41;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">24</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Self-Injurious&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Self-Injurious Thoughts and Behaviors Interview &#40;SITBI&#41;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">25</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Eating disorder&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Children&#39;s Eating Attitudes Test &#40;ChEAT&#41;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">26</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Psychotic experiences&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Prodromal Questionnaire-Brief &#40;PQ-B&#41;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">27</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>COVID-19 impact&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">UCLA Brief COVID-19 Screen for Child&#47;Adolescent PTSD<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">28</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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