IntroductionElectronic survey mode has become a more common tool of research than it used to be previously. This is strongly associated with the overall digitization of modern society. However, the evidence on the possible mode effect on study results has been scarce. Therefore, the aim of this study is to investigate the comparability of findings on health and behaviours using a paper-versus-electronic mode of survey with randomization design among schoolchildren.MethodsA randomized study was conducted using a mandatory questionnaire on international Health Behaviour in School-aged Children (HBSC) study in Lithuania, enrolling 531 schoolchildren aged 11–15 years. The questionnaire included health and social topics about physical activity, risk behaviours, self-reported health and symptoms, life satisfaction, bullying, fighting, family and school environment, peer relationships, electronic media communication, sociodemographic indicators, etc. The schoolchildren within classes were randomly selected for electronic or paper mode.ResultsIt was found that by study mode differences are inconsistent and in the majority of cases do not exceed 5%-point difference between the modes. The only significant difference was that in the paper survey the participants reported more exercise than in the electronic survey (OR=8.08, P<.001). Other trends were nonsignificant and did not show a consistent pattern – in certain behaviours the paper mode was related to healthier choices, while in others - the electronic.ConclusionsThe use of electronic questionnaires in surveys of schoolchildren may provide findings that are comparable with concurrent or previously conducted paper surveys.

The aim of the study was to analyze the trends of adolescent substance use in four eastern European countries over the time period from 1994 to 2018. The four countries in focus were selected based on their shared historical backgrounds and major economic and social transformations experienced. Methods: Two decades (1993/1994–2017/2018) of repeated cross-sectional data from the Estonian, Latvian, Lithuanian, and Polish Health Behaviour in School-aged Children survey were used. Data comprised 42,169 school children 15 years of age (9th grade). The following categories of substance use were included: regular alcohol consumption and drunkenness, tobacco smoking, electronic cigarette smoking, and cannabis use. Trends in substance use over time were tested using Jonckheere’s trend test. Results: Prevalence of substance use among adolescents over time revealed that the Baltic states and Poland have faced relatively different temporal trends. In the Baltic states, there was a general increase during the period of 1994–2002, which was followed by a period of peaking or stability between 2002–2010, and then decreasing trends of these risky behaviors from 2010 onwards. In Poland, the same period had less consistent patterns, with decreasing trends starting much earlier on. The prevalence of cannabis use, which had been measured since 2006, had its own unique pattern with many fluctuations within and between countries. Conclusions: The findings on the prevalence of substance use among adolescents from 1994 to 2018 revealed that the Baltic states and Poland have faced relatively different temporal trends. These countries might be facing new public health challenges in a near future, e.g., use of electronic cigarettes and cannabis use among adolescents.

Background: Worldwide statistics highlight that many adolescents suffer from various types of maltreatment, which often tend to co-occur in the form of poly-victimisation. The experience of maltreatment at a young age causes physical and mental health problems, and can also lead to self-harm and suicide.The aim: To explore the possible impact of maltreatment and polyvictimisation on adolescent self-harm and suicide attempts. Participants and settings: In total, 1898 students (15-18 years old) from Lithuanian vocational schools completed the survey (65.5% male). Method: The impact of maltreatment and poly-victimisation on self-harm and suicide attempts was tested using multivariable binary logistic regressions. Results: Different maltreatment types were significantly associated to selfharm (odds ratio from 2.47 to 3.80, p < 0.001) and suicide attempts (odds ratio from 3.15 to 7.58, p < 0.001). The odds ratios for self-harm and suicide attempt increased as the number of different types of maltreatment experienced increased. A history of experiencing four types of poly-victimisation increased adolescent risk for self-harm (OR = 18.57, p < 0.001, 95% CI: 5.77-59.72) and suicide attempts (OR = 45.54, p < 0.001, 95% CI: 14.37-144.28) the most. Conclusion: Adolescents with experience of maltreatment, particularly if polyvictimised, are at greater risk of engaging in self-harming and suicidal behaviours.adolescents, maltreatment, poly-victimisation, self-harm, suicide attempts Key Practitioner Messages • Adolescents with experience of maltreatment are more likely to engage in self-harm or suicidal behaviours compared to non-victimised peers. • Sexual abuse is associated with the greatest probability of suicide attempt compared to other forms of maltreatment. • The risk of self-directed violence increases as the number of maltreatment types experienced increases.