Adolescent risk behaviours and family settings in Bulgaria: An evidence-based approach to effective family support policies

Prevalence of health risk behaviours among Bulgarian adolescents, overall and by age and gender (Health Behaviour in School-aged Children (HBSC) – Bulgarian dataset, 2017-2018)_

Health risk behaviour			Overall				Boys	Girls	Boy-to-Girl prevalence ratio
	Age	Total(1)	No. of cases(2)	Boys	Girls	Prevalence	Prevalence	Prevalence
Current cigarette smoking	11 y.o.	1660	118	54	64	7.1	3.3	3.9	0.84
	13 y.o.	1371	152	85	67	11.1	6.2	4.9	1.27
	15 y.o.	1517	506	207	299	33.4	13.6	19.7	0.69
	Total	4548	776	346	430	17.1	7.6	9.5	0.80
	11 y.o.	1660	313	170	143	18.9	10.2	8.6	1.19
	13 y.o.	1371	364	212	152	26.5	15.5	11.1	1.39
	15 y.o.	1517	606	327	279	39.9	21.6	18.4	1.17
Regular alcohol consumption	Total	4548	1283	716	726	28.2	15.7	16.0	0.99
Sexual debut	15 y.o.	1517	451	245	206	29.7	16.2	13.6	1.19
Current cannabis use	15 y.o.	1517	264	133	131	17.4	8.8	8.6	1.02

Results of logistic regression models of sexual debut and current cannabis use of Bulgarian adolescents aged 15 (Health Behaviour in School-aged Children (HBSC) – Bulgarian dataset, 2017-2018)_

	Model 3a. Sexual debut - main effects		Model 3b. Sexual debut - interaction effects		Model 4a. Current cannabis use - main effects		Model 4b. Current cannabis use - interaction effects
	OR	Sig.	OR	Sig.	OR	Sig.	OR	Sig.
Demographics:
Boy (ref.)	1		1		1		1
Girl	0.59	***	0.60	***	0.82		0.83
Structure of family:
Living with both parents (ref.)	1		1		1		1
Living with one parent	1.10		1.11		1.74	*	1.74	*
Living with other relative/ foster care	1.05		1.05		1.02		1.02
Family affluence scale:
Family affluence - low (ref.)	1				1
Family affluence - medium	0.86				0.85
Family affluence – high	1.00				1.08
Family support:
Family support - low (ref.)	1				1
Family support – high	0.51	***			0.64	*
Interaction between Family support and FAS
Fam.support – low & FAS - low			2.35	***			1.75	**
Fam.support – low & FAS - medium			1.65	***			1.30
Fam.support – low & FAS - high			2.19	***			1.97	**
Fam.support – high & FAS - low			0.62				0.78
Fam.support – high & FAS - medium (ref.)			1				1
Fam.support – high & FAS - high			0.88				0.82
Communication with parents:
Communication with mother - easy (ref.)	1		1		1		1
Communication with mother – difficult	1.28		1.28		1.20		1.20
No mother	1.67	*	1.66	*	1.01		1.01
Communication with father - easy (ref.)	1		1		1		1
Communication with father – difficult	1.03		1.04		0.94		0.95
No father	0.89		0.89		0.74		0.74
Parental monitoring - mother
Low (ref.)	1		1		1		1
High	1.25	*	1.25	*	0.85		0.85
Parental monitoring - father:
Low (ref.)	1		1		1		1
High	0.99		0.99		0.96		0.96
School-related parental support
Low (ref.)	1		1		1		1
High	0.89		0.89		0.78	*	0.78	*
Constant	0.69	*	0.34	***	0.32	***	0.19	***
Log likelihood	-832.1		-829.8		-625.9		-624.4
Nagelkerke pseudo R-sq	0.04		0.04		0.03		0.03
N of observations	1411		1411		1438		1438

Results of logistic regression models of current cigarette smoking and regular alcohol consumption of Bulgarian adolescents aged 11, 13 and 15 (Health Behaviour in School-aged Children (HBSC) – Bulgarian dataset, 2017-2018)_

	Model 1a. Current cigarette smoking - main effects		Model 1b. Current cigarette smoking - interaction effects		Model 2a. Regular alcohol consumption - main effects		Model 2b. Regular alcohol consumption - interaction effects
	OR	Sig.	OR	Sig.	OR	Sig.	OR	Sig.
Demographics:
Boy (ref.)	1		1		1		1
Girl	1.26	*	1.26	**	0.94		0.95
11 y.o. (ref.)	1		1		1		1
13 y.o.	1.44	**	1.45	**	2.75	***	2.75	***
15 y.o.	5.89	***	5.90	***	6.40	***	6.42	***
Structure of family:
Living with both parents (ref.)	1		1		1		1
Living with one parent	1.60	***	1.60	***	1.34	**	1.34	**
Living with other relative/foster care	1.24	*	1.25	*	1.33	**	1.34	**
Family affluence scale:
Family affluence - low (ref.)	1				1
Family affluence - medium	1.13				1.11
Family affluence – high	1.12				1.28	*
Family support:
Family support - low (ref.)	1				1
Family support – high	0.65	***			0.79	**
Interaction between Family support
and FAS
Fam.support – low & FAS - low			1.29				1.09
Fam.support – low & FAS - medium			1.45	***			1.18	*
Fam.support – low & FAS - high			1.61	**			1.55	**
Fam.support – high & FAS - low			0.88				0.88
Fam.support – high & FAS - medium (ref.)			1				1
Fam.support – high & FAS - high			0.79				0.93
Communication with parents:
Communication with mother - easy (ref.)	1		1		1		1
Communication with mother – difficult	1.16		1.16		1.33	**	1.32	*
No mother	0.92		0.93		1.20		1.20
Communication with father - easy (ref.)	1		1		1		1
Communication with father – difficult	1.10		1.10		0.95		0.95
No father	1.24		1.24		0.84		0.84
Parental monitoring - mother
Low (ref.)	1		1		1		1
High	1.00		1.00		0.73	***	0.73	***
Parental monitoring - father:
Low (ref.)	1		1		1		1
High	0.90		0.89		0.79	**	0.79	**
School-related parental support
Low (ref.)	1		1		1		1
High	0.90		0.90		0.84	**	0.84	**
Constant	0.07	***	0.05	***	0.22	***	0.20	***
Log likelihood	-1675.2		-1674.2		-2295.7		-2294.2
Nagelkerke pseudo R-sq	0.12		0.12		0.12		0.12
N of observations	4127		4127		4190		4190

Descriptive statistics of the family characteristics used in the analysis of adolescents’ health risk behaviours (Health Behaviour in School-aged Children (HBSC) – Bulgarian dataset, 2017-2018)

Variable	Categories	Frequency	Percent
	Living with two parents	3537	77.8
Family structure	Living with one parent	861	18.9
	Living with other relative/foster care	150	3.3
	Low	498	11.5
Family affluence scale (FAS-III)	Medium	3069	70.9
	High	760	17.6
	Low	2859	62.9
Family support scale
	High	1689	37.1
	(Very) easy	3775	84.3
How easy is it for you to talk to mother about
things that really bother you?	(Very) difficult	546	12.2
	Don’t have or see mother	155	3.5
	(Very) easy	3285	73.4
How easy is it for you to talk to father about
things that really bother you?	(Very) difficult	935	20.9
	Don’t have or see father	254	5.7
Parental monitoring scale - mother
	High	1632	35.9
	Low	2916	64.1
	High	1971	43.3
Parental monitoring scale - father
	Low	2577	56.7
School-related parental support	High	2791	61.4
	Low	1757	38.6