Results show for the first time that across three GSHS in 2007, 2012 and 2018 in Argentina, among both sexes a significant decrease in the prevalence of current cigarette use, passive smoking, trouble from alcohol use, and physically attacked, and among boys experience of hunger, parental tobacco use, current alcohol use, involvement in physical fighting, and multiple sexual partners, and among girls inadequate physical inactivity. However, overweight/obesity, obesity, leisure-time sedentary behaviour and insufficient fruit intake significantly increased among both boys and girls, and among girls not walking/biking to school, current other tobacco use, bullying victimisation, lifetime drunkenness, having no close friends, loneliness, worry-induced sleep disturbance, suicidal ideation, suicide plan, and ever sexual intercourse significantly increased over time.
The significant reduction in current cigarette use, and passive smoking, also found in the Argentina Global Youth Tobacco Survey [10], may be attributed to the introduction of the smoke-free law in Argentina in 2011, including a “total ban on smoking in public settings, prohibition of advertising and promotional activities regarding tobacco use, and enforcing manufacturers to include messages warning of the harmful effects of cigarette smoking on health.” [20, 21]. However, of concern is that the prevalence of other tobacco use, significantly increased among girls from 2007 to 2018. Current alcohol decreased among boys, trouble from alcohol use decreased among both boys and girls, and lifetime drunkenness increased among girls. Current alcohol use is high in both sexes (52% among boys and 56% among girls) and is among adolescents often associated with negative health outcomes, such as interpersonal violence [12]. Public health interventions may be indicated to reduce alcohol use among adolescents in Argentina [12]. Although some national policies and interventions are in place for alcohol use in Argentina, such as legal minimum age for on or off premise sales of alcoholic beverages (18 years), and legally binding regulations on alcohol advertising, health warning labels on alcohol advertisements, there is no written national alcohol policy, no legally binding regulations on alcohol sponsorship, and no restrictions for on-/off-premise sales of alcoholic beverages [22].
Overweight/obesity and obesity, sedentary behaviour, not walking/biking to school (particularly among girls), and inadequate fruit consumption increased from 2007 to 2018, which may be attributed to a nutritional transition (to increased intake of processed foods, sugar-sweetened soft drinks or juices, and reduction of total fruit consumption) in Argentina [23]. The increase in sedentary behaviour may be attributed to an increased internet and mobile devices use among adolescents in Argentina [24]. Among girls, the prevalence of physical inactivity decreased, and was among both boys and girls like global rates (85%) [25]. However, the prevalence of sedentary behaviour was much higher than global estimates among adolescents (30%) [25]. It is possible that not walking/biking to school increased among girls because of lower parental supervision and peer support [26], as found in this study. The extent of food insecurity was below 2.4% in 2018, decreased among boys and remained unchanged among girls. The federal in-school feeding programme may have had a positive impact to reduce food insecurity [27].
In line with some previous trend studies [14, 28–30], this study showed that physically assaulted and involvement in physical fighting declined over time. Perhaps, one factor contributing to the decline in interpersonal violence, is the decline of alcohol use among boys in this study [12]. In addition, we found an increase in school attendance in our study, which may also have contributed to the decline of interpersonal violence. Compared to boys, bullying victimisation increased significantly among girls. It is possible that the decline in peer support among girls in this study contributed to an increase in being bullied among girls. The prevalence of bullying victimization in this study was higher in girls than in boys, which has also been reported in a different study in Argentina, Uruguay, and Brazil [31]. Regarding sexual behaviour, among boys, sexual risk behaviour (multiple sexual partners and non-condom use) decreased over time, and girls ever sexual intercourse increased over time. The since 2006 a national programme on comprehensive sexual education curriculum has been integrated across school levels [32], which may have contributed to low sexual risk behaviour.
Among boys, all mental health indicators remained unchanged, while among girls all five mental health indicators (suicide plan, loneliness, suicidal ideation, no close friends, and worry-induced sleep disturbance) significantly increased from 2007 to 2018. In response to this a gender-responsive health for suicide prevention programme through the establishment of school-based health advisory services has recently been implemented and is being roll-out in Argentina [33].
Regarding protective aspects, school attendance increased among both boys and girls, while peer support significantly decreased among girls but not among boys. Parental supervision and connectedness significantly decreased among both boys and girls over time in this study. This decline in parental support may be related to recent changes in family transformations in Argentina, including “increases in the age at marriage, marital dissolution, nonmarital births, and cohabitation, and with women increasingly contributing to the economic support of their families.” [34]. It is possible that the decline of parental supervision and connectedness contributed to poorer mental health, in particular among girls in this study.
Study findings highlight a wide range of health risk behaviours that can be targeted in school health promotion activities among in Argentina. Comprehensive Protection of the Rights of Boys, Girls and Adolescents, PROSANE is developed as an “Integrated Care Policy for children and adolescents”. ‘PROSANE is part of the Primary Health Care strategy strengthening the link between the school and the health centre makes it possible to identify issues that require promotional actions in schools. PROSANE promotes and develops health promotion actions in conjunction with teachers, managers, and families, promoting learning and integral human development, improving the quality of life and the collective well-being of children and adolescents and other members of the community [35].
Study limitations
“Secondary education net-enrolment ratio” was 85.9% in Argentina in 2012 and 90.7% in 2018 [36], which implies that some adolescents not attending school were not included in this study in Argentina. Some GSHS study variables, such as oral and hand hygiene, soft drink and fast-food consumption, were not included in this paper, since they were only assessed in one or two waves of the Argentina GSHS. The study design was cross-sectional, which precludes from causal inferences. The GSHS collected anonymously data by self-report that could have contributed to some bias but may nevertheless have reported valid data, in particular on sensitive issues [37].