Family Structure through the Adolescent Eyes: A Comparative Study of Current Status and Time Trends over Three Decades of HBSC Study

Round 1

Reviewer 1 Report

The introduction is complete, explains and justifies the whole context of the research, but compared to the other sections of the study, I find it too long (2 pages). Thus, I suggest that it be reduced, more direct to the purposes of the study.

I recommend that authors use STROBE for the qualification of the text. This list presents some important methodological issues that should be mentioned in observational studies.

I suggest that Figure 1 be better sized, some graphical elements are misaligned.

I also recommend a greater care in the other figures of the article, smoothing their background lines, so that the data that is in the image is better understandable.

I consider two questions simple, but important to be presented in the text. 1. were the instruments used previously validated? And 2. were those who conducted the analyses blinded to the groups, exposures, and outcomes?

Finally, I also find the conclusion too long. I suggest that the authors present the main findings of the research, as well as a recommendation regarding the phenomenon (what and how to do considering the current scenario).

Author Response

To Reviewer #1

Dear Reviewer,

Thank you for your thorough analysis of our article, its overall positive evaluation, constructive comments and suggestions. We explained point-by-point the details of the revisions in the manuscript as described below in italic. Changes in the manuscript text are with "Track changes" function in Microsoft Word, so that changes are easily visible (see attached document). As there were many changes in the manuscript, we uploaded the final draft in pdf version without "Track changes" in text.

The introduction is complete, explains and justifies the whole context of the research, but compared to the other sections of the study, I find it too long (2 pages). Thus, I suggest that it be reduced, more direct to the purposes of the study.

Response: The introduction to our article has several objectives: to define the concept of family and its structure types, the importance of family structure to adolescent lifestyle and health, the availability of data on families raising children, and, most importantly, the assessment of family structure through adolescents themselves. The remaining three reviewers did not comment on the length of the introduction. In other articles, especially social content, the introductions to the articles are also detailed. However, your comment was taken in regard. We have carefully reviewed the introduction for reducing the text. Almost all section on international statistical data bases have been excluded without losing the logical structure of the introduction.

I recommend that authors use STROBE for the qualification of the text. This list presents some important methodological issues that should be mentioned in observational studies.

Response: Thank you for the kind suggestion. We followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) cross sectional checklist (https://doi.org/10.1016/j.ijsu.2014.07.013) when describing the results of 2018 survey. This study presents also data of repeated cross sectional design. Thus, listing in the article the extent to which each of the STROBE requirements is met would greatly expand the article.

I suggest that Figure 1 be better sized, some graphical elements are misaligned.

Response: We reduced the size of Figure 1 by about 10% and we improved the alignment of its elements.

I also recommend a greater care in the other figures of the article, smoothing their background lines, so that the data that is in the image is better understandable.

Response: All figures were revised: changed font size and type, smoothed grid lines, etc.

I consider two questions simple, but important to be presented in the text. 1. were the instruments used previously validated? And 2. were those who conducted the analyses blinded to the groups, exposures, and outcomes?

Response: 1. Only validated instruments are used in the HBSC study. In addition, there are strict requirements for the instruments to be accurately translated into national languages and piloted before the main surveys as described in the protocols of each HBSC study wave. In regard to the question about the family structure (with whom the child is living), its construct validity had been confirmed in all HBSC surveys, with a strong influence of family structure on adolescent lifestyle and health. Over the years the core of the question has been remained the same. Number of siblings and grandparents in the family have been supplemented in several waves of the HBSC study. In our study, we make a classification based on parents and stepparents in the family as indicated in Figure 1. In the revised manuscript, section "Measures" the following sentence was added: "Validity of the question was confirmed in all HBSC surveys, with a strong influence of family structure on adolescent lifestyle and health [52–58]".

2. The second concern do not really apply to a cross-sectional study as ours. We have analysed the data in line with the statistical golden standard for a repeated cross-sectional design.

Finally, I also find the conclusion too long. I suggest that the authors present the main findings of the research, as well as a recommendation regarding the phenomenon (what and how to do considering the current scenario).

Response: The conclusions have been reduced and reformulated to such an extent that we left only the essential findings of the study and recommendations as follows:

"Over the last three decades, the family structure in European and North America regions had distinct patterns and changed considerably. This has shaped the new type of family environment in which the young people live. The model of the intact family was challenged by the recent trends of increasing family union instability and physical separation of families due to emigration of parents or living apart together.

The present study demonstrates how the adolescent’s perspective can contribute to better understand the demographic trends and to provide deeper knowledge on the changing sphere of family and parenthood. Its findings may have implications for cross-national adjustment of adolescent health, well-being and behaviour by family structure, as well as for critical analysis of socio-economic family resources."

 

Author Response File: Author Response.pdf

Reviewer 2 Report

The study entitled “Family Structure Through the Adolescent Eyes: A Comparative Study of Current Status and Time Trends over Three Decades of HBSC Study” have the goals to understand the evolution of the family.

The article is well written and is a good window to the evolution of the family structure. Nevertheless, I have some points to underline

1.            one of the various aspects that it would be good to underline concerns the family with homosexual parents that are not mentioned in the article. I think it appropriate to highlight the limitation of the questionnaire which probably did not contain this question; a discussion about this new structure of family is recommended. I think that, if the article examined the structure of family, this aspect can't be not ignored, at least it is not clear where respondents place this type of family (sometimes this structure of family are created after a divorce between parents who are initially heterosexual, sometimes is consists in a biological parent and in a step-parent who adopts the child, ecc)

2.            What age have the adolescents that reply to the questionnaire? I suggest the researcher to indicate it in the paper

3.         If  possible, please indicate the number of family that are in a separation process (indicate al line 453)

Author Response

To Reviewer #2

Dear Reviewer,

Thank you for your thorough analysis of our article, its overall positive evaluation, constructive comments and suggestions. We explained point-by-point the details of the revisions in the manuscript as described below in italic. Changes in the manuscript text are with "Track changes" function in Microsoft Word, so that changes are easily visible (see attached document). As there were many changes in the manuscript, we uploaded the final draft in pdf version without "Track changes" in text.

The study entitled “Family Structure Through the Adolescent Eyes: A Comparative Study of Current Status and Time Trends over Three Decades of HBSC Study” have the goals to understand the evolution of the family.

The article is well written and is a good window to the evolution of the family structure. Nevertheless, I have some points to underline

Response: Thank you for your generous comments.

1. One of the various aspects that it would be good to underline concerns the family with homosexual parents that are not mentioned in the article. I think it appropriate to highlight the limitation of the questionnaire which probably did not contain this question; a discussion about this new structure of family is recommended. I think that, if the article examined the structure of family, this aspect can't be not ignored, at least it is not clear where respondents place this type of family (sometimes this structure of family are created after a divorce between parents who are initially heterosexual, sometimes is consists in a biological parent and in a step-parent who adopts the child, etc).

Response: The problem of homosexual parents was mentioned in the Introduction ("Different family structures include nuclear families, single parent families, stepfamilies, families headed by two unmarried partners, either of the opposite sex or the same sex..."). This actual issue requires detailed investigation, therefore, in this study, we did not want to analyze this problem superficially. In addition, the HBSC research methodology does not allow for an analysis of this problem as in the questionnaire the response alternatives were framed as “Stepmother (or father’s girlfriend/partner)” and “Stepfather (or mother’s boyfriend/partner )” which in not an optional way of asking about homosexual partners (it would be possible to analyse the problem if a child lives with the "mother" and "stepmother" or with the "father" and "stepfather"). The phrase "or living in homosexual family" has been added to the list of "other type" of family structure.

2. What age have the adolescents that reply to the questionnaire? I suggest the researcher to indicate it in the paper.

Response: The three age groups were presented. In the HBSC study the recommended national sample size per grade was 1,500, and the mean age should be 11.5, 13.5, and 15.5 years, where 90% of the sample should fall between +/- 6 months of the mean age. Should respondents report the actual age, we think this is too detailed and not ethical in respect of the anonymity of respondents.

3. If possible, please indicate the number of family that are in a separation process (indicate at line 453)

Response: We do not have this information. It is nor indicated at line 453. Of course the child knows if this is on-going, but we do not ask them.

Author Response File: Author Response.pdf

Reviewer 3 Report

The manuscript entitled „Family Structure Through the Adolescent Eyes: A Comparative  Study of Current Status and Time Trends over Three Decades of HBSC Study” focuses on an important protective factor, namely family structure that has a great impact on the entire development and functioning of adolescents.

It bases on a huge data from HBSC recorded during three decades with a standard methodology (seven surveys conducted from 1993/4 to 2017/18). The authors introduced the subject and its importance adequately, by pointing out the past literature, family structure definitions, and the history of the HBSC studies. The introduction is well prepared and allows the reader to get the main information about the studied issue. It ends with two study questions that describe the study aims.

Methodology

Small graphical corrections are needed in figure 1 as some parts are cut off or obscured by other text.

Results

Small graphical corrections are needed in figure 2 as some parts are cut off or obscured by other text.

The word “percent” is sometimes cut in half throughout the paper so it should be corrected e.g. lines 237 or 238

Discussion

In lines 334-5 the authors stated that adolescence is one of the most significant factors that impact family system transitions. This conclusion is questionable, why do you overestimate the adolescence period, and what kind of relation do you mean. Because judging by the study data I do not see the justification for such a conclusion.

In line 336 the authors used the word “recently” to describe results from the 2018 year – these results although important are not recent. Similar comment for line 438

Lines 348-352 The authors cited the differences in family structure between Eastern and Western Europe based on the data from 2017, it would be better to use more recent data from 2019.

The statement in lines 421-2 “This phenomenon is more common in countries from Eastern Europe” needs a proper citation, as in 2022 these trends have changed compared to 2018

Study strengths and limitations

In my opinion, the main study limitation is not included in the data the recent family structure data from 2021-22. Especially as the pandemic COVID 19 has an impact either on the mental health of adolescents or on families’ life and dynamics.

Author Response

To Reviewer #3

Dear Reviewer,

Thank you for your thorough analysis of our article, its overall positive evaluation, constructive comments and suggestions. We explained point-by-point the details of the revisions in the manuscript as described below in italic. Changes in the manuscript text are with "Track changes" function in Microsoft Word, so that changes are easily visible (see attached document). As there were many changes in the manuscript, we uploaded the final draft in pdf version without "Track changes" in text.

The manuscript entitled „Family Structure Through the Adolescent Eyes: A Comparative  Study of Current Status and Time Trends over Three Decades of HBSC Study” focuses on an important protective factor, namely family structure that has a great impact on the entire development and functioning of adolescents.

It bases on a huge data from HBSC recorded during three decades with a standard methodology (seven surveys conducted from 1993/4 to 2017/18). The authors introduced the subject and its importance adequately, by pointing out the past literature, family structure definitions, and the history of the HBSC studies. The introduction is well prepared and allows the reader to get the main information about the studied issue. It ends with two study questions that describe the study aims.

Response: Thank you for your generous comment.

Methodology

Small graphical corrections are needed in figure 1 as some parts are cut off or obscured by other text.

Response: We reduced the size of Figure 1 by about 10% and we improved the alignment of its elements.

Results

Small graphical corrections are needed in figure 2 as some parts are cut off or obscured by other text.

Response: All figures were revised: changed font size and type, smoothed grid lines, etc.

The word “percent” is sometimes cut in half throughout the paper so it should be corrected e.g. lines 237 or 238

Response: Thank you for your careful reading of our manuscript. We have made this correction three times in the manuscript.

Discussion

In lines 334-5 the authors stated that adolescence is one of the most significant factors that impact family system transitions. This conclusion is questionable, why do you overestimate the adolescence period, and what kind of relation do you mean. Because judging by the study data I do not see the justification for such a conclusion.

Response: We think the reviewer is commenting on the statement "Adolescence is one of the most significant of these transitions". We apologize that this statement is not really clear enough. It was therefore reformulated as follows: "Adolescence is one of the life course periods most sensitive to family structure change."

In line 336 the authors used the word “recently” to describe results from the 2018 year – these results although important are not recent. Similar comment for line 438.

Response: In the perspective of the study 1994-2018, a study based on data from 2018 is "recent" but in other cases this word was clarified to "in 2018".

Lines 348-352 The authors cited the differences in family structure between Eastern and Western Europe based on the data from 2017, it would be better to use more recent data from 2019.

Response: The reason for using data from 2017 is that this year is included in the study period 1994-2018.

The statement in lines 421-2 “This phenomenon is more common in countries from Eastern Europe” needs a proper citation, as in 2022 these trends have changed compared to 2018.

Response: The proper reference (Yanovich, 2015) was added to confirm the statement and the survey years were indicated. While the study covers the period to 2018, the further change would be possible to analyse once the HBSC data collection in 2021/22 is completed.

Study strengths and limitations

In my opinion, the main study limitation is not included in the data the recent family structure data from 2021-22. Especially as the pandemic COVID 19 has an impact either on the mental health of adolescents or on families’ life and dynamics.

Response: This data is not yet available. A separate paper on the impact of COVID 19 on adolescent and family life is presently discussed.

 

Author Response File: Author Response.pdf

Reviewer 4 Report

This is a very well-researched and clear paper. It'll be cited for this alone.

Thank you for centering youth and lifting the importance of collecting data directly from them. I do think there is an opportunity to expand on that a bit to emphasize why that matters more, thinking about how this data can be leveraged in intervention design and other forums. 

Self-report is very well-tested and though there is room for error, like everything human, the caveats here allude to an overstatement of potential complications with self-report and teeter on patronizing. mostly food for thought if you want to reframe this at all. 

Only other major consideration is if you can make this even more succinct. There are a lot of great charts in here already so I would not add more graphics but there is some rehashing and repetition that could be truncated a bit potentially. 

Thanks!

Author Response

To Reviewer #4

Dear Reviewer,

Thank you for your thorough analysis of our article, its overall positive evaluation, constructive comments and suggestions. We explained point-by-point the details of the revisions in the manuscript as described below in italic. Changes in the manuscript text are with "Track changes" function in Microsoft Word, so that changes are easily visible (see attached document). As there were many changes in the manuscript, we uploaded the final draft in pdf version without "Track changes" in text.

This is a very well-researched and clear paper. It'll be cited for this alone.

Response: Thank you for your generous comment.

Thank you for centering youth and lifting the importance of collecting data directly from them. I do think there is an opportunity to expand on that a bit to emphasize why that matters more, thinking about how this data can be leveraged in intervention design and other forums.

Response: We did not include a section on policy implications. This would be improving the article, but it is according to tree other reviewers already too long. In your interest, it is worth replacing official statistics with those in this article wherever such information is required.

Self-report is very well-tested and though there is room for error, like everything human, the caveats here allude to an overstatement of potential complications with self-report and teeter on patronizing. mostly food for thought if you want to reframe this at all.

Response: We have included self-reports as a weakness in the study already and we do not see the need to further elaboration on this issue.

Only other major consideration is if you can make this even more succinct. There are a lot of great charts in here already so I would not add more graphics but there is some rehashing and repetition that could be truncated a bit potentially.

Response: We have deleted a paragraph in the introduction, which appears again in the discussion. Moreover, we have shortened the conclusions as follow:

"Over the last three decades, the family structure in European and North America regions had distinct patterns and changed considerably. This has shaped the new type of family environment in which the young people live. The model of the intact family was challenged by the recent trends of increasing family union instability and physical separation of families due to emigration of parents or living apart together.

The present study demonstrates how the adolescent’s perspective can contribute to better understand the demographic trends and to provide deeper knowledge on the changing sphere of family and parenthood. Its findings may have implications for cross-national adjustment of adolescent health, well-being and behaviour by family structure, as well as for critical analysis of socio-economic family resources."

 

Author Response File: Author Response.pdf