**4. Discussion**

The aims of this study were to evaluate the current perceived health of upper secondary school students and its associations with multiple health-related factors; to compare physical, social, and environmental variables by health status; and to analyze the explanatory power of such variables on perceived health status.

Our findings show that almost three quarters of the studied population (74.4%) perceive their health as at least good. In accordance, the latest Austrian Health Interview Survey [22] reported that the vast majority of adolescents reported being satisfied with their health status, with less than 10% considering their health as poor or very poor.

A more detailed analysis of the results indicates that a high perception of health (very good, good) is very similar in male and female participants (44.5% and 57.9% of girls, respectively); however, two thirds of the "moderate health" group is represented by girls. This seems to be partially in line with previous studies suggesting that women tend to show a poorer perception of their health [23,24] or similar perception to men, despite the latter reporting higher incidence of health issues [25].

When analyzing the factors associated with perceived health in youth, the positive association between physical fitness and perceived health is clear. In fact, physical fitness seems to have a significant influence at all levels of health, as indicated by various studies [3,4]. In line with our findings, Liu et al. [26] proposed a significant association between overall physical fitness and general health, which, together, may predict adolescents' lifestyle choices and their willingness to engage in and promote healthy habits. The prominent role of physical fitness is also emphasized in studies focusing on different areas of youth's individual health, such as mental health [27], physical and metabolic health [28], social health [29], and overall quality of life [4]. Physical fitness, therefore, should be promoted in different settings, including the school environment, physical education, and leisure time.

Accordingly, leisure time physical activity appears to be an important determinant for perceived health, particularly discriminating between positive and low or negative perception of health [30]. Gomes et al. [31] report that leisure time exercise may positively influence mental health both directly and indirectly by reducing the time spent by youth in sedentary activities. These types of activities are also bidirectionally associated with health literacy, which may not only improve adolescents' health status, but also their knowledge and understanding of the indicators of health and, as a consequence, influence their lifestyle choices [32].

Our sample reported significantly better health for those engaging in sports club activities compared to those who did not. Participation in sports clubs, in fact, may be important not only for individual health but also as an opportunity for youth to reduce social and environmental inequities [33].

Similar to our findings on leisure time and organized physical activity, in our study, worse BMI scores were only associated with lower to poor perception of health, with no significant differences between those participants who reported being in very good or good health. This is in line with previous studies showing the impact of BMI and weight status on perceived health [7,9]. Additionally, BMI is considered a mediator of the relation between participation in physical activity and perceived health [9].

It may have been surprising that having electronic media in the bedroom did not affect the perception of health in our sample. Although some studies suggest a relation between media availability in the bedroom and certain factors associated with general health, such as sleep time and quality [34], increased screen time [35], or even depression symptoms [36], the availability of electronic media in the bedroom does not necessarily

lead to their usage or over-usage. In our sample, the fact that most of the participants stated to have media available in their bedroom regardless of the health group they belonged to might simply indicate that they do not make excessive use of them. However, when we combine these results with those on the daily usage of media, the difference between adolescents in the "very good health" group and those in the "moderate" and "poor health" ones becomes significant. It is also evident from our data that only the "very good health" group members (and partially the "good health" group ones) are close to the recommendations on maximum daily screen time (2 h/day) [37], whereas those who perceived lower or poor health spent an average of 3 h and 4 h on screen, respectively. Excessive screen time, therefore, should be considered as correlation of the perception of one's own health, as already stated elsewhere [10,12].

In addition, reported back pain is significantly lower in the "very good health" group compared to all the other groups. This is in line with previous studies on the impact of this issue on perceived health [11,15]. As the authors emphasize, back pain is logically strictly related to people's consideration of their own health as positive or negative. In fact, differently than physical fitness, physical activity, and body composition, which may be perceived very differently based on cultural aspects [38], and screen time, which some individuals may at times perceive as positive for their mental health [39], back pain is embedded in one's health condition, and may be even considered as a component of it. Therefore, it is reasonable to assume that those who did not report any back pain consider their health better compared to those who experienced such a problem. Finally, it is important to keep in mind that our results on back pain may not be sufficiently accurate, as the onset and duration of this issue (for instance, chronic vs. acute), as well as its intensity and source (mechanical, neurological, etc.), were not considered in the present study.
