Adolescents’ health challenges have become complicated and health tendencies change rapidly. Therefore, health education given at schools is a key factor for health promotion among adolescents. The influence of environmental factors within adolescents’ ecology is acknowledged early in health education and health-promotion (1, 2). In health education lessons, pupils learn essential health behavior knowledge and skills.  However, it has been previously shown that pupils have low interest in traditional health education at schools and suggested that pupils should be involved in planning these classes and health education should be integrated into other classes and subjects, student care, and school health services (3). This reciprocal interaction between school personnel and, particularly, with health nurses, creates an important but challenging educational collaboration and learning environment (4). Moreover, these communicative relationships and resources in an educational context in health promotion formulate adolescents’ personal behavioral development, attitudes and thoughts, and have, therefore, consequences to current and later health. 

This study belongs to a larger Finnish-Russian collaboration and research project, Addressing challenging health inequalities of children and youth between two Karelias (AHIC), which aims is to promote children and adolescents’ health and well-being. The aim of this study was to investigate changes between genders regarding self-evaluated health, health concerns, attitudes related to health education in schools, and relationship with school nurses among adolescents in two Karelias, namely North Karelia, Finland and the Pitkyaranta district in the Republic of Karelia, Russia, from 1995 to 2013.

(1) Edberg M. Essentials of Health Behavior: Social and Behavioral Theory in Public Health. Boston, MA: Jones and Bartlett Publishers; 2007. (2) Bronfenbrenner U and Evans GW (2000) ‘Developmental science in the 21st century: Emerging questions, theoretical models, research designs and empirical findings’. Social Development 9:115–125. (3) Lohrmann DK (2010) A Complementary Ecological Model of the Coordinated School Health Program. Journal of School Health. January 2010, Vol. 80, No. 1:1-9. USA. (4) Borup I (2002) The school health nurse’s assessment of a successful health dialogue Health and Social Care in the Community 10(1), 10–19 (5) Kemppainen U, Tossavainen K, Vartiainen E et al (2006) Environmental factors as predictors of smoking among ninth-grade adolescents in Pitkäranta (Russian Karelia) and in Eastern Finland. Res Nursing Health 29(6):543–555. (6) Kemppainen U, Tossavainen K, Vartiainen E et al (2002) Smoking patterns among ninth-grade adolescents in the Social determinants of adolescent smoking in Russia in Pitkäranta District (Russia) and in Eastern Finland. Public Health Nursing 19(1):30–39. (7) Kemppainen U, Tossavainen K, Vartiainen E et al (2004) An integrative model to predict adolescents` alcohol use: A cross-national study in the Pitkäranta district (Russian Karelia) and in eastern Finland. Diversity in Health and Social Care 1:81-92. (8) Kemppainen U, Tossavainen K, Vartiainen E et al (2007) Identifying Russian and Finnish adolescents´ problem behaviors. Health Education 107(1):81-98.