Risk health behaviors encountered in secondary school young people in Kosovo. The role of education in diseases prevention and quality of life

INTRODUCTION Kosovo, like the many other transitional countries, is facing serious public health challenges related to risk health behaviors among adolescents. Secondary school students represent a particularly vulnerable age group, during which lifestyle patterns are formed under the influence of social, economic, and cultural factors. Risk behaviors such as tobacco use, alcohol consumption, substance abuse, unhealthy diet, physical inactivity, and unsafe sexual practices significantly impact the quality of life and contribute to the early onset of chronic diseases in adulthood. Latest health statistics education institutions in Kosovo indicate a considerable prevalence of these behaviors among secondary school students. These behaviors are often linked to a lack of appropriate health education, peer pressure, and the absence of structured and continuous educational interventions within schools. This condition presents a very critical challenge for public policies in both the health and education sectors, which must address the urgent need for comprehensive and integrated health education for youth. In this context, health education plays an essential role in disease prevention and quality of life improvement. Educational policies and cross-sectoral strategies led by public institutions must focus on creating a health-promoting culture that encourages healthy lifestyle choices from an early age. Health education in schools not only influences individual behavior but also builds competencies for analyzing risks and making informed decisions. At the strategic level, Kosovo has taken steps to integrate health education into school curricula and to create a supportive environment for adolescents. Policy documents such as the Health Education Strategy in Schools (2022–2026) and the Action Plan for Youth Health Promotion aim to empower young people through access to accurate information, active engagement, and multi- sectoral cooperation. These initiatives are aligned with the policies of the World Health Organization (WHO) and the European Union, which emphasize early intervention to address the social determinants of health. The specific objectives of the study are to: -Identify and analyze the most prevalent risk health behaviors among secondary school students in Kosovo (e.g., tobacco use, alcohol consumption, substance abuse, physical inactivity, poor diet, unsafe sexual practices); -Assess the correlation between the level and quality of health education received and the presence of these risk behaviors; 7 -Explore the influence of educational institutions, families, and communities in shaping adolescents' health-related choices and behaviors; -Formulate evidence-based recommendations for sustainable, inclusive, and effective interventions in health education, aimed at preventing disease and promoting long-term well-being among youth. Vision of the Health Education Strategy in Schools: Kosovo’s youth will develop healthy lifestyle habits, be informed, aware, and capable of making decisions that promote their physical, mental, and social well-being. Core Principles of the Strategy include:  Active participation of young people  Equal and inclusive access to information  Sensitivity toward vulnerable groups  Gender equality  Cross-sectoral collaboration and institutional cooperation  Financial sustainability and cost-effectiveness PURPOSE AND IMPORTANCE OF THE STUDY The main purpose of this doctoral study is to investigate the prevalence and characteristics of risk health behaviors among secondary school students in Kosovo, and to evaluate the role of education in preventing disease and promoting a better quality of life among young people. By analyzing the current behavioral prevalence and patterns of health risk behaviors and the level of health awareness in this age group, the study aims to provide an evidence-based foundation for designing effective, youth-centered educational and preventive strategies. This research also seeks to fill existing knowledge gaps in the field of adolescent health in Kosovo, offering insights that can inform national policy development and cross-sectoral collaboration between the education and health systems. Also, this study is important because it provides new scientific data on a population and geographic area that has been little studied, and it supports the development of effective policies and programs for health promotion among young people. 8 RESEARCH QUESTIONS AND HYPOTHESES The research questions of the project will focus on: 1. What is the current pattern/distribution of risky health behaviors? 2. What is the prevalence of risky health behaviors? 3. Which dangerous behaviors are more frequent among high school youth and how are they associated with them? 4. Which categories or groups are most vulnerable to dangerous health behaviors? 5. What are the factors that influence and lead teenagers to dangerous health behaviors? 6. Can the findings provide comparable data at the national and regional level? Hypothesis 1. Adolescents with a lack of knowledge of risky behaviors are more likely to engage in risky behaviors compared to informed youth. Hypothesis 2. Adolescents who positively evaluate the role of education in preventing risky behaviors will show lower levels of risky behaviors (lower total risk) compared with adolescents who underestimate the role of education. This proposal is expected to make an important contribution both to the identification of the situation of young people's behavior and to the improvement of their knowledge in terms of approaches to positive health behaviors. SCIENTIFIC AND PRACTICAL CONTRIBUTION This study provides a significant contribution both scientifically and practically in the field of public health. Scientifically, it offers original data on risk health behavior among secondary school students in Kosovo, presenting a clear picture of the prevalence and influencing factors of these behaviors. Furthermore, the research emphasizes the importance of health education as a preventive tool against diseaeses and as a key factor in improving quality of life. On a practical level, the findings of this study can serve as a foundation for developing school-based intervention programs, leading public health policies targeting youth, and strengthening collaboration beetween educational and all health institutions. This thesis contributes to building a comprehensive 9 approach to youth health education and promotion, with the long-term goal pf preventing risky behaviors and enhancing overall wellness.