CANDACE CURRIE KATE LEVIN

Child and Adolescent Health Research Unit (CAHRU)UNIVERSITY OF EDINBURGH

Informing investment in adolescent health, the Health Behaviour in School-Aged Children Study

A case study from Scotland

National health in international context: providing an evidence base for action

Scottish Case Study participation over 20 year period in international study providing trends over time and international comparisons research influencing policy agendas knowledge transfer to develop practice research informing the development of programmes, interventions and their evaluation sharing national experiences in international forums

The Health Behaviour in School-aged Children (HBSC) Study

An international study that gathers data from young people about their health and well-being

• Physical activity• Consumption of food & drinks/weight control• TV & computer use/electronic communication• Sexual health• Body image/BMI• Fighting/bullying/injuries• Self-rated health/health complaints/life satisfaction• Risk behaviours: tobacco/alcohol/cannabis

The Health Behaviour in School-aged Children (HBSC) Study

…and data on social and developmental factors

• Family structure and relationships• Peer relations• School environment and social relations• Socioeconomic status of parents and family affluence

HBSC: background

• Initiated in 1982 by three countries and shortly afterwards became a WHO collaborative study

• Now has 43 member countries in Europe and North America

• International network of around 300 researchers from different disciplines

Growth of HBSC study: countries by survey year

1983/1984 1985/1986 1989/1990 1993/1994 1997/1998 2001/2002 2005/6

1. England2. Finland3. Norway4. Austria5. Denmark

1. Finland 2. Norway 3. Austria 4. Denmark 5. Belgium 6. Hungary 7. Israel

8. Scotland 9. Spain10. Sweden11. Switzerland12. Wales13. Netherlands

1. Finland 2. Norway 3. Austria 4. Belgium (French) 5. Hungary

6. Scotland 7. Spain 8. Sweden 9. Switzerland10. Wales11.Denmark12. Netherlands13. Canada14. Latvia15. N. Ireland16. Poland

1. Finland 2. Norway 3. Austria 4. Belgium (French) 5. Hungary 6. Israel

7. Scotland 8. Spain 9. Sweden10. Switzerland11. Wales12. Denmark13. Canada14. Latvia15. Northern Ireland16. Poland17. Belgium (Flemish)18. Czech Republic19. Estonia20. France21. Germany22. Greenland23. Lithuania24. Russia25. Slovakia

1. Finland 2. Norway 3. Austria 4. Belgium (French) 5. Hungary 6. Israel

7. Scotland 8. Sweden 9. Switzerland10. Wales11. Denmark12. Canada13. Latvia14. Northern Ireland15. Poland16. Belgium (Flemish)17. Czech Republic18. Estonia19. France20. Germany21. Greenland22. Lithuania23. Russia24. Slovakia25. England26. Greece27. Portugal28. Ireland29. USA

1. Finland 2. Norway 3. Austria 4. Belgium (French) 5. Hungary 6. Israel

7. Scotland 8. Spain 9. Sweden10. Switzerland11. Wales12. Denmark13. Canada14. Latvia15. Poland16. Belgium (Flemish)17. Czech Republic18. Estonia19. France20. Germany21. Greenland22. Lithuania23. Russia24. England25. Greece26. Portugal27. Ireland28. USA29. tfyr Macedonia30. Netherlands31. Italy32. Croatia33. Malta34. Slovenia35. Ukraine

1. Finland 2. Norway 3. Austria 4. Belgium (French) 5. Hungary 6. Israel

7. Scotland 8. Spain 9. Sweden10. Switzerland11. Wales12. Denmark13. Canada14. Latvia15. Poland16. Belgium (Flemish)17. Czech Republic18. Estonia19. France20. Germany21. Greenland22. Lithuania23. Russia24. England25. Greece26. Portugal27. Ireland28. USA29. tfyr Macedonia30. Netherlands31. Italy32. Croatia33. Malta34. Slovenia35. Ukraine36. Luxemburg37. Turkey38. Slovakia39. Romania40. Iceland41. Bulgaria

HBSC: methods

• Surveys conducted every 4 years using standard international questionnaire in all countries

• School–based, pupil self-complete questionnaire, teacher or researcher administered

• Class is sampling unit

• Three age groups with mean age 11.5, 13.5 and 15.5 years

• Sample size in each country: minimum of 4,500 (1,500 per age group)

Scottish data: Mental health and well-being

Prevalence: Boys Girls• Happiness: Very happy 52 45• Confidence: Always confident 25 16• Perception of looks: Good looking 36 26 • Life satisfaction: High life satisfaction 88 81• Multiple Health complaints: MHC 22 31• Self-rated health: Poor/fair health 24 16

Girls in Scotland doing worse than boys on all well-being outcomes

Scottish data: 1994-2006 trends

Proportion of boys and girls who are very happy

0

10

20

30

40

50

60

1994 1998 2002 2006

Boys

Girls

Scottish data: 1994-2006 trends

0

10

20

30

40

50

1994 1998 2002 2006

Proportion of boys and girls who think they are good looking

Boys

Girls

Scottish data: Mental well-being

• Happiness• Confidence• Perception of looks • Life satisfaction• Multiple Health complaints• Self-rated health

Self rated health poor/fair at age 11 & 15

At age 11Scotland: 13% (M) 14% (F)

At age 15Scotland: 18% (M) 34% (F)

Scottish data: Risk behaviours (15 yrs)

Prevalence: Boys Girls • Weekly smoking 14 23• Weekly drinking 39 36• Drunkeness (2+ times) 43 48• Cannabis use (ever) 29 27• Sexual intercourse (ever) 30 34

Higher rates of some of the most risky behavioursseen among girls

Scottish data: 1990-2006 trends

Trends in 15 yr olds weekly smoking

14

23

16

2221

16

17

23

2826

0

10

20

30

40

1990 1994 1998 2002 2006% r

epor

ting

that

they

sm

oke

at le

ast o

nce

a w

eek

Boys Girls

Weekly smoking at age 15:

• Ranges from 8% to 48%Scotland: 14% (M) 23% (F)

Scotland:Girls rank 6th

Boys rank 28th

Scottish data: 1990-2006 trends

Trends in 15 YEAR OLDS weekly drinking

3336

4042

4244

2937

4446

0

20

40

60

1990 1994 1998 2002 2006

% w

ho d

rink

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hol a

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st o

nce

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Boys Girls

Weekly drinkingat age 11 & 15

At age 11 ranges from 1% to 22%Scotland: 8% (M) 3% (F)

At age 15 ranges from 10% to 53%Scotland: 39% (M) 36% (F)

Ever hadsexual intercourseaged 15

Condom use at lastintercourseaged 15

Ranges from 12% to 61%Scotland: 30% (M) 34% (F)

Ranges from 61% to 95%Scotland: 82% (M) 74% (F)

Scotland: key trends and international comparisons

Positive long-term trends in emotional well-being Areas of concern: weekly smoking and drinking, particularly

among girlsSexual risk taking, alcohol and cannabis use relatively high Gender inequalities placing girls at high risk

Scotland: key trends and international comparisons

HBSC has also identified

Poor eating habitsLow levels of physical activityPrevailing socioeconomic inequalities

Scotland: HBSC research dissemination

Dissemination strategy

Feedback to schools, teachers and classroomsReach health and education practitionersInform policy makersGain attention of media

Scotland: HBSC research dissemination

Impact in long term

relationships with schools and education authorities which has enabled the study

building partnerships with government departments who use the study findings

invitations to government advisory groupsuse of study findings in policy developmentpublic visibility of study

Policy developments related to children and young people’s health in Scotland

HBSC findings have fed into a number of policy developments• National Programme for Improving Mental Health and Well-

being (Scottish Executive, 2003)

• Enhancing Sexual Wellbeing In Scotland: A Sexual Health & Relationship Strategy (Scottish Executive,2003)

• Schools (Health Promotion and Nutrition) (Scotland) Act 2007 requires education authorities to ensure schools are health-promoting and meals meet nutritional standards

Policy developments related to children and young people’s health in Scotland

• ‘Creating confident kids’ programme

• Equally Well: Report of the Ministerial Task Force on Health Inequalities (2008) aims to reduce health inequalities among children and young people

• Curriculum for Excellence (2009) to take a holistic approach to health and wellbeing across the school curriculum to improve mental, emotional, social and physical health and to promote resilience, confidence, independent thinking and positive attitudes.

HBSC findings informing health promotion practice

‘Growing Through Adolescence’ training resource

• HBSC findings on physical activity, eating habits and mental health identifying gender and developmental issues related to puberty

• we found that many teachers are challenged by topics such as body image, puberty and eating disorders

• HBSC team and national health promotion agency collaborated on production of training resource for practitioners

Growing Through Adolescence

Book 1 Evidence and Overview

Growing Through Adolescence in Europe

• WHO commissioned European version of Growing Through Adolescence

• Disseminated widely through Europe

• Uses HBSC international data

• Translated into Russian and German

Role of HBSC in programme development and evaluation

HBSC in Scotland developed close links with Health Promoting Schools Programme

helped identify areas for HPS action: eating habits, body image, physical activity, self-confidence ..

provided tools for evaluation of HPS using adapted HBSC instrument for baseline and follow up

Role of HBSC in programme development and evaluation

evaluation of HPS stimulated new research on barriers to physical activity among girls

provided evidence for new preventive programme to increase girls participation ‘Fit for Girls’ – being rolled out in all schools for 14-16 year old girls

participative approach to develop physical activity among low active girls

evaluation of preventive programme being undertaken at CAHRU

HBSC International Forum sharing national experiences of study impact

WHO and HBSC jointly initiated an annual Forum platform for countries share experiences of how

HBSC research has had impact on health improvement policy and practice

main purpose is to have impact on social and economic determinants of adolescent health

International Forum for sharing impact on policy and practice

Forum topics to date obesity prevention mental health environment

scaling up from national experiences to international platform

key messages from Forums feed into European Ministerial Conferences aiming to inform agendas

Benefits of being part of HBSC international study

Gain broader perspective on national picture of health of adolescents

Cross-national comparisons highlight areas of concern and areas where doing well

Trends over time from survey every four years Changes in relative health profile over time Potential to have impact on policy Lessons for practice

Academic dissemination of HBSC research impact

International Journal of Public Health HBSC Volume 54, Supplement 2. 2009

Young I and Currie C (2009) The HBSC Study in Scotland: can the study influence policy and practice in schools

Koller et al (2009) Addressing the socioeconomic determinants of adolescent health: experiences from the WHO/HBSC Forum 2007

Acknowledgements

Young people participating in HBSC Study internationally

International HBSC research network

HBSC national team in Scotland

WHO Regional Office for Europe

Organisations that fund HBSC

Further information on HBSC

HBSC International Coordinating CentreChild and Adolescent Health Research Unit

University of Edinburgh

Email:info@hbsc.org

Website: www.hbsc.org

Further information on HBSC

Website:www.hbsc.org