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Young People’s Health in an International Context

The Health Behaviour in School-Aged Children (HBSC): WHO Collaborative Cross-National Study. Young People’s Health in an International Context. Candace Currie HBSC PI for Scotland & HBSC International Coordinator. Antony Morgan HBSC PI for England & Head of HBSC International

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Young People’s Health in an International Context

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  1. The Health Behaviour in School-Aged Children (HBSC): WHO Collaborative Cross-National Study Young People’s Health in an International Context Candace Currie HBSC PI for Scotland & HBSC International Coordinator Antony Morgan HBSC PI for England & Head of HBSC International Policy Development Group

  2. Gaining a perspective on young people’s health in the UK: evidence from HBSC • Comparativeanalysis : how does the health of young people in the UK compare to those of other countries in the Europe and North America • Trends over time: how has health of young people in the UK changed over last two decades • Health inequalities: how does health vary according to gender and socioeconomic status • Implications for improving young people’s health in UK: examples of good practice and policy

  3. What is HBSC? • An international study conducted in member countries in WHO European Region, USA and Canada • Initiated in 1983 in 3 countries in Northern Europe interested in gathering comparative data on young people’s health in social context

  4. HBSC study ‘short history’ • shortly after its initiation designated as WHO collaborative study; new members began to join • First cross-national survey in five countries in 1983/4 followed by second in 1985/6; thereafter survey every four years • now 43 participating countries • HBSC international network of >270 researchers

  5. Austria Belgium (Flemish) Belgium (French) Bulgaria Canada Croatia Czech Republic Denmark England Estonia Finland France Germany Greece Greenland Hungary Iceland Ireland, Republic of Israel Italy Latvia Lithuania Luxembourg Macedonia, Tfyr Malta Netherlands Norway Poland Portugal Romania Russian Federation Scotland Slovakia Slovenia Spain Sweden Switzerland Turkey Ukraine USA Wales HBSC countries 2005/06

  6. Broad aims of HBSC • increase understanding of young people's health and well-being, health behaviours and their social context • inform and influence policy and practice at national and international levels

  7. HBSC objectives • initiate and sustain national and international research on young people’s health • contribute to theoretical and methodological development as well as empirical evidence • establish and strengthen a multi-disciplinary international network of experts • disseminate findings to relevant audiences

  8. HBSC network collaboration National teams collaborate on all aspects of international study through their membership of the HBSC network • Design of survey instrument and protocol • Development of survey methodology • Data analysis • Publication and dissemination

  9. HBSC in UK • Scotland and Wales joined the study in the mid 1980s and England in 1998; N Ireland participated in surveys 1990, 1994 and 1998 • HBSC International Coordinating Centre based at Child and Adolescent Health Research Unit (CAHRU), University of Edinburgh since 1995

  10. Survey method • School –based, pupil self complete, teacher or researcher administered • Three age groups with mean age 11.5, 13.5 and 15.5 years • National surveys conducted at time of year to obtain correct mean ages • Sample size: 1,550 per age group • Every 4 years

  11. Health and behaviour • Perceived health, well-being and life satisfaction • Smoking, drinking and cannabis use • Physical activity and sedentary behaviour • Eating and dieting • Body image • Height and weight • Sexual behaviour • Bullying and fighting • Injuries

  12. Social and developmental context • Family structure and relationships • School environment • Peer relations and social behaviour • Neighbourhood • Socioeconomic circumstances

  13. Highlighting key health issues in the UK • look at comparative analysis, trends over time and health inequalities • focus on various aspects of young people’s health of policy concern: substance use, physical activity, BMI and body image, healthy eating, well-being • present examples of dissemination to policy and practice

  14. Comparative analysis Alcohol use

  15. Percentage of boys aged 15 who are weekly drinkers (HBSC 2001/2)

  16. Percentage of girls aged 15 who are weekly drinkers (HBSC 2001/2)

  17. Observations • England and Wales have among highest rates of weekly drinking internationally for both boys and girls • Differential between boys’ and girls’ weekly drinking rates in UK smaller than in many other countries

  18. Drinking trends 1990-2006 Scotland * *** ** ** ** ** *

  19. Observation • Gender differences present in early 1990s with lower rates of weekly drinking among girls • Steep increase in weekly drinking rates among girls between 1994 and 1998 close gender gap which remains through to 2006

  20. HBSC 2001/02: Boys (15 years) drunk 4+ times

  21. HBSC 2001/02: Girls (15 years) drunk 4+ times

  22. Observations • Levels of drunkenness among boys in England and Wales among highest across all countries • After Finland and Denmark, levels of drunkenness among girls in UK highest across countries • Smaller gender differences in UK than elsewhere (in Scotland almost no difference)

  23. Drinking trends 1990-2006: Scotland *** * *** *** * ***

  24. Observation • Large gender difference present in 1990 disappear as girls’ drunkenness rates rise more steeply than boys • Gender gap closes by 1998 and remains through to 2006

  25. Percentage of 15 year old boys who are weekly smokers (HBSC 2001/2)

  26. Percentage of 15 year old girls who are weekly smokers (HBSC 2001/2)

  27. Observations • Much lower rates of smoking are found in the US and Canada • Scotland and Wales have lower rates of weekly smoking among boys than in England • There is a pattern in western Europe of higher rates of weekly smoking among girls than boys

  28. Smoking trends 1990-2006: Scotland * *** * *** ** * * ** ** *** *** ** ***

  29. Observation • Whereas in 1990 boys and girls had equal rates of weekly smoking, increasing rates are accompanied by a growing gender gap • From 1994 to 2006 girls’ rates are significantly higher than boys

  30. Observations: gender trends in substance use • Over the sixteen years studied there is rather little change in the substance use habits of boys with similar levels at the beginning and end of this 16 year period • This is in contrast to very substantial changes in girls’ substance use behaviour which has increased considerably over this time period

  31. Health improvement implications • Are there different risk and protective factors operating in relation to substance use among boys and girls – how have these changed across the last two decades? • What social and developmental factors need to be addressed in any prevention/ intervention programmes • What lessons can we learn from other countries? E.g. Norway (smoking), France (drinking)

  32. ‘Global’ gender patterns

  33. Global gender patterns • Suggest powerful biological and cultural determinants of behaviour and well-being • These may be more difficult to intervene on? • Should we expect equality in health outcomes? Have any countries achieved it?

  34. HBSC 2001/02: Boys (15 years) meeting physical activity guidelines

  35. HBSC 2001/02:Girls (15 years) meeting physical activity guidelines

  36. Observation • Netherlands only country where boys and girls levels of PA are equal • Boys in England and Wales have among highest levels of PA

  37. % overweight boys

  38. % overweight girls

  39. Observation • Universal finding that boys are more likely to be overweight than girls • But next slides show that in all countries girls more likely than boys think they are too fat • Interventions need to take into account these differences in actual and perceived levels of overweight

  40. Boys (15 years) report ‘too fat’

  41. Girls (15 years) report ‘too fat’

  42. Socioeconomic inequalities Family affluence and adolescent health

  43. Scotland * England Wales

  44. 43% 34% 35% 31% 24% 29% FAS and daily fruit: Scotland 2002 †Significant differences between FAS groups (p<0.01)

  45. Daily fruit and FAS • FAS gradients in around half countries especially in Eastern Europe • higher percent of daily fruit consumption among young people with higher FAS

  46. 27% 25% 20% 18% 14% 10% FAS and perceived health: Scotland 2002 †Significant differences between FAS groups (p<0.01)

  47. FAS and perceived health FAS gradients found in almost every country with better health among young people with higher FAS

  48. Dissemination • Scientific • Policy • Practice

  49. Data analysis and scientific publications • Complete list of all HBSC papers on: www.hbsc.org/publications/journal-articles.html • Every scientific article logged on international publications database and tracked on-line through progress from planned to accepted • 165 published papers; 127 currently in prep/ submitted

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