HBSC Findings From the WHO Health Behaviour in School-aged Children Study Professor Fiona Brooks CRIPACC, University of Hertfordshire [email protected]

HBSCFindings From the WHO Health Behaviour in

School-aged Children Study

Professor Fiona BrooksCRIPACC, University of Hertfordshire

[email protected]@f_m_brooks

mailto:[email protected]

Health Behaviour in School-aged Children

• WHO collaboration - over 40 countries Europe & North America

• Over 200,000 young people each round - 5335 England 2014

• Time trends across 12 years – 2002, 2006, 2010 & 2014

• Survey methodology in schools age 11, 13 and 15 year olds

2010 report can be downloaded from: www.hbsc.org and wwwhbscengland.com

http://www.hbsc.org/

The Links Between Attainment and Child

Well-being – Why Does It

Matter? The link between pupil health and wellbeing and attainment: a

briefing for head teachers, governors and staff in education settings PHE 2014

https://www.gov.uk/government/publications/the-link-between-pupil-health-and-wellbeing-and-attainment

Why adolescents ?

There are 7.4 million adolescents aged 10-19 living in the UK, accounting for 12% of the population and forming part of 4.8 million UK households (Hagell, Coleman and Brooks 2013).

‘The misery of youth: Teenagers depressed and fearful as drink, drugs and crime take their toll’

July 2008, Daily Mail

Myth 3Our teenagers are much worse than anywhere else!

• Increased synaptic pruning and increased myelination in the prefrontal cortex

• Enhanced amygdala reactivity to emotional stimuli– Exaggerated reactivity to rewarding stimuli– Reduced sensitivity to aversive stimuli

– What is rewarding and what is aversive is culturally and environmentally dependent

THE TEENAGE BRAIN DOES WHAT?

• There is an interaction between the environment and the adolescent brain

• How you spend your time guides the structure of the brain and becomes hard wired into your brain

• BUT Toxic environments impede normal brain development

USE IT OR LOSE IT

MeasuresMandatory Measures in HBSC

Unique study

Includes measures on physical, emotional and social health and well-being

Only study looking at Sexual health in the UK

Only study collecting data on new domains of adolescent

Only study with internationally validated measures on areas such as sleep, family support, neighbourhood

Employing measures of Social capital and resilience

Health Related Behaviours

Health and Well-being

Family Life

School

Peers and Community

OPTIONAL PACKAGES

VALIDATED MEASURES

Primary Health Care Services

• 80% of young people reported that they had visited their GP in the last year (78% of boys and 82% of girls)

Health Risk Behaviours

Smoking

2002 2006 2010 20140%

5%

10%

15%

20%

25%

30%

21%

13%10%

6%

28%

18%

14%

8%

15 year olds who report weekly smoking 2002 - 2014

BoysGirls

• Overall 3% reported weekly smoking

• Rising to 6% in 15 year old boys and 8% in 15 year old girls

Alcohol

2002 2006 2010 20140%

10%

20%

30%

40%

50%

60%52%

41%

32%

12%

48%

36%

23%

9%

15 year olds who report weekly drinking, 2002 - 2014

BoysGirls

• Overall, 5% of young people drink alcohol weekly

Alcohol

2002 2006 2010 20140%

1000%

2000%

3000%

4000%

5000%

6000%

5500%

4400%

3900%

2900%

5500%5000%

4500%

3200%

Figure 4.7: 15 year old young people who reported having been drunk two or more times by gender

2002-2014

boys Girls

Bases: All respondents in 2002, 2006, 2010 and 2014

Among 15 year old weekly drinkers, 83% of boys and 57% of girls had been drunk 10+ time in last 30 days

Substance misuse

2002 2006 2010 20140%

1000%

2000%

3000%

4000%

5000%

4300%

2600% 2500%2100%

3800%

2300%2500%

2000%

Figure 4.8: Young people who reported that they have ever used cannabis during their life time at least once by gender

2002-2014

BoysGirls

Base: All respondents in 2002, 2006, 2010 and 2014

• 21% of 15 year olds reported having had sex

• Young people reporting having sex has decreased from 2002

Sexual Intercourse

2002 2006 2010 20140%5%

10%15%20%25%30%35%40%45%

36%

26% 27%

19%

40%

31%34%

24%

15 year olds who report having sex, 2002 - 2014

BoysGirls

• Proportions reporting very early sexual initiation have decreased significantly since 2002

Sexual Intercourse

11 years or younger

12 years 13 years 14 years 15 years or older

0%

10%

20%

30%

40%

50%

60%

8% 3%13%

30%

47%

2% 2%11%

32%

53%

Figure 5.4: Age of onset for sexual intercourse among sexually active 15 year olds

BoysGirls

Base: All respondents aged 15 years in 2014 who had sexual intercourse

• Condom use has however declined since 2010 – when it had over two survey cycles been showing an increase

Sexual Intercourse

2002 2006 2010 20140%

10%

20%

30%

40%

50%

60%

70%

80%

90%

67%

80% 80%

61%69% 74%67%

57%

Figure 5.7: 15 year olds using condom at last in-tercourse 2002-2014

BoysGirls

Base: 15 year old respondents in 2002, 2006, 2010 and 2014

• 25% of boys and 9% of girls involved in a physical fight at least twice in the last 12 months

• Between 2002 and 2014 the proportion of both boys and girls involved in physical fights has decreased

Fighting

2002 2006 2010 20140%5%

10%15%20%25%30%35%40%

34% 33%28%

25%

14% 13%9% 9%

Young people involved in a physical fighting at least twice, 2002 - 2014

BoysGirls

Health

Health Complaints

Overall, 65% of young people (59% of boys and 71% of girls) reported experiencing at least one health complaint on a weekly basis.

Will come back to feeling low

Injuries

11 years 13 years 15 years 0%

5%

10%

15%

20%

25%

30%

25% 27% 26%

15%21%

16%

Figure 6.1: Injured at least twice in the last 12 months

BoysGirls

Base: All respondents in 2014

2002 2006 2010 20140%

5%

10%

15%

20%

25%

30%

35%

40%35%

29% 30%

26%

20% 18% 20% 17%

Figure 6.2: Reports of two or more injuries in last 12 months, 2002 - 2014

BoysGirls


Sleep & Concentration

11 years old 13 years old 15 years old0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

93%

74%

48%

93%

73%

46%

Young people who report having at least 8.5 hours sleep on school nights

BoysGirls

Nearly three quarters (73%) of young people reported having at least 8.5 hours sleep on school nights

However this decreased significantly by age

Sleep & Concentration

11 year olds 13 year olds 15 year olds0%5%

10%15%20%25%30%35%40%45%50%

13%19%

29%

11%

25%

43%

Young people who don’t have enough sleep to concentrate, by age and gender

BoysGirls

• Overall, 22% of young people cannot concentrate at school due to lack of sleep

• Increases with age

• Gender differences

Having a long term condition or disability

Having a long term condition or disability23% of young people reported having long term illness or disability (23% of boys and 22% of girls).Type of condition or disability About half had asthma

11 13 150%

500%

1000%

1500%

2000%

2500%

3000%

3500%

2500%2300% 2300%

1700%

2900%2900%

BoysGirls

Proportions that report having a long term condition effects their participation in school

Emotional Wellbeing

Life Satisfaction

2002 2006 2010 20140%

10%20%30%40%50%60%70%80%90%

73%81% 81%

74%65% 67% 69%

55%

15 year olds who report high life satisfaction by gender, 2002 - 2014

BoysGirls

Achievement = Well-beingWell-being = Achievement

The health and well-being of children and young people contributes to their ability to benefit from good quality teaching and to achieve their full academic potential

Academic success – impacts on a child’s subjective life satisfaction Subjective life satisfaction impacts on behaviour and school engagement – ability to acquire academic competence.

Feeling Low 2

2002 2006 2010 20140%

10%

20%

30%

40%

50%

60%

34%

27%23% 25%

44% 46% 45%

54%

15 year olds who report feeling low once a week by gender, 2002 - 2014

BoysGirls

Feeling Low 1

11 year olds 13 year olds 15 year olds0%

10%

20%

30%

40%

50%

60%

14% 15%25%

18%

36%

54%

Young people who report feeling low at least once a week, by age and gender

BoysGirls

• Overall, 26% of young people feel low at least once a week

• Increases with age

• Gender differences

Feeling Low 2

2002 2006 2010 20140%

10%

20%

30%

40%

50%

60%

34%

27%23% 25%

44% 46% 45%

54%

15 year olds who report feeling low once a week by gender, 2002 - 2014

BoysGirls

Feeling Low by Age, Gender and Country

Feeling Low 3

Full of Energy 1


10%20%30%40%50%60%70%80%

67%55%

45%63%

44%23%

Young people who feel full of energy, by age and gender

BoysGirls

• Overall, 51% of young people felt full of energy always or very often during the last week

Self-harm

Boys Girls0%5%

10%15%20%25%30%35%

11%

32%

Proportion of 15 year olds who report they have self-harmed

• Overall, 22% of young people said they had self-harmed

• In comparison with other studies, self-harm increasing over the past decade

Self-harm 2

• Overall, 22% of young people said they had self-harmed

• In comparison with other studies, self-harm seems to be on the increase

Everyday Several times a week

Once a week A few times a month

Once a month0%

10%

20%

30%

40%

50%

60%

10%5% 6%

16%

54%

15%7%

16% 15%

39%

Figure 6.5: Frequency of self-harming

BoysGirls

Base: All respondents aged 15 years in 2014 who reported ever self-harming

Body image

• Proportions reporting dissatisfaction with their body size has remained relatively stable since 2002

• 23 % of 15 year old boys reported they were too thin compared 9% of girls

2002 2006 2010 20140%

5%

10%

15%

20%

25%

30%

35%

40%

45%

25% 24%22%

22%

40%36%

39%38%

Figure 3.21: Young people who report they are "too fat" 2002 - 2014

BoysGirls

Base: All respondents 2002, 2006, 2010 and 2014

Cyberbullying 2 questions – one via messages second photographs/pictures. 18% reported experiencing cyberbullying (previous two months). 24% of girls 12% of boys. Cyberbullying increases with age for both boys and girls -more traditional forms of bullying decreases with age


5%

10%

15%

20%

25%

30%

35%

10% 12%16%16%

28%31%

Figure 9.12: Young people who reported being cyberbul-lied in the past two months

BoysGirls


Cyberbullying


5%

10%

15%

20%

25%

30%

35%

10% 12%16%16%

28% 31%

Figure 9.12: Young people who reported being cyberbullied in the past two months

BoysGirls


It’s like about this, is like one bad thing a photo or something can get found out about and it goes on and on for ages, so is more upsetting than like some-one who picks on you from another classKatie, age 16

Cyberbullying

Healthy Behaviours

11 13 150%5%

10%15%20%25%30%

Young people physically active for 1 hour a day

BoysGirls

Physical Activity

• Overall 19% meet physical activity guidelines - 22% of boys and 15% of girls

• Physical activity levels have remained stabled in girls since 2002

Physical Activity

The proportion of girls being physically active for at least an hour every day of the week has remained relatively stable since 2002, however boys physical activity levels have fluctuated – recent decline

Physical Activity

Positive health behaviours – physical activity

UK study - the amount of moderate to vigorous physical activity at age 11 impacted on academic performance across English, maths and science at age 11, 13 and final GCSE exam results The percentage of time girls spent in moderate to vigorous physical activity at age 11 predicted increased science scores at 11 and 16 years High performing schools have higher levels of participation in physical activity and sports

Physical Activity

Older adolescents are less likely to eat vegetables every day; 44% of 11 year olds, 44% of 13 year olds and 41% of 15 year olds. Relatively flat trend since 2006.

Eating Vegetables

2002 2006 2010 20140%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

Figure 3.8: Eating vegetables everyday 2002 - 2014

BoysGirls


• Across all age groups boys are more likely to eat breakfast every day• Eating breakfast has actually increased from 2010 to 2014 – rising

from 67% to 74% in boys and 55% to 60% in girls.

Eating Breakfast


10%20%30%40%50%60%70%80%90%

83%71% 65%74%

50% 49%

Young people who eat breakfast every day, by age and gender

BoysGirls

Five a day

11 year olds 13 year olds 15 year olds0%5%

10%15%20%25%30%35%40%45%50%

45%35%

30%

47%

35% 32%

Figure 3.9: Young people who eat 5 portions of fruit or vegetables a day

BoysGirls


38% of respondents reported meeting the recommended consumption of five fruit and vegetables every day.

Energy Drinks


2%

4%

6%

8%

10%

12%

8%10%

9%

3%

6%5%

Figure 3.14: Young people who report drinking energy drinks at least five times a week

BoysGirls


Around 20% of boys across 13 & 15 year olds drink energy drinks 2-3 times a week and 12% of girls – The pattern is the same for fizzy drinks with around 17% of 15 year boys drinking fizzy drinks and 12% of girls (daily)

Sugary Drinks

11 years 13 years 15 years0%

5%

10%

15%

20%

25%

30%

21% 21% 22%22% 24%18%

Figure 3.13: Young people who reported consuming squash that contains sugar daily

BoysGirls


Key protective factors or essential assets for positive mental health and well-being is

the family, including access to one supportive adult

Community and family life

Community & Neighbourhood

Family life 1

2002 2010 20140%

1000%

2000%

3000%

4000%

5000%

6000%

7000%5800%

5600%

4800%4900% 4600%

3800%

Figure 7.6: Young people who make decision about their free time by themselves, by age and gender 2002-2014

BoysGirls

Base: all respondents in 2002, 2010 and 2014

Family life -2 parental support

Family life – time spent together


1000%

2000%

3000%

4000%

5000%

6000%

7000%

8000%

9000%

7800%7900%

7400%

8000%7600% 7500%

Figure 7.8: Young people who reported eating even-ing meal/dinner at least 3-4 times per week with

their families, by age and gender

BoysGirls

Base: all respondents in 2014


1000%

2000%

3000%

4000%

5000%

6000%

7000%

6000%

4400%3100%

5000%

3400%2200%

Figure 7.9: Young people who reported to have a family sports activities at least once a week,

by age and gender

BoysGirls


Positive health behaviours –

Young People engaging in self development activities (including sport, physical activity) – achieved 10-20% higher GCSEs – 2009 and had better emotional well-being

But Socialization Gap widened in last 30 years – Poorer families cannot provide such opportunities

School life


500%

1000%

1500%

2000%

2500%

3000%

3500%

4000%

4500%

900%1200%

1900%

900%

1600%

4100%

Figure 8.4: Young people who reported being pressured 'a lot' by school work by age and gender

BoysGirls


School Culture and Ethos

Longitudinal USA studies - feeling connected to school and having a sense of belonging - key protective asset

Protective of emotional health and well-being Preventive of behaviours linked with poor emotional health - substance misuse, violence, alcohol misuse and early sexual initiation.

School connectedness generated by extra-curricular activities (especially PA), positive class room management and tolerant disciplinary policies, feeling safe

School Culture and Ethos

pupils who reported they enjoyed school at age 11 had better attainment at key stage 3, especially for maths pupils who hold positive attitudes about their school at age 14 have higher academic achievement by age 16 pupils who have been bullied have lower key stage 1 SAT results and are more likely to have friends who are involved in antisocial activities pupils who are bullied at age 14 have significantly lower GCSE scores at age 16

School life 2 Connectedness

2002 2010 20140%

10%

20%

30%

40%

50%

60%

70%

80%

60% 61%

76%

58% 62%

74%

Figure 8.9 : Young people who say that they feel like they belong in their school

2002-2014

BoysGirls



1000%2000%3000%4000%5000%6000%7000%8000%9000%

10000%

8700%

7200%7700%

9000%

7500% 7400%

Figure 8.11: Young people who reported that they have at least one teacher they can go to

in case of problem, by age and gender

BoysGirls

Base: All respondents are in 2014

School Belonging

Agree (belong)

Neither Disagree

Regular smoker

4.4% 5.5% 10.6%

Weekly alcohol consumption

11.6% 13% 20 %

Drunkenness at least twice

17% 20 % 29%

Been bullied 3.1% 4.3% 10.9%

Physical Fighting (3x 12 months)

8.8% 11.5% 18.8%

Feeling low 21.1% 34.4% 50.1%

Teacher connectedness : interested in me as a person

Agree Neither Disagree

Regular smoker

4.2% 5.1% 10.1%

Weekly alcohol consumption

11.2% 12.1% 22 %

Drunkenness at least twice

14.9% 20 % 31%

Been bullied 3.8% 3.6% 7.4%

Physical Fighting (3x 12 months)

9.8% 9.3% 16.9%

Feeling low 22.9% 29.2% 39.5%

Multiple substance use among 15 year olds & life satisfactionProtective Factors/Assets – most

vulnerable

1. Parental participation in how spend free time

2. Teacher Connectedness –

3. Feeling safe in community and having friendly neighbourhood

School Culture and Ethos – Peer Relationships

Disruptive classroom behaviour directly influences pupil attainment.

Bullying at school is one of the strongest predicators of wellbeing

pupils who have been bullied have lower key stage 1 SAT results and are more likely to have friends who are involved in antisocial activities pupils who are bullied at age 14 have significantly lower GCSE scores at age 16

Bullying

11 years 13 years 15 years0%5%

10%15%20%25%30%35%40%

33% 29% 30%36% 37%

28%

Figure 9.10: Young people who re-ported being bullied in the past two

months

BoysGirls



5%

10%

15%

20%

25%

30%

19%24% 25%

10%

19%13%

Figure 9.12: Young people who reported bully-ing another student in the past couple of

months

BoysGirls


Bullying 2 – types of behaviour

PSHE

Social and emotional competencies – the whole school approach

Actions relating to each of the following areas: learning and teaching specific time allocated within the school curriculum in order to help students develop the knowledge, attitudes and skills needed to support health and wellbeing.

Ethos and physical environment promoted through the ‘hidden’ or ‘informal’ curriculum, which encompasses the leadership practices, values and attitudes promoted within the school, as well as the physical environment and setting of the school.

Engagement with families and/or communitiesrecognition of the importance of these other spheres of influence on children’s attitudes and behaviours in school.

11 year olds 13 year olds 15 year olds

Boys Girls Boys Girls Boys Girls

Health and wellbeing 56% 54% 69% 70% 58% 50%

Staying safe 66% 64% 58% 58% 43% 45%

Sex and relationships 41% 40% 52% 48% 57% 50%

Personal and social skills

73% 75% 68% 66% 55% 50%

Economics and career education

47% 50% 54% 45% 42% 43%

Topics in PSHE

Young people who reported topics were well covered in PSHE

Improved skills to care for others


10%

20%

30%

40%

50%

60%

70%

80%

90%

80%68%

58%

84%71%

57%

Young people who said PSHE improved their skills and abilities to care for other people, by age and gender

BoysGirls

• Overall, 70% of young people said PSHE improved their skills to care for other peoples health

• Decreases with age

Improved skills to look after own health


10%20%30%40%50%60%70%80%90%

100%

85%75%

63%

88%75%

60%

Young people who said PSHE improved skills to look after their own health, by age and gender

BoysGirls

• 74% said PSHE helped them look after their own health

• Decreases with age

PSHE and health behaviours

• Young people have more positive health behaviours if health and wellbeing was covered well in PSHE classes

Health and wellbeing covered well

Health and wellbeing covered poorly

Self-harmed 19.2% 30.3%

Smoked on 6 or more days in last 30 days

6.1% 8.4%

Drunk alcohol 6 or more times in last 30 days

5.5% 9.0%

Drunkenness 4 or more times in last 30 days

1.1% 3.0%

On a diet 17.5% 22%

Eat breakfast every day 59.7% 52.5%

• Overall, 21% of 15 year olds reported having had sex…

• …compared with 28% of those who said sex and relationship education was covered poorly and 18% who reported it had been covered well

PSHE and sex

Sex and relationship educations covered well

Sex and relationship education covered poorly

Sexual intercourse 18.3% 28%

Final thoughts…

• Health risk behaviours - declining trends

• Positive behaviours in most instances - static

• Poorer emotional well-being

• A move from reducing risk factors to improving positive health behaviours and emotional well-being – significance of these as OUTCOME MEASURES

BUT• Promoting resilience (through social learning interventions – although clearly part of the

jigsaw) alone is insufficient

• Strengthening protective factors or health assets gained from schools, the home and in local communities can make an important contribution to improving emotional health and young people’s well-being.

Protective Health Assets model for young people

“Promoting physical and mental health in schools creates a virtuous circle reinforcing children’s attainment and achievement that in turn improves their wellbeing, enabling children to thrive and achieve their full potential.”

Brooks, F. 2013. Chapter 7 : Life stage: School

Years. In Chief Medical Officer's annual report

2012: Our Children Deserve Better: Prevention

Pays

Documents

HBSC Findings From the WHO Health Behaviour in School-aged Children Study Professor Fiona Brooks CRIPACC, University of Hertfordshire [email protected]