Monitoring the health of youth: the Health Behaviour in School-Aged Children Study HBSC

1. Monitoring the health of youth: the Health Behaviour in School-Aged Children StudyHBSC Professor Candace Currie HBSC International Coordinator Director Child and Adolescent Health Research Unit (CAHRU) University of Edinburgh

2. What is HBSC? European and North American study that gathers data from young people about their health and wellbeing

3. The data collected enables countries to monitor the status of their young people’s health It allows: • Comparisons of data across time – trends analysis • Comparisons with other countries – cross-national analysis • Comparisons among social/ demographic groups – analysis of health inequalities

4. HBSC study purpose and scope To gain new insight and increase our knowledge and understanding of adolescent health in social and developmental context

5. HBSC key objectives (1) • to initiate and sustain national and international research on young people’s health behaviour, health and well being and social contexts • to monitor and to compare young people’s health, health behaviour and social contexts in member countries • to disseminate findings to relevant audiences including researchers, policy and practice, and public

6. HBSC key objectives (2) • to promote and support establishment of national expertise on young people’s health • to develop a multi-disciplinary international network of experts in this field • to provide information and expertise at national and international levels on adolescent health

7. HBSC study ‘short history’ • Initiated in 1982 by researchers from three countries and soon after became a WHO Collaborative Study • Growth in study membership over 25 years and now 43 member countries: European Region & North America • HBSC international network of >260 researchers from different disciplines • Growing interest in HBSC globally

10. OECD countries in HBSC/ not in HBSC Australia (but in discussion) Austria Belgium Canada Czech Republic Denmark Finland France Germany Greece Hungary Iceland Ireland Italy Japan Korea Luxembourg Mexico Netherlands New Zealand Norway Poland Portugal Slovak Rep Spain Sweden Switzerland Turkey UK US

11. Countries invited to OECD membership talks that are / are not in HBSC Chile Estonia Israel Russia Slovenia

12. Countries with enhanced OECD engagement Brazil, China, India, Indonesia, South Africa None of these are members of HBSC Under current rules these countries cannot become full-members However terms of reference for collaborative status are under development with some implementation

13. HBSC study • The HBSC Study is developed and conducted by a multi-disciplinary network of national teams • Network operates on democratic principles for decision making about study development • Elects an international coordinator and databank manager • International Coordinating Centre based at: Child and Adolescent Health Research Unit, University of Edinburgh • International Databank based at Centre for Health Promotion, University of Bergen

14. HBSC network collaboration Network members collaborate on all aspects of study and meet regularly: • development of survey questionnaire and protocol • analysing data • writing scientific papers • producing international reports • developing the study They also work to agreed Terms of Reference on rights, duties and responsibilities of members

15. HBSC surveys of schoolchildren • conducted every four years at same time in all countries • common standardised survey questionnaire and survey method • data collected on nationally representative samples of 11,13 and 15 year olds in each country • sample size: 1,550 per age group • school class is sampling unit • stratified cluster sampling

16. HBSC scope • Includes measures on physical, emotional and social health and well-being • Measures comprehensive range of behaviours that both risk and promote health • Places health and behaviour of young people in social and developmental context

17. Tobacco, alcohol and cannabis Physical activity Consumption of food and drinks Toothbrushing Weight control behaviour Fighting and bullying Sexual behaviour TV and computer use Electronic communication Health related behaviours measured in HBSC

18. Health and well-being measures in HBSC • self-rated health • life satisfaction • health complaints • body image • Body Mass Index (BMI) • injuries

19. family socioeconomic status family structure family relationships Social context measures in HBSC

20. School environment: liking school academic pressure academic achievement support from classmates Social context measures in HBSC

21. Peer relations: spending time with friends having close friend numbers of friends Social context measures in HBSC

22. ‘HBSC approach’ • monitors of social context as well as health and behaviour • investigates how health is influenced by social circumstances and developmental processes • draws attention to health inequalities • focuses policy on social and economic determinants

23. National monitoring and reporting • All countries produce national reports on their latest HBSC survey • These reports take many forms in terms of content, length, focus and style • In a number of countries HBSC is part of national and sub-national youth health monitoring systems • In many countries HBSC data are used in government reports

24. Case studies on: use of HBSC data Belgium (Flemmish) • Ministerial Department of ‘Well Being, Public health and Family’ finances HBSC study and uses HBSC data to evaluate/ monitor their health targets - on eating and food patterns, substance use, injuries and mental health • HBSC data used by “Strategic Advisory Council” for school health policy development Estonia • HBSC indicators used for monitoring National Programme of Cardiovascular Disease Prevention; also for monitoring risk behaviour • Regional level HBSC indicators are presented on National Institute for Health Development website and used for monitoring health behaviour in regions of Estonia.

25. Case studies on: use of HBSC data Portugal • HBSC is part of a formal national and sub-national monitoring system for youth health for oral hygiene, tobacco, alcohol, drugs, sexual behaviour, bullying, and physical activity. HBSC data are also reported in government statistics. • HBSC is part of an official partnership with Ministry of Education, and actively involved in 2 sub systems of Ministry of Health: Drug and HIV who partly fund HBSC Canada • HBSC data used as part of a ‘Report Card’ which is an advocacy and policy tool specific to physical activity, its determinants, and its outcomes. Widely used by schools, local and national public health agencies, policy makers, and researchers across Canada.  • See http://www.activehealthykids.ca/Ophea/ActiveHealthyKids_v2/programs_2008reportcard.cfm for more details

26. Inequalities in Young People’s Health Report from the Health Behaviour In School-Aged Children 2005/06 Survey in 41 countries Currie et al, 2008. WHO, Copenhagen Health Policy for Children and Adolescents, No. 5

27. Focus: Inequalities in young people’s health • evidence of widespread and diverse forms of inequality in young people’s health • why important? • negative health experience and poor quality of life for many young people in Europe and North America • affects their education and social development • tracks through to adulthood affecting health, social and economic outcomes

28. Inequalities in Young People’s Health Report Takes systematic look at inequalities related to: • gender • age • geography • socioeconomic status (measure: HBSC Family Affluence Scale)

29. Iceland Chart showing country variation in levels of family affluence in 2005/06 Family affluence low medium high Turkey

30. Selected findings to illustrate inequalities School context: • liking school • classmate support • pressured by schoolwork • school performance

31. Age, gender and geography 11, 13 and 15 year olds who like school a lot HBSC International Report: Inequalities in Young People’s Health. (Currie et al, 2008). WHO Copenhagen.

32. Liking school: inequalities • decline in liking school with age among both boys and girls • girls more commonly report liking school at all ages than boys • large variation between countries • association with higher family affluence among girls in around half of Northern European countries and US

33. Age, gender and geography 11, 13 and 15 year olds who agree friends are kind and helpful HBSC International Report: Inequalities in Young People’s Health. (Currie et al, 2008). WHO Copenhagen.

34. Classmate support: inequalities decline in classmate support between age 11 and 13 years gender differences are small large variation between countries – lower levels of classmate support reported in eastern Europe associated with higher family affluence in Northern European countries and the US especially among boys

35. Age, gender and geography 11, 13 and 15 year olds who feel pressured by schoolwork HBSC International Report: Inequalities in Young People’s Health. (Currie et al, 2008). WHO Copenhagen.

36. Pressured by schoolwork: inequalities at age 11, boys more likely to report feeling pressured than girls, opposite is true at ages 13 and 15 significant increase between ages 11 and 15 among boys and girls large variation between countries – lower levels of schoolwork pressure reported in western Europe in only a few countries is there association with family affluence; where it does exist association is with lower affluence

37. Age, gender and geography 11, 13 and 15 year olds who report good perceived school performance HBSC International Report: Inequalities in Young People’s Health. (Currie et al, 2008). WHO Copenhagen.

38. Good perceived school performance: inequalities significant decline with age among boys and girls at all ages girls more likely to report they are doing well than boys large variation between countries – but no clear geographic pattern poor perceived performance significantly association with lower affluence in most countries

39. Associations between school context and youth health • Previous HBSC reports and papers have highlighted that positive perceptions of school and school support are related positive well-being • Illustrated with respect to self-reported health, life satisfaction, smoking and bullying in ‘Young People’s Health in Context (2004)’

40. Implications • The evidence on health inequalities among young people has implications for policy development at national and international levels • Programmes devised to improve young people’s health need to take account of existing inequalities and avoid making the gaps wider

41. Other HBSC research dissemination In collaboration with WHO • HBSC input to development of WHO European Strategy for Child and Adolescent Health (CAH) • HBSC/ WHO Forums on social and economic determinants of adolescent health • WHO Report Series ‘Health Policy for Children and Adolescents (HEPCA) Report Series

42. HBSC country data has been used as key source for other recent work UNICEF Innocenti Report Card: An Overview of Child-Well-Being in Rich Countries (2007)

43. Further information HBSC web-site www.hbsc.org • List of all scientific publications • List of all International reports (WHO HEPCA series) • 1996: Health of Youth • 2000: Health and Health Behaviours of Young People • 2002: Gender and Health • 2003: Alcohol and Young People • 2004: Young People’s Health in Context (download) • 2008: Inequalities in Young People’s Health (download) Email HBSC International Coordinating Centre (info@hbsc.org)

44. Acknowledgements The young people we study The HBSC Network The HBSC partner WHO Organisations who fund the study