Transcript International perspectives on adolescent health: the

Monitoring the health of youth:
the Health Behaviour in School-Aged Children Study
HBSC
Professor Candace Currie
HBSC International Coordinator
Director
Child and Adolescent Health Research Unit (CAHRU)
University of Edinburgh
What is HBSC?
European and North American study that gathers data
from young people about their health and wellbeing
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
HBSC study purpose and scope
To gain new insight and increase our knowledge
and understanding of adolescent health in social
and developmental context
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
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
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
Growth of HBSC study: countries by survey year
1983/1984
1. England
2. Finland
3. Norway
4. Austria
5. Denmark
1985/1986
1989/1990
1. Finland
2. Norway
3. Austria
4. Denmark
5. Belgium
6. Hungary
7. Israel
8. Scotland
9. Spain
10. Sweden
11. Switzerland
12. Wales
13. Netherlands
1. Finland
2. Norway
3. Austria
4. Belgium (French)
5. Hungary
6. Scotland
7. Spain
8. Sweden
9. Switzerland
10. Wales
11.Denmark
12. Netherlands
13. Canada
14. Latvia
15. N. Ireland
16. Poland
1993/1994
1. Finland
2. Norway
3. Austria
4. Belgium (French)
5. Hungary
6. Israel
7. Scotland
8. Spain
9. Sweden
10. Switzerland
11. Wales
12. Denmark
13. Canada
14. Latvia
15. Northern Ireland
16. Poland
17. Belgium (Flemish)
18. Czech Republic
19. Estonia
20. France
21. Germany
22. Greenland
23. Lithuania
24. Russia
25. Slovakia
1997/1998
2001/2002
2005/6
1. Finland
2. Norway
3. Austria
4. Belgium (French)
5. Hungary
6. Israel
7. Scotland
8. Sweden
9. Switzerland
10. Wales
11. Denmark
12. Canada
13. Latvia
14. Northern Ireland
15. Poland
16. Belgium (Flemish)
17. Czech Republic
18. Estonia
19. France
20. Germany
21. Greenland
22. Lithuania
23. Russia
24. Slovakia
25. England
26. Greece
27. Portugal
28. Ireland
29. USA
1. Finland
2. Norway
3. Austria
4. Belgium (French)
5. Hungary
6. Israel
7. Scotland
8. Spain
9. Sweden
10. Switzerland
11. Wales
12. Denmark
13. Canada
14. Latvia
15. Poland
16. Belgium (Flemish)
17. Czech Republic
18. Estonia
19. France
20. Germany
21. Greenland
22. Lithuania
23. Russia
24. England
25. Greece
26. Portugal
27. Ireland
28. USA
29. tfyr Macedonia
30. Netherlands
31. Italy
32. Croatia
33. Malta
34. Slovenia
35. Ukraine
1. Finland
2. Norway
3. Austria
4. Belgium (French)
5. Hungary
6. Israel
7. Scotland
8. Spain
9. Sweden
10. Switzerland
11. Wales
12. Denmark
13. Canada
14. Latvia
15. Poland
16. Belgium
(Flemish)
17. Czech Republic
18. Estonia
19. France
20. Germany
21. Greenland
22. Lithuania
23. Russia
24. England
25. Greece
26. Portugal
27. Ireland
28. USA
29. tfyr Macedonia
30. Netherlands
31. Italy
32. Croatia
33. Malta
34. Slovenia
35. Ukraine
36. Luxemburg
37. Turkey
38. Slovakia
39. Romania
40. Iceland
41. Bulgaria
OECD countries in HBSC/ not in HBSC
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Australia (but in discussion)
Austria
Belgium
Canada
Czech Republic
Denmark
Finland
France
Germany
Greece
Hungary
Iceland
Ireland
Italy
Japan
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Korea
Luxembourg
Mexico
Netherlands
New Zealand
Norway
Poland
Portugal
Slovak Rep
Spain
Sweden
Switzerland
Turkey
UK
US
Countries invited to OECD membership talks
that are / are not in HBSC
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Chile
Estonia
Israel
Russia
Slovenia
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
HBSC study
• The HBSC Study is developed and conducted by a multidisciplinary 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
HBSC network collaboration
Network members collaborate on all aspects of study and
meet regularly:
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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
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
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
Health related behaviours measured in HBSC
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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 and well-being measures in HBSC
• self-rated health
• life satisfaction
• health complaints
• body image
• Body Mass Index (BMI)
• injuries
Social context measures in HBSC
• family socioeconomic status
• family structure
• family relationships
Social context measures in HBSC
School environment:
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liking school
academic pressure
academic achievement
support from classmates
Social context measures in HBSC
Peer relations:
• spending time with friends
• having close friend
• numbers of friends
‘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
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
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.
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/progra
ms_2008reportcard.cfm for more details
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
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
Inequalities in Young People’s Health Report
Takes systematic look at inequalities related to:
– gender
– age
– geography
– socioeconomic status (measure: HBSC
Family Affluence Scale)
Iceland
Chart showing country variation
in levels of family affluence
in 2005/06
Family affluence
low
medium
high
Turkey
Selected findings to illustrate inequalities
School context:
• liking school
• classmate support
• pressured by schoolwork
• school performance
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.
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
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.
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
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.
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
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.
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
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)’
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
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
HBSC country data has been used as key
source for other recent work
UNICEF Innocenti Report Card:
An Overview of Child-WellBeing in Rich Countries
(2007)
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 ([email protected])
Acknowledgements
The young people we study
The HBSC Network
The HBSC partner WHO
Organisations who fund
the study