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Informing investment in adolescent health, the Health Behaviour in School-Aged Children Study A case study from Scotland. CANDACE CURRIE KATE LEVIN Child and Adolescent Health Research Unit (CAHRU) UNIVERSITY OF EDINBURGH. - PowerPoint PPT Presentation
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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
alco
hol a
t lea
st o
nce
a w
eek
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:[email protected]
Website: www.hbsc.org
Further information on HBSC
Website:www.hbsc.org