Saoirse Nic Gabhainn

The Health Behaviour in School-aged Children: WHO Collaborative Cross-National (HBSC) Study: origins, concept, history and development 1982–2008

This paper traces the history of the HBSC study from its origins in the early 1980’s to the present day describing how it was first conceptualised scientifically and how this influenced issues of study design. The challenges of managing a cross-national study are explained as are changes and adaptations over time with growth of the study from 3 to over forty country members. The key partnership with the World Health Organisation and its benefits are presented. With developments in scientific management and theoretical perspectives, HBSC has made a substantial contribution to the area of youth health. The last decade has seen increased dissemination to policy makers and evidence that scientific information arising from the study has influenced strategic policy development and practical health improvement programmes. This paper considers some of the key success factors and challenges for the study as it attempts to maximise its scientific output and channels the research findings into health improvement for young people. Future challenges for the study are also considered.

Socioeconomic Inequality in Exposure to Bullying During Adolescence: A Comparative, Cross-Sectional, Multilevel Study in 35 Countries

OBJECTIVES We examined the socioeconomic distribution of adolescent exposure to bullying internationally and documented the contribution of the macroeconomic environment. METHODS We used an international survey of 162,305 students aged 11, 13, and 15 years from nationally representative samples of 5998 schools in 35 countries in Europe and North America for the 2001-2002 school year. The survey used standardized measures of exposure to bullying and socioeconomic affluence. RESULTS Adolescents from families of low affluence reported higher prevalence of being victims of bullying (odds ratio [OR] = 1.13; 95% confidence interval [CI] = 1.10, 1.16). International differences in prevalence of exposure to bullying were not associated with the economic level of the country (as measured by gross national income) or the school, but wide disparities in affluence at a school and large economic inequality (as measured by the Gini coefficient) at the national level were associated with an increased prevalence of exposure to bullying. CONCLUSIONS There is socioeconomic inequality in exposure to bullying among adolescents, leaving children of greater socioeconomic disadvantage at higher risk of victimization. Adolescents who attend schools and live in countries where socioeconomic differences are larger are at higher risk of being bullied.

Contraceptive use by 15-year-old students at their last sexual intercourse: results from 24 countries.

OBJECTIVES To identify and report cross-national patterns in contraceptive use among sexually active adolescents. DESIGN A cross-national cross-sectional survey. SETTING Data were collected in 2002 by self-report questionnaire from students in school classrooms. PARTICIPANTS A cluster sample of 33,943 students aged 15 years from 24 countries. MAIN OUTCOME MEASURES International standardized questions on ever having had sexual intercourse and contraceptive use at last sexual intercourse. RESULTS The percentages of students reporting having had sexual intercourse ranged from 14.1% in Croatia to 37.6% in England; 82.3% of those who were sexually active reported that they used condoms and/or birth control pills at last intercourse. Condom use only was most frequent and ranged from 52.7% in Sweden to 89.2% in Greece. Dual use of condoms and contraceptive pills was also relatively frequent, ranging from 2.6% in Croatia to 28.8% in Canada. The use of contraceptive pills was most frequent in northern and western Europe. No contraceptive use at last intercourse was reported by 13.2% of students. CONCLUSIONS A substantial minority of 15-year-olds have engaged in sexual intercourse. Condom use is the most frequent method of contraception reported by the sexually active respondents, followed by the dual use of condoms and contraceptive pills and contraceptive pills only. The proportions of poorly protected and unprotected youth remain high, and attention to international policy and practice determinants of young sexual behavior and contraceptive use is required.

The role of behavioural factors in explaining socio-economic differences in adolescent health: A multilevel study in 33 countries

Attempts to describe and explain socio-economic differences in health have mainly focused on adults. Little is known about the mechanisms of the relationship between socio-economic status (SES) and health in adolescence including inconsistent findings between SES and health among young people. Data were derived from representative samples of 13 and 15-year-old students in 33 European and North American countries (n=97,721) as part of the Health Behaviour in School-aged Children (HBSC) study 2001/2002. Multilevel logistic regression models were used to investigate socio-economic differences in self-rated health among adolescents and the contribution of health-related behaviours to the explanation of such differences. Odds ratios of self-rated health by family affluence were calculated before and after adjustment for behavioural factors (tobacco smoking, physical activity, television use, breakfast intake, consumption of fruits and vegetables). On average, adolescents from low affluent families had an odds ratio for low self-rated health of 1.84 for boys and 1.80 for girls, compared to those from high affluent families. The majority of behavioural factors were significantly associated with family affluence in all countries and explained part of the relationship between self-rated health and family affluence. Smoking, physical activity and breakfast consumption showed the largest independent effect on health. The present study suggests that behavioural factors in early adolescence partly account for the association between self-rated health and socio-economic status. Prevention programmes should target unhealthy behaviours of adolescents from lower socio-economic groups to help prevent future life-course disadvantages in terms of health and social inequalities.

Early Adolescent Sexual Initiation as a Problem Behavior: A Comparative Study of Five Nations

PURPOSE Using a Problem Behavior Theory framework, this article examines the extent to which psychosocial correlates of early sexual initiation (before age 16) vary across developed nations. METHODS Fifteen-year-old participants (n = 5,624) in the 1997-1998 World Health Organization collaborative Health Behavior in School-Aged Children survey (Finland, Scotland, France, and Poland) and the 1996 U.S. Add Health survey self-reported substance use (alcohol and tobacco), school attachment, positive parental communication, and early sexual intercourse experience. Stratifying by gender, we performed univariate, bivariate, and multivariable analyses controlling for family socioeconomic status, family structure, and nation fixed effects. RESULTS Self-reported early sexual experience, substance use, school attachment, and positive communication with parents varied significantly across nations for both boys and girls. In both crude and adjusted analyses, substance use was positively associated with early sexual experience among boys and girls across nations, although associations were stronger in Europe than in the United States (adjusted odds ratio [AOR]; range, 1.56-3.74). School attachment was similarly inversely related to early sexual experience among boys and girls across nations (AOR range, .63-.94). However, positive parent communication was significantly inversely related to early sexual experience only among U.S. females (AOR .50). CONCLUSIONS Findings overall supported the fit of early adolescent sexual initiation as a risk behavior within a Problem Behavior Theory framework cross-nationally, suggesting that similar factors could be targeted to prevent early sexual initiation across some developed nations. However, further research is warranted examining the temporality of these relationships.

The relationship between parental socio-economic status and episodes of drunkenness among adolescents: findings from a cross-national survey

BackgroundBehavioral factors such as (excessive) alcohol consumption play a major role in the explanation of social inequalities in health. The unequal distribution of health risk behaviors among socio-economic groups has important consequences for both the current and future health status of the younger generation. However, little is known about socio-economic differences in unhealthy lifestyles during adolescence. The purpose of the present study is to investigate socio-economic differences in adolescent drinking behaviour among 11–15 year old adolescents in Europe and North America.MethodsData was obtained from the Health Behaviour in School-aged Children (HBSC) study 2001/02, a cross-national survey conducted in collaboration with the World Health Organization. The present analysis is based on 69249 male and 73619 female students from 28 countries. The effect of parental occupation and family affluence on episodes of drunkenness was assessed using separate logistic regression models controlling for age.ResultsSocio-economic circumstances of the family had only a limited effect on repeated drunkenness in adolescence. For girls only in one out of 28 countries a significant association between family affluence and repeated drunkenness was observed, while boys from low and/or medium affluent families in nine countries faced a lower risk of drunkenness than boys from more affluent families. Regarding parental occupation, significant differences in episodes of drunkenness were found in nine countries for boys and in six countries for girls. Compared to family affluence, which was positively related to risk of drunkenness, a decreasing occupational status predicted an increasing risk of drunkenness. This pattern was identified within a number of countries, most noticeably for boys.ConclusionParental socio-economic status is only of limited importance for episodes of drunkenness in early adolescence, and this very limited role seems to apply for girls more than for boys and for parental occupation more than family affluence. For future studies it might be important to look at the effects of socio-economic status within the context of other peer, family and school related factors in order to assess to what extent those factors might mediate the effects of social class background.

Food poverty and health among schoolchildren in Ireland: findings from the Health Behaviour in School-aged Children (HBSC) study

OBJECTIVES To investigate the relationships between food poverty and food consumption, health and life satisfaction among schoolchildren. DESIGN Analysis of the 2002 Health Behaviour in School-aged Children (HBSC) study, a cross-sectional survey that employs a self-completion questionnaire in a nationally representative random sample of school classrooms in the Republic of Ireland. SUBJECTS A total of 8424 schoolchildren (aged 10-17 years) from 176 schools, with an 83% response rate from children. RESULTS Food poverty was found to be similarly distributed among the three social classes (15.3% in the lower social classes, 15.9% in the middle social classes and 14.8% in the higher social classes). It was also found that schoolchildren reporting food poverty are less likely to eat fruits, vegetables and brown bread, odds ratio (OR) from 0.66 (95% confidence interval (CI) 0.45-0.87) to 0.81 (95% CI 0.63-0.99); more likely to eat crisps, fried potatoes and hamburgers, OR from 1.20 (95% CI 1.00-1.40) to 1.62 (95% CI 1.39-1.85); and more likely to miss breakfast on weekdays, OR from 1.29 (95% CI 0.33-1.59) to 1.72 (95% CI 1.50-1.95). The risk of somatic and mental symptoms is also increased, OR from 1.48 (95% CI 1.18-1.78) to 2.57 (95% CI 2.33-2.81); as are negative health perceptions, OR from 0.63 (95% CI 0.43-0.83) to 0.52 (95% CI 0.28-0.76) and measures of life dissatisfaction, OR from 1.88 (95% CI 1.64-2.12) to 2.25 (95% CI 2.05-2.45). Similar results were found for life dissatisfaction in an international comparison of 32 countries. All analyses were adjusted for age and social class. CONCLUSIONS Food poverty in schoolchildren is not restricted to those from lower social class families, is associated with a substantial risk to physical and mental health and well-being, and requires the increased attention of policy makers and practitioners.

Moved by Music: A Typology of Music Listeners.

A typology of music listeners was constructed on the basis of importance attributed to music and four types of music use: mood enhancement; coping with problems; defining personal identity; and marking social identity. Three Listener Groups were identified through Latent Class Analysis of internet survey data of 997 Dutch respondents, aged 12—29. High-Involved listeners (19.7%) experienced music as a very important medium and used music most often for mood enhancement, coping with distress, identity construction and social identity formation. Medium- (74.2%) and Low- Involved (6.1%) listeners formed two distinct groups with less intense importance/use patterns Furthermore, High-Involved listeners reported that they liked a broad range of genres (Pop, Rock, High Brow, Urban and Dance) and experienced the most intense positive affect when listening. However, both High- and Medium-Involved listeners also reported more negative affects (anger and sadness) when listening, compared to the Low-Involved group. Even the Low-Involved group listened frequently to music and used music as a mood enhancer. Generally, people who are ‘moved by music’, either positively or negatively, use it for mood enhancement and coping more often. Therefore, the High-Involved group seems to benefit most from music’s capacity to enliven and enlighten life.

Victims of Bullying Among Students With a Disability or Chronic Illness and Their Peers: A Cross-National Study Between Ireland and France

PURPOSE To explore bullying victimization among French and Irish students with a disability or chronic illness (D/CI), considering individual, social, and family factors. We investigated this issue in France and Ireland because of the documented differences between these two countries on relevant contextual factors. METHODS Data from 12,048 students aged 11, 13, and 15 years (50.1% were boys) as part of the cross-national study 2006 Health Behaviour in School-aged Children were analyzed. Self-completion questionnaires were administered in classrooms; information on socio-demographic characteristics, bullying involvement, D/CI, school participation, social network, and family were collected. Multivariate logistic regressions were performed with individual, social, and family cofactors. RESULTS Overall, the prevalence of bullying victimization was significantly higher in France compared with Ireland (34.2% [33.1-35.5] and 25.9% [24.5-27.4, respectively]). Youngest were more likely to report victimization; however, no gender differences were observed. In both countries, students with D/CI were significantly more likely to report that they have been bullied compared with students without D/CI, and a significant additional risk of being bullied was found when students reported D/CI with restriction in school participation. Regardless of country and D/CI status, being bullied was significantly associated with weaker social support and difficulty of communication with fathers, with even stronger associations found among students with D/CI. CONCLUSION Adolescents with D/CI are more likely to be victimized than their peers, with a similar risk in both countries. Besides individual, social and family factors are consistently associated to bullying victimization across countries. These results will guide future antibullying prevention programs.

Trends and socioeconomic correlates of adolescent physical fighting in 30 countries

BACKGROUND AND OBJECTIVES: No recent international studies provide evidence about its prevalence, trends, or social determinants of physical fighting in adolescents. We studied cross-national epidemiologic trends over time in the occurrence of frequent physical fighting, demographic variations in reported trends, and national wealth and income inequality as correlates. METHODS: Cross-sectional surveys were administered in school settings in 2002, 2006, and 2010. Participants (N = 493874) included eligible and consenting students aged 11, 13, and 15 years in sampled schools from 30 mainly European and North American countries. Individual measures included engagement in frequent physical fighting, age, gender, participation in multiple risk behaviors, victimization by bullying, and family affluence. Contextual measures included national income inequality, absolute wealth and homicide rates. Temporal measure was survey cycle (year). RESULTS: Frequent physical fighting declined over time in 19 (63%) of 30 countries (from descriptive then multiple Poisson regression analyses). Contextual measures of absolute wealth (relative risk 0.96, 95% confidence interval 0.93–0.99 per 1 SD increase in gross domestic product per capita) but not income inequality (relative risk 1.01, 95% confidence interval 0.98–1.05 per 1 SD increase) related to lower levels of engagement in fighting. Other risk factors identified were male gender, younger age (11 years), multiple risk behaviors, victimization by bullying, and national homicide rates. CONCLUSIONS: Between 2002 and 2010, adolescent physical fighting declined in most countries. Specific groups of adolescents require targeted violence reduction programs. Possible determinants responsible for the observed declines are discussed.