How is Scotland Doing?National Highlights from the 2009/10 HBSC International Survey

Dr Jo InchleyHBSC ScotlandUniversity of St Andrews

Interpreting national findingsHow can international data enhance our understanding of young people’s health in Scotland?

• How does Scotland rank compared with other countries?

• Has rank changed over time?

• How do national trends compare with international trends?

• How does prevalence compare across age and gender groups?

• Are age and gender differences the same as in other countries?

• What are the levels of relative socio-economic inequality?

Presentation of findings

Topics:• Health behaviours

• Risk behaviours

• Health outcomes

• Social context

Themes:• Gender inequalities

• Socio-economic inequalities

• Where we are doing well

• Future Challenges

International comparison

HIGH Top ⅓ countries (rank = 1-13)

MEDIUM Middle ⅓ countries (rank = 14-26)

LOW Bottom ⅓ countries (rank = 27-39)

Ranking:

International comparison

Colour coding:

Performs WELL relative to other countries

About average

Performs POORLY relative to other countries

HEALTH BEHAVIOURS

Tooth brushing• HIGH ranking all ages• England and Wales also in

top ⅓ of countries• Prevalence higher among

girls• Steady increase in tooth

brushing since 1990Girls 70% to 81%Boys 48% to 66%

• Significant FAS effect in both boys and girls 11yrs 13yrs 15yrs

0

10

20

30

40

50

60

70

80

90

100

68 6863

80 82 83

% brush teeth more than once a day

boys girls

9 7 9

Soft drink consumption• MEDIUM ranking• Major decrease in ranking

since 2002• Reflects decreasing

prevalence since 2002• Girls below HBSC average at

all ages.• Higher among boys at ages

13 and 15• Increase with age,

especially among boys• Lower than England

11 yrs 13 yrs 15 yrs0

5

10

15

20

25

30

35

40

45

50

18

25

32

1518

21

% drink soft drinks daily

boys girls

24 23 18

Relative inequality: soft drinks

Physical activity

29 29 34

• LOW ranking at all ages• Major fall in ranking since

2006• Reflects decreasing

prevalence in Scotland• Lower than England and

Wales• Lower prevalence among

girls and older adolescents• Small but significant FAS

effect (positive) among boys11 yrs 13 yrs 15 yrs

0

5

10

15

20

25

30

35

40

24

19

1316

108

% meeting PA guidelines

boys girls

RISK BEHAVIOURS

Weekly smoking

35 21 25

• LOW ranking 11 year olds• MEDIUM ranking 13 and 15

year olds• Fall in ranking since 2006• Reflects decrease in

prevalence among girls• Previous gender difference

has disappeared• Small but significant FAS

effect for girls • Early smoking initiation also

decreased since 2006

11 yrs 13 yrs 15 yrs0

5

10

15

20

25

30

0

4

14

0

5

15

% smoke at least once a week

boys girls

Alcohol consumption

12 7

• HIGH ranking among 13 and 15 year olds for weekly drinking

• HIGH ranking among all ages for drunkenness

• Weekly drinking higher among boys (11 &15 yrs)

• Drunkenness higher among girls (15 years)

• Similar to England and Wales

• No FAS association11 yrs 13 yrs 15 yrs

0

10

20

30

40

50

60

3

14

40

1

16

46

% been drunk on two or more occasions

boys girls

7

Sexual health (15 year olds)Sexual intercourse• 27% boys and 35% girls report having had sexual intercourse• HIGH ranking = 7th (out of 36)

Condom use• 72% boys and 70% girls report using a condom at last

intercourse• LOW ranking = 27th (out of 32)

Pill use • 14% boys and 21% girls report use of contraceptive pill at last

intercourse• MEDIUM ranking = 18th (out of 34)

Relative inequality: sexual intercourse

HEALTH OUTCOMES

Life satisfaction

9 1112

• HIGH ranking across all ages• Increase in ranking since

2006• No major change in

prevalence since 2002• Gender difference at age 13

and 15• Decrease with age between

11 and 15 for boys and between 11 and 13 for girls

• Higher prevalence than England and Wales

11 yrs 13 yrs 15 yrs0

20

40

60

80

10092 90 8790

84 82

% reporting high life satisfaction

boys girls

Relative inequality: life satisfaction

Self-rated health

14 26

• HIGH ranking among 13 and 15 year olds

• Increase in ranking among 15 year olds since 2002

• No significant change in prevalence since 2002

• Gender difference among 13 and 15 year olds

• Increase with age is more marked in girls

• At age 15, Wales has similar prevalence to Scotland, but England is lower

11 yrs 13 yrs 15 yrs0

10

20

30

40

50

1416

22

12

24

34

% reporting poor or fair health

boys girls

Relative inequality: self-rated health

SOCIAL CONTEXT

Close friendships

8 21

• HIGH ranking all ages• Ranking has increased since

2002• Gender difference at ages

11 and 13• England and Wales also

rank in top 10 countries• Small but significant

positive FAS effect11 yrs 13 yrs 15 yrs

0

20

40

60

80

100

87 89 899195

90

% have 3+ close friends of same gender

boys girls

Electronic media contact (EMC)

10 65

• HIGH ranking all ages• Increase in prevalence since

2002• No major change in ranking• Higher among girls at all

ages• England and Wales also in

top ⅓ of countries @ age 15• Significant positive FAS

effect girls and boys 11 yrs 13 yrs 15 yrs0

10

20

30

40

50

60

70

80

26

45

60

39

6875

% have daily EMC with friends

boys girls

THEMES

• Inequality• Where we are doing well• Future challenges

Gender inequalities in Scotland• HEALTH BEHAVIOURS: Boys eat breakfast more often and are more physically

active but are more likely to consume soft drinks. Girls eat more fruit and brush their teeth more regularly.

• RISK BEHAVIOURS: Overall, boys are more likely to be involved in risk behaviours – alcohol use, cannabis use, fighting, bullying. There are two exceptions: sexual intercourse and drunkenness among 15 year olds.

• HEALTH OUTCOMES: In general, girls are more likely to rate their health as fair or poor, report more frequent health complaints, think they are too fat and be on a diet. Boys have higher life satisfaction but report more medically attended injuries.

• SOCIAL CONTEXT: Boys report better communication with their fathers and spend more time out in the evenings with friends. Girls are more likely to have 3 or more close friends and spend time talking to friends by phone, text or internet. Girls also report more favourable attitudes towards school but feel more pressure from schoolwork as they get older.

Socio-economic inequality in ScotlandYoung people from low affluent families are more likely to: • Perceive their health as fair or poor• Experience more frequent health complaints• Drink soft fizzy drinks every day• Watch TV for 2+ hours a day• Have had sex• Have been bullied at school in past couple of months• Spend time out with friends in the evening

• Start smoking at age 13 or younger (GIRLS only)• Smoke weekly (GIRLS only)• Have used cannabis (GIRLS only)• Have been in a physical fight in the last 12 months (GIRLS only)

Socio-economic inequality in ScotlandYoung people from low affluent families are less likely to: • Eat breakfast regularly• Eat fruit daily• Brush their teeth at least twice a day• Have used a condom at last intercourse• Report high life satisfaction• Find it easy to talk to their father• Have 3 or more close friends• Talk to their friends every day by telephone, text or internet• Perceive their school performance as good or very good• Think their classmates are kind and helpful

• Find it easy to talk to their mother (GIRLS only) • Like school a lot (GIRLS only)• Meet current physical activity guidelines (BOYS only)• Report at least one medically attended injury in last 12 months (BOYS only)

Relative socio-economic inequalityScotland has HIGH relative inequality compared to other HBSC countries for: • Soft drink consumption• Sexual intercourse• Classmate support• Having been bullied• Self-rated health• Tobacco initiation (girls only)• Lifetime cannabis use (girls only)• Communication with mother (girls only)

Where is Scotland doing well?

• Life satisfaction

• Peer relationships

• Smoking

• Cannabis use

• Oral health

Future challenges

• Physical activity• Sexual health• Alcohol consumption

• School experience• Family communication

AcknowledgementsWith thanks to…….

• Scottish schools and pupils who took part in the survey

• Local Education Authorities

• NHS Health Scotland

• Fellow members of the HBSC Scotland team:Candace CurrieDorothy CurriePaula Grieve (to 2011)Carol JacobJo Kirby (to 2012)Kate LevinJanine MuldoonWinfried van der Sluijs