The study was designed to address health risk behaviours such as smoking, alcohol and drug use and dietary practices, but also examine determinants that affect the health of youth such as their home, school and peer group experiences.
An increasing body of research has demonstrated that the health behaviours and self-perceptions of youth are directly related to their lives in schools. In the HBSC surveys students who were well adjusted at school were found to be more likely to have positive relationships with their parents, to be healthy and happy and to avoid health risk behaviours. For many young people school is richly satisfying, but for others school is an unpleasant or threatening place were they feel criticized and excluded. If students do not feel supported and accepted at school and their needs are not being met, the health and social costs to both the students and Canadian society could be substantial. Overall, Canadian students were generally satisfied with their school experience compared with students from other countries, but they were less likely to say their fellow students were kind and helpful. Satisfaction with and adjustment to school decreased as students progressed through the grades. Student satisfaction with school varied through the 1990s with 1993-94 being a high point.
In comparing student satisfaction across countries, highly structured school systems that streamed students early did not have a notably different effect on student satisfaction in comparison with those school systems that delayed streaming until the latter years of secondary school such as Canada, Norway and Sweden. A key factor in school satisfaction appeared to be students' perceptions of caring, fair teachers and student-centred modes of teaching.
A small but significant proportion of students felt unsafe at school (10% of boys and 6% of girls). Bullying behaviour was common in schools (approximately one-third reported being bullied "this term"), and the proportions of young people who have been bullied have increased between 1994 and 1998. The victims of bullying tended to be isolated and felt lonely, helpless and depressed.
The way in which parents interact with their children has a profound effect on their children's social and physical health. Adolescence can be a particularly stressful period, and in this study the students who had a good relationship with their parents were better adjusted in all aspects of their lives—physical and mental health, adjustment to and satisfaction with school, avoidance of health-risk behaviours and peer relationships. The findings from the HBSC surveys reinforce the importance of a supportive home life based on effective communication, trust and understanding.
Nearly three-quarters of the Canadian sample of students lived with both their natural parents. This appears to be the optimum setting in which to develop a happy and healthy youth. Generally speaking, Canadian youth were happy with the support from and communication with their parents but here were some real concerns. The proportion of children (especially girls) who were able to communicate effectively with their fathers decreased sharply from Grade 6 to Grade 10 and remained relatively low across all survey years. Canadian children seemed to be more distanced from their parents than was the case in a number of European countries. Girls appeared to experience more strain at home than boys although there were declines over the three surveys in the proportion of both Grade 10 boys and girls who said there were times they would like to leave home (boys 44 to 33%, girls 55 to 46%). Although there was a slight decline in the proportion of youth who felt what their parents thought of them was important over the three age groups, the proportions by Grade 10 were still over 70%. In the areas of trust, understanding and expectations in particular, children's relationships with their parents appeared to decline as the children moved through their adolescent years.
The findings from this study are consistent with similar research in that it was found that young people who are not well integrated socially are far more likely to manifest physical and mental health problems. Students who have good friends in whom they can confide and with whom they can confide and with whom they can share activities are more likely to have confidence in themselves, to be well adjusted at school and to get along with their parents. Therefore, it is positive to note that the proportions of students who had fewer than two close friends declined slightly over the three surveys. Interestingly, in countries such as Poland, Switzerland, France and Norway more girls are likely to have fewer than two close friends while in Canada and Germany the reverse is true.
There can be harmful consequences for those who have close friends with whom they spend a great deal of time. Students who spent a great deal of unstructured time in the evenings with their friends were more likely to engage in health-risk behaviours such as smoking and drug and alcohol use. The number who spent such time with friends continued to be high ; for example, 33 percent of grade 8 boys spent five or more evenings a week out with their friends.
There appear to be differences among youth in their capacity to cope with the stresses and strains of adolescence. Those with higher self concepts and self-confidence appear to be better able to deal with pressures at home and school. The strain of middle adolescence can be seen in that the proportion of youth who felt "very happy" with their life declined sharply between Grades 6 (52%) and 10 (30%). By Grade 10, over one-third of the girls and one-fifth of the boys indicated that they had felt depressed at least weekly.
Girls scored notably lower than boys on self-confidence, decision-making and self-acceptance, and nearly twice as many girls as boys said they often feel lonely. Fortunately, the trend was slightly down over the three surveys, and especially for girls : between the 1990 and 1998 surveys the proportion of girls who indicated that they often wished they were somebody else dropped from 42 to 32 percent for grade 6 girls, and 41 to 37 percent for Grade 10 girls. Girls were far more likely than boys to say there was something about their body they would like to change with the numbers increasing sharply from grade to grade. By Grade 10 over three-quarters of the girls and one-half of the boys agreed with this statement.
The students' general perception of their health was found to be highest for the Grade 6 respondents and declined through to Grade 10 (55% of the Grade 6 boys indicated they felt very healthy compared with 41% of Grade 10 boys ; the corresponding figures for the girls were 48% and 21%). Students' who viewed themselves as healthy were more likely to have a positive attitude toward school, good relationships at home and with their peers, self-confidence, healthy eating patterns and greater acceptance of their body image.
Headaches and backaches were very common among girls with higher proportions of older girls reporting these ailments. On the 1998 survey, 45 percent of Grade 10 girls indicated they had headaches at least once a week and 63 percent of them had a backache at least once a month. There was little change in the proportions of youth with headaches, backaches and stomachaches over the three surveys. Canadian youth, especially girls, were more inclined to use medication for their ailments than youth from other countries.
About 28 percent of the boys and 33 percent of the girls reported that they had a long-term illness or medical condition ; allergies and asthma predominated.
Regular physical activity builds cardiovascular endurance and reduces the risk of chronic diseases. Over the three HBSC surveys, there was a decline in the proportion of students who exercised at least twice a week outside of school hours, but an almost corresponding increase in the proportion who exercised at least four hours a week. Canadian youth were mid-range in a ranking of the eleven countries by physical activity level.
Some television watching is not likely to be unhealthy for young people, but if it is watched for four or more hours per day it may be at the expense of more beneficial physical or creative activities. The proportions of boys who watched television at least four hours a day was high and changed little over the three surveys (just over 30% Grade 6, just below 30% Grade 8, and 23% Grade 10), but declined for Grade 6 girls (27% to 22%) and increased for Grade 10 girls (14% to 19%). There was a sharp increase between 1994 and 1998 in the proportion of boys who played computer games at least four hours weekly.
Adolescents are particularly susceptible to poor eating habits as they become more independent in their choice of foods. For example, by grade 10, just over half the boys and nearly two-thirds of the girls indicated that they did not have at least juice and toast or cereal for breakfast each day.
Although 75 percent of the Grade 6 students said they ate fruits and vegetables daily, the figure was down to 70 percent by Grade 10. There was a decline in the proportion of students who ate fruit and vegetables daily over the three surveys and, overall, there was a slight reduction in the percentage of students eating more nutritious foods and a corresponding increase in the percentage eating less nutritious foods.
More girls than boys indicated they thought they needed to lose weight with the proportion increasing from grade to grade. By Grade 10, far more girls (45%) than boys (18%) indicated they needed to lose weight.
Canada ranked behind most of the other countries in the proportion who brushed their teeth twice daily or more—just over half the boys met this standard.
Unintentional injuries are the leading cause of death among children and youth, and Canada ranks particularly high in comparison to other countries in the proportion of young people who have a least one injury requiring medical attention a year. Over one-third of grade 6 students and about 40 per cent of Grade 8 and 10 students reported an injury requiring medical attention during the past year. boys were more likely to be injured than girls. The figures were down slightly between the 1994 and 1998 surveys. Younger students were more likely to be injured around the home, and older students at sports facilities.
Legislation is in place in Canada mandating the use of helmets by bicycle riders and seatbelts by automobile drivers and passengers but compliance is not universal. A third of Grade 8 an 10 students did not always wear a seat belt when riding in an automobile. Many younger bicyclists and the vast majority of older bicyclists did not usually wear protective helmets.
The effects of smoking and excess alcohol consumption on health have been clearly documented, but young people continue to take health risks with these substances. Seventeen percent of Grade 10 boys and 23 percent of Grade 10 girls were daily smokers. These numbers have increased slightly since 1990.It is not surprising that by Grade 10 over 90% of our sample of young people had tried alcohol, but it is disturbing to note that over 40 percent of the Grade 10 students said they had been drunk at least twice. Among the eleven countries compared, Canada ranked third behind Denmark and England in drunkenness among youth.
Of particular concern is the sharp increase in marijuana use between the 1994 and 1998 surveys—over 40 percent of the Grade 10 students said they had used hashish/marijuana during the past year. Also, youth who engaged in one health risk behaviour were more likely to engage in others ; for example, 90 percent of Grade 10 smokers had also used marijuana.
In the nineties, risk behaviours among youth related to smoking and drug use have not declined despite legislation and program initiatives to reduce them. Efforts targeted at particular risk behaviours, such as smoking, do not take into account the role that peer groups play in providing support and acceptance for disaffected youth. Many young people show evidence of stress related to teacher and parent expectations, body image, relationships and social adjustment. These two broad areas of health concern-substance use and stress associated with interpersonal relations and academic and parental expectations-appear to be related to a lack of understanding and emotional support for youth. Programs to increase the involvement of parents and young people with schools to ensure that the school and family climate create a supportive framework appear to be necessary. Continuity and collaboration across levels of government and agencies that attend to the needs of the child from birth through adolescence are required.