1. HBSC Findings From the WHO Health Behaviour in School-aged Children Study Professor Fiona Brooks CRIPACC, University of Hertfordshire f.m.brooks@herts.ac.uk @f_m_brooks

2. Health Behaviour in School-aged Children WHO collaboration - over 40 countries Europe & North America Over 200,000 young people each round - 5335 England 2014 Time trends across 12 years – 2002, 2006, 2010 & 2014 Survey methodology in schools age 11, 13 and 15 year olds 2010 report can be downloaded from: www.hbsc.org and wwwhbscengland.com www.hbsc.org

3. The Links Between Attainment and Child Well-being – Why Does It Matter? The link between pupil health and wellbeing and attainment: a briefing for head teachers, governors and staff in education settings PHE 2014 https://www.gov.uk/government/publications/the-link- between-pupil-health-and-wellbeing-and-attainment

4. Why adolescents ? There are 7.4 million adolescents aged 10-19 living in the UK, accounting for 12% of the population and forming part of 4.8 million UK households (Hagell, Coleman and Brooks 2013).

5. ‘The misery of youth: Teenagers depressed and fearful as drink, drugs and crime take their toll’ July 2008, Daily Mail Myth 3 Our teenagers are much worse than anywhere else!

7. Increased synaptic pruning and increased myelination in the prefrontal cortex Enhanced amygdala reactivity to emotional stimuli – Exaggerated reactivity to rewarding stimuli – Reduced sensitivity to aversive stimuli – What is rewarding and what is aversive is culturally and environmentally dependent THE TEENAGE BRAIN DOES WHAT?

10. There is an interaction between the environment and the adolescent brain How you spend your time guides the structure of the brain and becomes hard wired into your brain BUT Toxic environments impede normal brain development USE IT OR LOSE IT

11. Measures Mandatory Measures in HBSC Unique study Includes measures on physical, emotional and social health and well-being Only study looking at Sexual health in the UK Only study collecting data on new domains of adolescent Only study with internationally validated measures on areas such as sleep, family support, neighbourhood Employing measures of Social capital and resilience Health Related Behaviours Health and Well-being Family Life School Peers and Community OPTIONAL PACKAGES VALIDATED MEASURES

12. Primary Health Care Services 80% of young people reported that they had visited their GP in the last year (78% of boys and 82% of girls)

13. Health Risk Behaviours

14. Smoking Overall 3% reported weekly smoking Rising to 6% in 15 year old boys and 8% in 15 year old girls

15. Alcohol Overall, 5% of young people drink alcohol weekly

16. Alcohol Among 15 year old weekly drinkers, 83% of boys and 57% of girls had been drunk 10+ time in last 30 days

17. Substance misuse

18. 21% of 15 year olds reported having had sex Young people reporting having sex has decreased from 2002 Sexual Intercourse

19. Proportions reporting very early sexual initiation have decreased significantly since 2002 Sexual Intercourse

20. Condom use has however declined since 2010 – when it had over two survey cycles been showing an increase Sexual Intercourse

21. 25% of boys and 9% of girls involved in a physical fight at least twice in the last 12 months Between 2002 and 2014 the proportion of both boys and girls involved in physical fights has decreased Fighting

22. Health

23. Health Complaints Overall, 65% of young people (59% of boys and 71% of girls) reported experiencing at least one health complaint on a weekly basis. Will come back to feeling low

24. Injuries

25. Sleep & Concentration Nearly three quarters (73%) of young people reported having at least 8.5 hours sleep on school nights However this decreased significantly by age

26. Sleep & Concentration Overall, 22% of young people cannot concentrate at school due to lack of sleep Increases with age Gender differences

27. Having a long term condition or disability 23% of young people reported having long term illness or disability (23% of boys and 22% of girls). Type of condition or disability About half had asthma Proportions that report having a long term condition effects their participation in school

28. Emotional Wellbeing

29. Life Satisfaction

30. Achievement = Well-being Well-being = Achievement The health and well-being of children and young people contributes to their ability to benefit from good quality teaching and to achieve their full academic potential Academic success – impacts on a child’s subjective life satisfaction Subjective life satisfaction impacts on behaviour and school engagement – ability to acquire academic competence.

31. Feeling Low 2

32. Feeling Low 1 Overall, 26% of young people feel low at least once a week Increases with age Gender differences

33. Feeling Low 2

34. Feeling Low by Age, Gender and Country Feeling Low 3

35. Full of Energy 1 Overall, 51% of young people felt full of energy always or very often during the last week

36. Self-harm Overall, 22% of young people said they had self- harmed In comparison with other studies, self- harm increasing over the past decade

37. Self-harm 2 Overall, 22% of young people said they had self- harmed In comparison with other studies, self- harm seems to be on the increase

38. Body image Proportions reporting dissatisfaction with their body size has remained relatively stable since 2002 23 % of 15 year old boys reported they were too thin compared 9% of girls

39. Cyberbullying 2 questions – one via messages second photographs/pictures. 18% reported experiencing cyberbullying (previous two months). 24% of girls 12% of boys. Cyberbullying increases with age for both boys and girls -more traditional forms of bullying decreases with age Cyberbullying

40. It’s like about this, is like one bad thing a photo or something can get found out about and it goes on and on for ages, so is more upsetting than like some-one who picks on you from another class Katie, age 16 It’s like about this, is like one bad thing a photo or something can get found out about and it goes on and on for ages, so is more upsetting than like some-one who picks on you from another class Katie, age 16 Cyberbullying

41. Healthy Behaviours

42. Physical Activity Overall 19% meet physical activity guidelines - 22% of boys and 15% of girls Physical activity levels have remained stabled in girls since 2002

43. Physical Activity The proportion of girls being physically active for at least an hour every day of the week has remained relatively stable since 2002, however boys physical activity levels have fluctuated – recent decline Physical Activity

44. Positive health behaviours – physical activity UK study - the amount of moderate to vigorous physical activity at age 11 impacted on academic performance across English, maths and science at age 11, 13 and final GCSE exam results The percentage of time girls spent in moderate to vigorous physical activity at age 11 predicted increased science scores at 11 and 16 years High performing schools have higher levels of participation in physical activity and sports

45. Physical Activity Older adolescents are less likely to eat vegetables every day; 44% of 11 year olds, 44% of 13 year olds and 41% of 15 year olds. Relatively flat trend since 2006. Eating Vegetables

46. Across all age groups boys are more likely to eat breakfast every day Eating breakfast has actually increased from 2010 to 2014 – rising from 67% to 74% in boys and 55% to 60% in girls. Eating Breakfast

47. Five a day 38% of respondents reported meeting the recommended consumption of five fruit and vegetables every day.

48. Energy Drinks Around 20% of boys across 13 & 15 year olds drink energy drinks 2-3 times a week and 12% of girls – The pattern is the same for fizzy drinks with around 17% of 15 year boys drinking fizzy drinks and 12% of girls (daily)

49. Sugary Drinks

50. Key protective factors or essential assets for positive mental health and well-being is the family, including access to one supportive adult Community and family life

51. Community & Neighbourhood

52. Family life 1

53. Family life -2 parental support

54. Family life – time spent together

55. Positive health behaviours – Young People engaging in self development activities (including sport, physical activity) – achieved 10-20% higher GCSEs – 2009 and had better emotional well- being But Socialization Gap widened in last 30 years – Poorer families cannot provide such opportunities

56. School life

57. School Culture and Ethos Longitudinal USA studies - feeling connected to school and having a sense of belonging - key protective asset Protective of emotional health and well-being Preventive of behaviours linked with poor emotional health - substance misuse, violence, alcohol misuse and early sexual initiation. School connectedness generated by extra-curricular activities (especially PA), positive class room management and tolerant disciplinary policies, feeling safe

58. School Culture and Ethos pupils who reported they enjoyed school at age 11 had better attainment at key stage 3, especially for maths pupils who hold positive attitudes about their school at age 14 have higher academic achievement by age 16 pupils who have been bullied have lower key stage 1 SAT results and are more likely to have friends who are involved in antisocial activities pupils who are bullied at age 14 have significantly lower GCSE scores at age 16

59. School life 2 Connectedness

60. School Belonging Agree (belong) NeitherDisagree Regular smoker 4.4%5.5%10.6% Weekly alcohol consumption 11.6%13%20 % Drunkenness at least twice 17%20 %29% Been bullied3.1%4.3%10.9% Physical Fighting (3x 12 months) 8.8%11.5%18.8% Feeling low21.1%34.4%50.1%

61. Teacher connectedness : interested in me as a person AgreeNeitherDisagree Regular smoker 4.2%5.1%10.1% Weekly alcohol consumption 11.2%12.1%22 % Drunkenness at least twice 14.9%20 %31% Been bullied3.8%3.6%7.4% Physical Fighting (3x 12 months) 9.8%9.3%16.9% Feeling low22.9%29.2%39.5%

62. Multiple substance use among 15 year olds & life satisfaction Protective Factors/Assets – most vulnerable 1. Parental participation in how spend free time 2. Teacher Connectedness – 3. Feeling safe in community and having friendly neighbourhood

63. School Culture and Ethos – Peer Relationships Disruptive classroom behaviour directly influences pupil attainment. Bullying at school is one of the strongest predicators of wellbeing pupils who have been bullied have lower key stage 1 SAT results and are more likely to have friends who are involved in antisocial activities pupils who are bullied at age 14 have significantly lower GCSE scores at age 16

64. Bullying

65. Bullying 2 – types of behaviour

66. PSHE

67. Social and emotional competencies – the whole school approach Actions relating to each of the following areas: learning and teaching specific time allocated within the school curriculum in order to help students develop the knowledge, attitudes and skills needed to support health and wellbeing. Ethos and physical environment promoted through the ‘hidden’ or ‘informal’ curriculum, which encompasses the leadership practices, values and attitudes promoted within the school, as well as the physical environment and setting of the school. Engagement with families and/or communities recognition of the importance of these other spheres of influence on children’s attitudes and behaviours in school.

68. 11 year olds13 year olds15 year olds BoysGirlsBoysGirlsBoysGirls Health and wellbeing56%54%69%70%58%50% Staying safe66%64%58% 43%45% Sex and relationships41%40%52%48%57%50% Personal and social skills 73%75%68%66%55%50% Economics and career education 47%50%54%45%42%43% Topics in PSHE Young people who reported topics were well covered in PSHE

69. Improved skills to care for others Overall, 70% of young people said PSHE improved their skills to care for other peoples health Decreases with age

70. Improved skills to look after own health 74% said PSHE helped them look after their own health Decreases with age

71. PSHE and health behaviours Young people have more positive health behaviours if health and wellbeing was covered well in PSHE classes Health and wellbeing covered well Health and wellbeing covered poorly Self-harmed19.2%30.3% Smoked on 6 or more days in last 30 days 6.1%8.4% Drunk alcohol 6 or more times in last 30 days 5.5%9.0% Drunkenness 4 or more times in last 30 days 1.1%3.0% On a diet17.5%22% Eat breakfast every day59.7%52.5%

72. Overall, 21% of 15 year olds reported having had sex… …compared with 28% of those who said sex and relationship education was covered poorly and 18% who reported it had been covered well PSHE and sex Sex and relationship educations covered well Sex and relationship education covered poorly Sexual intercourse18.3%28%

73. Final thoughts… Health risk behaviours - declining trends Positive behaviours in most instances - static Poorer emotional well-being A move from reducing risk factors to improving positive health behaviours and emotional well-being – significance of these as OUTCOME MEASURES BUT Promoting resilience (through social learning interventions – although clearly part of the jigsaw) alone is insufficient Strengthening protective factors or health assets gained from schools, the home and in local communities can make an important contribution to improving emotional health and young people’s well-being.

74. Protective Health Assets model for young people “Promoting physical and mental health in schools creates a virtuous circle reinforcing children’s attainment and achievement that in turn improves their wellbeing, enabling children to thrive and achieve their full potential.” Brooks, F. 2013. Chapter 7 : Life stage: School Years. In Chief Medical Officer's annual report 2012: Our Children Deserve Better: Prevention Pays