New WHO study reveals that while smoking by school-aged children has declined significantly, young people’s health and well-being is being undermined by gender and social inequalities

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Copenhagen, 15 March 2016

A new pan-European WHO survey of schoolchildren reveals that the proportion of 15-year-olds who first smoked at the age of 13 has fallen significantly since 2010. The report goes on, however, to warn that while 80% of respondents report generally high rates of life satisfaction, differences between genders and socioeconomic status are adversely affecting many young people's health, well-being and lifestyle choices at a critical stage in their development.

The Health Behaviour in School-aged Children (HBSC) study, which is updated every four years, reveals that the proportion of 15-year-old Europeans who reported having a first cigarette at the age of 13 or younger fell from 24% to 17% between 2009/2010 when the last survey was conducted and 2013/2014. The reduction reported among girls (22% to 13%) was larger than that among boys (26% to 22%), and the data show no consistent association with family affluence, suggesting that smoking behaviour is only partially determined by socioeconomic factors.

This positive news on smoking is tempered by other aspects of the report, however, which reveal that overall life satisfaction decreases slightly as children grow older and that those from lower-income families generally report lower levels of satisfaction. 

Successive studies carried out since 2002 have shown that differences in reported life satisfaction between adolescents in western and eastern Europe have narrowed, with countries such as Croatia, Estonia, Latvia, Lithuania, the Russian Federation and Ukraine reporting significant increases in life satisfaction over the period, although figures have stabilized since the last study in 2010. 

Data inform policy development for adolescents

Data collected for the study are based on surveys completed by thousands of adolescents, thereby ensuring that their voices and concerns can be taken fully into account when WHO frames its European strategies, policies and actions for improving child and adolescent health and well-being. The study feeds into a growing body of evidence calling for more effective and targeted interventions by governments and policy-makers to tackle the effects of social, health and gender inequalities among young people in Europe.

"Health behaviours and social habits and attitudes acquired in the critical second decade of a young person's life can carry on into adulthood and affect the entire life-course," said Dr Zsuzsanna Jakab, WHO Regional Director for Europe. "A good start can last a lifetime." 

"Despite considerable advances in adolescent health, such as the welcome reduction in adolescent smoking behaviours, many still face huge inequities; girls and children from lower-income families consistently report poorer physical and mental health and lower rates of physical activity than boys and children from more affluent families, for example. The data in the HBSC study point us to interventions that can narrow this gap and support the development of positive, lifelong health behaviours." 

The WHO report Growing up unequal: gender and socioeconomic differences in young people's health and well-being covers 42 countries in Europe and North America. Results are analysed by 340 in-country researchers supported and coordinated by the International Coordinating Centre at the University of St Andrews in Scotland and the Data Management Centre at the University of Bergen in Norway. 

The cross-national survey covers diverse aspects of adolescent health and social behaviour, including self-assessment of mental health; obesity and body image; dietary habits; engagement in physical activity; support from families and peers; tobacco, alcohol and cannabis use; and bullying (see attached summary of key findings from the cross-national survey).

The latest HBSC report, which presents data from the 2013/2014 surveys, has a special focus on the effects of gender and socioeconomic differences on the way that young people grow and develop.

Dr Jo Inchley, HBSC International Coordinator and lead editor of the report, said: "The findings highlight large gender disparities in health, which emerge or worsen during the adolescent years. While girls are more likely to eat fruit and vegetables and brush their teeth than boys, they report more negative self-perceptions and poorer mental well-being. Boys are generally more physically active but also more likely to engage in risky behaviours. Differences across countries show the importance of understanding the role of gender norms and cultural expectations in influencing behaviour. 

"Many aspects of health are socially patterned. Young people from more disadvantaged backgrounds not only report lower levels of health-promoting behaviours and poorer health outcomes but also have fewer social assets such as support from family and friends." 

Much of WHO's European strategy for improving child and adolescent health is based on data drawn from successive HBSC studies. The strategy sets out a vision, guiding principles and priorities for countries working across sectors – from governments to nongovernmental and civil society organizations – to protect and promote the health and well-being of children and adolescents throughout the WHO European Region.

The HBSC study has influenced policy and legislation in numerous European countries in the 33 years since its first report was published. After its 2003 report identified a dramatic spike in alcohol consumption among young Germans, for example, the Government of Germany increased tax on "alcopops" and improved labelling; this has led to a significant decline in such consumption. Data gathered in successive HBSC reports were used to inform the development of the Scottish Government's Pregnancy and Parenthood in Young People Strategy of 2013, and alarming downward trends in the mental health of young Swedes identified by HBSC prompted a major initiative by the Public Health Agency of Sweden to identify the causes of this decline and address them.

"We must no longer treat young people as a homogeneous group for whom a uniform set of interventions is an appropriate response for tackling their needs," said Dr Zsuzsanna Jakab. "Young people are as rich and diverse as their adult counterparts; they require a range of interventions that reflect their diversity and take fully into account their age and gender, and their social and cultural environments. In the report, young people tell it like it is and highlight what is important to them – we must act on this trust."