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AUTHOR King, Alan; And Others TITLE The Health of Youth: A Cross-National Survey. WHO Regional Publications, European Series No. 69. INSTITUTION World Health, Organization, Copenhagen (). Regional Office for Europe. SPONS AGENCY Ministry Of Education, Quebec (Canada). REPORT NO ISBN-92-890-1333-8; ISSN-0378-2255 PUB DATE 96 NOTE 463p AVAILABLE FROM Office of Publications, WHO Regional Office for Europe, Scherfigsvej 8, DK-2100, Copenhagen 0, Denmark. PUB TYPE Reports Research/Technical (143) Statistical Data (110)

EDRS PRICE MFO1 /PC19 Plus Postage. DESCRIPTORS *Adolescents; *Child Health; Children; Cross Cultural Studies; Dental Health; Depression (Psychology); Foreign Countries; Health Promotion; Injuries; *Mental Health; Nutrition; Parent Child Relationship; Peer Relationship; *Physical Health; Questionnaires; Smoking; Social Adjustment; Student Attitudes; Student Behavior; Student Needs; Surveys; Tables (Data); Well Being; Youth; *Youth Problems IDENTIFIERS Health Surveys; *Risk Taking Behavior

ABSTRACT This report presents the preliminary findings from WHO's (World Health Organization) fourth Health Behaviour in School-Aged Children (HBSC) Study. The study has two main objectives: (1) to monitor health-risk behavior in youth over time in order to provide the necessary background and clear targets for health promotion initiatives; and (2)to provide information to researchers that will enable them to understand and explain the development of health attitudes and behaviors through early adolescence. Approximately 1300 respondents in each of 3 age groups--11, 13, and 15 years--were targeted in 24 countries during the 1993-94 school year. The findings of the survey include: (1)in every country surveyed, the use of tobacco and alcohol increased with age; (2) in most countries, as young people progress from age 11 to 15, they exercise less frequently;(3) there is evidence to suggest that the diet of a significant number of young people in all countries does not conform to current nutritional advice; (4) in only one country, , did the majority of 11, 13, and 15 year olds rate themselves as very healthy; (5)in nearly all countries, only a small minority of students regularly felt lonely, helpless, or left out, while the majority thought they made friends easily, had at least two close friends, and found it easy to talk to their mother;(6) nearly 30 percent of the respondents reported an injury requiring medical attention during the previous year; this reaffirmed other research findings that unintentional injuries may be the most serious health problem to face school children in western societies; and (7) schools with a hospitable environment and caring teachers appear to contribute positively to students' emotional well-being and social development. Several implications for policy are included. Appendixes include: characteristics of countries, sample design and sampling error, a list of the principal investigators, and a list of-HBSC publications. Contains 123 references. (AA) EDUCATIONALOffice of Educational RESOURCES Research and INFORMATION ImprovementU.S. DEPARTMENT Of EDUCATION *This document has been reproducedoriginatingMinorreceived as changes it. from thehave person been made Or organization to improve CENTER (ERIC) onai Public Lions, European Serles No 69 reproductionOERImentPoints dopositionof viewnotquality. necessarily Oror opinionspolicy. statedrepresent in th official docu- ( A Cross-N tior Su Ney PERMISSION TO REPRODUCEDISSEMINATE AND THIS MATERIALHAS BEEN GRANTED BY TO THE EDUCATIONAL RESOURCESINFORMATION CENTER (ERIC) 7\(veck\A,SIO`n andNationsThe publicWorld with health.Health primary ThroughOrganization responsibility this isOrganization, a specialized for international which agency washealth of createdthe matters United in themmentknowledge1948, toby lead theall and citizens healtha socially experience professions of andthe withworldeconomically theof of overaim a level of 180 productive making of countries health possible life. that exchange will the permitattain- their embracesularthroughoutThe healthWHO some problemsRegionalthe world, 850 millionOfficeof each the withcountries forpeople Europeits own living it serves.programis onein an ofThe area gearedsix European regionalstretching to the Regionofficespartic- from WHOPacificGreenlandindustrial therefore shores inand theof post-industrialconcentrates the north Russian and the Federation.bothsociety Mediterranean on andthe onTheproblems those European in faced theassociated south byprogram the to emerg-with the of duciveOfficeIn ingits strategydemocracies isto arranginghealth, for a attaininghealthyof its central activities environment, the and goal easternin three Of healthandEurope main appropriate areas:for and all, the lifestyles the formerservices Regional USSR.con- for natingguagesTheprevention, European informationspoken treatment byRegion its to peoples, andall is who characterizedcare. andmay the need resulting byit. Applicationsthe difficultieslarge number for in rightsdissemi- of lan- of translation of Regional Office books are therefore most welcome. 4 5 WHO Regional Publications, European Series No. 69 Alan King F BenteChrisYossi HarelTudor-Smith Wold A Cross-National Survey

School-AgedA report of the Children: 1993-94 A survey WHO results Cross-National of Health Study.Behaviour in 0Health Behaviourin School-Aged Children II The preparation of this report was funded by Health Canada. g o World Health Organization CrosstNational Study 7 TheWHO health Library of youthCataloguing : a cross-national in Publication survey/ Data by Alan King ... 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In the improveultimateinternationalinvestigatorsinternationally. thegoal health network isin tothis ofunderstand Study theof researcherschildren has how created in besteachwhose antoof The collaboration of becameorganization'srecognizedtheir countries, a WHO an goal collaborative opportunitythe of WHOhealth forRegional study toall. further Thein Officeproject the 1982. studyThetheir Regionalcountries. in a number Office of supports ways, includingthis important the ThesetookFinland, part countries ,in the first have Scotland, survey been ofjoined Wales the HBSC by and Austria Study. 19 others addition,theareasdesignation Study such the and as of HBSC the itsWHO overallinternational Study collaborating data is linked management. coordination centres to another for Inof Regionalwillto grow. participate England, Office inisincluding Greecedelightedthe next and HBSC Canadathat the interest United survey. and theinStates Thethis numbers continue 40ThisNetworkmajor is Regional a pan-Europeanof Health Office Promoting initiativeproject Schools involving (ENHPS).countries. almost Its aim is to make the school the European EuropeaninformationStudy has Region.spread on schoolchildren's to Indeed,countries comparativeoutside knowledge, the WHO alliancesalientschoolsetting baselinepopulation.a to health support datapromoting health Thefor the HBSC promotion ENHPSenvironment Study and in provides schools.a forstrong the Thepromotionschoolattitudes, unique setting behaviourprograms database are of thatkeyand and hasimportancepolicies. perceptions resulted tofrom healthof the internationalsupportWHO, alongfor the findings with publication Health of the ofCanada, this report provided of the 1993-94 survey. monitorpromotionimportantsurveys changescarried backgroundinitiatives outwithin toand information dateand a reliable amongrepresents methodforcountries. health both to FurtherresearcherstheThis data report work analysis represents from will thatbe participating done willonly within bethe conducted beginning countries.and across byof theriskfacilitateIt enables commonality behaviour, examination analyses such of healthasbetween of smoking. variations problems countries It illustrates in in healthyouth that informationcountries to now take available. advantage of the wealth of 10 makerscompriseantecedents.across on countries an health-related unprecedented The data and yielded issues. the resource similarity by the for Studypolicy of WHODr J.E. Regional Asvall Director for Europe 11 iv researchersThe Health fromBehaviour several in countries, School-Aged under Children the auspices (HBSC) of the Study Regional involves Office the for collaboration Europe of the of k ®` ed e of ts andparticipatingoutWorld byadministration Healththe researchers countries. Organization of the everyTapani 1993-94 (WHO). few Piha years survey. ably Comprehensive and represented Erio are Ziglioused the to surveysensured investigate WHO of WHORegional 11, health 13 standards and Office issues 15 yearwouldduring within olds bethe and aremet planning acrosscarried in the thoseandThepreparation administrationenthusiastic who contributed of this and report.of committed thesubstantially surveys efforts made to ofthe this 25 preparation teamsreport of possible. researchers of this Thereport. from following, The 24 countriesprincipal listed ininvestigatorby the country, planning arefor eachWolfgang AnselmAustriacountry DarEderis mentioned first; see Appendix C for addresses and affiliations. MaiKailiEstonia Maser Kepler DafnaYossiIsrael Harel Kanny CarolynCandaceScotland Thomson Currie BelgiumElsLea VanMaes de (Flemish)(French) Mieroop ArjaLasseFinlandEpp TasaLiinamo Kannas IlzeSandraIevaLatvia Kalnins Ranka Berzina SpainMiroSlovakiaJoanna Bronis Todd CanadaFranciscoMichelDanielle Boutsen Piette Navarro FranceRailiJormaRiikka Valimaa TynjalaPotsonen AisteApolinarasLithuaniaIveta PukseDirzyte Zaborskis JoanManuelAnaRamon Manuel Carrasco MendozaSanchez-Garcia Batista-Foguet MatthewMaryBeverleyAlan KingJohnston ColesKing GermanyMarie-PierreNicoleChristiane Damestoy Dressen Janvrin JeanNorthernNidaLinas CraigZemaitiene Sumskas Ireland UllaSwedenMariaIsabel Marklund ReyesRodriguez-Ortiz Sagrera LadislavZdenekCzechWendy Republic WarrenKucera Csemy MichaelGreenlandElisabethAndreas PedersenKlocke Nordlohne BenteNorwayJoe Copeland Wold YvesSwitzerlandEmmaYann Francois Wistrand LeGauffey Bj0rnDenmarkDzamilaDobromila E. HolsteinStehlikova Nevolova RozsaAnnaHungary AszmannMandoki PolandDagOddrunLeif StenvollEdvard Samdal WalesJurgenDenise RehmMader 12 BirgitPernille Palleson Due JuliaJudit VarhegyiDersery 13 AleksanderRussianIlonaBarbara Burzynska Woynarowska FederationKomkov ChrisLaurenceChris Roberts Tudor-Smith Moore Theministries, data collection research in foundationseach country and was other funded funding at a bodiesnational in level.the participating We are grateful countries. for the financial support offered by the various government ACKNOWLEDGEMENTS preparingof HealthForEdinburgh, the Promotion,1993-94the data Scotland. bankHBSC University for survey, the study. of Chris Bergen, Tudor-Smith, Norway, servedHealth asPromotion research Wales,coordinator. served The as administrative present international coordinator coordinator and Bente is Candace Wold, Research Currie, UniversityCenter for Special thanks go to Dag Stenvoll at the Norwegian Social Sciences Data Services for standardizing the data files and Thereport.contributions Socialpreparation Program ofof Christhis Evaluation report Roberts, has Group, Healthbeen fundedQueen's Promotion by University, Health Wales, Canada, who Kingston, helped under Canada, in the the coordination interpretation was largely of responsible ofMary the findingsJohnston. for andfinal We drafted preparationalso gratefully the technical of thisacknowledge report. appendix Mary theof the organizedJohnston,thesubstantiallyMatthew secretarial/clerical Healththe King distribution to Canada, whothe preliminary supervised assistedteamand collection of draftsallbyHeidi aspectsAnnick of ofElliott, thethe Gauvin-Fleurant,of report,survey the Heather data Heleninstruments, analysis Kenney, Connop gave for didKelly advicewhothis preliminary internationalForrestcontributed and direction and data toCarol presentation analysesChapter throughout Belanger. 9and and of theassisted survey researchedHazel project. withfindings,Fotheringham The theproofreading. research literature Marjorie editedteam and SpecialPeart wasBeverley the who comprised manuscriptthanks contributed Coles go of towho and Last,coordinatedforWendy butmaking not Warren. itsleast, this final survey wePamela preparation. are possible.very Charlton, grateful Liaison Mary for betweentheStewart cooperation Burgherthe WHO of and all Regional Gillthe students Nissen Office ofwho thefor were RegionalEurope willing and Office to production share assisted their coordination withexperiences final editing withwere andus, the and publication responsibilities details. of to their schools 14 15 vi FOREWORD iii CHAPTER 4: DIETARY HABITS, DENTAL CARE TT e ©f C Marts A.ACKNOWLEDGEMENTSCHAPTER Background I: 2 INTRODUCTION iv ANDB.A. BODY NutritiousIntroduction IMAGE foods 38 40 1. Fruits and vegetables 40 C.B. SamplingThe questionnaire and data 3collection 42. 1.Sampling Participating procedures countries 4 4 C. Non-nutritious foods 44 2. 1.SweetsWhole Hamburgers wheatand soft and and drinks rye hot breads 46dogs 4442 G.F.E.D. CharacteristicsInterpretingOrganizationPresentation theof of of findingsfindingsthe respondents report 7 8 10 3.9 Data collection and file preparation 6 G.F.E.D. AppearanceDietingSummaryDental care 50 54 4852 B.A.CHAPTER TobaccoIntroduction 2: TOBACCOuse 1514 AND ALCOHOL1. Experimentation with smoking 16 B.A.AILMENTSCHAPTER GeneralIntroduction 5:AND healthGENERAL MEDICATION 58 59 HEALTH, USE PHYSICAL C. Alcohol consumption 18 2. 1.EpisodesCurrent Experimentation use of drunkenness18 and current 22 use 20 C. Health problems 64 3.2. 1.BackacheStomachache Headache 68 64 66 ACTIVITIESCHAPTERD. Summary 3: EXERCISE 24 AND LEISURE-TIME D. Use of medication 76 6.5.4. NervousnessDifficultyBeing in a gettingbad and mood dizzinessto sleep (irritable) 70 74 72 C.B.A. Leisure-timeExerciseIntroduction 28 activities26 28 1. Watching television 30 4.Medicine3.2.1. MedicineHeadacheStomachache for for medicationnervousness difficulty medication 76getting 80 78 to sleep 80 16 D. Summary 34 3.2. PlayingWatching computer videos 32 games 32 17 E. Summary 82 5. Cough/cold medication 82 CHAPTER 6: PSYCHOSOCIAL ADJUSTMENT CHAPTER 8: THE SCHOOL EXPERIENCE CHAPTER 10: SUMMARY AND POLICY CONTENTSvii B.A. MentalIntroduction health 86 87 1. Happiness 87 D.C.B.A. SatisfactionAchievementTeachersIntroduction 139 with 130 134 school 136 B.A.IMPLICATIONS SummaryIntroduction of findings180 1811. Tobacco and alcohol 181 C. Peer relationships 984.3.Helplessness2. 5.ConfidenceLoneliness Depression 9094 92 (feeling low) 96 F.E. PeersParents 146 142 2. 1.Bullying Classroom behaviour atmosphere 148 146 4.3.2. DietaryGeneralExercise habits,health, and leisure-time body physicalcare image 181ailments activities and dental 181 1. Friendships 98c.b.a. TalkingMakingClose friends to new friends friends 100 of the 98 same gender 102 A.CHAPTERH.G. SchoolsIntroductionSummary 9: andINTERRELATIONSHIPS 154 health156 153 6.5. 7.PsychosocialInjuries The school 182 adjustment experienceand 182 182medication use 181 2. Time spent with friendsa.d. TimeTalking 106 spent to withfriends friends ofgender the after opposite school 104 106 B. Health-risk behaviour 1571. Factors influencingbehaviour health-risk 157 REFERENCESC. Policy implications 1838. Interrelationships 186 183 D. Relationship with parents 110 b. Time spent with friendsevenings in the 108 C. Mental health 162 2. 1.Predictors Factors influencingof beingsmoking happy mental158 162 health 162 APPENDIXERROR k B: CHARACTERISTICS SAMPLE DESIGN OF AND COUNTRIES SAMPLING 211 191 E. Summary 114 2. 1.Communicating Communicating with with father mother 112 110 D. Physical health 166 2.1. FactorsPredictors associated of feeling with healthy166 feeling healthy 166 THEAPPENDIXSURVEY COUNTRIES C: PRINCIPAL PARTICIPATING INVESTIGATORS IN THE HBSC FOR A.CHAPTERC.B. Introduction SevereAll injuries 7: INJURIES injuries 116 118 120 E. Developmental patterns of 2.attitudesbehaviours 1.Mental Physical 168 health and health 172 170 APPENDIX D: HBSC PUBLICATIONS 217 220 G.F.E.D. TypeContextInjuryWhere of preventioninjuries injuryof injuries 126 occur programs 124 122 126 F. Summary 177 4.3. RelationshipsInjuries 176 174 H. Summary 128 1 9 viii Irath es mad. 'Figures countryTableTABLES 1.21.1 9 MeanSample ages size, of byrespondents, country 4 by computerFigureleast four 3.63.5 hoursgames Students a 34week who 33 watched videos at Factors associated with playing FIGURESwithTable them, 1.3 Students by country who 11 had siblings living FigureChaptergames 4.1at3.7 4 least Students four hours who playeda week computer 35 Students who ate fruit once a day Figure(map)Chapter 1..1 51.2 I Survey administration: 1993-94 Countries and regions in the survey Figureryeor more bread 4.24.3 often once Factors 41 a day associated or more oftenwith eating43 Students who ate whole wheat or ChaptermotherFigureschool 1.3year and2 Students father, 6 by who country lived 10with both Figurehotdogshamburgers/hot 4.54.4 once Students a day dogs orwho 44more ate oftencandy/chocolatehamburgers 45 or Figurewith smoking 2.32.22.1 StudentsFactors 17 associated who smokedhave with experimented cigarettes smoking 16 Figuremorebars once than 4.74.6 a onceStudents day ora day more who 49 oftenwerebrushed 47on theira diet teeth or felt Figuredrunkonce a 20week2.52.4 StudentsFactors or more associated who 19 drank with alcoholic having been Figurechangethe need 4.84.9something to Factors lose weight aboutassociated 51 their withwithbody wanting thinking52 to ChaptertwoFigurebeverages or more2.6 3 atStudents leasttimes weekly 23 who had21 been really drunk tothereFigurethey change?" areanything 4.10 good Students55 lookingabout your who 53 bodyresponded you would yes to like "Is TVFigureactivity 30 3.23.1 twoFactorsStudents or more associated who times took per withpart week inwatching physical 29 FigurehealthyChapter 5.15.2 559 FactorsStudents associated who felt verywith healthyfeeling 61 20 videosFigurefour hours 3.43.332 FactorsStudentsa day 31 associated who watched with TV watching at least 21 inFigure the morning 5.3 Factors 62 associated with feeling tired schooltimesFigure a 5.463week Students in the morningwho felt whentired fourthey orgo more to Figurelonely 6.4906.3 StudentsFactors associated who felt lonely with feeling very or reallyeasyFigure to bother 6.21talk toStudents them their 111 mother who found about it things very easythat or FIGURESTABLESix AND weekFigureheadaches or 5.65.5 more Students Factors64 during associatedwho the previoushad a headachewith six having months once 65 a helplessnessFigurequite often 6.5 Factors91 92 associated with ChapterreallyeasyFigure to bother 6.22 talk7 toStudents them their 113 father who aboutfound thingsit very that easy or Figuremonthsonce a week5.85.7 67 Students or more who during had the a backachestomachacheprevious sixonce confidentFigureor often 6.76.6 93 94FactorsStudents associated who felt helpless with feeling always duringFigure 7.27.1the SudentsStudentspast year who who121119 reported reported severe injuries injuries difficultyFigure69a week 5.9or getting moreFactors during to associated sleep the 70 previous with having six months FiguredepressedFigure 6.86.10 6.9 Students Students 96Factors who whoassociated always felt low felt with orconfident depressedfeeling 95 FigureFigure 7.3 7.5 7.4Place ContextInjuries most serious atof schoolmost injury serious 123 occurred injury 122 124 Figurepreviousgetting 5.115.10to six sleep Students months once 71awho week werehad or difficulty morein a bad during mood the Figureeasyonce toa week6.116.12make Students or new more friends who97 99foundhad two it easyor more or very Figurecause 126 7.87.77.6 TypeSchool,Sport of injuries homemost serious and125 street injury injuries, 126 by weekFigureprevious(irritable) or 5.12 more six once Students months during a week whothe 73 orprevious felt more nervous during six months once the a 75 Figuretalkingclose friends 6.146.13to same-gender StudentsFactors 101 associated who friends found with102 it very ease easy of or FigureChapterbelt 127 8.17.9 8 Austria'sStudents educationalwho always system used a 131 seat pillsFigurefor a forheadache 5.135.14 a stomachache Students Students during who thewho during previoustook took medicine the medicine month previous or 77 pillsor Figuretalkingeasy to 6.16 6.15talkto opposite-gender StudentstoFactors friends whoassociated of foundthe friends same itwith very gender104 ease easy of 103or Figuresystem 8.38.2 131 Sweden'sNorthern Ireland'seducational educational system 132 previouspillsFiguremonth for 5.1579 difficulty month Students 81 getting who to took sleep medicine during theor easyFigureafter to talkschool 6.176.18 to friendsfourStudents Factors or offive whoassociatedthe days opposite spent a week time with gender 107 with spending 105friends FigurewellFigure 8.4in 8.68.5school France's FactorsRussia's 134 educational associated educational withsystem system achieving 132 133 ChaptercoughsFiguremonth 5.16 and/or6 83 Students colds during who took the previousmedicine for homeeveningsFigure 1096.19 peraway Students week from with homewho friends spent with awayfriendsfive to from seven108 schoolFigureachievement 8.78.8136 Students'Factors 135 associated perceptions with of their liking school Figuretheir 6.16.2 life FactorsStudents 89 associated who felt withvery happiness happy about 87 22 childFigure communication 6.20 Factors associated 110 with parent- BEST COPY AVAILABLE schoolFigure is8.9 a Studentsnice place who to be agreed 137 that their 23 TABLES AND FIGURES x teachersFigure 8.10 show Factors an interest associated in students with feelingas yearFigure -old 9.6 females Predictors 169 of feeling healthy, 11- Figure 9.23 Students who found it easy to talk Figureviewsteachersindividuals 8.11 in encourageclass Students 139 141 whothem responded to express thattheir their own Figurevery healthy 9.89.7 Students 170 who ateindicated fruit at they least are once toFigure themtheir 9.24fathermother 174 Students about about things whothings foundthat that really itreally easy bother bother to talk schoolparentsFigure to8.12are talk always Students to teachers willing 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a lot 176 Figureothers 8.181508.17 StudentsFactors associatedwho took part with in bullyingbullying alwaysFigurealways 9.159.14or oftenfeel Students confident feel helpless who 172 indicated 172 they monthstreatedFigureteachers 9.30by 176treat a doctorStudents them orfairly whonurse 176 had in thean injurypast 12 FigurealoneFigureothers 8.20 at at8.19 school leastFactors Factors once 152 associated thisassociated school with withterm a positive being151 left oftenFigureschool 173 9.179.16173 Students who felthave left felt out alone of things at malesFigureChapterattitude 1599.1 toward9 Predictors school of 153 smoking, 15-year-old ratherFigureschool often9.199.18this term Studentslonely 173 173 who werehad been very bulliedoften or at FiguremalesfemalesFigure 9.3 1639.2 Predictors161 Predictors of ofhappiness, smoking, 13-year-old 15-year-old nervousnessFigureor irritable 9.219.20 once Studentsonce a aweek week who or or experiencedweremore more in 173 173a bad mood yearFigurefemales -old 9.59.4 165 males24 Predictors 167 of feelinghappiness, healthy, 13-year-old 11- bodywouldFigure 174 like9.22 to Students change somethingwho indicated about they their 25 S j ) CHAPTER 7 0

d 4 0 \ A , 26 -7';" Norway 27 CHAPTER B.A. lintwoductrionBackgroundThe questionnaire TheA.collaborative Background Health Behaviour cross-national in School-Aged research Childrenstudy sponsored (HBSC) by Study the World is a C. Sampling and data collection3.2.I. ParticipatingSamplingData collection procedures countries and file preparation theof increaseHealthyoung researchers peopleOrganization understanding aimand theto improve(WHO).context of the health-related in theThe which quality goal they of attitudesof thedevelop. health HBSC and promotionUltimately, Study behaviours is to G.F.E.D. CharacteristicsInterpretingPresentationOrganization the ofof of findingsfindingsthe respondents report questionnairecollectionSinceprograms 1982, ofand dataHBSC surveyshealth from researchers education havea growing been for have numberconducted youth. planned of countries. to anddate coordinated and Four the separate next the is Theresearchfindingsplanned content forteamsand the of preliminary thein1997-98 24 surveys countries school analyses has inevolvedyear. the from This1993-94 substantially surveys report school presents administered year.over the the basic first by procedures.wasparticipatedhealthfour givenperiods behaviour to flexibilityTheofin questionnairethe firstitems survey surveyin has content development remained. developmentoffered and standardization participatingAs process, more although and greater of countriesmore a administration basic countriesattention core little of oftoprovidedflexibility selectquestions. contentconsiderable in selecting This areas greater content opportunity they flexibility found to be forincluded,relevant in researchers questionnaire tobut add the from tonext the structure each two basic surveyscountry core and itemsTheandcontent survey thattended madeeach reported to participatingitrestrict difficult on here analysis to included countryachieve on some a wascomparabilitylarge important required component to issues.across implement. of common countries 28 added.threeasThe the core surveys.most items useful Items from items, theon injuriesinfirst terms questionnaire andof relevance attitude were towardand includeddesign, school from as were well all 29 3 backgroundriskThe behaviourStudy has and intwo clear youth main targets over objectives. time for health in orderThe promotion first to provide is to monitorinitiatives. the necessary health- The topics.usedAs explained, in All each countries of this the survey four were surveys expectedincludes and ato coreadditional include of items these items that items on have specificon beentheir CHAPTERIntroduction I enablesecondshouldattitudes themobjective provide and to understandbehaviours is the to analyticalprovide andthrough information explain framework early the adolescence. to developmentnecessary researchers for The of thatthe researchhealth designwill consistsregionaloptionalsurvey ofinterest. in items.core addition items, OtherIn other to common thantheir words, the own itemscore each special questions,related national questions to specificquestionsor regional of nationaltopics concerning survey and and Inprograms.of thiseffective chapter, health the promotionquestionnaire, intervention sampling and procedures health education and data psychosocialSchool,versionschool and ofbecause theinjury development survey. itwere is an common important of youth to thesetting occurs, 1993-94 in playswhich international a thecrucial physical rolestandard asand a chaptersofinterpretationcollection the students is arebriefly of discussed. surveyed findings outlined. inare An this presented. explanation report follows. Finally, of the Then, the presentation contentcharacteristics of andthe problemsresearchbaseplace for to implementing monitorhas at school indicated current and health ahealth. link health promotion between For behaviours example, aprograms. number feelings and ofPrevioustrends psychosocial of alienation and HBSC as a meetings.variousQuestionnaireB. Me researchquestionnaire A research topics teams protocol for and HBSC finally guides surveys selected both dataare at discussed collectioninternational amongprocedures project the thanschool(Nutbeamat school those children arewhoet al., associated whodo 1989; not are feel Nutbeamsocially with part ofhealthwell &school Aar0,integrated compromising life 1991). (1990a,1990b). report Eder better behaviourfound health This that fromTheandis thetheconceptual the generaldevelopmental social sciencesprogress framework perspective. and of the has for Study twothe Three maindesign (Wold agecomponents. ofet groups al.,the 1994).survey (11, First 13 comes there and 15 inSincethesurvey youth school unintentional expands as environmentwell onas theseloss injury of findingsand schoolis the major healthtotime, clarify cause theand researchersthe happiness of relationship death and incorporatedof students.morbidity between incorporatesofchangesyear puberty olds) that wereto occurhealth the selected middle in outcomes health asof behaviourstargetsadolescence. and factors for dataand Second,which attitudes collection may the from influence toframework examinethe onset or programs.countriesinformationitems related and was tois fundamentaltype, generally place notand to available thecause design of injuries.in of most injury participatingThis prevention type of headachessuchalcoholshape as the abuse,happiness outcomes. and andbackaches. and levelOutcomes loneliness of Determinants physical include and activity, behaviours physical include psychosocial problems suchattitudes as smoking, suchrelated states as understoodbehaviours,The core questions, to such affect as health, smokingother andthan andvarious demographic physical psychosocial activity, ones, aspects concernthat are of theprovidesinteractto school, design andexamples ofparents therefore survey of and theitems. be peers.utilization interchangeable Outcomes of the framework and in analyses. determinants that hasChapter guided may 9 30 health, such as depression and happiness. 31 CHAPTERI 4 Introduction TheI.C. Participating Sanwfiing 24 countries countries and in data which coOkedon research teams administered AustriaCountryTable 1.1 Sample size, by country 11 year 1614olds 13 year 1788olds 15 year olds1815 RussianIsrael,Denmark,questionnaires Latvia, Federation, Estonia, Lithuania,are Austria,Finland, Scotland, Northern ,France, Slovakia, Germany, Ireland, Canada, Spain, Norway, Greenland,Sweden,the Czech , Republic,Hungary, the CzechCanadaBelgium Rep. Fr.Fl. 2289109417331935 2250129015851424 2219120116761349 communitythesurveyand Flemish-speakingWales. was were conductedIn France,surveyed only Germany independently.community in regions and (see theand In RussianFigure orderthe French-speaking to1.1). Federation, simplify In Belgium, the the France*FinlandEstoniaDenmark 1461171412191170 1283127911671379 1260119413141179 thecommunitiesispresentation, referred Russian to Federation eacharein the designated of following the is 25 identified areas Belgium text in aswhich Russia.a(Fl.) country; surveys and Brief Belgium the were descriptions two conducted (Fr.)Belgian and of IsraelHungaryGreenlandGermany* 130120721104457 164619441121490 135217591050 375 appearandthe participating the in grades Appendix countries,in which A. the characteristicsquestionnaires of weretheir school administered systems NorwayN.LithuaniaLatvia Ireland 1614134617831307 1701135518861248 1637126917591263 Approximately2. 13Sampling and 15 yearsprocedures 1300 respondents in each of three age groups were targeted in each country. School classes or 11, SlovakiaScotlandRussia*Poland 2007108813531473 1352157912941514 137313541540 934 orwaseachschools school used,country at classinthe whichor appropriate regionlevel the and to first be thengrade surveyed.level all levels of students sampling Thus, were ina randomlycluster occursthe appropriate sample at selectedthe schooldesign age in WalesSwitzerlandSwedenSpain 2009127212251507 3438133212081576 3251126614871151 eachatofsizesgroup theageGreenland were timegroupare metsurveyed. of was is theby relatively surveyed, mostsurvey. Table participating small, Awith 1.1 detailed the showsthe exception entirecountries. description that in-school the of Since thoseminimum of populationthe thenot population samplingpresent sample for point.* France, The Germanygrade levels and Russia correspondingTotals are represented to the only desired by regions. age ranges are 37 147 37 129 36 027 theinThedesign a remaining countryguidelines is provided should 10for32 percent thein fall Appendix survey within no morestate one-half B. thatthan 90 one-halfa percentyear of a theof year the mean beyondrespondents age thisand furthere.g.,begins6, 8Wales, and details at 10 age the in about most7,grade the thecountries; gradelevels targeted levels are however, 7,groups are 9 and 5, inwhere7 11. andeach See compulsory9. country. InAppendix a few countries,education A for 33 Figure I.1 Countries and regions in the survey CHAPTERIntroduction

Sweden 3 Northern Scot Denmark ir rsburg Russia Ireland`, Wales France r-3Nan Bel Swi /591n'Geimany RussiaGermanyFranceIn three countries, Nordrhein-Westfalen the sample consists (N.W.) of students drawn only from regions: St.Nancy Petersburg and Toulouse and district 34 4 35 6 CHAPTER I Introduction etEvery3. Dataal., effort1994) collection was was taken followed.and tofile ensure preparation Researchers that the research tried to protocol use common (Wold CountryFigure 1.2 Survey administration: 1993-94 school year1993 1994 Oct Nov Dec Jan Feb Mar Apr May Jun I anddefinitions to use standardof most terms,data collection to make theand survey processing instruments procedures. similar, Austria I I I Questionnaires were administered in school classrooms between Belgium Fl. 1 October 1993 and June 1994. Each research team worked out a Belgium Fr. 1 I procedure to ensure students' anonymity. Specially trained or Canada i I counsellors,instructed personnel school psychologists, (i.e., teachers, or members school of nurses, the survey guidance team) Czech Rep. I I Denmark I Theywere responsiblefollowed a setfor ofadministering instructions thethat survey conformed to the in respondents. principle to Estonia I I I the guidelines in the protocol. Finland I I Figure 1.2 indicates when data were collected in each country. For France* I I the most part, dates of survey administration were selected to Germany* I I asproduce possible. mean ages of the samples as close to 11.5, 13.5 and 15.5 HungaryGreenland I inNational Bergen, files Norway were exported where they to the were HBSC checked International and cleaned. Data BankData Israel 1 I I eachfrom set students of cleaned outside national the targetedfiles was agechecked ranges for were items removed and response and LithuaniaLatvia I I I significantlykeys that differed different from from the international the standard standard. were excluded Items thatfrom were the N. Ireland I analyses presented in this report. PolandNorway I I ScotlandRussia* I I I SpainSlovakia I SwitzerlandSweden L. I 36 Wales* France, Germany and Russia are represented only by regions. 37 I 7 MostD. of Presentationthe findings are ofpresented findings in simple bar graphs according yousame to sex talk about to friends things of that the really opposite bother sex you?; about How things easy that is really it for CHAPTERIntroduction I foralternativeto weekly.country, example, Althoughageor athe and combination proportion gender. an effort Typically of has of response respondentsbeen the made data alternatives tofrom whoinclude only smoke are theone presented; proportions responseat least youlikebother youspendto you?;make were time How beingnew with many friends? left friends out close of rightFor things?;friends theafter social do and,school?; you Is integration have?;it easyHave orHow you difficult scale oftenever thefelt fordo theof responsesifrespondents interpretation the reader are requireswho available of findings,selected more from theinformation,those the remaining WHOdata are Regional tables responsenot included. which Office alternatives include However, for Europe. all in the TheusefulofCronbach's scale scale for reliability scorethe alpha basic for for isattitude analyses. allonly countries moderately toward combined school high was butwas similarly still 0.69. makes This constructed. theindicator scale Coefficientsaremeasures presented (happiness, of correlation using symbols health, for factorsalcoholto represent related use and ranges: to smoking, important 0.15 tofor outcome 0.19, example) 0.20 IrulesTheIt belong consists students in thisat ofthis school 12are school; items: treated are Ourfair;How too school Our doseverely/strictly youschool is feelclean; is about a My nice inteachersschool place this school; atto encourage present?;be; I Thefeel graphsTwodatato 0.29, for different are 0.30all usedcountries to types0.39 to indicate and byof figuresgender0.40 trends +. forareThese across eachemployed correlation age all group.countries in Chapterfigures across combine 9. Line the inWhenme and,me to asexpress IMost needa person; of extra my the Theown studentshelp, students views I can in in getmyin class; my it;class(es) class(es)My My teachers teachers are enjoy kind show treatbeing and anhelpful.me together; interest fairly; The availablepatternsfromthree ageregression acrossgroupings.from the countries.equations authors. Symbols areSpecific representing used to details illustrate standardized on thesegeneral analysesbeta prediction weights are ThecountriesCronbach'sfor responses a scale combined alphaof to this two wasfor type. items 0.81,the attitudewere an indicator combined toward of relatively to school obtain high scorea measure reliability for all of ofTheTwo theinformation scales scale broad are scores concepts simply presented. are devices socialused inintegration Theused the items toanalyses reduce andused andattitudeas for summary simplify the toward scales the measures school.amount were Thisfatherthemparent report to aboutcommunication. talk presents thingsto their thatthe mother basic reallyStudents findings andbother werehow them.of easy askedthe survey it how was and easyto talkillustrations it wasto their for Thethenanalysisdetermined socialused for to integration individual throughdetermine factor countriesscale the final analysisconsists and scale forofand items. 10all face items:countries validity. Do combined you Reliability ever feelwas investigatorsanalysesof the types specific participatingof analysisto each country/region thatin the can study. be done.will be More done bysophisticated the principal endotherbulliedlonely?; up students beingthis Other school alone?; do students not term?; wantHow accept How toeasy spend often isme it time foras has I you with am;it happened to youHave talk at to youschool thisfriends ever term and ofbeen thatyou the 38 39 8 CHAPTER I Introduction VariousE. Interpreting difficulties thein achieving findings comparable data for 25 regions must Slightcertain differences items, about in physicalage characteristics activity levels of samples or diet, canfor example.influence oneinevitablereachingbe taken research intoconclusions discrepancies team account administers aboutwhen in thedatamaking the populations collection survey international instrument. resultsampled. comparisonswhen In For this more example, survey, than and country.questionnaireIt whenis not they Termspossible take items to updescribe to aare ensure behaviour interpreted behaviours that such all identically conceptsaslike smoking smoking fromcovered or and alcohol country brushing by use. the to suchaccountsystemsseveral problems design andin the cultural aredatafactors unlikely analysis.and language to accountNevertheless, differences fully for it canthe largebe argued variations that cluster sampling, differences in school must be taken into versionphrasesbutteeth it arehas ofin easilybeen thesome questionnaire difficult translatedlanguages or impossible and toto representdescribe understood to psychosocialfindterms similarly appropriate used in concepts everywhere, the words standard such and lessTheandacross correlatedbehaviourscluster countries, sampling across that genders were respondents used and revealed in agethe dependingsurveygroups in these inmeans health-related data.on the items extent are toattitudesmore which or Specificcountryhabitsas loneliness are toguidelines areflect good or depression. culturalexample for making differences. Indeed truly some reliable items comparisons using the had to be modified from country to those about dietary depressedsimilarofthose view. that viewForor make be example, aboutlonely up each their ora class clustersmoke teacher of sharestudentscigarettes. or aabout similar is moreTherefore, school behaviour likely than togreater orshareto point feel a nothere.thumbsurvey to To attach compare todata be much consideredare across providedweight age towhen differencesingroups, Appendix interpreting genders of B.seven theorOnly countries,findings percentage a general is it provided ispoints rule best of impossibleThebehaviourimportance variety than to ofachieve canin school attitude be both attached systems toward homogeneity to includedschool. smaller in the indifferences theages survey of the in sampledmade smoking it theyparthighlightedor less. ofare aIn mentioned.general the if theytext trend areaccompanying less in comparing than this; the however, genders figures, if ordifferences the across differences countries, are not are classAlthoughcountrieschildren lists (seeandthe were school Figureto notcollect class available1.2). data was The generally atpriorityschools the same was werethe giventimesampling used. ofto Also,matchingthe cluster, year in wheresome inages. all inonly.onSince someaggregated Relationships the countries. figures data presenting Substantialfromwith particularall countries, coefficients relationships factors they may ofindicate may correlation be bestronger generalpresent areor patterns inweaker based some particularprocedureincountries school systemsthe classes.targeted age distributionwith the policiesspecified in of classes age failing groups was students) soin aheterogeneous school that the rather sampling (e.g.,than standardThecountries, cluster errors but sampling are than not wouldprocedure apparent occur whenused in inadata randomly the are survey aggregated. selected results in sample. higher 40seasonsSince1993 the toand dateJune atweather differentof 1994, administration conditionschildren points werein would oftheir surveysresponding school likely varied year.affect to items Differencesfrom responses in October different toin datafactorsStandard from have eight errors been countries. havecalculated been See produced forAppendix selected using B variables for a details.model using where survey design 41 Table 1.2 Mean ages of respondents, by country CHAPTER9 I characteristicsadditionBeforeF. Characteristics the to resultstheir of age,the of younggenderthe of survey respondents peopleand aregrade involvedpresented level, respondents arein this described. report, provided some In AustriaCountry 11 year olds11.3 13 year olds13.3 15 year olds15.2 Introduction familytohowinformation the they question socioeconomic perceive about "How the their well composition status socioeconomic off inis theyour ofanalyses. family?" their circumstances. household Below, were used the and Responses tomean indicated indicate age, CzechCanadaBelgium Rep. Fr.Fl. 11.911.511.6 13.514.013.5 15.616.015.5 Thesummarized.home mean situation, age ofand all number the respondents of siblings inof eachthe respondents group surveyed are briefly was EstoniaDenmarkFrance*Finland 11.511.811.411.6 13.513.813.313.6 15.515.815.315.6 WalesandEstonia,11.6, those older. 13.6Lithuania in theand Czech 15.5 and years RussiaRepublic, (Table were Hungary, younger 1.2). Respondents Northernthan the average Ireland in Austria, ageand IsraelHungaryGreenlandGermany* 11.812.011.611.5 13.513.813.6 15.615.815.5 NorwayN.LithuaniaLatvia Ireland 11.411.811.511.9 13.313.713.513.9 15.915.215.715.5 Russia*PolandSlovakiaScotland 11.811.511.111.7 13.713.513.1 15.615.015.7 TotalWalesSwitzerlandSwedenSpain 11.611.911.5 13.613.513.9 15.515.915.415.6 42 * France, Germany and Russia are represented only by regions. 43 CHAPTER I Introduction 0 In all countries, except Greenland, 73 percent or more of respondents Figure 1.3 Students who lived with both mother and father, 80reported percent living of withrespondents both parents lived (Figure with 1.3).both In their 11 countries, parents. overThe by country* (% of three age groups combined) I percentage of respondents living with one parent and a step parent Greenland I 57 percentranged fromin Canada, under Denmark, two percent Greenland in Spain and and Sweden. Israel to In over one-third eight Latvia I 7375 of the countries surveyed less than 10 percent of students lived Denmark I 76 with a single parent, in most cases their mother. In the remaining Belgium Ft I two-thirds of countries the percentage living with a single parent Estonia I I 76 livedranged with from someone10 to 23 percent. other Verythan fewat least of the one young parent, people except surveyed in Russia** I I 76 Greenland (12%). Scotland I I Sweden I I 7776 proportion(TableExcept 1.3). offor young Inrespondents Israel, people the hadgreatest in one Greenland siblingproportion living and lived atIsrael, home with twowiththe siblings.highest them FinlandCanada I I 77 withIsrael three and Northernor more siblings. Ireland hadTwo-fifths substantial of respondents numbers of in respondents Greenland Wales I 1 7877 and Russia reported they were the only child living at home. HungaryNorway I I 79 G.The Organization remainder of this of thereport report is divided into nine chapters. Chapter LithuaniaFrance** II. 1 J 8381 tobacco2 presents and the drinking findings alcohol.on the students' Chapter health 3 describes risks related the physical to smoking and Switzerland I I 8483 activities,leisure-time both activities in and out of ofthe school, students television in terms watching of sports, and fitness other N.Czech Ireland Rep. I I 84 anactivities,leisure assessment pursuits. their of attitudes theirThe amountfitness toward oflevel time them, are they discussedreasons reported for in spendingparticipating this chapter. in these and BelgiumAustria Fl. 8685 The topics in Chapter 4 are related to diet and dental care the Poland I I 88 various foods eaten or drunk, some healthy and some not, as well Slovakia I I 9089 Chapteras the care 5 is taken concerned with withteeth. ailments and medication. In it, students' Israel I I 91 44takenparticularresponses medication problemsto questions in in the the about past last howmonthsix months often for they specificand whetherhad ailmentsexperienced they hadare *** SpainFrance and Russia are representedGermany only by did regions. not include this item. 45 Table 1.3 Students who had siblings living with them, by country* discussed. Relationships with family, with peers and with teachers CHAPTER11 I Country (% of three age groups combined) 0 siblings 23 1 sibling 55 2 siblings 17 3 +5 in Chapter 6,7 presentsPsychosocialso essential the responses Adjustment. in the lives to the of itemshealthy related adolescents, to injuries are the main topics Introduction BelgiumAustriaCanada Fl.Fr. 292117 604557 181617 659 experience,questionsand the use related theirof seatbelts. teachers to their In and general Chapter their fellowattitude 8, the studentsstudents' toward are theirresponses discussed. school to FinlandEstoniaDenmarkCzech Rep. 25242316 54595160 20141319 647 surroundingamongChaptersuggestions 9,health-risk Interrelationships, them. are offered In factorsChapter regarding presents and10, thediscusses the findingsthe implications analyses someare summarized of of relationships thethe survey issues and for IsraelHungaryGreenlandFrance** 224017 8 21663141 36261017 351216 2 ageInpolicy chapters and and gender. program 2 through In development.these 8, data figures, are presented countries in are figures ordered by fromcountry, the N.LithuaniaLatvia Ireland 211913 56436441 21203111 24 428 ofitem.theleast correlation gender positiveThese with chapters to for thethe factors highest most also includepositive related proportions figures responsesto specific responding presenting and outcome the positively the ordering coefficientsmeasures. to is the by NorwayScotlandRussia**Poland 371818 545959 1517 7 528 AsassociatedThe mentioned, data in withthese notspecific figures all items serveadolescent included to consolidate behaviours. in the the survey literature are presentedon factors SpainSlovakiaSweden 201513 5862 1718 10 478 findingsandCorrelation discussed do not matricesin include the text and alland multipleresponse the figures linear alternatives used regression to present for analyseseach the item. basic used *WalesSwitzerland Germany did not include this item. 2216 6053 18 5 tablesincluded.to provide used The thein WHO the specific study Regional figuresavailable Office that on for appearrequest. Europe in Further willthe reportmake information the are basic not ** France and Russia are represented only by regions. 46 on the analyses may be obtained from the study authors. 47 48 49 CHAPTER A. Introduction TobaccoB.A. TobaccoIntroduction use and Alcohol2.I. ExperimentationCurrent use with smoking producedstudiescausesBoth tobacco of extensivehave morbidity beenand documentationalcohol conductedand premature use have throughout about mortality. been the shown thedeleterious In worldexcessto be prominent that ofhealth 50,000 have D.C. SummaryAlcohol consumption 2.I. ExperimentationEpisodes of drunkenness and current use deatheachIneffects fact, year in associatedtobacco theand developed has use been with alone identified tobaccoworld accounts (Peto asuse thefor (Freedman et leadingnearly al., 1992; threecause & Pan Cohen, millionof preventable American 1993).deaths disease,isHealth 1993;associated Organization, Johnson,lung withcancer, 1991). a wide 1992). chronic Similarly, range Thus bronchitis of it disease,theis now adverse and recognized such emphysema and as long-term coronary that smoking(WHO, effectsheart riskofdepression.and excessivesocial includesexual and Alcoholbehaviour,certain alcoholeconomic cancers, misuse consumption violence,problems, hasstroke, also crime,onincluding hypertension, been health associatedlabour haveroad absenteeism liverbeenaccidents, with diseaseestablished a number high- and componentsdeathPoliciesimpaired from and work programstobaccoin performance the health designedand strategies alcohol(Royal to reduceCollege useof many have this of Psychiatrists,tollcountries thus of formedill health (Healthy 1986). keyand alcoholbasicNutbeamPeople approaches, 2000,in etgiving al., 1990; 1993). up namely Healthor cuttingThese to Promotion support policiesdown onexisting andAuthority their programs habit, users for andof advocateWales, tobacco to dissuade 1990; andtwo educationadoptioncountriestheyoung first people place. ofhas to healthy improve beenfromTo this undertakingstarting lifestyle end, knowledge a towide choices. use activities range andabout Theseabuse of the organizationswhich theseharmfulactivities emphasize substances effects include: in many the ofin 59 policiesthetobaccosocial development andpressurespromoting, other ofsubstanceto abilitiesforsmoke example, anduse and usecoupled socialsmoke-free alcohol; skills with and techniquesnecessaryenvironments the development toto resistfoster and of 51 15 tobaccoalcohol.restrictions andThe on alcoholsocial the availability, significance use among sale ofyoung these and people, advertisingpreventative in particular, of efforts tobacco tocannot curband In spite of legislative acts to restrict the1.bauce availability use of tobacco TobaccoCHAPTER and Alcohol 2 Thetobe 1993; beunderestimated development initiated Pulkkinen, during andas1983). themany form adolescent future of policies health-related years and (Bertrand programs behaviours & Abernathy, to prevent seem towithprogramsproducts smoke. tobacco and which In use, inthe the underscore a1989/90 significant presence WHO-HBSC the ofproportion long-termcomprehensive of survey,healthyoung health riskspeople The associatededucationHealth continue of mostconsiderablecountries.young expensive people For variation from example,tobacco becoming in istaxes withinseven onsmokers timestobacco, the European that varies such of themarkedly that Unionleast the costexpensive betweenthere of the is oldspercentagesurveyedallCanada's from but one11 Youth:had countries ofcountry, studentstried Views smoking (Kingmore who and &than responded Coles,atBehaviours halfleast 1992), of once. thatthe of it15-year-old theyBy was11, age smoked13found 15,and that,thestudents 15at leasttotal yearin raisingandprohibitivetobacco promotion the available legislativelegal of agetobacco (Longfield, tochanges purchase products have 1994). cigarettes, to been youth. Inenacted Canada, These requiring regarding changes increasingly prominent theinclude sale theweremalesoccasionally 24 used andparticipating tofemales ranged estimate respectively.countriesfrom the 19 extent to permitting 39 Forof percent tobacco this comparison survey,and use 16 amongto the 39 betweensame percent youth items the forin bothSimilarly,cigarettewarning the labelssalesmoking there of to are alcohol be in variations displayedschools. and thebetween on totalcigarette countriesnumber packages of in outlets.legislation and restricting In manyabout wereinresults whetherboth. asked of Young two theyabout HBSC people had their ever surveysin experience allexperimented the for countries thoseof tobacco withcountries participating smokinguse. thatThey in(evenparticipated were the surveyif asked it was barrierscountries,outletsScandinavian and to suchrestrict the countries, aspurchase salesFrance, strictto specific ofthere laws alcohol are limittimes, comparatively (Baldwin,the whereas sale of in alcohol1995). fewother legislative to EuropeanAlcohol specific onlydecisionInvery allonce) occasionally). countries, toand smoke. whether a varietyCigarette they of were advertisingfactors currently influence is a smokingvery young powerful (evenpeople influence, if in only their age.minimumageconsumption atWhile which legal the is amajority age alsoperson varies mitigated ofis among countriespermitted by countries;legal also to restrictions havepurchase from laws 16 concerningwhichalcohol. to 21 prohibityears This the of notacrossSmokingespecially young countries is whenglamorizedpeople can an can alsoadolescent in afford bethe influential movies tohero smoke. and is in promotingon determining TheseTV. The pressures thecost whether product. variable on or macrosocialnationalblooddriving alcohol while variations factors, intoxicated, levels in relatedvaries the again,social widely to tobacco theand fromdefinition economic and country alcohol of circumstances, legally to country.use acceptable must Such also or Thereeducationadolescentsof its is harmful mounting programs can results. counter evidence which promoteto to some suggest abstinence extent that smokingthe of effects smoking is a of powerful because health cross-nationalthesebe considered products dataimportant (Mendoza, presented determinants 1990). in this Therefore, chapter of national requires the interpretationconsumption particular care. of 52 accuratecontendinpredictor relation that predictorof to participation alcoholself-reported of abuse both in alcoholandcigarette other illicit health-risk abuse smokingdrug and use. behaviours, illicit seemsTorabi drug toet beal. primarilyuse a(1993) morethan, 53 16 Tobacco and Alcohol CHAPTER 2 tobaccofindingsoffor use. example, Other use,by demonstrating perceivedstudiesalcohol on and risk health-risk illicit strongof harm drug positive behaviours or usepeer and correlationsapproval/disapproval corroborateother health-risk between these HaveFigure been 2.1more Studentsdrunk likely towho smoke are Factors associated with smoking 11 year oldsM F 13 year olds M F 15 year oldsM F peerbehavioursincreasinglyactivities group structure(Kingare evidentdoing & is soColes, now thatcollectively considered youth 1992; whoand King a criticalnot participate et as al.,social factor 1988). isolates.in thehealth-risk It initiation isHence, also SpendBullywith friends otherseveningstime with away friends from after home 0 0 O o o o and1991; maintenance Van Roosmalen of adolescent & McDaniel, smoking 1989). (Urberg, 1992; Clayton, AchieveschoolHave apoorly negative in school attitude towards O o o o o wereandshowData poor fromalsoa link academic shown this between survey to achievement.be smoking stronglyrelated. and Figurereinforce Smokinga negative 2.1 these shows and attitude findings. bullying the towardfactors Theybehaviour schoolwhich also genderFindBe tired it friendseasy in the to morning talk to opposite O o o o o o theresmokingwherestudentscorrelated was behaviourvery alsoin substantially allfew a countriessubstantial studentswas having combined. withsmoke, relationship been smoking thedrunk. For only betweenthefor For meaningful 11-year-oldboth 13 and malethese 15 correlate andyeartwo age female oldsriskgroup of disparitybetweenCorrelation thein coefficient: the ages levels of 11 0of .15 andreported to 15. .19 Nevertheless,0 experimentation .20 to .29 0 .30 there to with.39 was smoking a wide o o .40+ likelywithbehaviours. friends. tothan find non-smokers Smokers Bothit easy male to from talkand to with spendfemalethe twoopposite-gender their 15-year-old older evenings groups smokers friendsaway were from werealso and homemorealong oftriedinbetween Estonia,countries. smoking. countries. Finland, Only The girlspatternAt Latvia all from ages, was and Finland quitea Slovakiarelatively different were reported highconsistently for proportion girls that in amongthisthey of group haveboys the boysmoreafterwith 13-year-oldandschool.likely 15-year-old to All have girls13 a year boysnegative were olds, and more attitude girlsas likely well were toward asto more 15-year-oldspend school; likely time towith13-year-old boys do friendspoorly were experimentationgirlspercentagelargerhigher outnumbered than proportions of in girls any among otherin boys Greenland having13- country in and each experimented15- and who ageyear-old this had group. was tried females the with Further, smokingonly smoking.in country Greenland rateswas where far ofThe I.relationshipsmoreat Experimentationschool. likely Thirteen- to is bully presented withand others. 15-year-oldsmoking in AChapter more detailedsmokers 9. examinationof both genders of thesewere suchwereallexceeded other experimentation.less participating likelythose reportedthan their countries.Indeed, for counterparts both Israel For male eachwas inand theage other femaleonly group, countries country respondentsyoung into Israelis whichreport in ingender.reportedFigure the number 2.2 It having indicates shows of tried youngthe that 54 proportionsmoking in people all countries atwho of least young reported there once people was both having a inbydramatic the agetried survey group smoking increase who and Twotriedfewer 15:distinct smoking. thanin eastern twopatterns out European of of five smoking 15-year-old countries experimentation moreboys andboys girls emergedthan reported girls by at having ageall ages 55 Figure 2.2 Students who have experimented with smoking (%) 17 11 year olds 5025 13 year olds 1 41 15 year olds 8177 TobaccoCHAPTER and Alcohol 2 Slovakia 1 48 13 Slovakia [..tr.,,,LaIMIY10111110111616110.115,110111.1 5273 Finland I 8155 FinlandLatvia 4124 8 LatviaFinland 29683270 EstoniaLatvia 465281 CzechEstonia Rep. 40413420 GreenlandEstonia [..maLuiversava...useaysteerm 21597463 AustriaSlovakia 41777178 LithuaniaGreenland 31 6 CzechLithuania Rep. 573758 GreenlandLithuania I I 768477 Russia*Austria 2913 9 HungaryAustria 1.4,..:66.1.14141221111111.6ljI 51435645 SwedenHungary 71707261 HungarySweden 252716 PolandRussia* 512529 CzechPoland Rep. 625065 SwitzerlandPoland 25241014 DenmarkSweden 45464844 WalesScotland 60696166 N. Ireland 2315 Germany* 4441 Belgium Fl. 1 6049 CanadaDenmark 20172217 WalesSwitzerland 41504434 SwitzerlandRussia* 59576044 BelgiumSpain Fl. 1914 7 ScotlandCanada 40474146 CanadaDenmark IJ 586469 Scotland 1816 France* 4043 Norway I 5861 Germany* 131815 N. Ireland 3944 Germany* Ii 615763 BelgiumFrance* Fr. 18 9 Norway 333730 BelgiumFrance* Fr. fl 5857 Wales 17 BelgiumSpain Fr. 353336 N. Ireland Ii 5658 Norway 1610 Belgium H. 1 3424 Spain 5566 Female Israel* France, Germany and Russia are represented only by regions: see Chapter 1 for details. IH 5 6 14 4 Israel 2010 Israel 1 3934 0 Male 5 18 Tobacco and Alcohol CHAPTER 2 2.countries,reported Current having Canadause triedand Greenland, smoking, butthis ingender most pattern western was European reversed. bothAsC. previously alcoholAlcohol advertising stated consumption in terms and itsof usetobacco in media use, similarproductions exposure tend toto determineagain,Of those while who the others experiment prevalence experiment with of current tobacco, further tobacco andmany take decideuse, up students the not habit. to do were Toso alcoholwere,restrictionscounter indeed, usethe lawsuntilon sufficient the andthey sale education reach and to compelthe consumption programslegal young drinking warning peopleof alcoholicage, about tothe abstain incidence beveragesalcohol. from ofIf showsweek,optionasked, thebut"Howof responding: proportionnot often everyday; do of youI youngdo and smoke not less peoplesmoke; at than present?" who everyday;once reported aand week. wereat current least Figure given once use 2.3the ofa amongtheworthydrinking preceding 11, of behaviour 13mention andWHO-sponsored 15 in amongyear the olds, context 11 however, tostudy 15of thisyearof ahealth-related report.large olds proportionwould As evidenced scarcelybehaviours of youth bybe exceptLessattobacco least than for onceby 5 girls agepercent a groupweekin Greenland, of andare11 yearreferredgender. 6olds percent Only toreported as those ofcurrent whom that who theysmokers. reportedreported smoke smokingsmoking weekly foralcoholicByhave malesage already 15, beveragesand the tasted 45 proportion percent alcohol on a weekly foras of early females.students basis as age Suchwasin 11 this (Kingas data surveyhigh would& asColes, who52 seem percent 1992).drank to withproportionat smokingleast age weekly. in takingallweekly countries. But, up in the asGreenland, By withhabit age experimentationon 15, awhile nearlymore more regularhalf ofthan with bothbasis a quartersmoking,sexes rose reportedsharply reported the agewithlawsindicate limits regulatingalcohol that would alcoholat muchits infer. availability. misuseearlier agesamong Clearly, than young theyoung legislation people people occurs are prescribing involved despite Gendercurrentunderdoing soone-tenth smokers.differences in Austria of andIsraeli in currentFinland. 15 year use At oldstheof tobacco other indicated end were of that the particularly theyscale, were just smallhadtheirThe ever young useamount) tastedof peoplealcohol. they an alcoholic tookparticipating Specifically, alcoholic drink, indrinks theyhow the werefrequently surveysuch askedas were wine, (even whether asked spirits, if only about they beer a easternmanymarked15 European yearboys in oldsmostas girls incountries eastern the said Baltic that European reported they states smoked relativelyandcountries; Slovakia, weekly. low for ratesInmoreexample, fact, of than girlsweekly among twice from as assumedpeople'sdrunk.and, in In several reports tocontrast be exaggeratedofcountries, toalcohol reported consumptioncider, (Nutbeam, levels and of whether adolescentand 1989). drunkenness they Nevertheless, smoking, had areever usuallyyoung been the Belgiuminweekly smokingall western smoking (both at allEuropean the amongages. Flemish- By 15and way year North and of olds French-speakingcontrast, American was higher the countries, prevalence for communities),girls apart than of reported fromboys strikingNumerousanddata abusepresented similarities among studies here young ofrepresentbetween adolescent people. correlatesreasonable behaviour of indicators cigarette have demonstratedofsmoking alcohol with use 58 Finland and Greenland. predictorsthanSomethose variables of researchers of alcohol adolescent thought use assert (Torabismoking to thatpredict et andthe al., illicit psychosocialdrinking 1993; drug McDermott have use moreand and demographicother inet commonal., deviant 1992). 59 19 Figure 2.3 Students who11 smokedyear olds cigarettes once a week or more (%) 46 13 year olds 22 15 year olds 46 TobaccoCHAPTER and Alcohol 2 N. GreenlandIreland G=1 34 CanadaGreenland 13111417 AustriaGreenland 492931 CzechCanada Rep. 2 N.France* Ireland E3F3=1 131011 CanadaGermany* 272128 Scotland 32 1 Wales E=3 12 8 Spain 2720 Belgium Fl. 1 Scotland 11 7 Wales 18 France* 23 1 Germany*Finland E?z] 15 89 Finland 2630 HungaryFinland 2 1 Belgium Fl. 8 Scotland 2521 Denmark 1 Belgium Fr. 10 8 N.France* Ireland 2523 LatviaGermany* AustriaDenmark 7586 BelgiumDenmark Fr. 21242314 Slovakia Hungary 9578 Norway 20212319 SpainWales 2 1 Russia*Spain 13 35 SwedenHungary 251519 Russia*Belgium Fr. .3.432 CzechNorway Rep. 457 SwitzerlandBelgium Fl. 321718 Sweden 0 .3 1 Sweden 43 Latvia E:==]F!!!51 3314 SwitzerlandPoland 0 .22 LatviaSwitzerland 435 CzechPoland Rep. 231213 Austria 0a .2 1 Israel 13 32 Russia* 191016 NorwayEstonia .4.2 1 PolandSlovakia 528 EstoniaIsrael 69 Lithuania 0 .1 Estonia 6 1 Slovakia 1-1 2219 5 El Female *Israel France, Germany and Russia are represented only by regions: see Chapter 1 for details. 60 20 Lithuania .2 3 Lithuania 15 4 tl Male 61 CHAPTER 2 20 behaviours among adolescents (Thorlindsson & Vilhjalmsson, 1991). Figure 2.4 Factors associated with having been drunk Tobacco and Alcohol riskreinforcetoIn bethis behaviours similar survey the toidea as those tendwell, that toof thethe socializesmoking correlatesadolescents cigarettes.more of whodrinking with engage Thetheir alcohol data peers in alsothese werethan strongly health- foundthose SpendSmoke eveningscigarettes awayare from moreStudents likely whoto have been drunk 11 year olds M F 13 year olds M F 15 year olds M F Figurelinkwho betweendo 2.4 not showssmoke disaffection theand factors drink with alcohol. which school correlate andFurthermore, health-risk highly they behaviours. with indicate having a HaveBehome tired awith negative in thefriends morning attitude toward 0 0 0 0 0 0 likelyatbeen all drunkthree to smoke agein all levels,cigarettes. countries students combined.Male who and hadfemaleFor bothbeen 13 malesdrunk and 15and were year females more olds FindafterSpendschool schoolit time easy with to talk friends to opposite 0 0 0 0 0 0 watchingexcessfromwho hadhome was beenvideos linkedwith drunk friendsfor with 15-year-olds. were spending and moreto be time tiredlikely Thirteen-year-old with in to the friendsspend morning. eveningsafter girls Drinking school are away also and to WatchBullygender others videosfriends 0 0 0 0 0 talktolikely alongspend with to with spendtimefriends 13-year-oldwatching time of the with opposite videos. friends girls weregender.These after moreschool students Boys likely andat alsoall 13-year-oldto three findhave ageit a easy negative levels boys to CorrelationneededHave been medical injured coefficient: treatment and 0 .15 to .19 0 .20 to .29 0 .30 to .39 0 .40+0 0 excessbullyyearattitude other wereto requiretoward students. more medicalschool. likely Thirteen- toBoys treatment. be injuredandof each 15-year seriouslyage groupold boys enough were who more in drank the likely last to to In I.most Experimentation countries, the and majority current of use11 year olds reported that they alcoholGreenland,Israel,had15, tasted the Latvia,reported proportionan Norway alcoholic Norway, by andfewer who drink; Switzerland reportedRussiathan only half among and having wasof 11Switzerland girlssuch year tasted inexperimentation olds.Estonia, an Byalcoholicand Greenland,the boys age withdrink inof alcohol.percentallreached countries of nearly boys except 100and 54percent Israel; percent inamong ofWales girls 15-year-old andreported exceeded that Israelis, they 80 percenthad only tasted 68in 62 thereincreaseddrinkingCurrent was consumption somesubstantiallymore kindthan aof doublingofwith alcoholic alcohol, age. of Figure beverage thewhich proportion 2.5 in shows atthis least reportof that everystudents in is all week,defined countries between also as 63 Figure 2.5 Students who drank alcoholic beverages at least weekly (%) 21 11. year olds .1 I 22 8 Wales 13 year olds 22 15 year olds 45 TobaccoCHAPTER and Alcohol 2 1 Wales France* I 5 1 3113 1 1 152 31 Israel 1 2010 France* .. 1 I 2025 N. Ireland 4525 Wales I 1815 BelgiumN. Ireland Fr. - 1 I 2212 Belgium Fl. 4426 Belgium Fr. 1 15 6 Israel I I 22 BelgiumAustria Fr. 4326 CzechSlovakia Rep. ' 17 2 Scotland 1 I 22217 1 Scotland 4232 1 1 5 Austria 1 18 9 Denmark 4133 BelgiumScotland Fl. 1 1 4 Czech Rep. 1 i 18 8 France* 4018 N. Ireland p-' I 1 1 4 Slovakia 1 I 17 76 Czech Rep. 403819 Austria I 19 Belgium N. _1_ I 14 Slovakia 3310 P 7 Canada 1 8 24 Finland 63 Denmark 1 I 12 91 CanadaSpain 1925 LithuaniaCanada bELI[10 263 Russia* I I I 8 Germany* 252518 Russia* 12:3 6 Poland 10 4 Hungary 2414 SwedenSpain Li 362 HungaryFinland ry 17E=3 I 8495 PolandIsrael 2411 9 Poland E3 I 5 1 Lithuania r__I 84 Russia* 1 2211 Estonia C3L 50 S pain 111-1 75 Latvia 1 2021 8 Denmark El 42i LatviaSweden Di 724 FinlandSweden 1911 9 HungarySwitzerland 24 1 Estonia LILl 7 1 Lithuania 1416 56 LatviaGermany* P:1 32 SwitzerlandGermany* Eln := 54I NorwayEstonia 14 7 Norway 0 1o Norway 0 24I Greenland 10 87 1 Female a 11 3 3 Greenland* France, Germany and Russia are represented only by regions: see Chapter 1 for details. '64 0 Greenland 0 1 Switzerland 4 1:1 Male 65 22 Tobacco and Alcohol CHAPTER 2 theSlovakia.apart ages fromof 11 Overall, amongand 15 more whoboys boysreported in Israel than current girlsand Francereported consumption and drinking among of alcohol,alcohol girls inat Israel.lowest15%) Again,level reported (less a low drunkennessthan percentage 10% of ofboyson 15-year-old two and or girls) more females was occasions recorded (less thanin in the thatlowwasAtleast all in relatively10weekly agesGreenland, percent the (except high proportion or Norway lessfor for both of11- 15-year-oldreportingand andboys Switzerland. 13-year-old and regular girls females in Greenlandic The alcoholWales studyreported and consumption also relativelystudents). weekly reveals following countries: Estonia, France, Israel, Russia and Switzerland. 2.consumption Switzerland.Greenland,Episodes of of drunkennessLatvia, alcohol Lithuania,in the following Norway, countries: Poland, Estonia, Slovakia Finland, and 2.6severalalcoholReported shows misuse.occasions drunkenness the proportion Young may maypeoplebe ofviewed be young whoseen as report aspeople a indicativespecial having in eachrisk beenof group. ancountry "drunk"episode Figure who onof thanwithcanreported begirls,age seen twoand apart that inor from mostmore in all 13 countriesepisodes countries, year olds itof in was suchdrunkenness Sweden more alcohol frequentand bymisuseGreenland age among and increased and sex. boys 15 It weremultipleyear oldsrecorded episodes in Denmark. in Denmark, of drunkenness Among Finland, 15 (half year Scotland orolds, more andthe of highestWales, boys and whilelevels girls) the of Sweden 66 67 Figure 2.6 Students who had been really drunk two or more times (%) CHAPTER23 2 Slovakia 11 year olds 1115 65 Wales 13 year olds 23 349 Denmark FINEEMEMBEEME"15 year olds 5656 7 9 Tobacco and Alcohol DenmarkWales 2:1 39 DenmarkScotland 1!!:3 2 156 WalesScotland 5356 1 BelgiumScotland Fl. 728 FinlandSlovakia 22201 5 FinlandAustria 4635 0 AustriaBelgium Fr. 627 AustriaN. Ireland I7151 6 SlovakiaGreenland rj_F=1 4620 3 FET3 12 3 6 LithuaniaCzech Rep. 5 1 BelgiumCanada Fl. 1 35 CanadaN. Ireland ==3 .=3 443 8 2 7 F:1 1 239 0 CanadaN. Ireland 425 GreenlandCzech Rep. 1314 CzechHungary Rep. FT!!1 361937 PolandGreenland 43 BelgiumPoland Fr. I013 56 Latvia =1 26352I Switzerland 4 1 Latvia 1 0 4 Poland FeT= 341 8 1 5 Germany* El 1 6 Finland 3 1 Hungary 48 Belgium Fl. [=3 E=Z:3V, ./T40 ',:, ' :%.:,. 2931 France* 331 Lithuania 58 BelgiumNorway Fr. 230 0 LatviaIsrael 231 EstoniaRussia* 3728 Lithuania 271 7 Germany* 12 France* 7 Sweden EI=1 272 21 0 Russia*Hungary a 02 IsraelGermany* 57 1 France*Estonia Er=71 2613 1 E=1 24 Spain 2 Spain 54 Spain 19 Estonia 0 Switzerland 25 Switzerland kE:]EZ:D 22231I 32 Norway a Norway 5 Russia* EE:=1 21 0 Female Sweden*France, Germany and Russia are represented only by regions: see Chapter 1 for details. a 0 Sweden 23 Israel El =3 86 69 Male 24 Tobacco and Alcohol CHAPTER 2 D. Summary andOf interest, drinking also, behaviours are the factors in all associated countries. with These adolescent data verify smoking the damagingyoungThesurvey, data Europeans inbehaviours. more this chapter than and In Northtwo-fifths overindicate halfAmericans thethat of countries thea significant areyoung engaging participating people proportion in reportedhealth- in the of spentcorrelationsschool,interrelatedness with and friends between peer of away grouphealth-risk factors from affiliation homesuch behaviours, asin smoking,theby evenings,showing alienation alcohol and strong from lowmisuse, homeacademicpositive time and countriesdrunkenness.group,hadexperimenting taken more in up reported thanthe However,with habit onetobacco levels inby there tenthe byof reportedwassmokingtheage age ofconsiderable 15.of twoand 13 Among anddrinking.or more one-fifth variation this episodes Greenland,oldest that among theyage of advertisingavailabilitydifferencesachievement. regulations of in theseAlthough macrosocial products or socialthis to survey factorsacceptability young does people,such not of as tobacco theirtake the cost,commercialinto and accountnational alcohol thehighestatCanada all lowest ages, andproportion proportions withIreland Lithuania areof youthnotablein Greenland and who forIsrael drankhigh and at prevalence low weeklyNorway. prevalence was levels in levels.Walesof smoking andThe peoplethattheseuse, primarilythe findings in data deterring show transmitsuggest aadolescent link that knowledge between conventional tobacco individualare not and health effective alcohol factors. education use.with On programsallthis young level, followsremainsbutIn many the the data countries,the trend priorityfor thateastern more hasconcern girls takenEurope than there.place boyssuggest inHowever, reportedwestern that Europesmokingif eastern over cigarettes, by Europe recent boys theuseinyears, smoking exceptionwas then more in prevalence theofcommon 13 future, year among and girlsolds overtake mayin boys Greenland be than expected the girlsboys. and into Sweden. Reported allshow countries an increasealcohol with 70 71 Eji>.,,Kamch juI CHAPTER

72 Germany CHAPTER Exercise and Leisure-time InA. inthis Introduction the chapter type of we physical examine activity the extent which to whichis both young beneficial people when engage they C.ActivitiesA.B. IntroductionLeisure-time Exercise activities exercise.andwatchingare young playing Their television and computer/video likelyinvolvement (TV) to encourage and games, invideo leisure-time a lifelongcassette is considered involvementrecorder activities, in (VCR)relation insuch physical movies to as the D. Summary 3.2.I. WatchingWatching televisionvideos Playing computer games importantenhancesPrevioushealth implications research physical,role in thehas of mental preventiondemonstratedthese activities. and ofsocial thatcardiovascular well-being,moderate physical disease and plays activity (CVD) an asPowellriskterm(Bouchard well factorstudies et (Sallis al., foret of 1987).al., CVDadults & 1990). Faucette, Regular andhave Inpremature shown the physical1992). past that mortality20 Sincephysicalactivity years risk severalcaninactivity(Leon factor benefit etlarge, al.,islevels childrena 1987;majorlong- in consideration.Indecreasingchildhood addition predict to these the benefits levelsrisk factors in related young in to adulthoodchildren the prevention is (Cresanta an important of CVD, et al., physical health1986), behaviour,Physicalet (Kenyonactivityal., 1985) activity appears &constituteand McPherson, to andto enhance promote sports, important 1973).self-esteem improvedas well socialization as mental inbeing children healthan arenas important (Gruber, in adults for 1986).youthhealth (Taylor carelessnessFaucette,participationThe benefits 1992). inofor physical unnecessary While activityactivity most risk isofare nottaking, the extremely necessarily risks some are important; are riskassociated just free outcomes however,(Sallis with & 74 ofand injuriestaking effectiverisks minimizedpart associated safety in games measures. withwith and appropriateactivity play. Chapter forBenefits ouramounts 7 summarizes sample tend of to ofphysical beyoung the maximized incidence people.activity 75 CHAPTER27 3 ActivitiesExerciseLeisure-time and A 4. 1 C :71.-1-75*:-{, 7w' I

Norway availableFirst,playingThe amount time computer for devoted ofhealth-important time and toyoung video these people games essentiallyphysical spendis examined activity. passivewatching Second, for activities televisionthree those reasons. is who andnot Cross-countryopportunitiessamethe questionnaires time of comparisons varythe year greatly were and notfrommust seasonal administered onebe cautiously country differences toin interpreted another.every in outdoor country For because example, activity at the aemphasizeetspend set al., of 1992).time values violentwatching Third, that acts influence both TV which tendtelevision youngtomay develop contribute programspeople's poor behaviour.to nutritionand the computer development habits games (Felts of fromthe sports those played played by at young the same people time in winterof year in in Finland Israel. differ greatly CHAPTER 3 28 leisure-timeExercise and Activities studentsInB. orderExercise towere obtain asked an estimatehow often of perweekly week cardiovascular they exercise activity,outside describedLeisure-timeC. Leisure-time earlier activities as wellactivities include as the manythe out-of-school other pursuits sports in which and exercisestudents was2showsschool to quite3 times thehours highpercentage per until among week they of boysor arestudents more inout all often. of whocountries, breath Theexercise orlevel but they outside lessof sweat. physical so schoolamong Figure activity hoursgirls. 3.1 ThereTV,are involved. watching are numerous In movies this sectionstudies on VCRs weof the examineand effect playing theof televisioncomputerpastimes ofongames. watching children, differencebetweencountriesBetween 41 said62 between and and they 84 92 exercised thepercent percent proportions of vigorously of the the girls of boys boys did.two across andInor manymore girls age timeswhocountries groups exercise a week; and the fullyVCRrecentmuch in viewing ofyears, section it centred concern and3 below.) computeron hasthe Although grownnegative games. toTV includeimpact (Theviewing, latter ofmovies andviolent are watching availabletreated images. videomore for In consistentlymoregirlsis noteworthy. than times boys quiteper said week;For small. theyexample, only Although participated in in Norway Spain the trendin 39 werevigorous percent was gender for fewerexercise fewer differences 15-year-old 15-year- two or andprocessinghavedegreemovies, children been of iscognitiveandshown often to meaning be regardedto able orbe mentalcomprehension attentiveto asperceive a effort.passive and moral to For(Hawkinsactivity, be example, themesinvolved it & does Pingree, and TV in require messageinfer viewers 1987) thesome fewandboysold students Poland, countriesdeclined 11%;to by moreexercise more Finland, 13-year-old than than 15%;10 11 percent and and girls 13 Slovakia, in thanyear only 11olds, four 19%).year thecountries olds proportionsAlthough exercised (Estonia in ofa violentfromtheunderlying other 3 televisionto hand,15 messages percent, recent programs in inresearch what aggressive (Clark, they indicated watch1993) behaviour and(Christenson, a measurable it hasamong been viewers1986). notedincrease, thatOn of Incountries.mosttwo Austria or countries more a hightimes andpercentage per the week, decline ofby boys age exceeded 15maintained the proportions 12 an percent exercise declined in regime many in Researchersviewerswithover facilitating1000 to separate future have aggressive, also violence reports found andantisocial (Comstocka relationship reviews behaviour associate & between Strasburger, and media excessive desensitizing violence 1993). TV RespondentsGreenland,Germanyas 15-year-olddid 11- and Lithuania 13-year-oldAustrianNorwaywere alsoand girls.were Spain.girls,asked Overall,likely but how thereto more exercisemany was girls ahours substantial and in Austria, fewera week dropgirls Finland, they for in &viewing Killen, and 1995; poor Felts dietary et al., habits 1992; and Groves, a sedentary 1988). lifestyle (Robinson items.wereageexercise. groups78 in the Only for lower both Austrian thirditems. ofstudents Students the countries werein Spain consistent; across and the all Czech theyages led Republicfor in both all 79 Figure 3.1 Students who took part in physical activity two or more times per week* (%) 29 1 41 CHAPTER 3 CzechGreenland Rep. 11 year olds 66596350 CzechLithuania Rep. 13 year olds 1 685743 CzechSlovakia Rep. 15 year olds 476264 ActivitiesLeisure-timeExercise and Spain 1 6940 Greenland L-1 6948 Greenland 1 1 6545 Denmark 6963 Slovakia 7054 1 6728 Lithuania 1 7150 1 7142 Spain 1 7062 Latvia 1 7350 Russia**Spain 7349 Finland 7150 Norway 7367 Belgium Fl. 1 7353 Poland 1 7167 Russia**Belgium Fl. 775776 LatviaDenmark 75557466 Russia**EstoniaNorway 724739 Sweden 7759 Sweden 1 I 7564 Hungary 7252 Hungary 7866 Finland 7568 Belgium Fl. 1 7344 SlovakiaGermany** 67817969 NorwayHungary 79727656 DenmarkLithuania 746242 Scotland 8177 Estonia 1 8057 Sweden 1 7658 Poland 8269 Belgium Fr. 1 8257 Germany** 1 7761 Canada 8271 Poland 1 1 8265 Latvia 1 7846 Belgium Fr. 8363 Israel 1 1 8358 Israel 7948 Estonia 8371 France** 1 1 8366 Belgium Fr. I 8052 Wales , . 8376 Scotland 8567 Canada 1 1 8156 France** 5784 Canada I. 8567 N. Ireland 1 8158 Finland 1 I 8575 Germany* * 1 1 8669 Wales 8252 Israel 1 1 6587 N. Ireland 1 8675 Scotland 1 8253 N. Ireland 1 7887 Wales 68 France** 1 1 1 54 **Austria *France, Switzerland Germany did not and include Russia this are item.represented only by regions: see Chapter 1 for details. 192 84 Austria 192 8387 Austria 898468 MaleFemale 81 CHAPTER 3 30 I. Watching television Figure 3.2 Factors associated with watching TV Leisure-timeExercise and Activities programming,dataWatching must TV be is obviouslytheviewed novelty witha popular of caution TV viewingpastime since inand allthe countries,access availability to but other the of Watch videosmoreStudents likely towho watch TV are 11 year olds M F 13 year olds M F 15 year olds M F Whenactivitieswatch coefficients mayTV. be contributing of correlation factors were in thecalculated extent to for which all countries students PlayDrinkEat candy/chocolate computer sweet soft games drinks bars 0 0 0 0 00 0 0 0 almostgendersconsumptionaggregated, certainly and ofall an foodsage underestimate association groups with a high(Figure between thesugar 3.2).strength content The TV ofcorrelations wasviewing the found relationship; and for shown boththe CorrelationtowardsHave a negative school coefficient: attitude .15 to .19 0 0 .20 to .29 0 0 0 viewingHowever,watchinganalysis andby TVthe country aggressive, fordata lengthy tendsshow toonlyperiodsbullying show a slight strongerofbehaviour. time relationship andrelationships There poor between dietis abetween habits.strong TV 0 0 betweencorrelationoldage boysgroups, watching betweenand and 13-year-old among TV watching and all playing malegirls TV whorespondents andcomputer watched watching games.and TV videos 11-year-old a greatEleven-year- among deal females wereall Theoneday;likely majority ofin to only thehave of agefive studentsa negative countriesgroups did doattitude didnot so halfwatch (Figure toward of eitherTV 3.3).school.more boys The than or patterns girlsfour hoursin at of least aTV butmorewatching15. there 13At yeareachtendedfor each olds age, to age thanbe more agroup 11decline boys year were thaninolds thesomewhat girlsspent proportions watched time different. in watching front TV fourGenerally, of theby or ageTV,more andinyearhours six 15 olds countries a year day, where olds but compared higher(Israelthere was proportionsand with aScotland, slightmore of anomalygirls girlsrespectively). in spent only in thisone time Boyspatterncountry watching and for girls TV1311 82 moreone-thirdandin all boys age hours ofgroupsin theLatviaof TVcountries from perand Estonia, day.Poland where Israel, appearedthe most Lithuania, studentsconsistently Russia watched amongand Wales,four the or 83 Figure 3.3 31 Students who11 watched year olds TV at least four hours a day* (%) 36 13 year olds 45 15 year olds I 40 ExerciseCHAPTER and 3 Russia** 3651 Estonia 152 41 Estonia 1 4250 Leisure-time . 1 51 49 Activities Poland 1 4933 Lithuania -ter 4851 Wales 1 4941 IsraelEstonia 484952 WalesRussia** 4851 PolandLithuania 1 374022 Lithuania I 1 42364734 IsraelPoland 44494536 Israel 3834 WalesLatvia 36354137 GreenlandLatvia 38443630 GreenlandLatviaRussia** 32282435 N. HungaryScotlandIreland 34263631 HungaryCzech Rep. 37252638 HungaryScotland 26132833 GreenlandCanada 312519 N. ScotlandIreland 33283437 BelgiumAustria Fr. 242225 FinlandCzech Rep. 2923 DenmarkCanada 272026 NorwayCanada 231618 BelgiumDenmark Fr. 25271718 Germany**Finland 272019 CzechN. Ireland Rep. 221418 SpainNorway 211816 BelgiumNorway Fr. 25222718 DenmarkBelgium Fl. 211215 BelgiumAustria Fl. 16141710 AustriaSpain 20192125 Germany**Spain 201719 SwitzerlandGermany* * 1614 7 SwitzerlandBelgium Fl. 16181319 France**Finland 18151911 France***** Slovakia France, andGermany Sweden and did Russia not include are represented this item. only by regions: see Chapter 1 for details. 84 14 France** 1417 Switzerland 1513 85 MaleFemale CHAPTER 3 32 2. Watching videos students spent four or more hours per week watching videos less Leisure-timeExercise and Activities childrenTheyIn the represent last to few those yearsall thattypes rental feature of entertainmentvideos extreme have violence.become widely Analysis available. of the from movies made for morecountriesthan 20boys percent watched than girls of videosgirls of all and fourages less or in than moreall countries 35 hours percent per did week. ofso. boys However, in most 3.4).gamesvideosaggregated An andand association between similardata show pastimes video with substantial aggressivewatching correlations and behaviour poor dietary betweenwas nothabits evident. watching (Figure A watching TV and playing computer inbehaviours3. ThePlayingthe majoritydamaging computer among of effectschildrenrecent games researchof and increased adolescents literature aggressive have on computerbeen and documented antisocial games watchingamongbetweenpositive 13-correlation watching videos and 15-year-oldand videoswas having found and been boysin spending all drunk. andage and15-year-old evenings gender withgroups girls friends surveyed,between and everviolentnoted(National more that as elementscomplex the Coalition content matrixof on fantasy of Television ofthese visual and games challenge effectsViolence, has needed become are 1990). intertwined to gratifyItincreasingly has alsoskilled in beenan waswhosurveyedappearThe data15-year-oldspent to in(seebe four thisa Figuremajor hourssurvey boys leisure-time 3.5). inor show Greenland.more The that highestper activity VCR week For proportion movie amongthewatching most watching the of part, youngVCR boys very does moviesorpeople girlsfew not gender-roleproductareplayplayers. responding computer from Research stereotyping this gamesto audience a has perceived than also to (Clark,females beshown demandrampant 1993). thatand for amongmalesthat anOne game increasingly are studythe moremanufacturers top revealed sellinglikely violent to Figure 3.4Students who watch videos Factors associated with watching videos 11 year olds 13 year olds 15 year olds kidnappedacharactersNintendo quarter of ingames;or the 47 cast gamesof inthethere a gamesperilousfeatured were (Provenzo, asituation a total plot ofin and1992).which115 has male Furthermore,a to woman beand rescued. 9 is female either over WatchPlay computer televisionmore games likely to 0M 0 F 0M 0 F 0M 0F teamworkautonomousAnother concern (Provenzo, and aggressiveabout 1992). computer Most action games games rather involve is than that an collaboration theyindividual emphasize player or SpendEatDrink potato sweetevenings chips soft with drinks friends 0 00 00 00 00 00 Yet,feelingbattling some of againstresearchers community enemy contend seldpm forces. that figures Developing the arcadein the cooperative plotsenvironment of these spirit games.itself or a EatHave candy/chocolatehamburgers/hot been drunk dogsbars 0 0 0 0 0 youngthesetension-reductioncan provide games people youthacts to meet (Wigandas with a communicationand opportunities interactet al., 1986). with for"icebreaker" Theyothers social suggest in interactiona nonmediated by that enabling playing and 86 Correlation coefficient: 0 .15 to .19 0 .20 to .29 0 .30 to .39 relievingsocial environment. activities by Computer diverting games attention may from also functioneveryday as stresses. tension- 87 Figure 3.5 Students who watched videos at least four hours a week* (%) CHAPTER33 3 Finland 11 year olds 3923 Finland 13 year olds 1 3420 Greenland 15 year olds 153 37 Leisure-timeExercise and LatviaBelgium Fr. 1 31322118 WalesGreenland 332328 LatviaBelgium Fr. 34362519 Activities Sweden 1 3015 Belgium Fr. 1 322417 Finland 331918 Denmark 1 1229 Sweden 1 3116 Sweden 3112 GreenlandRussia** 281329 PolandDenmark 1 303117 WalesPoland II 302531 Wales 2617 Latvia 1 3016 Russia** 2716 N. Ireland 2613 Russia** 1 2617 Hungary 2613 ScotlandIsrael 24251516 CzechScotland Rep. 25261516 EstoniaDenmark 1 23132514 HungaryPoland 231311 HungaryCanada 242013 LithuaniaAustria 1 1 221212 Canada I 2213 Lithuania 2413 Israel 1 211116 CzechLithuania Rep. I 2011 9 N.Israel Ireland 2316 Czech Rep. 1 2116 Estonia 181019 7 Austria 202210 ScotlandCanada 201918 8 SwitzerlandFrance** 1517 9 SwitzerlandEstonia 171118 NorwayBelgium Fl. 1 181019 AustriaNorway 1415 87 NorwayGermany** 1517 86 SwitzerlandGermany* * IIJ 171218 7 Germany**Belgium Fl. 111210 7 France**Belgium Fl. 1415 97 N.France** Ireland 14121711 Female **Spain *France, Germany and Russia Slovakia did not include this item. B only86 by regions: see Chapter I for details. Spain B 68 Spain 68 Male 89 34 CHAPTER 3 Exercise and Figure Students who play computer 3.6 Factors associated with playing computer games 11 year olds 13 year olds 15 year olds D. Summary Leisure-time Activities Watch televisionvideos games are more likely to OM O F MO O F MO0 0 F studentsandinThe this maintainedlevel survey in of the physical is future. generallythere activityshould quite beamong high. obvious theIf this studentshealth activity benefits who is encouragedparticipated for these SpendEatDrink potato sweetevenings chips soft with drinks friends O O O 0 moreadolescence.thanThe findingsboys physically and Othersuggest, the active gender studies however, than differences have girls thatalso (Sallis girls shownseem &are to thatFaucette, lessincrease boys physically are 1992).during generally active Boysearly CorrelationEat hamburgers/hotcandy/chocolate coefficient: dogs bars 0 .15 to .19 0 .20 to .29 0 .30 to .39 O O0 andtosocietyreceive be videos more toa greatplay andinvolved sports dealplaying of andin encouragement computersedentary be physically games. activities fromactive. theirsuch Boys, families as though, watching and tended from TV watchingandFigure other 3.6 activities.videos shows andthe Those relationships television who doshows. between so are Younger more playing likely game computer to playersspend games time are isfromsomewhatAmong that the countries northerneastern lower, with European especially a longer countries. girlstradition when the compared Oneoflevel focusing explanation of tophysical on 15-year-old gender of thisactivity equality, finding girls is Thegirls.surprisingmore data likely in to this seeto drink surveythat there soft affirmed aredrinks more the and relationshipsgender eat potato differences for chips. boys in It thanplaying is notfor Whenparticipationovercomingsuch as designing Denmark the in sports.traditional interventions and Norway, gender-based aimed have at promoting stereotypesbeen more physical associated successful activity, with in highthey3.7computer shows, playeda proportion games, only computer in with ofSwitzerland Swiss boys games; girlsfar didmoreamong as a boys substantiallikely the played. 11to beyear number players.Computer olds, of Asalmost girls gamesFigure say as areI-IBSCisit isadopted, perceivedof paramount survey maintained asindicate the importance main andthat motivation discontinued.social, to know entertainment howfor Findings sport habitual participation and from physical health the motives1985-86activity (Wold yearcommonlypatternare least olds), by likely countryplayedScotland, to be by related played boysSwitzerland toin Spain,availability.Denmark, and but Wales. overallNorthern Computer there Ireland isgames no (11predictable are and most 13 Theseskillsmoreimportant& Kannas, importancein findings sport reasons 1993). seem imply forto Competition to sport liking decrease that being sport, health in fun.and with importance promotion achievementsWinning older pupils as andprograms pupils seeming achieving are grownot aimed to rated older.attachbetter atas 90 designedcooperation,moreincreasing effective and thepromoted fun level andif physical ofsharing, (Sallis physical and&activities Faucette, activitysimply becomingandamong 1992). games children more emphasizing active would were be 91 35 WalesFigure 3.7 Students who11 played year computerolds games at least four hours a week* (%) 4012 13 year olds 146 14 Wales 15 year olds 36 8 ExerciseCHAPTER and 3 Scot land 3914 Wales I 4211 Scotland 1 30 6 ActivitiesLeisure-time N. Ireland 303913 DenmarkScotland 37 79 Russia** 291830 4 DenmarkSwitzerland 3411 7 N. SwitzerlandIreland 36213712 LithuaniaSwitzerland 29 37 Israel 32 8 Lithuania 1 36 4 Germany* * P 1 29 3 Finland 30 5 Finland 3010 Denmark 1 2629 5 LithuaniaSweden 262710 8 Germany**Israel 28 7 PolandLatvia 25 43 LatviaCanada 252610 5 SwedenRussia** 27 65 FinlandCanada P 24 43 BelgiumRussia** Fr. F 1 2223 65 PolandCanada 26 56 NorwayBelgium Fr. 22 62 PolandNorway F 1 21 5 LatviaNorway 2526 7 EstoniaN. Ireland 20 3 HungaryFrance** 2017 46 AustriaBelgium Fr. 2325 56 IsraelAustria 2019 52 EstoniaBelgium H. 16 5 CzechFrance** Rep. 2022 48 GreenlandFrance** 17 43 CzechAustria Rep. 1516 64 HungaryEstonia Ft 1819 34 HungarySweden 1517 42 GreenlandGermany** 1414 44 GreenlandBelgium Fl. F 1517 45 CzechBelgium Rep. H. 1215 23 Spain*** Slovakia France, didGermany not include and Russia this item. are represented only by regions: see Chapter 1 for details. 92 92 Spain 112=1 10 3 Spain 12 2 93 El Male Female CHAPTER 3 36 The greatest resource for promoting physical activity is physical leisure-timeExercise and Activities peerscombinedparticipationFindings (Wold of effects the inet leisure-timeal.,1985-86 of 1994).their experiencesHBSC Such physical surveyfindings activityat home,indicate imply is at influenced thatschoolthat knowledgeadolescent and by with the programsschoolseducation have (Rossin school failed et al., (Sallis to 1987). provide & McKenzie,According the students to1991). 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96 Canada 97 CHAPTER Dietary Habits, Dental Care SoundA. Introduction nutritional practices have been clearly demonstrated to A. B.andIntroduction Nutritious Body foods ImageI. Fruits and vegetables recommendationsestablished.life.contribute It is during to physical Most foradolescence sound andcountries emotional dietary that have habits, patternswell-being developed which of and food focus a long choicenutrition on healthy the are C. Non-nutritious foods I.2. HamburgersWhole wheat and and hot rye dogs breads following:importance of a diet that includes a variety of foodsfibre and includecontent, the e.g., breads and other grain products, F.E.D. AppearanceDietingDental care 2. Sweets and soft drinks apreparedlower-fatvegetables limited withamountdairy and little fruits;products, of or salt no and fat;leaner alcohol. meats and foods G. Summary maintainthateatingWhile do habits,adolescents not a healthypromote external arebody growth pressures at weight.an andage candevelopment whereFor influence example, they could themand many do developto not youngchoose help healthy people foods them conformManyindulgencefrequently students with ingo popularfast to are fast foods concerned images;food can restaurants contribute concern that their about towith anweight weight excessivelyfriends and and and appearance appearance fatty frequent diet. Thequalityinfluencecan items lead ofon to food foodanorexia available choicehabits and includedand bulimia.at home.family in Even thisincome survey social can soughtclass affect background information the type andcan becauseinHowever, itonquestion difficult frequency they the can provide toquestions ofbe assess consumption generally fibre, thewere qualityvitamins considered ordered and notof and based thequantities beneficial cancer-fighting diet on ofwhether consumed, thoseto good the surveyed.benefits health foodsmaking 98 previousSuchgood(fruit, health avegetables, categorization HBSC because data low they(Nutbeam fatof are foodsmilk, high etwholehas al.,in beenfat, 1991; wheat cholesterol, employed Aar0 breads) et al., saltin or analyses1995; harmfuland sugar. King ofto 99 CHAPTER39 4 never.day;byStudents choosing once The a descriptionindicated day;one of at theleast how of following some onceoften foodathey week,five itemseat responses: orbut varied drink not daily;eachfrom more listedone seldomthan country's food once and item a ImageDietary and Habits, Dental Body Care Tothefoodsquestionnaire interpretanalyses. differently the to findingsanother. from the Datait standardis necessary from countries questions to make that were judgments defined omitted specific about from countrieshightheavailable availability fat foods may in all ofthereforesuch theof theasfoods hamburgers participatingreflect in various differences andcountries. countries. hot in dogs availabilityFor Differences example,are not orequally typicalbetween other Spain Tohealthyculturaloften learn foods.they variations,about brush dental their rather hygiene teeth than and the the how respondents students' often they attempts were use dental asked to choose floss. how In alcoholunhealthyfoods& Coles, is abuse part 1992). foods of and a Theis health-enhancingsmoking. related results to Thus, indicate other the lifestyle,health-risk foodthat consumptionitems while behaviours in thisconsumption survey of healthysuch may asof behavioursSeveralflossingthis chapter isquestions not andwe viewed discusshow were young as fully a asked health people only relatedpriority the perceive item toin about somethetheir issues brushing appearance.countries. of dietingbecause The thanbe better comprehensive perceived as measures indicators of ofhealthy health-related or unhealthy lifestyles diets. rather idealcountriesInterpretationstudents' weight responsesin availabilityand has appearance. beenare summarized and cautious types ofin and foodlight examined andof differences in attitudes in this chapter. acrosstoward CHAPTER 4 40 There was a wide variation in the percentages of respondents who Image andDietary Dental Habits,Care Body grainFormanner this breads analysis, if theyonIL a consumedlhotritious dailyit was basis, assumed fruits, while foods vegetables,that at the students same low timeate fat in limitingmilk a nutritious and their whole girlsoldate fruitfemalesGreenlandic than every boys (Figure day,of males the ranging 4.1). same to Ina age high frommost reported of acountries, low91 percent ofeating 31 higher percent fruitfor Czech daily.proportions for 11-year-13-year-For both of foods.frequencycrisps,consumption hot with dogs of chocolatewhich and hamburgers. students and candy, ate a sugaryBelow representative soft is a drinks, discussion group potato of of chips/these the increasesmoresaidgenders, they pronounced in inate manythe fruit proportion forcountries, at boysleast than ofonce fewer students girls. every 15 Only yearwho day. in oldsate GreenlandThe fruit than decreases between 11 were year were there agesolds tofruit ForI.three Fruits is decades, essential servings and vegetables nutritionistsin of maintaining fruit per dayhave a cangeneral asserted also state reduce that of daily health.the riskconsumption Eating of certain two of Rawbywas11 the much andvegetables difficulty 15, lower although andarethan acost inthegood any ofoverall purchasingsourceother consumption country. of dietary fresh This fruit fibreby may Greenlandic in and Greenland.be explainedvitamins. youth maypartiallyofnutrition-related both be solublehelpful digested, fibrein diseases. reducingplays and ainsoluble role Manyblood in regulating fruitscholesterol.fibre. provideSoluble blood-sugar Apples, fibre,adequate which strawberries levels amounts is onlyand asandrichDark of turnip, in dietarygreen vitamins are and fibre an deepA abundantwhich and yellow-orange C.may Vegetables,source be linked of vitaminsvegetables, to such the preventionas and broccoli, in minerals particular, of cabbage specific as well are andbeInsoluble citrus1993).helpful fruitsFruits fibre,in preventing arealso alsosome known certainimportant of as the typesroughage, best sources of sources cancers isof not vitamins of(Harris digestible soluble A & and Ferguson, andfibre. C. mayThese ofthanGenerally,cancers. the boys students ate fewer raw in thanvegetables each half age of groupdaily. the students In ate Israel raw and three-quartersvegetables slightly more daily, or moregirls far A,studiesvitamins1993). C and have are E appearindicatednecessary to thathavein maintaining consumption an anticarcinogenic healthy of foods skin containing effect and bones. (Bornstein, vitamins Recent atcountrydoingmore least thanso. daily. rankings There in any inwas other terms little country. of consistencythe proportions Very few across who Welsh ageate rawboysgroups vegetables reported of the 102 103 Figure 4.1 Students who ate fruit once a day or more often* (%) CHAPTER41 4 11 year olds 38 I Dietary Habits, Body France**Greenland 1- 5456334 1 WalesGreenland 13 year olds ri 505539 WalesGreenland 15 year olds H 43513845 Image and Dental Care Wales 1-1 5560 France** 1 6059 France** 53 EstoniaNorway 6164 NorwayLithuania 54616260 LithuaniaNorway I 41575554 Latvia 6264 Latvia 1 6361 Latvia 5557 BelgiumLithuania Fr. 67666465 BelgiumRussia** Fr. 68656164 Scotland 624960 Switzerland 6854 Switzerland 6756 DenmarkEstonia I 634960 Germany*Russia** * 71686960 ScotlandEstonia 70646967 BelgiumRussia* *Fr. 66616357 ScotlandFinland 64746274 SwedenDenmark 677160 Germany**Switzerland 69516859 BelgiumSweden FL 76707467 FinlandGermany** 77587563 BelgiumFinland Fl. 1-11-1 735155 DenmarkN. Ireland I-1 67797280 AustriaBelgium Fl. 776664 SpainSweden IJ 70745673 AustriaSpain ---, 1---j li 8065 8 CanadaN. Ireland 757868 AustriaCanada I 63770 CanadaSlovakia TjI-I 77827 8 1 SpainSlovakia 74797778 N. SlovakiaIreland r 1-1 73807076 Poland 85 Poland 1 8587 Poland 8183 Israel I _j 90 8583 Israel 1 8290 Israel 81 Czech Rep. 90 Czech Rep. 1 91 Czech Rep. lJ ri 90 85 MaleFemale *** France, Germany and Russia areHungary represented did not only include by regions:this item. see Chapter 1 for details. 104 90 86 105 CHAPTER 4 42 2. Whole wheat and rye breads Image andDietary Dental Habits,Care Body thatsubstitutesconstituteWhole high grain daily important for products,fibrefoods intakesources high such isin of associated fat. insoluble as Epidemiological whole withdietary wheat low fibre incidence and studies and rye are ofbreads,suggest healthy colon fermentationcarcinogensmechanismand rectal orcancer,(Harris results indirectly &butfrom Ferguson, it throughtheremains fibre 1993). the eitherunclear process acting whether of directly absorption the protectiveon colonic and wholeTherespondentswheatAn excellent proportion wheatbread who source orand ofrye indicated ryemales ofbread fibrebread. and atthey is least femaleswholeFigure ate dailywhole grain 4.2who was wheat products,shows reported quite or thesimilar.rye such that numberbread asthey For whole daily. ate11of every(10year13- and olds, dayor 815-year-old onlyorpercent more in France often.respectively) boys Thereand and Slovakia girlswere say either;not they did large substantially atein differencesGreenlandwhole grain more 11between bread percentboys However,boysinmore Austriadid of so. the there and 13-year-old Germanyare large girls differences13 percentthan the moreboys across ate15-year-old countriesfibre-rich girlsbread in the than and leastRussianculturalbreadproportions once daily. factors,Federation a ofThisday, young in may,an the almostextremely people intypes part, all ofwho reflectstudents smallbread reported differences,percentageavailable. ate wholeeating Whereas ofdeterminedgrainthese Lithuanian breadtypes in the byofat Sweden,fibre-richandstudents Latvia reported Switzerlandbread large106 every doingproportions day,and so. WalesbutIn Denmark,of substantially students tended Estonia, toconsistently fewereat whole Finland, in Austria, grainsaid Greenland they bread.Spain, eat 107 43 Figure 4.2 Students who ate11 whole year oldswheat or rye bread once a day or more often* (%) 0 13 year olds 6 15 year olds 4 DietaryCHAPTER Habits, 4 Body LithuaniaSweden 18191413 SpainLithuania El 1715 0 SpainLithuania 251319 6 Image and Dental Care WalesSpain 22824 6 AustriaSweden 263023 AustriaWales Ii 1 2033 AustriaSwitzerland 31353229 France**Wales 29273025 SwedenSwitzerland H 24263219 France**Poland 343403035 5 Germany**SwitzerlandPoland 3237443125 France**PolandGermany** 46293331 BelgiumCanadaGermany** Fl. 484641 SlovakiaCanada 47444138 CanadaCzech Rep. 4039373136 CzechSlovakia Rep. 50455143 BelgiumCzech Rep. Fl. 1 48455054 ScotlandSlovakia 1 50544240 IsraelN. Ireland 555458 ScotlandN. Ireland 555153 BelgiumN. Ireland Fl. Ii 5954 BelgiumScotland Fr. 6557 BelgiumIsrael Fr. Ii 65625658 IsraelBelgium Fr. 5254635956 FinlandNorway 6967637072 FinlandNorway IJ 747277 FinlandNorway 79766974 LatviaGreenland 79 GreenlandDenmark II Ii 799081 LatviaDenmark - I 1 84838179 EstoniaDenmark Ii J91 88828581 EstoniaLatvia 938684 EstoniaGreenland 948785 ID Female *** Russia**France, Germany and Russia areHungary represented did not only include by regions:this item. see Chapter I for details. 1.1 97 95 Russia** I 97,198 Russia** 98 Male CHAPTER 4 Figure 4.3 Factors associated with eating hamburgers/hot dogs Image andDietary Dental Habits,Care Body goodeatingTheC. Mon-nutritious cornerstone health sufficient without amounts compromising goods of essential these nutrients benefits neededby eating to excessive enhance of healthy eating is to achieve a balance between Eat potato chipshotStudents dogs are whomore eat likely hamburgers/ to 11 year olds M F 13 year olds M F 15 year olds M F kepttoamounts eat to a varied aof minimum. any diet,one nutrient,consumption In this such discussion as of fat non-nutritious or sugar.of non-nutritious While foods it is shouldimportant foods, be EatDrinkEat candy/chocolate french sweet fries soft drinks bars 0 0 0 0 00 0 I.especiallydrinksemphasis because ishigh placed thesein fat on foodsand hamburgers sugar, are recognized thus and offering hot by dogs, littlenutritionists nutritivesweets asand value. being soft WatchPlaySpend computer eveningsvideos games with friends 0 0 0 00 0 0 areof Althoughthe high meat in animal andhamburgers meat (saturated) alternates and hot fat. dogs foodHamburgersIn some satisfygroup, countries, somethese and ofhotparticular the the dogs list requirements included meats Correlation coefficient: 0 .15 to .19 0 .20 to .29 0 .30 to .39 0 .40+ 0 0 dailyOccasionalcountries.sausage, consumption which No use differentiation of may such would have food beenincrease items has interpreted beenis notfat made intakeconsidered differentlyin to this a harmful,higher discussion. across than but quarterand/oreachexceptIn most ageor hotNorthern countries,more group dogs of every (40% Ireland,both few day boysof respondents 11andwhere andyear Lithuania, girlsone-third olds) ate ate saidwherethese these or they more productsapproximately meats eat of hamburgers regularlythe every boys one- day in Fewregularasrecommended fast respondents food,meals. and level. ate may Moreover,only often one betype this consumed of type non-nutritious of food between is typically food. or insteadAs regarded shown of (F1.),hamburgers(Figure Switzerland 4.4).and hot The and dogs thelowest at Scandinavian least proportions once a daycountries. or reporting more Almost were that inno Belgium Finnish they ate spentyearmorein Figure -old likelytime girls,4.3, in to the students eatstudents evenings other whowhounhealthy with ate friends.hamburgers foods Thirteen-year-old as well. andand hotExcepthot dogs dogs for often, boys,were 15- nutritiouseatingTheregirls ate habits.were these food slight In thanmeats almost girls,gender as allfrequently and countries,differences there is as no boysonce country in theatea day. morestudents'in which fatty the fast and amount foodnon- suggestingspendalong with time that11-year-old watching they may boysvideos not beand and/orspending 13-year-old playing very girls much computer tended time exercising.as games, well, to staysdogstheseplayeaten an increases thefoods.by important samegirls In withsurpasses orsome even role the countries, diminishes.inadolescents' thatdetermining of the the age,intake boys. patterns while ofAge hamburgers inof does other consumption not countries seemand hot of toit Figure 4.4 Students who ate hamburgers or hot dogs once a day or more often* (%) CHAPTER45 4 LithuaniaN. Ireland 11 year olds 40292623 N. ScotlandIreland 13 year olds 26331517 N.Lithuania Ireland 15 year olds 31323010 ImageDietary and Habits, Dental Body Care IsraelScotland 26181917 IsraelLithuania 2223 82 Russia**Scotland 231510 9 SpainRussia** 171415 WalesRussia** 112 417 5 WalesIsrael 1115 29 CzechEstonia Rep. 131610 8 CzechSpain Rep. 1013 79 PolandCzech Rep. P=1I ' 10 45 WalesGreenland 121013 6 SlovakiaCanada 10 854 SpainEstonia 8793 PolandCanada 1012 57 GreenlandPoland 834 Germany**Austria nRI 637 Germany**Slovakia 496 EstoniaAustria 473 CanadaBelgium Fr. 62 LatviaAustria k 648 LatviaGermany** 47 SlovakiaGreenland 536 1 Belgium Fr. InJ 36 Belgium Fr. 36 Latvia LnJ 25 SwitzerlandFrance** 5 1 SwitzerlandFrance** 46 SwitzerlandFrance** 34 Denmark 42 1 Belgium Fl. 32 Sweden 31 Sweden 4 1 Denmark 32 Belgium Fl. 2 Belgium Fl. 3 Finland 20 1 Denmark b 2 Finland 30 Sweden 2 1 Norway 2 Female Norway*** France, Germany and Russia areHungary represented did not only include by regions:this item. 112 2 Norway see. Chapter 1 for details. Finland II 0 113 Male CHAPTER 4 46 2. Sweets and soft drinks Soft drinks such as colas or lemonades are frequently taken with Image andDietary Dental Habits,Care Body calorichighYoungsugar in inputpeople sugar,supplies can namely are resultthe often body candyin habitualweight with and quick-release gain. chocolateconsumers Chocolate bars. offood foodsbars, Although energy, in notoriously particular, toodietary much everyIrelandessentiallyhighestfast food day andproportion such than Scotland.the as samegirls hamburgers of studentsForandas those theit is mostdrinking andremarkablefor part,sweets,hot softdogs. more drinksmainlyto The boysnote countriesat drankIsrael,that, least bysoftdaily Northern withage drinks were 15,the ascancer.andcaffeine.are coffee, nutritionallyincreased Because High tea and dietary risk caffeine deficientcolas, of fat heart it intakeis is becausealso importantattack, is found positively theystroke into otherareminimize andcorrelated high food specific in chocolate-barproducts both with types fatobesity such and of Ireland.highestover 60 incidence percent offor the all boysages and in six both countries genders occurredwere doing in Northern so. 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ScotlandIreland 64696677 Image and Dental Care PolandScotland .11 61605870 EstoniaIsrael 6369596 8 EstoniaBelgium Fr. 636458 LithuaniaEstonia 595752 BelgiumPoland Fr. 1 585761 Germany**Israel 545156 BelgiumSlovakia Fr. iJ 5855 LithuaniaGermany** 5752505451 LatviaLithuania - 11 11 4651485354 Germany**Russia** iJ 56485357 LatviaRussia** Ii 394851 Russia**PolandSwitzerland fj 37485251 CzechWalesLatvia Rep 464740 AustriaSlovakiaWales 45404347 WalesGreenland 464533 Spain 414339 Greenland 4944 Austria ]I I 444238 AustriaFrance** 35363139 SwitzerlandCzech Rep. 40394147 BelgiumCzech Rep Fl. 38313941 Greenland 323536 Belgium Fl. I II 463833 DenmarkSlovakia 453746 CanadaBelgium Fl. 2632 DenmarkSpain 1-1 363537 Canada II 253432 II 2832 II 28 Sweden I1 24 SwitzerlandDenmark 2724 France**Canada 323334 France** II 3123 FinlandSweden 16171012 FinlandSweden 27233026 NorwaySpain 26294016 Norway 13 8 Norway I II 2016 Finland -1JI 2319 MaleFemale *** France, Germany and Russia are Hungaryrepresented did onlynot include by regtons.--see this item. Chapter 1 for details. P 116 .1 117 CHAPTER 4 48 Image and DentalDietary Care Habits, Body &dietsIt hasD.Morris, can Denta0long lead 1986). been to caredental establishedGood cavities,tooth-brushing that poor sugar nutrition habits intake and and in preventive obesityyoung people's(Rogers dental hygiene,motivatedresearchersof excessive such by as haveamountssocial using suggested reasons dental of sugar flossto thatbrush on regularly, students dental their teethhealth. can are regularly offsetmore However, thelikely than effects some toto be haveStudentsthatmotivated fresh regular breath were by brushing concerns asked(MacGregor, towas ofindicate diseasemost 1994). oftenhow prevention. oftenassociated they Findings brush with wantingtheir indicated teeth to floss:aonceusing week; a daily;the day; and following atweekly;never. least They once seldom;response werea week or also categories: never. but asked not everyhow more often day; than theyless once usethan adental onceday; percentmorecountriesAs shown than for in once ingirls. the Figure a proportions Lithuanianday 4.6,from overall 21 boysof to students 85 thereand percent girls was who brushedfor a brushedwide boys their rangeand their 35teeth across toteeth 97the brushedteethSwedishproportionsleast; more Swedish their 15-year-old than increasing teeth onceyouth much boys a day.asbrushed more andthey In frequently97 all got percent thecountries older. most thanof Eighty-five thefrequentlyand did girls age boys. groups,brushed percentIn with ranking girlstheir the of Ingroups.brushedthe several countries the countries least by female and one-third the responses, most or weremore the similarof countries the students across in which thedid threenot students know age one-halfin thatwhatCanada they dental of (females) werethem floss not say is.andfamiliar they However, Russia flossed with (males dentalevenat least and where floss, weekly. females) veryno students few did usedmore indicated118 it. than Only 119 Figure 4.6 Students who brushed their teeth more than once a day (%) 49 1 CHAPTER 4 11 year olds 1 40 13 year olds 35 15 year olds I 1 35 Dietary Habits, Body Lithuania 1 4227 Lithuania 1 3621 Lithuania I 1 2144 Image and Dental Care Finland 1 4226 Latvia 1 1 4521 Latvia 1 1 5426 Russia* 1 4329 Spain 1 1 4733 Russia* I 5529 Latvia 1 4633 Finland 1 1 4722 Estonia 1 5934 Belgium Fl. 4833 Estonia 1 1 4834 Belgium Fl. 6035 Estonia 1 5132 Russia* 1 5228 Spain 6528 Spain 5138 Belgium Fl. 5832 1 Finland 1 6529 Belgium Fr. 5640 Belgium Fr. 624 Belgium Fr. 1 6943 Hungary 1 6135 Hungary 6339 Greenland 1 7037 GreenlandFrance* 1 6352 GreenlandSlovakia 6541 France* 1 7149 1 6549 6644 Slovakia 1 7342 Slovakia 1 Wales 1 6546 France*Austria 1 6854 PolandAustria 4774 6552 7249 1 7446 Scotland Scotland 1 Scotland Canada 6653 Israel 7353 Israel 1 1 7655 55 1 51 Poland 69 Wales 1 73 1 7854 N. Ireland 7151 N. Ireland 7453 CanadaHungary 1 7947 Israel 7146 Poland 57449 2 N. Ireland 1 8059 Czech Rep. 7154 1 75 1 8055 1 Czech Rep. 51 1 Austria 7254 1 75 Germany* 8160 Canada Wales 1 7761 1 8058 8458 Czech Rep. 1 SwitzerlandNorway 8168 Norway 1 7082 Switzerland 1 8655 1 Germany* 67 71 Germany* 8276 Switzerland 1 1 783 4 Norway I 88 Sweden 8570 Denmark 1 84 Denmark 1 I 8867 H 79 1 749 1 73 Female Denmark* France, Germany and Russia are represented only by regions: see Chapter 1 for details. '29 1J 7886 Sweden 1 8 1 Sweden I 197 85 191 Male CHAPTER 4 50 students' concern about their weight was the gender differences Image and DentalDietary Care Habits, Body becomeassociatedDietingE. Dieting toextremely withlose howweight self-conscious students or concern feel about duringabout themselves. theiradolescence, weight Young is and directly people most withwasproportionnoted. substantiallyage. In Twenty-twoevery of girls country higher dieting to than 44 andor percentwho forfor boysfelteach of that and theage they increased11-year-old group should surveyed, significantly be girls on awere thediet forpeopleexpressingstudents their may age who serious andnot are heightaccept dietingconcern because the standard orabout theyfeel their arethe norms influenced appearance.need of to appropriate lose by Somemedia weight weightimagesyoung are toongirlsconcerned bea diet were,less or concerned about andthought by their age they about weight,15, should 37 their to but be. 61 weight 30 Boys,percent to 49 byon percentof thethe the timeother girls of theyhand, 13-year-old were reached tended either Researchhavedefinitionsof slim, of theirbeautiful has of own beautyshown bodywomen can that image also adolescentand influence (Wardle,muscular, females the 1993). handsomeperceptions are more men. young likely Cultural people than intheBelgium 15.Estonia, most Girls (Fr.),likely Lithuania,in Belgiumthe to beCzech dieting Norway, (Fr.), Republic, or Israel, conscious Poland Scotland Slovakia and of andRussiatheir and Spain weight.Wales tended were and Students to among boys rank in orexercisebehaviours,males anorexia to to perceive control nervosasuch asbody themselvesbinge(Mikow, weight, eating, 1995; which as fasting fat Levine can and resultand toet excessive al.,engagein bulimia 1994.). in physical nervosa eatingYouth threepercentagesFewamong boys countries the of least beingany indicatedlikelyage among said to theydiet 11they yearorwere were to olds: sayactually dieting. they over dietingneed 10 By percent toage with lose 13, the ofweight. the themhighest only in hopelessnesspsychosocialofwho body develop weight unhealthy distress (Page, and physical characterized1991).eating behaviours They attractiveness areby feelingsduealso to at sufferdistorted increasedof loneliness considerable perceptions risk and of morewereincidence10 percentonthan a ofdiet.10 116ofpercent The 15-year-old percent figures of the dieting forgirls boys girls wasin in 10 wereall for countries countries boys much in higher wereAustria; indicated dieting, less that withthan they at age 11 needresponseStudentsdeveloping to lose choiceswere health weight; asked were: problems andif No, they Yes. becausedue were Incidence to nutritionalon my a weightdiet of todieting deficiencies. islose fine; weight.and No, attitudes but Their I do atreportedgirlsIsraeli age in 15.girls 17 the countries athighest 20 percent. incidencesaid they By ageatwere 29 13 percenton and a diet 15, at and overage again, 1310 and percent Israeli 35 percent of girls the obviousweight,majoritytoward weightbut patternof 11-this are and wasin summarized responses13-year-old not the case to instudents this amongFigure item were154.7. regarding year Insatisfied all olds. countries dieting Thewith mosttheir andthe muscularoldertheyBoys needed (agewere which 15). generally to loseIt involves may weight more be weight that whenlikely older gain. they to boys feel were feelthe younger needthe need to (age diet to be11)or morethink than Figure 4.7 Students who11 were year on olds a diet or felt the need to lose weight* (%) 44 13 year olds 49 15 year olds CHAPTER51 4 Slovakia 4325 Belgium Fr. 49 Slovakia I 586616 ImageDietary and Habits, Dental Body Care CzechWales Rep. 4230 WalesGermany* * 4826 IsraelBelgium Fr. H-----i- I 5526 41 4629 Hr----1 I 5422 Belgium Fr. 4130 Scotland 4626 Wales I 5320 France** 3722 Israel 4623 Scotland [1-1-1kr-1' I 5122 IsraelGermany** 253726 N. CzechIreland Rep. 4622 AustriaSpain kr.__.-1-1I 0 j1 I 20528 i ScotlandN. Ireland 27352537 SpainSlovakia 45463022 BelgiumGermany** H. kr_1 I 50205118 Austria 332734 France** 4521 France** 1-1.---ei_i_i__, I 5016 Spain 3329 Austria 4329 N. Ireland I 5016 Belgium FL 3324 SwitArland 4220 Latvia 1 r+ I 4912 Finland 3122 Denmark 4023 Sweden I 4817 DenmarkCanada 243022 FinlandBelgium Fl. 402221 CanadaSwitzerland iLIr-lti_r____Li I 214822 Greenland ' 282329 Canada 3823 Czech Rep. 1-1_ 1 r--i I 452347 SwitzerlandLatvia 202619 GreenlandLatvia 193716 LithuaniaDenmark I 4521 4 Sweden ' 252618 Sweden 363718 Russia** 1111111-1 I 4414 Russia**Estonia 2514 EstoniaRussia** 331918 GreenlandEstonia I 214313 Female Lithuania 2418 Norway 2132 Norway I[---11-1 0 1 4217 NeedOn to a dietlose weight Norway 2319 Lithuania 1632 Poland lam I I 38 9 Male On a diet Poland*** France, Germany and Russia are Hungaryrepresented did onlynot include by regions: this item. see Chapter I for details. 124 2022 Poland BEST COPY AVAILABLE 3016 Finland lif-1 3718 125 Need to lose weight CHAPTER 4 52 Figure 4.8 Factors associated with wanting to change something Image andDietary Dental Habits,Care Body appearancewithPhysicalE Appearance the changesappearance was associatedvalued is very more with important than becoming any to adolescentsother mature "lifestyle adults. as they Physical factor" cope changeStudentstheir something bodywho wantare moreabout to likely to about their body 11 yearM olds F 13 year oldsM F 15 year oldsM F culturallythoseimportanceconsidered who accepted inseeincreased the themselves Minnesota definition with age ofasHeart (Prokhorovtheunattractive termHealth have Youth et been inal., the 1993).program shown generally Asto and sufferwell, itsor FeelappearanceBe Saydissatisfied like they an outsiderneed with to losetheir weight 0 0 0 0 0 0 helplessnesslooking"adolescentsvarious types categoryand who ofshyness. believed psychosocial experienced Society their weight distress.has more tended placed Pagefeelings tothem emphasize (1991) outside of loneliness, found thefemale "good that FeelNot belonelydepressed happy 00 0 0 0 00 0 Data(Rodriguez-Tomebemore less fromthan satisfied thismale survey attractiveness with et al.,tend their 1993; to corroboratebody and Richards studies than theseettheir show al., findings: male1990; adolescent counterparts (; adolescentsok, girls1990). to FeelBe irritable nervoushelpless 0 0 0 0 andunhappywho happy believe and to they feelthose are lonely who not and thoughtgood depressed looking they were (Figure were good more4.8). looking The likely conversetended to be to feel confident was also found to be true (Figure 4.9). withHavetowards parents poora negative school communication attitude 0 0 0 excessfromIsThe there factors reinforcing body anything associated weight about data among with showingyour an adolescents,body affirmative the you prevalence would indicateresponse like of to the toperceptions change? thecritical question, aside role of Correlation coefficient: 0 .15 to .19 0 .20 to .29 0 .30 to .39 helplessnesswereyear-oldpersonal vulnerable boysappearance and dissatisfiedto to feeling feelings plays like with inof an theunhappiness, outsider.something lives of Respondentsyoung aboutloneliness, people. their inappearancedepression, Thirteen-each of theiraofthe negative these other parents. problems. age attitude and gender Eleven- toward groups, and school 13-year-old were and likelypoor girls communicationto sufferwere likely one or to morewithhave CHAPTER53 4 Figure 4.9Students Factors who associatedthink they with thinking they are good looking 11 year olds M F 13 year olds M F 15 year oldsM F ImageDietary and Habits, Dental Body (are BeFeel well-integrated confidentmoreare good likely looking socially to are 0 0 0 0 0 0 NotFeelFeelanything want happy healthy to aboutchange their body 0 0 00 0 0 0 AchieveNotoffBelieve feel their helplesswell familyin school is well 0 0 0 0 00 0 CorrelationwithHave theirgood parents coefficient:communication 0 .15 to .19 0 0 Q .20 to .29 0 .30 to .39 0 0 Adolescentsing,looking,a series I don't ofabout whothinkresponse average, responded about alternatives my not theylooks) very are good were (very very/quite looking,more good likely good looking,not toat looking feelall quitegood confident, from look-good municateyearfeelingbe well-integrated -old good girlsmore looking and easily 13 socially was yearwith related olds, parents. and it tofeel was doing happy. related well For toin being school,younger and students for 11- able to com- genderThesechangeIn almost findingssomethingdifferences all countries, also about on confirm thethis their proportion issue. bodythose In increased from almost of students studies allwith age whoageshowing groups (Figurewould distinctand like 4.10). all to landcountriesthey15, did more considered so. more than In contrast, females70 themselvespercent thethan ofvast malesthe average majority girls responded in looking. every of students country yes; in indicated exceptfact, by Green- thatage 128 129 CHAPTER 4 54 In response to whether they felt their body was too thin, too fat or The results suggest a negative development of eating habits with Image and DentalDietary Care Habits, Body however,studentsabout right, saidmore more they boys males were than than agirls bit females toothought fat saidthan themselves about said right.they too were Overall,thin andtoo moremorethin; choicesandthanincreasing 15, that thereof of age.young younger is The a markedpeople diet students. of occur. change15 year During Often, inolds the surveyed parentsthesettings years strongly wasin between which less influencenutritious the age food 11 betweendifferencesresponsegirls a bitthe categories too genderson dietingfat. By which,in behaviour.age both 15, of the course,there a bit were istoo consistent fatsubstantial and muchwith differences the too gender fat andregulatemoney.what children theirmeals However, spendyoung and general less children these time schedules parental together. eat: they andinfluences Peers purchase control seem decreaseavailable andto have prepare spendingasa strong parents food, betweenforAsG. thewould Summarythe selected countries be expected, food with items. respectthe Since findings to the reported items indicate consumptionincluded major in differences this patterns survey usedthedevelopingimpact1990). significance arena on Thus, children's morefor promotingthe ofhealthy findingsyouth food food cultures. choiceshealthy of habitsthis outsidesurveydietsHowever, should is imply theschool. take the home thatinto most Since efforts(Kleppconsideration commonly students aimed et al., at implicationsdifferentappropriatenessis arevirtually not countries.intended impossible for educationalof to However, the measure various to make programsthethe foods findingsquality sound eatenin of doconclusionsnutrition, the haveby diet young some of as respondents, well aboutpeopleimportant as thefor in it suggest(Dwyerwithspend nutrition extensive &that Bourgeois, school-based education time in1992). schooland educational forA this numbermodelling setting of programs nutritionsoundis ideal nutrition for mayeducation reaching be principles effective studies them consistentfoodsadoptmore generalandhealthier fewerwith health food thoseeating promotionhabits from the less thanmore nutritiousfor boys detailed youth. with foods. In dietarymore general, These eating surveys girls findings the inseemhealthy other are to in 1989;influencing Klepp adolescents& Wilhelmsen, to choose 1993). a healthier diet (Stone et al., orproblemDietingstudies think ofthey habitsfor populations girlsshould and than beconcern forofthan youngboys. 11-year-old about Morepeople weight 15-year-old girls(Andersen appear and the girlsetto margin al.,be are more1995). onbetween a of diet a aboutAlthoughandthe responses15 their years many body, ofof students, age.boys most and feltespecially girls they increases were girls, average wanted substantially toor change good between lookingsomething 11 or toboys.The saidimprove dental Thus, they bothboysdidhabits not foodseem ofthink girlshabits to constituteabout tend and their todental abe looksvital more hygiene. target at positiveall. group thanfor programs those of 131 Figure 4.10 Students who responded yes to "Is there anything about your body you would like to change?" (%) 55 Czech Rep. 11 year olds 635867 Wales 13 year olds 785579 Wales 15 year olds 5784 DietaryCHAPTERImage Habits, and Dental4 Body Care FinlandHungary 58466350 FinlandCzech Rep. 76597766 CzechSweden Rep. 59827283 WalesSlovakia 435739 Germany*N. Ireland 474974 N. SpainIreland I ® 468250 Lithuania 38544656 HungaryPoland 50724873 LithuaniaFinland 58805981 IsraelRussia*France* 45523653 France*Sweden 46477171 NorwayPoland Hip' 478054 PolandN. Ireland 39514052 Russia*Austria 52694370 Germany*Slovakia 517853 BelgiumGermany* Fr. 41493350 LithuaniaSpain 48684469 DenmarkCanada 547757 DenmarkCanada 37473349 DenmarkSwitzerland 446747 SwitzerlandBelgium Fr. 477752 AustriaSweden 35453247 CanadaSlovakia 50663967 HungaryEstonia 537654 BelgiumScotland Fl. 334438 BelgiumIsrael Fr. 47644866 IsraelAustria 55754976 EstoniaSpain H 35423143 ScotlandNorway 61456239 Russia*France* 43667475 Switzerland Ii 3438 Belgium Fl. 4257 Belgium Fl. 4773 NorwayLatvia 293634 LatviaEstonia 345647 LatviaScotland 397056 Female Greenland* Germany, France and Russia are represented only by regions: see-Chapter 1 for details. lJ 1L9 2832 Greenland ,,, 1 2945 Greenland 5258 -133 _Male , 134 135 CHAPTER General Health, Physical A.The Introduction period of adolescence is characterized by rapid physical growth, C.B.A. GeneralIntroductionHealth problems health ilments and Medication Use inpeoplerelationships. significantother often areas originate Itpsychological of is theirnot surprising fromlives. the developmentStress-related stressthat the and physical anxiety and symptoms changes ailments they experiencecaused inof personalyoung by 3. Backache2.I. Stomachache Headache Althoughabdominalmuscular tension painthere and hasfrequently dizziness. been a takelimited the formamount of recurrent of research headaches, on the D. Use of medicine 6.S.4. NervousnessDifficultyBeing in gettinga bad and mood to dizziness sleep (irritable) disturbancesisrelationship thein young case among people, betweenand the adults. they quality sleep are There disturbance ofassociated, psychosocial are also and thoughstrong depressionrelationships. linksto a lesser between and Insomniaextent anxiety sleep than 4. Medicine3.2.I. Stomachache for nervousness medication MedicineHeadache for medication difficulty getting to sleep generallyyoungotherhas been school-related people lowfound perception have to be matters.been related of health.associated Into otherfear Recurrent of studies,with school abdominalmental headaches and worrystress pain among (RAP)andabout a E. Summary S. Cough/cold medication AlthoughSharrerstresshas also (Montgomery, & itbeen isRyan-Wenger, difficult widely 1994;torecognized determine 1991). Kaiser, as 1992;to a whatpsychosomatic Wright extent & the Wright, responsephysical 1992; to relationships,statusexperience.someailments extent and described otherIn the alcohol Chapter outcomes aspects here and 9, are thedrug ofof psychosomatic, relationship students'certain use, physical stresses lives between theyexercise that(parent do generalyoung represent and and schoolpeople health peer to experiencetheirInexperience) this general chapter, is discussed. ishealth considered.how andyoung The the peopleextentspecific toview types which themselves of they physical use both medicationailments in terms they of 136 theirhowimportantto treat theyresponses the interpretto symptoms keep to in thevarious mind relevant of thathealth-relatedthese thequestionnaire ailments vocabulary terms is items.also of strongly young examined. peopleinfluences It and is 137 59 Respondents11 Genera° gave heaDth an indication of their perception of their general FigureareStudents 5.1 more wholikely feel to healthy Factors associated with feeling healthy 11 year olds M F 13 year olds M F 15 year olds M F CHAPTERSPhysicalGeneral Health,Ailments and dimensionfeelnothealth verytired by healthy.whendescribing to this you summaryResponses go themselves to school measure to the asin very thequestionof health. morning?" healthy, "How quite added often healthy anotherdo you or BeFeel well confidenthappy integrated socially 0 0 0 0 0 0 Medication Use ofstatement,The positive findings "a factors soundpresented are mind associated in resides Figure in with 5.1 a sound feelingmake body". a healthy,good An case abundanceincluding for the NotlooksBe satisfied befeel irritable depressed with their 0 0 0 0 0 0 appearance.depressed,beingfeeling irritable.happy Withdo and not Mostthe confident, feelexception young helpless being ofpeople 11- well-integrated and and who are 15-year-old feelsatisfied healthy socially boys, with are andhealthy their not BelieveNot havefeel family helpless headaches is well off 0 0 0 00 0 0 0 0 0 girlswithattitudestudents and13 towardtendyear 15 year notolds, school, toolds thathave do achieve their headaches.not experiencefamily well Elevenacademically is well dizziness. year off. olds Thirteen-year-old and Regular have believe, a exercise positive along ExercisetowardHave a schoolpositive regularly attitude 0 0 Q0 0 0 0 0 0 boys.is associated with feeling healthy for 15 year olds, especially the AchieveCorrelationNot havefeel well dizzy stomachaches at school coefficient: 0 .15 to .19 0 .20 to .29 0 0 0 0 .30 to .39 0 0 0 60 CHAPTERGeneral 5Health, proportionsAlthough few of students students considered who described themselves themselves not very as very healthy, healthy the theyIt is togo be to expectedschool in that the morning.students will However, occasionally chronic feel tiredness tired when may Physical Ailments and Medication Use easterninespeciallyvaried Northern widely European boys, Ireland from were countries country were highly theto positivecountry least positive. (Figureabout their 5.2). Students health Swedish fromwhile students, manythose Estonia, Hungary, Latvia, Lithuania, relatebeactivities.in aan wellconstant indication to Being others state of physically orphysicalof notfatigue feel or tired may likeemotional in notbeing the perform morning distress.part of well extracurricular Studentsmay in resultschool, who from not are tosuchcountriesPoland feel disparate very and to healthy.Russiafeel locations very were healthy. as less Austria, likely Conversely, France, than students moreIsrael ofand from the Spain studentsmost tended other in arethefromphysical proportionscompared mental causes distress, with of students those anxiety who who haveor frequently depression. difficulty feel Latergetting tired in in to thisthe sleep. morningchapter, hunger, a poor night's sleep, lack of exercise or SpaintwoveryOverall, older healthy, and groupsSweden, boys but were ofthis for respondents. moredifference example, likely were wasEleven-year-oldthan moreequally girls pronouncedto likelyindicate boys to feelthat and among healthy;they girls thewere in thanveryhowever,15-year-old girlshealthy. substantiallysaid In boysthey Canada, wereexpressed more sixvery percentof thishealthy, the view. 15-year-old more but of22 the percent boys 11-year-old than more girls of boys thefelt felt.saysurveyedAge In they as the well feltmajority were as very gender more healthy. of countries,appearedlikely It shouldthan to the influenceboth beyoungest notedgroups how that groupof healthy byolder age of the students students15, students only toin supportedmoreonlySweden four than did countries by 50 more other percent than health of50 boysresearchpercent feel of(Connelly very girls healthy. feel et very al., This 1993).healthy finding and isin France, Israel, Sweden and Switzerland did Figure 5.2 Students who felt very healthy (%) 61 N. Ireland 11 year olds 2316 EstoniaN. Ireland 13 year olds 2015 9 HungaryN. Ireland 15 year olds 191617 8 GeneralCHAPTERSPhysical Health, Ailments and PolandEstoniaScotland 312622 HungaryScotland P!=:1 ==1 25221911 EstoniaPoland 25241310 Medication Use WalesHungary 31303319 WalesPoland 27311914 Russia*Scotland 292814 9 Russia*Latvia 38233428 LithuaniaRussia* !T!=1 352034 WalesGreenland 31292413 Denmark 40363933 LatviaGreenland P=1F=:] 243637 CzechLatvia Rep. T==1 25323217 BelgiumCzech Rep. Fl. 3945384235 NorwayDenmark 42283829 BelgiumLithuania Fl. FT!= 20343318 FinlandCanada 47414635 CzechCanada Rep. 31423029 CanadaNorway 22383616 Germany*Norway 484149 Germany*BelgiumFinland Fl. 43422832 SlovakiaDenmarkGermany* 402328 BelgiumSwitzerlandSlovakia Fr. 53494451 BelgiumSlovakia Fr. 4450454634 AustriaBelgium Fr. 4640374632 GreenlandSpainAustria 51555657 SpainSwitzerlandAustria 45554254 IsraelSpainFinland 3347364637 IsraelFrance* 596253 France*Israel 48614456 France*Switzerland 55405440 Female Sweden 1 6965 Sweden 6661 Sweden 5857 Male * France, Germany and Russia are represented only by regions: seetliapler 1 for details. 142 70 71 , 143I 73 CHAPTERS 62 Figure 5.3 lists the main factors that are correlated with feeling Figure 5.3 Factors associated with feeling tired in the morning Physical Ailments and General Health,Medication Use morningschooltired in whichthe because, morning. may suggestfor Significantly them, that attending some there young schoolis a relationshippeople is stressful. feel withtired As likingin one the Feel depressedtheStudents morning who areare moreoften tiredlikely in to 11 year oldsOM OF 13 year olds0M 0F 15 year olds0M 0F suchanddifficultymight irritability. as expect headaches, sleeping feeling It is anddizziness, tiredalso the associatedin mentalthe stomachaches morning health with is physical directlyproblems and backaches. relatedhealth of depression problemsto having Older NotsleepHaveBe irritable like difficulty school getting to O OO 0 0 0 0 indrunk.youth the morning whoFor 11feel year and tired olds,feeling in thethere unhappy morning is a relationship and are feeling more between likely like an to feelingoutsider. have beentired FeelHave dizzy headachesstomachaches O O 0 0 0 0 5.4).frequentlyNorwegians)Austrian, Students Israelifeel studentsin tired Greenland, and in Scandinavianthewere mornings Latvia, more likely Lithuania, on (especially school than Polandother days 15-year-old (seestudents and Figure Spain to FeelHave nervousstressed backaches at school O O 0 0 0 0 4 andrangewere 34 theof percent responses least likelyfor 11from toyear feellowest olds tired andto fourhighest between or morewas 3 andsubstantial, times 50 percenta week. between for The Havewith their beenpoor parentscommunicationdrunk 0 -0 0- 0 0 weretheGenerally15 differences yearmore olds. morelikely inboys to their report than responses feelinggirls felt tiredwere tired when not at schoollarge. they went Olderfrequently, to students school. but CorrelationFeelBe unhappy like an coefficient: outsider 0 .15 to .19 0 0 0 .20 to .29 63 NorwayFigure 5.4 Students who 11felt year tired olds four or more times a week in the morning when they go to school* (%) 3432 Norway 13 year olds 4036 Norway 15 year olds 5047 PhysicalGeneralCHAPTER Health,Ailments 5 and DenmarkAustria 25212927 FinlandAustria 33263432 AustriaSweden 373829 Medication Use IsraelFinland 24251617 SwedenDenmark 32223118 DenmarkFinland 32253.534 Germany*N. Ireland * 232415 Germany**Israel 26242822 IsraelGermany* * 29282928 ScotlandBelgium Fr. 23212015 N. BelgiumIreland Fr. 24252620 N.Canada Ireland 292627 CanadaEstonia 18151916 ScotlandCanada 2321 BelgiumWales Fr. 282530 HungaryWales 1716 France**Wales 2321 1815 ScotlandBelgium Fl. 27292116 Russia**Sweden 16141513 BelgiumEstonia H. 1617 8 SlovakiaHungary fJ 20231918 Slovakia 1511 Hungary 1516 Estonia _ 1 1915 France** 1113 8 Slovakia 1511 9 France**Czech Rep. 111915 CzechBelgium Rep. Fl. 11 7 Russia**Czech Rep. H 131116 Russia** 141516 9 Latvia H 976 SpainGreenland II 10 86 SpainGreenland 121014 GreenlandSpain 567 Poland 784 Latvia 576 LithuaniaPoland 54 LithuaniaLatvia LJ 56 LithuaniaPoland H 753 MaleFemale *** France, Germany and Russia are representedSwitzerland only didby regions:not include see' this Chdpler item. 1 for details. 146 E e, 147 64 CHAPTERGeneral Health, 5 C. Health problems likelysuffer to fromfeel healthy headaches and alsoare oftenappear tired to be in unhappy.the morning. The Girlsrelationship who Physical Ailments and Medication Use badvariousordizzinessHealth induced mood problems, aches or and/or byinsomnia, and stress. suchfeelingpains amongThe as and headaches,nervousfrequency otheradolescents conditions, or withstomachaches,dizzy, can which beare such of useful studentsorganic as backaches, being general origin have in a withproblemsthat the lonelinesstheir loneliness arepeers. preventing is isworrisome contributing some and young to ambiguous: health people problems from it may fullyand/or indicate integrating the healtheither onceconditionsStudentsindicators a week; during wereof about students' theasked once previous physical howevery oftensix week; and months: theyemotional about had most once experiencedhealth. days; every more month; thanthese betweencountriesinFrequent several headaches20 betweencountries and 30 were30 percent(Figure and reported 40 of5.6). percent 11-year-old by In a more high of 11-year-old proportionthan boys one-half said of girlsthey students of andhadthe respondentsproblemsageand groupseldom whois or presentedwho never.reported indicated The thatand, proportion they theyin a frequently laterhad of taken section,males experience medication and the females proportion these for in healththese each of stable.boysandcountries,headaches 15 the Studentsin figures theexcept onceproportion werein Estonia, a Canada, week either of or there lowergirlsFinland, more waswho by in ageantheIsrael, experienced increase 15previous orNorthern remained between sixheadaches. months.Ireland relatively age andInFor11 all HeadachesI.problems are within a common the last complaint month.Headache of young people in many parts SwedenFigure 5.5were more likely than those in other countries to have Factors associated with having headaches controversyheadachesof 1993).the world Research tends over (Tynjala to the focusinto incidence et the onal., occurrencemigraine 1993; of tension Kristjansdottier headaches of headaches childhood and among& thereand Wahlberg, adolescent is young some Have likelyheadachesstomachachesStudents are who more often have to 11 year olds M F 13 year olds M F 15 year olds M F aspectsoflowpeople. headaches level Eyeof of a youngstrain,physical in young changesperson's activity people. inlife haveFrequentweather, and been he orallergies,headaches associated she may depression can respondwith affect the by onsetmanyand not a HaveBeFeel depressed dizzy backaches 0 0 0 0 00 0 0 Althoughcompleting(Montgomery, survey school 1994;data work do Kaiser, not or indicate 1992;avoiding Labbe, a direct challenging 1988). link to poor activities school sleepHaveFeelBe irritable nervous difficulty getting to 0 0 0 0 00 0 0 Figuresuchheadachesperformance, as 5.5). stomachaches, are These they also symptoms showmore backaches, thatlikely are the likelyto young nervousnesshave to otherpeoplehave aphysical and negativewho dizziness complain problemsinfluence (see of FeelNotBe tired feellonely inhealthy the morning 00 0 0 0 00 0 0 0 0 0 toon beachievement depressed148 and motivation.irritable. It isSuch not studentssurprising are that also they more-n are likely less CorrelationNot feel happy coefficient: 0 149 .15 to .19 0 0 0 0 .20 to .29 0 .30 to .39 0 0 0 0 Figure 5.6 Students who had a headache once a week or more during the previous six months* (%) CHAPTER65 LithuaniaSlovakia 11 year olds 244030 IsraelCanada 13 year olds 422741 CanadaIsrael 15 year olds 27493053 GeneralMedicationPhysical Health, Ailments Use and IsraelN. Ireland 27393238 FinlandN. Ireland 2641 N.Sweden Ireland 25442747 CanadaRussia** Arrf.MtV:..-11.7;rmtorog. '.,Ta74-ttIMMX 28263738 LithuaniaSweden 27402541 ScotlandFinland 4422 BelgiumWales Fr. 28263536 Russia**Wales 39254019 BelgiumLithuania Fr. 41422522 EstoniaFinland w.,01xviatk) 22332335 SlovakiaBelgium Fr. 213623 SlovakiaWales 412022 HungarySweden iwt,t7-,,m7rizvam. 22312332 HungaryScotland 21342635 Russia**Hungary 411919 PolandGermany* * fre;,1.ftt- 29301416 France**Estonia 23203133 France**Austria 373819 LatviaAustria Prr.*L-177,;2rikette 281819 AustriaSwitzerland 192921 LatviaPoland 333614 ScotlandDenmark 22272818 DenmarkLatvia 281617 DenmarkGreenland 33163212 BelgiumFrance** Fl. or4"41Rt,.. 262118 BelgiumGermany** Fl. 26281815 EstoniaGermany** 32193116 SwitzerlandNorway 21231914 NorwayPoland 21261614 BelgiumNorway Fl. 31162717 El Female Greenland* Czech Republic and Spain did not include this item. mroPtfol 15 Greenland 2012 Switzerland 1423 0 Male ** France, Germany and Russia are represented only by regions: see Chapter Ifor details. 150 , 151 66 Physical Ailments and CHAPTERGeneral Health, responsesasheadaches boys to wasfrequently. report also frequent greater In many for headaches countries,girls than by girlsfor age boys. were 15. twiceThe rangeas likely of Medication Use foundRecurring2. Stomachache to be abdominal a psychosomatic pain among response young topeople stress has (Sharrer frequently & Ryan- been metthanLowerWenger, orwas exceededpercentages 1991).the case 25 for percentof headaches students in 11 (Figurereported countries 5.7). frequent for For 11 girls, year stomachaches proportions olds, in 10 girlswithmightcountries experiencingmenstrual be thatfor 13for cramps.year some stomachaches olds adolescent The and decreasein five may girls countries be instomachache becausethe proportion for their15 wasyear menstrual ofequated olds. older It percent.Forcycle11-year-old the is most moreThere part, established. boyswas few no in clearboysthree complainedregional countries pattern did of thestomachaches. to proportionthe countries exceedOnly where for 25 headaches.intoCanadian,stomachaches haveIsrael stomachaches and Israeli Stomachaches Canada were and Slovakian theatwere all most agealsowere levels.studentsor among least least As frequent were prevalent.those noted among most previously, in BelgiumBelgian thelikely most studentsto (Fr.),likely (Fl.),have speakingheadache(Fl.),Denmark, Denmark andGreenlanditem. Flemish-speaking andInterestingly, Greenlandand Russia. Belgian Threecommunities of students these werecountries from at the extremeFrench- also ranked low on the frequent Belgium differencewereInends every frommore country between eachlikely other thanexcept girls on boys andthisGreenland to boysmeasure. report in theirand frequent in responses each stomachaches. age varied group, widely girls The 152 withwasby country. inagestomachaches Wales fqr Theboth for greatestgirls11 tendedyear and oldsdifference boys to decline(15%). in almost between Theor remainevery proportions males country. relatively and of studentsfemales stable 153 67 Figure 5.7 Students who11 had year a stomachache olds once a week or more during the previous six months* (%) J 38 13 year olds 35 15 year olds 31 GeneralCHAPTER Health, s Belgium Fr. 3526 Belgium Fr. 2921 Belgium Fr. 2919 1 Physical Ailments and IsraelSlovakia j 34273 4 CanadaIsrael 28292418 CanadaIsrael 26272117 Medication Use Canada *1 1 3324 France** 16 Sweden 15 N.Wales Ireland 203218 N. Ireland 262716 Slovakia I 231525 Slovakia 18 1 1 France** 14 3218 2614 1T 2313 Estonia Sweden Finland 1-1 1 29 26 1 22 LithuaniaFrance** 281517 Lithuania 251713 Lithuania I I 221010 Estonia Wales *r i 1 Latvia 2715 Finland 2516 I 1 Latvia I- 1-1 fI 1 29 Finland 25 15 Scotland 2418 1 21 10 J Scotland 1 1524 Switzerland 23 I 1 18 1 16 Estonia 13 Hungary 1 Norway 1 2415 Wales 2314 I 1 1018 1 Norway 1 Scotland 2317 Latvia 2010 I 1 18 9 1 Austria f--1 1 1 Poland 2312 Germany** 19 7 188 Switzerland I 2312 1 1318 N.Germany** Ireland I 1-1 1417 Germany** 221 1 PolandNorway 18 7 I 1 I 1117 Sweden 2118 17 SwitzerlandHungary I 1 I 17 8 Hungary 1 12 Denmark Fl I 2013 Denmark 17 7 Denmark I 1 1 15 5 Austria 1 1117 1 16 8 I 1114 1 Russia** Russia** I 1 16 I I 1 15 13 GreenlandRussia** 111312 AustriaBelgium Fl. 1210 8 BelgiumPoland Fl. I 1-1 H 11 86 *Belgium FL Czech Republic and Spain did not include this item. H fj 12 9 Greenland 7 Greenland EILfi 57 MaleFemale ** France, Germany and Russia are represented only by regions: see Chapter 1 for details. , 154 155 68 Physical Ailments and CHAPTERGeneral 5Health, 3.Having a backache is typically Backacheregarded as a common physical Medication Use atstomachacheslessailment least bothered ofone older of the people.by agebackaches Younggroups people surveyed, than in by this reportedeither survey headaches did backaches seem to beorat but, in 13 countries, one-fifth or more of students, in frequent(Fr.),Asleast was weekly. Canada true backaches for and headaches Slovakia (Figure and 5.8). were stomachaches, Denmark the most and likely students France to complain alsoin Belgium tended of Thebackaches.Scotlandto rank incidence high. were Students of consistently backaches from Latvia, was among similar Lithuania, the for least malesPoland, likely and Russia, to females report and backaches.Inhadoracross Greenland,more suffered age girls groups backaches thantwice boyswith as many onceain few Hungary, boysa exceptionsweek as orgirls,Latvia more at28 and age into the14 Slovakia15. percent,past Seven six said months.reportedpercent they andthanAlso,(17%) Germany11 fifteen year and oldsyearAustria (both witholds 13%). (13%) thewere largest andmore for increaseslikely boys to in havebeing Greenland frequent for girls (14%), backachesin Canada Canada 156 157 Figure 5.8 Students who11 hadyear a oldsbackache once a week or more during the previous six months* (%) 13 year olds 15 year olds GeneralCHAPTERS69 Health, BelgiumSlovakia Fr. rrAimp: 20161918 CanadaBelgium Fr. MOW 232227 BelgiumCanada Fr. 273033 MedicationPhysical Ailments Use and DenmarkCanada 161417 SwitzerlandSlovakia 20142221 France**Slovakia 2523272230 IsraelFrance** 131512 France**Denmark 2018 AustriaDenmark 2321 Germany**Hungary 1213 89 IsraelGermany** 171914 SwedenGermany** 22232118 GreenlandSweden 1014 9 AustriaSweden 151613 IsraelHungary 1111.0111111MWEIRI 202115 BelgiumAustria H. 1011 8 WalesHungary 15141810 SwitzerlandBelgium Fl. 1918 EstoniaNorway 10 948 FinlandGreenland 13111416 WalesNorway 1517 WalesSwitzerland 1213 9 NorwayBelgium H. 121314 LatviaFinland 141517 7 PolandLithuania 938 Russia**Lithuania 1210 7 EstoniaGreenland I. 1428 FinlandRussia** 978 EstoniaScotland 1113 9 Russia**Scotland 1413 7 LatviaScbtland 678 LatviaPoland 87 PolandLithuania 1111 EliFemale *** France, Germany and Russia are representedCzech Republic, only by regions:Northern see Ireland Chapter and ISpain for details. did not include this item. 5 8 DMale 70 Physical Ailments and CHAPTERSGeneral Health, Significant4. Difficulty cultural getting differences to sleep in the sleeping habits of young people FigureStudents 5.9 who often have difficulty Factorssleep associated with having difficulty getting to 11 year olds 13 year olds 15 year olds Medication Use agetooproportionwere littlegroups. found sleep of Studentsin participants varied the 1990 significantlywho HBSC reporting have sleeping survey among trouble (Tynjala difficultiescountries falling etasleep as onceal., well 1993). and aas week amonggetting The or Feel depresseddizzylikelygetting to to sleep are more M F M F M F andinmore 1992).their is mayviewed social Insomnia be reactingasrelationships a responseis also to problemslinked atto homethe to psychological distress in or different at school over areasschool-related distress(Wright of thattheir & Wright, results. lives,matters BeFeel irritabletired nervous in the morning O 0 0 0 0 0 isproblemsFigure affected 5.9 for byindicates thea different respondents some combination of inthe this factors survey. of factors. associated Of Physicalcourse, with each problems, sleeping child Have backachesheadachesstomachaches O 0 0 0 0 0 getorNervousness suchthey enough may as sleepheadaches resultand aredepression from more lackand likely mayof backaches, sleep. tobe be causes Certainlyirritable. ofinterfere sleeping Foryouth some whowithdifficulties students do sleep. not Feel lonelyhelplessleft out of things O 0 00 0 0 0 0 SubstantialTheseproblemsloneliness problem are may proportions clearly areas be the linkedrequire primary of students to further poor cause in communicationanalysis. Canada, France with and parents. Wales for some girls, sleeping CorrelationBewithHave unhappy parents poor communicationcoefficient: 0 .15 to .19 0 .20 to .29 0 .30 to .39 0 0 0 0 00 sleepingHungary,gettingofreported girls toin frequent acrossLithuania sleepthese atthecountries sleeping least andthree Polandonce age difficultiesand agroups. wereweek.nearly the (Figure Studentsas least many likely 5.10): fromboys to over Belgiumhadhave 40 difficulty difficulty percent (Fl.), weresleep.agenumbers far 11 moreto of age the likely 15. other The than countries exception 15 year increased wasolds Denmark to orhave decreased trouble where slightly11getting year fromoldsto andsomethereMore 13 weregirlshigher percent than not ranking werelargeboys reportedcommon.differences countries, difficulty Only between where in gettingIsrael differences their did to responses sleep,slightly of but betweenmore generally,except boys in7 rankedBelgiumIn sleepinggeneral, among (Fr.), substantiallythan the Denmark,felt top tired ten higher most Estonia,countries daysproportions Northern(Figure on both of 5.4). questions;studentsIreland Among and had for11 Scotlanddifficulty 15year year olds, 16 studentssleepingTherethan girls was difficulties remainedfind no itclear difficult about withpattern to age.the sleep of sameIn either nineat allfrom countries,anage increaseage levels. to theage; or proportions aboutdecrease equal inof weekandPolandamongolds, the those or tendedthe least more topfrom likely tooften.ten. Canada,be Students amongto experience Northern the from least Greenland, difficulty Ireland,likely to Sweden feel getting Lithuania, tired and to in sleeptheWales Latvia morning once were and a 161 71 Figure 5.10 Students11 year who olds had difficulty getting to sleep once a week or more during the previous six months* (%) 44 13 year olds 42 15 year olds 44 GeneralCHAPTER Health, 5 CanadaDenmark 1 39 424143 CanadaFrance** 423435 CanadaWales 42344437 MedicationPhysical Ailments Use and WalesFrance** 41334239 WalesSwitzerland 413930 SwedenFrance** 403632 BelgiumRussia** Fr. 3832 N. BelgiumIreland Fr. 37273835 N.Slovakia Ireland 393432 EstoniaScotland 372938 SlovakiaEstonia 372629 ScotlandBelgium Fr. 29383135 N.Sweden Ireland 343835 SwedenRussia** 35323624 EstoniaSwitzerland 22322934 NorwaySlovakia 31263433 ScotlandDenmark 322733 IsraelRussia** 30333125 Germany**Switzerland 28243029 FinlandGermany** 28293023 DenmarkGermany** 29243027 FinlandIsraelAustria 263124 AustriaIsraelNorway 25312728 FinlandNorwayAustria 27212922 Latvia 222528 Latvia 1 252418 Greenland 3125 Lithuania 232224 Greenland 1 212422 Latvia 24251915 PolandHungary 202219 PolandLithuania 201517 LithuaniaPoland 1 H 2215 BelgiumGreenland Fl. 20171519 BelgiumHungary Fl. 13141618 BelgiumHungary Fl. 201217 0 FemaleMale *** France, Germany and Russia are representedCzech Republic only by andregions: Spain see did Chapter not include 1 for this details. item. 162 163 CHAPTER 5 72 5. Being in a bad mood (irritable) Physical Ailments and GeneralMedication Health, Use teenagersPerhaps one is the of frequent the most mood widely swings recognized they experience. characteristics As Figure of exceedorthe5.11 girls adolescent shows, one-half who irritability indicated participants in 10 countries seemed they in werethis forto survey.be 11irritable a year frequent Proportions olds, once occurrence11 a countries week of boys or among formore and/ 13 wereInmostEstonian,year the olds likely also13- andIsraeli and amongto 15 say15-year-old andcountries they the Slovakian weremost for groups, in likely 15 studentsa badyear Lithuanian to mood olds. bein allirritable. once age and agroups week Russian Students orwere more. girls the in onceandGreenland, Switzerland a week especially or more. were 11among and 13the year least olds, likely Belgium to be in (Fl.), a bad Austria mood > Latvia,largerOverall,11-year-old gender Lithuaniagirls differences were girls andmore and Russia. onboyslikely this in item toThere France, report among was being but all no a age irritable.difference15 groupspercent There in betweendifference Estonia, were In most countries, 15 year olds were more likely than students in Lithuania thethanreversedbetween past girls six 15 theindicating months.year pattern olds theyto in any thathad extent, country.been irritablewith Only eight at 11 least percent year once olds more a in week Israel boys in anditdifferenceother is girlslarger age in groupsisfor Belgium very girls slightto in be(Fr.) France inin andCanada,a bad andHungary. mood Greenland Denmark, once Norwayaand week among orand more. both Scotland; boysThe 164 185 73 FigureSlovakia 5.11 Students who11 wereyear inolds a bad mood (irritable) once a week or more during 5765 Slovakia 13 year olds the6171 previous six months* (%) Slovakia 15 year olds 6274 CHAPTERSPhysicalGeneral Health,Ailments and IsraelEstonia 64564959 Russia**Estonia laaatamakatts...,-a..dr-J 43645067 EstoniaLithuania 49675771 Medication Use FinlandN. Ireland 51555856 IsraelN. Ireland 63626563 LatviaIsrael 53656466 DenmarkCanada HaateAt.Oneassewerricatemeivaaletead 4653 LithuaniaFinland 476255 SwedenRussia** 53476562 LatviaLithuania 40345253 SwedenLatvia 49573761 FinlandN. Ireland . 47586159 SwedenRussia** 42483951 DenmarkCanada 46515356 CanadaBelgium Fr. 51554757 NorwayScotland 344446 BelgiumScotland Fr. 4838 France**Hungary 405544 PolandWales 32403942 France**Norway 414546 PolandDenmark r--1 48523650 BelgiumGermany** Fr. 111111a1=111111111P 363239 PolandGermany* * 374538 NorwayWales 47394743 AustriaFrance** 30293334 HungaryWales 444536 Germany*Scotland * 374649 BelgiumHungary Fl. 222324 GreenlandAustria 24323336 AustriaGreenland 34412742 SwitzerlandGreenland 21202219 BelgiumSwitzerland Fl. 22272129 SwitzerlandBelgium Fl. 1-1 --"rj 233014 MaleFemale *** France, Germany and Russia are representedCzech Republic only byand regions: Spain did see not Chapter include 1 this for item. details. 166 H 167 74 Physical Ailments and CHAPTERSGeneral Health, The6. students were asked to indicate howNervousness often they and felt dizziness nervous responsesthan in any for other males country. in all age For groups all the isother 5 percent countries, to 24 the percent; range forof Medication Use differentlyappearstomachache,(uneasy) as vague across and symptoms.nervousness dizzy.cultures Unlike and As and,a well,cautious such to thea lesserailments approachterms extent, may asshould be headachedizziness understood be taken often and withoncedisorders,females Estonia, a week. it girlsis Canada, 10Generally, were percent moreIsrael, tothe likely 32Northern differences percent. than Ireland boys Similar were toand feelnot Walesto dizzygreat.other tended atAlonghealth least to respondentsnervousnessato sensenational of comparative uneasiness may by thoseconsider data. which who Tension,dizziness experiencemay orstrain the may orvague it. notworry In be feelinga usually similarreferred of produce light-way, to as andcountriesThererank no was clearamong where not overall thea greatstudents top pattern countriesdeal responded ofin theconsistency on responses this most measure. acrosspositively of students age onlevels of this different in item the wasThesevereheadedness quiteproportion forms high associated of in ofdisorientation somestudents withcountries. who hunger such said In as or Israel,they vertigo. lack frequently ofPoland sleep and or feel only Slovakia, nervous more frequentlyboys,toages. 15 year In12 some for olds, felt girls), countries, dizzymainly the were for proportionsthere girls.within was In three thea steadyof majority percentage 11 andincrease of 15 countries points.year from olds 11Finnish (15 towho for13 more.ofweekhigh males proportions orIn moreDenmark,and /or (Figure females of Greenland, students 5.12). said In acrossthey Norway many had age countries, feltand levels nervous Scotland felt one-third oncenervous less athan orweek once more one- or a responsesandgirls' 15 responses were consistentlyshowed the greatestlow across difference age groups. between ages 11 from 13 percent to 24 percent. Only the Belgium (Fr.) feelAsquarter13 with nervous and ofother 15 students yearonce health olds.a reported weekproblems Among or nervousnessmore. described, 11 yearThis olds was girlsweekly inconsistently were six or ofmore more the likely countries,trueoften. for to FeelingtheBelgiumboys differences werenervous [Fr.], more were increased Denmark, likely very thanfromsmall. Finland, girlsage 11 to France tofeel 15 nervous inand most Israel), countries.(Belgium but overall The[Fl.], Althoughandrange11 8 to ofto 60 responses73 feelingpercent percent isfordizzy for consistently 11 15 yearis year not olds; olds. a wide major 14 withinto health68 percent each problem age for group, 13 amongyear from olds thatpercentcountries.adolescents, they of felt Ingirls dizzyEstonia, it and does once one-third aseem avery week to largeof orbe the more. proportiona boys cause This at forall is of age substantiallyconcern students levels) in (overreported highersome 40168 169 Figure 5.12 Students who felt nervous once a week or more during the previous six months* (%) 75 Slovakia 11 year olds Hehazedeatil. liftelesiONSSEMItGri 5460 Slovakia 13 year olds 5368 Slovakia 15 year olds 5773 GeneralCHAPTER Health, 5 Israel 506053 Poland Herania.utsakates...mare..brattrzi- 595162 Poland 1...ialsbardIMINN10011.....samizavirailseetell-1kfmraMiatiobiumersuressex.....-1--1 665169 PhysicalMedication Ailments Use and Russia**Poland 42444127 HungaryIsrael 51445460 HungaryIsrael 49616359 LithuaniaN. Ireland 41423235 Russia**Lithuania 50315137 LithuaniaBelgium Fr. 55395751 HungaryCanada 38373934 N.Estonia Ireland 48374933 EstoniaFrance** 415445 BelgiumEstonia Fr. 35413732 CanadaBelgium Fr. 3945 LatviaRussia** 48315334 WalesFinland 344129 France**Sweden 40383441 CanadaFinlandSweden 433747 LatviaBelgium Fl. 29223336 BelgiumFinlandLatvia Fl. 40413933 BelgiumN. Ireland Fl. 363443 AustriaScotland 292829 WalesScotland 35293721 ScotlandAustria 28362936 France**Sweden 233127 Austria 313033 WalesGermany* * 273133 Germany**Switzerland 222312 DenmarkGermany* * 23202422 NorwayGreenland 22232417 NorwayDenmark 13242017 SwitzerlandNorway 232017 Denmark 20171616 *Greenland Czech Republic and Spain did not include this item. 11 Greenland 1814 Switzerland 8 MaleFemale ** France, Germany and Russia are represented only by regions: see Chapter 1 for details. 170 t 171 76 Physical Ailments and CHAPTERGeneral 5Health, TheD. Use use of of medication medication by students for the various physical ailments studentscountries. in allOne age major groups anomaly indicated was they Slovakia took medication, where the but fewest where Medication Use adultcountriestodescribed note population that mayin thethe influence towardscostprevious and medicationits availabilitysection use. As is couldwell,considered of medicationthehave general a here. bearing Itattitudein is individualon important whether of the boys.Usingthe13 mostThis and headache was 1115 year yeartrue medicationolds oldsin all indicated were countries in was the they moreat middle allsuffered agecommon ranges. levels from among except headaches. girls among thanThe thethe-countersurveyor not latter students question that (OTC) are choose did referred drugs, not to distinguish take we to assumebypills the or between respondents. otherthat in medicine. mostprescription of the Although cases, and over- itthe is particularlytheproportions previous11 year ofamong month.olds boys in female andMedicationGreenland girls students; had andusage taken Switzerland,the tended medicine greatest to increase increasefor where a headache withalmostoccurred age, inequal manyavailableAdvertisementsI. Headache countries, OTC medication headache drugs. for OTC Amongpills headache are theprobably top medications countries one of the arein moststudent pervasive. readily use Inof between 11 and 13 years of age. countries.Swedenallheadache age groups also medicationIt is tended (Figureinteresting towere 5.13). be to amongCanada, note Belgium that the Northern among top(Fr.), third France, Irelandsome of high of Scotlandand the utilization Wales high-use and in YoungFrance.Unitedcountries, people Kingdom there in areall countries threecommon age andgroupscultural Canada, were roots, consistently and for Belgiumexample, less (Fr.) thelikely three and to medicationThereGreenland,take medication was, asHungary,and expected, frequency in PolandAustria, a relationship of andheadaches. the Slovakia. Czech between For Republic, each the age use group, ofGermany, headache more studentsheadaches.thethan top one-half 10 at amongeach Canada, of theage countries countries wereBelgium among where in (Fr.), the the respondents top Northern10 10highest on thisIreland reportedranking item and are countries frequent alsoWales in 172 eightForconsistentlyon the bothin 13 the andmeasures. higher 15within year ranking Only theolds lowest Austria,overall, countries 10 14Greenland ranking countriesand six countries (girls)in showed the lowerand for consistency, Poland both ranking items. were 173 Figure 5.13 Students11 who year took olds medicine or pills for a headache during the previous month (%) 13 year olds 15 year olds CHAPTERS77 CanadaBelgium Fr. 41463648 N.Canada Ireland 41446158 CanadaWales 166 4447 MedicationPhysicalGeneral Health,Ailments Use and WalesN. Ireland 34433745 WalesSweden 47385457 N.Scotland Ireland 40606438 ScotlandFrance* 3442 BelgiumScotland Fr. 38503653 SwedenFrance* 39583459 SpainSweden 33383440 France*Finland 364737 FinlandBelgium Fr. 33563957 BelgiumLithuania H. 32372838 IsraelBelgium H. 324233 IsraelDenmark 48303251 LatviaIsrael 26352937 DenmarkSpain 294042 NorwayBelgium H. 482947 EstoniaFinland 273430 Russia*Lithuania 21382839 SpainSwitzerland 23402946 Russia*Denmark 342619 NorwaySwitzerland 28263635 Germany*Lithuania 24372138 NorwaySwitzerland 21253029 LatviaGreenland 272231 AustriaRussia* 23363715 Germany*Poland 252019 Germany*Estonia 282429 LatviaPoland 36153616 Hungary 232518 Hungary 27152821 Greenland 263135 CzechGreenlandAustria Rep. 20232119 CzechPolandAustria Rep. 201725 CzechHungaryEstonia Rep. 24183119 Slovakia France, Germany and Russia are represented only by.regions: see Chapter 1 for details. 174 1319 Slovakia 131814 Slovakia 221214 X175 MaleFemale 78 Physical Ailments and CHAPTERGeneral Health, 5 As2. we have seen, stomachaches wereStomachache a less common medication health Medication Use menstrualcomplainedisespeciallyproblem difficult than olderpain. to of understand headaches stomachaches.Also,girls, didparents take thisfor maystomachyoungresponse Possibly have people, medication morebecausethey tookcontrolbut fewer some (Figuremedication over older students, 5.14).the girls use for It ThisreportedInof pillsthree was by countries,having trueyounger in taken nine children. more stomachcountries than medicationone-quarter for 13-year-old in of the 11-year-old previous girls and month. ingirls 16 Takingonlythatcountries they formedicine 11 hadfor year 15-year-oldtaken for olds stomachachesmedicine in Belgium girls. for The a (Fr.). wasstomachache proportion most common of exceeded boys inwho Belgium 25 reported percent reportalsowell(Fr.) frequent asmorein 13all andagelikely occurrences 15groups. thanyear oldsmostGirls, of thisin others there, Wales ailment. werein and their Students Northernalso age the groupsin most Ireland, France, likely to wereastake to OP' TheconsistentlyRepublic,stomachache relationship Germany, among medication.between the Greenland,least the likely. incidenceStudents Hungary offrom stomachaches and Austria, Sweden the and wereCzech the oforveryuse loweststomachaches. of little medication useconsistency of medication Only for betweenstomachaches the studentswith the those countries in is reportingFrench-speaking tenuous reporting similarat best. the incidence BelgiumThere highest is measures.stomachaches.reported both Greenlandic high medication students use were and at thehigh low incidence end on both of Sweden , 176 177 Figure 5.14 Students who took medicine or pills for a stomachache during the previous month (%) 79 Belgium Fr. 11 year olds 2736 Belgium Fr. 13 year olds 4222 Belgium Fr. 15 year olds 2150 GeneralCHAPTERPhysical Health, Ailments 5 and Latvia 273017 France* 3921 Wales I 150 45 15 Medication Use Lithuania 25 Wales 3217 France* I 421115 Spain 212522 N. Ireland 301716 N. Ireland 1 40 8 France* 24 Spain 1 29 Israel 1 40 8 Switzerland 2316 Canada 1 2713 Scotland 1 35 N.Estonia Ireland 22232118 IsraelScotland 27261011 DenmarkSwitzerland 3334 28 Canada 18 Switzerland Hi 16 Canada 1 1 11 2217 Lithuania 2415 Spain 1132 Scotland 21 1 Wales 211518 Poland 231224 Finland 3132 45 BelgiumPoland Fl. 1519 LatviaDenmark 2114 5 PolandNorway 1 29 8 Russia*Israel 10161317 EstoniaFinland 201619 7 LatviaLithuania 261011 GreenlandSlovakia 1613 8 SlovakiaBelgium Fl. 171319 9 EstoniaSweden 2226 84 Hungary 1013 79 Russia* 1516 9 BelgiumSlovakia Fl. 2119 9 FinlandGermany* 97 HungarySweden 15 56 Russia* 1610 8 Sweden 496 Norway 1415 74 Austria 1514 8.6 AustriaDenmark 878 Germany*Greenland 11 6 Germany*Hungary 14 7 NorwayCzech Rep. 7 CzechAustria Rep. 10 876 CzechGreenland Rep. 12 473 I=1 Female Male * France, Germany and Russia are represented only by regipns: see Chapter 1 for details. 178 . I, 179 CHAPTER 5 80 3. Medicine for difficulty getting to sleep Physical Ailments and General Health,Medication Use inBelgiummedicationFor each the agemost (Fr.), orgroup part,Russiapills to extremelyto takeand help Switzerlandmedicine them low sleep percentagesfor were (Figurethis among purpose, 5.15). of the students but, Studentsmost even likely took in Useboys)theseSwitzerland of countries,and medication in the was vastreported for itmajority above sleeping usage 15of countrieswasdifficultiespercent low. (17% itOnly wasby for allforbelow agegirls 11 fiveyeargroups and percent. olds 16% was in for difficulties.comparedGenerally,almost negligible verywith few inthe Austria, studentsproportion Finland, took who medicationHungary, reported Norway to somehelp and them sleeping Sweden. sleep declinedmedicationforBoys sleeping and fromgirls or problems. werepillsage 11 toalmost tohelp The 15. equallythem proportion sleep likely either of to youngreport remained takingpeople the medication who same took or ofthe Very4.11-year-old highest few proportion students boys reported andbeing girls 12 that percent.in they Estonia, take MedicineBetween medicine Lithuania, for10 andnervousnessfor Spain nervousness,12 percent and medicationAlthoughtheySwitzerland had taken the tended proportions along medicine to withdecrease for11-year-oldof students nervousness between who girls ages indicated inin 11 theLatvia and previous 15, thatand students theyRussia month. took saidin ofmedicinewhereincidencethe feeling above students for countriesofnervous usage.nervousness. often andremainedThere felt Estonian nervouswasSwiss among little studentsand and correlationthose Lithuanian those reportedwho where reportedbetween students a studentslow the countriesincidence were highest took in 180 girlsthanverythe than middle girlssmall, boys to range. buttaketo do there medicineGender so. was differences a for tendency nervousness in for the more use and of 11-year-oldmore medication 15-year-old boyswere 181 Figure 5.15 Students who took medicine or pills for difficulty getting to sleep during the previous month (%) 81 Switzerland 11 year olds 121617 Switzerland 13 year olds 698 Switzerland I 15 year olds Tj 65 PhysicalGeneralCHAPTER Health,Ailments 5 and EstoniaRussia* 11 89 France*Belgium Fr. 465 France*Belgium Fr. E:=1 46 Medication Use BelgiumGreenland Fr. 11 98 EstoniaRussia* [=1[7:=1 7546 Russia*Greenland EY=1 35 Latvia 78 Greenland IRMIRRIN 56 Canada [= H 52 Scotland Latvia 5 Lithuania 2 Canada 9687 Lithuania 45 Wales a-1 34 SpainLithuania 596 WalesSpain Ea3 45 SpainBelgium Fl. 3 N.France* Ireland 56 CzechCanada Rep. 3 EstoniaCzech Rep. 23 BelgiumWales Fl. 546 N.Denmark Ireland H 3 ScotlandLatvia 2323 PolandGermany* 54 SlovakiaScotland H 3 SlovakiaN. Ireland 42 4 22 23 SlovakiaCzech Rep. 34 BelgiumPoland Fl. 23 IsraelGermany* R 2 Denmark 4 Austria 12 Austria 2 1 Israel 42 Germany* 12 Poland 6-1 2 1 Hungary 23 Hungary 2 1 Denmark 2 1 Norway 23 Israel 2 Finland 9 1 Sweden 2 Finland Hungary 1 1 Austria 12 1 Norway Norway 9 1 Female Finland* France, Germany and Russia are 182 represent ed only by regions: 'see Chapter 1 for details.1 Sweden a. 4 Sweden 9 183 Male 82 CHAPTERGeneral 5Health, Overall,5. higher proportions, ranging Cough/coldfrom one-fifth medication to one-half, of E. Summary Physical Ailments and Medication Use Republic,stomachache.in studentsthe previous Polandhad Across monthtaken and medicineall thanWales age had groups, were fortaken coughs among students medicine and/orthe in mostto Canada, coldstreat likely headache (Figure the to Czech have 5.16) or emergesespeciallytheyHigh areproportions veryfrom girls. healthy.the In of fact,findings adolescents theMany overall is causeare in troubledportrait many for particular countries of by the physical health concern.do notof ailments, girls feel Boys that seasontheIsraeltaken survey thecold/cough for least coughs in thelikely. medicinewinterand All colds; of months, theand however, higher students generally ranked Denmark in Austria, countriesconsidered also Denmark administeredadministered to be andthe theirdizzinesslikelyhave physicala to more reportand positivesleeping aches health and perceptiondifficulties,problems pains. such of and their asto headaches, takehealth medication and stomachaches,girls or are pills more for coldsurveysmedicationthe survey medicine. in May, at was this but used. time, Spain Austria, as ranked did several Israel relatively andother Spainhigh countries on administered the usein which of cough/ their less problemstheyolderYounger go students. youngto students school. people Fewer tendAge report: 11alsoto yearfeel appears while moreolds feelyoungertopositive be tired associated aboutstudents in the their morningwith have health the fewer healthwhen than virtuallyamongcoughsThe proportions changedthe all oldestage groups veryof students students little and with all surveyedwho countries age; had percentages takenin more half medicine of thearethe girls slightlycountries. for had colds lower used orIn typeMedicationtendsymptoms toof getmedicine more for of headachesheadache, stomachaches. students and backache,use. coughs/colds Few studentsnervousness are take the or medicationmost dizziness, common for they countries.incold/cough only six countriesmedicine, andbut thein only difference one age was group more in than each 10 of percent those nervousnessstudentssymptomssleeping difficultiesreported does than not treated alwaysstomachaches, or nervousness.them mean with that medicine. studentsbackaches, The presence take dizzinessmedicine. of physical More and 184 185 Figure 5.16 Students who took medicine for coughs and/or colds during the previous month* (%) CHAPTER83 5 WalesCzech Rep. 11 year olds 535450 CzechWales Rep. 13 year olds 5257 WalesCzech Rep. 15 year olds Halosamilmile.magarmatashH 5350 GeneralMedicationPhysical Health, Ailments Use and CanadaScotland 504253 Canada 4149405043 Germany* * 45374647 BelgiumPoland Fr. 4849394346 SpainN.Poland Ireland 374742 SpainPolandCanada 34444036 BelgiumLithuania H. 474336 Germany*Belgium Fr. * 32443345 LithuaniaBelgium Fr. 43314139 EstoniaGermany** 414538 LithuaniaScotland 423744 N.Scotland Ireland 404135 LatviaSpain 43394438 HungaryBelgium H. 2638374036 HungaryBelgium Fl. 34373038 HungaryN. Ireland 404233 GreenlandSweden 373238 FinlandFrance** 31352636 France**Greenland 333837 LatviaFrance** 32352833 EstoniaSweden 27343035 SlovakiaSwedenRussia** 3531363237 Russia**FinlandEstonia 33313435 SlovakiaRussia**Latvia 332131 FinlandNorway 32332934 SlovakiaNorway 2930283125 AustriaNorway 2330243234 AustriaDenmark 25182326 DenmarkAustria 222619 DenmarkGreenland 20252617 Female Israel*** France, Germany and Russia are representedSwitzerland only did bynot regions:include this see item.Chapter 1 for details. 186 2319 Israel 2217 Israel 187 1918 Male CHAPTER

188 Sweden , 189 CHAPTER A. Introduction GoodA. Introduction health practices include not only those that contribute to B. Mental health 2.I. schosocialLonelinessHappiness Adjustment beingofphysical sound is closely well-being,emotional, linked socialbut with also andthe those qualitymental that ofhealth. facilitate social Psychological relationships the development youngwell- 5.4.3. Confidence Helplessness supportiveofpeople the critical are familyable components to and establish accepting of with sound and family mentalunderstanding members health are andfriends, a peers.caring both Two and of C. Peer relationships 2.I. Time spent with friends FriendshipsDepression (feeling low) goodofself-concept.which a young about contribute person. themselvesA good to It theself-image is alsodevelopment are true more contributes that likely young of self-esteem to to peopleexperience the healthy who and domaturation emotionala positivenot feel E.D. SummaryRelationships with parents2.I. Communicating with father Communicating with mother peopleparentsProblemsproblems. experience.and in friends establishing are Many among and studies maintainingthe most have common focused good relationships difficultieson the quality young with of theirinteraction.people.relationships,the parent-child peers Open may Young schoolcommunication be lonelyrelationship peopleexperience and who becomeis and the believeand risk-taking basis depressed,its they influencefor positive arebehaviours especiallynot onacceptedparent-child theof ifyoung peer they by questions:In(Ramsey,suffer this extreme chapter, 1994; forms weVara, attempt of 1994; exclusion toKafka provide such & London, asanswers bullying 1991). to andthe avoidancefollowing HowDoWhat they wellmuchis thefind do timemental ityoung easy do health theytopeople make spend status communicate friends with of the andtheir young to friends?with talk people theirto their parents? surveyed? friends? , 190 191 87 TheinfluencedB. mental health by all statusother areas of young of their people life: bothrelationships influences with and others, isMentz° heaDth Figure 6.1areStudents more wholikely are to happy Factors associated with happiness 11 year oldsM F 13 year olds M F 15 year olds M F PsychosocialCHAPTER Adjustment6 health:Foradjustment this how survey happy at schoolfive they items said and theythewere riskswere used theyand to how mayassess often take students' theywith felt their mentallonely, health. HaveFeelBe schoolwell healthy a positiveintegrated attitude socially toward O O O O O O helpless,TheI. Happiness concept confident of beingand depressed. "very happy about your life" captures the Not feelbe irritable nervousdepressed O O O O O O "Intheirthelevel general,most ownof contentment important personality how do youareas young and feel inphysical aboutpeople their yourlife feelcharacteristics. life?" when students they are To could satisfied the question,respond: with school, family, friends and parentsHaveFeel confident good communication with O O O O O O withabsenceHappiness,very life happy; ofas worry,a or whole quite subjective anxiety (Robinsonhappy; well-being,and not etdepression veryal., 1991). happy;is an and In attitude Figureaor general not suggesting6.1, happy satisfaction the factorsat all.the NotschoolSayBe feel satisfied parents helpless to talk arewith with willing their teachers appearance to come to O O 0 0 O 0 Satisfactionsuggestslisted.that are Good most that healthwith strongly health school and is correlatedhappiness an and important good tendedwith relationships happiness component to be linked inwith together,thisof parentshappiness. survey which and are themSaywith parents problemsto do well encourage are at at willing school school to help them 0 0 0 00 00 O0 0 0 nervousnessthatpeers happy were childrenassociated and helplessness were with less happiness. likelyand more to haveIt likely is also periods to important be confidentof irritability, to note and aboutNotAchieveBelieve want their theirwell to body change familyin school anythingis well off 0 0 0 0 0 0 tiredheadaches,satisfied in the with morning.to betheir dizzy, appearance. to have difficulty They were getting also less to sleep likely and to tohave be Not havefeel stressed headachesdifficulty at gettingschool to sleep 00 0 0 O0 0 Oo CorrelationNot befeel tired dizzy in thecoefficient: morning 0 .15 to .19 0 .20 to .29 0 .30 to .39 0 0 O O 192 .'r 193 CHAPTER 6 88 The majority of students said they were either very or quite happy, Psychosocial Adjustment eachhappy.frombut, as agecountry canMore group be tostudentsseen indicated country in Figure from inthey the 6.2,Sweden were proportion there very than were happy. who from pronounced saidStudents other they countries differences werein Canada very in Lithuania,EuropeanmoreFrance, positive Greenland, countries Russia, respondents and ofNorthern the Slovakia Czech atIreland allRepublic,tended ages. and to Scotland StudentsEstonia,be the least Hungary,were in likelythe among eastern Latvia,to saythe wereSlightlystudentsthey somewere more were exceptions:very boys the happy. mostthan in girlslikely AustriaThese felt to very saycountriesand happytheyFinland, were inare mostgirls' notalso countries.happyresponses those at where all.There were likelywithpercentmore their positiveto morebe life. very of Israelithan happy.the boys'13-year-old boys acrossand girls girlsage at groups,thanage 13 boys and and were 15 in were Norwayvery equally happy 11 inproportionsEvenThe France, youngest in some Greenland of students respondents of the and tendedcountries Sweden, said to theyhave where the are the proportion very mostcomparatively happy, optimistic of studentsfor example, outlook. higher who respectively,oldSweden,felt boysvery 64happyfelt percent feltvery declined, this happy, of way. 11-year-old sometimesbut by age girls substantially,15 and only 70 percent38 and by 49of age 11-year-percent, 15. In 194 195 Figure 6.2 Students who felt very happy about their life (%) CHAPTER89 6 Russia* 11 year olds I 1715 Russia* 111 13 year olds 11 95 Russia* 15 year olds 76 Psychosocial Adjustment EstoniaHungary 231818 CzechEstonia Rep. 1I 2 I LithuaniaLatvia 87 LatviaCzech Rep. H II 2219 LithuaniaHungary 1510111 2 HungaryEstonia lU 12 98 LithuaniaSlovakia 31252826 LatviaSlovakia 17121917 CzechSlovakia Rep. 13 6 FinlandDenmark 403733 Germany*Finland 242633 Germany*Belgium Fr. H11 25222127 IsraelBelgium Fr. 44393837 DenmarkBelgium Fr. Ii 32262928 FinlandIsrael 2534 BelgiumAustria H HH 46414440 AustriaIsrael H 3438 PolandSpain II 28252617 Germany* 384437 Belgium Fl. 1-1I 26363935 Denmark II 353027 NorwayWales 4443 PolandWales 3732 BelgiumNorway Fl. II 23322931 Switzerland 1 4644 Scotland I 3830 Wales 2833 PolandScotland LI li 49565045 CanadaNorway , 4038493732 GreenlandAustria II 1-1 33223337 Spain 5550 Switzerland 1 4134 Scotland 2534 CanadaN. Ireland H 11 55534752 GreenlandN. Ireland LI 39454043 N.SwitzerlandCanada Ireland 31373834 GreenlandFrance* 4955 France*Spain I 47 France* 404137 Sweden* France, Germany and Russiairg-tresented 1 1644 56 only by regions: See Chapter 1 for details. Sweden 6153 Sweden 4938 197 FemaleMale 90 Psychosocial Adjustment CHAPTER 6 Although2. Loneliness most adolescents feel lonely occasionally, young people Figuremore 6.3Students likely to who are lonely are Factors associated with feeling lonely 11 year olds M F 13 year olds M F 15 year olds M F notdistress.maywho want feelare to Generallyfrequently rejectedbe regarded or speaking, lonely may as loners be may experiencingteenagers byhave others. difficulty want other to be relatingserious accepted emotionalto others,and do FeelFeel depressedunhappy left out of things 0 0 0 0 O O0 physicalrelationshipsLoneliness well-being indicates and can (Pagean haveabsence et aal., profound of 1986; satisfying Young, impact social 1982). on and emotional Manyinterpersonal studies and BeFeel irritable alonehelpless at school 0 0 0 0 OO OO0 moreethealth-riskhave al., found likely1994; behaviours tolonely Page, use marijuana,youth1990; compared toMijuskovic, be smoke highly with cigarettes, youth susceptible1986). who These be are tophysically not participatingadolescents lonely inactive (Page are in friendsFindFeel nervousit difficult to make 00 0 0 0 O O haveand1995; have a devastating Page, eating 1990). disorders effect Social on (Tones isolationboth the Rivas mentaland &rejection Fernandezand physical by one's Fernandez, health of peers can LackHavethemFeel other confidenceasbeen they studentsbullied are do not accept 0 0 0 0 0 0 thingsNotadolescents surprisingly, (Figure (Brage 6.3) the etandlonely al., to 1993). studentbe an easy was target for bullies. Of more likely to feel left out of great HavetheirHave difficulty parents poor communication getting to sleep with 00 00 00 00 0 0 citedtoconcern be above,associated are thethose physicalwith adolescents loneliness. and emotional who Echoing felt lonelyproblems the results these of the data studies show were more likely to SayFeelHave parentsdizzy headaches are not willing to 0 0 0 0 0 0 headaches,nervousdistress.experience Theyand physicalstomachaches to were lack more problemsconfidence; likely and anddizziness.to theybe various depressed, also However, formstended helpless, of to unlikepsychosocial suffer irritable, lonely from FeelHaveschoolhelp stressed them stomachaches withat school problems at 0 0 0 0 0 andwhostudents drink described to reported excess themselves thanin other their researchas peers. lonely studies, were the youth in this study no more likely to smoke theirWantFeel unhealthy bodyto change something about 00 00 00 00 0 0 toFrequent 15be apercentyear major feelings olds problemor suffered less of loneliness,of for 11 from the and majority loneliness 13with year a offew olds students. very exceptions, and less In mostthan did countries, one-fifthnot of or quite often (Figure seem HaveappearanceBe afewdissatisfied negative or no closeattitude with friends their toward 0 0 0 0 0 198 (1 c, 6.4). Correlationschool coefficient: 0 .15 to .19 0 .20 to .29 0 .30 to .39 199 0 0 .40+ 0 Figure 6.4 Students who felt lonely very or quite often (%) CHAPTER91 6 CanadaLithuania 11 year olds 141815 LithuaniaGreenland 13 year olds 23241817 BelgiumLithuania Fr. 15 year olds 261917 Psychosocial Adjustment Russia*France* 1617 BelgiumRussia* Fr. 22172317 France*Russia* 25261415 GreenlandBelgium Fr. 171618 LatviaCanada 201319I0 LatviaHungary 2514 EstoniaBelgium Fl. 1416 France*Hungary 13181219 CzechGreenland Rep. 22241415 WalesN. Ireland 1415 EstoniaIsrael 101812 IsraelCanada 21221711 IsraelHungary PIP011111,111. 14141215 SlovakiaWales 121617 EstoniaAustria Fore=kic. 20211110 LatviaFinland 131314 N. ScotlandIreland 1016 SlovakiaPoland 121819 7 ScotlandSlovakia 15131114 Germany*Austria 1516 8 SwitzerlandWales 101812 Germany*Austria 121113 8 BelgiumPoland Fl. 121415 7 Germany*Belgium Fl. 1710 7 PolandCzech Rep. 1110 6 CzechSwitzerland Rep. 101411 N.Scotland Ireland 1416 98 SwedenNorway 10 578 SwedenFinland 1013 69 SwedenSpain 1314 58 SpainDenmark 6767 SpainNorway 688 FinlandNorway 1112 7 *Switzerland France, Germany and Ru2iPprf4represented only by resiorz.T see Chapter 1 for details. 96 Denmark 56 Denmark 2e59201 . O Female Male CHAPTER 6 92 Of the countries with the highest proportions of lonely students in Figure 6.5 Factors associated with helplessness Psychosocial Adjustment leastappearedeach likelyage ingroup, toall experience three Belgium groups.Denmark, loneliness. (Fr.), Students Finland, Greenland, in the Norway Scandinavian Lithuania and Sweden and countries Russia and Spain were the Not bemore wellStudents likely integrated to who feel socially helpless are 11 year oldsMO O F 13 year olds OM O F 15 year olds M F Incountries,Girls Poland, were twice morefor example, aslikely likely, than at especially allboys ages, to frequently amongtwice as the many feel 13 andlonely of 15the year girls olds. felt in some FeelFeelLack unhappy depressedconfidence OO O O O O O Hungary,forlonely. 13 and Pronounced Latvia15 year and olds, genderLithuania and in differences Austria, for 15 France,year also olds. Germany, occurred Greenland,in Canada HaveBeFeel irritable nervous poor communication with O O O O O O andaboutfromGenerally, Israel, age the 11 same.the theto responses 15proportion In whilea few of boys'countries, ofboth girls responsesboys who suchand frequently girls asdecreased the increased feltCzech lonely or remainedRepublicwith increased age. appearanceBeFeeltheir dissatisfied stressedparents at withschool their 0 0 0 0 O O 0 vulnerableA3. Helplessnessfeeling of and helplessness powerless tois influencecharacterized the form by a and sense direction of being of WanttheirFeelHave to unhealthybody changedifficulty something getting toabout sleep 0 0 00 0 0 0 theirandcannotone's unprotected. self-imagelife. influence Students and whatSuch who their goesfeelings frequently interactions on around would feel with them.certainly helpless others. They maynegatively may believe feel affectalone they CorrelationHaveschool a negative coefficient: attitude toward 0 .15 to .19 0 .20 to .29 0 .30 to .39 0 00 0 0 0 0 varietywaspowerlessnessA number also of found reasons: of withinresearchers this theirsocial survey. appearance, isolation haveYoung associated(Robinson people traumatic may et experiences helplessness feelal., 1991),helpless which(e.g., for or a Relativelytowardfeelsomething stressed school. fewabout at studentsschool their body. and younger Girls and girls younger to have boys a poorwere attitiudelikely to 10 percent or fewer in each age group Theisrelationshipsthe factorpoor death social most of a athighlyintegration loved home correlated one, or at(Figure the school. separation with 6.5). feeling Helplessness of helpless parents) inwas andthis associated stressfulsurvey haddifferent(Fr.),always feelings however, or interpretation oftenof helplessness. two felt to helpless three of times Thisthe (Figure term thismay number 6.6). helplessnessbe explained In ofFrance students in and thepart frequently Belgium French by a unhealthy.alsoandwith generalmore poor likelyYounger relationships unhappiness. to lack students withconfidence, Students peerswere andmore who feel parents, likelyoften nervous periodstofelt want andhelpless of generallyto depression change were girlsinthan language.Greenland, mostin Hungary other Thirteen 13-year-old students and Poland.and to 15girls feel year in helpless Northernolds in as Lithuania Irelandwere 11-year-old and were 15-year-old more boys likely , 202 s. 203 93 Figure 6.6 Students 11who year felt olds helpless always or often (%) 30 13 year olds 28 15 year olds I 27 PsychosocialCHAPTER Adjustment 6 BelgiumFrance* Fr. rj 23222812 BelgiumFrance* Fr. 130 2223 BelgiumFrance* Fr. H 212219 Wales 141112 Lithuania 10131215 Lithuania 141015 8 N.Greenland Ireland HI I 1211 HungaryN. Ireland 11 8 HungaryPoland 13 7 Hungary 1/ 1110 9 Scotland 11 98 Greenland P 10 88 LithuaniaSwitzerland 1-1 I1I0 9 PolandGreenland 11 9 BelgiumN. Ireland H. 10 7 Poland 10 9 Wales 9 Germany* 1 94 SlovakiaScotland 9 Germany*Czech Rep. 498 NorwayAustria 59 AustriaSpain 11 788 CanadaSpain L 68 WalesSlovakia JIi 678 8 Belgium Fl. 758 Switzerland 10 7 Spain 478 EstoniaDenmark 758 SlovakiaBelgium H. 87 ScotlandCzech Rep. H 57 Canada 7 Norway 576 LatviaSwitzerland HP ' 75 Germany*Norway 647 LatviaAustria 637 Canada 564 LatviaCzech Rep. 76 Russia*Estonia 56 Russia*Israel 357 Russia* 7436 Sweden 265 Sweden 435 SwedenIsrael 4 IsraelDenmark . 643 EstoniaDenmark 34 Female Finland* France, Germany and Li Russi2rolresented only by43 regiorks: see Chapter 1 for details. Finland 23 Finland 2n523 Male 94 Psychosocial Adjustment CHAPTER 6 thatSix percentthey always or less or oftenof students felt helpless. in Finland, Other Sweden countries and with Russia relatively said FigureStudents 6.7 who are confident Factors associated with feeling confident 11 year olds 13 year olds andarelow Denmark,proportionsthe Czech Latvia,Republic of youth Estonia (11who and often(13 15 and felt year 15 helpless olds). year olds), Thereacross and wasage Canada groupsa high LikeBe well theirare integrated more appearance likely socially to OMO OF O M O0 F 15 year olds MO OF inyearlargestdegree Israel olds genderof did in similarity France,slightly differences Germany,more between of the theHungary, male responses respondents Lithuania, of boys in and every and Poland. girls.age group OnlyThe only 5 to 6 percent occurred for 15 FeelNot feelhealthyhappy helpless O O O O O O0 4.differencessay Confidence they often by age. or always feel helpless. There were only small NotwithHave feel theirgood stressed parents communication at school 0 0 00 0O 0 0 associationsorResearchers self-concept. havebetween studiedThe confidence literature confidence andpresents as friendship a component evidence (Torres of forself-esteem Rivas strong & AchieveNottowardHave feel awelldepressed schoolpostitive in school attitude 0 0 0 0 0 00 amonget1994)Fernandez al., 1994). and girls. betweenFernandez, TheThese latter findings,confidence association1995; including Connolly and was perceptions found the & Konarski,gender to be of particularlydifferences appearance 1994; Connor, noted,strong (Fox SayNot parentsfeelbe irritable nervous are willing 0 0 0 0 0 lookswhomthatare borne contribute (Figure they out can in6.7). tothiscommunicate a The sensestudy: findings of for confidence theeffectively also students showed included andsurveyed, that satisfaction confidentgood the friendsmain with children factors theirwith betweenCorrelationschoolto help them the withcoefficient: genders problems is0.15 at most to .19pronounced 0 .20 to .29 by 0.30 age to 15 .39 when, in the 0 0 0 irritability.manifestandare more a good problems likely relationship to associatedhave a positivewith with parents, attitude depression, and toward they nervousness homeare less and likely school, and to decreasedIngirlsmajority general, always of as the countries,feel they proportion confident. got betweenolder: of 13students' 10 and and 15 22who year percent always olds weremore feel less boysconfident likely than toBelgiumconfidentThe say greatest they (Fr.), were were proportionGermany, from always France Poland ofconfident. students and and Spain Sweden who (Figure weresaid theyalso6.8). more alwaysStudents inclined feel in Estonia, Northern Ireland, wasofthan 15-year-oldboth more11 yearboys pronounced olds and boys to girls andalways for tendedgirls girls. feel were The toconfident. decreasemore exception likely Although with is than in age, Greenland either the the proportions ofdecrease the where other 2os differencessubstantiallystudentsScotland, were Slovakia up lessto less 25 likely percent andlikely Walesthan forto alwaysboys11 were year to among oldsfeelalways inconfident. France.the feel countries confident The Girls difference whose werewith inresponsesage Canada,the groups proportion of France, Danishsurveyed of Poland, girls to werewho have Spain alwayssimilar confidence and at feltSweden. age confident 11 in and themselves. 15. was The substantial decrease The 207 Figure 6.8 Students who always felt confident (%) CHAPTER95 6 CzechSlovakia Rep. 11 year olds 211612 SlovakiaEstonia 13 year olds 181810 6 SlovakiaEstonia 15 year olds 1612 54 Psychosocial Adjustment FinlandEstonia 26241417 N.Wales Ireland 2119 8 N.Scotland Ireland E=1 2120 8 N.Austria Ireland 27262017 ScotlandFinland 232210 7 BelgiumWales Fl. 2221 88 WalesScotland 29281617 Russia*Czech Rep. 24231714 HungaryRussia* 11 22221510 DenmarkRussia* 31292617 BelgiumNorway Fl. 272615 NorwayCzech Rep. E=1 251224 HungaryLatvia 33232731 HungaryAustria 281811 AustriaFinland Ei=3 26132611 SwitzerlandGreenland 34213327 GreenlandDenmark 293014 LatviaSwitzerland 26281718 NorwayBelgium Fl. 223626 LithuaniaLatvia 33253023 LithuaniaCanada 31213014 IsraelLithuania 413735 CanadaSwitzerland 39213415 DenmarkIsrael 34332016 Germany*Belgium Fr. 454433 IsraelGermany* 41283922 SwedenPoland 38372218 PolandCanada 344943473,5 SwedenPoland 26422531 Germany*Belgium Fr. 20413819 France*Sweden 513650 France*Belgium Fr. 4326 GreenlandFrance* 1 4134 *Spain France, Germany and Russia are represented only by regions: ae6'hapter 1 for details. nr10 1 168 62 Spain 4960 Spain 5233 209 MaleFemale 96 Psychosociat Adjustment CHAPTER 6 Depression5. Depression among (feeling young low) people is frequently linked to other problems FigureareStudents 6.9more wholikely feel to depressed Factors associated with feeling depressed 11 year olds M F 13 year oldsM F 15 year oldsM F statedegreesschoolsuch characterizedas (Morrisonofinsomnia, intensity, etpoor byfrom al., thoughts self-image 1985).a general Depressionof feeling suicideand a oflack (Dixon, can"sadness" of occur achievement 1987). toin a varying mental Some in FeelBe irritable lonelynervous O0 O0 O0 O0 O0 O0 depressionappeardepressedstudies to have reactat(Connelly some found differently level, etover al., although 1993).(Barona quarter Boys & relatively Campbell,of and young girls few teens 1993).who are are suffer Whileseverely depressed from boys HaveNotFeel feeldizzy headaches happy OO OO O O O O becomeandmay consequently be less irritable, positive withdraw loseabout weight their socially body and becomeimage; and suffer they sad fromloseand unhappy.their insomnia, appetite, girls sleepHaveHave difficulty backachesstomachaches getting to O O OO OO OO O andtotendedIn thosethis for tostudy bothreported have thegenders, other students in problemsother they whostudies were as described well, more(Figure with likely themselves gender6.9). to At differenceshave all asgrade headaches, depressed similarlevels Feel tiredhelplessleft out in theof things morning OO O O O O OO andtiredbackaches toin bethe unhappymorning.and stomachaches, Theyoverall. tended The and to relationships befeel irritable, isolated nervous,from were other stronger dizzy students and for NotFeel feelalonestressed healthy at schoolat school OO O O O O O Studentsandclearlyfemales. health a seriousThisin professionals. Canada, combination issue France, that requires of Finland, physical the attentionIsrael and emotional and of Northern health problems educators Ireland is LacktowardHave confidencea schoolnegative attitude O 0O 0O 0O 0O alsoDenmarkoncewere more consistentlya week likelyand or 13 than more amongand most 15(Figure those yearother more oldsstudents6.10). inlikely ElevenHungary to tofeel report depressedand and being13 Sweden year frequently. depressed olds were in aboutCorrelationWantHave their beento changebody bullied coefficient: something 0 .15 to .19 0 .20 to .29 0 .30 to .39 0 .40+ 0 0 0 0 girls,isPolandAcross a wide there theand range threeis Switzerland a difference ageof responses groups, were of students35 the for percent least different in likelybetweenAustria, groups to feelGermany,the countriesdepressed.of students. Greenland, ranking There For asmoreage 15-year-oldage groups. likely increased. thanGirls girls boys inIn as almost Denmark,to boys feel everydepressed,said for they age example, weregroup with thedepressed in three differenceevery times country at least wideningas many wereonce a 219 betweenhighest and highest lowest and for lowest each are age 31, group. 29 and For 28 boys, percent the for differences the three BEST COPY AVAILABLE week. Minor exceptions were found among 11-year-old respondents.211 Figure 6.10 Students who felt low or depressed once a week or more* (%) CHAPTER97 6 11 year olds 1 1 4432 13 year olds 1 1 46 15 year olds I I 54 Psychosocial Adjustment Denmark 4240 Israel . I I 4138 Hungary I 1 385234 Israel 2831 Hungary 1 4128 Israel I I 50 Finland 31 N. Ireland 1 3928 France** I I 4237 N. Ireland 3026 Finland 3731 SwedenN. Ireland 1 I 4030 France** 1 28 France** 36 1 21 Lithuania 1J 252716 Denmark 35193617 FinlandCanada I I I 24253939 Canada Sweden 1 Slovakia 2226 2232 Wales 1 2138 Ii 2616 Canada 1 32 1735 1 18 Russia** 1 2615 Russia** I 30 Russia** 34 Latvia 25 Wales I I 271719 BelgiumDenmark Fl I 3310 Scotland 1 25 20 1 WalesHungary 2319 Lithuania 1 2715 Belgium Fr. I 2233 Estonia 1 1 2315 Belgium Fl 24 Estonia 1 3217 1 1 2115 Slovakia I fj 1 242017 Lithuania 1 3117 NorwaySweden 1 2113 Estonia i, 1 2413 Latvia I 1 3117 Belgium Fl. 2119 Latvia 23 I 1 31 Scotland 1619 Norway I 11 I 231617 NorwayScotland I I 291517 15 1 23 1 29 BelgiumGermany** Fr. 1614 9 SwitzerlandBelgium Fr. I I 221415 PolandSlovakia I 2512 1 1 20 Poland 1213 8 Poland I 2018 9 Greenland I li H 241914 SwitzerlandAustria 13 9 Greenland ' 1512 Switzerland I 1918 Greenland II 9 AustriaGermany** Li 11 9 Germany**Austria I 1019 Female *** France, Germany and Russia are representedThe Czech only Republic by regions: and Spain see Chapter did not 1include for details.. this item. 212 L__I 213 Male CHAPTER 6 98 Fifteen year olds were more likely than younger students to feel say they make friends easily. About 80 percent or more of students Psychosocial Adjustment depressed.wereInthan the 15 depressed majority year In only olds ofincreased Denmarkreport countries, being with and thedepressed age;Slovakia proportion in 18 among did countries, of more girlsboth 11 boyswho the year increasessaidand olds girls.they Russiastudents.makingin Israel, in new LessNortherneach friendsthan age 70 groupIreland easy,percent said andas oftheydid Swedenstudents almostfind it in easy90 Estonia,each percent to agemake Lithuania group of friends. Spanish found and In theyHungaryslightlyincreasewere dropped7 percent or between where remain 22 or they percent.moreage about increased11 with theand same,Hungarian 15. 14 Boys' the percent most responsesgirls andnotableregistering in tended Denmark exception a to29 increase percent where being couldOverall,lessRussia, made make the boys friends countrynew were friendseasily. slightlyranked easily. lowest,more The likely about difference than 60 percentgirls in theto offeel responses students that they ofor AC. section,number Peer relationshipsincludingof dimensions friendships, of peer relationshipstime spent with are friends examined and inwhether this responsesaresayandboys nottheyWales and togreat. girlsmade increase did by afriends substantiallycountry slightly easily. is fromtypically higherThe age general small;11 proportion to 15; only tendency however, in of the 11-year-old Czechis differences for students'Republic girls relationshipssensehavinggroup.young ofStudiespeoplesupportive belonging, (Hartup, feelof peer friends they a relationships1993). positiveare are included associated Other outlook suggest aspects or with excluded and that ofa good peersuccesshaving from self-concept,relationships, friends theirin future peer and a ForExperience.includingI. Friendshipsmany bullying young behaviour,people, having are examined friends in indicates Chapter 8,that The they School are behaviourandshapeaccepted; they the can it(Connollylives is help an of important movesome & Konarslci, themyoung indicator toward people 1994; orof as Hartup,awaytheir much self-worth.from 1993; as familyhealth-promoting Shulman, Friends members, 1993; can makeThea.Parkhurst Making proportion new &friends new Asher, of friendsis students below1992; three-quartersYouniss who responded & Haynie, in only that 1992). a they very findfew countries;it easy to 2214 studentscountries(Figurehowever, 6.11).in there were other wereFor lessEuropean example, interestinglikely regions to studentsfind differences andit easy inin Israel most tofrom make were easterncountry friends, more Europeanto likelycountry while to 215 99 Russia*Figure 6.11 Students 11who year found olds it easy or very IJ 57 easy to make new friends (%) 13 year olds Ii 62 15 year olds 64 PsychosocialCHAPTER Adjustment6 EstoniaSwitzerland 6167615954 LithuaniaRussia*Estonia 6064 EstoniaLithuaniaRussia* 656360 LithuaniaCzech Rep. iJ 68616769 Germany*Latvia 74717063 CzechLatvia Rep. 7368727165 Latvia fJ 6872 Czech Rep. 7472 Belgium Fr. - .- I 7775 Belgium Fr. 7270 1 Switzerland 7681 Greenland 7870 Belgium Fl. 1 73776 Belgium Fr. 767875 Finland 7876 ScotlandGermany* 757674 FinlandHungaryBelgium Fl. 757976 HungaryGermany* 777876 CanadaHungary [1.9a1.1111f.01....11:111.11,31.1524111.1e.1001011j 7679 Canada 808280 SwitzerlandNorway I 8078 FinlandFrance* 777674 DenmarkGreenland 1 817872 DenmarkSlovakia 80 Wales 767784 N. Ireland aWlitiVANI66.101.0011.1,2111151.7061 8183 Belgium H. 8170 AustriaSlovakia 7880 France* YIN JI 798276 Canada 808182 ,..-..J.C.,42.121.1014 1119 78 Norway 82 Poland H.ZiffeadialftION1.11112.9111M7 82 N. Ireland 7981 Wales 82 Sweden , 82 SwedenNorway L..11 838077 AustriaScotland wassiber oust 818380 IsraelScotland li...,-A...... :.4.:...... m.--, 848283 GreenlandIsrael Hile117.110MNIMM.O..11.1.11.01.48.1.11i 768287 PolandSlovakia 788382 WalesAustria 848382 Denmark ,,..,,,,_,,,,:_, 1 7883 Sweden 1 8284 N. Ireland 8384 Poland 1 7983 Israel 8585 France* 7985 Spain* France, Germany and Russia are regelead only by regions: see Chapter 1 for details. 908883 Spain 191 87 Spain 908687 MaleFemale Psychosocial Adjustment CHAPTER 6 100

Theb. vastClose majority friends of students had two or more close friends (Figure ofIn mostclose countries, friends, butboys gender were more differences likely than are girls small. to have The a greatest number Spain closeofwere6.12). these fromfriend. The countries, Austria,students In the Germany,90 Czechmost percent likely Republic, Slovakia, or to more have Lithuania, students Swedenmore than andPoland,had one Wales.more close Russia than In friend some oneand countriesTherefemalegender wasdifferencestudents no clear in is each inage Poland age pattern group where in had students' 15 more percent than responses. or one more close male In friend. some than Austria, the Czech Republic, Hungary and Israel the 218 weretwoSpain, or the morefewer mostleast close students likely friendships. toto than feelhave theyin more Interestingly,most could than other make one countries although newclose friends friend. reportedSpanish easily, students having they forlargestthree15 both inage decrease Norwaygirls groups and byfrom areboys. 15 within age percentThe 11 aresponses fewto and 15 percentage inis Scotlandinof Lithuaniagirls points increased by 11 of percent. each from other. age 11 The to 219 about 10 percent figure 6.12 Students who had two or more close friends (%) 15 year olds CHAPTER101 6 CzechSpain Rep. 11 year olds 797564 LithuaniaSpain 13 year olds 75647265 LithuaniaSpain 1 61696473 Psychosocial Adjustment Norway 818073 Russia* 797666 CzechRussia* Rep. II 777365 Greenland 63 Czech Rep. F 826480 Latvia 1 7078 LithuaniaPoland 72728382 FinlandCanadaPoland r 87827783 PolandFinland 67818079 FinlandLatviaRussia* 84728380 EstoniaLatvia 79748584 EstoniaBelgium H. 838272 CanadaBelgium H. 1 858478 SwitzerlandNorway I 86828580 NorwayCanada IJ Il 84878688 Switzerland 8779 Belgium Fl. 1 8780 Belgium Fr. I I 8784 Scotland 1 82881 7 France* 868782 France* 1--1 839079 Belgium Fr. 8187 IsraelBelgium Fr. 88 SwitzerlandGreenland I 8390 DenmarkEstonia 828888 Denmark 908988 Hungary 1 8590 N. Ireland Li 8885 N. Ireland 90 Israel L 1 9085 Hungary 1 85 Hungary 1 9185 Scotland j 92 Israel 8987 AustriaScotland 9190 DenmarkSweden I 9190 France*Germany* 8289 Wales 92 Austria 1 90 Wales 8490 Greenland I 9283 N. Ireland 9192 Sweden 9190 Germany* II 9392 Germany* 195 92 Austria I 9391 Sweden r 9392 Wales 195 92 Female Slovakia* France, Germany and Russia are represented only by regions: see Chapter 1 for details. 220 -I 95 93 Slovakia 1 9590 Slovakia 1 9593 o 221Male 102 Psychosocial Adjustment CHAPTER 6 Itc. isTalking difficult to for friends some of young the same people gender to share their thoughts and Figure 6.13 Factorsgender associated friends with ease of talking to same- wascorrelatedeasefeelings thein talking casewith with fortheir to easegirls friends friends, in(Figure talking of even the 6.13). oppositetothose friends These of thegender of findings same the wassame gender. reinforce more gender For strongly thoseboys, than ofFind the it opposite easyaretalkStudents moreto same-gender talkgender wholikely to findfriends to itfriends easy to 11 year olds MQ F 13 year oldsM F 15 year oldsM F inskillsfrom talking otherand witha studiessense friends of that belonging was show linked an (Hartup, association to acceptance 1993). between At by all others grades,good and social ease for themFeelFind thatitas easy they other to are makestudents new accept friends 0 0 0 0 0 0 communicationForfemales the in younger all age with groups students, parents. it is linked it was with correlated not feeling with alone effective at school. theirHaveschoolSpend parentsgood time communication with friends after with 0 0 0 0 0 0 likelyGirlstoBelgian report in than France (Fr.)difficulty most and and otherEstonian talking Greenland students to students their and to same-gender boyssay at all they in ages Norway find friendswere it weredifficult the (Figure most also to 6.14).likelymore talk NotwithSpend feel friends evenings alone at away school from home 00 0 0 theyWalesCountrieswith foundfriends in it oftheeasy the United to same talk Kingdom gender.with friends Scotland, of the same Northern gender Ireland in all andage as well as Finland had higher proportions of girls who said TheCorrelationHave proportionsmore close coefficient: friends of boys 0 .15 andto .19 girls in all countries who replied that 0 .20 to .29 0 .30 to .39 Q .40+ 0 difficulty,mostSwitzerlandgroups. others Thirteen but and inin theirHungary,15 and year age 15-year-old olds Lithuania,group in Sweden to indicateRussia girls were inand thatalsoCanada, Spain, theymore boys Spainhavelikely found little thanand it increasesgradualbetweenthey found increase agefor it boys 11 easy and fromand to 15 girlstalk 11 and, tobetweenwith 13in almostfriendsto 15age years 11all of and countries,the of 15 sameage. were The genderthere in greatestBelgium was rose a boyssubstantiallyGirlseasier did obviously to with talk theirmoreto foundsame-gender maleboys it easier (8%)friends. friends.tofind talk At it withageeasier 11,their to only talk female within Spainfriends their didmale than Norway.(Fr.), France, Switzerland and Wales and, for girls, in Denmark and 222 thewhoandfriends. girls. Spain found By could ageit easy 15, do tothe so, talk same but with in proportion no same-gender country of didboys thefriends as proportion girls exceed in Greenland of that boys of 223 Figure 6.14 103 Students11 year who olds found it very easy or easy to talk to friends of the same gender* (%) 11 13 year olds 15 year olds PsychosocialCHAPTER Adjustment 6 France** 615760 Estonia 11 II 696268 Greenland 7674 Belgium Fr. 11 6655 Greenland i, 1 68 Estonia 8063 Estonia 6762 Belgium Fr. 1 I 756/07, Belgium Fr. 8370 Greenland 69 Latvia 1 1 78 Poland 8480 Poland II 6970 France** I 1 7966 France** 8478 Latvia 7071 Czech Rep. 1 8170 Russia** IJ 8581 Denmark H 1 6272 Poland 8271 Latvia 1 8779 1 61 Russia** Czech Rep. 75 Czech Rep. 1 72 fi LI 8278 87 Norway 7461 Lithuania 1 1 8386 Israel 7989 Slovakia 1 Russia** 7574 1, 871 Hungary Il 8986 Switzerland H 7766 Denmark 1 871 5 Lithuania 9087 Germany** 7764 Norway 1-1 866 5 Denmark 1 9171 Canada 7769 Hungary 1 1 8783 Germany** 1 9175 Spain ,1 LI 7985 Sweden I 1 8769 Slovakia 9176 Sweden 8066 Israel 1 1 8770 Spain 9291 Wales 6580 Germany** 8873 Norway 1 9365 Finland 6980 Spain I fj 1 8984 Sweden 9372 Hungary 8180 Switzerland I 1 9071 N. Ireland 9375 N. Ireland Finland 1 I 8162 2 Scotland I 9070 CanadaScotland 9476 Scotland 1 1 72 78 LithuaniaIsrael LI 8265 N.Canada Ireland ( 193 90 4 FinlandSwitzerland 1 195 8194 Slovakia 8386 Wales I 1 6894 Wales ( 195 75 Female *** France, Germany and Russia are representedAustria and only Belgium by regionsv:.see (Fl.) did not Chapter include 1 this for item.details. 224 74 71 80 225 Male 104 Psychosocial Adjustment CHAPTER 6 d. isBecomingTalking one of theto comfortable friendsmain challenges of theconversing opposite of adolescence with gender friends and of a thesign opposite of growing sex Figure 6.15Students who find it easy Factorsgender associated friends with ease of talking to opposite- 11 year olds 13 year olds 15 year olds withfindingself-confidence sociability it easy toand talk thesense with development of same-gender acceptance of importantor friends, belonging itsocial was (Figure skills.associated 6.15). Like ofFind the itfriends same easyto talk gender toare totalk more opposite-gender to likelyfriends to M0 OF M 0 F0 0M 0 F aftersmoking.However,associated school Both ease and with males ofin thedrinkingtalking and evening females to to opposite-gender withexcess were friends. and, more amongSeveral likely friends to olderstudies spend was students, show timealso homeSpendfriendsFind it with eveningseasy friends to make away new from 0 0 0 0 0 0 (Hartup,areadolescent important 1993). friends to teenage are very culture, similar suchin attitudes as smoking and behaviours and drinking that themFeelafterSpend other schoolas time they students with are friends accept 0 0 0 00 studentsfriendsEstoniaBoys and of and in thegirls eachFrance opposite from age were all groupgender three the were (Figureleastage groups amonglikely 6.16). to inthe In findthe Hungarymost Czechit easy likely Republic,and to talk toSpain, feel to HaveSmoke morebeen cigarettes drunkclose friends 0 0 0 Ininyearcomfortable theircontrast olds age in to group Canadatalking the patternto weretofind friends foritalso easy same-gender moreof to the talk likely other to opposite-gender friends,thangender. most boysThirteen other were friends.students and more 15 Correlation coefficient: 0 .15 to .19 0 .20 to .29 0 .30 to .39 0 .40+ 0 0 percent.Onlymalelikely friends. into France,findIn Denmark itHowever, easy Lithuania to this talk by pattern andageto female Poland15, was differences friends reversed,did the than differenceswere asgirls 10not werepercent pronounced. exceed to talk more 10 to talkingthe11-year-oldgirls opposite than to boysopposite-gender girlssex. found Bytended ageit easy to15, friendsbe togirls reticenttalk werein to Canada, opposite-gender aboutmost likelytalking Spain to andwith reportfriends. Wales. friends ease Most inof respectively.increasedshowedStudents' steadily an capacity increase from to ageoftalk 38 11 easily and to 13 47with to percent 15, the especially opposite for males ingender Wales and generally females, which 226 -" 227 105 Figure 6.16 Students11 year who olds found it very easy or easy to talk to friends of the opposite gender* (%) 18 13 year olds 21 15 year olds 34 PsychosocialCHAPTER Adjustment 6 CzechDenmark Rep. (I 29232816 BelgiumEstonia Fr. II 30343733 EstoniaDenmark 1-1 475740 EstoniaFrance** 23321431 DenmarkCzech Rep. 353836 7 Russia**Czech Rep. 52494648 Wales 2432 Norway 1 3140 Norway 4849 Norway 33 Latvia 43 Latvia 1-1 5553 BelgiumScotland Fr. 243419 Russia**France** 443529 BelgiumGermany** Fr. 57555053 Russia**Finland 353034 GreenlandFinland II II 45444038 France**Finland 52564555 Latvia 263436 Israel 4544 Slovakia J 5759 CanadaGermany** 20382736 PolandWales 41473545 SwedenGreenland 586058 SwedenN. Ireland 392535 SwedenGermany* * 474142 IsraelSwitzerland 46605659 PolandIsrael M. 414026 SwitzerlandScotland 504047 PolandLithuania 496162 GreenlandSlovakia 47484645 N.Slovakia Ireland 544643 ScotlandN. Ireland 6465 SwitzerlandHungary 513449 CanadaLithuania 495537 CanadaSpain 11 657170 Lithuania 1 5446 Spain 585056 Wales 1 70 Spain 5539 Hungary 6047 Hungary 1 7165 MaleFemale *** France, Germany and Russia are representedAustria and only Belgium by regions: (Fl.) did see not Chapter include 1 this for item. details. 228 . ,I 229 106 Psychosocial Adjustment CHAPTER 6 Spending2. Time spent time with friends is a common pastime for young people therewithIn general,friendsis a substantial after more school of difference the several boys thanbetween days the a'week. girlsthe responses reported In several spendingof countriesgirls and time mayschoolincreasesand1990). the indicate time amount Thethrough gives amount whether of adolescence antime indicationof orspenttime not young in (Larsonthe ofthe timetheir peoplecompany & levelthey Richards, spend spendof of socialization friendstogether 1991; with typically outsideBrown,friends and of andacrosswiththose Sweden. friendsof the boys; age after that groups schoolis, 10 in percent Belgiumfour or or five (Fr.),more days Estonia,boys a week. than Finland, girls This spent occurred France time thetimemembersinterferes week. with friends withand homework. otherafter schoolaspects Here, and of theirduring the life,focus the such eveningis on as thosetime most with who days family spend of olds);amongpattern.byAlthough country in girls The Denmark, many (e.g., wasgreatest students'inCanada, Sweden16 decrease percent responsesGermany, (12% in fewer response fewer wereIsrael), 15-year-old 15 similarbetween year there olds fromis boysage no than 11ageconsistent than 11and to year 11- age15 withstudentsfriendsAlmosta. Time their at allspentwho leastfriends students spent withonce after almost friendsasurveyed week.school. every after Figure spent dayschool 6.17 time shows after schoolthe proportion with their of four or five days a week school.year -old boys spent four to five days a week with friends after Thetimeforthe responses 40girls. with to 50 Overfriends percentof studentshalf after ofrange schoolstudents in formost mostboys ofin the days.Greenlandand countries the Girls 30 intoand are Israel40 Norway clusteredpercent at all rangespentthree in schoollikelyage levels,were studentsto socialize from and toBelgium13- spendwith and friends 15-year-oldfour(Fr.), or the almost five Czech daysFrench daily Republic a week afterboys withschool.wereand Lithuania.friends also The highly leastafter Figure 6.17 Students who spent time with friends after school four or five days a week* (%) CHAPTER107 6 GreenlandNorway 11 year olds I 64 525152 GreenlandNorway 13 year olds 54575658 GreenlandNorway 15 year olds 56605752 Psychosocial Adjustment Scotland 513639 SpainFrance** 53425437 Germany**France** 48445337 SwedenFinland 384939 PolandScotland 385239 CanadaSweden 482732 France**SpainCanada 48354936 LatviaGermany** 46404835 SpainIsrael 474243 Germany**Wales 47424832 FinlandWales 463638 SlovakiaAustria 46384740 PolandAustria L1 45394737 CanadaAustria I-IH 45364630 LatviaHungary 45463637 HungaryIsrael 433244 'N. Israel Ireland 444536 PolandScotland 44354533 DenmarkEstonia 42432836 Russia**Hungary 42364329 BelgiumWales H. 42284430 N. Russia**Ireland L 41374233 EstoniaSweden 40254131 Russia**Finland II 39404130 SlovakiaLatvia Li 37394032 DenmarkBelgium Fl. 33303538 EstoniaN. Ireland 372327 CzechBelgium Rep. Fl. H 30262333 BelgiumSlovakia Fr. 33223431 LithuaniaBelgium Fr. H 27213323 H 19 Czech Rep. 28 Czech Rep. 30 Lithuania 3016 3219 2826 MaleFemale Belgium*** France, Fr. Germany and Russia are represzejoySwitzerland by did regions: not include see thisChapter item. 1 for details. 26 Lithuania rt 27 Denmark Ii 233 26 CHAPTER 6 108 b. Time spent with friends in the evenings Figure 6.18 Factors associated with spending evenings away Psychosocial Adjustment withamountAgain health-risk and of time again spent in behaviours. this with report friends it Figure inhas the been evenings 6.18 noted summarizes appears that associated these a significant areawayStudents more from likely home who to withspend friends evenings from home with friends 11 year olds M F 13 year oldsM F 15 year olds M F relationshipsshewithrelationships. wasfriends also involved was moreWhile more poor likely the likely eating student to to smokehabits,have who good watching andspends communication drink avideos great to anddeal playingskills, of time he/ excess. Other WatchEatBe well potato videos integrated chips socially 0 0 OO OO O O Figurebegincomputer to 6.19 spend games. presents a great Parents dealthe should proportionsof time be with concerned oftheir students friends when inin their eachthe evenings.teenagers country HaveEatSmoke hamburgers/hot been cigarettes drunk dogs 0 0 O O O O NorthernwhoSome reportedsaid countries Ireland, they this spendNorway, stand behaviour five out Scotland oras across morehaving and ageevenings high Wales.groups: proportions a Far weekFinland, fewer with ofGreenland, students studentsfriends. PlayDrink computer sweet soft games drinks 0 0 O O O O students.weekandin Austria, Switzerland with Belgiumfriends reported (Fr.), thatthe Czechthey spent Republic, five evenings France, Lithuania fewer than five percent of Belgian (Fr.) or more a Correlation coefficient: 0 .15 to .19 0 .20 to .29 0 .30 to .39 FifteenatorSimilar leastmore year five toevenings oldsafter-school evenings were a week more a socializing, week with likely with friends than friends.more younger in almostboys The thanstudents largestevery girls country. todifference spend spent five Hungary,withgirlsis in andDenmarkfriends. 16Latvia, percent There where Poland more were between and boys alsoSlovakia spent agesnotable (boys five11 and increasesto and 15, girls), 25 in percentand Greenland, in Norway seven evenings a week more both(girls). boys In Northernand girls234 actuallyIreland, decreasedScotland and as ageSpain, increased. the responses of 235 Figure 6.19 Students who spent five to seven evenings per week with friends away from home (%) 15 year olds CHAPTER109 6 11 year olds 32 13 year olds 1 38 46 Scotland 414234 Scotland I 453648 FinlandGreenland 154 4740 Psychosocial Adjustment N.Finland Ireland 354027 GreenlandFinland 294530 Scotland L1 403331 WalesGreenland 342039 WalesN. Ireland I I 393040 WalesNorway 342536 NorwaySpain 31332118 CanadaNorway I I 23282628 SlovakiaN. Ireland 32233418 Russia*Canada 241916 Russia*Spain I 24212720 DenmarkLatvia 29343020 Slovakia 10113 9 Latvia 24213 Sweden 222814 LatviaSweden 1816 99 SlovakiaDenmark 11 21141913 PolandCanada 27252722 DenmarkEstonia 13 7 PolandSweden ri 16181 8 Russia*Hungary II 24261617 Israel 12 7 Israel 1614 9 BelgiumSpain FL 1 2312 PolandGermany* 11 0 BelgiumGermany* Fl. 121014 Estonia 1 202011 Belgium Fl. 10 67 Lithuania 12 89 Israel Il 201917 AustriaLithuania 10 96 HungaryEstonia 1112 8 LithuaniaGermany* 1 15 9 France* 473 France* 694 Austria Ia 1 1411 6 HungaryCzech Rep. 54 CzechAustria Rep. LJ 768 CzechSwitzerland Rep. I 'I 1011 9 Switzerland 43 I Switzerland ED 163 France* FL, 48 Female *Belgium France, Fr. Germany and Russia are represented only by regions: see Chapter 1 for details. 236 4 Belgium Fr. 4 Belgium Fr. 237,, 4 Male CHAPTER 6 110 ED. Relationship with parents Figure 6.20 Factors associated with parent-child communication Psychosocial Adjustment depression,toIn 1994),positivestudies greaterof relationshipslower adolescents, involvementrisk-taking with among scores parents in the school (Field variables are and higheret al., communityshown 1995;self-esteem, to Ryan be activities related et less al., themSay parents withmorewell problemsStudents are with likely willing their towho at parents schoolto communicate help are 11 year olds M 0 0 F 13 year olds M F 15 year olds M0 0F childrencommunication.al.,(Chubb 1994). & find TheFertman, it basis easy The 1992)ofto quality antalk effective and with of better the their parent-child relationship school parents performance will relationship in almostfamilies (Ryancertainly is where open et towardHaveFeelBe well happy a school positiveintegrated attitude socially 0 0 0 0 0 0 Forbe the better items than on those communication where children with find mother communicating and father, studentsdifficult. BelieveFeelNot feel confidenttheir helpless family is well off 00 00 0 0 0 0 thatfordifficult.had this youngfour analysis. Theresponse people very These tend easychoices: to dataand find veryeasyreinforce it easier responseseasy; otherto easy; communicate haveresearchers' difficult; been combinedwithand findings verytheir do SayNotwell beparents at tiredschool encouragein the morning them to 0 0 0 0 0 00 00 relatedAmother parent (Shulman,to communication ease of talking1993). scaleto mother was developed and ease of that talking included to father. items _ Not be irritableBeNot satisfied have difficulty with their sleeping 0.0 0 0 0 attituderesearch,resultsScale scores are toward these summarized were findingsschool correlated and in tend Figure other withto show sound6.20. the othera Inrelationships,similar comparison survey relationship items butwith andnot other with the NottoSayappearance school parentsfeel depressed to aretalk willing to teachers to come 0 0 0 0 andcommunicationimportantsame satisfaction associations factors withwith with school.foundparents risk-taking Poor towere be relationships goodbehaviours.associated relationships with Perhapswith parents witheffective the peers weremost CorrelationNot feel stressed coefficient: at school 0 .15 to .19 0 0 .20 to .29 0 .30 to .39 0 0 0 .40+ 0 youngerwasirritability,associated associated two groups withsleep with loneliness, problemsof effectivestudents, and, a parent-student perceivedlack among of confidence, familygirls, relationships. depression. economic helplessness, status For the The60motherI. Communicatingmajority for all about age of thingsgroupsstudents with that in reported mother allreally countries bother communicating andthem; the the variation percentage easily inwith responses is their above 238 countries(Figureinacross Finland, countries said6.21). Greenland,they was found not it Hungary,great. easy toAcross communicate Israel all andage Swedengroups, with their more than mother studentsin other 239. BelgiumFigure 6.21 Fr. Students11 year who olds found it very easy or easy to talk to their mother 6968 Belgium Fr. Il 13 year olds aboutl things that reallyI bother them* (%) 6863 Belgium Fr. 15 year olds 6561 CHAPTER 6 7875 1 I 7079 1 6764 Psychosocial Adjustment France** I I 7883 Czech Rep. 7274 Canada 6776 Czech Rep. fj 8082 France** 1 7371 Norway 73 Austria Canada Scotland 1 68 Canada I 8280 N. Ireland H 777379 N. Ireland 1 736978 Denmark I 82 Scotland 1J 74 Czech Rep. 70 EstoniaScotland 838584 EstoniaAustria 7577 Russia**France** 727170 Belgium FL IJ 8487 Denmark 7776 Austria 1 7369 SwitzerlandSlovakia fj1-1 8487 SlovakiaSwitzerland Il 78777985 DenmarkSlovakia 737775 NorwayN. Ireland f1 868488 WalesGermany** 7980775 BelgiumEstonia Fl. fi 76.757465 LatviaGermany** lj1 878988 BelgiumNorway Fl. 11 79798483 WalesGermany** 7675 SpainRussia** I I 8688 LithuaniaRussia** II 81848074 LatviaSwitzerland 79747776 Wales ij 939289 Poland ljLIl 828385 Israel 8080 Israel CII 89 Spain 7784 Lithuania 80 HungaryPoland 1j 909289 LatviaGreenland 878685 GreenlandSpain 82717781 Lithuania 1 9192 Finland 87 Sweden 80 92 1 8587 83 GreenlandFinland I 193 9291 IsraelHungary 8988 PolandHungary 848183 Female Sweden*** France, Germany and Russia are representedThese figures only by are regions: based on see totals Chapter that 1do for not details. include the response, "Don't have or see this person". 240 192193 Sweden 11 9808 Finland 241 8583 Male CHAPTER 6 112 Students in Belgium (Fr.) were more likely than all others to find it There was some similarity between students' responses to the two Psychosocial Adjustment AustriaOthertendedanddifficult the students to andCzechto have talk Northern withRepublic,morewho their didtrouble Ireland. not mother.and findthan 13 Eleven andcommunicationothers 15 andtalkingyear 13 olds yearwith easyin olds theirCanada, were in mother. France from also measures.BelgiumHungary,parent items. (Fr.),tended Countries,the to rankCzech high Republicsuch on talking as Finland, and with France both Sweden, weremother low Israel and on father; bothand 2.decreasedTheGender Communicating proportion differences from of age students werewith 11 to fatherremarkably who15 in found every itsmall country.easy for to talkall three with agetheir groups. mother itsothingsFar easy with fewer thatto their talk students really mother. with bother theirfelt Swedish they father. them could (FigurestudentsThe talk responses 6.22)easily were than thewithof studentsmost felt their they likely father in could Finland, to about find do andInof Greenland,easegeneral, Estonia in child-father studentswere Hungary, less in likely communication. Austria,Israel to and communicate Belgium Lithuania (Fr.), alsoeasily the indicated withCzech their Republica high father. level InlikelyoldsFifteen all in countriesthan France,year many olds and inothers atNorthern13 all and to age do 15 levelsIrelandso. year (witholds and in Scotland,one Canada exception 11were and also 13 yearless 11-year- Estoniatalkold15-year-old Lithuanians), with (26 their percent) father.boys boys and and There were girlsFrance morewere in most (27 likelysubstantial percent). countries, than girls differences withto find the itbetween largesteasy to in 242 decreasefromproportiondecreasedThe proportion age for11 from of togirls girls of15.age studentswhile In decreased11 Estonia, to that 13 who toof at for 15foundboys a farinexample, the wasithigher easy majority only there torate 12talk thanofwaspercent. with countries. thata their33 ofpercent fatherboys The 243 figure 6.22 Students who found it very easy or easy to talk to their father about things that really bother them* (%) 113 CzechBelgium Rep. Fr. 11 year olds 58555241 Belgium Fr. 13 year olds 51573932 Belgium Fr. 15 year olds L.7 344428 PsychosocialCHAPTER Adjustment 6 France** 6245 Austria 1 4158 Canada 4549 6756 Canada 1 5841 N. Ireland 1 1 4249 EstoniaAustria 6863 CzechEstonia Rep. 5844 Scotland 1 3052 Scotland 1 1 56 -I 37 Austria 3953 1 70 59 France** Czech Rep. 1 55 BelgiumSlovakia FL 716561 ScotlandN. Ireland 614660 Norway 453055 1 Estonia 56 Canada J 7256 Wales 6251 Slovakia 1 5637 Denmark 1 7263 Belgium Fl. 6353 France** 1 5730 N. Ireland 7263 Slovakia 1 6546 Denmark 1 43 6 7 1 57 Spain 6476 Denmark 1 516548 Wales 1 425749 SwitzerlandWales 6577 Switzerland 1 4566 Belgium Fl. 4359 6977 Germany** 5667 Switzerland .. .1 1 4659 Germany**Norway 7770 PolandNorway 684967 Germany*Spain * 1 633962 Poland 7770 Spain 1 6951 Poland 1 40 Latvia 1 7771 Lithuania 6962 Russia** 1 4163 Russia** 7870 Russia** 1 7048 Latvia 4264 Lithuania 8081 Latvia 1 7456 Lithuania 1 47 Hungary 8272 Finland 1 1 7555 Finland 1 695266 Israel 8375 Greenland 1 7756 Israel 6953 Sweden 8473 Israel 1 7763 Sweden I 53 Finland J 8475 Hungary 1 7855 Greenland 1 5169 1 72 Female Greenland** France, Germany and Russia These figures are based on totals that do not include the respoi;se, "Don't have or see this person". ar2e4e2ynted 190 77 only by regions: see Chapter 1 for details. Sweden rrddI 6 llt 61 Hungary 245 7251 Male CHAPTER 6 114 E. Summary Psychosocial Adjustment peopleThereveryand werepeers. happy.in the substantial Theareas The majority youngestof mental differences of students studentshealth across and tend do relationships not tocountries have describe the among most withthemselves optimisticparents young as lonely,fardepressed,veryoutlook more happy. depressed and, likely and Youngerin tomore most feeland likelycountries, confident,helpless.students to feel slightly areItwhile aappears senseless girls morelikely of that, are confidence. boys to moreas feel children than likely lonely girlsBoys toreach andfeel are leastAlthoughandtheir in adolescenttwo their closethe social majority friends, years, environment. ofthey the students complexitiesfeel less make secure, friends of friendshipboth easily psychologically and are haveclearly at everyhowever,atheirdifficult reasonable peer day for group.spend after a numbersmall excessiveMostschool minority. of andthedays amounts youngevery Theseand eveningspeople evening.of students time surveyed with withFor feel friends youth friends;excluded seem who to some, spendfrom are almost Boysusesometimesseeking of and tobacco, recognition girls negate are alcohol almostthat and ofand equallyacceptance,parents, drugs. likely particularly the to findinfluence itwith easy respect ofto peersmake to newcanthe relationshipthespendfriends evening. far and more items to The havetime across differences thantwo age girlsor groupsmore with in close indicatetheirstudents' friendsfriends. that responses socialafter Boys, schoolskills however, to develop andpeer- in communicatingthanStudentsrapidly with from are their ageable with 11 tofather to communicateboth 15. butparents. some more students easily withhave their difficulty mother 246 247 CHAPTER 7

C) (J \ 248 Spain 249 CHAPTER A. drrqwiesIntroduction InjuriesA. [Introduction are the greatest health problem facing school children in E.D.C.B. ContextAllSevereWhere injuries injuries of injuries occur childrenmajorityTraumathe western and Research,of deathsworldyouth; from(Harel,injuries1985; injury Gordon, 1988;represent throughout Scheidt, 1949; the leading Wheat 1988;the world cause Committeely, 1949). areof death among The on in H.G.F. TypeSummaryInjury of prevention injury programs Althoughetdaysinjuriesthe al., first as 1995; well accounthalf the as ofBaker riskan the for unacceptable of human eta injury largeal., 1992; life proportionis amountso span Rodriquez,great (Barss of ofthat lifetime hospital etmost 1990;al., disability people 1991).and Harel, school-loss sustainNonfatal (Scheidt 1988). a implementationobjectivegivensignificant to injuries information injury of in at injurythe some on research injuriesprevention time on duringhas children's initiatives. inhibited their health.life, the This developmentlittle reportThe attention absence provides and ofis injuriesThereacrossthe type isthree occur ofa tendencyinformation age by groups. chance, among that but can the in be generalfact used the to publicoccurrence monitor to believepatterns of injuries that of injury mostis to circumstancespreventionina great which extent people strategies determined in live which and injuriesare playby basedthe and cancharacteristics the onoccur products an andunderstanding theofthey therisk use. environment behaviours Effective of the sporthomesEnvironmentalthat cause can to bereduce them adapted changes the(Harel, torisk reduce can of1988; beinjury. risks.made Scheidt, EquipmentProtective to playing 1988; equipment fields,used Rivara, in arenas play for1985). andanduse 250 bicycleofespeciallyin sportcourse, canhelmets in legislationbe school improved. can settings,play regarding Supervisionan importantcan also such and reduce role things education in the prevention. as risk seat of ofyoung belt injury. usepeople, And and 251 In arethis considered, chapter, the as types well ofas injuriesthe places that they require occur medical and the treatmentactivities in Respondentsschool, sport named facility, the for place example), where what the injury they were occurred doing (home,when the CHAPTERInjuries117 7 It isacrossseatwhich probably belts thethose as participating advisable an injured example areto becountries ofengaged cautiouspreventive becausewhen when behaviour they comparing of aare number is hurt. also injury The ofexamined. factors. ratesuse of theytheinjuryinjury). type were occurred of injured.Respondents injury (riding (broken aalso bicycle, bone,indicated playing, cuts, the concussion monthengaged of inthe or a yearothersport), in head andwhich byTheandacross season. data utilization countrieswere There collected areof (see medical differences Chapter at different services 1 across for details) timesand countries the during and extent injuriesin thethe to schoolavailabilitywhich tend topeopleyear vary TheRepublic injury questionsand Germany. were not used on the survey in the Czech Seventheusefuldefine situations antoitems lookinjury on inat as thewhichthe requiring surveytypes they of were occur.medical injuries directly attention. by age concerned group Therefore, and with gender it injuries. is more and TheseStatistics,(Scheidtand itemsinternational et were1989). al., 1995;derived studies Harel from on et the al.,childhood questions 1994; National usedand adolescentin severalCenter nationalfor injuries Health sixnurse.duringRespondents additional Ifthe students past werequestions; 12 reported monthsfirst asked if theyanwhich injury,how reported had many they been more injuries were treated than asked they oneby toahad injury, doctorrespond incurred they or to a injuryThewereserious severity asked that injury neededto of answer theythe medical injury had the experienced.same was treatment sixindicated questions such by as twofocusing the measures: placement on the 1)most of an a cast,schoolinjury stitches, thator other causedsurgery, usual the oractivity. respondent an overnight to staymiss in at hospital; least one and full 2) day an of 252 253 CHAPTER 7 118 B. ADD Oniagries Injuries thatimpulsivenesstheareThere more conceptsmay is very inclinedcontribute little ofand inexperience, to drugdata beto abusedescribinginvolvedinjury are (Robertson, risk-taking, inused the accidents. characteristicsto describe 1992). sensation-seeking,Generally those A of preliminary behavioursyouth speaking, who associatedunderwaycoefficientsanalysis13- and using to15-year-oldwith of investigate aggregatedover injuries 0.15 boys.betweenamong datapsychosocial fromFurther school-aged alcohol this analysessurveyand abuse behavioural children yielded and of injurythese incorrelation various factors amongdata are TheoneFigurecountries. figure, injury 7.1 therefore, requiringpresents the medicalindicates percentage attention the proportionof youth in the whoprevious of reportedstudents 12 months. atwho least Overall,duringinjuriessustained the requiringboys year such in before all an medical countries injury the survey andattention surveyed does was not sustained conducted.reported represent bya higher thethe total respondents injury number rate of yearpreviousoverthan -old girls.one-quarter boysyear. In about in The Canada, of. halfhighest girls of France the reportedrates countries, and of injuryWales. at least over were In one mostone-third among injury countries, of13- during boys and gender and15-the Theratesandifferences exception; resultsof injury. arealso there, greater indicate boys among andthat girls forolder allin students allage age groups groups surveyed. countries reported Denmark such similar asis comparedCanada, France, with254 Greenland, Scotland and Poland, Wales Russia, show Slovakiahigh injury and rates Sweden. when 255 Figure 7.1 CHAPTER119 7 Students who reported11 year injuries olds during the past year* (%) 34 13 year olds 40 15 year olds I 38 Injuries IsraelFrance** 4331 WalesFrance** 1I 4747 32 WalesFrance** r 1 45 1 Scotland I 3730 Canada I 4233 Canada 1_7 35 I 4432 29 1 31 27 Belgium Fr.Fl. I 363237 N.Scotland Ireland I 413242 N.Belgium Ireland Fr. 3926 Wales 1 I I 31 6 Israel 353924 Belgium Fl. 3825 Canada I , 234 9 Austria 2537 Scotland 233725 N.Austria Ireland 253328 SwitzerlandSpain .1 332935 AustriaIsrael 352936 SwitzerlandSpain Li 1 262332 Belgium Fr.Fl. 31233229 SpainSwitzerland 342229 EstoniaFinland LI 261619 NorwayDenmark 27282230 NorwayDenmark 30263129 Lithuania I 1 2520 Estonia 2514 Finland 2921 Norway 2625 19 Hungary 241818 Sweden 251116 HungaryDenmark 1-1 2517 FinlandLithuania 1 242217 EstoniaLatvia 1 242513 Russia**Latvia 2241815 2 LatviaPoland 22122214 Hungary 221518 Slovakia 2114 Greenland 1 2113 GreenlandLithuania 221918 Poland I I 2012 Russia** 1 2015 Slovakia 1912 SwedenGreenland 1 I 191314 4 SwedenSlovakia 161912 Russia**Poland L1H 18101813 MaleFemale *** France and Russia are representedThe Czech only by Republic regions: and Germany did not include this item. H 256 see Chapter 1 for details. 257 120 CHAPTER 7 Injuries seriousFigureC. Severe 7.2injury, presents iniuries i.e., anthe injury proportion that caused of young them people to miss who at reportedleast one a gender,Although age these group data and, relate most only notably, to severe cross-national injuries, differencesthe effects areof isofaday cast, basedthe of magnitudestitches,school on 21,807 or surgery required of injuries the ordatabase medical hospitalization. from employed95,939 procedures total To in givesuchthisstudents. study,someas placement In indicationthe general, figure of girlswithalmostScotland experiencedhigh identical injury and Wales, rates,toa severethe such datamore injury aspresented than Canada, during one in oftheFrance, Figurefour past boys year,Northern 7.1. and whileIn countries one Ireland, among of five whileratesyearabout were forseveretwo-thirds boys classified injury ranged of ratesthe asfrom injuries severefor 10girls toreportedusing ranged 38 percent these fromby students criteria. acrossabout 7 all in Severeto theage 33 previous percent.groups, injury experiencedandlow injurySweden, rate a fewersevere countries thaninjury. such one asof Greenland,five boys andLatvia, one Poland, of seven Russia girls

258 259 Canada Figure 7.2 Students who reported severe injuries during the past year* (%) CHAPTER121 7 11 year olds 25 13 year olds I 33 15 year olds 23 Injuries France** 2334 France** I 2337 Wales 3038 Belgium Fr. 2718 Wales I 2337 France** I 2337 Israel 2327 N. Ireland 1 2433 Canada I I 2033 WalesScotland 2621 ScotlandCanada 3221 N.Belgium Ireland Fr. I 3219 CanadaN. Ireland 252021 IsraelAustria 2302511 AustriaScotland 28243018 LithuaniaAustria 202416 DenmarkBelgium Fr. [ 22231816 IsraelDenmark 1 2213 EstoniaSpain 20191013 SpainLithuania 211315 FinlandBelgium Fl 2011 DenmarkHungary 16171812 NorwayHungary I 17131914 SpainLithuania 181213 Belgium Fl. 111613 Poland 161711 8 Norway 1714 9 NorwayFinland 101611 GreenlandEstonia 15 98 LatviaSweden 1317 9 SlovakiaPoland 12151016 LatviaSlovakia 1215 8 PolandHungary 151216 8 LatviaRussia** 1410 8 Russia**Belgium Fl. 1411 SlovakiaEstonia 1415 9 GreenlandSweden 1310 8 SwedenFinland 1114 89 GreenlandRussia** 1113 7 Female *** France and Russia are representedThe Czech only byRepublic, regions: Germany see Chapter and Switzerland1 for details. did not include this item. [!T= Male 260- st. 261 122 CHAPTER 7 Injuries D. Where iniuries occur numbersInjuries at in school this figure are presented, represent theby country,proportion in ofFigure young 7.4. people The AinjurypreventionIdentifying significant occurred programs. where shift and was injuriesthat Students evident information occur werefrom is askedage isthe summarized 11 first where to 15step theirin inthein most developing Figureproportion serious 7.3. yearbeenschool.whose -oldinjured mostboysGenerally seriously andserious Canadian speaking, at injury school 15-year-old boysduring in thewere thepast more lastgirls year. 12likely reported Israeli months than 11- the girlsoccurred and highest to 13- have at Girlsofincreaseproportion street-relatedinjuries were in thatthe moreof proportioninjuriestook injuries likely place occurring towas occurringin be eachsimilar injured setting. in at across and sportat home Therearound gendersfacilities. than was the and boys,aThe homedecline age proportion but groups.and in both thean Greenland,proportion ofLatvia, injuries Slovakia at school. and School Sweden. injury rates were lowest in in areas,andhome.malesFigure was onThe and7.3 similar a proportionincludedfemalesfarm for or allat becameinjuries ofwork.age injuries groups experiencedless occurring andlikely genders. over in at parks school timeThe or categoryto was recreational be substantial injured "Other" at figure 7.3 Place most serious injury occurred (%) Female 1461MNIMISMILIONIIIMMIONINIE1111111111111101111MOMMIIIOHMale 11 year olds 30 13 year olds 27 15 year olds 23 SchoolHome 212527 212320 201716 Sport facility 141812 24117 -2 311324 Street H 1915 01111111111111101111111 2016 2114 *Other* "Other" was a response choice for this item.262 L 20 20 263 22 123 Figure 7.4 Injuries at school* (%) 8 6 CHAPTERInjuries 7 Israel 11 year olds 10 89 Israel 13 year olds 1 11 968 Wales 15 year olds 84 France**Belgium Fr. 86 WalesSpain 97 IsraelBelgium Fr. 7 Spain 798 France** 8 Norway I 11 74 CanadaBelgium Fl. 7 N.Scotland Ireland 78 SpainCanada 68 Scotland 67 Denmark 674 France** 6657 FinlandN. Ireland 65 BelgiumCanada Fr. 56 N.Belgium Ireland Fl 365 Austria 56 Belgium Fl. 65 Scotland 6 1 NorwayDenmark 65 Russia**Norway 637 LatviaAustria 45 Wales 53 Austria 45 Denmark 1 25 HungaryLithuania 53 EstoniaPoland 53 Russia**Estonia 4 1 Russia** 43 Finland 4 Hungary 43 EstoniaPoland 24 LithuaniaHungary 34 FinlandPoland 23 SwedenLatvia 34 SwedenSlovakia 32 SlovakiaLithuania 32 Slovakia 32 Latvia 31 Sweden HH 2 Greenland 1 30 Greenland 20 Greenland 2 Female *** France and Russia are representedThe Czech only byRepublic, regions: Germany see Chapter and Switzerland1 for details. did not include this item. 264 'I' 266 Male 124 CHAPTER 7 Injuries ofThe E.activity second Context in step which ofin developing injuries a young person interventions was involved is to examine at the timethe type the injury.theTheSport Welsh figures Medicine, Overall, and are Canadian surprising1S,boys 1993; were Abraham, 15-year-old far highmore for1992; likely boys some Michelihadthan countries. experienced girls & to Klein, beA quarterinjured one 1991). such ofin The7.5.wheninjury largest they occurred. sustained group The of their injuriesactivities most occurred seriousin which duringinjury the students aresome presented sporting were involvedin activity Figure Analysislikelya sporting to occur ofevent. causes include Countries of Estonia,injuries in which withinGreenland sport-related each and type Lithuania. injuries of environment were least proportionoccurredpeopleor play. trippedThe while of second young over students largestpeople or fell were whogroup off something.werebicycling of injuries injured or A occurredby roller number an automobile skating. when of injuries young The was playandthecanprovides in contextbeat sports school.addressed an ofimportant and theOver to playgroundinjuries prevent half insight of that childhoodinjuries into occurredactivities, the occurring injuries. modifiable in whilethe Figurehome,at school arisk substantial 7.7on factors theinvolvedindicates street that theirFigurebecausecomparatively most 7.6 such seriouspresents injuries small, injury the but are proportion requiringstill more significant likely medical of youngto andbe attention fatal. particularlypeople duringwho important, indicated the past butproportiontypicallystruck/cut also include involvedinvolve category a significantbicycles, being was struck,most roller number prominent. skatescut orof and, falling.falls/being ofStreet-related course, At home struck automobiles, the byinjuries fall/ an encouragedareyear inparticularly occurred part relatedby whileadults at to risk theypoor (Cook for weretraining fractures, & participating Leit, procedures cuts1995; and inAmerican and aoveruse sport. aggressive Young injuriesCollege attitudes athletes which of programs.object, and cuts. Each setting requires its own particular prevention Figure 7.5 Female Context of most serious injury (%) Male Sport or playground injury 11 year olds 1 2531 13 year olds 3731 15 year olds 1 4135 Falling off something or tripping 271419 15231016 2112 6 BeingBicycling struck or rolleror cut skatingby an object 17 98 389 10 8 FightingAutomobile accident 43 645 7476 * "Other"Other* was a response choice for this item.266 1621 rreae-ta.e.-1 267 2115 2015 CHAPTER125 7 Figure 7.6 Sport injuries* (%) 12 13 year olds 12 15 year olds 11 Injuries France** 1019 Wales I 25 13 Wales I I 25 14 Israel 1117 N. Ireland 2115 Canada 1 1724 Scotland 1610 Canada 2021 France** 1 2211 SpainBelgium Fl. 1610 ScotlandFrance** 2012 N.Belgium Ireland Fl. 1 2211 BelgiumN. Ireland Fr. 151216 9 IsraelSpain 151911 5 ScotlandSpain 181910 8 WalesCanada 1511 AustriaDenmark 131114 BelgiumDenmark Fr. 1710 Austria 111210 Belgium Fl. 1311 9 Norway 1412 8 DenmarkFinland 10 5 HungaryBelgium Fr. 1312 8 FinlandAustria 111413 SlovakiaHungary 95 PolandNorway 1112 4 SwedenIsrael 1 1312 94 Russia**Norway 686 Russia**Sweden 948 LatviaEstonia 10 35 PolandLatvia eyWl 834 LatviaSlovakia 8294 HungaryRussia** P 10 972 EstoniaSweden 647 EstoniaFinland 746 PolandSlovakia 8596 Lithuania FL__1 53 Lithuania 573 Greenland 478 Female Greenland*** The France Czech and Republic, Russia are Germany represented and Switzerland only by regions: did not see include Chapter this 1 item.for details. 268 4 Greenland 6 Lithuania 7 269 Male CHAPTER 7 126 Figure 7.7 Injuries 53 School School, home, and street injuries, by cause (%) Home G.inThere this Injury are study. many prevention Traffic prevention safety programs guards and in place playground in the various supervisors countries are programs 14 usereduceexamples. of helmetsthe riskThere hasof isinjury been no question demonstratedboth in sport that protective andto be in remarkably play. equipment For example, effective acts the toin 29 OautomobileEl sport and playground 31 Oother struck/fall/cut Obicycling/roller skating injuriesduringadvertisingreducing 1982 to head bicyclists campaign to injuries 1985 incontributeddesigned among Australia cycliststo increase(Woodto a 20(Thompson &percent the Milne, use ofreduction et1988). bicycle al., 1989). helmetsin head An IE Type of injury participatingtheirbeAnother effective passengers injury in is this the prevention studylegislation to wear have program seatrequiringenacted belts. that such both hasMany legislation automobile been of demonstrated the but driverscountries others and to bonescommonseriousFigure occurred 7.8injury while summarizes category. formost 11- often. and theFor 13-year-old typesgirls, sprainsof injuries boys and that brokenstrains fall and wereinto dislocated the most automobilethemanyhave study automobiles not. were andIn some Figureasked are countries, hownot7.9 summarizesequipped often particularly they with thewore seat proportioneastern a belts. seat European beltThe who whenstudents said countries, in they anin Figure 7.8 Type of most serious injury (%) belts.norm,always Ingirls wear countries were one. slightly In such those as more countriesCanada, likely Finland,where than boys using France to seat always and belts Germany, wear was seatthe Sprain, strain or pulled muscle Female Male 2027 13 year olds 2330 k-lansomati.lauwemen,-.BMAH 15 year olds 2833 Broken or dislocated bone 21242515 30251914 18122823 Concussion/head/neckCut or puncture wound injury 68 65 6 BurnsBruises or internal bleeding 327 226 25 *Other* "Other" was a 270 response choice for this item. 1719 271 1518 1419 127 Figure 7.9 Students who 11always year usedolds a seat belt * (%) 13 year olds 9 15 year olds 4 InjuriesCHAPTER 7 Russia**Greenland 22171610 Russia**Greenland 201613 GreenlandRussia** 201910 LatviaSlovakia 212719 LithuaniaSlovakia 242225 LatviaLithuania 2321 LithuaniaEstonia 1 282429 EstoniaLatvia 272925 EstoniaSlovakia 24222427 BelgiumCzech Rep. Fr. it 29273736 SpainCzech Rep. 503935 BelgiumCzech Rep. Fr. 34383129 BelgiumSpain Fl. 40433937 HungaryBelgium Fr. 414339 ScotlandSpain 49424246 SwitzerlandHungary 304240 DenmarkSwitzerland 5251 4145 HungaryBelgium Fl 42484147 IsraelPoland 48535651 BelgiumPoland Fl. 45525751 SwitzerlandDenmark 48444952 DenmarkAustria 635158 ScotlandIsrael 54585557 NorwayPoland 615558 ScotlandN. Ireland 636656 AustriaN. Ireland 58635361 N.Sweden Ireland fi 64546358 France** 1 71 5 Finland 6269 Austria 606457 Germany**Finland r 71_1 75 7275 CanadaNorway 62706369 FinlandFrance** I 676265 NorwaySweden 1_ 69 7076 France**Sweden 707266 CanadaIsrael 64696765 Female Canada* Wales did not include this item. 1 _1771 68 Germany** 6874 Germany** 7069 Male ** France, Germany and Russia are represented only by regions: see Chapter 1 for details. 272 1 273 128 CHAPTER 7 Injuries groupsapproximately said they two-thirds always wear or more a seat of belt.the students Students in in all the three eastern age programsThe sport thatinjury address literature specific includes types many of sport suggestions activities for (for prevention example, vehicle.aLithuania,European seat belt and Russiacountries very and few Slovakiaof Greenlandic the Czech were youth farRepublic, less use likely a seatbeltEstonia, to always when Latvia, wear in a neededaexample,wearing wider inspectrum multi-causeprotective some countries. of clothing)communityactivities. Not only orGreater intervention more legislative usegeneral ofprograms) support,seat approaches belts thatbut is makingaddressclearly (for greatinThis H.school-aged chapter toSun indicate mirypresents children. a serious an overviewIn all health countries, of problemthe incidence injury requiring rates of nonfatalare preventionsufficiently injuries sure vehicles have the necessary equipment is fundamental. placementmoreallamonginitiatives. injuries days girls, of Boysrequiringlosta injurycast, from tend stitches, rates contactschool to be are injuredsurgery orwith also in asubstantial. moredoctor medicalor hospitalization. frequently or procedure nurse About result than two-thirds suchOver girls,in one as 40 yet, the orof falloccurthatpercent andcan during ofbeare alldirectly struck sport injuries and ortargeted occurcut playground by forin objects. school intervention. activities, or at home, Injuriesand when two most environmentsyoung frequently people schoolplaygroundeffectiveIf the school environments, prevention activity-related systems thenstrategiesin the 80injuries, participating percent aimed and of at(b) all (a) countries improvingschool reducing injuries can the sport developsafety will and be of injuries,injuriesusedaddressed as athata vehiclebycommunity-based occurprimary to outside provide prevention the approachsafety school intervention. education toenvironment. enhance Also, designed the schools safetyAs to to reducecan homeof the be 274 strategyhome environment to address adolescent to prevent homefalls andinjuries. cuts might be an effective 275 n] 311'si(3r)] CHAPTER

276 Lithuania - 277 CHAPTER B.TheA. AchievementIntroduction School Experience andChildrenA. Introductionschoolsocial spend development.experiences much of theirexert In lives thisa powerful surveyin activities impactthe factorsassociated on their that with emotionalinfluence school, F.E.D.C. PeersParentsTeachersSatisfaction with school constitutespasthomethe health few and yearspeers ofthe youth good butthere arealsoschool, hasbroadened the been thereshaping substantialhas to rolebeeninclude of virtually schools. notresearch only no While workthe on role whatin done the of H.G. SummarySchools and health 2. BullyingI. Classroom behaviour atmosphere Recognitiontoandon fillthe mental that relationship gap. health of the of between importance youth. theThis schoolschool survey experience plays represents in the and ansocial, initialthe physical mental effort CommunitiesRegionalNetworkand physical ofOffice Healthhealth and forthe ofPromoting Europe, Councilyouth can theof Schools beEurope. Commission seen sponsoredin The the project rapidly of the by varies expandingEuropeanthe WHO from typicallytoschool cardiovascularschool to involvehealthschool initiatives in fitnessparents form to and and aredeveloping purpose programdefined becausepositiveat goals the schoolrange prioritiesself-esteem fromlevel. with improving Programs to regardreducing Slovakia.countriessmoking and andsuch alcohol it as is theparticularly use. Czech The projectRepublic, prominent has expandedHungary, in eastern to Poland includeEuropean and 24 betweentheirinvolvementschoolOne teachers aim schoolmore of this satisfying.and ofachievement survey their their parents analysis schoolIn order and are peersis tooverall to considered.do identify as this, wellschool how the as Thestudentsfactors satisfactionthe relationshipdegree that relate make ofis to therelationshipexamined influencegeneral with health between of schoola viewof young these on to thedetermining factorspeople social andis and considered. health. whetheremotional In orthe adjustment not final there section isand a Figure 8.1 Austria's educational system Figure 8.2 Northern Ireland's educational system CHAPTER131 8 1 2 3 4 5 6 7 8 9 10 11 12 13 Grade 1 2 3 4 5 6 7 8 9 10 11 The School Experience Shaded bars indicate the population from which the sample was drawn. Age3 Tr 4 5 6 7 8 9 10 11 12 13 14, 15 16 17 18 19 Shaded bars indicate the population from which the sample was drawn. Age4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 systemsAlthoughorientationsubstantial in there the todifferencescountriesare students. many similaritiesparticipating (Appendixin general in thein organization,A the structure presents survey, of an therethe programsoutline educational are some of andthe havepartvocationalearly thesedifficulty years studentsprograms of answeringelementary are that not typically the included school questionnaires. terminate and in our then atsurveys agetend 16. tobecause For move the mosttheyinto externalprogramdifferenceseducational standardized students in system the agestake oftests orat each whichthe are type country.)used decisions of differently school First, are they madeacross there attend. regarding systems;are Second,critical forthe example,programSome countries and students, course require withchoice parentalchildren very early. help, to makeIn make Austria decisions important and Germany, regarding program for secondarystudents,onexample, the results orsome educational to of determine school such tests systems institutions. which to guide rely students schoolmuch Third, are moreor thereeligibleprogram heavily are to decisionsdifferences thanenter others post- for haveprogramsbyeducationdecisions early career formal offeredwhensystem, implications, they sorting, in outlined secondary are onlybut ininvolve also 10 Figureschool. years by teachers8.1,strong These of age.is characterizedvocationallyearly Theas well decisions, Austrian as parents.notoriented publicwhich only learning,studentsgenerallyacross countries little tothe less opportunityrange didacticin isthe from teaching to approaches teacher-centredmake decisionsand learningin which orapproaches, engage methods students in experientialwhich favoured:are given give yearsfurtherconsequencesStudents later. differentiates required In Northernare usually to them make Ireland required by decisions programand toScotland make and/orearly anotheran with school,external suchdecision, three examination long-term or which four sorecognizedThevarying identified need degrees for in arespecial most ofcommonly responsibility countries. education provided The programs for three their with tofor own specialsix low learning.percent ability programs of students students in the is 289 examination(academic)Northerngiven at age Ireland or11to a isdetermine secondary used public to guideeducation school whether program (Figure system, they selection. 8.2). attend all students At a agegrammar 11, write in the an 281 132 The School Experience CHAPTER 8 Figure 8.3 Sweden's educational system Figure 8.4 France's educational system Grade 1 2 3 4 5 6 7 8 9 10 11 12 GradeHe 1 2 3 4 5 6 7 8 9 10 11 12 Sc University *Shaded Six year bars olds indicate attend the a common population pre-school from which year. the sample was drawn. Age5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 Shaded bars indicate the population from which the sample was drawn. Age3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 schoolthesedecisionsMost countriesdecisions attendance. in their require are Inninth made most students or corresponds Canadian tenth to makeyear provinces, to ofprogram- theschool. last students orrequired Often school-related are the year given year of (FiguretheendSome sameof countriessecondary 8.5), core although courses. delay school theirsorting Russia by enablingschools decisionsis the allowmost best for studentssomeexample most specialization studentsto of take this essentially approach until in the Thedecisionsgradeopportunities flexibility 10, relate but to toitchange to isselect various not courses alwayscourses career or clearat programspaths. different how allowedtheir levels course-selection ofstudents difficulty also in impacttheIt issenior countries important on grades the participating toresponses of understand secondary of in students.the thisschool. school study The structure because student differences of sample their potential in across some suchopportunitiesa specializedvaries as France,across program to countries. changeonce of the studyprograms For decision example, after (Figuregrade is inmade 9,Sweden 8.3).but to there Inenter each other are astudent substantial particularcountries, selects students.circumstancesexaminationscountries Onmay the used be may otherdrawn to guideincrease hand, from critical in a theschoolother program/schoollevel countries year of characterized stress the same experienceddecisions. ageby externalsample These by 282backprogram to a at more age 15,prestigious it is more program difficult (Figure to change, 8.4). certainly to change howplacedschools.may students onbe students drawnEach feel organizational fromabout to make a school, school decisions frameworkteachers year whereabout and has courses,themselves.there283 its own is programslittle influence pressure or on 133 Figure 8.5 Russia's educational system feel excluded in any way from school-related activities, they are TheCHAPTER School Experience 8 Grade 1 2 3 4 5 6 7 8 9 10 11 researchers(Kingmore likely & Peart, haveto disengage indicated1990). Consistentthemselves that the relationship from with all these aspects between findings, of self-esteem school some life Pre otherorUniversity onmediatedand a schooldaily (Wiggins basis achievement seems et al., to benefitis1994). both Positivestudentsmutually student-teacherwith reinforcing moderately and interaction low teacher self- educationsecondaryPcd- countriesindependence.interestsesteem and and with may skills a Therefore, student-centredbetter by engendering enable we students wouldapproach an atmosphere expectto todevelop teaching that of theirstudents belonging and individual learning, from and Age3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 Thereexperience.similar are to thatimportant used in differences Denmark, wouldfrom countryhave a more to country satisfying in the school use makeUnderSomeShaded decisions educationalbarsthese indicate conditions about the systems population how students and are from what moreare which typically they studentthe sample learn given centred wasand drawn. opportunitiesare than more others. likely to completingFrance)toof failingmove hold ongrades. the with back work Sometheir students of age(e.g.,a grade. group Norwayjudged These while toand differences have others Sweden) been (e.g., profoundly allowunsuccessful Belgium all students affect and in programinto engageDenmarksome otherand in hands-onis both countries.more class inclined learning and special to experiences. take teachers this approach The remain educational than with is the the system same case All 7 to 16 year olds take a common satisfactionsocial interaction with school. in a class as well as student motivation and toperspectives.periodgroup be more of of students. free authoritarian, Schools discussion Students in countries employing to at encourageeach such grade teacher-centred, as thelevelFinland growth engage and rote-learning of Russiain personal a weekly tend satisfiedother.methodscentreddecision Research whichwith (Tye, making school allow on1985; andteaching studentswhen Lightfoot, when they suggests theirlittle are 1983). classroomopportunity given that According students some experiences to responsibilityinteract tend to these to with are be studies, morestudenteach for positiveesteem.bestudents' cultivated. student-teacher If satisfaction students Teachers perceive in relationships playschool thata critical is they enhanced and dorole a not sensein by belongnurturing theof belongingdegree in thestudent schoolto whichcan self- or 284 285 CHAPTER 8 134 Acf>DUevemtentt Figure 8.6 Factors associated with achieving well in school The School Experience 8.6achievementIs there lists anyfactors relationship and associated other healthbetween with schooland student school-related achievement perceptions usingfactors? of their aggregated Figure school FeelLike teachersschoolin schoolStudents show are who more personal achieve likely towell 11 year olds M0 0 F 13 year olds M F 15 year olds 0 M 0F inwithotherdata. school teachersItaspects is not is not surprisingofand satisfaction accessible liking to school. find withto thatall Sinceschool, students, school above-average such achievement the as generalgood relationshipsachievement is feeling related toof appearanceBeFeelinterest satisfied happy in with them their 0 0 0 0 0 0 associatedavailablewell-being to thatwith all appears goodstudents. school to be There associated achievement, are many with suchschoolpositive as success confidence, attributes is not toNot expressSay smoke teachers their cigarettes encourageown views them 0 0 0 0 0 0 Gradinglikelyprominentgeneral to good schemessmoke; for health the reasons differ 11 and year from anfor olds. absencethis country Noteare suggestedof tothat stress, country, high that in achievers andChapter are it particularly is virtually9.are less NotFeel feelconfidenthealthy stressed at school 0 0 0 0 0 theirachievementachieveimpossible teachers some to was thinkmake level used ofletter of theirin standardization, thisgrades work study: andin school.the percentages students aThey simple were werecompatible. measure askedgiven whatfour To of toSayBe school well parentsteachers integrated to aretalk treat willing with themsocially teachers tofairly come 0 0 0 0 Theisresponse shown rangeproportion alternatives:in of Figure students of respondents8.7. verywho good,indicated who good, answeredtheir average school very and work belowgood was and average. good good or theInCorrelation most girls countriesthan coefficient: the boys where viewed gender their differences work as good were or evident, very good. more The of 0 .15 to .19 0 .20 to .29 workPolishyearvery -oldgood among and boys wasCanadian the quiteto 11 a highand wide,students 13 of fromyear85 were percent oldsa low most and offor Canadapositive24 11-year-old percent retainedabout for Polish theirLatvian its highestschool girls. 13- differencessmallexceptions15-year-old in France, on were standardized boys. Belgium Swedish However, (Fl.subject and and Welsh gender aptitudeFr.) and13-year-old differences testsScotland. tend boys toAlthoughtended be and relatively to German genderbe quite whichofearlyranking good sorting encourages andamong veryof students the good all15 workstudents yearinto distinctolds.for theto Interestingly, takeprograms,13 and the 15 same producedyear Germany, course olds, low and program, rankingswith Russia, its Itcountries is1991;small, not Eccles,surprisingin has the been past 1987). consistently 15to findyears that the higherasschool the than needachievement that to differentiate of boys of girls (Randhawa, inamong western producedcloser to the mid-range lowest rankingfor 15 year for olds.the 11286 year olds and a ranking Spainagrades,students good and orthe throughvery least proportion good pronounced the level useof students declined.of inexaminations Latvia who The andsee drop Lithuania.themselves increased is most pronounced Russiathroughachieving is the inat 287 Figure 8.7 Students' perceptions of their school achievement* (%) 135 Russia** 11 year olds 392635 Germany* * 13 year olds 3832 Germany** 15 year olds 383236 TheCHAPTER School Experience 8 Scotland I 4837 Russia* * 4328 France** 1 3836 Estonia 1 29 Estonia 26 27 FinlandLatvia 53503249 SwedenFrance** 48443843 EstoniaLatviaHungary 422226 France**Germany* * 564451 AustriaFinland 434542 AustriaSweden 4244 LithuaniaHungary 37594757 ScotlandLatvia 472446 ScotlandSpain 444540 AustriaBelgium Fr. 556059 Belgium Fr.Fl. 475049 BelgiumFinland Fl. 474639 WalesBelgium Fl. 606159 HungaryWales 405155 BelgiumRussia** Fr. 45493548 CzechSweden Rep. 546561 DenmarkLithuania 51593255 WalesDenmark 475051 N. Ireland 6369 Spain 625359 CzechLithuania Rep. hi- 5333 NorwayIsraelDenmark 69766275 GreenlandCzechNorway Rep. r-I 655758 IsraelNorway 56495551 Slovakia 796578 N. Ireland 67666456 Poland 61526058 Female GreenlandSpain 8369 Israel 1 6177 N. Slovakia.Ireland 6259 Very good Canada 8476 Slovakia 7855 Greenland 1 6657 0Male Good 185 74 Canada 1 8168 HI 7256 Very good "France,GermanyandRussiaarerersentedonly*Poland Switzerland did by not regions.-,see include this item. Chapter 1 for details. P2f ,f881 71 Poland 60 Canada 62 Good 289 CHAPTER 8 136 only country where students' perceptions of their school work Figure 8.8 Factors associated with liking school The School Experience achievementmoreimprovedSlovakia, students over where categories. the who threestudents reported age takegroups. commonthemselves Countries programs, suchto be as tendedin Canada the tohigh and have FeelSay schooltheymoreStudents belong likely is a nice to whoat their place like school schoolto be are 11 year olds M0 eF 13 year olds M F 15 year olds M F FigureC. Satisfaction 8.8 lists the factors with most schooD strongly correlated with liking school FeelSay rulesteachersteachers in this treatshow school them personal arefairly fair 0 0 0 0 0 0 0 0 0 withtotheusing be" other liking dataand school-related "Ifrom school. feel all I belong countriesHow items studentsin this in such aggregatedschool" relate as "Our areto theirform.most school teachersstrongly Not is surprisingly, a nice correlatedis also place an SayAchieveinterest they in wellcan them getin school extra 00 0 0 0 0 0 0 toclearitems,important enjoy that such school. thecomponent as students smoking It is particularly ofwho and liking engagealcohol school. important in abuse these When are to activities restate examinedthe health that are it abehaviourless becomesstudent's likely FeelNotneedhelp be fromhappyit tired teachers in the morningwhen they 0 0 0 0 00 0 0 being.satisfaction with school is linked to his/her general sense of well- NotSayseverely feel otherthey stressed are students not at treatedschool are kind too and 0 0 00 0 0 .00 0 0 able"OurinformationThe purpose andschool secure isaboutof a three nicestudents students' placeof the feel to school-relatedgeneral be" in isschool. concernedattitude "Iquestions feeltoward with I belong how theiris to comfort- produceschool. at this helpfulSay teacherstheir school encourage is clean 0 0 0 0 0 0 present?"background.teachersschool" is and (like designed peers, Responsesit a lot/a tono measure matterlittle; to I"How don'twhat how likewelltheirdo youit students levelvery feel much/atof aboutareachievement accepted all)school should by orat Notthem havesmoke to been expresscigarettes drunk their own views 0 0 0 0 0 0 0 sessingroletheirindicate ofneeds. schools.this whether dimensionIn other Thisor not words, item of the school wasstudents it is only life.intended believe moderately to their assess schoolsuccessful the functionalis meeting in as- CorrelationNotFeel feelbeconfident irritable pressure coefficient: from teachers 0 .15 to .19 0 .20 to .29 0 .30 to .39 0 .40+ 0 0 0 0 0 0 0 feltcoursesthedidResponses nottimingin schoolfavourwas ofto not the major any(Figure clearly school particular decisions linked 8.9). is a pattern nicetoThere about how place of comfortablewere,the school item selection however, showed organization, 290or ofsecure thatprograms significant studentsstudents that is,or studentssayteaching/learning.differences that theirfrom by school Belgium country Overall, is a (Fl.), associatednice German Norway-place studentswith to and be, the Swedenalthough wereapproach most were 13-year-old likelytaken equally to 291 Figure 8.9 Students who agreed that their school is a nice place to be* (%) CHAPTER137 8 11 year olds 3735 Russia* * 13 year olds II 2018 l 15 year olds II 15 The School Experience Russia** 1 Russia** 20 Slovakia 3847 Wales LI 34 Scotland I 31 37 1 32 Finland 5537 Scotland I, 1 434039 Greenland 334232 Poland 5945 Slovakia I 1 4736 Wales 3531 WalesIsrael 6043 IsraelPoland 1 4732 IsraelSlovakia 4333 'Hungary 1-1 il 556557 1 N. Ireland 1 4835 Finland 1 J 4437 65 1 38 33 Latvia fj 1- 6761 Hungary 45151 3 Poland 4438 Greenland 1 6865 France**Lithuania I 4553 HungaryLithuania 4743 Scotland 7058 4254 Belgium Fr. 1 4738 Czech Rep. 1 1 7058 Greenland fj 1 5550 1 I 48 N.France**Lithuania Ireland 60726770 FinlandLatvia I H 564933 N. France**Ireland 51484934 Canada 7257 CzechAustria Rep. H I 5749 LatviaAustria 5242 Belgium Fr. r 1 7265 5847 53 Sweden 66669 DenmarkEstonia rj 5952 EstoniaCzech Rep. H Ii 5346 Denmark 1 Belgium Fr. 6258 Denmark 5551 71 1 Belgium Fl. 1 667473 Canada 1 526357 Sweden 505955 EstoniaNorway Ii 777074 SwedenGermany** H 746572 BelgiumNorway Fl. I I .625761 1 7765 Ci I 7570 1-1 1-1 6254 Germany**Austria 8567 NorwayBelgium Fl. I I 7661 Germany**Canada I 6857 Female *** France, Germany and Russia areSpain represented and Switzerland only by regions: did not includesee Chapter this item. I for details. 292 79 66 r J 66 293 Male 138 The School Experience CHAPTER 8 satisfyingpositive. The for studentsRussian at system all grade produced levels. Countriesschools that characterized were least fromThe decline the 11 year in the olds proportion to the 15 yearof students olds was who quite liked pronounced. school a Forlot theonDenmarkby thisaUnited more measure and Kingdomstudent-centred Sweden although countries, did all notapproach were Scotland, achieve above to conspicuouslyWales learningthe average. and such to aInterestingly, lesserhighas Canada, scores extent proportionfewpercentexample, countries and among of among boys there German dropped Lithuanianwas girlslittle by the change:only girls proportion one from for percent. example,58 dropped to In16 thepercent. fromin countriesPoland 64 Forto the21 ata slightlylikelyOnNorthern all than three more Ireland, boys measures, boys to tended feel than positiveand togirls scoreat allindicated about threebelow school. grade the that average levels,schoolIn a very on girlsis fewthisa nicewere measure.countries place: more schoolsimilarthe bottom isdeclines a niceof the placeacross rankings to the be" thethree and proportion age"I feel groups I belongdropped on the at less. thismeasures Thereschool". "Ourwere stronglyResponses(15Russia year (11, olds).correlated, to13 the and I 15like althoughyear school olds), and there Wales school were (13 is yearsome a nice olds) differences place and itemsGreenland in were the (76%),atEleven-year-oldcountries' their Austriaschool rankings in (73%),boys Germany on were the Greenland, twomost (77%), measures. likely Fr.Hungary to Belgium say they and (76%), feelSweden they Norway belong(all at Norwayallby72%). gradeBelgium (75%)Germany levels (Fr.) and for was andIsrael both highest Austria genders.(74%). for (79%), Russia Perhaps11-year-old Sweden was surprisingly, among girls (77%), (81%), the inHungary lowest view followed of at and its bySwedenallstudent-centred Germanythree was grade highest(67 levels perspective,and for75%), for both both Norway boys Denmark genders. and (67 girls wasand At (74 69%)thealso and 13-year-old relatively and 77%), Fr. followedBelgium low level at girlsandmore(63 Hungarianand (62%). likely 69%). to feelgirls Among they (63%), belong 15 Swedish year at olds,school boys Swedish andfollowed Canadian girls by German (69%)and Estonian wereboys 294 295 139 D. 'Teachers Figure 8.10 Factorsinterest associated in students with as individualsfeeling teachers show an TheCHAPTER School Experience 8 relationshipFigureimportantshow 8.10 an interestitems listsdimension the are in factors strongly me of asschool correlated acorrelated person". life forwith andThe students. thetogether other item, three make "Teachers teacher- up an This point is Say theyan interestareStudents can more get in extralikelywho them sayhelp toas ateachers fromperson show 11 year oldsM F 13 yearM olds F 15 M year olds F reinforcedimportanceschool and by school theof thelink rules atmosphere to arethe fair.items These established school relationships is a niceby teachers place,emphasize I inlike the the expressSayteachers teachers their when encouragetreatown they themviews need themfairly it to 0 0 0 0 0 0 betweenindicationparentsclassroom. arehome ofThe willing the and moderately importance school. to come strong toof school developing relationship to talk a withgoodto teachers" the relationship item is"My an LikeSay schoolrules school in is this a nice school place are to fair be 0 0 0 0 0 0 SayFeel theirotherthey school belongstudents is at clean aretheir kind school and 0 0 0 0 0 0 AchievehelpfulschoolSay parents well to talk in are school with willing teachers to come to 00 00 00 00 00 00 SayFeelcompany otherstudentshappy students enjoy accepteach other's 0 0 0 0 0 0 withSayBethem well parents problemsas integratedthey are are at willing school socially to help them 0 0 0 0 296 Correlation coefficient: 0 .15 to .19 0 .20 to .29 0 .30 to .39 0 .40+ 297 140 The School Experience CHAPTER 8 teachingteachers.theirYoung teachers people fromThere view arecountry are strongly them differences, to and country influenced the form noted and of bywithin above, their their interactioncountries. perceptions in the approach Itwith isof to howtheir be to highpreviousexceptions. ranking. item Northernto the middle Ireland of the dropped group fromwhile its Canada high ranking retained on its the Generallytheirapproachesexpected teachers thatspeaking, to encourage thestudents learning as can inthem countriesprocessbe seento express wouldin withFigure their be more 8.11,more own student-centred thisinclinedviews is thein toclass. case. say manysharplystatementIn most cases, countries,lower "Mythis among declineteachers the proportion15 corresponds show year anolds ofinterest thanstudentsto the among in time mewho when as13 agreed a year person" students witholds. was the In (Fr.)andtheThe lowestScotlandCzech was the onRepublic, highest tendedthis measure for Finland,to be11 amongyearwhile Russia olds. Canada, the and Opportunities highest. Slovakia Israel, However, Northernwere provided consistently Belgium Ireland in the small,ThebeginSlovakian largest toalthough have declinesgirls many in andthe subject top-rankedwereCanadian teachersfor Belgianboys. countries rather Gender (Fl.), onthan thisdifferencesCzech, one item, main Israeli girls wereteacher. were and quite TheteachernotDanish proportion appear relationships. educational to giveof students this system country who for asaid studentsspecial their advantage teachersto discuss inencourage issuespositive freely student-them did "IDifferencesthem.more can likely get extra fromto think help country theirfrom toteachers my country teacher(s) showed were notwhen a personalas Igreat need on interestit". the In item 11 in Ireland,acrossstudentsto express the Scotlandprogressed theirgrade own groups and through views Wales. in declined Denmark,school. Gender However,slightly Hungary,differences in there most Norway, acrosswas countries little countriesNorthern change as the yearRussianthecountries olds statement from students 80 Finlandpercent and were 74 orand percentleast more 15 likelyyear of or the olds moreto 11-year-old agree from of thefollowed the 11-year-oldCzech girls by agreed Republic 11 and boys. with 13 Perhapsninewere percentquite the small mostmore on notable females this item, difference than although males across in Northerneach countries age groupIreland in students'agreed. at least Inteacherranked andCanada Slovakia. on measures. thisthe proportionitem Generally were ofalso speaking,students lowest whoon the the agreedcountries other with relationship that the were statement lowestwith ofFinnishwho"Myattitudes 11-year-old agreedteachers 13-year-old toward with show Greenlandic theirthe girls an statement school interest and 15-year-old girls.emerged inranged me Students as fromin boysa responseperson". ainto low aGreenland high of Theto 14 ofthe proportionpercent83 question rankedpercent of itabout"I decreasedcan theget same extra with for help age. all from threeGender my age differencesteachers groups, butwhen were for I the needsmall. other it" remainedcountries itemslowinterestingforhighest the needon 11onthe not thisand toexpress benote measure13 highly yearthat my Austria oldsforowncorrelated. all andviews three is Austriaconsistently item,ageCountries groups, whichfor the high with followedsuggests 15 on moreyear this by olds.that formalitem, Canada these It but is Lithuania,educational tended systems to and rank didactic lowest teachingon this item, such butas Finland there were and 298 , 299 Figure 8.11 Students who responded that their teachers encourage them to express their own views in class* (%) CHAPTER141 8 CzechRussia** Rep. 11 year olds 11 40393837 CzechRussia" Rep. I 13 year olds LI 37342923 SlovakiaRussia** 15 year olds 25312432 The School Experience Lithuania 434742 Austria 383 87 Czech Rep. I 1 322826 AustriaFinland II 45464341 EstoniaLithuania 3837 AustriaFinland li ri 393530 LatviaSlovakia 4644 FinlandSlovakia 313940 France**Lithuania IJ 1 4137 52 I 41 Poland 494148 Denmark 454041 Sweden I 4638 NorwayDenmark 484451 PolandFrance** 424641 GreenlandEstonia fj fj 444643 Estonia 5150 Latvia 4644 Poland 1 1 Ij 4550 France** 5451 Greenland 4846 Hungary I I 495150 HungaryGermany* * 565257 HungarySweden 504751 BelgiumDenmark Fl. I I 4452 Sweden 57 Belgium Fl. 1.1 5051 Latvia 4852 WalesGreenland 595258 WalesGermany** Ij 445654 Germany** ij fj 555052 Belgium Fl. P 636557 Norway I 505755 NorwayBelgium Fr. fj 5753 N. ScotlandIreland 57686366 IsraelScotland 11I-I 606463 CanadaWales 605855 CanadaIsrael 11 716668 CanadaBelgium Fr. lj 656264 ScotlandIsrael Ii 665760 Belgium Fr. 73 N. Ireland rj 1 605766 N. Ireland 7 5857 MaleFemale *** France, Germany and Russia areSpain represented and Switzerland only by did regions.' not include this item. 300 Chapter 1 for details. 301 142 The School Experience CHAPTER 8 talkTheIE. tosurvey Parentsteachers" item is"My a useful parents indicator are willing of parents' to come involvement to the school with to proportionforcountrytheir all child's three to of country studentsage school. groups (Figure who There and 8.12). answered Estonia, were Denmark dramatic Finland,always and to IsraelGreenland,differences this ranked item Latvia, fromhighest in the indifferent83Lithuania 10 thepercent percent life expectations andoffor thefor11-year-old Russia Estonianschool acrosslowest. rather Israeli and countries The Finnishthan girls. responses the regardingThis 15-year-old level pattern ranged of parent parental appears boys from involvement to to concerna a reflectlow high of of teachers.theirOverall,about parents the Gender there school were was alwaysdifferences progress a slight willing oftendency werechildren. to come not for pronounced tofewer the schoololder althoughstudents to talk with to 12 say problemsWhenapercent difference the more at always school, not 11-year-old evident andmy parentsoften in Polish the responses are responses girls ready than toto ofhelp boysthe Polish me",question responded 15were year "If combined always,olds.I have washigh,(boys,Greenlandover substantially the80 78%) percentsame (boys, were pattern 53%; belowofincluded the was girls, the11 truein averageyear54%) this for oldscategory.and13 for and Lithuanianin both 15every Although year13 andcountry olds.and 15 notSwitzerland Greenlandyear quiteexcept olds, as progresssaidlevels.with theirLithuania There through parents was and school;awere Switzerland slight always declinegender aor littledifferences inoften the below proportionready the were to average help ofsmall. studentsthem at all as threewhothey , 302 303 Figure 8.12 talk to teachers (%) 143 Students11 who year responded olds that their parents are always willingII to come to the school to 19 13 year olds 12 - I 15 year I olds 1411 TheCHAPTER School Experience 8 Russia*Estonia 21222418 EstoniaRussia* 2171418 0 EstoniaRussia* 101213 FinlandGreenland Il 31252219 FinlandLithuania II Ii 22217 0 LithuaniaFinland 261810 LatviaLithuania 333130 LatviaGreenland II 2826223 3 LatviaGreenland 302623 PolandHungary 48363738 HungaryPoland 41353433 PolandHungary 4038 Belgium Fr.Fl. 49515046 BelgiumCzech Rep. Fr. H 474643 SlovakiaCzech Rep. II 46403839 SlovakiaCzech Rep. 57554452 CanadaSlovakia 53504847 AustriaBelgium Fr. II 45484642 Switzerland H 605056 Austria 54954 4 Canada Ij 535049 Canada Ii 6356 Switzerland IrII 5855 Belgium Fl. 5549 ScotlandAustria 67616557 Germany*Belgium Fl. II 61665857 SwitzerlandScotland HI 60556053 France*Sweden 69656962 WalesScotland 6359 Germany*Sweden 625261 Wales 6968 N. Ireland 6963 N. Ireland 1 6254 NorwayGermany* 72687069 France*Spain IJ 67706971 WalesSpain 686554 N.Spain Ireland 687481 NorwaySweden H 737265 NorwayFrance* 1-1 i J 71626965 Denmark H 76 Denmark Il I 7179 Denmark ii JI 7077 Female Israel * France, Germany and Russia 30p4esented I 83 73 only by regions: see Chapter 1 for details. Israel 71 Israel 73 Male 305 144 The School Experience CHAPTER 8 Success in school for students is typically equated with strong career childrenparentsstudentsopportunitiesacademic becausewill attain haveperformance. are init access effectivelydefinedschool. to university.AcademicItand is determines maya social even Therefore,achievement reality be whether limited thatstudents is orbyfuture important not the who theirgrades do to communicationmarginalstress.arenot meetapt The to parents' experienceacademic strain and inbetween the teachers' performanceconsiderable parent-child the expectations parent psychologicaloftenrelationship and resultsby child. attaining brought inandStudies diminished high emotional about markshave by communicatingphysicalaredemonstrated better and socially mental with that their children adjusted health parents whothan and (King can childrenmore &talk Peart,likely openly who 1994). to havewithexperience Some theirdifficulty parents good young expectationsrelationshipandpeople this perceive added during are theirstress likely adolescence. parents' has to bea expectationsnegative particularly Students' effect to responsesintense be on unrealistically the if totheyparent-child high parent high are in a Latvia Lithuanianparentsgrade/yearStudents expect whereinand Spaintoo Israeli critical much were students of program the them most wereat decisions schoollikely also in(Figuremore mustall likely be8.13). made. than Russian, most groups to feel their Greenlandhigh.More boysThis andthanis true 13 girls year for tended allolds groups in to Latvia. feel except parents' In over 13 expectations andhalf 15of the countries, year olds in were too tooStudentsyearothers high olds into Denmark,werefeel in Greenland high far less expectationsFinland, likely and Germany,toLatvia feel from thatranked their Hungary parents' parents.high expectationsand on Eleven thisSweden. measure. and 13 were whowereexpected 15felt decreases year this too oldsway. muchwith were age of more them in thelikely at proportion school, than 11 but year of in both sevenolds boys to countries feel and that girls there parents 306 307 Figure 8.13 Students who responded that their parents expect too much of them at school* (%) 145 11 year olds 1 69 13 year olds 1 1 64 15 year olds II 57 TheCHAPTER School Experience 8 Spain 1 1 72 58 Spain l 1, 4770 Spain 1 4362 Greenland Israel Israel 1 58 66 1 54 Russia** 5406255 7 Russia** 1 404754 Lithuania 435553 Latvia 46 Lithuania 5452 BelgiumRussia** Fr. 1 L-1 1 4052 EstoniaIsraelLithuania 31513954 EstoniaGreenlandLatvia 365054 GreenlandFrance** 4855493650 France** 1 3646 Czech Rep. 4440 Scotland 4737 Czech Rep. 1 433844 France** 1 4432 Estonia 4636 Slovakia 324137 Austria 244033 Latvia 1 284638 BelgiumAustria Fl. 2636 NorwaySlovakia I 1 32940 9 N.Norway Ireland I 1 3044 Poland 2233 I 1 30 Belgium Fl. 1 1 4429 Scotland 1 Norway 3217 Wales I 3438 Canada 1 1 4335 1 32 37 42 Wales 1 3124 Belgium Fr. 34 Wales 4137 N. Ireland 1 3118 Belgium Fl. 3727 Poland 1 28 Germany*Canada * 22282030 N. CanadaIreland 20363036 SlovakiaCzech Rep. 342939 SwedenScotland 271419 PolandSweden 25342535 AustriaHungary II 343130 1 27 Hungary 2714 Germany* * 3127 Sweden 1 3320 Denmark 1 16 Denmark 3017 Germany** 11 25 Finland 2617 8 Hungary I 1 2826 Finland 232812 EL, Finland 1 1 282 6 Denmark L-1I I 2113 MaleFemale *** France, Germany and RussiaSwitzerland arannted didonly not by include regions: this see item Chapter and 11 year1 for olds details. in Belgium Fr were not asked this question. 309 146 The School Experience CHAPTER 8 It is Peersdifficult to separate students' relationship with their peers in indicator.Latvianson this measure andEleven-year-old Greenlandics included Hungary, students tended Israel were to be anda littlerelatively Sweden. more likelyThelow Czechs,on to thissay behaviourchapterlonelinessschool peerfrom in among therelationships their broader young overall inschoolpeople socialthe school iscontext development. discussed classroom are inconsidered. Chapteras The well problem as 6. bullying TheIn this of excludedSchoolandthe students15-year-old is from the enjoyed main the school peer place being group mates. where together in Gender thisyoung environment in peopledifferencescomparison socialize even were with occasionally and small.their being 13- canrelationshipsconsequencescomponentacceptance lead to alienation canof of theirfor contributeyoung many socialfrom people areasschool. development, to a of negativeby their their life. and schoolpeers For it also example, isexperience ahas fundamental far-reaching poor that peer aloneLithuaniaBelgium at least (Fr.),were once themore or Czechis twicelikely distressing Republic,during than most forthe them.schoolDenmark, others Across term. to report Greenland Least age beinggroups, likely andleft to students in Austria, peopleTheI. Classroomgeneral work atmosphere together atmosphere and of how a classroom they feel influences about themselves how well in young other Overall,alsoFinland,feel theyamong females Spain,had those been were and less excluded Sweden.more likely likely to byNorwegian report friendsthan boysbeing at 13 schoolto leftand have alone. 15 were felt year left students olds alone were in extentindicatesandschool mutual tosettings. whichthat support, there Teachersstudents werebut students widefeltcan thatestablish differences must their also classmatesa climate contribute.across of countries were collaboration Figure kind in 8.14 and the countriespeerstheat school, countries, to have werebut feltthis11-year-old more leftpattern likely alone. changed females than By ageboys slightlywere 15, to girls havemore with in felt likely onlyage. that one-thirdInthan other about their students half of male the of andmeasuremosthelpful. 13 inclined year Studentsespecially olds to feelwere in among this Denmark most way. females.critical Belgium and of Czech,Sweden their (Fl.) peers Latvianalso at all rankedwith age and Czech, levelshighRussian onIsraeli were this 11 agetherelikelydid 11not wasin to want all 15.a countriessteady to be decrease with to feel them. inthat the Younger they proportion had beenstudents who left feltbywere themselves; alone the frommost ThislikelyInand most Scottish pattern than countries girls wasstudents to most at say all in notablythat threethe theirlowest age reversed classmates groups, ranking for boys forall are thethree werekind 15 age andslightlyyear groups helpful. olds. less in classesThelessGreenland likelyproportion enjoyed toand say for of beingthat 15 respondents yeartheir together oldsclassmates in whoalways Israel. agreedare Overall,or kind often the and 15 studentswas helpful. year highest olds in theirwere for 310 countries(79%)(83%),Danish 11-year-oldDanish11-year-old with relatively15-year-old boysboys high and(86%) boys Danishproportions (81%),followed 11-year-old Fr. byresponding Belgian Polish girls (80%)13-year-old always (79%). and or PolishOther oftenboys 311 Figure 8.14 Students who agreed that the students in their class(es) are kind and helpful* (%) CHAPTER147 8 Latvia 11 year olds I I 4341 Czech Rep. 13 year olds 4039 Israel 15 year olds 454238 The School Experience Russia* * Il 4541 Latvia 4139 CzechScotland Rep. 1 344432 Czech Rep. 39 Russia** 40 1 Canada 5154 Scotland 3945 Greenland 1 5244 IsraelGreenland II 575455 WalesEstonia 39464045 Russia**Wales 11 48464045 Wales 4755 Greenland H 1 5447 Lithuania 4948 France**Scotland 545552 IsraelLithuania 44495048 LatviaEstonia H 465142 N. EstoniaIreland 45594358 CanadaN. Ireland 46385352 France**Belgium Fr. 515152 Lithuania 5660 Poland 11 5554 Canada JI 4756 BelgiumPoland Fr. 60586157 France**Belgium Fr. 1-1 505755 PolandSlovakia 48575356 NorwaySlovakia 616364 SlovakiaHungary 1-1 596057 N. HungaryIreland 515838 FinlandHungary 675865 NorwayFinland 616450 Germany**Norway 11 61586056 Switzerland Ii 666967 Germany* * I 6855 Austria 64 Germany** H 726471 Austria 6965 Switzerland I] IiII 676366 Belgium Fl. H tJ 7466 SwitzerlandSweden 6965 FinlandSweden 6865 Sweden I 7772 1 I 7365 Belgium Fl. 1 7065 DenmarkAustria 1 182 7971 BelgiumDenmark Fl. I 587476 Denmark 777559 MaleFemale *** France, Germany and RussiaSpain did not include this item. only by regions: see Chapter 1 for details. t, 313 CHAPTER 8 148 2. Bullying behaviour Figure 8.15 Factors associated with being bullied The School Experience Beinginfrom the the a form peer object ofgroup. bullying of bullying Studies is a worldwideishave an shownextreme phenomenon that example aggressive of among exclusion behaviour young Be left alonebulliedStudents at areschool who more have likely been to 11 year olds 0M 0 F 13 M0 year olds 0F 15 0M year olds 0 F bullyontakespeople. school placeand It playgroundscanvictim, usually be some to over level andsort a periodofit of is self-esteem physical frequently of time. contact Mostlinked,or confidence. orbullying in verbal the case takesabuse (Olweus, of place boththat FeelacceptSayHave otherlike bullied them an students outsider asothers they do are not 0 0 0 00 0 0 FigureWilson,1994; 8.15 1992;Smith indicates Ziegler& Sharp, that& 1994; Rosenstein-Manner, the Oliver,students 1994; in this Neary, 1991).study 1994; who Stein,had been 1992; notFeelSay kind lonely fellow and helpful students are 0 0 0 0 0 00 tothey communicatebulliedfeel were unhappy, moretended inclined andhelpless, to oftenhave to depressed,fewfelt bully leftfriends others. alone nervous with Theyat school. whom wereand viewPerhaps alsothey morethemselves could ironically, likely easily FindFeel helplessunhappyit difficult to make friends OO O0 00 00 00 0 bulliedInas someoutsiders. duringcountries, the high school proportions term. Across of students age groups,reported studentshaving been in other'sSayFeel studentsnervousdepressed company do not enjoy each O O 0 0 0 bulliedIreland,likelyBelgium to (Figure Norway, have(Fr.), been 8.16).Germany, Scotland, bullied; Israel, farSlovakia, fewer Lithuania studentsSweden and inand Russia Canada, Wales were Northernhad more been CorrelationFeel stressed coefficient: at school 0 .15 to .19 0 .20 to .29 0 .30 to .39 0 0 ratherBoyssubstantiallyThe were large proportion much gender by more age differencesof 15.studentslikely For to example, in have whomore been had than25 bullied percentbeen half ofbullied than fewer the girls,countries. Danish dropped with 15 betweenthan 11 year age olds groups had 314beenwas 30bullied percent. and, in Belgium (Fl.), the decrease 315 Figure 8.16 Students who were bullied at least once this school term* (%) 149 Greenland 11 year olds 1 77 6772 Belgium Fr. 13 year olds 677566 Belgium Fr. 15 year olds 517458 TheCHAPTER School 8 Experience Belgium Fr. 1 1 1 77 68 Lithuania 6672 Germany* * 5264 IsraelEstoniaRussia** 1_____I 55715675 Russia*Germany*Greenland * * 676858 Russia**LithuaniaIsrael 5434554761 Lithuania I-1 6067 1 4864 1 38 Germany** 1 666653 EstoniaIsrael 6447 LatviaAustria 1 443046 BelgiumDenmark Fl. 1 605463 DenmarkFinland 57526241 France**Greenland 42454347 France**Hungary 1 47586359 LatviaFrance** 524751 DenmarkEstonia L-1 3935431 1 Latvia 1 5849 Austria 5042 Finland 3729 Finland 1 5747 Belgium Fl. 1 4732 Poland 1 3617 Czech Rep. 365652 CzechSwitzerland Rep. 463719 BelgiumSwitzerland Fl. 1 113321 SlovakiaAustria 3954 Hungary Li 4136 Norway 1 2332 1 1 3051 2639 1 3016 NorwayPolandSwitzerland 493351 NorwayWalesScotland II 37313338 CanadaCzechHungary Rep. 20272229 N. Ireland 1 4023 Canada 1 29 Slovakia 1 252610 WalesCanada 3831393040 SlovakiaPoland 3429352336 ScotlandWales 201719 Scotland 3031 N. Ireland II 3424 N. Ireland 1811 Female ***Sweden France, Germany and Russia arensetedSpain did notonly include by regions: this item. see Chapter 1 for details. 2017 Sweden 1916 Sweden 1513 317 Male ISO The School Experience CHAPTER 8 It isin remarkablethe negative that behaviour so many of students bullying indicated others. Figurethat they 8.17 participated shows that Figure 8.17Students who bully others Factors associated with bullying others II year olds 13 year olds 15 year olds (FigureThehealth-riskthose extent who 8.18). ofbehavioursbully bullyingIn someothers variedcountries,of tend smoking dramaticallyto dislike Austria, and drinking school Belgium from andcountryto excess.(Fr.), toDenmark country engage in the towardHave arebeena negativeschool more bullied likely attitude to M0 0F 0M 0 F 0M 0 F bullyingothersand Germany, during behaviour, the the school majorityfor example, term. of In students Northern others, hadfar Ireland, fewer taken Scotland,students part in bullying reportedSweden CorrelationHaveSmoke been cigarettes coefficient: drunk 0 .15 to .19 0 .20 to .29 0 0 .30 to .390 0 0 Switzerland)bullyBoysand Wales. wereothers. more theyIn somelikely were countries than at least girls, twice (e.g., in every as Northern likely country to Ireland, engage and age Polandin group, bullying and to 0- actedageThebehaviour. group.proportion as bullies Among ofthan boys the 11 girls, whoand 1513had year bullied olds.olds others were morewas similar likely toin haveeach

318 , 319 151 GreenlandFigure 8.18 Students11 year who olds took part in bullying others at least once this school term* (%) 7867 Germany** 13 year olds 186 76 Germany* * 15 year olds 186 72 TheCHAPTER School Experience 8 Denmark 1 7661 I 8266 I 1 59 Germany* * 1 1 7652 DenmarkAustria 1 I 8065 DenmarkAustria I 755378 Belgium Fl. I 7358 Greenland I I 60 I 1 53 73 Lithuania 1 73 I I 51 I J, 58 1 56 BelgiumAustria Fr. 1 725773 Belgium Fr. I I 5572 Belgium Fr. 4070 1 Lithuania 71 Greenland Israel I 6337 Estonia I 1 6641 Estonia 1 6432 Estonia 1 6033 Israel 36 Belgium Fl. 1 1 34 1 65 62 Hungary 1 6032 Belgium Fl. ..____I 6343 Israel 5725 SlovakiaLithuania 55325938 FinlandHungary 34625833 NorwayFinland 562619 Finland 5430 1 Latvia 40 Latvia 36 Switzerland 1 235 Poland I 2454 3954 1 54 France** Russia** 1 513 9 Slovakia 5329 Russia** 463549 Poland I 5022 Russia** 48 Canada 1 23 1 52 42 France** I 4945 France** 1 40 Switzerland 1 1 13 1 52 42 Czech Rep. 1 4941 Switzerland 5117 Hungary 18 Latvia I ,1 35 1 I 25 2340 Norway 1 464723 NorwayCanada 3248 SlovakiaCzech Rep. 1639 Canada 1 1 402 8 Czech Rep. I 433345 Scotland 3516 Scotland 1 1 3519 N. Ireland 1 18 Poland 1434 1 37 N. SwedenIreland I 21i 0 7 WalesScotland I 193020 Sweden 321012 21 1 30 N. Ireland 29 Female Wales*** France, Germany and Russia Spain did not include this item. are320 represented only by regions: see Chapter 1 for details. 1911 Sweden I 2311 Wales 2813 Male 321 152 The School Experience CHAPTER 8 The datagroup from of thecountries two bullying where items students tend wereto corroborate less likely each to other.have Figure 8.19 Factors associated with being left alone at school moreWales.bulliesbeen bulliedlikely In Belgium to was be bulliedsimilar (Fr.), byto Germany othersthe group and and whereto takeGreenland, there part inwere bullying students not as others. manywere Canada, Northern Ireland, Scotland, Slovakia, Sweden and FeelHave left schoolbeen Studentsout bullied areof thingsmore who this likely are term left to alone at 11 year olds 0M 0 F 13 year oldsM 0 F0 15 year oldsM 0 0 F oftenThe8.19. mental feel Such alone health students is a of serious students are often concern who the haveaseasy can fewtarget be friendsdeduced of bullies. at from school They Figure and tend NotFeelacceptSay otherfeellonely them happy students as they do are not 0 0 0 0 0 0 0 areleftofto havethe farout problems lessdifficultyof things, likely they makingandto beface do happy notfriends,and feel lackand feelaccepted confidence.often helpless feel by depressed. otherinObviously dealing students. with they Theymost feel friendsFindFeel helplessit difficult to make new 0 0 0 0 0 0 NotFeelandSay have helpful otherdepressed close students friends are not kind 0 0 0 00 00 0 0 NotschoolNot feel spend confident time with friends after 0 0 0 00 00 0 0 DislikeFeelgenderFind stressedit friendsdifficulttheir appearanceat schoolto talk to same- 0 0 0 O 0 o CorrelationFeelBe irritable nervous coefficient: 0 .15 to .19 - 0 0 .20 to .29 0 .30 to .39 0 322 323 Figure 8.20 Factors associated with a positive attitude toward CHAPTER153 8 G.happinessDoes Sch the ols schoolof and young experiencehealth people? In actually order to contribute begin finding to the an healthanswer and to moreattitudeStudents likely toward who to have school a positive are school 11 year olds M F 13 year olds M F 15 year olds M F The School Experience questionnaireitemsthis1. questionSimple was developed. scalea and school thescores The findingssatisfaction scalewere isare correlated described summarizedscale based within more on inother 12Figure detail questionnaire items in8.20. Chapter from the FeelAchieveBe happy well integratedwell in school socially O O 0 0 0 0 withsatisfactionA general school feeling forare all also of gender well-being more and likely age or to happinessgroups. be socially Students is correlated integrated, who arewith that satisfied school is, to comeSaywith parents problems to school are at willingto school talk to to help 0O 0O 0 0 0 0 particularlyandarehave also getting friends more supportstressed withlikely whom to from at be school communicating theythem cannor regarding communicatedo they positively school. feel pressure effectively. Theywith their do from not parents They their feel doSayNotteachers well parentsfeel at stressed school encourage at school them to 0 0 0 0 0 0 toteachers. likelyfeelfeel depressed,confident to The bully students other irritable,and students.towho feel or are tiredhealthy. Theysatisfied in arethe And, withmoremorning as school likely expected, and toare they use less they areseat likely less arebelts, teachersNotwithHave feel parentsgood pressure communication from 0 0 0 0 0 00 ofWhileless good likely it ishealth difficultto smoke patterns, to and know itdrink isthe probably specificto excess. dynamicstrue to say in that the establishmenta supporting UseNot bea seat tiredirritable belt in the morning OO OO 00 00 00 0 happinessand accepting of young school people. atmosphere can contribute to the health and NotFeel havefeel confident depressed been drunk O O 0 0 0 0 NotFeel havesmokehealthy bullied cigarettes others 0 0 0 0 0 0 324 CorrelationNot feel helpless coefficient: 0 .15 to .19 0 0 .20 to .29 0 0 .30 to .39 325 154 The School Experience CHAPTER 8 H. Summary characteristicparticipatinglearningThere are methodologies notable in impact the survey. differences on the acrossEach satisfaction in approach the the school structure, of to studentssystemseducation content ofin has andthethe its countriesteaching/school own Czechandschool Sweden.on Republic, their was psychologicalSatisfaction highest Finland, in Belgium Lithuania,with adjustment. teachers (Fl.), Russia wasCanada,General and lowest Slovakia. satisfactionGermany, in Austria, Students Norway with the wasTheencouragedfrom lowestexpectation Northern inthem eastern Ireland that to express parents European were theirwill most countries goown inclined to views.school and to highestand say talk their in to Denmarkteachers teachers Interestingtheexpectand least.Israel. too differences Spanishmuch of students them surfaced at wereschool across most and countries likely Danish to and sayin the thatFinnish description their students parents Republic,their(F1.),of relationshipsclassmates Denmark, Israel, were Latvia, with Sweden kind peers Russia and andin school.helpful andSwitzerland Scotland Studentsand students wereleast from mostlikely. from Austria, likely the CzechBelgium to say Denmark,wasthoseandSubstantial thismost who is Germanypronouncedofwere numbersspecial bullied andconcern of amongtendedstudentsGreenland because toboys indicated have and inboth health leastAustria, that those in theyproblems. Northern who Belgium had bulliedbullied BullyingIreland, (Fr.), andothers happinessSchoolparticularlyScotland, atmosphere Swedenand vulnerable health appearsand of to Wales.youth. being to contribute bullied.Lonely students significantly326 were to found the overall to be 327 CHAPTER

328 Greenland 329 CHAPTER A. Introduction A. B.Introduction InterrelationshipsHealth-risk behaviour2. PredictorsI. Factors influencingof smoking health-risk behaviour theinattitudesWhile relationships which the andthey main behaviours develop, among purpose these and ofof this youth, thebehaviours reportevolution it is is also toand of present important riskattitudes, behaviour the to health-relatedthe understand context over the D.C. PhysicalMental health health 2. PredictorsI. Factors influencingof being happy mental health Previoususeditemsthree to are ageguide research,integrated cohorts policy conductedin inand the order programsurvey. to to illustrate Inascertain development. this chapter, how the therelationship data findings regarding mightbetween selected be E. Developmental patterns ofI.2. Physical behavioursPredictorsI. Factors health associatedof and feeling attitudes healthy with feeling healthy andexerciseindicatesparticular mental andthat behaviourshealth nutrition smoking of youth. have tobacco,and Thegooda significant findingsdrinking or poor in impactalcohol, health this survey on practices,using both not illegal the only stronglyphysical drugs,verify F. Summary 4.3.2. RelationshipsInjuriesMental health youththeirpeople'sthese socialrelationships are participation directly relationships. influencedbut also in health-risk revealIt byis clearrelationships a strong thatbehaviours correlationthe withhealth andparents betweenbehaviours the andnature young peers of measures,onisand family, that by the in-school than friends data is are the andexperiences. more case school comprehensive in similar as The well researchparticular as anda broader include studies. strength range more of ofinformationthis health survey riskbehaviourstoThree demonstrate behaviours items, and each healthhow as broadlysmoking, itthe status.has information dealingbeen feelingSmoking proven with happy collected was an to chosenimportantand be canaperceived strong to be represent aspect used predictor health to of predicthealth- health status of were selected chosenwasthoughtparticipation chosen to to represent represent as in an other indicator physical the types most of healthof positivemental health-risk because health,aspect itbehaviours. is andof believed mental health Happiness,well-being,to status represent was andofregression mostfactors health. reliably predictingtechniques perceptions thewere criterion used of tophysical measuresdetermine well-being. ofthe smoking, relative Multiple importance happiness linear 157 mayPredictors precede, include be coincident, activities, orpredispositions even follow theand manifestation relationships ofthat a forsuch example, as smoking some cigarettes, young people drinking in aalcohol closely and knit taking group drugs. smoke, If, CHAPTERInterrelationships 9 figures;Notbehaviour all significant only or an those attitude. predictors predictors They for are were each not included countrynecessarily are where presentedcausal. significant in the groupbehaviour,ofthere the is wheregroup. implicit young their Rather peer peoplefriends approvalthan canare being takingfind for isolated supportthat similar behaviour by and risks their encouragement inamong high-risk an atmosphere members health in a formattheseandprediction female analyses: and weights studentsthe the small data were combined. numberfile found for Switzerland offorTwo cases six countries or for morewas Greenland not arecountries in not an included appropriate make for male the in expectationscommunicationplaywhere a the strong values regarding role withsupport in parents, academichealth-risk such behaviours.as wellachievement, behaviour. as a Family lack haveof relationships Asupport lackbeen offoundand open alsolow to childrenrelationshipssubstantiallypoweranalyses ofsince regressioninvalid many frommay for attitude notequationscountry that be country. asand to topronounced country.behaviouralpredict It is the important Also, criterionin patterns younger the to strengthvariables arenote as usually inthat ofvariesolder the relationshipsalsowellbe related academicallymore tolikely health-riskdo not to and appearsmoke have behaviour. tocigarettesa negativediffer Studentsdramatically andattitude drink who toward alcohol.from do not school culture achieve These are to participatingcohortsAnalysesnot as wellin of the the formedcountries. studyevolution in are younger Simple ofbased risk children.line onbehaviour graphsdata aggregated areacross used the to threefromillustrate ageall Thorlindsson(Dingesculture1986; and Chassin & have Getting, & been Vilhjalmsson,et al., found 1993; 1986; in McDonald Nutbeama 1991;number Clayton, ofet &studiesal., Towberman, 1993). 1991; around Krohn the 1993;world. et al., thatThisareselected must discussion to bebe developmental developed.explored and analysis if effective Factors trends. is designed healththat might toprograms introduce explain and the similaritiessocial relationships policies and researchdifferencesand economicthe team findings across are characteristics preparingmustparticipating be viewed more of countrieseach comprehensivein termscountry. are of nottheMembers linguistic,fully analyses developedof the ofcultural HBSCthe data.I.B. Factors Health-risk influencing behaviour health-risk behaviour importantbehaviour.toPerhaps influence the in best Manyinfluencingby using example studies the others oftypical havea health-risk to educationaltakefound part thatfactor in health-riskpeersstrategies that mayare isextremelybehavioursbe smoking difficult 3 3 3 158 Interrelationships CHAPTER 9 Nevertheless,designedAll2. Predictors participating to demonstrate of as smoking was countries shown the health have in Chapter problemsintroduced 2, associateda substantial education with numberprograms smoking. of partquestionnaireincountries. all of countries. the Smokinglifestyle items In of onwas countries the drug found drug use, users.to wherefindings be associated research indicated with teams smoking alcohol included is abuse also predictingsummarizeyouth are smoking smokingthe findings regularly among from 15-year-old theby themultiple age of maleslinear 15. Figures regressionand females 9.1 analysisand in 9.2 22 ofawaytimeTypically, this withfrom time their inhome was most friends,spent and countries, away in notrestaurants, from only smokers the after influence cafés spent school, and an of inordinatecoffeebut their in parents.theshops amountevenings, and, Some asof numberpeopleofa result, the recognize smokeadolescent drinking with that cigarette coffeefriends smoking and insmoker. is socialsoft not drinksa settingsInhealthy most becomes countries,behaviour,that also part promote although aof substantial the lifestyle other young intowardInhealth-risk school.many school. countries, behaviours. Smokers youth werewho smokedalso less tended likely toto have obtain a poor good attitude marks somelinkedonlyIn a numberone of to biologicalthe nervousness ofparticipating countries, parent and evidence was countries. irritability linked of to strainIn and smoking. some atto homea countries, lack Smoking and of exerciseliving cigarettewas with also in Canada andpurchasesmoking Wales). wascigarettes associated (for example, with the availabilityCzech Republic, of spending Northern money Ireland to 334 335 159 Figure 9.1 Predictors of smoking, 15-year-old males InterrelationshipsCHAPTER 9 Have been drunk DrinkhomeSpend with coffeeevenings friends away from 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 AchieveNot feeling poorly healthy in school 0 0 0 0 0 0 0 0 00000 0 0 0 0 0 0 0 0 0000 0 WellExercisePoor attitudeintegrated rarely toward socially school 0 0 0 0 0 0 0 0 0 0 0 0 0 0 NotHaving living spendingwith both money parents 0 0 0 0000 0 0 0 0 0 00 0 0 0 0 0 stomachaches,Health(inOften a bad irritable problems mood) nervousness) (e.g., 0 0 0 0 0 0 Poorparents dietcommunication (e.g., cola, candy) with 0 0 0 0 0 0 0 0 0 highParents' expectations are too Multiple R 0.62 .62 0.50 .560 0.59 .50 .67 0.70 .53 .59 .59 .52 .55 .53 .58 0.65 .53 .640 .57 .64 .53 .55 .57 ModerateStrong relationship relationship (beta (beta > .15) = .06 to .145) 336 BEST COPY AVAILABLE 337 160 Interrelationships CHAPTER 9 buthealthBoys there were problemsare verysome similar wereexceptions. relatedto girls Not onto smoking mostfeeling of thehealthy in predictorsmore and/or than of half varioussmoking, of the familiesexerciseproblems,countries predictedare forsuch more both as nervousnesssmoking likelyboys andto in smoke. girls.more and irritability, Overall,countries The influence females for and girls males of with thansingle-parent who forphysical rarelyboys. TheadditionalboysNot survey doing and items girls, wellcountries are inand schoolquite infor six girls.powerful predicts additional insmoking predicting countries in five smoking for countries boys behaviour and for seven both analysiscountry.theas can last be line for Forseen inAustria, girls, eachfrom figure,morethe Canada, multiple smoking but Finland, there correlations behaviourare Germany, differences (Multiple is Northernexplained from R) country shown Ireland, by the toas BelgiumEstonia,andNorway Slovakia. and(Fr.)Finland, Sweden andIn the Denmark.Norway, andcase less of Russia thefor boys,Estonia, and the Slovakia, Israel, figures Lithuania, areand highest lowest Poland for 338 339 161 Figure 9.2 Predictors of smoking, 15-year-old females InterrelationshipsCHAPTER 9 HavehomeSpend beenwith evenings drunkfriends away from 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 00 0 AchieveNotDrink feeling poorlycoffee healthy in school 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 ExercisePoor attitude rarely toward school 0 0 0 0 00 0 0 0 0 0 0 0 0 0 HavingNotWell living integrated spending with bothsocially money parents 0 0 0 0 0 0 0 00 0 0 stomachaches,Hesalth(inOften a bad irritable problems mood) nervousness) (e.g., 0 0 0 0 0 0 0 0 PoorparentsPoor diet communication (e.g., cola, candy) with 0 0 0 0 0 0 0 0 0 0 0 0 highParents' expectations are too .6900 .62 .54 0 0 00 0 0 0 0 ModerateStrong relationship relationship (beta (beta > .15)= .06 to .145) Multiple R 340 .63 .59 .59 .47 .69 .60 .67 .60 .48 .54 .49 .65 .69 .50 .57 .59 .42 .55 .69 .58 341 162 Interrelationships CHAPTER 9 I.C Factors influencing mental health ental health The2. Predictors subjects of beingthe study happy were not asked what makes them feel happy, unloved,negatively.depressedYoung people helplessness Theand who characteristics tend are to andexperiencing view a sense of themselves depression of poor failure. mental includeand There healththeir loneliness,are surroundingsvariousare frequently feeling levels GoodrelatedFiguresbut they health items 9.3were andis were askedan 9.4 important associated indicateif they componentwere howwith generallytheir ofhappiness.responses the happy sense onaboutof well-beingother their health- life. of frequentamongof childhood adults, and longand not adolescent term all are should severe. depression be addressed. Nevertheless, and, similar depression to the condition that is ofspentgirls 13boys were yeartime in slightlyolds thewith best in and mostfewer integrated communicated countries. countries. socially, InIn with almost17 that countries, effectively. is, all they countries, a had positive This friends the was attitude happiest theytrue disappointments,member.example,thatThe couldday-to-day Others parentalcause lives themare disagreements divorce minor:of to adolescents feel pressure orlow the or with aredeath depressed. from madebrothers of friends, upan Some ofimmediate or a embarrassment, sisters,series are major, of feelingfamily events for Thistoward was theschool case was for girlsan important in 14 countries.. dimension of happiness for boys. Asarnowsametocategorizedunattractive, bear set in of etmind ascircumstances.al., difficultyinternal 1987;that no andCompas two with external (Ramsey, adolescents school et al., factors. 1987; work.1994; react Of Dixon, ConnellyThese course, the same 1987;are it et is frequentlyway al., importantMcGuire 1993;to the andsampleA& summaryMitic, peers analysis 1987) in measurecontributing in order of topositive to determine youths' mental sensethe rolehealth of playedwell-being. was by chosen home, for school this 163 Figure 9.3 Predictors of happiness, 13-year-old males CHAPTERInterrelationships 9 FeelWell healthyintegrated socially 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 FeelRarelyPositive confident irritable attitude (in toward a bad school mood) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 RarelyparentsGood communication feel helpless with 0 0 00 00 0 000 0 0 0 000 BelieveSatisfied family with appearance is well off 0 0 0 0 0 0 0 0 0 0 0 0 000000 0 0 sleepRarelyNot tired have in thedifficulty morning getting to 0 0 0 0 0 0 00 0 0 0 0 0 0 AchieveParentsproblems are well willing at in school school to help with 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Living with both parents Multiple R .420 .55 0.53 0.59 .42 .54 .57 .52 .54 0.62 .50 .510 0.53 0.47 0.53 .55 .55 0.50 0.57 .49 0.50 .60 .60 0Q Moderate relationship (beta = .06 to .145) Strong relationship (beta > .15) 344 345 164 Interrelationships CHAPTER 9 Ingirlsparents,A happya numberand ishomein one slightly of oflife,countries, the characterizedless predictors than the one-half financial of by happiness effective of status the countries incommunicationof mostthe family countries for boys. was with for an tiredisofindicator feelingphysical in the ofhealthy, morning. healthhappiness, ishaving Beinglinked particularly no satisfiedto difficulty happiness forwith boys.getting intheir each Typically, appearance to country, sleep orsome andwhethernot aspectrarelybeing it Intendsboysbeing summary, andtoin bea girlsbad confident in mood inmost about countries,areand halfalso rarely prominentof happy feelsthe countries. helpless.13 indicatorsyear olds The tendof happy happiness to feel student they for Theandattitudeare healthy, aremultiple satisfiedtoward have correlations school, withgood their friends, communicate for appearance. happinessare successful effectively indicate in and with that have theirthe a items positiveparents in Slovakia.(Fl.)smoking.the analysis and Canada, For For are girls, the not and boys, the as lowest predictive powerful it is forslightly Austria, powerpredictors less was the overall; Czechhighestas was and,Republic forthe Canada,Belgiumcase and for - - \ RepublicGermany, theSweden lowest. and Wales are highest and Austria and the Czech Scotland 346 347 165 Figure 9.4 Predictors of happiness, 13-year-old females InterrelationshipsCHAPTER 9 Feel healthy RarelyPositiveWell integrated irritable attitude (insocially toward a bad school mood) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 parentsGoodFeel confident communication with 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 00 RarelyBelieveSatisfied feel family helplesswith appearance is well off 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 00 0 0 sleepRarelyNot tired have in thedifficulty morning getting to 0 0 0 0 0 00 0 00 0 0 0 0 0 0 AchieveproblemsParents are well at willingschool in school to help with 0 0 0 0 0 0 0 0 0 0 0 Living with both parents Multiple R .46 .68 .56 .680 .48 .57 .53 .57 .60 .54 .56 .56 .540 .560 .53 .60 0.58 .58 .60 .48 .58 .61 .64 0 ModerateStrong relationship relationship (beta (beta > .15)= .06 to .145) 348 t. 349 166 Interrelationships CHAPTER 9 D. Physical health stomachachenumber of countries, were less likelyyoung to people feel healthy. who frequentlyOther physical experienced symptoms whopainsAI. great have of numberyoung frequent people of headaches,studies are frequently have for Factorsshown example, related thatassociated are tothe stress.often physical withfound Young feelingaches to people suffer and healthy Toscalewithsuch examine the aswas dizziness,health the employed relationship of students. backache to assess between and the nervousnessfeeling quality healthy of the were and students' alsodiet, associateda simple diets. A &schoolfrom 1989;Mitic, depression difficulties, Smith,1987; Sharrer1987; to family some Aro, & Ryan-Wenger, degree. problems1987). ThereThis or peer stressis1991; less relationships isHallam,research typically 1991; identifying (McGuirerelated Offord, to the acandy,diet goodhealthy that adiet emphasizedpoor diet, was one. and an Asimportantone fruit can that andbe involved seenpredictorvegetables in the excess of two was feeling figures, consideredamounts healthy in of10 to colasforcountries indicate either and The2. ofspecificPredictors generalbeing factorshealthy. concept of feeling that of contribute healthy feeling healthy to young was people chosen having to illustrate a strong sensethe achievement.levelAnotherboys or of girls. indicationphysical In a number well-beingthat, in of students' countries is the minds, relationship(nine health for boys is to notand academic strictly five for a students'toequationselements the item, that viewswere "How young preparedof healthy theirpeople health fordo associate youthe are 11-year-oldfeel?" notwith (Figures related good group health. exclusively9.5 andusing The 9.6). regressionresponses toClearly their relationshipinfluencesResearchgirls), doing between has the well shown level inhow school thatof well health the isoff positively socioeconomicyoung of the people child,linked perceived buttostatus feeling in this oftheir thehealthy. survey family family a TheFeelingatphysical school strongest healthy state and ofpredictorrelationships goeshealth hand but of infeelingalso with hand to parents howhealthywith they a generaland is perceive feeling peers. sense happy;their of experienceswell-being. in almost innotto halfbe all. and ofFor thetheir example, participating own health this is countries statusthe case was infor foundseven girls. countriesin some countries for boys andbut Twosurveyedreflectsall countries, measures a who state students'exercised of of self-concept happiness. perception regularly areIn were aboutthatalso more theystrongly half areinclined the inassociated countries,very to feelgood withhealthy. healththose the problemsgirlswasbeIt was a themore were not case anticipatedsuchimportant more in asa numberlikelyheadaches factorthat than beingof in countries.and boystheir satisfied stomachaches, healthto experienceAs with forwas their boys shown and appearance physicalthan it in follows forChapter girls healthwould that as6, people,self-confidencethemselvesfeeling especially of werebeing boys, wasmore healthy. low. betweenlikely Second, First, to beingfeel studentsthere healthy satisfied is anthan who withassociation those felt their whoseconfident looks for level youngand inof nervousnessbyperceivedthe thepresence absence level andof ofthese sleepingof health. other sympthms Ondifficulties health the wasother problems morein hand, more influential boys suchcountries were as for dizziness, influencedthan females' were mostcontributesItfeeling is not commonly healthy. surprising to young linked people'sthat tothe poor feelingabsence350 health that of wasthey physical headacheare healthy. health although The problems ailment in a hascountriesgirls. a strongerExercising for boys influence regularlythan it on was girls. was for girls.associated How well with off health their familyin more is 351 167 Figure 9.5 Predictors of feeling healthy, 11-year-old males InterrelationshipsCHAPTER 9 Feel happy RarelySatisfiedConfident have with headaches appearance 0000 0 0 0 0 0 0 0 0 0 0 0 0 000000 00 0 0 0 AchieveExercise wellregularly in school 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 vegetables)GoodBelieve diet family (e.g., is fruits, well off 0 0 0 0 0 0 0 00 0 0 0 0 0 0 problemsRarely have (e.g., otherstomachaches nervous, health dizzy) 0 0 0 0 0 0 0 0 Do not want to change their body Multiple R 0.44 0.44 00.49 .420 0.37 .45 .450 .470 0.42 .41 .47 .38 .43 .38 .43 .50 .44 .430 .490 0.35 .390 .470 .480 ModerateStrong relationship relationship (beta (beta > .15) .06 to .145) 352 353 168 Interrelationships CHAPTER 9 correlations,smokingThe measures and the happiness.usedrelationships to predict Aswere canhealth strongest be wereseen among notfrom asboys thestrong for multiple Belgium as for E.Israel;theIsrael,(Fr.), Developmenmeasures Norway Lithuaniaand weakest is and greatestand Scotlandfor Slovakia. the for Czech andBelgiumattitudes Among weakestRepublic, (Fr.),girls, for Germany theDenmark, the predictive Czech and France Republic, Scotland. power and of 1 patterns of behaviours and differtheandThe ages attitudesdata by ofreportedgender. 11 of and young Adolescence here 15. people Asindicate well, surveyed is thatthe a period degreemany change of aspectsof dramatic significantlychange of the withphysical behaviour betweenage and can timethosehormonalemotional for aroundall youth changeschange them. and when which The this youngonset exacerbates profoundly of people puberty theaffectexperience doesuncertainty their not relationships growthoccur and at spurts tension the samewith and inAdolescentsbethebetween manyaccompanied emotional thecultures sexesoften strains by continuesduringcome physical associated to the resent problemsforearly witha theirprolongedteenage becoming associateddependence years. period. sexually Forwith on youngThe menstruation.adults, mature increased women, which may promoteswell,health-riskdemonstratetension adolescents betweenunrealistically behaviours, their childrenindependence are an suchuniform importantand as adultsandsmoking concepts maturity targetcauses and of ofby somedrinking bodyadvertising experimentation adolescents image alcohol. whichand As toin Topressure.behaviour.adolescent compile The Figuresyears emotional makes 9.7 to youngand 9.30, physical people the data turmoilparticularly from characteristic the vulnerable participating of to the such 354 incidencehealth,placecountries from in ofrelationshipshave age injury. been11 to aggregated15 with in specific parents, to aspectsillustrate peers andof the physical teachers, changes and and that mental in take the 169 Figure 9.6 Predictors of feeling healthy, 11-year-old females InterrelationshipsCHAPTER 9 Feel happy ConfidentRarelySatisfied have with headaches appearance 0 000 0 0 0 0 000 0 0 0 0 0 0 0 000 0000000 0 0 0 AchieveExercise wellregularly in school 0 0 0 0 00 0 0 00 00 0 0 0 000 00 0000 Believevegetables)Good family diet (e.g., is well fruits, off 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 problemsRarely have (e.g., otherstomachaches nervous, health dizzy) 0 0 0 0 0 0 0 0 0 0 0 0 Do not want to change their body Multiple R .420 0.48 0.50 .410 .34 .53 .41 .44 0.50 .37 .44 0.52 0.46 0.43 .49 .45 .450 .42 .39 0.43 0.43 00.48 0.40 0 ModerateStrong relationship relationship (beta (beta > .15).06 to .145) 356 357 170 Interrelationships CHAPTER 9 ThedecreasedI. Physicalproportion with health of age students (Figure who 9.7). indicated Less than they half of 11-year-old males were very healthy Figure 9.7 50 Male Students who indicatedo Female they are very healthy (%) useful,perceivedBy(44%) age and at 15 thisthemselves femalesonly point, 37 (38%) percentto as look having considered atof the malesa high survey themselves leveland results 23 of percentphysical to regarding be ofhealth. females factors It is very healthy. 203040 oftheshown physical data to were be ailments associated analyzed and bywith use country ofthe tobacco health statusand alcohol. of respondents when diet, daily exercise, frequency 11 year olds 10 0 13 year olds 15 year olds inoveroneThe sports serving datatime activitiesreveal (Figure per day that 9.8).every of the fruits The percentageday andpercentage dropped raw ofvegetables steadily respondents of students (Figure moderately eatingwho 9.9). participated decreased Specially more than Figure 9.8mm Male Students who ate fruite=s at Female least once a day (%) did.boysamongnoteworthy, By took female age part 15,however, instudents the sports percentages are activitiesin thegeneral. comparatively are every While 21 percentday, 28 only lowerpercent for 17 ratesboys percent of 11-year-oldofand exercise ofonly girls 8 406080 percent for girls. 11 year olds 20 0 13 year olds 15 year olds Figure 9.9mo Male Students who participatedMO in sports every day (%)Female z 202530 1015 5 , 35$ 11 year olds 0 359 13 year olds 15 year olds Figure 9.10 Students who had headaches once a week or CHAPTER171 9 essentiallyhadaGirls weekly headaches were basis muchthe sameweeklyat more all overthree likely increased all ages thanthree and boyswith age the groupstoage. percentages experience Boys' (Figure responses headaches 9.10). were on of girls who Both 50 Male more (%)a Female Interrelationships boysmedicationConsistentas andage girlsincreased with forwere headaches these less and likely findings more by to girls likelyexperience is asthe age toincrease increases.experience stomachaches in consumption However, weekly girls of backaches. 203040 Therestomachachesasalso they increased was grew a sharpolder, decreased.their increasealthough consumption inthe students' proportion of medication use reporting of tobacco for atstomachaches and alcohol least weekly 11 year olds 10 0 13 year olds 15 year olds regardingrosebetweenand from from the youths8 7 percentages to 19who of percent to13 said 22 and percentthey for15 years.havefemales between been Weekly (Figure really the smokingages drunk9.11). onThe in four males finding or of 13 and 15 Figure 9.11 25 Male Students who smoked at least weekly (%) Female yearbehaviourmore olds. occasions Boys from wereshowedalmost more no a pronouncedlikely11 year olds elevation to almost 17 percent of 15 than girls to report weekly alcohol in this health-risk 201510 consumption or frequent misuse of alcohol (Figure 9.12). 11 year olds 05 13 year olds 15 year olds Figure 9.12ow Male Studentsmore who times had (%) been really drunk four or Female 202515 360 11 year olds 10 05 13 year olds 15 year olds 361 172 Interrelationships CHAPTER 9 evidencechangesIt2. wasMental anticipated experienced of health mental that and by the emotionalyoung rapid adolescents and strain intense across would physical the result three and inage emotional increased groups. Figure 9.13om Male 50 Students whoEa indicated Female they are very happy (%) verytheThis 11-year-old happy,was found this maletofigure be andthe dropped femalecase. Althoughsignificantly students nearlyrated with themselves 40 only percent 26 percent as of being both of 204030 Thehappinessmales questions and among 22 that percent the were 15 ofyear designed females olds (Figure toexperiencing measure 9.13). such the areas same as degree self- of 11 year olds 10 0 13 year olds placeandextentconfidence, their across of schoolsstudents' loneliness,the three provided assimilation age helplessness groups. a summary in For their and adolescentsof families, bodythe changes image theirthe asthatdevelopment peerwell can groupas take the Figure 9.14 confidentStudents who (%) indicated they always feel 15 year olds indicatorslifestylegrowthof a strong and choices. ofundoubtedlyself-concept students' Thus, measuresitadjustmentmay contributes be one of toofself-confidenceto thetheir mostcontinuously ability critical to are make aspectsimportant shifting healthy of Now Male4030 ® Female Althoughfeelingsdemands of of thisself-confidence their substantial social environment. moredecrease highly is Generally, apparentat 11 than studentsfor at 15 both years rated boys of their age.and 2010 bulliednote,themselvesgirls, feelingsa higherdecreased as ofalwaysproportion helplessness, or remainedfeeling of boysconfident being the than same left (Figuregirls alone with in age. atall9.14). school, age However, On groups anda positive being girlsrated Figure11 9.15year olds 0 Students who indicated they always or often feel 13 year olds 15 year olds feelStudentsdemonstrated nervous were as also anthey increase more grew likely older in feelingsto (see be inFigures aof bad loneliness 9.15mood to (irritable) 9.21). (14 to 20%).and to 12 Male helpless (%)® Female 10 68 362 11 year olds 024 363 13 year olds 15 year olds Figure 9.16 Students who have felt alone at school (%) Figure 9.19 Students who were very often or rather often CHAPTER173 9 Num Male 4050 o Female 25 Male lonely (%)o Female Interrelationships 2030 201015 4IIRNIFIRMER1110RWEERELIELMI 11 year olds10 0 13 year olds 15 year olds 11 year olds 50 13 year olds 15 year olds Figure 9.17 Male Students who ofelt Female left out of things often (%) Figure 9.20 onceStudents a week who or were more in a(%) bad mood or irritable 1012 8 -- 421.11E7,57.72C/X11-1461.1...... 961111111=1=M111 5060 Male o Female 246 203040 Figure11 year 9.18 olds 0 Students who have been bullied at school this 13 year olds 15 year olds Figure11 year 9.21 olds 10 0 Students who experienced nervousness once a 13 year olds 15 year olds 60 Male term (%)o Female omm Male 50 week oro Femalemore (%) 304050 203040 11 year olds 2010 0 13 year olds 364 15 year olds 11 year olds 10 0 13 year olds 15 year olds 365 174 Interrelationships CHAPTER 9 feelingsThe broad about concept their of appearanceself-esteem canand bebody seen image. to include When students' asked Figure 9.22 somethingStudents who about indicated their body they (%) would like to change fromsteadilyyearwhether -old51 fortothey students 75 boys would percent over responded like timefor to girls (fromchange "yes". (Figure 40 their Whileto 9.22).53%), body, the Concernit almostproportion surged half aboutdramatically increasedof weightall 11- I Male 6080 o Female yearindicatedforalso boys. steadily-old females thatAccordingly, increased they controlled were for only ongirls theira fourdiet.over weight percentBytime contrast, bywhile dieting.of it15-year-old gradually16 Thepercent percentage declined malesof 15- 2040 Relationships3.51of Relationships thoseto 46 studentspercent with forwho boysparents, felt andtheir peersfrom bodies 45 and areto teachers, 35about percent right and for dropped thegirls. school from Figure11 year 9.23 olds 0 aboutStudents things who that found really it bother easy tothem talk (%) to their mother 13 year olds 15 year olds berelationshipsdevelopment.environment underestimated. contributein Theshaping importance significantly the emotional of to supportive anmaturation adolescent's andof youthpsychosocial affirming cannot my Male100 80 o Female meaningfulwithItems eitherin the surveycommunicationtheir mother which questioned or with their parents father students steadily demonstrated about decreased their relationships that with easy, age 204060 showexpectations.parent-child(Figures an average9.23 relationship, Theand overall 9.24).figures students increaseIn indicating conjunction also of 5 perceivedthat percent with parents theseacross an expectincrease changes the threetoo in inparentmuch agethe Figure11 year 9.24 olds 0 aboutStudents things who that found really it easy bother to talkthem to (%) their father 13 year olds 15 year olds groups. i Male 6080 o Female 2040 / 366 11 year/ olds 0 367 13 year olds 15 year olds 175 percentagesyoungerOlder students students. for spent male Survey moreand female timedata awayreveal students from the who samehome spent steadywith five friends incline to seven than in Figure 9.25 Male owithStudents Female their who friends spent (%) five or more evenings a week CHAPTERInterrelationships 9 thesewithcongruentevenings same- age pergroups with and week theopposite-gender (Figures with finding their 9.26 that friends andstudents' friends 9.27).(Figure steadily ability The 9.25). consistent toincreased Thiscommunicate pattern shift across inis 202530 andaffiliationemphasis connectedness mayfrom indicate secure as the thefamilial parent-child increasing relationships importance relationship towards of peerevolves. peer affirmation group 1015 5 takinginAs health-riskpreviously drugs. Youth noted,behaviours tendthis isto sucha engage time as when smoking,in these students behaviours drinking are apt alcoholtoas participatemembers and Figure11 year 9.26 olds 0 withStudents same-gender who found friends it easy about or very things easy that to reallytalk 13 year olds 15 year olds Anotherduringgroupof groups affiliationthis significant and, transitional therefore, and variable higher period. an to ratesassociationbe considered of substance between involves use increased theseems relationship to peer-exist Imo Male100 bothero Femalethem (%) environmentslevelofbetween success of confidence,students and which achievement and motivation theirprovide school positiveat and environment.school self-efficacy. reinforcement are correlated Students' Thus, and experiences withclassroom facilitate their 406080 outcomesstudent-teacherthe development for students. relationships of student autonomy are most and likely of mutually to realize respectful positive Figure11 year 9.27 olds 20 0 Students who found it easy or very easy to talk 13 year olds 15 year olds 60 Male reallywitho botherFemale opposite-gender them (%) friends about things that 304050 368 11 year olds 2010 0 13 year olds 15 year olds 36 CHAPTER 9 176 Survey items which examined the relationship between students and Figure 9.28 Students who liked school a lot (%) Interrelationships Atproportionschooltheir age 11, school a of26 lot. studentspercent However,environment whoof boys byreported ageanddemonstrate 15,36 enjoying percentonly 14 atheir of strikingpercent girls school said ofdecline experience. boysthey liked andin the 17 ma Male 4030 ® Female thatrelationshipstudents'percent older of responses studentsgirls also agreed conform towere questions with less to the thislikely whichstatement general to pertainedfeel pattern. (Figure that they to Figure 9.28).the are student-teacher treated Furthermore,9.29 reveals fairly 2010 inthetheirby them teachers.proportion own dropped views They of and studentsfrom were would 51 also who toreceive 38less felt percent likelyhelpthat theirwhen ofto boysfeel teachers they they and needed werecouldfrom it. interested54 expressOverall, to 38 Figure11 year 9.29 olds 0 Students who agreed their teachers treat them 13 year olds 15 year olds 4.percent Injuries of girls. 80 Male fairlyesta Female(%) likelyremainedthatFigure they to 9.30 be suffered about injuredshows the thatatthan leastsame the girls. proportionone for significant each ofage young group.injury people overBoys who the were pastindicated more year 4060 Figure11 9.30year olds 20 0 Students who had an injury treated by a doctor or 13 year olds 15 year olds 40 Male nurse® Female in the past 12 months (%) 2030 immENNEINgszeIRMA9EnruicullgonEF 370 11 year olds 10 0 371 13 year olds 15 year olds 177 OnethemesDespiteF. of Summary the relatedunderlying most to critical health-risk cross-cultural findings behaviours in differences, this study can be isa identifiednumberthe verification of for common youth. that happinessbesurveyedThere of concernwere who and differences manifested positiveto health inrelationships socialprofessionals.the proportion and emotional with of Declines parents,younger problems andandin confidence, increases olderthat should youth in InterrelationshipsCHAPTER 9 toareyouth important,have less who positivelikely engage this to and experience finding in supportive risky further behaviours high relationships suggestslevels such of achievementthat aswith smoking health-risk their parents. andin schoolbehaviours drinking More or girlstoamongdisconcerting.nervousness, dietary to girls, problems disorders. must irritability The beincreaseassociated viewedIn andfact, in helplessnessas concernoverall, with a problem, emotional aboutthe with greaterespecially body ageand image, vulnerability are mental as particularly it especially may health lead of satisfyingsubstandardexperiencetheare developmentconnected relationships major academicto ofthe stressself-esteem need withinperformance infor their social and their home self-efficacy.integration peer areenvironment group. more among Young inclinedIn the asyouth people pursuita resultto and seekwho oftoof warrants special attention. Theandyoungaffirmation disaffection.policy people implications and who acceptance, have hadof these similarthey findings typically experiences are gravitate quite of socialclear: towards educationalienation other thatprogramstosmoking prevent contribute designed among alienation to ayoung reductionto anddiscourage people disaffection in arehealth-risk such likely among health-risk to behaviour. be youth ineffective. arebehaviours more Programs likely as ofanddefinedConcepts well-being with by peers such young and areas people. self-esteemhealthfundamental andPositive happiness in to young relationshipsthe development people. were found atPrograms home of to a beandgood designedbroadly school sense findings.socialto makecommunicate development school more effectively acceptingof youth with wouldand their supportive, appearchildren to to and follow encourage to facilitate from parents such the 372 373 74 Northern Ireland 375 CHAPTER A. Introduction A.Su Introduction mary and Policy o proyidesHealthThis report Behaviour a wealth presents of in theinformation School-Aged preliminary about findingsChildren the health from (HBSC) and WHO's lifestyles Study. fourth Itof B.lmPlac Summary 2. ExerciseI. and leisure-time activitiesTobacco and alcohol tions whoundertakensurveyover were100 conducted 000 instructed by children research during to livingfollow teams the in1993-94 ain 24rigorous each countries schoolof studythe whoparticipating year. protocol. participated The surveyAny countries survey in was the 6.4.3. GeneralDietary5.Injuries Psychosocial habits, health, body physicaladjustment image ailments and dental and medication care use questionnaireChapterensuringcarried out consistency 1, by such being more problemsadministered thanin data one collection. researchare in furthera variety teamIn this compoundedof will survey,educational have as problems outlined systems, by the inin C. Policy Implications 8.7. TheInterrelationships school experience hand,oncomparisonscomparabilitylanguages the theHBSC dataand of survey cultures.theofpresented dataprevalence should from Given in be thisofdifferent such treatedindividual report reservations withcountries, do health caution.reveal behavioursabout cross-country considerable On the the likely basedother maybebeenbehavioursvariations fully arguedtherefore accounted and among elsewhere common reflect foryoung bypatterns that the reality.people such above in thelarge from Strongmethodological prevalence differences different similarities of countries.individual are problems, unlikely in healthIt thehasand to Notwithstandingthesegoodinterrelationships differentevidence countries. that thesebetween there methodological isvariables validity in in different considerations,comparing countries the thedata are results fromalso healthusedfindingspromotingpresented in of the are young publicheredevelopment summarized peoplehave health. a in number andof ThusEurope policies strategies in ofandthe andimportant followingNorth are programs suggested America. implicationssections to that improve themight main forthe be 181 InI.B. Tobacco every Summary country and alcohol of the findings use of tobacco and alcohol increased with age. generallytheypeopleand Scotland seem mature appear less consume and likely more gain to sweets controllikely choose at toover least healthyeat their less once foods, foodnutritious a day. consumption such Second, foods as fruit. as and patterns young Boys less SummaryCHAPTERImplications and 10 Policy smokerssubstancesexceptionBy the age and andof drinkers, 15,those a hard the in majority corewith Israel) of about respondents of had youngone experimented in fourpeople had reporting gone (with on with the totwo be principal the or regular moretwo phenomenondietingbylikely the toconsumption or eat feeling nutritious among a need ofgirls. foods hamburgers, to Fourth, losethan weightgirls; boys hot this are dogsappears isalso indicated,and less to soft be likely drinks.a for widespread thanexample, Third, girls countries,nationalamongepisodes boysgender ofCanada drunkenness. than variations andgirls Greenland in in nearlyWhile tobacco moreallalcohol use; countries, girls in use most than was there westernboys more weresmoked, Europeancommon cross- but Latviadaily,fewerto brush whereasthanand their Lithuania.half teeth among of thetwice 15-year-old15-year-old daily. In fact boysgirls in brushedthisthe majoritywas theirthe caseof teeth countries only twice in 2.in easternExercise Europe and leisure-time this situation activities was generally reversed. 4. oldsInGeneral only rate one themselveshealth, country, physical Sweden,as very ailments healthy. did the and majorityThis medication proportion of 11, use13 was and generally 15 year boys,Examinationintosuggests 15frequency such years that ofold, of inbythe theymostactivity the data ageexercise countries, on wasof exercise 15 generally less at as least frequently. patternsyoung three-fifthsmore people outside marked The progress downwardof school forboys girls fromhoursin trend allthan 11 backaches,botheredthelowest, United at by below andKingdom frequent more a third headaches likelycountries. in each to resortage than Overall, group, toby medication frequent instudents eastern stomachaches when seemedEuropean they more andhad or inwhereascountries only fiveamong exercised countries girls two this (Austria, or level more of timesexerciseDenmark, a week participation Finland, outside Germany schoolwas achieved hours, and headaches,likelydataheadaches also than indicated than stomachachesboys when to sufferthat they inand fromhad most irritability), the a countriesrange other ofailments to ailmentsgirlstake medication wereasked (for much about. example, to more easeThe namelylessgirlsNorway). likely in watchingthe Overall,to eastern participate television exerciseEuropean in theand participation countries less videos active and and leisurerates playing Spain. were pursuits computer Girls lowest weresurveyed, amonggames. also thelivesare,very symptoms in healthy.of part, young relatedof The thesewomen. gender to ailments the These differences onset andnegative of tomenstruation rateassociated health themselves indicators with at this theseas stageless were ailments than in also the thispeople'sAlthough3. Dietary survey. dietary there habits, First, are habits, body there difficulties imagefour is evidence areas inand interpreting ofdental toconcern suggest care the are thatdata highlighted the about diet the of by younga coughs.stomachachesgenerally15 year more olds andcommon tended to take toamong medicationbe least older likely than for youngersleepingto frequently students, difficulties suffer though and from whileGreenlandictosignificant current over nutritional number two-thirds and Welsh of advice. young of 11 13 peopleForyear year example, olds oldsin all do in countries overnotIsrael, eat two-fifths Northern fruitdoes oncenot of conform IrelandFrench, a day, 378 379 182 Summary and Policy CHAPTER 10 Implications 5. peersresponsesAlthoughPsychosocial and therefamily,to questions adjustment were in nearlysubstantial about all mental countries differences health only and between a relationshipssmall countriesminority with ofin effective,use,preventionSince a mostform varied injuriesofprograms injury widely occur prevention can acrossaround be targeted theschoolsthat countries. has to andbeen these sport Overdemonstrated settings. facilities, 60 percent Seatbelt injury to beof ofandmajoritystudents students found regularlyfelt it did easythey not to madefelt describetalk lonely, friendsto their themselves helpless easily,mother. orhad Lessas left atvery outpositively,least happy,of two things, close withthe while majority thefriends 15-the 7.forNorthern studentsThe Greenland school Ireland, always experienceand Norwaywore most seat eastern and belts Sweden; European in Austria, the countries. figure Canada, was France, much Finland,lower withtodescribeyear suggest -oldthan themselves andthatboys. eastgirls For European foundin example, these their terms. students teenagein most There generally yearscountries was more also the fewerfurtherdifficult least girls evidencelikely to copethan to to tendeddevelopment.Schoolscontribute to with show positively aStudents hospitable positive to who students' attitudes environment indicated emotional in severalthey and are well-beingcaring areas: satisfied teachers they andwith were social appearschool less outfrequentlyconfident,boys of describedthings. lonely and Moreover, morethemselves and asof with being them severalas regularly describedvery of happy the depressed mentalthemselves and ashealth and being feeling asindicators feelinghighly left Satisfactionmoreteachers,likely likely to beparents to smokerswith feel school andhealthy. orpeers tovaried drink tended widely excessively; to be across positive; countries,relationships and they but weretherewith Thisdifferences6.(such Injuriesstudy as reaffirmedwidenedloneliness, as other ageconfidence increased. research and findings depression) that unintentional the gender Germany,wasschoolwere a somenice as much Norwayplace commonalities. as to girls be.and Generallyand Sweden fewer Boys, were studentsindicated for most the in that most satisfiedBelgium they part, thought with(Fl.), did school.notCanada, school like year:reportedchildreninjuries two-thirds mayinan western injury be of the requiringthese societies. most injuries serious medical Nearly resulted health 30attention percent in problem at least during of the oneto thefacerespondents missed previous school day thanmentalwhoBullying bullygirls health behaviour indicatedand problems those at they whoschool as well,bullied are was bullied especially foundor were both to loneliness. bebullied reported quite withcommon. Far physical themore largest Those boysand Fortoaof cast, reportschool younger surgery injuries or studentsrequired or hospitalization.in all injuriesmedical countries were procedures Boysin more all wereage likely suchgroups. consistently to as occur the placement in more the home,likely of Greenland.proportions reporting this view in Austria, Denmark, Germany and byschool.sites.but brokenamong Over Sprains or15 40 dislocatedyear percent and olds strains ofsport bones. reported were facilities the injuriesmost 380were common theoccurred most injuries common at home followed injury or at 381 183 8. Interrelationships dailyand was 15-year-old around four girls times in Hungary as great in were Sweden almost as itthree was timesin Lithuania, as likely SummaryCHAPTER and 10 Policy makesLaderbehavioursThe interrelationships &it possibleMatheson, have beento examine 1991; betweenwidely Resnick these studied and interrelationshipsthe et (e.g., determinantsal., 1993). Glendinning The ofacross variousHBSC et countries.al., Studyhealth 1994; nearlyunbalancedexperimentedas their all countriescounterparts diet, with werea significant in smoking,inactive Austria proportion in to regularlytheir feel leisure depressed. of the used time, young alcohol,Nevertheless, suffered people atefrom had an in a Implications report;Onlytwopreparing illustrative orresearchers three more years.analyses extensivein many The of interrelationships of analysesanalyses the participating ofundertaken HBSC are countries datapresented for over this will inthe report this benext improvementearlieranalysesrange of HBSC conductedailments over surveys andthe by pastweresome have decade inof indicated poorthe in countries mentalthe thatlevel health. therewho of regular have has Furthermore, beencarried smoking, little out wereoldsconcerned and feelings smoking of amonghealth amongin15 mostyear 11 olds,countries, year happiness olds. smoking The among key by findings 1315 year year olds is associated with PromotionillicityoungSuch drug findings people Agencytaking willsuggest and for need alcoholNorthern that to be healthmisuse Ireland, a priority promotion among 1995; for young Robertsthe initiatives upcoming people et a1., targeted (Health 1995).period atif particularlyalcoholandfeeling away unhealthy, misuse from strong andhome spending among .a lackand boys; aotherof lot exercise. of health-risk time with These friends behaviours, relationships outside such school were as significantrestrictingSecond,the goals the of proportion the datathe availabilityHealth demonstrate of for youth All of thatas movementtobacco young despite as and 13arelaws alcoholhave to in be sufficientmany achieved. to minors,countries access a byhappyandpositive feelings little13 year attitude evidenceof beingolds toward in healthy,of the physical majorityschool, good and satisfaction offriendships, emotionalcountries with areproblems;success theircharacterized appearance in and a onIllinois,relatingMoreto tobacco sales active forto of andtheseexample, tobacco enforcement alcohol substances measures to to underage regularly and would undertaken strengthening consumers, thereforeengage to inenforce seemoftheir whichsales consumption.theadvisable. legislation legislationincluded In C. Poky Orafkationssatisfactionreflect11 year their olds' withstate theirperception of happiness, appearance that level andthey ofa are lackconfidence in of good physical inhealth themselves, problems. tends to (Davis,illegalcaughtintroducing salesin1991). illegal afrom tobacco possession 70 percent retailer's of to cigarettes, licence under fiveand resulted smallpercent fines in in a 18decreasefor months minors in whichNevertheless,preliminaryAs previously have implicationsanalyses mentioned,these analyses of the forthe data those findingshave from planningidentified presentedthe 1993-94 action a number here toHBSC are promote of based themessurvey. theon amongshowinghealthThird, promotionthe 13 the datayear extent indicateolds programs. ofhighlight regular the need For thesmoking example,to importance carefully and the theconsider findingsof misuseearly theinintervention of Chapter timing alcohol of2 proportionFirst,healthbehaviours considerableof adolescents of 15-year-old were variations foundin Europe boys between who inand adolescentbrushed North countries; America.their health teeth for atexample, and least health twice the 382 futureatDeveloping,among the priority.elementary elementary field testing and school nursery and students disseminating school to reduce child project mayfuture materialsbe substance an important targeted use. 383 184 Summary and Policy CHAPTER 10 Implications years.Fourth,adolescent The the data data girls show indicate may that require adolescentthat much the individual closer girls wereattention health more in likelychoices the next than offew methodologydespite the previously and in the mentioned prevalence variability of the health between behaviour. countries in andInhealth,their addition, North male and America,werecounterparts in many less likely smokingcountries, to to experience engage was and more particularlyin regular poorcommon physicalleisure-time in among western and girls exercise. Europemental than inresultinterrelationshipsOn one a in practicalcountry youth healthbeing level, among programsdisseminated such determinants whichcross-country for have use of acrossbeenhealth successfullyhomogeneity Europebehaviours and piloted Northcould in thewasmuchboys. motivations subtly Itof has the directedbeen attention of argued their towards given female elsewhere boysto counterparts adolescent and that failed during smoking,to to thesmoke adequately 1970s for(Smith andexample, address 1980set al., youthbasedAmerica,1993). healthprograms Itthough may promotion also somehave allow hadprevious programs thedisappointing development cross-national across several results of adaptionscommon countries, (Nutbeam agendasof such school et al,as for continuedorparticularly feeling1994). aefforts need theThese desire to are losemotivations requiredto weightbe slim; to is as learnwidespreadhave was more muchshown about among toin Chapterdo adolescent girls.with 4, Althoughself-image, dieting girls' Europe.thewhich CommissionEuropean is Thisa joint projectNetwork projectof the aims European of theHealthto createWHO Communities Promoting healthRegional promoting Schools Officeand the for Councilschools,(ENHPS) Europe, of a toFifth,initiativesmotivations consider although more each in in adopting relevanthealth the past behaviour to practitionersunhealthy females separately, is behaviours, aand matter researchers the of results somemaking have urgency. presented current tended andthattowardsattentionhealth the in wider promotingeach improvinggiven community of tosome the school the health 30 (Youngschool European being education environment &one Williams,countries whichcurriculum balances and1989).ten with linkspilot It actionthe isschoolswith intendedeffort directed parents willand thewaswithhere contribution associatedyoungprovide people. support withmade For alcohol byfor example, interventions a lifestyle misuse. in all approach Whilewhich countries itaddress hasto smoking health been only argued promotion onebehaviour health that Seventh,programtest1993). the concept atthe both data thein clearly practice international identify prior andtoa challenge a nationaltraining to levelsand most dissemination (WHO educational et al., organizedamagingdevelopingbehaviour health shouldlifestyles initiatives promotion not as whichbe a underestimated wholefor consider young may people. behealth-enhancing a (Nutbeam more effective et al., or health-way1989), to theyshowspositivesystems become that, toexperience create in more general, a positive alienated for asyoung youngschool from people. peopleenvironment their Evidence schools progress and and from throughprovide that the students asurveyschool more interrelationshipsindicateinSixth, different despite some parts the striking of differingbetween Europe similarities socialand and determinants North and between cultural America, of conditionscountries health HBSC behaviours. Studyregardingprevailing data studentsshouldengagewho have inadapt is healthprovideda negative in damagingorder by school theto providewider behaviours. experience literature a more A consensusonare positive alienation particularly experienceon and how includes,likely schools for to andThisofthis smoking. istime report illustrated spent which This with by associationshows onefriends, of a consistent384the both wasexamples afterstrong association school presented in virtually and between in in allChapter the countriesthe evenings, amount 9 of participativeorientatingmeaningfulfor example, traditional approaches,contribution providing didactic/autocratic andstudents to examiningschool with and/or opportunitiesandteaching reinforcingcommunity methods to notions life,maketowards re- of 385 a 185 organizationpersonal social of theresponsibility school (Calabrese, through 1987). teaching and through the SummaryCHAPTER and 10 Policy playgroundsinjuriesrepresentEighth, thethat a seriousfindings occurcan be healthat reducedindicate home, problem withatthat school unintentionaleffective in all and countries. inprevention sport injuries The facilities programs.number in youth and of Implications Furtherprograms.directionand contextual analysis to those of factorsthe responsible data thatdesigned contribute for tothe understand development to injuries the psychosocial ofmay prevention provide peercarriedresearchFinally, groups, out doneit isin areclear onlyaround unlikely one from the setting, theworld,to be data such sufficient that presented as health the toschool promotionproMote here, or andwith healthy interventions from families livingother or socialassociatedindicateamong status, young that with while youngpeople. both young people's theirFor example,people's feeling perceptions about decisionthe data school ofdiscussedto feelingsmoke and their is inhealthy associatedChapter family's are 9 potentialwitheducation,and both coordinated of parental young health peopleandprogrampromotion peer is relationships.thereforeof programs action likelywhich targeted Maximizing to includes require at parents, schoola the sustained andhealth health work facilities.bymeasureswith tobacco youth such companiesorganizations, as restrictions and improvementalong on advertising with a rangein youth-orientedand of sport environmental sponsorship leisure 386 387 186 Chassin,TheCalabrese, High L., School R.L. 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Head Accident (1993).injuries Analysis Pressto pedal Release. andcyclists Prevention, World and theno-tobacco 20:177-185.promotion day: of 396 397 Austria is a relatively small country (83,853 inmostcompulsory primary common school for pattern nine ( Volksschule), years, of schooling from age then is6 tofour 15. years The 191 il\ppendikChanIcteDisfics off GermanicpopulationsquareCroats,language), kilometres) Magyarsof country butabout there 7.6 in(Germanand are million.central Slovenessignificant EuropeItis isthe primarily andminorities official with smaller aa of meanscurriculaorganizedin middle that and intoschoolat ageacademic two 10, (Hauptschule)streams students requirements. differentiated face theirwhich Thisfirst by is participatingThecountryfiguresCountrdes ethnocultural outlining are countries presented. makeup the areeducational briefly Asand much economy described system as possible, of of and the each andeconomygroups mining, river/air of is Romanians, basedand transport there on agriculture,are Serbs largecompanies. andcommercial manufacturing Italians. About banks The a anoneseveralfirstcrucial apprenticeship yearstage transitionchoices of of pre-vocational secondary in decision. the program, ninth school, After training,year: or completing studentstheyan academicleading may have take the to responsesaspectscountrythe figures of to of eachemployallow the systemyoung for the comparisons same peoplethat mightformat surveyed. affect offor those each The the Mosthandicrafts.manufacturingquarter schools of the are wood, labour nationally glass, force administered;textile is involved and ceramic a few in additionaltechnicaltoprogram four years and programs. options thenfor teacher enter upon Therefore, a training,training entering there college vocational the are second for three up or yearthewereschoolshaded 24 ofdrawn. participatingyearsschooling, areas Although from indicate here which countries various and the the in grades, studenttheterms to maindenote are forms samples bodyused each orinof andhavecurriculumare eitherschool some regional autonomyisorganization. developed or privatein nationally,designing School institutions. attendance curriculumbut schools The is trainingprograms.universitystage of secondary college All preparation secondary programs school: school or general work-orientedculminate programs education, inand a includedyearnumberedthe report, of education.only sequentially the if term enrolment "grade" Preschool from is the is50 used firstpercent education compulsoryand or each more isis Austria's educational system of the eligible age group. Grade Pr sch of 1 P ma2 3 4 Hi her 5 1st 6 7 8 n H9 her Gen 10 11 ral12 13 orUniversity I other essiional/nichl I I educationpost-secondary Pre at sludcati naltentg 398 Age3 BEST COPY4 AVAILABLE 5 6 7 8 9 10 11 2 13 14 c 15 16 17 18 19 399 192 APPENDIX A Characteristics studentmatriculation for entrance examination to post-secondary which qualifies education. a predominate,languages; Flemish with less (60%) than and one French percent (40%) however,compulsory at 15,for students12 years may or from continue age 6 in to part- 18; of Countries secondseventhFor the HBSCyears stage of survey, ofthe secondary first students stage and inschool yearthe fifth 1 wereof andthe nationalinlanguagespeaking modern life. groups TheGerman. Belgium leading has Thecreated affectingindustries presence a profound includeevery of the facetsteel, duality two of schoolartsofferstime andeducation four each vocational. types last until ofsix education: years,age Primary 18. the General general, latterand secondarywith educationtechnical, three compulsorygrades.therepeatsurveyed. lower a school Physical gradesThe throughout year proportion to rangeseducation 8 schoolpercent from of for students in 2.5 classesbetween the percent higher who aretwo in majorproductiontextilecoal, chemical producer industry. of cobaltandof Belgium coal petroleum and tar, leadsradiumfertilizers firms, the salts, worldand and plastics.and a in large isthe a tertiaryentranceschool,two-year programs studentsorcycles. short outside Upon(3-4 are years) completioneligibleuniversities. or longfor of universityStudents(4-5 secondary years) classroomoptionaland four and/or withhours content subject a week. determinedteachers. Health education mainly by is groups.administer(federalized)The education There schools with systemare threefor official each iseducation "communauterized" of schoolsthe three ministries andlanguage free to transitionalarequalifyeducationwho two complete forages program entrance choice:at secondary which must to at studentshigher agetakeschool 12, aeducation. seventh makein they a vocational aselect crucialyear There to a ItborderingBelgium hasBelgium a population isthe a ,small countryof about France on 10 the andmillion North Germany. in Sea its InThefundedschools, Flanders Flemish by most the there school state, of are which systemprovincefour schoolare andreligious; networks: municipality. all state, are generalvocationaland at age education 14, education they path.or choose a pre-vocational or to arts, continue technical, program in the or 30,519Belgium's square (Flemish) kilometres. educational There are system three official provincial, municipal and Catholic. School is gradesindicateThe13 5survey and to that10 15 in wasyearfour order olds.administeredpercent to selectMinistry of aprimary sample ofto educationstudents studentsof 11, indata GradePre ch of 1 2P 'ma 3 4 5 6 7 8Se on 9 Ty 10 11 12 haverepeatsecondary repeated at least school atone least yearone-third one of grade. school of the Physical and students by stls ge st 2 Gege d orUniversity Healthiseducation taughtThe Frencheducation for is betweencompulsory school is optional. one system forand each two agehours group a week. and PreGe eral TecArt educationsecondarypost-other butsystemandThere forFrench are thehas many first beensystems. two similaritiesadopted years The by athree commonbetweenthe two-yearBelgian thecurriculum French,Flemish cycles 400 Age 3 4 5 6 7 8 9 10 11 12 Vob 13 14 15 16 Vo 17 18 19 401 optioneducation.general,is offered. is now technical,The Atavailable traditional age 14,artistic to two studentsvery three-year orfew vocational muststudents cycles choose in 193 Belgium's (French) educational system inStudentsthe the French sixth aged system. grade 11, 13 of and primary 15 should school normally and thebe ofCharacteristicsAPPENDIX Countries A Grade Pre- cho 1 2 P ima 3 4 5 6 7. eco 8 da Ge 9 eral 10 11 12 University anarespectively,second grade. average and By offourththe but 24 first apercent highlevels year rate of secondaryofthe students students school repeat have CurComlum cu- on Te hnic, I secondarypost-otheror 54secondaryrepeated percent. a yearschool The of survey school;this figure was by thehasadministered fourth increased year toof VoAr atio . al education theagestostudents the targeted 10-19) sixth from level andages the ofthe fifthwas secondary international thengrade extracted of school primary sample (normally from school with the Age3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 Canadaorthree fortotalunavailable. hoursall sample. grades a week. Physicaland Health is taught education education for between is is compulsory optional two and Canada's educational system Itterritorieskilometres,Canada, borders with three comprises a an populationoceans area ten of of9,976,185provinces almost 28 and million.square two school Grade 1 e- grademe s 1- to , 1-62 3 4 5 6 Granter estedi 6 to9,7 8 9 (GSec10 nda 11 12 University Educationtwoand Arcticofficial is languages offered in both languages where and the United States. There are Englishthe andPacific, French. Atlantic 7 or 1-8) 7-8 i r 7- 10-8-1 2)TeAc hnicdem c/I/ , 9-1des -11, or educationotherpost-secondaryor naturalEnglish-speakingprogramswarranted resources byhave population, beenwhich Canada. widely are and Therethe French implementedbasis are for immersionextensive lumber, in V atio al OACI(Ont CEGEP predominantlyOnmining, the prairies gas and manywheat, oil, and types which hydroelectric of isgrain a major are industries. grown export. Age5 6 7 8 9 40210 11 12 13 14 15 16 17 18 (Quebec-2 or 3 yrs) contributemanufacturingsourceCanola of production revenue. to the and economy. Major ishigh-tech also financial becoming industries institutions, a major also 4'03 APPENDIX A Characteristics 194 thereEducation are several is a provincial structural variationsresponsibility, across thus the Czech Republic's educational system of Countries territory,country.age 6 and Attendancechildren 16. Depending attend is compulsory primary on the school province between from or Grade 1 2 3 4 5 6 7 8 .9 10 11 12 13 schoolsschoolgrades10-12. from 1-5,from In some grades1-6, grades provinces 1-7 7-11, 6-9, or 1-8 7-87-12, there orand 8-12,7-9.are secondary intermediate Students 9-12 or re ch ol Prlmar ecomdary otherorUniversity vocationalprogramsentrance.Academicin Ontario Credits atareSecondary programs.two required levels(OAC) toschools ofUponto complete difficultyqualify completion usually for six asuniversity Ontariowell offer asof educationsecondarypost- importantTheentrancesecondary age to at educationalcommunity school, which studentsCanadian colleges decisions areand youth varies eligibleuniversities. makeacross for Age3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 madegradearethe country.made 10.at age Inat Quebec, Forage17 when the15 ormosta criticalthe16 part,studentsat the decision these beginning determine decisions must beof TheCzech Czech Repubnc Republic's population of 10,300,000 Formal15. Changes education in is thecompulsory system arefrom underway. age 6 to programsd'enseignementtheir(CEGEP), program or university which choices general can entrance. at leadentry et professionnel to to work-related a College partareaSlovaksis a mixture ofof the78,863 (3%) former of andCzechssquare Czechoslovakia. others kilometres(81%), (3%) Moravian who in Inthe live1989, western (13%), in thean secondaryofwhichStudents primary comprises attend school fourbasic and (in school thefive future, years for ninefive) of lower yearsyears school. Basic school is aacrossStudents grade the in from country. Canada, grade It especially is6, rare 8 and for 10 studentsup were to grade surveyedto repeat 8. In resultedtheCzechoslovakiacommunist Czech in Republica regime period separated collapsedof and great Slovakia.into change two and, countries Thisin for 1993, both has (academicallyorarecomprehensive seventhhigh achievers year oriented but, mayand since school). leaveattend 1990, after Generally,a gymnasiumthechildren fifth, at sixthwho age compulsoryCanada,asecondary subject, physicalbutschool up rarely to a studentgrade educationa whole 9.may year. have classes In to most repeat are of Formal health goodscountries.incomeindustrialized such from The as the Czechnationtextiles, production derivingRepublic shoes, of64 manufacturedis glasspercent a highly and of its conservatories(grammar),secondary15, students (technical),school secondaryare directed types or tospecializedvocational. one of three The and upper gymnasium studentstheseeducation classes, in is grade usually often 7 to taughtby 9. specialist in conjunction teachers with for 404 service45aboutmachinery. percent 14 industries. percent ofAgriculture the to labour the nationaland force forestry is income. employed contribute About in 405 examinationsdecisionsucheducationSecondary as is nursing, basedalong specialized and withon achievement technical the specialized schools results education, provide of studyin entrance school. generalin areas and 195 accounting.and the gymnasium, For those attending the four- these or schoolsfive-year Denmark's educational system CharacteristicsAPPENDIX A whichprogramsentrance qualifies end or otherwith the apost-secondary matriculation student for examinationprograms.university The Grade Pr sch of 1 2 Pdima 3 4 5 6 7 8 9 10 11 12 of Countries programsenteredapprenticeshipsecondary this vocationaltype examination. of institution schools Students with are highthree-year who grades have which conclude with an Ad(B anc d) is o otherorUniversity examinations.generalfour-yearfrom their programcompulsory which education finishes can with choose both a education and apprenticeship educationsecondarypost- proportiongradesFor the 6, international 8 andof students 10 were sample, repeatsurveyed. a studentsgrade A substantial and from this Age4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 educationrespondentsincreased15. They is fromhavethecompulsory numberthetwo surveyed or forthree of students grades.out-of-rangelessons up Physical per to ageweek grouped in classes and remain together for nine curriculum; it is usually integrated with other (familyIn(the levelthe decision 1995-96 education)with isone up school lesson towill the be year,principalper optional week. health of at the eacheducation school). grade upperdeterminesstudentsyears. secondaryUpon write their completion a futureschoolleaving path.offor examination this three They stage, years may at age(35%), whichattend 16, EstoniasubjectsEstonia isand located taught on sporadically. the Baltic Sea (between the Denmark,Denmark with a population of 5.1 million, is part chargeaschoolbasic board vocational of(19%). of staffing parents Every training and and schoolmanagement. schoolteachers is administered (46%) whoCurriculum or are leave byin squareLatviaGulf1.5 of million kilometres. andFinland Russia. is and mainly The theIt haspopulation Gulf of aEstonian landof Riga) areaof slightlydescent and of 45,100borders over(62%) onlySweden,kilometres.of Scandinavia. 3 percent the populationLike is of Its itsnon land neighbours, - isDanish areavery ishomogeneousorigin. 43,077 Norway The square official and and augmentedandasdevelopment at theobjectives local at level, takesthe local requirements.with place minimumgovernment at the national national These and ascontentschool wellare government.politicalwithindependence the restevents Industrymainly have and Russiangivenaccounts a democratic Estonia (30%). for more back Recent form than its of Dairymachinery,mainlylanguage and on is meat textilesDanish.industry products andThe (food-processing, furniture) Danish are principal economy and agriculture. exports. ismetals, based inquestionnaire.board theseventh Danishlevels. and In schoolVery Denmark,ninth few system. grades students students From responded repeat agein the 7a to gradefifth, to16, the Theemploysone-halfand manufacture metal one-third of workingthe ofgross of textiles, the are domesticlabour the automotive two force; mainproduct engineering partsindustries. andand ageofMost age; 16. children educationPrimary attend and is compulsoryalower preschool secondaryytipils class from at age 6 years 7 are to '91 136 compulsory,educationstudents have per but two notweek. hours formally ofHealth compulsory given education space physical in the is contributeleather goods, to the agriculture,national economy. and fishing also 407 196 APPENDIX A Characteristics Estonia's educational system The educational system is administered of Countries Grade 1 2 3 4 5 6 7 8 9 10 11 12 curriculum.languagedepartmentsnationally studies Fundamental althoughhave someand thelocal control(compulsory) health and over education regional second school Pr -sch of Ele ent ty SeLo ernd SU ander ry schoolconsists16, students fromis of from grade grade entergrade Ito 7 9,eitherto 1 age 9.to After 6a7 vocationalandto 16;grade intermediate elementary 9, school at or age VoAc atiode is al University surveyed.Estoniantoan enteracademic the studentsIt workforce isschool. very inrare Theand grades fortheformer studentslatter 5, prepares7 for and inuniversity. Estonia9 themwere Age'3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 theandweek.compulsoryto repeat program13; Health at agea for isgrade.education 15 determinedeach it is age Physicaloptional. is group compulsory at the forThe education school two duration at hours level is ofa age 11 Finland's educational system yearFinlandand olds ranges and from16 to 1838 tohours 38 hours for 13 per yearolds. year for 11 Grade 1 2 3 4 5 6 7 8 9 10 11 12 approximatelyborderingFinland lies Norway, in 5the million northernSweden people and reaches Russia, in its of 338,145 andEurope has Pke- P *ma II Lo wer square kilometres. The vast majority are Finnish sdhool Se on orUniversity areEducationtwowith sufficient officiala small is Swedish languages,available numbers. population in Finnish SwedishPulp and (6%);and where paper Swedish. there there and are al educationsecondarypost-other industriestextilesincludecountry'swoodworking andheavy manufacturing glass/ceramics.account makemachinery, up for a high over shipping,However, output. percentage 60 percent Industries chemicals,the service of theof 408 Age 6 7 8 9 10 11 12 13 14 15 16 17 18 19 409 MunicipalitiesFinland's1994) assumedgross anddomestic theschools main product. recently responsibility (August, for 197 inauthoritiesaccordingimplementing matters torelating and a national schoolscurricula to teaching curriculum have goals increasing arrangements and outline. objectives latitude Local and France's educational system ofCharacteristicsAPPENDIX Countries A 7givenFinlandeducational to 16). in Theaconsists nine-year content.lower ofcycle comprehensive Compulsorybasic of sixgeneral years schooling schooliseducation taught (age byin GradePre. sch 1 Pri ary2 3 4 5 6 Sec 1st7 eye, da 8 , 9 Se10 2 and 11ey lery 12 University an teachers.secondary)aupper classroom secondary After of teacher; this,three school at years age the for 16, upperisthree taughtstudents years cycle by canwhich subject(lower enter Te,Ge eramc I educationsecondarypost-otheror educationApproximatelyoffers general and 40 60 percentor percent vocational vocational. select education. general Upon 1 ational Theuniversityacompletion matriculation surveys admission. of were the examination general administered program, to to qualify students for sitin Age3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 classesFinlandproportionthe fifth, areis extremely seventhcompulsoryof students andsmall. whofor ninth twoPhysical repeat togrades. three a education grade hours The in servicesyearsgovernmentcountry has hasto tried its aservices, tradition22 to regions.decentialize but of duringAhighly small administrative thecentralized part last of few the insixIn primaryFrance, secondaryhours a the dayschools, school schools(8:30 students today 11:30;(colleges is comparatively attend 1:30 and to classes 4:30) lycees), long: and, for ofotherper 11,10 week subject lessonhealth throughout periods areas.education At of schoolage physicalis 13integrated andin Finland. education 15, a into minimum At various each age equipmentnationHowever,economy and consists Francecars, and aircraft,of is heavyagriculture, now telecommunications a leadingmachinery including industrial wine. are rectorate,rectoratesTheclasses HBSC averagethe of 11-year-old survey Nancy eight hourswasand sample Toulouse.conducted a day. was takenIn in each the Othertrafficlife,year humanis healthsafety.spent relations on topicsThis health education areand topics taught human issuch withincompulsory. biology as family other and areStudentsEducationmanufactured 6 to 11; in is thethecompulsory there. four-yearfive grades from college of age primary (or6 to secondary 16 school years. oldssecondaryofmainly primary were from inschoolschool). secondtwo typesand The or year thirdof majority school:1 ofyear the of ofyearscollege thethe college;134 (lowerand year 5 Francesubject hasareas. a population of 57 million living in a three-yeargeneral,At age1st 15, cycle)technical programstudents program or forchoose vocational. includesthose to 15 attend those to The 18 aged ayearslycee, lycee: 11 of ato 15. otheroftwo-thirdsthe the 15 years,collegeyear drawn olds that and were from is, the second athe remainderlittle third moreyear and collegediverse spreadfourth years overwithand percentagePortugal;populationcountry of of the551,500 immigrantsis quiteofficial square homogeneous language from kilometres. North is withAfricaFrench. The a French andsmall The 410 Theoptionbyage, about four-yearleads consists 60 to percent theprogram of baccalaureata two-of students. leads or four-year to whichaThe baccalaureat. vocational program. is taken secondarythefirstspecialized time year thelycee schoolstudents pedagogical, and other about are typesin technical 50 the ofpercent fourth school schools). year have(e.g., of By 411 198 APPENDIX A Characteristics of Countries healthTherephysicalrepeated istopics educationno at compulsory leastare included onetwo tograde. healththree in biology hours education, perclasses. week. but Schools offer economyplastics.chemicalof steel, industryautomobilesAis basedsubstantial produces on service and share drugs, machinery.industries. of fertilizers Germany's The and proportionfallseventhThe samplewithin and of in secondaryninth studentsGermany years who was ofschool repeatschooldrawn astagefrom allgrade of the I. whichvaries fifth,The millionGermany in has a countrya population that of comprises approximately 356,910 81.2 6GermanadministeredThe to 16.German Studentsstate. dueEducationeducation attendto the primaryfederalis system compulsory structure school is regionally from for of four agethe andforyearwith thosein betweenthe the typein ninth year 0.08of year school.7, andthe between range2.8 For percent studentsis4.3 4.5 and repeatto 7.16.5in thepercent. percenta year; fifth northwesterninTurkishpopulationsquare the region origin.kilometres. are ofThe immigrantpart Nordrhein-Westfalen HBSC ofAbout Germany survey workers, 8 percent was and conductedmainly ofinhas thethe ofa gymnasiumyears).dividedbyyears program until The into age options and Stage(academic), 10, school. Iwhen upon(6 years) Secondary theyentering secondary andare differentiated StageStage education general, III are(2-3 isa subjectcompulsory,threePhysical age areas. health levels. but instruction is integrated is compulsory into different at the Health education is also segmentallresources,ispopulation heavilysorts of accounts mainlyslightly preciousdependent oilover for metals. and 3717 on naturalmillion.percent importedThe manufacturing gas Theof asthe economynatural well gross as education,apprenticeshipintermediateMany students Stage school from schoolsat II, ageor theprovides a comprehensive15secondary continue or both16. Secondarygeneral vocational into school. andan Germany'sdomestic product educational and producessystem large quantities and general education. Grade schPre of 1 Pri 2 ary 3 4 5 6 7 ary 8 9 10 11 SeSt geand 12 H 13 G nilermefdiate VocFullGy timetionnasi m post-otherorUniversity Ge VocPar tiontime I educationsecondary 412 Age4 5 6 7 8 9 10 11 C 12 13 hen ve 14 15 16 (Du 17 1 Sys em) 18 19 413 199 G withGreenlandreen0and a population is a land of of 57,000. 2,175,600 About square 18 kilometrespercent of Greenland's educational system Grade ofCharacteristicsAPPENDIX Countries A mixturethe restpopulation are of knownnative is European, aspeoples Greenlandic, andmainly Scandinavians many Danish, being and a 1 2 3 4 P ima 5 6 7 8 9 10 11 Se and 12 rY 13 14 Thebutwho Danish countrymajoritysettled in isis of Greenlandalsoan the autonomous used people andhundreds speak taught part Greenlandic,of in yearsDenmark, school. ago. levediffi(Tw$ s) ulty Gy nas UM secondarypost-otherorUniversity andfishingGreenland'sgoverned reindeer. industry. by economyGreenland home There rule. is is issome dependent theThe farmingonly major source upon of part sheep ofthe of a education nationally.Thealuminium.mineral educational called Young Tourism cryolite people system is whichincreasing. aged 6is is to administeredused 15 are in requiredmaking Age6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 compulsoryagrades,to secondary attend after school. school whichexaminations Primary forsuccessful two school years. upon studentsconsists There entry of attendare intonine no Hungarysquare kilometres is a landlocked on the easterncountry edge of 93,032 of Europe dividedThesecondarygeneral first intoprimary level, with four academic(elementary educationlower yearsand or andtechnical withbasic four classroomschool) yearsschools. ofis completionprogramsteacherssecondary and at ofschool. parents. twothe two-yearlevels Evaluation Secondary of secondary difficulty. schools is made program, Upon offer by populationwithGermans,Magyarwith a population Slovaks, is relatively small of Croats over ethnic and 10homogeneous million.Romanians. minorities The The of specializedgrammarteachers.teachers, schoolandAt secondary age four (academic), 14, upper schoolstudents years (e.g.,technical continue with arts) orsubject or other theyto a preparedesignedgymnasium.students to maymainly take There enterexaminations for isaolder alsothree-year students a which two-year program wouldwho program wish enable in to a politicalandpeopleofficial the changes alsolanguageemphasis speak have is isGerman Hungarian,now taken on andplace a market Russian.but in manyHungary economy. Recent of the trainingoriented,gymnasiacontinue and inthe are eacha tradestechnical predominantly school training isschools allied school. with academicallygive anWhile practical industry the gradesAnmaythem effort attend to 6, attend 8was aand university university.made 10. The to insurveyproportion StudentsDenmark. all who studentsof students qualify in employedequipment.produceHungary mustits in iron One-thirdmining import and andmuchsteel, of manufacturing, ofthebuses, its labour raw and material forcerailroad about tois universitymatriculationgymnasiaor agricultural entrance. and examinationconcern. technical Outstanding Students schoolsto students qualify from insit the forthe a isandeducationwho compulsory optional repeat is compulsory afor forgrade 15 all year threeis forveryolds; age 11 small.health andgroups. 13 education Physicalyear olds 414 Childrenthe16. service15 Education percent must industries. attend in isagriculture dividedschool between into and eightjust age under years6 and half of in secondary8Forspecial of the primary schoolsHBSC school school sample,may were apply and students surveyed. yearfor higher 2 in (Grade gradesBy education. year 10)6 and2 ofof 41.5 APPENDIX A Characteristics 200 secondary school, a substantial number of Hungary's educational system of Countries atofferstudents least physical three have times repeatededucation, a week; a yearwhich many or ismore. schoolscompulsory, Schools have Grade 1 2 3 4 5 6 7 8 9 10 11 12 sporadicallydaily lessons. taught by classroom and subject Health education is more Pre sch ol lem :ntar; I S curriculumnursesteachers, and sometimes doctors.in 1995 involved Changeswith the theparticipationto theinclusion national of Lower PP r A post-otherorUniversity !Israeleducation.Thesignificant curriculum amounts also of defines health-related the aims knowledge. of health TrVo educationsecondary officialwhichkilometres)The population live languages, in is cities. about ofand Hebrew5.1 Israel many million, andIsraelis(20,700 theArabic majorityalso square are speak the of Age3 4 5 6 7 8 9 10 11 12 13 14 Tr 15 16 17 18 products,needsproduction.English. are cut Three-quartersmet diamonds, Other by industriesdomestic electronic of their produce agricultural equipment,national chemical food Israel's educational system textilesHigh-techfertilizer, and clothing, military products many equipment, are alsoof which a majorprocessed are exported.export. foods, Grade 1 2 3 4 5 6 7 8 9 10 11 12 Sport5Education to 16. is Theresponsible is Ministry compulsory for of theEducation, for educational young Culture people system andage re-s hool K* leme tat), Junior Hi h** Higl4Scho Adadem c then universityArmy, bodiesandsupervision supervises1.3 run ratio the of secondarymunicipal religious most schools; to schools.councils secular under There schoolsand publicthis is ina the VT catiohnic alI/ educationsecondarypost-otheror juniororeithercountry. eight high six years Studentsschool years elementary elementaryand follow three a yearsand school,school four high program threeyears school years high of 3 4 5 6 7 8 9 10 11 12 13 14 15 A 16 ricul 17ural 18 416 forserviceschool. boys. isAfter Attending mandatory high school, university for girls two duringand years three thisof yearsarmy time *** Some schools have eight elementaryKindergarten and four is compulsory. high schoolAge years. 417 201 attendis not permitted. university, After vocational army service, or community students independence.1940 by the USSR Manufacturing and, in 1991, industries regained its agearts 15or balletor 16, school.students At may the continueend of grade in one 9, atof APPENDIXCharacteristics A noweresurveyedcollege. information included Studentsin Israel. in regardingthe Thefrom international appropriate grade the percentage6 file. to age 11 There groups were ofis electronicelectricdomesticcontribute railroad product. equipment. about cars, The 60 household There mainpercent industriesis also appliances of somethe produce gross steel, and andeducationschoolthe abovethere or isenter requirestypes a university the of secondary workforce.school, entrance enter school Post-secondary examination.a vocationalgraduation of Countries educationtaughtisstudents compulsory for who is 2optional repeat tofrom 3 hours 8a for toyear. 18all per Physicalyearsage week. groups. of ageeducation Health and is AgricultureInsignificantcement, Latvia, processed the contributionsand educational a large food tofishingand system the textile economy isfleet administered production. make as well. allinPhysicalSurveys Latvia, targeted wereeducation three age administered times groups. is compulsorya week Health in (total grade foreducation 3 5,hours),all 7 schools and for is9. LatviaLatviaOne of hasthree a populationsmall countries of 2.7 on million the Baltic people Sea, attendanceguidelinesnationally16) years implementedis through ofcompulsory age, or ministry toby from the each completion6 school.(orof education7) to School 15 of (or the LithuaniaLithuaniaoptional. is a Baltic country with a population nationalities.34twoand percentpercentan area ofof Russian Latvia, the64,100 inhabitants declaredsquare and 14 arekilometres. anpercent Latvian independent (Letts), otherFifty- ninthschool(grades1-4) grade. studylevels, 5-9) All a and studentscommonelementary secondary maycurriculum. students choose (grades Atspecialized (grades the 10-12) primary Russianpopulationkilometres.of 3.7 million (9%) are Moreand Lithuanianand Polish an than area (7%) 80and of percent population.there65,200 is asquareof small theThe Latvia'sand democratic educational statesystem in 1919, was occupied in study in a grammar school or in a technical, music, officialcentralandcountry 20th language Europe.was centuries, frequently is Lithuanian. historically occupied Although during it belongs the the 18th to In 1991, independence was Grade 1 2 3 4 5 6 7 8 9 10 11 12 accountsandindustriesrestored oil refining. for inare aboutLithuania. chemicals, Theone-quarter agricultural machinery, Its most of the important electronics economicindustry Pile - school em nta C ice of S ho ry I I Se ondprys: otherorUniversity byschool.Childrenoutput a classroom ofThe between the first country. teacher level, the age oris dividedofprimary 7 and into 15school, must four taughtattendyears. MGr sic/ m ar its ec al t icaV cati nal educationsecondarypost- whenorintoThe 16, fivesecond they students years, may level, with graduatechoose or subject basic to toattend teachers. school,secondary a gymnasium is At divided schoolage 15 Age3 4 5 6 7 8 4189 10 11 12 13 14 15 16 17 18 19 secondarygivespecial(3 years), specialized secondary technicalschools training concentrateschool. school for a(1-3Technical profession. on years) music schoolsor Special or other art. 419 202 APPENDIX A Characteristics Lithuania's educational system gymnasiumStudents from must the pass secondary examinations schools for theor of Countries Grade 1 2 3 4 5 6 7 8 9 10 11 12 orexaminations).school-leaving other post-secondary In ordercertificate to qualify schools (matriculation for (colleges, university re- cho I rt ry as Gy um otherorUniversity proportionStudentsstudentsinstitutes, ofmustin Lithuaniangradeacademies), write 5, an7 and studentsentrance 9secondary were whoexamination. surveyed. repeat school aThe 1Telhnidal - _ educationsecondarypost- education,yeargrade11, with 12ranges and the which 13higherbetween years is compulsory, figure of 1 age. and applying Schools2 percent at least tooffer studentsfor twice physical each a Age3 4 5 6 7 8 9 10 11 12 13 14 15 16 a 17 18 19 physicianssometimesweek. Health often by byeducation biology participate classroom teachers.is taughtin health teachers, sporadically, Nurses education. and Northern Ireland's educational system Ireland.kilometresNorthernNorthern It Ireland has situated a population covers Ireland northeast an area of ofabout of the 14,000 Republic1.6 million square of Grade 1 2 3 4 5 6 7 8 9 10 11 administeredwithThepeople, country England, mainly is through partof Scotland Scottish of the Westminster United and and English KingdomWales Parliament. ancestry. and along is ScPr of ima ry GSe andm ar ry studleve dv nce University industriesforcealsoThe officialspeak in Northern some(education, language Irish. Ireland isThe English,government, majority is in but the of 10 the health).service percent work Se nd ry College (vocational) agriculture,shipbuildingTheAbout major one-fifth industriesforestry and is employed aircraft.and are fishing textiles in There manufacturing. interests. (clothing), are also 420 4Age 5 6 7 8 9 10 11 12 13 14 15 16 17 or other18 training 421 eitherforandSchool the 16. grammar primaryis Students compulsory level or are secondary (7 groupedfor years) all children and heterogeneouslyschool at age between based 11 enter on 4 203 examination,reservedan examination. for childrenthe Althoughcurriculum who passgrammar is the the same compulsory schools for both are Norway's educational system ofCharacteristicsAPPENDIX Countries A inwhentypes which theyof school.they are 14,will Atpupils sit the public choose end examinationsof the the subject third year,areas two Grade 1 Pr"mar2 3 4 5 6 Lo er7 8 9 10 per 11 12 fifthexaminationsthree-quartersyears year. later. Young Generally, in of atpeople leastsecondary all whofive grammar passsubjects students at schoolleast after threetake andthe school Se nd EGS ucaner 1ion con. ry otherorUniversity leavingtheexamstwoof the students more five for age examinationsyearsentry choose who intoto remain studyto university. go can to for inremain further schooladvanced-level About at education schoolafter half the for of T hni al/ cati nal educationsecondarypost- HBSCrecognizedundertakecolleges survey, training vocational to studentsstudy which vocationalqualifications. inmay grades lead to7, subjects nationally9 Forand the11 or Age6 7 8 9 10 11 12 13 14 15 16 17 18 19 numberchildrenhealthwere sampled. education ofthroughout hours Physical peris compulsory theirweek schooleducation is not career,specified.for asall wellschoolbut the as NorwayScandinavianNorway is situated peninsula on the western bordering part the of North the wasforsea, the theNorway's Norwegian forests andfirst industry the big waterfalls export and economy. product are the basis afterFish coast71stretchSea. degrees Themakes over country's north).athe latitude climate The323,882 of milder Gulf13 degrees square Stream than that (fromkilometres along of 58other the to andhavebasiswhich this beenof the thehas exportharnessed economy.attracted of timberpower toThe give numerous intensivebecame cheap electricity thewaterfallsindustries major Theandmillioncountries villagescountry inhabitants at the isand thinly same the and otherlatitude. andhalf unevenlyof half them Norway in liverural populated; in has areas.towns 4.2 theNorwegianNorwaysuch mainstay as aluminium found continental of the gas and Norwegian and ferroalloys.shelf oil and resources economy. these In the are 1960s,in today the themostand coast1814. people democratic line. It live is Norway a in culturallyconstitutional the easternhas beenhomogenous part monarchy a sovereignand along countrysince intofromnationallyThe primaryeducationalage 7 andto 16 (1-6) regionally. and system andincludes lower isSchool gradeadministered secondary is1 tocompulsory 9, divided (7-9) both 422 andNorwegian,communitiesexcept relates for strongly the hasin theSami two north.to different Danishand The Finnish-speaking andofficial written Swedish. language, dialects The Upperremainkeptschool. together. secondary Thethe same students For exceptschool grade in elementary educationfor7-9, elective these isclassesclass .courses.optional, units are 423 204 APPENDIX A Characteristics of Countries education,attend.but everyone Upon at agebetween entry 16, students 16 to and upper 19may has secondaryselect the right one ofto Poland's educational system advanced-levelwhich13 foundation lead to anprogram courses apprenticeship in (vocational the two mainor atraining) moretypes Grade re- 1 2 3 emegtary 4 5 6 7 8 9 10 11 12 13 bothvocational/technicalof secondary types giveschools a education).general (general competenceeducation Since 1994, and hoot secondarypost-otherorUniversity compulsoryverysurveyeduniversity.examination rarely for Studentsphysical repeatthis for study. admission educationingrades. grade In Norway, 5,Schoolsclasses to 7 collegeand studentstwo 9 offerwere (age or education intoseparately,grades.11 other and 13)Health subjects. but or anthree efforteducation (age is 15) made times is to notper integrate weektaught M it all Age6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 hasPoland,Poland an area a republic of 312,677 situated square on kilometres the Baltic and Sea, a chooseremain insecondary school until education age 17. which At 15, is students offered andStudents year in1 (gradegrade 59) and of secondary7 of elementary school school were strifelanguage,homogeneouspopulation in the Polish. ofpast over and few There 38almost years, million. has butall been speakThesince some population 1991the political official Poland is basicmayvocationalin generalvocational be pursued (3-year) (4-year), secondary after schools. studentstechnical schools. Technical graduate (5-year) The education four from or week.curriculumtaughtsurveyed. There at agePhysical is noso11, national instruction13 education and 15 health foris iscompulsory two optionaleducation hours andper or involvedmanufacturing/mining;one-quarterhas had a in fully agriculture. of democraticthe labour Industries a politicalsimilarforce is include percentageemployedsystem. textile, Over inis requireyearseducation.student of generalthe for However, studentsuniversity secondary post-secondaryto and write education other an post-secondary entrance prepare institutions a unavailable.nursesteachers, and sometimesSometimes physicians itby participating.is biology taught by teachers, classroom with Inequipmentmachineiron Poland, and steel, toolseducationand chemical,shipbuilding. and ismachinery, administered and petrochemicals, electronic nationally examination to qualify. toAttendance through17. Elementary theat school Ministry school is compulsory ofucationincludes studentsNational by grade fromarethe Education. 1unabletime age to 8. 7they to completeare 15, they their must basic 425 205 inRussia area. isIt almosthas a population 17.1 million of approximately square kilometres 150 Russia's educational system ofCharacteristicsAPPENDIX Countries A country.million.100 different Russians The sample nationalitiespredominate, for this survey butrepresented there was are taken overin the GradePre- cho 1 rim2 ry 3 4 5 asic 6 Seco da 7 8 9 Upp10 r dary11 Russiamadepeople.from many St.has Changes Petersburg abundantareas ofin Russiaandlife natural itsdifficult. regionin recent resources ofAlthough years6.7 million have SecGe eral secondarypost-otherorUniversity copper,enterprises.themakespetroleum, workforce it butdifficult natural its Major forestry isto gas, employedextract exports coal, industry them. iron are in Theore state-ownediron(one-fifth themajority ore climate and of Vo tion 1 ech ical education Petersburg,machineitsthe manufacturing world's buildingforests shipbuilding industries,are andin Russia) andmetalwork. the the isemphasis manufacturein decline. In is St. onIn Age3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 centralizedAlthoughof industrial educationalthrough equipment the policies Federalare major and Program industries.programs of are Incourseswhilethe the secondary regionabout of study. of one-third schools St. Petersburg, offer specialize common grade in6, education 8various and 10 industries.engineeringreplaceStream. heavy Economically projects industries and Scotland finance with is andhigh-tech struggling service to Tourism is very much a growth compulsorydemographicindividualstandardsEducation of socioeconomic, fromDevelopment,the characteristics. different age 6 to regions17. ecologicaltheThere Education reflecteducation are three theirand is optionalthecompulsorystudents targeted forwere allwith age surveyed.ages. 68groups. hours Physical Healthper year education educationrequired for isis manufacturedcountry'sasindustry an international and main Edinburgh goods exports such financial is are growing as oil, woollens, natural centre.in importance textiles,gas The and 10)secondary1levels to on,4), of basicstudents compulsory (grade secondary must 10 and education:pass (grade 11). annual From 5 toprimary examinations grade9) and 5(grade upper (age ScotOandScotland forms the northern part of the island of withEducationwhisky additional and is machinery. financed funds fromby the local central taxes. government Scotland program.achievers,to 11,continue "special" A but to certificate the most subjects next students grade. is aregranted Fromtakeavailable ona grade common passing to 8 highto andapproximatelyScotlandislandsGreat English Britain. as has wellis a the It80,000population isas main made the square mainland spokenup of ofjust numerouskilometres. overlanguage, and 5 coversmillion small aidedCatholic);fundedapproximatelyhas its and ownschools the independent distinctive remaining 95 (of percent which education 5schools. ofaboutpercent pupils 10 attend Theattendsystem percent elected grant- state- and are learning.enternationalschool. university examinationsIn Students St. Petersburg, or other sit atentrance institutionsthe slightly end examinations of over secondary of higherhalf of to 426 climatethelegally,although country is 80,000 thetempered is national situated Scots by language. also thequite warmspeak far Geographically, north,airGaelic of the butwhich, Gulf the schoolgeographicalRegionalfor the from provision and age area.Island 5 to of 12 Councilsschool years educationand are comprehensive responsible within their Children attend primary 427 206 APPENDIX A Characteristics of Countries Scotland's educational system ofvocational) secondaryyoung people from schools ageremain (that at school is academic beyond age and 12 to 16. Over 50 percent Grade Pr of 1 2 Pri3 ary4 5 6 7 8 9 10 11 12 13 University yearseducation,16. of schooling examinations (Highers are and set inSixth the lastYear two For those wishing to continue their sc nal ndishen ive secondarypost-otheror mayKingdom.Studies). enter Thoseany university who pass within the good United grades education isScotlandHBSC2Scottish compulsory survey. studentsto repeat up andin ato grade.primary age 16 Physical 7,and and taught secondaryeducation for a 4 (grade 9 andIt 11) is very were raresurveyed for a forchild the in Age3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 Slovakiacross-curriculareducationminimum is of taught one subject. athour all ages, per week.but is mostly Health a Slovakia's educational system andSlovakiaUntil has a comprisespopulation of almost 1993, the eastern part of Czechoslovakia, 49,035 square kilometres5.4 million. The Grade 1 2 3 5 8 9 10 11 12 agricultureemploysSlovakian about economy and the is service based on industries. industry, which The 40 percent of the work force, s hoote- rim rY 4 Se and 6 rY 7 Him School enertal orUniversity andpetrochemicals.engineeringmanufacturing zinc are equipment, the Copper, industrymajor mineral refinediron, produces lead, petroleum resources. manganese metals, and In cal educationsecondarypost-other privateareagriculture,Slovakia's grown and and church several educational some schools aregrains, exported. system and potatoes is administeredincludes and flax state, V cati nal schoolfromnationally. 6 to 16. School There areattendance three divisions: is compulsory primary grade 1-4, secondary grade 5-8 and 428 5 6Age 7 8 9 10 11 12 13 14 15 16 17 18 429 gradehighsit schoolentrance (vocational, examinations technical for high or schoolgeneral) which 9-10/11/12. At the end of grade 8, students determine whether they attend a gymnasium Spain's educational system CharacteristicsAPPENDIX207 A etc.)(chemistry,(humanities for four-year building, oriented) programs electricity, or a specialized or nursing,a vocational school arts, 1 2 3 4 5 6 7 8 9 10 11 12 of Countries programs.school which Upon offers completion two-, three- of and courses four-year at a GradePreF Pri aiy e ocwo darjUePcP o da exam,specializededucation.gymnasium, which At school, studentsthealso end qualifiesstudents of may the programssitthemopt a for"maturity" for higher inpost- the school (B ic) ace laur ate advancedorUniversityprofessional schoolStudentssecondary were in education. thesurveyed sixth, foreighth this andstudy. tenth In Slovakia, years of Voca ional secondarypost-Othertraining 2grade,approximately percentcompulsory over of 3 15 percent 2 year forpercent theseolds. of 13of Physical threeyear11 year olds age oldseducation and groups repeat almost is anda 4Age 5 6 7 8 9 10 11 12 13 14 15 16 17 18 education perSpaiinstudents year. Health receive education about 120 is mostlyhours of optional. instruction theThe schoolcentral system,government which defines in some the basisareas for is andtwo 9consecutive and 10. In grades,Spain, almostthat is, 105 and percent 6, 7 and of 11 8, 40andbordersSpain million the is AtlanticPortugal, part speak of Ocean. France, mainlythe Iberian The theSpanish, populationMediterranean peninsula which of is overand Seathe yetconsideredsystemgoverned in all the operate by regions. to the be regional moreat An present: oldprogressive, government, and the new new schoolhas but one,been not atcloseyear least olds, to one32 almost percent grade. 19 of percent 15 year of olds 13 haveyear oldsrepeated and officialGaliciaBasqueregions language, (Galician).(Basque),which have although CataloniaThe co-official country there (Catalan) haslanguages:are 505,992three and attendprimaryisimplemented compulsory primary and overlower from school the secondaryage past for 6 few tosix 16 years.years, school. which Educationthen coversPupils two educationleastmandatoryPhysical 105 education hours andeducation, 70 in ishoursthe compulsory andthird in students both stage atthe ofall receive first primarylevels and atof aregovernment.communities,square important kilometres The eachto the touristdivided with economy, its trade intoown and 17asparliament autonomousare agriculture mining, and baccalaureatevocationaltwo-year16, some stages program studentsprogram of secondary and which proceed others leads school. to to toa a two-yearadvanced two-year At age educationsecondsubject stage at is all consideredof levels secondary of mandatory an education. interdisciplinary education. Health steel,andsteel,fishing textiles cork. petroleum and and manufacturing cement. products, The oranges, ofmain products exports olives, such are wine as 430 theuniversityprofessional11, survey 13 and wasentrance. 15 training conducted year Althougholds or areforto examinations ineach mostgrade age of 6, group Spain's8 and for in 10, 431 APPENDIX A Characteristics 208 Sweden Sweden's educational system of Countries geographicallyFinland.ScandinavianSweden shares (449,964 peninsula the northernsquare with kilometres). Norway part of Overandthe It is the largest of these countries GradePre- 1 Lower 2 3 In 4 5 6 7 per 8 9 Up10 er 11 12 language,extremelysouthern90 percent half religion of homogeneous ofits the 8.6 and country. million culture. peopleThewith There population respect live is a insmall the tois sch 1 * Bas Iasime ate asic pro2 aSe ram nda de ic University withSami.group about Swedenof Finns one is(265,000) amillion highly andindustrializedpeople a smaller employed groupcountry inof pro14 ram cati nal alsoelectronicaluminium,manufacturing significant equipment cars, industries products machinery, and chemicals. producing such electric asThere lumber, steel, and are 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 Throughoutmajorproductspaper, exports. glassware such Sweden as cheeseand the furniture. education and lingonberries curricula are Agricultural subject teachers. There are no examinations; Age Questionnaires were administered to students betweenschoolarenationally responsible the activities. administeredages for of organizing7Education and and 16 andthe and is municipalities consistsimplementingcompulsory of academicafteruppermarks grade secondaryare or awarded9. vocational These school asschools aprograms basiswhich offer for students of eitherentrance two orgeneral attend three into forPhysicalnoin repeaterseach grade age and 5, group 7 inhealth and the in9 Swedishintheeducation Sweden. study. schoolStudents Thereis compulsory aresystem. receive virtually to 3;classroom7three tointermediate, 9. levels Up teachersto of grade three grade and, years6, 4 tostudents in 6;each: the and senior lower,upper,are taught level, gradegrade by 1 leadtheyWhenyears, tochoose whichuniversitystudents from will enteror soontwo from academic thesebe 14 a standardvocational schools programs three at programs. age whichyears. 16, 390Sports hours and of instruction Health between in a subject age 7 calledand 16. Play, 209 Switzerland$witzealland has a population of 6.7 million and Switzerland's Education System APPENDIXofCharacteristics Countries A acrossandEurope,occupies Liechtenstein. 26 bordering cantons41,293 Italy,andsquare Its the France, population kilometresmajority Germany, of theinis spreadcentralAustriapeople schoolP. Grade 1 2 Pri 3 aly 4 5 6 ls17 cyc 8 Sec 9 nda10 2 11 12 13 14 confidentialitySwitzerlandGerman,live in urban French, is ofareas.known its bankingItalian Officialfor its system.andneutrality languages Romansch. The and Swiss arethe Te M University higherforhaveeconomy about been percentage one-fifthhas recruited grown of ofto rapidly the foreign-bornfill labourjobs; and they force.foreign nowresidents There workers account is in a secondaryOther post- tourismThechemicals,Switzerland economy and banking.machinery, isthan based in any Majoron pharmaceutical manufacturing,other exports European are products, country.food,trade, Age 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 education ownSwitzerlandTheretextiles educational is and no watches. ascentral each system. canton ministry In is recent responsible of education years, forthere inits tograde Switzerlandmeet 5 tothe 10 criteria and selected then of theconstructed a sample targeted of a agestudents subsample groups. from Bansweredstudent and the samples Part other A Partwhilewere C. oneselected. Physical group answered education Part is All students ofhas ninecompulsoryin been the grades. somestructure More fromeffort andofage to the morehave6 to systems. 15 areasmore or thehave consistency completion adopted School is studentswereIt is difficultincluded who hadarein to part estimateheldrepeated to back,catch athe but13grade. andproportion grade 15The 6year Swissand old of8 occasionallyeducationgivencompulsory for three is for covered optional45-minute each surveyed within for periods these ageother a ages,week.group curricular Healthbutand is enteringtwo-,bya six-year a three-year three-, the elementary four-second first or cycle five-yearcycle (primary) secondary at agesecond system 15, school cycle.university- followed Uponand a survey was divided into three parts and two areas. enterlanguages,secondarybound a normalstudents orschool maths school attend and (teacher sciences. one of training three They maytypes for pre-also of Greek and Latin, modern betwoyears,primary, part to or fourof aprimary, thesetrade years. orprograms. secondary-firstApprenticeshiptechnical secondary cycle) training school for may five for 434 435 APPENDIX A Characteristics 210 Wales Wales' educational system of Countries theWales Irish is partSea ofon the the United west andKingdom, England bordering on the 1 2 3 4 11 kilometres.millioneast. Its lives Englishpopulation in an is thearea of official approximatelyof 20,768 language, square used three GradePre Primary 5 6 7 8 9 10 12 iri 13 therepopulationby the has vast been also majority; a speaksstrong nationalistWelsh. about In a recentfifthtrend oftoward years, the sch ol sta e e 1 K y sta e 2K y reh nsi I Secior 6 hF rms secondarypost-otherorUniversity productstheAgricultureinstructionmaintaining economy are andis thewidelyof offered manufacturing Wales;Welsh produced, in languagemeat, Welsh arewool andin importantand alland plastics, schoolareas. dairy to Ionmi colleges education Educationmanufactured.automobilechemicals, is financed electricalparts and by equipment, theairplane Welsh syntheticenginesHome Office fibres,are Age3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 achievementandTherein combination detailed is a national guidelinesare with issued curriculumlocal ofto education contentall schools. of and 11 authorities. expectedChildrensubjects HealthIn ofselectedWales, students education students to complete who is from repeatoptional, the grade survey.a grade except7, 9 Theand is fornegligible. 11proportion those were Welsh)coreforschoolsmust those subjectsattend provideare under schoolundertaken (English, 5. nursery Tests from on age andatmaths, national age 5reception to 7, 16,science 11 curriculum but and classes many and14. compulsorysubjectstopicsReferences which and since are sex included September,education, in national 1994. which curriculum has been programs.thatthenChildren offersenter University-bounda attendbothcomprehensive academic primary school students secondaryand vocational to remain age school 11 in and Paris:Developent.Organisation OECD. (1995).for Economic Education Co-operation at a glance. and post-secondarycolleges.Asecondary level exams Teacher school ineducation until tertiary training age orare18 colleges furtheror also 19 available.or educationand study other for 2ndencyclopediaPostlethwaite, ed. Oxford: of Pergamon. national T.N. systems(1995). of International education, An important consideration when interpreting An important element of random error is 2 1 1 Sa ndix Thisaccuratelythe resultsextent appendix representpresented to willwhich outline the throughout the true thesurvey population sources this estimates report of values. error is population.respondents,thatsamplingestimated a survey error, The from rather that degreeis the based whichthan survey of a random arises censuson data a from sample errorestimate.of the the can totalfact of beThe Sam lin le design and Err r errorstheemployedestimates.which implications ofcan the in impact Detailsthe survey HBSCfor on measurement estimatesof the Study the accuracy sampleare are provided ofdiscussed. of standard design survey and sourcesaccountestimate'sstandard ofof error reliabilitysampling random provides errorerror, or precision anda such measure other as and randompossible oftakes an methodologyparticipatingaDesign selection factors of for variablesare inestimating introduced the acrosssurvey. standard and eight presented Finally, countrieserrors for a questions)responseSample error or coding (e.g.,design errorserrors. and in interpretation calculation of of otherSources survey variables of error is presented. On FIBSC survey thesamplesHBSC populationstandard survey that are data of not errorsschool-aged are simple obtained random children. from samples national Were of Thecharacteristicestimatecan totalresults be error seen and associated theasof the interest.true difference population with The a survey component between value estimate for parts that the thiseachframechoosing the country.case, which individuals the listedUnder sample all such at school-agedwould random a design, be fromselected the children a standard sample by in samplingreferredof 1987).the total to error as error bias) is importantare and systematic random (Butcher error, error of& (oftenwhichElliot, sizeoldstheerror sample (e.g.,smoking of a totalproportion proportion weekly number in can ofof Wales) interest15 be year calculated and (e.g.,olds the sampled 15sample using year example,willdesigningWhile be every completely biasthe effort study, may is be it madefree ispresent unlikely of to suchavoid in thatHBSC error. bias the when datadataFor equation:insertingin Wales respondingthese figures to into these(p) question)the following and pq , where q = 1-p (Eqn 1) ofowing comparabilityandsamplethese tothe vary question selectionresulting between waswording or problem notedsurveycountries effects, in non-response.of Chapter incross-national methodsthe survey 1. Biasof All whomyearUsing olds the23% inabove reportthe Welshexample, that samplethey there smoke (n=1257)are 1257 weekly 15 of 438 relatinginformationcannot tobe true quantified external population to without thevalues. HBSC additional survey (p=0.23). Therefore:se(p) =1 (0.23 x 0.77), = 0.0119 = 1.19% 1257 439 2 1 2 Sample Design andAPPENDIX B estimateThe 95% is confidence given by: interval of the survey likely to reduce standard errors and should be Hwhere: = number of strata (e.g. regions) Sampling Error whichintervals in the of current 23% +/- example 2.3%P (or +/-gives 20.7% 1.96 confidence xto se(p) 25.3%). calculateTherecalculated.taken areinto standard a accountnumber errors of when methods that they take available areaccount being toof andyhnh = similarlycharacteristicnumber of forschools/classes ofvariance interest inof in school/classx stratumand covariance h i instratum h intervals.liesIn issimple asomewhere 95% Itterms, shouldchance these -bebetweenthat resultsnoted the true however,indicate the population calculated that that there in value a straightforwardTheLehtonencomplex Taylor &survey Pahkinen, series designscomputationally expansion 1995; (see Lee foriset al., theexample and1989). most is This&(x,y). Elliott, method (See 1987.) for gives example a reasonable Kalton, estimate1983; Butcher of the wereindicatestatistical undertaken that sensthe if a onnumber different confidence of identical samples intervals fromsurveys the proportionsurveysapproximateemployed of(e.g., interestin standardmany SUDAAN, is expressedcomputer errors PC from as CARP).programs a ratio complex (r)The to . dependingthemuchstandard schools variation error onor classeswhich provided in the isselected number the that primary therefor of thechildren issampling sample,not too in Inofwouldsame thecommon population,timecontain (Gardner with the the true the & majority populationconfidenceAltman, of 1989). populationvalue intervals 95% year(x).attributeof For oldsthe example,(y) numberin andWales the if in smokingtotal r the is numberthe sample proportionweekly, in with the then sample aof giveny 15 is asfor(se(x)/x)beunit. measuredaexample, proportionThe orextent put usingclass simply toof sizethewhich the coefficientin thesample avariation countrystandard size of expressedexists variation errorfor thatcan of, classclusteredtheto surveys,collect HBSC is the sampledata complex primarysurvey. in designeach surveysamplingAll country in countries whichdesigns unitparticipating the rather areemploy school employed than in ora standardtheis the numbersample total error numberofresponding childrenof r is of now Welshsmoking to estimated the 15 question. weekly year as: olds and The in x alternativeexpansionexceedscountry. 0.1If theshouldmethod (or coefficient less be ideallyis used. not ofreliable 0.2)Coefficients variation the andTaylor of an ofx the individual pupil. Given such a design, the I (Eqn 2) HBSCvariation survey for those were countriesbelow 0.1 examinedin all cases. in the otherorindependent,pupils' school than responses areto pupils moreas pupils cannotlikelygenerally. within to be be Cluster assumedthesimilar same sampling to toclasseach be rwhere: = estimated proportion = y/x se(r) = x21 [ var(y) + evar(x) - 2rcov(yx)] ofDesign standard factors errors and forthe otherestimation randomsizebetherefore higher of samplesample. results than would was Consequently,in standard obtained be the errors case using standard ifthat thea simpletend errorssame to andxy = populationcharacteristic of ofinterest interest (e.g., number of 15 year olds)olds smoking weekly) acrossforWhilesurvey all the proportionsit is24 estimates possible countries of to interest calculate participating in standardall age in groups theerrors withinthatmust takes be schools calculated account or classes.of using the correlationan appropriate of children method var(y) h H=l nh 1-41117_i y )2 doing1993/94 so. In survey, particular, there there are practicalis the issue problems of how in classifyingA number of the countries sample alsoframe stratify into smaller their sample, units, nnh usingbest a todesign present factor in reportmodel. form The standarddesign factor errors alloften regions geographical in the country. areas, to This ensure stratification coverage ofis 440 i=1 Yhi 441 obtainedderived(deft) is assuming thefrom ratio a complexabetween simple randomthe survey standard sample, and error that variables focusing on the school as a setting. rearranging Equation 3 such that APPENDIX213 B effectThe design (dell), factor the isratio the ofsquare the variancesroot of the (Kish,design deft = ssialcomplex se(p),,, (Eqn 3) particularlyareperceptionsFor often example, large, of for whether reachingvalues 11 year teachers ofa olds. maximum deft treat This for them pupils'isof tofairly1.76, be aofIt usefulis deft sometimes values strategy for suggested for a number producing that of taking variablesusable an values average can be ofse(n - -complex ) se(P). x deft SamplingSample Design Error and estimatecomplexWelsh1965). 15 usingReturning standard year Equation olds to error smokingthe 2 example isobtained 1.57%, weekly, of resultingthefor 23%thisthe of 2.theexpected likelyRelatively school toas measured.hold pupils high similar withindesign views schoolsfactors on thoseareor classes found aspects arefor of mightwerevariables.deft for recorded be estimating used However, tofor provide one standardif particularly of athese more errors variables conservative high for values other this sampling).25.3%ofin 95%19.9% underconfidence to The 26.1% the value assumption intervals (compared of deft around of for withsimple this the 20.7% estimateestimate random to hamburgersgroups.other1.50 variables For are example,or foundhotfor certaindogs valuesfor among countriesdaily of deft11 consumption and exceedingand/or 15 year age of variables,enjoyingfeelingestimate. theof beingFor belongingvalues example, together of deft at if can schoolitfor is be15 assumed seen yearand asoldsstudents thatrelated in the [Fr.],calculatedValuesis therefore Canada, of deftfor 1.57/1.19, eight for Estonia, selected countries or 1.32. Finland,variables (Austria, Norway,have Belgium been orbeinghamburgersolds explainedhot in locateddogs. Belgium. Children orby near hot some adogsSuch shopat schools these for aselling finding lunch,schools regularly hamburgers or aremay schools likelyserving be Walesformerconservativean average are value 1.60 value ofandapproach 1.60 1.40,of 1.50.when respectively,would However, estimating be to applythegiving standard more the reportolds,separatelyScotland given are providedinand that Tables Wales)most by1-3 survey age for and group.11,13 estimates are and presentedIn order 15 in year this to to 3.clustering.athave Lowerother higher valuesschools, consumption of deft resulting are levelsrecorded in thansubstantial for those certain theTableintervals.errors design 4and provides factorusing approachanthese illustration to buildto estimating ofconfidence the use true of schoolsvariablestocalculate have oruniquetrue and classes). standard primary identifiers Values errors, sampling it ofof was deftstratifying units necessary are (i.e., not sameThesefeelingvariables, school findings confident notably or classsuggest and easeare academic thatno of more makingpupils achievement. likely within friends, to hold the agreeofavailablestandard 15 year that errorsdata. olds school Forfor saying othereach is athey country,survey nice agree placevariables the or proportion stronglyto usingbe is variablestheonpresented four extremely or (less formore smoking than occasionssmall 1% weeklyprevalencesin manyfor 11 and countries). year being forolds these drunkgiven True therepupilstheirsimilar iscolleagues selected viewsstill some or on behave thanvariationa purely they in random aby would similar age andbasis. with manner country, Whileother to Usingrandomestimatepresented the sample of deftalong standard values andwith 95% forerrorthe eachrelevantconfidence assuming country sample intervals. a given simple size, in greatInspectionstandardSUDAAN variation errors of software Tables havein design been package1-3 factorsrevealscalculated (Shah betweenthat et using thereal., 1995). the is ofareonsimple the anless assumptiontrue standard likely standard to errors be of significanterror. simple for such random variablesunderestimates sampling based theallowingTable precisiontrue 3 for95% the belonging influenceof confidence the estimates atof school, samplingintervals to be estimates assessed. designare given on of thegroup.selected1. findings Design However, variables andfactors thesebasic for tend patternsare each tosummarized becountry do higher emerge and forbelow. from agethose 442 complexstandardcalculatedUsing the error survey for values aof selection adesign variable of deft canof accounting variables, thatbe estimated have the for been true theby 443 2 I 4 Sample Design andAPPENDIX B Sampling Error AcademicTable 1 Designachievement* factors for selected proportions: 11 year olds Austria 1.16 Belgium Fr. 1.10 Canada 1.11 Estonia 1.31 Finland 153 Norway 1.18 Scotland 132 Wales 136 ExerciseLike school four or more times/week 1.161.45 1.051.50 1.091.35 1.641.10 1.261.30 1.151.37 1.41154 1.151.17 Eat hamburgers or hot-dogs daily 1.101.23 1.021.66 1.281.22 133121 0.981.33 1.111.15 1.191.47 1.011.26 TeachersIVery belong or quiteat treat this healthy usschool** fairly** 1231.10 1.711.12 1.451.44 1.451.44 1.601.40 1.451.42 1.76157 1.401.60 BulliedStudents one always or more enjoy times being together 1.111.13 1.251.29 1211.33 131154 1.091.45 1.181.41 1561.42 1.401.01 FindOne orit easymore to evenings make friends with friends weekly 128132 1.171.67 1.011.30 0.92n/a 1221.22 0.981.18 1.141.28 1.141.11 * Feel confident Those who indicated their teachers think their work at school is good or very good. 132 1.24 1.21 1.10 1.27 1.11 124 124 n/a** ThoseQuestion whoTable not agreed asked. 2 or strongly agreed. Design factors for selected proportions: 13 year olds LikeAcademic school achievement* Austria 1.14 Belgium Fr. 1.181.34 Canada 1.691.41 Estonia 1.531.06 Finland 1.281.09 Norway 1.151.01 Scotland 1.191.15 Wales 1.231.46 ExerciseDrunkSmoke fourweekly four or ormore more times times/week 1.121.19 1.131.241.25 1.201.351.39 1.051.111.17 1.161.091.15 0.931.181.09 1.171.351.23 1.191.521.29 IVeryEat belong hamburgers or quiteat this healthy school** or hot-dogs daily 1.231.051.15 1.041.001.45 ' 1.14 1.641.16 1.481.141.33 1.451.241.00 1.171.031.00 1.281.081.25 1.241.141.32 BulliedStudentsTeachers one always treat or more us enjoy fairly," times being together 1.151.341.16 1.451.051.15 1.351.391.28 1.171361.48 1.201.441.48 1.291.411.45 1.291.151.22 1.301.161.37 FindOne orit easymore to evenines make friends with friends weekly 0.911.19 1.261.37 1.001.65 1.05n/a 1.071.02 . 1.061.30 1.041.05 0.941.29 444 n/a*** ThoseQuestion whoFeel not agreed confident asked. or strongly agreed.Those who indicated their teachers think their work at school is good or very good. BEST COPY AVAILABLE 1.05 1.20 1.34 1.18 1.01 445 1.07 1.11 1.08 2 1 5 TableAcademic 3 Design achievement* factors for selected proportions: 15 year olds Austria 1.05 Belgium Fr. 1.11 Canada 1.34 Estonia 0.99 Finland 1.14 Norway 1.00 Scotland 1.49 Wales 1.43 SamplingSampleAPPENDIX Design Error andB DrunkSmokeLike school fourweekly or more times 1.511.451.39 , 1.17 1.311.22 1.561.471.06 1.361.261.34 1.571.431.29 1.411.261.37 1.261.321.16 1.331.201.46 EatExercise hamburgers four or or more hot-dogs times/week daily 1221.17 1.561.28 1.241.231.40 1.201.10 0.941.221.05 1.101.00 1.051.101.13 1.191.31 Teachers1Very belong or quite at treat this healthy us school** fairly** 1.331.161.17 0.981.53172 1.261.37 1.441.651.34 1.221.33 0.951.351.30 1.231.20 0.971.211.17 BulliedStudents one always or more enjoy times being together 1.251.17 1231.39 1.171.141.19 1.431.09 1.151.23 1.071.171.56 1.231.171.01 0.980.83 FeelFindOne orconfidentit easymore to evenings make friends with friends weekly 1.101.071.27 1.211.131.14 1.131.30 0.991.05n/a 0.951.051.13 1.141.28 0.941.26 0.971.121.24 n/a*** ThoseQuestion whoTable not agreed asked. 4 orEstimation strongly agreed. of trueThose confidence who indicated intervals their teachers for think proportions their work at ofschool 15 isyear good olds or very agreeing good. that Our school is Countrya nice place to be" using values of deft for "I feel I belong at this school" Prevalence Sample size Standard error (SRS) SRS 95% confidence interval Design factor confidence interval True 95% Austria 455 16291799 1.17 43.2 to 47.8 1.221.16 44.542.8 to 50.548.2 CanadaBelgium Fr. 51.959.6475 22101153 1.471.04124 49.057.645.1 to 54.861.649.9 1.371.65 47.156.8 to 56.762.4 NorwayFinlandEstonia 58.8385 16231183 1221.41 56.135.7 to 41.360.9 1.331.30 55.734.8 to 61.942.2 WalesScotland 446 31.831.3 12601369 BEST COPY AVAILABLE 1.311.25 29.228.9 to 33.834.4 1.171.20 28.828.4 to 34.834.2 447 2 1 6 Sample Design andAPPENDIX B Sampling Error estimateMultiple theregression regression influence analyses of analyses certain were factors used onto ofThecan focusedthe be analyses characteristicspredicted at the would individual by the be of predictors morethe country variables informative level.employed. otherBecause if notexceptions:ofthesmoking, the analysesin ancountries happinessappropriate arethe presenteddata in and file the format health. forin survey Chapter Switzerland and The with the 9results for small each twowas of research.wouldanalytical be appropriate techniques in such the as next logistic stage regression of the usedInanalysesnumber each with analysis, invalidof listwise cases forwardfor deletionfor that Greenland stepwisecountry. of missing selection made values wasthe NM13.errorsButcher,References London: manual. B. & OPCS. OPCSElliott, New D. (1987).Methodology A sampling Series Thevariables(only standardized students named that in beta thehad equation weightsvalid responses were are presentedincluded). for all StatisticsMedicalandGardner, statistical with Journal. M.J.confidence: guidelines. & Altman. Confidence London: D.G. intervals (1989). British conducted,or0.06ranges;in theabove. to figures 0.145moderately aFor Multiple and if eachthey strong strong Rfallregression hasbeta beta into been weights weights either produced analysis of two as from0.15 sampling.Kish,Kalton, L. Beverly (1965).G. (1983). Hills:Survey Introduction Sage sampling. Publications. New to survey York: foronlyvariablesan indicatorsix predictor or inmore the of variables equation.countries,the predictive that The forare figureeither inpower the equationincludesmale of the or Hills:(1989).Lee,John E.S.,Wiley. Sage Analysing Forthhofer, Publications. complex R.N. survey & Lorimor, data. Beverly R.J. offiguresAsfemale few thesea result countries. students,because items some isthey becauseHowever,items reflected are are ofimportant excluded thespace in predictive the constraints. onlymultiple from for powerthe a Shah,complexPracticalLehtonen, B.V., surveys. methods R.Barnwell, & Chichester: Pahkinen,for design B.G. John &and E.J. Bieler Wiley.analysis (1995). G.S. of conductedshouldcorrelationsas examples be arenoted that quite of arethathow exploratory included thewell regression the in outcomeand the are figures. analyses to variables448 serve It Institute.Researchanalysis(1995). SUDAAN Triangleof correlated Park, user's NC: data,manual: Research Release Software Triangle 6.40. for 449 Austria Czech Republic 217 c/oofLudwigDr Health WolfgangInstitute Boltzmann and of Dur Medicine Sociology Institute for the Sociology SokolskaCzechDr121 Zdenek 39Health 54Prague Kucera, Promotion 2 CZECH President Foundation REPUBLIC TEL:A-1010UniversitatsstrasseNeues + Institutsgebaude43 Vienna 1 402 93AUSTRIA 60 7/2 27/35/22 of University of Vienna Denmarke-mail:FAX:TEL: ++ [email protected] 22 2929 1414 0404 DepartmentMsBelgiumFAX: Lea +43 Maes, (Flemish) 1 of597 Public Associate 1871/402 Health, Professor9363 University of Ghent BlegdamsvejUniversityDepartmentDr Bjorn E. of Holsteinof 3 Copenhagen Social Medicine TEL:B-9000DeAcademisch Pintelaan + 32 Ghent 9 240 185Ziekenhuis BELGIUM 3628 - Block A e-mail:FAX:TEL:DK-2200 +45 [email protected]+ 4531 Copenhagen3535 2211 79 81 66 DENMARK DrBelgiume-mail:FAX: Danielle + [email protected] (French) 9 Piette,240 4994 Associate Professor KaldaDepartmentDrEstonia Mai tee Maser 44-9 of Pediatrics, Tartu University EcoleB-1070RouteUniversite de deSante Brussels Lennik Libre Publique 808,de BELGIUM Bruxelles CP 596 FinlandFAX:TEL:EE-2400 ++372 372 Tartu 347 441 77 222239 ESTONIA Canadae-mail:FAX:TEL: ++ [email protected] 2 2 555 555 4081 4049 SeminaarinkatuUniversityDepartmentDr Lasse Kannas, of of Jyvaskyla Health15 Associate Sciences Professor Queen'sDuncanSocialDr Alan McArthur UniversityProgram J.C. King, Evaluation Hall Director Group e-mail:FAX:TEL:SF-40100 +358+358 [email protected] Jyvaskyla 4141 602602 154141 10 FINLAND 450 e-mail:FAX:TEL:Kingston, ++ 1kinga1 613613 ON [email protected] K7L 62552556 3N6 CANADA 451 218 thePrincipal Countries Investigators Participating for APPENDIX C ComiteDrFrance Christiane francais Dressen, d'education Chef pourde service la sante GraduateDrIsrael Yossi Harel,Program Head in Medical Sociology ResearchDrNorway Bente WoldCentre for Health Promotion in the HBSC Survey TEL:F-921702Service Rue + Auguste-Comte 33 etudes Vanves 1 46 45et FRANCEstrategie45 00 FAX:RamatBarTEL: Ilan + Gan 972 +University 972 529003 6353 531 0995 ISRAEL 8967 TEL:N-5007OisteinsgateUniversity +47 Bergen 55 of 213 Bergen 2808/3223NORWAY UniversitatDrGermanyFAX: Andreas + 33 1 Bielefeld, Klocke46 44 06 64Research Centre MedicalDrLatviae-mail: Ieva [email protected], Academy Department of Latvia of Pediatrics II DrPolande-mail:FAX: Barbara + [email protected] 55 Woynarowska 90 16 99 TEL:PF&Prevention Adolescence 100131 +49 521 D-33501& Intervention106 3890/3834 Bielefeld in ChildhoodGERMANY FAX:TEL:LV-100716 Dzirciema++ 371371 Riga 457 82 76 Str.LATVIA 81 05 55 TEL:01ULNational 211 Kasprzaka + 48Warsaw Research 22 632 17a POLAND 15 Institute 49 of Mother & Child DrGreenlande-mail:FAX: Michael +49 [email protected] 521 Pedersen, 106 2987 HBSC Greenland KaunasDrLithuaniae-mail: Apolinaras [email protected] Medical Zaborskis Academy DrRussiane-mail:FAX: Aleksander + Krzysztof 48 Federation 22 632 Komkov [email protected] 94 54 FaergevejWHOTEL:DK-3600 Collaborative +45 66 47Frederikssund 38 7207 Study Project DENMARK TEL:LT-3007EivieniuLaboratory + 370 str. Kaunas 77for 4 94 Social 752LITHUANIA Pediatrics TEL:DinamoResearch197042 +78122350131 2 St.Institute Petersburg of Physical Culture RUSSIAN FEDERATION NationalHungaryDrFAX: Anna +45Institute Aszmann 47 38 of 7208 Child Health MsNortherne-mail:FAX: Linda + a.zaborslcis@kmalt370 IrelandBarclay 77 96 498 or socped @kma.lt FAX:ResearchDrScotland Candace+7 812 Unit 235 Currie in01 Health31 and FAX:TEL:H-1094Tuzolto + +361 361 StreetBudapest 15215 037-9 66 40 HUNGARY 90 NorthernTheDirector18 Health Ormeau of Ireland ProgrammePromotion Avenue AgencyDevelopment for TeviotTheDepartmentBehavioural University Place ofChange Public of Edinburgh Health SciencesMedical School 452 FAX:TEL:Belfast +44+44 BT2 12321232 8HS 3131 NORTHERN 16111711 IRELAND 453 Edinburgh,e-mail:[email protected]:TEL: +44+44 EH8 131131 9AG 650650 6192/36902 SCOTLAND Slovakia Wales APPENDIX219 C 816SasinkovaInstituteMr Miro37 Bratislava ofBronis 13 Health Education SLOVAKIA Ffynnon-Las,HealthDirectorMr Chris Promotion ofTudor-Smith Research Ty Glas Wales & Avenue Development inthePrincipal the Countries HBSC Investigators Survey participating for DrSpainFAX:TEL: Ramon +42+42 77 Mendoza, 376378 14298 64 Associate Professor FAX:TEL:CardiffLlanishen +44+44 CF4 12221222 5DZ 7575 UNITED 2260 22 00 KINGDOM CampusUniversityFacultyDepartment del of Carmen Artsof of Huelva Psychology& Sciences of Education RegionalDrWorlde-mail: Erio [email protected] Adviser Organization for Health Promotion and e-mail:FAX:TEL:21007 +34+ Huelva [email protected] 59 59 27 27 10 04 00 11 ext 2453 SPAIN DK-21008WHOInvestment Scherfigsvej Regional Copenhagen Office for DENMARK Europe BoxNationalDrSweden Ulla 27848 Marklund Institute of Public Health e-mail:FAX:TEL: [email protected] +45+45 3939 1717 1218 35 18 SwitzerlandFAX:TEL:S-11593 +46+46 Stockholm 88 783783 3535 1945 SWEDEN Av.ProblemsSwissDr Yann Ruchonnet Institute Le Gauffey for 14 Prevention of Alcohol & Drug e-mail:FAX:TEL:CH-1001 ++41 [email protected] Lausanne 21 323320 2919 3021 SWITZERLAND 454 455 220 Aaro,Research L.E., PublicationsWold, B., Kannas, L. & Rimpeld, M. happinessEder,interrelations A. (1990). and health Risk between in factor 11-, 13- socialloneliness. and 15-year-oldintegration, On the Appendix11 SC 'ublications D: firstphilosophy,WHO(1986). survey. cross Health Health methodsnational behaviour Promotion, andsurvey. selectedin school1(1): A presentation 17-33. results children. of the Aof Integration.Eder,Promotion,schoolchildren A. & Aaro,5(1): Drogalkohol, 19-33.L.E. in 9(1989). European 3: 177-186.Rauchen countries. und soziale Health behaviourAaro,Drogalkohol,health L.E.,L.E. and &Laberg, among Eder,3:lifestyle 163-176. J.C.,A. adolescents:(1989). & of Wold, school Video B. (1995). consumption,Towards children. Health a InternationalinAaro,Honkala, Austria, L.E. E., & Gilles,England,Kannas, Dental P. Journal, L.,(1988). Finland Rimpeld, Dental38: and131-138. M., health Norway.Wold, habits B., MissingAbbet,Research,hypothesis J.P., values 10(1): of Rehm, two in 83-93. responsesdimensions. J. & Spinatsch, to questionsHealth M. Education (1994).on drug issue:countries.OralHonkala, hygiene 873. E., Journal Rise, habits J., of ofKannas, Dental adolescents L.Research, & Aaro, in 11 L.E.68, European special(1989). Beroud,376.Swissuse: The public caseG., Muller,schools.of classroom R. Addiction & questionnaire-surveysSpinatsch, Research, M. (1988). 1:367- in King,everydayandKannas, recreational A.J.C. L. life? & Vuolle,& Drogalkohol, Coles,athletes P. (1989).B.J. immune 3:(1992). 149-162.Are to top temptations The performance health of Hygiene,consommationcomportementsPermanence 45: 2026-2032. d'alcoola risque deset de ecoliers tabac. suisses.Medecine Leur et et changement dans les Health13-Canada's and and 15-year-olds youth. Welfare Views Canada. from and 11 behaviours countries. Ottawa:of 11-, Individual,Aggleton,schools,Currie, C.E. P.,sexual (1990).Davies,cultural behaviour Young P. and and policyHart,people and G. in dimensions.(Eds.).AIDS. independent AIDS: In: King,Unit,school(1995).Adolescentfemale (WorkingA.J.C., andpeers.A.J.C. Connop, andPaper Toronto: Peart, SeriesH., smoking: King,Ontario M.J.No. M.A., 12). (1996). InfluenceTobacco and Mercer, Researchof home, T. Factors ScottishpatternsCurrie,London: C.E. school ofThe drinking& Falmer McQueen,children. andPress. Drogalkohol, D.smoking (1989). in Differences 3:15 137-148. year old in policy.adulthood.inhibitingYouth Toronto: in theIn: transition: Thompson Galaway,transition Perspectives Educational B.of andyouth Hudson, to onPublishing. work research J. (Eds.).and to and influences.2:behavioursCurrie, Family, C.E., Edinburgh: ofpeer,Todd, Scottish schoolJ. & Wijckmans Healthschoolchildren: and Educationsocioeconomic (1993). Report HealthBoard Community-wideschoolPromotingKlepp, KI.,children. healthy Wilhelmsen, eating youth B.U. patterns health& Andrews, among promotion: Norwegian T (1990). In: Haglund,BJ.A. et al. (Eds.). 456 Gesundheitsbegriff.TheorienEder,for Scotland. A. und(1990). Materialien Vienna: zu Springereinem systemischen Verlag. Risikofaktor Einsomkeit. 457 ForbesStrategies, Publishers. implementation and evaluation. London: 221 Life-stylesMendoza, It of Batista-Foguet, European school-children: J.M. & Oliva, Findings A. (1994). of Piette,Stevens, D., Maes,A., DeSmet, L., Peeters, P. & Smith, R., Prevost, C. (1993). M., The Smith, C., Nutbeam, D., Moore, L., Roberts, C. & APPENDIXH DBSC Publications ofhealth.In:the Dauwalder,WHO Bern: cross-national J.P.Hogrefe (Ed.).Psychology &study Huber on health-behaviour.Publishers. and promotion ArchivesMethodologyHealthWorld ofHealthbehaviour Public Organization Health,and in school dissemination 51: children 387-405.collaborative in Belgium.of study:data. Medicine,Wales,attitudesCatford, 1986-1992. and 16(2): J. (1994).behaviour 165-171. Current among changes adolescents in smoking in Journal of Public Health 1:59einerMuller,11- -68. risikoreichen bis R. 16-jahrigen(1987). Zeittrends Verhaltensweise. Schuler der - KonstanzTrinkgewohnheiten Dmgalkohol, and Wandel opinions,Piette,(1994). D., Renard, andAdolescents behaviours F., Prevost, and concerning AIDS:M. & De knowledge, Smet, AIDS P. school-agedfrombehaviourSmith, the WHO C.,research childrenWold, cross-national with B. study. &adolescents: Moore, Healthhealth L. A behaviour(1992). Promotionperspective Health in Editeurs.masculineadolescent.Muller, R. (1993). In: et Arvis,ses Les pathologies. G.toxicomanies et al. (Eds.). Paris: chez La lepuberte Doinjeune ThePoskiparta,Belgium.prevention use ofArchives M., inmedication French-speaking Kannas, ofPublic L. among & Health, Tynjala, community Finnish 52:47 J. (1989). -62. and of Promotion,peopleJournalSolantaus, ofAustraliain three 2: T. 19-27. (1987). European 2(2): Hopes 41-44. countries. and worries of young Health Nutbeam,perspektive.SchweizerMuller, R. &D. schulkindem: Spinatsch,Drogalkohol, (1988). Planning M. (1988).2: 3-17. for Lebensstil a smoke-free von eine interkulturelle Rehm,certainNorwegianYearbook J., health Efionayi-Mader, youth of habits Health in relation and Education D.living &to Abbet,perceived conditions. Research. J.P. (1993).health, The nationalhealthlowSumskas, physical among surveyL. &activity children Zaborskis, of health - inpredictors Lithuania: A. behaviour (1995). of Acardiovascular Smoking WHO in school- cross- and Nutbeam,generation.infor Europe. Europe D. Copenhagen: (1988).(Smoke-freeCopenhagen: Health WHOEurope, WHO for allRegional No.6). Regionalyoung peopleOffice Office ofdentalRise,inDas der Schnuffeln J., Schweiz. Wold,health B.behaviours Drogalkohol,von & Aare, losemittelhaltigen inL.E. Nordic (1991).7(2): school 99-108. Determinants Produkten children. Book,JuneInternationalaged Abstract: 1, children. Barcelona 262.Heart Paper (Catalonia-Spain).Health presented Conference at MaytheAbstract 2nd28 Nutbeam,pupilfor Europe. attitudes D. & Aaro, towards L.E. school: (1991). the Smoking implications and (1991).Rise,Community19. J., DistributionHaugejorden, Dentistry &of 0., Oraldental Wold, Epidemiology, health B. & behaviours Aaro, 19: L.E. 14- schoolofseekingThuen, health-related children.F., and Klepp, safety-seeking behaviours K.I. & Wold, behaviours: among B. (1992). Norwegian A studyRisk- Health Education Research, UnderstandingNutbeam,Educationfor health educationResearch,D., Aaro, children's 6(4):withL.E. healthyoung&415-421. Catford, behaviour:people. J. (1989). Health The Smith,&in OralNordic C., Epidemiology, Moore,school L.,children. Wold, 19: B.9-13.Community & Catford, DentistryJ. (1993). background.ofTynjala, 7(2):Finnish 269-276. J. school& Kannas, children L. (1993). by sociodemographic Sleeping habits Nutbeam,325.people.implications Social D., Aaro,forScience health L.E. and & promotion Medicine, Wold, B. (1991). 29(3):for young 317- The Europestudy.andHealth implications In: behaviours (Ed.).Association Prevention from in forschool WHO's Paediatric children: in cross-nationalchildhood Education Findings inof youngTynjala,8(4): Europeans281-289. J., Kannas, fall L. asleep. & Valimaa, Health R. Education (1993). How Health Promotion International, Nutbeam,people.lifestyleWorld Results D.,concept Health Smith, fromStatistics and C., healtha Moore,WHO Quarterly, education international L., Bauman, 44: with 55-61. study.young A. Smith,dieducationaldegenerative Roma C. "La& aspects.Nutbeam, Sapienza". adult Rome: D. diseases; (1992). Universita Adolescent paediatric Degli Studi drug L.VanResearch, school-aged& de Adriaanse, Mieroop, 8(1): 69-80. E.,H. children Vergeer,(1994). Health F.,in Peeters,Flanders perceptions RE, and Maes, ofthe Health,behaviour.Alienation(1993). 29(1): Warning! from Journal 25-30. school Schools of andPaediatrics can its impactdamage and onyour healthChild health: 458 56.use in Wales. British Journal ofAddiction, 87: 49- Publicsouthern Health, parts 52(5-6). of the Netherlands. Archives of 459 222 APPENDIXHBSC Publications D aspectsWold, B. of & familyAnderssen,N. and peer (1992). influences Health promotion on sport school-agedWold, B. & Aaro, children. L.E. (1990). A WHO Health cross-national behaviour in amongWold,Psychology,participation. B. adolescents & Kannas,23: 343-359. L. in (1993). Finland, Sports Norway motivation and International Journal of Sport ofResearch(1983/84)survey, Bergen. Summary Centerand the for second of Health publications survey Promotion, (1985/86). from University the Bergen: first Wold,ScienceSocialSweden. B., in Oygard, Sports,reproduction Scandinavian L.,3: 283-291.Eder, ofA.Journal &physical Smith, of MedicineC. activity (1994). & Promotion,94nationalbehaviourWold, study. B., survey. inAaro,Bergen: school-agedUniversity L.E.Research Research & Smith, children. of protocol Bergen, Center C. A(1994). forWHO for (HEMIL the Health cross-1993/ nationalA.,Zaborskis,Europeanimplications & Narutavicience, surveyA.,Journal Zemaitiene,N., for onhealthofPublic healthL. (1995).promotion Health,Sumskas, behaviour The in 4:WHO L.,young 163-168. Dirzyte,among cross- people. ResourceagedWold,rapport:4). children. B. package (Ed.) (1993). Aof WHOquestions Health cross-national 1993/94.behaviour Bergen: in survey. school- Aprilat aResearchschool-aged conference: 20-21, Protocols University children Public and inofhealth DocumentsLithuania.Tartu. Paper presented past and present, behaviourWorldofResearch Bergen. Health Center in Organizationschoolchildren. for Health (WHO)Promotion, A cross-national (1985). University Health DepartmentResearchschoolAare, L.E. children. protocol & ofWold, Social A for B.WHO the(1986).Psychology, 1985/86 cross-national Health study. University behaviour Bergen:survey. ofin Officesurvey. for Protocol. Europe. Copenhagen: WHO Regional TablesschoolAare,Bergen. L.E. children.and & figures Wold, A WHOfromB. (1988) the cross-national international Health behaviour survey. data inof ResearchschoolAare,Psychology,the 1985/86 L.E. children. & protocolsurvey. UniversityWold, A WHOB.Bergen: for(1989). of cross-national theBergen. Department Health 1989/90 behaviour of survey.study. Social in 469 Copenhagen:TermsBergen.Department of reference of WHO Social forRegional Psychology, the HBSC Office Study University for Europe. (1989). of 461 ISSNISBN 0378-225592 890 1333 8

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