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HBSCFindings From the WHO Health Behaviour in
School-aged Children Study
Professor Fiona BrooksCRIPACC, University of Hertfordshire
[email protected]@f_m_brooks
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Health Behaviour in School-aged Children
• WHO collaboration - over 40 countries Europe & North America
• Over 200,000 young people each round - 5335 England 2014
• Time trends across 12 years – 2002, 2006, 2010 & 2014
• Survey methodology in schools age 11, 13 and 15 year olds
2010 report can be downloaded from: www.hbsc.org and wwwhbscengland.com
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The Links Between Attainment and Child
Well-being – Why Does It
Matter? The link between pupil health and wellbeing and attainment: a
briefing for head teachers, governors and staff in education settings PHE 2014
https://www.gov.uk/government/publications/the-link-between-pupil-health-and-wellbeing-and-attainment
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Why adolescents ?
There are 7.4 million adolescents aged 10-19 living in the UK, accounting for 12% of the population and forming part of 4.8 million UK households (Hagell, Coleman and Brooks 2013).
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‘The misery of youth: Teenagers depressed and fearful as drink, drugs and crime take their toll’
July 2008, Daily Mail
Myth 3Our teenagers are much worse than anywhere else!
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• Increased synaptic pruning and increased myelination in the prefrontal cortex
• Enhanced amygdala reactivity to emotional stimuli– Exaggerated reactivity to rewarding stimuli– Reduced sensitivity to aversive stimuli
– What is rewarding and what is aversive is culturally and environmentally dependent
THE TEENAGE BRAIN DOES WHAT?
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• There is an interaction between the environment and the adolescent brain
• How you spend your time guides the structure of the brain and becomes hard wired into your brain
• BUT Toxic environments impede normal brain development
USE IT OR LOSE IT
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MeasuresMandatory Measures in HBSC
Unique study
Includes measures on physical, emotional and social health and well-being
Only study looking at Sexual health in the UK
Only study collecting data on new domains of adolescent
Only study with internationally validated measures on areas such as sleep, family support, neighbourhood
Employing measures of Social capital and resilience
Health Related Behaviours
Health and Well-being
Family Life
School
Peers and Community
OPTIONAL PACKAGES
VALIDATED MEASURES
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Primary Health Care Services
• 80% of young people reported that they had visited their GP in the last year (78% of boys and 82% of girls)
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Health Risk Behaviours
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Smoking
2002 2006 2010 20140%
5%
10%
15%
20%
25%
30%
21%
13%10%
6%
28%
18%
14%
8%
15 year olds who report weekly smoking 2002 - 2014
BoysGirls
• Overall 3% reported weekly smoking
• Rising to 6% in 15 year old boys and 8% in 15 year old girls
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Alcohol
2002 2006 2010 20140%
10%
20%
30%
40%
50%
60%52%
41%
32%
12%
48%
36%
23%
9%
15 year olds who report weekly drinking, 2002 - 2014
BoysGirls
• Overall, 5% of young people drink alcohol weekly
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Alcohol
2002 2006 2010 20140%
1000%
2000%
3000%
4000%
5000%
6000%
5500%
4400%
3900%
2900%
5500%5000%
4500%
3200%
Figure 4.7: 15 year old young people who reported having been drunk two or more times by gender
2002-2014
boys Girls
Bases: All respondents in 2002, 2006, 2010 and 2014
Among 15 year old weekly drinkers, 83% of boys and 57% of girls had been drunk 10+ time in last 30 days
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Substance misuse
2002 2006 2010 20140%
1000%
2000%
3000%
4000%
5000%
4300%
2600% 2500%2100%
3800%
2300%2500%
2000%
Figure 4.8: Young people who reported that they have ever used cannabis during their life time at least once by gender
2002-2014
BoysGirls
Base: All respondents in 2002, 2006, 2010 and 2014
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• 21% of 15 year olds reported having had sex
• Young people reporting having sex has decreased from 2002
Sexual Intercourse
2002 2006 2010 20140%5%
10%15%20%25%30%35%40%45%
36%
26% 27%
19%
40%
31%34%
24%
15 year olds who report having sex, 2002 - 2014
BoysGirls
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• Proportions reporting very early sexual initiation have decreased significantly since 2002
Sexual Intercourse
11 years or younger
12 years 13 years 14 years 15 years or older
0%
10%
20%
30%
40%
50%
60%
8% 3%13%
30%
47%
2% 2%11%
32%
53%
Figure 5.4: Age of onset for sexual intercourse among sexually active 15 year olds
BoysGirls
Base: All respondents aged 15 years in 2014 who had sexual intercourse
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• Condom use has however declined since 2010 – when it had over two survey cycles been showing an increase
Sexual Intercourse
2002 2006 2010 20140%
10%
20%
30%
40%
50%
60%
70%
80%
90%
67%
80% 80%
61%69% 74%67%
57%
Figure 5.7: 15 year olds using condom at last in-tercourse 2002-2014
BoysGirls
Base: 15 year old respondents in 2002, 2006, 2010 and 2014
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• 25% of boys and 9% of girls involved in a physical fight at least twice in the last 12 months
• Between 2002 and 2014 the proportion of both boys and girls involved in physical fights has decreased
Fighting
2002 2006 2010 20140%5%
10%15%20%25%30%35%40%
34% 33%28%
25%
14% 13%9% 9%
Young people involved in a physical fighting at least twice, 2002 - 2014
BoysGirls
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Health
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Health Complaints
Overall, 65% of young people (59% of boys and 71% of girls) reported experiencing at least one health complaint on a weekly basis.
Will come back to feeling low
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Injuries
11 years 13 years 15 years 0%
5%
10%
15%
20%
25%
30%
25% 27% 26%
15%21%
16%
Figure 6.1: Injured at least twice in the last 12 months
BoysGirls
Base: All respondents in 2014
2002 2006 2010 20140%
5%
10%
15%
20%
25%
30%
35%
40%35%
29% 30%
26%
20% 18% 20% 17%
Figure 6.2: Reports of two or more injuries in last 12 months, 2002 - 2014
BoysGirls
Base: All respondents in 2002, 2006, 2010 and 2014
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Sleep & Concentration
11 years old 13 years old 15 years old0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
93%
74%
48%
93%
73%
46%
Young people who report having at least 8.5 hours sleep on school nights
BoysGirls
Nearly three quarters (73%) of young people reported having at least 8.5 hours sleep on school nights
However this decreased significantly by age
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Sleep & Concentration
11 year olds 13 year olds 15 year olds0%5%
10%15%20%25%30%35%40%45%50%
13%19%
29%
11%
25%
43%
Young people who don’t have enough sleep to concentrate, by age and gender
BoysGirls
• Overall, 22% of young people cannot concentrate at school due to lack of sleep
• Increases with age
• Gender differences
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Having a long term condition or disability
Having a long term condition or disability23% of young people reported having long term illness or disability (23% of boys and 22% of girls).Type of condition or disability About half had asthma
11 13 150%
500%
1000%
1500%
2000%
2500%
3000%
3500%
2500%2300% 2300%
1700%
2900%2900%
BoysGirls
Proportions that report having a long term condition effects their participation in school
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Emotional Wellbeing
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Life Satisfaction
2002 2006 2010 20140%
10%20%30%40%50%60%70%80%90%
73%81% 81%
74%65% 67% 69%
55%
15 year olds who report high life satisfaction by gender, 2002 - 2014
BoysGirls
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Achievement = Well-beingWell-being = Achievement
The health and well-being of children and young people contributes to their ability to benefit from good quality teaching and to achieve their full academic potential
Academic success – impacts on a child’s subjective life satisfaction Subjective life satisfaction impacts on behaviour and school engagement – ability to acquire academic competence.
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Feeling Low 2
2002 2006 2010 20140%
10%
20%
30%
40%
50%
60%
34%
27%23% 25%
44% 46% 45%
54%
15 year olds who report feeling low once a week by gender, 2002 - 2014
BoysGirls
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Feeling Low 1
11 year olds 13 year olds 15 year olds0%
10%
20%
30%
40%
50%
60%
14% 15%25%
18%
36%
54%
Young people who report feeling low at least once a week, by age and gender
BoysGirls
• Overall, 26% of young people feel low at least once a week
• Increases with age
• Gender differences
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Feeling Low 2
2002 2006 2010 20140%
10%
20%
30%
40%
50%
60%
34%
27%23% 25%
44% 46% 45%
54%
15 year olds who report feeling low once a week by gender, 2002 - 2014
BoysGirls
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Feeling Low by Age, Gender and Country
Feeling Low 3
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Full of Energy 1
11 year olds 13 year olds 15 year olds0%
10%20%30%40%50%60%70%80%
67%55%
45%63%
44%23%
Young people who feel full of energy, by age and gender
BoysGirls
• Overall, 51% of young people felt full of energy always or very often during the last week
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Self-harm
Boys Girls0%5%
10%15%20%25%30%35%
11%
32%
Proportion of 15 year olds who report they have self-harmed
• Overall, 22% of young people said they had self-harmed
• In comparison with other studies, self-harm increasing over the past decade
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Self-harm 2
• Overall, 22% of young people said they had self-harmed
• In comparison with other studies, self-harm seems to be on the increase
Everyday Several times a week
Once a week A few times a month
Once a month0%
10%
20%
30%
40%
50%
60%
10%5% 6%
16%
54%
15%7%
16% 15%
39%
Figure 6.5: Frequency of self-harming
BoysGirls
Base: All respondents aged 15 years in 2014 who reported ever self-harming
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Body image
• Proportions reporting dissatisfaction with their body size has remained relatively stable since 2002
• 23 % of 15 year old boys reported they were too thin compared 9% of girls
2002 2006 2010 20140%
5%
10%
15%
20%
25%
30%
35%
40%
45%
25% 24%22%
22%
40%36%
39%38%
Figure 3.21: Young people who report they are "too fat" 2002 - 2014
BoysGirls
Base: All respondents 2002, 2006, 2010 and 2014
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Cyberbullying 2 questions – one via messages second photographs/pictures. 18% reported experiencing cyberbullying (previous two months). 24% of girls 12% of boys. Cyberbullying increases with age for both boys and girls -more traditional forms of bullying decreases with age
11 year olds 13 year olds 15 year olds0%
5%
10%
15%
20%
25%
30%
35%
10% 12%16%16%
28%31%
Figure 9.12: Young people who reported being cyberbul-lied in the past two months
BoysGirls
Base: All respondents in 2014
Cyberbullying
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11 year olds 13 year olds 15 year olds0%
5%
10%
15%
20%
25%
30%
35%
10% 12%16%16%
28% 31%
Figure 9.12: Young people who reported being cyberbullied in the past two months
BoysGirls
Base: All respondents in 2014
It’s like about this, is like one bad thing a photo or something can get found out about and it goes on and on for ages, so is more upsetting than like some-one who picks on you from another classKatie, age 16
Cyberbullying
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Healthy Behaviours
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11 13 150%5%
10%15%20%25%30%
Young people physically active for 1 hour a day
BoysGirls
Physical Activity
• Overall 19% meet physical activity guidelines - 22% of boys and 15% of girls
• Physical activity levels have remained stabled in girls since 2002
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Physical Activity
The proportion of girls being physically active for at least an hour every day of the week has remained relatively stable since 2002, however boys physical activity levels have fluctuated – recent decline
Physical Activity
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Positive health behaviours – physical activity
UK study - the amount of moderate to vigorous physical activity at age 11 impacted on academic performance across English, maths and science at age 11, 13 and final GCSE exam results The percentage of time girls spent in moderate to vigorous physical activity at age 11 predicted increased science scores at 11 and 16 years High performing schools have higher levels of participation in physical activity and sports
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Physical Activity
Older adolescents are less likely to eat vegetables every day; 44% of 11 year olds, 44% of 13 year olds and 41% of 15 year olds. Relatively flat trend since 2006.
Eating Vegetables
2002 2006 2010 20140%
5%
10%
15%
20%
25%
30%
35%
40%
45%
50%
Figure 3.8: Eating vegetables everyday 2002 - 2014
BoysGirls
Base: All respondents in 2002, 2006, 2010 and 2014
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• Across all age groups boys are more likely to eat breakfast every day• Eating breakfast has actually increased from 2010 to 2014 – rising
from 67% to 74% in boys and 55% to 60% in girls.
Eating Breakfast
11 year olds 13 year olds 15 year olds0%
10%20%30%40%50%60%70%80%90%
83%71% 65%74%
50% 49%
Young people who eat breakfast every day, by age and gender
BoysGirls
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Five a day
11 year olds 13 year olds 15 year olds0%5%
10%15%20%25%30%35%40%45%50%
45%35%
30%
47%
35% 32%
Figure 3.9: Young people who eat 5 portions of fruit or vegetables a day
BoysGirls
Base: All respondents in 2014
38% of respondents reported meeting the recommended consumption of five fruit and vegetables every day.
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Energy Drinks
11 years 13 years 15 years 0%
2%
4%
6%
8%
10%
12%
8%10%
9%
3%
6%5%
Figure 3.14: Young people who report drinking energy drinks at least five times a week
BoysGirls
Base: All respondents in 2014
Around 20% of boys across 13 & 15 year olds drink energy drinks 2-3 times a week and 12% of girls – The pattern is the same for fizzy drinks with around 17% of 15 year boys drinking fizzy drinks and 12% of girls (daily)
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Sugary Drinks
11 years 13 years 15 years0%
5%
10%
15%
20%
25%
30%
21% 21% 22%22% 24%18%
Figure 3.13: Young people who reported consuming squash that contains sugar daily
BoysGirls
Base: All respondents in 2014
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Key protective factors or essential assets for positive mental health and well-being is
the family, including access to one supportive adult
Community and family life
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Community & Neighbourhood
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Family life 1
2002 2010 20140%
1000%
2000%
3000%
4000%
5000%
6000%
7000%5800%
5600%
4800%4900% 4600%
3800%
Figure 7.6: Young people who make decision about their free time by themselves, by age and gender 2002-2014
BoysGirls
Base: all respondents in 2002, 2010 and 2014
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Family life -2 parental support
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Family life – time spent together
11 years 13 years 15 years 0%
1000%
2000%
3000%
4000%
5000%
6000%
7000%
8000%
9000%
7800%7900%
7400%
8000%7600% 7500%
Figure 7.8: Young people who reported eating even-ing meal/dinner at least 3-4 times per week with
their families, by age and gender
BoysGirls
Base: all respondents in 2014
11 years 13 years 15 years0%
1000%
2000%
3000%
4000%
5000%
6000%
7000%
6000%
4400%3100%
5000%
3400%2200%
Figure 7.9: Young people who reported to have a family sports activities at least once a week,
by age and gender
BoysGirls
Base: All respondents in 2014
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Positive health behaviours –
Young People engaging in self development activities (including sport, physical activity) – achieved 10-20% higher GCSEs – 2009 and had better emotional well-being
But Socialization Gap widened in last 30 years – Poorer families cannot provide such opportunities
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School life
11 years 13 years 15 years0%
500%
1000%
1500%
2000%
2500%
3000%
3500%
4000%
4500%
900%1200%
1900%
900%
1600%
4100%
Figure 8.4: Young people who reported being pressured 'a lot' by school work by age and gender
BoysGirls
Base: All respondents in 2014
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School Culture and Ethos
Longitudinal USA studies - feeling connected to school and having a sense of belonging - key protective asset
Protective of emotional health and well-being Preventive of behaviours linked with poor emotional health - substance misuse, violence, alcohol misuse and early sexual initiation.
School connectedness generated by extra-curricular activities (especially PA), positive class room management and tolerant disciplinary policies, feeling safe
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School Culture and Ethos
pupils who reported they enjoyed school at age 11 had better attainment at key stage 3, especially for maths pupils who hold positive attitudes about their school at age 14 have higher academic achievement by age 16 pupils who have been bullied have lower key stage 1 SAT results and are more likely to have friends who are involved in antisocial activities pupils who are bullied at age 14 have significantly lower GCSE scores at age 16
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School life 2 Connectedness
2002 2010 20140%
10%
20%
30%
40%
50%
60%
70%
80%
60% 61%
76%
58% 62%
74%
Figure 8.9 : Young people who say that they feel like they belong in their school
2002-2014
BoysGirls
Base: All respondents in 2002, 206, 2010 and 2014
11 years 13 years 15 years0%
1000%2000%3000%4000%5000%6000%7000%8000%9000%
10000%
8700%
7200%7700%
9000%
7500% 7400%
Figure 8.11: Young people who reported that they have at least one teacher they can go to
in case of problem, by age and gender
BoysGirls
Base: All respondents are in 2014
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School Belonging
Agree (belong)
Neither Disagree
Regular smoker
4.4% 5.5% 10.6%
Weekly alcohol consumption
11.6% 13% 20 %
Drunkenness at least twice
17% 20 % 29%
Been bullied 3.1% 4.3% 10.9%
Physical Fighting (3x 12 months)
8.8% 11.5% 18.8%
Feeling low 21.1% 34.4% 50.1%
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Teacher connectedness : interested in me as a person
Agree Neither Disagree
Regular smoker
4.2% 5.1% 10.1%
Weekly alcohol consumption
11.2% 12.1% 22 %
Drunkenness at least twice
14.9% 20 % 31%
Been bullied 3.8% 3.6% 7.4%
Physical Fighting (3x 12 months)
9.8% 9.3% 16.9%
Feeling low 22.9% 29.2% 39.5%
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Multiple substance use among 15 year olds & life satisfactionProtective Factors/Assets – most
vulnerable
1. Parental participation in how spend free time
2. Teacher Connectedness –
3. Feeling safe in community and having friendly neighbourhood
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School Culture and Ethos – Peer Relationships
Disruptive classroom behaviour directly influences pupil attainment.
Bullying at school is one of the strongest predicators of wellbeing
pupils who have been bullied have lower key stage 1 SAT results and are more likely to have friends who are involved in antisocial activities pupils who are bullied at age 14 have significantly lower GCSE scores at age 16
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Bullying
11 years 13 years 15 years0%5%
10%15%20%25%30%35%40%
33% 29% 30%36% 37%
28%
Figure 9.10: Young people who re-ported being bullied in the past two
months
BoysGirls
Base: All respondents in 2014
11 years 13 years 15 years0%
5%
10%
15%
20%
25%
30%
19%24% 25%
10%
19%13%
Figure 9.12: Young people who reported bully-ing another student in the past couple of
months
BoysGirls
Base: All respondents in 2014
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Bullying 2 – types of behaviour
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PSHE
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Social and emotional competencies – the whole school approach
Actions relating to each of the following areas: learning and teaching specific time allocated within the school curriculum in order to help students develop the knowledge, attitudes and skills needed to support health and wellbeing.
Ethos and physical environment promoted through the ‘hidden’ or ‘informal’ curriculum, which encompasses the leadership practices, values and attitudes promoted within the school, as well as the physical environment and setting of the school.
Engagement with families and/or communitiesrecognition of the importance of these other spheres of influence on children’s attitudes and behaviours in school.
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11 year olds 13 year olds 15 year olds
Boys Girls Boys Girls Boys Girls
Health and wellbeing 56% 54% 69% 70% 58% 50%
Staying safe 66% 64% 58% 58% 43% 45%
Sex and relationships 41% 40% 52% 48% 57% 50%
Personal and social skills
73% 75% 68% 66% 55% 50%
Economics and career education
47% 50% 54% 45% 42% 43%
Topics in PSHE
Young people who reported topics were well covered in PSHE
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Improved skills to care for others
11 year olds 13 year olds 15 year olds0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
80%68%
58%
84%71%
57%
Young people who said PSHE improved their skills and abilities to care for other people, by age and gender
BoysGirls
• Overall, 70% of young people said PSHE improved their skills to care for other peoples health
• Decreases with age
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Improved skills to look after own health
11 year olds 13 year olds 15 year olds0%
10%20%30%40%50%60%70%80%90%
100%
85%75%
63%
88%75%
60%
Young people who said PSHE improved skills to look after their own health, by age and gender
BoysGirls
• 74% said PSHE helped them look after their own health
• Decreases with age
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PSHE and health behaviours
• Young people have more positive health behaviours if health and wellbeing was covered well in PSHE classes
Health and wellbeing covered well
Health and wellbeing covered poorly
Self-harmed 19.2% 30.3%
Smoked on 6 or more days in last 30 days
6.1% 8.4%
Drunk alcohol 6 or more times in last 30 days
5.5% 9.0%
Drunkenness 4 or more times in last 30 days
1.1% 3.0%
On a diet 17.5% 22%
Eat breakfast every day 59.7% 52.5%
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• Overall, 21% of 15 year olds reported having had sex…
• …compared with 28% of those who said sex and relationship education was covered poorly and 18% who reported it had been covered well
PSHE and sex
Sex and relationship educations covered well
Sex and relationship education covered poorly
Sexual intercourse 18.3% 28%
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Final thoughts…
• Health risk behaviours - declining trends
• Positive behaviours in most instances - static
• Poorer emotional well-being
• A move from reducing risk factors to improving positive health behaviours and emotional well-being – significance of these as OUTCOME MEASURES
BUT• Promoting resilience (through social learning interventions – although clearly part of the
jigsaw) alone is insufficient
• Strengthening protective factors or health assets gained from schools, the home and in local communities can make an important contribution to improving emotional health and young people’s well-being.
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Protective Health Assets model for young people
“Promoting physical and mental health in schools creates a virtuous circle reinforcing children’s attainment and achievement that in turn improves their wellbeing, enabling children to thrive and achieve their full potential.”
Brooks, F. 2013. Chapter 7 : Life stage: School
Years. In Chief Medical Officer's annual report
2012: Our Children Deserve Better: Prevention
Pays