October 2004

Information

Health Determinants - Study Results

The report Young People in Canada: Their Health and Well Being is based on data from the World Health Organization's collaborative, cross-national study, Health Behaviours in School-Aged Children (HBSC). It uses the population health approach by studying the broad set of interrelated factors that shape the health of children and youth, including individual capacities, coping skills and social and economic determinants in the settings where young people live, learn, work and play.

Overall, the data reveals the strong impact certain determinants can have on young people's lives and the importance of positive home and school experiences for securing and maintaining health. The most powerful determinants of physical and emotional health for young people evident from the 2002 HBSC survey were gender, family affluence, school climate, and the influence of peers on risk-taking behaviours.

Socio-economic Status

Family income level represents one important indicator of socio-economic status and many studies have revealed that significant relationships exist between income and youth health. More than half of the students surveyed indicated that their families were well-off, although this decreased for students in the older grades. Boys were slightly more likely than girls to report that their families were well off or quite well off. At the same time, on average, 13 per cent of students reported at least sometimes going to bed hungry because of lack of food at home.

Students whose families were relatively affluent or very affluent also tended to report that they were healthy and satisfied with their lives, which emphasizes the link between socio-economic factors, self-reported health, and life satisfaction among youth.

The Home Experience

Adolescents who have a good relationship with their parents demonstrate positive psycho social functioning and less involvement in risk-taking. Most students surveyed reported a happy home, however, reports of happiness at home decreased as students moved up through the higher grades. There were clear gender differences in the relationships students had with their parents: girls reported more strains in these relationships than did boys. For example, older girls reported more difficulties talking to their fathers, felt less understood by their parents, and were less satisfied with their home life than both boys their age and younger girls.

Having a good relationship with parents was related to higher life-satisfaction in both genders and served as a protective factor against involvement in risk-taking behaviours, such as smoking, getting drunk and using marihuana. Students with a more positive relationship with their parents were somewhat less likely to engage in sexual intercourse. In addition, students with middle or high family affluence not only felt that their parents provided them with the support they needed at school, but they also reported being highly satisfied with their home life.

The Peer Group

Having friends is fundamental to adolescent development. Boys, especially in the lower grades, found it harder to communicate or discuss their troubles with same-sex friends than did girls. The data show that younger boys and girls were less comfortable in opposite-sex interactions than in same-sex friendships. The ease of communication with members of the opposite sex improved for older students as they gained more confidence.

Students who were well-integrated socially and had positive peer influence reported higher life satisfaction and fewer risk-taking behaviours than did students who had poor social integration and negative peer influence. Minor risk taking occurred more in socially integrated students and major risk taking (eg. hard drugs) occurred more in students with poor social integration.

The School Experience

A large portion of the lives of Canadian adolescents is spent in schools interacting with teachers and peers. In addition to the direct teaching of academic skills, schools provide opportunities for adolescents to develop social connections that often have lasting impacts on their lives. The school climate can in itself have an impact on the health and well-being of the students.

Most Canadian students in the 2002 HBSC survey liked school, but this peaked in 1994, and subsequently the proportion of students who liked school dropped steadily. Secondary students' perceptions of school tended to be more negative than that of elementary students and boys had more overall negative views of school than did girls. A major finding was that students who had positive experiences at school were less likely to be involved in health risk behaviours such as smoking, drinking, and using marihuana.

Emotional Health

Mental health and physical health are strongly related in that those who suffer from emotional problems are also more likely to manifest both physical and mental health problems. Mental health is the capacity for each of us to feel, think and act in ways that enhance our ability to enjoy life and deal with the challenges we face (Health Canada, 2003).

Four individual symptoms of emotional health (two somatic and two psychological) were examined: headaches, backaches, feeling depressed or low, and irritability or bad mood.

The majority of students in the survey reported good emotional health. Girls were more likely to report somatic (headache) and psychological (depression) symptoms, and this increased with age. Previous surveys indicate that self-reports of depression or feeling low remained essentially unchanged across the years. Poor emotional health was also associated with lower life satisfaction and lower subjective health in higher grades.

Students were asked how they viewed their health. Life satisfaction was consistently higher for boys than for girls across all grade levels, while life satisfaction decreased progressively across grades. Adolescents who were satisfied with their lives tended to have higher levels of self-esteem and life satisfaction and this, was more strongly related to positive relationships with parents than to social integration with peers. Regardless of life satisfaction, girls experienced more emotional health complaints.

Perceived health provided a second measure of emotional health. Across grade levels, boys more frequently than girls, rated their health as "excellent"; or "good."; The factors associated with perceived health mirrored those associated with life satisfaction. Like life satisfaction, parental relationships played a stronger role in promoting perceived health than did social integration.

Governments Are Taking Action

Research has demonstrated that coordinated actions across sectors that use the school setting to coordinate and deliver health promoting interventions are effective, particularly in the areas of chronic disease, youth risk taking and social behaviours. Strategies and resources, such as the Federal Tobacco Control Strategy (FTCS) and Canada's Physical Activity Guide for Children and Youth, are building awareness of the importance of healthy lifestyles and support healthy choices through sustained actions. Children and youth have also been designated by the Federal/Provincial/Territorial Ministers of Health as deserving special attention in the Integrated Pan-Canadian Healthy Living Strategy, which aims to improve the health of all Canadians, reduce heath disparities and reduce the burden on the health care system. The initial area of emphasis for the Strategy will be physical activity, healthy eating and their relationship to healthy weight.

Voices and Choices, a school-based planning tool developed by Health Canada and available on Health Canada's website, can also be of significant benefit to schools across Canada in promoting healthy living among youth and in developing strategies to improve student health. It allows schools to engage students in identifying their health-related needs and in developing and implementing strategies to address these needs within their own school. It focuses on five paths that influence school and student health and well-being: psycho-social environment (school climate), physical environment, personal resources, personal health practices, and support services. Voices and Choices is appropriate for students in Grade 6 to secondary school graduation and has been tested in schools at the intermediate and secondary levels. For more information, visit the following web site: http://www.phac-aspc.gc.ca/vc-ss/

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Backgrounders:

• Healthy Living and Risk Taking Behaviours
• Young People in Canada: Their Health and Well-being - Report Overview