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           C H A P T E R




Scotland
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C H A P T E R                                                     A. Introduction
                General Health, Physical
                                                                  The period of adolescence is characterized by rapid physical growth,
                Ailments and Medication Use                       significant psychological development and changes in personal
                                                                  relationships. It is not surprising that the physical ailments of young
                A. Introduction
                                                                  people often originate from the stress and anxiety they experience
                B. General health
                                                                  in other areas of their lives. Stress-related symptoms caused by
                C. Health problems
                                                                  muscular tension frequently take the form of recurrent headaches,
                  1.   Headache
                                                                  abdominal pain and dizziness.
                  2.   Stomachache
                  3.   Backache                                   Although there has been a limited amount of research on the
                  4.   Difficulty getting to sleep                relationship between sleep disturbance and depression and anxiety
                  5.   Being in a bad mood (irritable)            in young people, they are associated, though to a lesser extent than
                  6.   Nervousness and dizziness                  is the case among adults. There are also strong links between sleep
                D. Use of medicine                                disturbances and the quality of psychosocial relationships. Insomnia
                  1.   Headache medication                        has been found to be related to fear of school and worry about
                  2.   Stomachache medication                     other school-related matters. In other studies, headaches among
                  3.   Medicine for difficulty getting to sleep   young people have been associated with mental stress and a
                  4.   Medicine for nervousness                   generally low perception of health. Recurrent abdominal pain (RAP)
                  5.   Cough/cold medication                      has also been widely recognized as a psychosomatic response to
                E. Summary                                        stress (Montgomery, 1994; Kaiser, 1992; Wright & Wright, 1992;
                                                                  Sharrer & Ryan-Wenger, 1991).
                                                                  Although it is difficult to determine to what extent the physical
                                                                  ailments described here are psychosomatic, they do represent to
                                                                  some extent the outcomes of certain stresses that young people
                                                                  experience. In Chapter 9, the relationship between general health
                                                                  status and other aspects of students’ lives (parent and peer
                                                                  relationships, alcohol and drug use, physical exercise and school
                                                                  experience) is considered.
                                                                  In this chapter, how young people view themselves both in terms of
                                                                  their general health and the specific types of physical ailments they
                                                                  experience is discussed. The extent to which they use medication
                                                                  to treat the symptoms of these ailments is also examined. It is
                                                                  important to keep in mind that the vocabulary of young people and
                                                                  how they interpret various health-related terms strongly influences
                                                                  their responses to the relevant questionnaire items.
                                                                                                                                                            59

B. General health                                                       Figure 5.1       Factors associated with feeling healthy                            CHAPTER 5

                                                                        Students who feel healthy       11 year olds      13 year olds       15 year olds   General Health,
Respondents gave an indication of their perception of their general     are more likely to                M      F          M      F           M      F     Physical Ailments and
health by describing themselves as very healthy, quite healthy or
                                                                        Feel happy                                                                          Medication Use
not very healthy. Responses to the question “How often do you
                                                                        Feel confident
feel tired when you go to school in the morning?” added another
dimension to this summary measure of health.                            Be well integrated socially
                                                                        Not be irritable
The findings presented in Figure 5.1 make a good case for the
statement, “a sound mind resides in a sound body”. An abundance         Be satisfied with their
                                                                        looks
of positive factors are associated with feeling healthy, including
                                                                        Not feel depressed
feeling happy and confident, being well-integrated socially and not
being irritable. Most young people who feel healthy are not             Not have headaches
depressed, do not feel helpless and are satisfied with their            Not feel helpless
appearance. With the exception of 11- and 15-year-old boys, healthy     Believe family is well off
students tend not to have headaches. Eleven year olds have a positive
                                                                        Have a positive attitude
attitude toward school, achieve well academically and believe, along    toward school
with 13 year olds, that their family is well off. Thirteen-year-old     Exercise regularly
girls and 15 year olds do not experience dizziness. Regular exercise
                                                                        Achieve well at school
is associated with feeling healthy for 15 year olds, especially the
boys.                                                                   Not feel dizzy
                                                                        Not have stomachaches

                                                                        Correlation coefficient:      .15 to .19       .20 to .29        .30 to .39
                 60

     CHAPTER 5          Although few students considered themselves not very healthy, the        It is to be expected that students will occasionally feel tired when
      General Health,   proportions of students who described themselves as very healthy         they go to school in the morning. However, chronic tiredness may
Physical Ailments and   varied widely from country to country (Figure 5.2). Swedish students,    be an indication of physical or emotional distress. Students who are
       Medication Use   especially boys, were highly positive about their health while those     in a constant state of fatigue may not perform well in school, not
                        in Northern Ireland were the least positive. Students from many          relate well to others or not feel like being part of extracurricular
                        eastern European countries – Estonia, Hungary, Latvia, Lithuania,        activities. Being physically tired in the morning may result from
                        Poland and Russia – were less likely than students from most other       physical causes – hunger, a poor night’s sleep, lack of exercise – or
                        countries to feel very healthy. Conversely, more of the students in      from mental distress, anxiety or depression. Later in this chapter,
                        such disparate locations as Austria, France, Israel and Spain tended     the proportions of students who frequently feel tired in the morning
                        to feel very healthy.                                                    are compared with those who have difficulty getting to sleep.
                        Overall, boys were more likely than girls to indicate that they were
                        very healthy, but this difference was more pronounced among the
                        two older groups of respondents. Eleven-year-old boys and girls in
                        Spain and Sweden, for example, were equally likely to feel healthy;
                        however, substantially more of the 15-year-old boys than girls felt
                        very healthy. In Canada, six percent more of the 11-year-old boys
                        than girls said they were very healthy, but 22 percent more of the
                        15-year-old boys expressed this view.
                        Age as well as gender appeared to influence how healthy the students
                        felt. In the majority of countries, the youngest group of students
                        surveyed were more likely than both groups of older students to
                        say they felt very healthy. It should be noted that by age 15, only in
                        Sweden did more than 50 percent of girls feel very healthy and in
                        only four countries – France, Israel, Sweden and Switzerland – did
                        more than 50 percent of boys feel very healthy. This finding is
                        supported by other health research (Connelly et al., 1993).
Figure 5.2 Students who felt very healthy (%)                                                                                     61
            11 year olds                                              13 year olds                            15 year olds
                                              16                                            9                                 8   CHAPTER 5
N. Ireland                                    23      N. Ireland                           20
                                                                                                N. Ireland                   17   General Health,
                                              23                                           15                                16
Estonia                                       26      Estonia                              22
                                                                                                Hungary                      19
                                                                                                                                  Physical Ailments and
                                              22                                           11                                10   Medication Use
Scotland                                      31      Scotland                                  Estonia                      24
                                                                                           25
                                              26                                           19                                13
Poland                                        31      Hungary                                   Poland                       25
                                                                                           27
                                              30                                           14                                 9
Hungary                                       31      Wales                                     Scotland
                                                                                           31                                28
                                              19                                           19                                14
Wales                                         33
                                                      Poland                                    Russia*
                                                                                           31                                29
                                              28                                           20                                24
Latvia                                        34      Russia*                                   Greenland
                                                                                           34                                29
                                              23                                           20                                13
Russia*                                       38      Lithuania                                 Wales
                                                                                           35                                31
                                              33                                           36                                17
Lithuania                                     39
                                                      Greenland                                 Latvia
                                                                                           36                                32
                                              36                                           24                                25
Denmark                                       40
                                                      Latvia                                    Czech Rep.
                                                                                           37                                32
                                              35                                           29                                18
Czech Rep.                                    42
                                                      Denmark                                   Lithuania
                                                                                           38                                33
Belgium Fl.                                   38      Norway                               28   Belgium Fl.                  20
                                              45                                           42                                34
Finland                                       39      Czech Rep.                           29                                20
                                              46
                                                                                                Norway
                                                                                           42                                36
Canada                                        41      Canada                               30   Canada                       16
                                              47                                           42                                38
Norway                                        35      Finland                              31   Slovakia                     22
                                              48                                           42                                40
Germany*                                      41      Belgium Fl.                          32   Germany*                     23
                                              49                                           43                                40
Slovakia                                      41      Germany*                             28   Denmark                      28
                                              51                                           44                                40
Switzerland                                   44      Slovakia                             34   Belgium Fr.                  32
                                              53                                           46                                46
Belgium Fr.                                   49      Belgium Fr.                          45   Austria                      37
                                              53                                           50                                46
Austria                                       51      Austria                              42   Finland                      37
                                              55                                           54                                46
Spain                                         57      Switzerland                          42   Spain                        36
                                              56                                           55                                47
Greenland                                     55      Spain                                45   Israel                       33
                                              59                                           56                                54
France*                                       53      Israel                               44   France*                      40
                                              62                                           61                                55
Israel                                        59      France*                              48   Switzerland                  40
                                              65                                           61                                57    Female
Sweden                                        69      Sweden                               66   Sweden                       58    Male
                                              70                                           71                                73
* France, Germany and Russia are represented only by regions: see Chapter 1 for details.
                 62

     CHAPTER 5          Figure 5.3 lists the main factors that are correlated with feeling        Figure 5.3 Factors associated with feeling tired in the morning
      General Health,   tired in the morning. Significantly there is a relationship with liking   Students who are often tired in    11 year olds     13 year olds   15 year olds
Physical Ailments and   school which may suggest that some young people feel tired in the         the morning are more likely to      M      F         M      F       M      F

       Medication Use   morning because, for them, attending school is stressful. As one          Feel depressed
                        might expect feeling tired in the morning is directly related to having   Be irritable
                        difficulty sleeping and the mental health problems of depression          Have difficulty getting to
                        and irritability. It is also associated with physical health problems     sleep
                        such as headaches, dizziness, stomachaches and backaches. Older           Not like school
                        youth who feel tired in the morning are more likely to have been
                                                                                                  Have headaches
                        drunk. For 11 year olds, there is a relationship between feeling tired
                                                                                                  Have stomachaches
                        in the morning and feeling unhappy and feeling like an outsider.
                                                                                                  Feel dizzy
                        Austrian, Israeli and Scandinavian (especially 15-year-old
                                                                                                  Have backaches
                        Norwegians) students were more likely than other students to
                        frequently feel tired in the mornings on school days (see Figure          Feel stressed at school
                        5.4). Students in Greenland, Latvia, Lithuania, Poland and Spain          Feel nervous
                        were the least likely to feel tired four or more times a week. The        Have poor communication
                        range of responses from lowest to highest was substantial, between        with their parents
                        4 and 34 percent for 11 year olds and between 3 and 50 percent for        Have been drunk
                        15 year olds.                                                             Be unhappy
                        Generally more boys than girls felt tired at school frequently, but       Feel like an outsider
                        the differences in their responses were not large. Older students
                                                                                                  Correlation coefficient:     .15 to .19     .20 to .29
                        were more likely to report feeling tired when they went to school.
                                                                                                                                   63
Figure 5.4    Students who felt tired four or more times a week in the morning when they go to school* (%)
               11 year olds                                           13 year olds                             15 year olds        CHAPTER 5
                                              32                                            36                                47   General Health,
Norway                                        34      Norway                                40
                                                                                                 Norway                       50   Physical Ailments and
                                              27                                            32                                29
Austria                                       29      Austria                               34
                                                                                                 Sweden                       38   Medication Use
                                              21                                            26                                37
Denmark                                       25      Finland                                    Austria                      37
                                                                                            33
                                              17                                            22                                34
Israel                                        25      Denmark                                    Finland                      35
                                                                                            32
                                              16                                            18                                25
Finland                                       24      Sweden                                     Denmark
                                                                                            31                                32
                                              15                                            22                                28
N. Ireland                                    24
                                                      Israel                                     Germany**
                                                                                            28                                29
                                              23                                            24                                28
Germany**                                     23      Germany**                                  Israel
                                                                                            26                                29
                                              21                                            20                                27
Belgium Fr.                                   23      N. Ireland                                 Canada
                                                                                            26                                29
                                              15                                            25                                26
Scotland                                      20
                                                      Belgium Fr.                                N. Ireland
                                                                                            24                                29
                                              16                                            21                                30
Estonia                                       19
                                                      Canada                                     Wales
                                                                                            23                                28
                                              15                                            21                                25
Canada                                        18
                                                      Scotland                                   Belgium Fr.
                                                                                            23                                28
Hungary                                       16      Wales                                 21   Scotland                     29
                                              17                                            23                                27
Wales                                         16      France**                              15                                16
                                              17
                                                                                                 Belgium Fl.
                                                                                            18                                21
Sweden                                        14      Estonia                               17   Hungary                      23
                                              16                                            16                                20
Russia**                                      13      Belgium Fl.                            8   Slovakia                     18
                                              15                                            16                                19
Slovakia                                      11      Hungary                               16   Estonia                      15
                                              15                                            15                                19
France**                                      11      Slovakia                              11   France**                     15
                                              13                                            15                                19
Belgium Fl.                                    8      Czech Rep.                             9   Czech Rep.                   11
                                              11                                            13                                16
Czech Rep.                                     7      Russia**                              16   Russia**                     15
                                              11                                            11                                14
Latvia                                        11      Greenland                             10   Greenland                     9
                                               9                                             8                                14
Spain                                          6      Spain                                  6   Spain                        10
                                               7                                             8                                12
Greenland                                      7      Poland                                 4   Latvia                        6
                                               6                                             8                                 7
Poland                                         5      Latvia                                 7   Poland                        5
                                               5                                             6                                 7    Female
Lithuania                                      4      Lithuania                              5   Lithuania                     3    Male
                                               5                                             5                                 5
* Switzerland did not include this item.
** France, Germany and Russia are represented only by regions: see Chapter 1 for details.
                 64

     CHAPTER 5          C. Health problems                                                       likely to feel healthy and are often tired in the morning. Girls who
      General Health,                                                                            suffer from headaches also appear to be unhappy. The relationship
                        Health problems, such as headaches, stomachaches, backaches,
Physical Ailments and                                                                            with loneliness is worrisome and ambiguous: it may indicate either
                        dizziness or insomnia, among adolescents can be of organic origin
       Medication Use                                                                            that the loneliness is contributing to health problems and/or the health
                        or induced by stress. The frequency with which students have
                                                                                                 problems are preventing some young people from fully integrating
                        various aches and pains and other conditions, such as being in a
                                                                                                 with their peers.
                        bad mood and/or feeling nervous or dizzy, are useful general
                        indicators of students’ physical and emotional health.                   Frequent headaches were reported by a high proportion of students
                                                                                                 in several countries (Figure 5.6). In more than one-half of the
                        Students were asked how often they had experienced these
                                                                                                 countries between 30 and 40 percent of 11-year-old girls and
                        conditions during the previous six months: most days; more than
                                                                                                 between 20 and 30 percent of 11-year-old boys said they had
                        once a week; about once every week; about once every month;
                                                                                                 headaches once a week or more in the previous six months. In all
                        and seldom or never. The proportion of males and females in each
                                                                                                 countries, except Estonia, there was an increase between age 11
                        age group who reported that they frequently experience these health
                                                                                                 and 15 in the proportion of girls who experienced headaches. For
                        problems is presented and, in a later section, the proportion of
                                                                                                 boys the figures were either lower by age 15 or remained relatively
                        respondents who indicated they had taken medication for these
                                                                                                 stable. Students in Canada, Finland, Israel, Northern Ireland and
                        problems within the last month.
                                                                                                 Sweden were more likely than those in other countries to have
                        1. Headache
                        Headaches are a common complaint of young people in many parts           Figure 5.5 Factors associated with having headaches
                        of the world (Tynjälä et al., 1993; Kristjansdottier & Wahlberg,         Students who often have       11 year olds       13 year olds      15 year olds
                        1993). Research into the occurrence of childhood and adolescent          headaches are more              M     F            M      F           M      F
                                                                                                 likely to
                        headaches tends to focus on migraine headaches and there is some
                                                                                                 Have stomachaches
                        controversy over the incidence of tension headaches among young
                        people. Eye strain, changes in weather, allergies, depression and a      Feel dizzy
                        low level of physical activity have been associated with the onset       Be depressed
                        of headaches in young people. Frequent headaches can affect many         Have backaches
                        aspects of a young person’s life and he or she may respond by not
                                                                                                 Be irritable
                        completing school work or avoiding challenging activities
                                                                                                 Feel nervous
                        (Montgomery, 1994; Kaiser, 1992; Labbé, 1988).
                                                                                                 Have difficulty getting to
                        Although survey data do not indicate a direct link to poor school        sleep
                        performance, they show that the young people who complain of             Be tired in the morning
                        headaches are also more likely to have other physical problems
                                                                                                 Not feel healthy
                        such as stomachaches, backaches, nervousness and dizziness (see
                                                                                                 Feel lonely
                        Figure 5.5). These symptoms are likely to have a negative influence
                        on achievement and motivation. Such students are also more likely        Not feel happy
                        to be depressed and irritable. It is not surprising that they are less   Correlation coefficient:     .15 to .19      .20 to .29    .30 to .39
                                                                                                                                   65
Figure 5.6    Students who had a headache once a week or more during the previous six months* (%)
               11 year olds                                           13 year olds                             15 year olds        CHAPTER 5
                                              40                                            42                                53   General Health,
Slovakia                                      30      Canada                                27
                                                                                                 Israel                       30   Physical Ailments and
                                              40                                            41                                49
Lithuania                                     24      Israel                                27
                                                                                                 Canada                       27   Medication Use
                                              39                                            41                                47
N. Ireland                                    27      Finland                                    Sweden                       27
                                                                                            26
                                              38                                            41                                44
Israel                                        32      N. Ireland                                 N. Ireland                   25
                                                                                            26
                                              38                                            41                                44
Russia**                                      26      Sweden                                     Finland
                                                                                            25                                22
                                              37                                            40                                44
Canada                                        28
                                                      Lithuania                                  Scotland
                                                                                            27                                22
                                              36                                            40                                42
Wales                                         28      Wales                                      Lithuania
                                                                                            25                                22
                                              35                                            39                                41
Belgium Fr.                                   26      Russia**                                   Belgium Fr.
                                                                                            19                                25
                                              35                                            36                                41
Finland                                       23
                                                      Belgium Fr.                                Wales
                                                                                            23                                22
                                              33                                            36                                41
Estonia                                       22
                                                      Slovakia                                   Slovakia
                                                                                            21                                20
                                              32                                            35                                41
Sweden                                        23
                                                      Scotland                                   Hungary
                                                                                            26                                19
Hungary                                       31      Hungary                               34   Russia**                     41
                                              22                                            21                                19
Germany**                                     30      Estonia                               33                                38
                                              16
                                                                                                 France**
                                                                                            23                                19
Poland                                        29      France**                              31   Austria                      37
                                              14                                            20                                19
Latvia                                        28      Switzerland                           29   Latvia                       36
                                              19                                            21                                14
Austria                                       28      Austria                               29   Poland                       33
                                              18                                            19                                14
Denmark                                       28      Latvia                                28   Greenland                    33
                                              18                                            17                                12
Scotland                                      27      Denmark                               28   Denmark                      32
                                              22                                            16                                16
France**                                      26      Germany**                             28   Germany**                    32
                                              21                                            15                                16
Belgium Fl.                                   26      Belgium Fl.                           26   Estonia                      31
                                              18                                            18                                19
Norway                                        23      Poland                                26   Norway                       31
                                              14                                            14                                17
Switzerland                                   21      Norway                                21   Belgium Fl.                  27
                                              19                                            16                                16
                                              15
                                                                                                                                    Female
Greenland                                             Greenland                             20   Switzerland                  23
                                              15                                            12                                14    Male

* Czech Republic and Spain did not include this item.
** France, Germany and Russia are represented only by regions: see Chapter 1 for details.
                 66

     CHAPTER 5          headaches frequently. In many countries, girls were twice as likely
      General Health,   as boys to report frequent headaches by age 15. The range of
Physical Ailments and   responses was also greater for girls than for boys.
       Medication Use
                        2. Stomachache
                        Recurring abdominal pain among young people has frequently been
                        found to be a psychosomatic response to stress (Sharrer & Ryan-
                        Wenger, 1991).
                        Lower percentages of students reported frequent stomachaches
                        than was the case for headaches (Figure 5.7). For girls, proportions
                        met or exceeded 25 percent in 11 countries for 11 year olds, in 10
                        countries for 13 year olds and in five countries for 15 year olds. It
                        might be that for some adolescent girls stomachache was equated
                        with menstrual cramps. The decrease in the proportion of older
                        girls experiencing stomachaches may be because their menstrual
                        cycle is more established.
                        For the most part, few boys complained of stomachaches. Only for
                        11-year-old boys in three countries did the proportion exceed 25
                        percent. There was no clear regional pattern to the countries where
                        stomachaches were the most or least prevalent. Belgian (Fr.),
                        Canadian, Israeli and Slovakian students were among the most likely
                        to have stomachaches at all age levels. As noted previously, students
                        in Israel and Canada were also among those most likely to have
                        headaches. Stomachaches were least frequent in Belgium (Fl.),
                        Denmark, Greenland and Russia. Three of these countries – Belgium
                        (Fl.), Denmark and Greenland – also ranked low on the frequent
                        headache item. Interestingly, Belgian students from the French-
                        speaking and Flemish-speaking communities were at the extreme
                        ends from each other on this measure.
                        In every country except Greenland and in each age group, girls
                        were more likely than boys to report frequent stomachaches. The
                        difference between girls and boys in their responses varied widely
                        by country. The greatest difference between males and females
                        was in Wales for 11 year olds (15%). The proportions of students
                        with stomachaches tended to decline or remain relatively stable
                        with age for both girls and boys in almost every country.
                                                                                                                                   67
Figure 5.7 Students who had a stomachache once a week or more during the previous six months* (%)
               11 year olds                                           13 year olds                             15 year olds        CHAPTER 5
                                              38                                            35                                31   General Health,
Belgium Fr.                                   26      Belgium Fr.                           21
                                                                                                 Belgium Fr.                  19   Physical Ailments and
                                              35                                            29                                29
Slovakia                                      27      Israel                                24
                                                                                                 Israel                       21   Medication Use
                                              34                                            29                                27
Israel                                        27      Canada                                     Canada                       17
                                                                                            18
                                              34                                            28                                26
Canada                                        24      France**                                   Sweden                       15
                                                                                            16
                                              33                                            27                                25
Wales                                         18      N. Ireland                                 Slovakia
                                                                                            16                                15
                                              32                                            26                                23
N. Ireland                                    20
                                                      Slovakia                                   France**
                                                                                            18                                14
                                              32                                            26                                23
Estonia                                       18      Sweden                                     Finland
                                                                                            14                                13
                                              29                                            26                                22
France**                                      17      Lithuania                                  Lithuania
                                                                                            13                                10
                                              28                                            25                                22
Lithuania                                     15
                                                      Estonia                                    Wales
                                                                                            17                                10
                                              27                                            25                                22
Latvia                                        15
                                                      Finland                                    Latvia
                                                                                            16                                 9
                                              25                                            24                                21
Finland                                       15
                                                      Scotland                                   Scotland
                                                                                            18                                10
Hungary                                       24      Switzerland                           23   Estonia                      18
                                              15                                            16                                13
Norway                                        24      Wales                                 23                                18
                                              15
                                                                                                 Norway
                                                                                            14                                10
Scotland                                      23      Latvia                                20   Austria                      18
                                              17                                            10                                 9
Poland                                        23      Germany**                             19   Germany**                    18
                                              12                                             7                                 8
Switzerland                                   23      Norway                                18   N. Ireland                   17
                                              12                                            13                                14
Germany**                                     22      Poland                                18   Hungary                      17
                                              11                                             7                                11
Sweden                                        21      Hungary                               17   Switzerland                  17
                                              18                                            12                                 8
Denmark                                       20      Denmark                               17   Denmark                      15
                                              13                                             7                                 5
Austria                                       17      Russia**                              16   Russia**                     14
                                              11                                             8                                11
Russia**                                      16      Austria                               15   Poland                       13
                                              12                                            10                                 6
Greenland                                     13      Belgium Fl.                           12   Belgium Fl.                  11
                                              11                                             8                                 8
Belgium Fl.                                   12      Greenland                                                                     Female
                                                                                             7   Greenland                     7
                                               9                                             7                                 5    Male

* Czech Republic and Spain did not include this item.
** France, Germany and Russia are represented only by regions: see Chapter 1 for details.
                 68

     CHAPTER 5          3. Backache
      General Health,
                        Having a backache is typically regarded as a common physical
Physical Ailments and
                        ailment of older people. Young people in this survey did seem to be
       Medication Use
                        less bothered by backaches than by either headaches or
                        stomachaches but, in 13 countries, one-fifth or more of students, in
                        at least one of the age groups surveyed, reported backaches at
                        least weekly.
                        As was true for headaches and stomachaches, students in Belgium
                        (Fr.), Canada and Slovakia were the most likely to complain of
                        frequent backaches (Figure 5.8). Denmark and France also tended
                        to rank high. Students from Latvia, Lithuania, Poland, Russia, and
                        Scotland were consistently among the least likely to report
                        backaches.
                        The incidence of backaches was similar for males and females
                        across age groups with a few exceptions at age 15. Seven percent
                        or more girls than boys in Hungary, Latvia and Slovakia said they
                        had suffered backaches once a week or more in the past six months.
                        In Greenland, twice as many boys as girls, 28 to 14 percent, reported
                        backaches.
                        Also, fifteen year olds were more likely to have frequent backaches
                        than 11 year olds with the largest increases being for girls in Canada
                        (17%) and Austria (13%) and for boys in Greenland (14%), Canada
                        and Germany (both 13%).
                                                                                                                                   69
Figure 5.8 Students who had a backache once a week or more during the previous six months* (%)
               11 year olds                                           13 year olds                             15 year olds        CHAPTER 5
                                              20                                            27                                33   General Health,
Slovakia                                      18      Belgium Fr.                           22
                                                                                                 Canada                       30   Physical Ailments and
                                              19                                            23                                30
Belgium Fr.                                   16      Canada                                23
                                                                                                 Belgium Fr.                  27   Medication Use
                                              16                                            22                                30
Canada                                        17      Slovakia                                   Slovakia                     22
                                                                                            21
                                              16                                            22                                27
Denmark                                       14      Switzerland                                France**                     23
                                                                                            14
                                              16                                            20                                25
France**                                      12      Denmark                                    Denmark
                                                                                            18                                21
                                              13                                            20                                23
Israel                                        15
                                                      France**                                   Austria
                                                                                            18                                23
                                              13                                            20                                23
Hungary                                        9      Germany**                                  Germany**
                                                                                            14                                21
                                              13                                            17                                23
Germany**                                      8      Israel                                     Sweden
                                                                                            19                                18
                                              12                                            17                                22
Sweden                                         9
                                                      Sweden                                     Hungary
                                                                                            13                                15
                                              10                                            16                                21
Greenland                                     14
                                                      Austria                                    Israel
                                                                                            15                                21
                                              10                                            16                                20
Austria                                       11
                                                      Hungary                                    Belgium Fl.
                                                                                            10                                19
Belgium Fl.                                   10      Wales                                 15   Switzerland                  19
                                               8                                            18                                18
                                              10                                                                              19
Norway                                         8
                                                      Greenland                             14   Norway
                                                                                            16                                17
Estonia                                       10      Finland                               14   Wales                        17
                                               4                                            11                                17
Switzerland                                    9      Belgium Fl.                           13   Finland                      15
                                              13                                            14                                17
Wales                                          9      Norway                                13   Latvia                       15
                                              12                                            12                                 7
Lithuania                                      9      Lithuania                             12   Greenland                    14
                                               8                                            10                                28
Poland                                         9      Russia**                              12   Estonia                      14
                                               3                                             7                                14
Russia**                                       8      Scotland                              11   Scotland                     14
                                               8                                            13                                13
Finland                                        7      Estonia                               11   Russia**                     13
                                               9                                             9                                 7
Scotland                                       7      Poland                                 8   Lithuania                    11
                                               8                                             7                                11
Latvia                                         7      Latvia                                 8   Poland                       11    Female
                                               6                                             5                                 8    Male

* Czech Republic, Northern Ireland and Spain did not include this item.
** France, Germany and Russia are represented only by regions: see Chapter 1 for details.
                 70

     CHAPTER 5          4. Difficulty getting to sleep                                              Figure 5.9 Factors associated with having difficulty getting to
      General Health,                                                                                          sleep
                        Significant cultural differences in the sleeping habits of young people
Physical Ailments and
                        were found in the 1990 HBSC survey (Tynjälä et al., 1993). The              Students who often have difficulty   11 year olds    13 year olds    15 year olds
       Medication Use                                                                               getting to sleep are more              M      F        M      F        M      F
                        proportion of participants reporting trouble falling asleep and getting     likely to
                        too little sleep varied significantly among countries as well as among      Feel dizzy
                        age groups. Students who have sleeping difficulties once a week or
                                                                                                    Feel depressed
                        more may be reacting to problems in different areas of their lives,
                                                                                                    Be irritable
                        in their social relationships at home or at school (Wright & Wright,
                        1992). Insomnia is also linked to distress over school-related matters      Feel nervous
                        and is viewed as a response to the psychological distress that results.     Be tired in the morning

                        Figure 5.9 indicates some of the factors associated with sleeping           Have headaches
                        problems for the respondents in this survey. Of course, each child          Have stomachaches
                        is affected by a different combination of factors. Physical problems,       Have backaches
                        such as headaches and backaches, interfere with sleep.
                                                                                                    Feel lonely
                        Nervousness and depression may be causes of sleeping difficulties
                                                                                                    Feel left out of things
                        or they may result from lack of sleep. Certainly youth who do not
                        get enough sleep are more likely to be irritable. For some students         Feel helpless
                        loneliness may be the primary cause – for some girls, sleeping              Have poor communication
                                                                                                    with parents
                        problems are clearly linked to poor communication with parents.
                        These problem areas require further analysis.                               Be unhappy

                        Substantial proportions of students in Canada, France and Wales             Correlation coefficient:     .15 to .19       .20 to .29     .30 to .39

                        reported frequent sleeping difficulties (Figure 5.10): over 40 percent
                                                                                                    numbers of the other countries increased or decreased slightly from
                        of girls in these countries and nearly as many boys had difficulty
                                                                                                    age 11 to age 15. The exception was Denmark where 11 year olds
                        getting to sleep at least once a week. Students from Belgium (Fl.),
                                                                                                    were far more likely than 15 year olds to have trouble getting to
                        Hungary, Lithuania and Poland were the least likely to have difficulty
                                                                                                    sleep.
                        sleeping across the three age groups.
                                                                                                    In general, substantially higher proportions of students had difficulty
                        More girls than boys reported difficulty getting to sleep, but generally,
                                                                                                    sleeping than felt tired most days (Figure 5.4). Among 11 year olds,
                        there were not large differences between their responses except in
                                                                                                    Belgium (Fr.), Denmark, Estonia, Northern Ireland and Scotland
                        some higher ranking countries, where differences of between 7
                                                                                                    ranked among the top ten countries on both questions; for 15 year
                        and 13 percent were common. Only in Israel did slightly more boys
                                                                                                    olds, those from Canada, Northern Ireland, Sweden and Wales were
                        than girls find it difficult to sleep at all age levels.
                                                                                                    among the top ten. Students from Greenland, Lithuania, Latvia and
                        There was no clear pattern of either an increase or decrease in             Poland tended to be among the least likely to feel tired in the morning
                        sleeping difficulties with age. In nine countries, the proportions of       and the least likely to experience difficulty getting to sleep once a
                        students remained about the same from age to age; about equal               week or more often.
                                                                                                                                   71
Figure 5.10 Students who had difficulty getting to sleep once a week or more during the previous six months* (%)
               11 year olds                                           13 year olds                             15 year olds        CHAPTER 5
                                              44                                            42                                44   General Health,
Canada                                        39      France**                              35
                                                                                                 Canada                       37   Physical Ailments and
                                              43                                            42                                44
Denmark                                       41      Canada                                34
                                                                                                 Wales                        34   Medication Use
                                              42                                            42                                42
France**                                      39      Switzerland                                France**                     32
                                                                                            30
                                              42                                            41                                40
Wales                                         33      Wales                                      Sweden                       36
                                                                                            39
                                              41                                            39                                40
Russia**                                      32      N. Ireland                                 Slovakia
                                                                                            35                                32
                                              38                                            38                                39
Belgium Fr.                                   38
                                                      Belgium Fr.                                N. Ireland
                                                                                            27                                34
                                              38                                            37                                39
Scotland                                      38      Estonia                                    Belgium Fr.
                                                                                            29                                31
                                              38                                            37                                38
Estonia                                       29      Slovakia                                   Scotland
                                                                                            26                                29
                                              37                                            37                                35
Sweden                                        35
                                                      Russia**                                   Switzerland
                                                                                            24                                22
                                              35                                            36                                34
N. Ireland                                    38
                                                      Sweden                                     Estonia
                                                                                            32                                29
                                              34                                            35                                32
Slovakia                                      33
                                                      Denmark                                    Russia**
                                                                                            33                                25
Norway                                        34      Scotland                              33   Israel                       31
                                              26                                            27                                33
Switzerland                                   31      Germany**                             32                                30
                                              29
                                                                                                 Denmark
                                                                                            23                                27
Germany**                                     30      Finland                               30   Germany**                    30
                                              24                                            29                                24
Austria                                       28      Israel                                28   Austria                      29
                                              24                                            31                                22
Israel                                        26      Austria                               28   Norway                       29
                                              31                                            25                                21
Finland                                       26      Norway                                27   Finland                      27
                                              28                                            24                                25
Latvia                                        25      Latvia                                25   Greenland                    25
                                              22                                            18                                31
Lithuania                                     24      Greenland                             22   Latvia                       25
                                              22                                            24                                19
Hungary                                       23      Lithuania                             21   Poland                       24
                                              19                                            17                                15
Poland                                        22      Poland                                20   Lithuania                    22
                                              20                                            15                                15
Greenland                                     20      Hungary                               18   Hungary                      20
                                              19                                            16                                17
                                                                                                                                    Female
Belgium Fl.                                   15      Belgium Fl.                           14   Belgium Fl.                  17
                                              17                                            13                                12    Male

* Czech Republic and Spain did not include this item.
** France, Germany and Russia are represented only by regions: see Chapter 1 for details.
                  72

     CHAPTER 5          5. Being in a bad mood (irritable)
      General Health,
                        Perhaps one of the most widely recognized characteristics of
Physical Ailments and
                        teenagers is the frequent mood swings they experience. As Figure
       Medication Use
                        5.11 shows, irritability seemed to be a frequent occurrence among
                        the adolescent participants in this survey. Proportions of boys and/
                        or girls who indicated they were irritable once a week or more
                        exceed one-half in 10 countries for 11 year olds, 11 countries for 13
                        year olds and 15 countries for 15 year olds.
                        Estonian, Israeli and Slovakian students in all age groups were the
                        most likely to say they were in a bad mood once a week or more.
                        In the 13- and 15-year-old groups, Lithuanian and Russian girls
                        were also among the most likely to be irritable. Students in
                        Greenland, especially 11 and 13 year olds, Belgium (Fl.), Austria
                        and Switzerland were among the least likely to be in a bad mood
                        once a week or more.
                        Overall, girls were more likely to report being irritable. There were
                        larger gender differences on this item among all age groups in Estonia,                                                             Lithuania
                        Latvia, Lithuania and Russia. There was no difference between
                        11-year-old girls and boys in France, but a 15 percent difference         In most countries, 15 year olds were more likely than students in
                        between 15 year olds in that country. Only 11 year olds in Israel         other age groups to be in a bad mood once a week or more. The
                        reversed the pattern to any extent, with eight percent more boys          difference is very slight in Canada, Denmark, Norway and Scotland;
                        than girls indicating they had been irritable at least once a week in     it is larger for girls in France and Greenland and among both boys
                        the past six months.                                                      and girls in Belgium (Fr.) and Hungary.
                                                                                                                                   73
Figure 5.11 Students who were in a bad mood (irritable) once a week or more during the previous six months* (%)
               11 year olds                                           13 year olds                             15 year olds        CHAPTER 5

                                              65                                            71                                74   General Health,
Slovakia                                      57
                                                      Slovakia                              61
                                                                                                 Slovakia                     62   Physical Ailments and
                                              59                                            67                                71
Estonia                                       49
                                                      Estonia                               50
                                                                                                 Estonia                      57   Medication Use
                                              56                                            64                                67
Israel                                                Russia**                                   Lithuania                    49
                                              64                                            43
                                              56                                            63                                66
N. Ireland                                            Israel                                     Israel                       64
                                              58                                            65
Finland                                       55      N. Ireland                            63   Latvia                       65
                                              51                                            62                                53
Canada                                        53      Finland                               62   Russia**                     65
                                              53                                            55                                47
Denmark                                       53      Lithuania                             62                                62
                                                                                                 Sweden                       53
                                              46                                            47
Lithuania                                     53      Latvia                                61   N. Ireland                   59
                                              40                                            37                                61
Latvia                                        52      Sweden                                57   Finland                      58
                                              34                                            49                                47
Russia**                                      51      Canada                                56   Belgium Fr.                  57
                                              39                                            53                                47
Sweden                                        48      Denmark                               51   Canada                       55
                                              42                                            46                                51
Scotland                                      44      Scotland                              48   Hungary                      55
                                              46                                            48                                44
Norway                                        44      Belgium Fr.                           48   France**                     55
                                              34                                            38                                40
Wales                                         42      Norway                                46   Denmark                      52
                                              39                                            41                                48
Poland                                        40      France**                              45   Poland                       50
                                              32                                            41                                36
Germany**                                     39      Germany**                             45   Wales                        47
                                              32                                            38                                43
Belgium Fr.                                   36      Poland                                45   Norway                       47
                                              36                                            37                                39
France**                                      34      Wales                                 44   Scotland                     46
                                              33                                            45                                49
Austria                                       29      Hungary                               44   Germany**                    46
                                              30                                            36                                37
Hungary                                       24      Austria                               36   Greenland                    42
                                              23                                            33                                27
Belgium Fl.                                   22      Greenland                             32   Austria                      41
                                              22                                            24                                34
Greenland                                     22      Switzerland                           29   Belgium Fl.                  30
                                              20                                            21                                23
                                                                                                                                    Female
Switzerland                                   21      Belgium Fl.                           27   Switzerland                  23
                                              19                                            22                                14    Male

* Czech Republic and Spain did not include this item.
** France, Germany and Russia are represented only by regions: see Chapter 1 for details.
                 74

     CHAPTER 5          6. Nervousness and dizziness                                             than in any other country. For all the other countries, the range of
      General Health,                                                                            responses for males in all age groups is 5 percent to 24 percent; for
                        The students were asked to indicate how often they felt nervous
Physical Ailments and                                                                            females it is 10 percent to 32 percent. Similar to other health
                        (uneasy) and dizzy. Unlike such ailments as headache and
       Medication Use                                                                            disorders, girls were more likely than boys to feel dizzy at least
                        stomachache, nervousness and, to a lesser extent, dizziness often
                                                                                                 once a week. Generally, the differences were not great. Along
                        appear as vague symptoms. As well, the terms may be understood
                                                                                                 with Estonia, Canada, Israel, Northern Ireland and Wales tended to
                        differently across cultures and a cautious approach should be taken
                                                                                                 rank among the top countries on this measure.
                        to national comparative data. Tension, strain or worry usually produce
                        a sense of uneasiness which may or may not be referred to as             There was not a great deal of consistency across age levels in the
                        nervousness by those who experience it. In a similar way,                countries where students responded most positively on this item
                        respondents may consider dizziness the vague feeling of light-           and no clear overall pattern in the responses of students of different
                        headedness associated with hunger or lack of sleep or only more          ages. In some countries, there was a steady increase from 11 to 13
                        severe forms of disorientation such as vertigo.                          to 15 year olds, mainly for girls. In the majority of countries (15 for
                                                                                                 boys, 12 for girls), the proportions of 11 and 15 year olds who
                        The proportion of students who said they frequently feel nervous
                                                                                                 frequently felt dizzy were within three percentage points. Finnish
                        was quite high in some countries. In Israel, Poland and Slovakia,
                                                                                                 girls’ responses showed the greatest difference between ages 11
                        high proportions of students across age levels felt nervous once a
                                                                                                 and 15 – from 13 percent to 24 percent. Only the Belgium (Fr.)
                        week or more (Figure 5.12). In many countries, one-third or more
                                                                                                 responses were consistently low across age groups.
                        of males and /or females said they had felt nervous once a week or
                        more. In Denmark, Greenland, Norway and Scotland less than one-
                        quarter of students reported nervousness weekly or more often.
                        As with other health problems described, girls were more likely to
                        feel nervous once a week or more. This was consistently true for
                        13 and 15 year olds. Among 11 year olds in six of the countries,
                        boys were more likely than girls to feel nervous (Belgium [Fl.],
                        Belgium [Fr.], Denmark, Finland, France and Israel), but overall
                        the differences were very small.
                        Feeling nervous increased from age 11 to 15 in most countries. The
                        range of responses is consistently wide within each age group, from
                        11 to 60 percent for 11 year olds; 14 to 68 percent for 13 year olds
                        and 8 to 73 percent for 15 year olds.
                        Although feeling dizzy is not a major health problem among
                        adolescents, it does seem to be a cause for concern in some
                        countries. In Estonia, a very large proportion of students (over 40
                        percent of girls and one-third of the boys at all age levels) reported
                        that they felt dizzy once a week or more. This is substantially higher
                                                                                                                                   75
Figure 5.12 Students who felt nervous once a week or more during the previous six months* (%)
               11 year olds                                           13 year olds                             15 year olds        CHAPTER 5
                                              60                                            68   Slovakia                     73   General Health,
Slovakia                                      54      Slovakia                              53                                57   Physical Ailments and
                                              53                                            62   Poland                       69
Israel                                        60      Poland                                51                                51   Medication Use
                                              50                                            59   Israel                       66
Poland                                        41      Israel                                                                  63
                                                                                            60
                                              44                                            54   Hungary                      61
Russia**                                      27      Hungary                                                                 49
                                                                                            44
                                              42                                            51   Belgium Fr.                  59
N. Ireland                                    35      Lithuania
                                                                                            37                                51
                                              42                                            51   Lithuania                    57
Lithuania                                     32
                                                      Russia**
                                                                                            31                                39
                                              41                                            50   France**                     55
Canada                                        34      Estonia
                                                                                            33                                41
                                              39                                            49   Estonia                      54
Hungary                                       37      N. Ireland
                                                                                            37                                45
                                              38                                            48   Russia**                     54
Estonia                                       32
                                                      Belgium Fr.
                                                                                            45                                34
Belgium Fr.                                   37
                                                      Canada                                45   Latvia                       53
                                              41                                            39                                31
Wales                                         35
                                                      Sweden                                41   Canada                       48
                                              29                                            34                                43
Finland                                       34      France**                              40   Sweden                       47
                                              41                                            38                                37
Belgium Fl.                                   34      Finland                               40   Finland                      43
                                              36                                            41                                36
Latvia                                        33      Belgium Fl.                           40   N. Ireland                   43
                                              22                                            33                                34
Scotland                                      29      Latvia                                39   Belgium Fl.                  36
                                              29                                            21                                29
Austria                                       29      Scotland                              37   Austria                      36
                                              28                                            29                                28
Sweden                                        28      Wales                                 35   Scotland                     36
                                              27                                            30                                27
France**                                      27      Austria                               33   Germany**                    33
                                              31                                            30                                33
Germany**                                     23      Germany**                             31   Wales                        31
                                              22                                            22                                24
Switzerland                                   23      Denmark                               24   Greenland                    23
                                              12                                            20                                17
Norway                                        22      Norway                                23   Norway                       22
                                              17                                            20                                16
Denmark                                       20      Switzerland                           23   Denmark                      20
                                              24                                            17                                16
                                              13                                                 Switzerland                        Female
Greenland                                             Greenland                             18                                17
                                              11                                            14                                 8    Male

* Czech Republic and Spain did not include this item.
** France, Germany and Russia are represented only by regions: see Chapter 1 for details.
                 76

     CHAPTER 5          D. Use of medication                                                    countries. One major anomaly was Slovakia where the fewest
      General Health,                                                                           students in all age groups indicated they took medication, but where
                        The use of medication by students for the various physical ailments
Physical Ailments and                                                                           the most 11 year olds indicated they suffered from headaches. The
                        described in the previous section is considered here. It is important
       Medication Use                                                                           13 and 15 year olds were in the middle ranges.
                        to note that the cost and availability of medication in individual
                        countries may influence its use. As well, the general attitude of the   Using headache medication was more common among girls than
                        adult population towards medication could have a bearing on whether     boys. This was true in all countries at all age levels except among
                        or not students choose to take pills or other medicine. Although the    11 year olds in Greenland and Switzerland, where almost equal
                        survey question did not distinguish between prescription and over-      proportions of boys and girls had taken medicine for a headache in
                        the-counter (OTC) drugs, we assume that in most of the cases, it is     the previous month. Medication usage tended to increase with age,
                        the latter that are referred to by the respondents.                     particularly among female students; the greatest increase occurred
                                                                                                between 11 and 13 years of age.
                        1. Headache medication
                        Advertisements for OTC headache medications are pervasive. In
                        many countries, headache pills are probably one of the most readily
                        available OTC drugs. Among the top countries in student use of
                        headache medication were Canada, Northern Ireland and Wales in
                        all age groups (Figure 5.13). Belgium (Fr.), France, Scotland and
                        Sweden also tended to be among the top third of high utilization
                        countries. It is interesting to note that among some of the high-use
                        countries, there are common cultural roots, for example, the three
                        United Kingdom countries and Canada, and Belgium (Fr.) and
                        France.
                        Young people in all three age groups were consistently less likely to
                        take medication in Austria, the Czech Republic, Germany,
                        Greenland, Hungary, Poland and Slovakia.
                        There was, as expected, a relationship between the use of headache
                        medication and frequency of headaches. For each age group, more
                        than one-half of the countries in the top 10 on this item are also in
                        the top 10 among countries where respondents reported frequent
                        headaches. Canada, Belgium (Fr.), Northern Ireland and Wales
                        students at each age were among the 10 highest ranking countries
                        on both measures. Only Austria, Greenland (girls) and Poland were
                        consistently within the lowest 10 ranking countries for both items.
                        For the 13 and 15 year olds overall, 14 countries showed consistency,
                        eight in the higher ranking countries and six in the lower ranking
Figure 5.13   Students who took medicine or pills for a headache during the previous month (%)                                      77
               11 year olds                                           13 year olds                              15 year olds        CHAPTER 5
                                              48                                             61                                66
Belgium Fr.                                   36      Canada                                 44
                                                                                                  Wales                        47   General Health,
                                              46                                             58                                66   Physical Ailments and
Canada                                        41      N. Ireland                             41
                                                                                                  Canada                       44
                                              45
                                                                                                                                    Medication Use
                                                                                             57                                64
Wales                                         37      Wales                                       Scotland                     38
                                                                                             47
                                              43                                             54                                60
N. Ireland                                    34      Sweden                                      N. Ireland
                                                                                             38                                40
                                              42                                             53                                59
France*                                       34      Belgium Fr.                                 France*
                                                                                             36                                34
                                              42                                             50                                58
Scotland                                      34
                                                      Scotland                                    Sweden
                                                                                             38                                39
                                              40                                             47                                57
Sweden                                        34      France*                                     Belgium Fr.
                                                                                             37                                39
                                              38                                             47                                56
Spain                                         33      Finland                                     Finland
                                                                                             36                                33
                                              38                                             42                                51
Lithuania                                     28
                                                      Belgium Fl.                                 Denmark
                                                                                             33                                32
                                              37                                             42                                48
Belgium Fl.                                   32
                                                      Israel                                      Israel
                                                                                             32                                30
                                              37                                             42                                48
Israel                                        29
                                                      Spain                                       Belgium Fl.
                                                                                             29                                29
Latvia                                        35      Denmark                                40   Norway                       47
                                              26                                             29                                29
Finland                                       34                                             39                                46
                                              30
                                                      Lithuania                                   Spain
                                                                                             28                                29
Estonia                                       34      Russia*                                38   Switzerland                  40
                                              27                                             21                                23
Denmark                                       34      Switzerland                            36   Lithuania                    38
                                              26                                             26                                21
Russia*                                       34      Norway                                 35   Germany*                     37
                                              19                                             28                                24
Switzerland                                   29      Greenland                              31   Russia*                      37
                                              30                                             27                                15
Norway                                        25      Latvia                                 31   Austria                      36
                                              21                                             22                                23
Poland                                        25      Estonia                                29   Poland                       36
                                              20                                             24                                16
Germany*                                      25      Germany*                               28   Latvia                       36
                                              19                                             21                                15
Hungary                                       25      Hungary                                28   Greenland                    35
                                              18                                             15                                26
Austria                                       23      Austria                                27   Estonia                      31
                                              19                                             20                                19
Greenland                                     21      Poland                                 25   Hungary                      31
                                              23                                             17                                18
Czech Rep.                                    20      Czech Rep.                             20   Czech Rep.                   24
                                              19                                             14                                14    Female
Slovakia                                      19      Slovakia                               18   Slovakia                     22    Male
                                              13                                             13                                12
*   France, Germany and Russia are represented only by regions: see Chapter 1 for details.
                 78

     CHAPTER 5          2. Stomachache medication
      General Health,
                        As we have seen, stomachaches were a less common health
Physical Ailments and
                        problem than headaches for young people, but some students,
       Medication Use
                        especially older girls, did take stomach medication (Figure 5.14). It
                        is difficult to understand this response because fewer older girls
                        complained of stomachaches. Possibly they took medication for
                        menstrual pain. Also, parents may have more control over the use
                        of pills by younger children.
                        In three countries, more than one-quarter of 11-year-old girls
                        reported having taken stomach medication in the previous month.
                        This was true in nine countries for 13-year-old girls and in 16
                        countries for 15-year-old girls. The proportion of boys who reported
                        that they had taken medicine for a stomachache exceeded 25 percent
                        only for 11 year olds in Belgium (Fr.).
                        Taking medicine for stomachaches was most common in Belgium
                        (Fr.) in all age groups. Girls, there, were also the most likely to
                        report frequent occurrences of this ailment. Students in France, as
                        well as 13 and 15 year olds in Wales and Northern Ireland, were
                        also more likely than most others in their age groups to take
                        stomachache medication. Students from Austria, the Czech
                        Republic, Germany, Greenland, Hungary and Sweden were
                        consistently among the least likely.
                        The relationship between the incidence of stomachaches and the
                        use of medication for stomachaches is tenuous at best. There is
                        very little consistency between the countries reporting the highest
                        or lowest use of medication with those reporting similar incidence
                        of stomachaches. Only the students in French-speaking Belgium
                        reported both high medication use and high incidence of
                        stomachaches. Greenlandic students were at the low end on both
                        measures.
                                                                                                Sweden
Figure 5.14   Students who took medicine or pills for a stomachache during the previous month (%)                                 79
               11 year olds                                           13 year olds                            15 year olds        CHAPTER 5
                                              36                                           42                                50
Belgium Fr.                                   27      Belgium Fr.                          22
                                                                                                Belgium Fr.                  21   General Health,
                                              30                                           39                                50   Physical Ailments and
Latvia                                        17      France*                              21
                                                                                                Wales                        15
                                              27
                                                                                                                                  Medication Use
                                                                                           39                                45
Lithuania                                     25      Wales                                     France*                      15
                                                                                           17
                                              25                                           32                                42
Spain                                         22      N. Ireland                                N. Ireland
                                                                                           16                                11
                                              25                                           30                                40
France*                                       21      Spain                                     Israel
                                                                                           17                                 8
                                              24                                           29                                40
Switzerland                                   16
                                                      Canada                                    Scotland
                                                                                           13                                 8
                                              23                                           27                                35
Estonia                                       21      Scotland                                  Switzerland
                                                                                           11                                 8
                                              23                                           27                                34
N. Ireland                                    18      Israel                                    Denmark
                                                                                           10                                 2
                                              22                                           26                                33
Canada                                        18
                                                      Switzerland                               Canada
                                                                                           16                                11
                                              22                                           24                                32
Scotland                                      17
                                                      Lithuania                                 Spain
                                                                                           15                                11
                                              21                                           24                                32
Wales                                         18
                                                      Poland                                    Finland
                                                                                           12                                 4
Poland                                        21      Latvia                               23   Norway                       31
                                              15                                           14                                 5
Belgium Fl.                                   19                                           21                                29
                                              15
                                                      Denmark                                   Poland
                                                                                            5                                 8
Israel                                        17      Finland                              20   Lithuania                    26
                                              13                                            7                                11
Russia*                                       16      Estonia                              19   Latvia                       26
                                              10                                           16                                10
Slovakia                                      16      Belgium Fl.                          19   Sweden                       26
                                               8                                           13                                 4
Greenland                                     13      Slovakia                             17   Estonia                      22
                                              13                                            9                                 8
Hungary                                       13      Russia*                              16   Slovakia                     21
                                               9                                            9                                 9
Germany*                                      10      Hungary                              15   Belgium Fl.                  19
                                               7                                            6                                10
Finland                                        9      Sweden                               15   Russia*                      16
                                               7                                            5                                 8
Sweden                                         9      Norway                               15   Austria                      15
                                               6                                            4                                 6
Denmark                                        9      Greenland                            14   Hungary                      14
                                               4                                            7                                 8
Austria                                        8      Germany*                             11   Germany*                     14
                                               8                                            6                                 7
Czech Rep.                                     7      Austria                              10   Greenland                    12
                                               7                                            6                                 3
                                                                                                                                   Female
Norway                                         7      Czech Rep.                            7   Czech Rep.                    7    Male
                                               7                                            8                                 4
* France, Germany and Russia are represented only by regions: see Chapter 1 for details.
                 80

     CHAPTER 5          3. Medicine for difficulty getting to sleep
      General Health,
                        For the most part, extremely low percentages of students took
Physical Ailments and
                        medication or pills to help them sleep (Figure 5.15). Students in
       Medication Use
                        Belgium (Fr.), Russia and Switzerland were among the most likely
                        in each age group to take medicine for this purpose, but, even in
                        these countries, reported usage was low. Only for 11 year olds in
                        Switzerland was it above 15 percent (17% for girls and 16% for
                        boys) and in the vast majority of countries it was below five percent.
                        Use of medication for sleeping difficulties by all age groups was
                        almost negligible in Austria, Finland, Hungary, Norway and Sweden.
                        Generally, very few students took medication to help them sleep
                        compared with the proportion who reported some sleeping
                        difficulties.
                        Boys and girls were almost equally likely to report taking medication
                        for sleeping problems. The proportion of young people who took
                        medication or pills to help them sleep either remained the same or
                        declined from age 11 to 15.
                        4. Medicine for nervousness
                        Very few students reported that they take medicine for nervousness,
                        the highest proportion being 12 percent. Between 10 and 12 percent
                        of 11-year-old boys and girls in Estonia, Lithuania, Spain and
                        Switzerland along with 11-year-old girls in Latvia and Russia said
                        they had taken medicine for nervousness in the previous month.
                        Although the proportions of students who indicated that they took
                        medication tended to decrease between ages 11 and 15, students in
                        the above countries remained among those who reported the highest
                        incidence of usage. There was little correlation between countries
                        where students often felt nervous and those where students took
                        medicine for nervousness. Swiss students reported a low incidence
                        of feeling nervous and Estonian and Lithuanian students were in
                        the middle range. Gender differences in the use of medication were
                        very small, but there was a tendency for more 11-year-old boys
                        than girls to take medicine for nervousness and more 15-year-old
                        girls than boys to do so.
Figure 5.15   Students who took medicine or pills for difficulty getting to sleep during the previous month (%)                 81
               11 year olds                                   13 year olds                                   15 year olds       CHAPTER 5
                                              17                                           8                                6
Switzerland                                   16      Switzerland                          9
                                                                                               Switzerland                  5   General Health,
                                              12                                           6                                6   Physical Ailments and
Russia*                                        9      Belgium Fr.                          5
                                                                                               Belgium Fr.                  4
                                              11
                                                                                                                                Medication Use
                                                                                           6                                6
Estonia                                        9      France*                                  France*                      4
                                                                                           4
                                               8                                           6                                5
Greenland                                     11      Russia*                                  Greenland                    3
                                                                                           4
                                               8                                           5                                5
Belgium Fr.                                    9      Estonia                                  Russia*
                                                                                           7                                3
                                               8                                           5                                5
Latvia                                         7
                                                      Greenland                                Canada
                                                                                           6                                2
                                               8                                           5                                5
Scotland                                       7      Latvia                                   Lithuania
                                                                                           5                                2
                                               7                                           5                                4
Canada                                         8      Lithuania                                Wales
                                                                                           4                                3
                                               6                                           4                                3
Lithuania                                      9
                                                      Spain                                    Belgium Fl.
                                                                                           5                                3
                                               6                                           4                                3
Spain                                          9
                                                      Wales                                    Spain
                                                                                           4                                3
                                               5                                           4                                3
France*                                        6
                                                      Canada                                   Czech Rep.
                                                                                           3                                2
N. Ireland                                     5      Czech Rep.                           3   Estonia                      3
                                               6                                           3                                2
Wales                                          5      Denmark                              3                                3
                                               6
                                                                                               Latvia
                                                                                           3                                2
Belgium Fl.                                    4      N. Ireland                           3   Scotland                     3
                                               5                                           3                                2
Germany*                                       4      Scotland                             3   N. Ireland                   2
                                               5                                           3                                4
Poland                                         4      Slovakia                             3   Slovakia                     2
                                               5                                           2                                3
Czech Rep.                                     4      Poland                               2   Germany*                     2
                                               3                                           3                                2
Slovakia                                       4      Belgium Fl.                          2   Israel                       2
                                               3                                           2                                2
Denmark                                        3      Austria                              2   Austria                      2
                                               4                                           1                                1
Israel                                         2      Germany*                             2   Poland                       2
                                               4                                           1                                1
Hungary                                        2      Hungary                              1   Denmark                      1
                                               3                                           2                                2
Norway                                         2      Israel                               1   Finland                      1
                                               3                                           2                                1
Sweden                                         2      Finland                              1   Hungary                      1
                                               2                                           1                                1
Austria                                        2      Norway                               1   Norway                       1
                                               1                                           1                                1    Female
Finland                                        1      Sweden                               1   Sweden                       1    Male
                                               1                                           1                                1
* France, Germany and Russia are represented only by regions: see Chapter 1 for details.
                 82

     CHAPTER 5          5. Cough/cold medication                                                   E. Summary
      General Health,   Overall, higher proportions, ranging from one-fifth to one-half, of
                                                                                                   High proportions of adolescents in many countries do not feel that
Physical Ailments and   students had taken medicine for coughs and/or colds (Figure 5.16)
                                                                                                   they are very healthy. Many are troubled by physical ailments,
       Medication Use   in the previous month than had taken medicine to treat headache or
                                                                                                   especially girls. In fact, the overall portrait of the health of girls that
                        stomachache. Across all age groups, students in Canada, the Czech
                                                                                                   emerges from the findings is cause for particular concern. Boys
                        Republic, Poland and Wales were among the most likely to have
                                                                                                   have a more positive perception of their health and girls are more
                        taken cold/cough medicine and students in Austria, Denmark and
                                                                                                   likely to report health problems such as headaches, stomachaches,
                        Israel the least likely. All of the higher ranked countries administered
                                                                                                   dizziness and sleeping difficulties, and to take medication or pills for
                        the survey in the winter months, generally considered to be the
                                                                                                   their physical aches and pains.
                        season for coughs and colds; however, Denmark also administered
                        the survey at this time, as did several other countries in which less      Younger students tend to feel more positive about their health than
                        medication was used. Austria, Israel and Spain administered their          older students. Fewer 11 year olds feel tired in the morning when
                        surveys in May, but Spain ranked relatively high on the use of cough/      they go to school. Age also appears to be associated with the health
                        cold medicine.                                                             problems young people report: while younger students have fewer
                                                                                                   symptoms of headache, backache, nervousness or dizziness, they
                        The proportions of students who had taken medicine for colds or
                                                                                                   tend to get more stomachaches.
                        coughs changed very little with age; percentages are slightly lower
                        among the oldest students surveyed in half of the countries. In            Medication for headaches and coughs/colds are the most common
                        virtually all age groups and all countries more of the girls had used      type of medicine students use. Few students take medication for
                        cold/cough medicine, but the difference was more than 10 percent           sleeping difficulties or nervousness. The presence of physical
                        in only six countries and in only one age group in each of those           symptoms does not always mean that students take medicine. More
                        countries.                                                                 students reported stomachaches, backaches, dizziness and
                                                                                                   nervousness than treated them with medicine.
                                                                                                                                   83
Figure 5.16 Students who took medicine for coughs and/or colds during the previous month* (%)
               11 year olds                                           13 year olds                             15 year olds        CHAPTER 5
                                              54                                            57                                53   General Health,
Czech Rep.                                    50      Wales                                 52   Czech Rep.                   50
                                                                                                                                   Physical Ailments and
                                              54                                            52                                53
Wales                                         53      Czech Rep.                            43   Wales                        47   Medication Use
                                              53                                            50                                46
Scotland                                      42      Canada                                40   Germany**                    37
                                              50                                            49                                45
Canada                                        46      Poland                                41   Canada                       36
                                              49                                            47                                44
Poland                                        43      N. Ireland                            42   Poland                       40
                                              48                                            47                                44
Belgium Fr.                                   39      Spain                                 37
                                                                                                 Spain                        34
                                              47                                            45                                43
Lithuania                                     43      Belgium Fr.                           33   Belgium Fr.                  39
                                              47                                            44                                41
Belgium Fl.                                   36      Germany**                             32   Lithuania                    31
                                              45                                            44                                41
Germany**                                     38      Scotland                              37
                                                                                                 Scotland                     35
                                              45                                            42                                40
Estonia                                       41
                                                      Lithuania                             36
                                                                                                 N. Ireland                   38
                                              44                                            40                                37
Spain                                         39
                                                      Belgium Fl.                           37
                                                                                                 Belgium Fl.                  30
Latvia                                        43                                            38   Hungary                      37
                                              38
                                                      Hungary
                                                                                            26                                34
N. Ireland                                    42                                            38                                36
                                              42
                                                      Sweden                                     France**
                                                                                            32                                26
Hungary                                       40                                            37   Finland                      35
                                              33
                                                      Greenland
                                                                                            33                                31
Greenland                                     38      France**                              35   Sweden                       35
                                              37                                            28                                30
France**                                      38      Latvia                                35   Estonia                      34
                                              33                                            32                                27
Russia**                                      37      Estonia                               34   Latvia                       33
                                              32                                            35                                31
Sweden                                        36      Finland                               34   Russia**                     33
                                              31                                            31                                21
Slovakia                                      35      Russia**                              33   Slovakia                     33
                                              33                                            25                                34
Norway                                        34      Norway                                31   Norway                       32
                                              29                                            28                                24
Finland                                       33      Slovakia                              30   Austria                      30
                                              32                                            29                                23
Denmark                                       26      Austria                               26   Greenland                    26
                                              23                                            22                                25
Austria                                       25      Denmark                               22   Denmark                      20
                                              18                                            19                                17    Female
Israel                                        23      Israel                                22   Israel                       19
                                              19                                            17                                18
                                                                                                                                    Male

* Switzerland did not include this item.
** France, Germany and Russia are represented only by regions: see Chapter 1 for details.
                         6
Desirée Nyman            C H A P T E R




                Sweden
6
C H A P T E R                                     A. Introduction
                Pyschosocial Adjustment
                                                  Good health practices include not only those that contribute to
                A. Introduction
                                                  physical well-being, but also those that facilitate the development
                B. Mental health
                                                  of sound emotional, social and mental health. Psychological well-
                  1.   Happiness
                                                  being is closely linked with the quality of social relationships young
                  2.   Loneliness
                                                  people are able to establish with family members and peers. Two
                  3.   Helplessness
                                                  of the critical components of sound mental health are a caring and
                  4.   Confidence
                                                  supportive family and accepting and understanding friends, both of
                  5.   Depression (feeling low)
                                                  which contribute to the development of self-esteem and a positive
                C. Peer relationships
                                                  self-concept. A good self-image contributes to the healthy maturation
                  1. Friendships
                                                  of a young person. It is also true that young people who do not feel
                  2. Time spent with friends
                                                  good about themselves are more likely to experience emotional
                D. Relationships with parents
                                                  problems.
                  1. Communicating with mother
                  2. Communicating with father    Problems in establishing and maintaining good relationships with
                E. Summary                        parents and friends are among the most common difficulties young
                                                  people experience. Many studies have focused on the quality of
                                                  the parent-child relationship and its influence on the peer
                                                  relationships, school experience and risk-taking behaviours of young
                                                  people. Open communication is the basis for positive parent-child
                                                  interaction. Young people who believe they are not accepted by
                                                  their peers may be lonely and become depressed, especially if they
                                                  suffer extreme forms of exclusion such as bullying and avoidance
                                                  (Ramsey, 1994; Vara, 1994; Kafka & London, 1991).
                                                  In this chapter, we attempt to provide answers to the following
                                                  questions:
                                                  •   What is the mental health status of the young people surveyed?
                                                  •   Do they find it easy to make friends and to talk to their friends?
                                                  •   How much time do they spend with their friends?
                                                  •   How well do young people communicate with their parents?
                                                                                                                                                                    87

B.    Mental health                                                        Figure 6.1 Factors associated with happiness                                             CHAPTER 6

                                                                            Students who are happy                11 year olds    13 year olds       15 year olds
                                                                                                                                                                    Psychosocial Adjustment
The mental health status of young people both influences and is
                                                                            are more likely to                     M      F        M       F          M      F
influenced by all other areas of their life: relationships with others,
adjustment at school and the risks they may take with their health.        Be well integrated socially
For this survey five items were used to assess students’ mental            Feel healthy
health: how happy they said they were and how often they felt lonely,      Have a positive attitude toward
helpless, confident and depressed.                                         school
                                                                           Not feel depressed
1. Happiness
                                                                           Not be irritable
The concept of being “very happy about your life” captures the
                                                                           Not feel nervous
level of contentment young people feel when they are satisfied with
                                                                           Feel confident
the most important areas in their life – school, family, friends and
their own personality and physical characteristics. To the question,       Have good communication with
                                                                           parents
“In general, how do you feel about your life?” students could respond:
                                                                           Not feel helpless
very happy; quite happy; not very happy; or not happy at all.
Happiness, or subjective well-being, is an attitude suggesting the         Be satisfied with their appearance
absence of worry, anxiety and depression and a general satisfaction        Say parents are willing to come to
with life as a whole (Robinson et al., 1991). In Figure 6.1, the factors   school to talk with teachers

that are most strongly correlated with happiness in this survey are        Say parents are willing to help them
                                                                           with problems at school
listed. Good health and happiness tended to be linked together, which
suggests that health is an important component of happiness.               Say parents encourage
                                                                           them to do well at school
Satisfaction with school and good relationships with parents and
                                                                           Believe their family is well off
peers were associated with happiness. It is also important to note
that happy children were less likely to have periods of irritability,      Achieve well in school
nervousness and helplessness and more likely to be confident and           Not want to change anything
                                                                           about their body
satisfied with their appearance. They were also less likely to have
headaches, to be dizzy, to have difficulty getting to sleep and to be      Not feel stressed at school
tired in the morning.                                                      Not have headaches
                                                                           Not have difficulty getting to sleep
                                                                           Not feel dizzy
                                                                           Not be tired in the morning

                                                                           Correlation coefficient:      .15 to .19      .20 to .29     .30 to .39
                   88

        CHAPTER 6         The majority of students said they were either very or quite happy,
Psychosocial Adjustment   but, as can be seen in Figure 6.2, there were pronounced differences
                          from country to country in the proportion who said they were very
                          happy. More students from Sweden than from other countries in
                          each age group indicated they were very happy. Students in Canada
                          France, Greenland, Northern Ireland and Scotland were among the
                          more positive respondents at all ages. Students in the eastern
                          European countries of the Czech Republic, Estonia, Hungary, Latvia,
                          Lithuania, Russia, and Slovakia tended to be the least likely to say
                          they were very happy. These countries are also those where
                          students were the most likely to say they were not happy at all.
                          Slightly more boys than girls felt very happy in most countries. There
                          were some exceptions: in Austria and Finland, girls’ responses were
                          more positive than boys’ across age groups, and in Norway 11
                          percent more of the 13-year-old girls than boys were very happy
                          with their life. Israeli boys and girls at age 13 and 15 were equally
                          likely to be very happy.
                          The youngest students tended to have the most optimistic outlook.
                          Even in some of the countries where comparatively higher
                          proportions of respondents said they are very happy, for example,
                          in France, Greenland and Sweden, the proportion of students who
                          felt very happy declined, sometimes substantially, by age 15. In
                          Sweden, 64 percent of 11-year-old girls and 70 percent of 11-year-
                          old boys felt very happy, but by age 15 only 38 and 49 percent,
                          respectively, felt this way.
                                                                                                                                  89
Figure 6.2    Students who felt very happy about their life (%)
               11 year olds                                           13 year olds                            15 year olds        CHAPTER 6
                                              15                                            5                                 6   Psychosocial Adjustment
Russia*                                       17      Russia*                                   Russia*                       7
                                                                                            9
                                              18                                           11                                 7
Hungary                                       18      Estonia                                   Latvia                        7
                                                                                           11
                                              23                                           11                                 7
Estonia                                       18      Czech Rep.                                Lithuania
                                                                                           12                                 8
                                              19                                           11                                 8
Czech Rep.                                    22      Hungary                                   Estonia
                                                                                           12                                 9
                                              22                                           10                                12
Latvia                                        22
                                                      Lithuania                                 Hungary
                                                                                           15                                 9
                                              26                                           12                                 6
Lithuania                                     28
                                                      Latvia                                    Slovakia
                                                                                           17                                13
                                              25                                           17                                13
Slovakia                                      31      Slovakia                                  Czech Rep.
                                                                                           19                                13
                                              33                                           33                                27
Denmark                                       37
                                                      Finland                                   Belgium Fr.
                                                                                           26                                21
                                              40                                           24                                22
Finland                                       37
                                                      Germany*                                  Germany*
                                                                                           28                                25
                                              38                                           32                                25
Belgium Fr.                                   39
                                                      Belgium Fr.                               Israel
                                                                                           29                                25
                                              44      Denmark                              26                                34
Israel                                        39
                                                                                                Finland
                                                                                           32                                25
Austria                                       46      Israel                               34   Poland                       17
                                              40                                           34                                26
Belgium Fl.                                   44      Austria                              38                                25
                                              41
                                                                                                Spain
                                                                                           35                                28
Germany*                                      37      Belgium Fl.                          39   Denmark                      27
                                              44                                           36                                30
Wales                                         38      Wales                                26   Norway                       35
                                              44                                           37                                31
Norway                                        43      Poland                               32   Belgium Fl.                  29
                                              44                                           37                                32
Switzerland                                   44      Scotland                             30   Wales                        23
                                              46                                           38                                33
Poland                                        50      Norway                               49   Greenland                    28
                                              49                                           38                                33
Scotland                                      45      Canada                               32   Austria                      37
                                              50                                           40                                33
Spain                                         56      Switzerland                          37   Scotland                     22
                                              50                                           41                                34
N. Ireland                                    55      N. Ireland                           34   Canada                       25
                                              52                                           43                                34
Canada                                        47      Greenland                            40   Switzerland                  38
                                              53                                           45                                37
France*                                       55      Spain                                39   N. Ireland                   31
                                              55                                           47                                40
Greenland                                     49      France*                              47   France*                      37
                                              56                                           53                                41    Female
Sweden                                        64      Sweden                               53   Sweden                       38    Male
                                              70                                           61                                49
* France, Germany and Russia are represented only by regions: see Chapter 1 for details.
                   90

        CHAPTER 6         2. Loneliness                                                              Figure 6.3       Factors associated with feeling lonely
Psychosocial Adjustment                                                                              Students who are lonely are          11 year olds    13 year olds    15 year olds
                          Although most adolescents feel lonely occasionally, young people           more likely to                         M      F         M     F         M     F
                          who are frequently lonely may have difficulty relating to others,
                                                                                                     Feel left out of things
                          may feel rejected or may be experiencing other serious emotional
                          distress. Generally speaking, teenagers want to be accepted and do         Feel unhappy
                          not want to be regarded as loners by others.                               Feel depressed
                                                                                                     Feel helpless
                          Loneliness indicates an absence of satisfying social and interpersonal
                          relationships and can have a profound impact on emotional and              Feel alone at school
                          physical well-being (Page et al., 1986; Young, 1982). Many studies         Be irritable
                          have found lonely youth to be highly susceptible to participating in       Feel nervous
                          health-risk behaviours compared with youth who are not lonely (Page
                                                                                                     Find it difficult to make
                          et al., 1994; Page, 1990; Mijuskovic, 1986). These adolescents are         friends
                          more likely to use marijuana, smoke cigarettes, be physically inactive     Feel other students do not accept
                          and have eating disorders (Torres Rivas & Fernandez Fernandez,             them as they are
                          1995; Page, 1990). Social isolation and rejection by one’s peers can       Have been bullied
                          have a devastating effect on both the mental and physical health of        Lack confidence
                          adolescents (Brage et al., 1993).
                                                                                                     Have poor communication with
                          Not surprisingly, the lonely student was more likely to feel left out of   their parents

                          things (Figure 6.3) and to be an easy target for bullies. Of great         Have difficulty getting to sleep
                          concern are the physical and emotional problems these data show            Have headaches
                          to be associated with loneliness. Echoing the results of the studies       Feel dizzy
                          cited above, those adolescents who felt lonely were more likely to
                                                                                                     Say parents are not willing to
                          experience physical problems and various forms of psychosocial             help them with problems at
                          distress. They were more likely to be depressed, helpless, irritable,      school
                          nervous and to lack confidence; they also tended to suffer from            Have stomachaches
                          headaches, stomachaches and dizziness. However, unlike lonely              Feel stressed at school
                          students reported in other research studies, the youth in this study
                                                                                                     Feel unhealthy
                          who described themselves as lonely were no more likely to smoke
                                                                                                     Want to change something about
                          and drink to excess than their peers.                                      their body
                          Frequent feelings of loneliness, with a few exceptions, did not seem       Be dissatisfied with their
                                                                                                     appearance
                          to be a major problem for the majority of students. In most countries,
                          15 percent or less of 11 and 13 year olds and less than one-fifth of       Have few or no close friends
                          15 year olds suffered from loneliness very or quite often (Figure          Have a negative attitude toward
                                                                                                     school
                          6.4).
                                                                                                     Correlation coefficient:       .15 to .19     .20 to .29     .30 to .39    .40+
                                                                                                                                  91
Figure 6.4    Students who felt lonely very or quite often (%)
                                                                                                                                  CHAPTER 6
               11 year olds                                           13 year olds                            15 year olds
                                              18                                           24                                29   Psychosocial Adjustment
Lithuania                                     15      Greenland                            17
                                                                                                Lithuania                    17
                                              18                                           23                                26
Canada                                        14      Lithuania                            18
                                                                                                Belgium Fr.                  19
                                              17                                           23                                26
France*                                       16      Russia*                                   Russia*                      15
                                                                                           17
                                              17                                           22                                25
Russia*                                       16      Belgium Fr.                               France*                      14
                                                                                           17
                                              16                                           20                                25
Belgium Fr.                                   18      Canada                                    Hungary
                                                                                           10                                14
                                              16                                           19                                25
Greenland                                     17
                                                      Latvia                                    Latvia
                                                                                           13                                14
                                              16                                           19                                24
Belgium Fl.                                   14      Hungary                                   Greenland
                                                                                           12                                15
                                              16                                           18                                22
Estonia                                       14
                                                      France*                                   Czech Rep.
                                                                                           13                                14
N. Ireland                                    15                                           18                                22
                                              14
                                                      Israel                                    Canada
                                                                                           12                                11
Wales                                         15                                           18   Israel                       21
                                              14
                                                      Estonia
                                                                                           10                                17
Hungary                                       15                                           17   Austria                      21
                                              12
                                                      Wales
                                                                                           12                                10
Israel                                        14      Slovakia                             16   Estonia                      20
                                              14                                           12                                11
Finland                                       14      N. Ireland                           16   Poland                       19
                                              13                                           10                                 7
Latvia                                        14      Scotland                             16   Slovakia                     18
                                              13                                           10                                12
Slovakia                                      14      Austria                              16   Wales                        18
                                              11                                            8                                12
Scotland                                      13      Germany*                             15   Switzerland                  18
                                              15                                            8                                10
Austria                                       13      Poland                               15   Belgium Fl.                  17
                                              11                                            7                                10
Germany*                                      12      Belgium Fl.                          14   Germany*                     17
                                               8                                           12                                 7
Czech Rep.                                    11      Czech Rep.                           14   Scotland                     16
                                              10                                           11                                 8
Poland                                        11      Switzerland                          14   N. Ireland                   14
                                               6                                           10                                 9
Norway                                        10      Finland                              13   Spain                        14
                                               7                                            9                                 8
Sweden                                         8      Sweden                               10   Sweden                       13
                                               5                                            6                                 5
Denmark                                        7      Norway                                8   Norway                       12
                                               6                                            6                                 7
Spain                                          7      Spain                                 8   Finland                      11
                                               6                                            6                                 9    Female
Switzerland                                    6      Denmark                               6   Denmark                       5    Male
                                               9                                            5                                 2
* France, Germany and Russia are represented only by regions: see Chapter 1 for details.
                   92

        CHAPTER 6         Of the countries with the highest proportions of lonely students in       Figure 6.5       Factors associated with helplessness
Psychosocial Adjustment   each age group, Belgium (Fr.), Greenland, Lithuania and Russia
                                                                                                    Students who feel helpless are      l1 year olds    13 year olds   15 year olds
                          appeared in all three groups. Students in the Scandinavian countries      more likely to                        M      F        M       F      M      F
                          – Denmark, Finland, Norway and Sweden – and Spain were the
                          least likely to experience loneliness.                                    Not be well integrated socially
                                                                                                    Lack confidence
                          Girls were more likely than boys to frequently feel lonely – in some
                          countries, twice as likely, especially among the 13 and 15 year olds.     Feel depressed

                          In Poland, for example, at all ages, twice as many of the girls felt      Feel unhappy
                          lonely. Pronounced gender differences also occurred in Canada             Feel nervous
                          for 13 and 15 year olds, and in Austria, France, Germany, Greenland,      Be irritable
                          Hungary, Latvia and Lithuania for 15 year olds.
                                                                                                    Have poor communication with
                                                                                                    their parents
                          Generally, the proportion of girls who frequently felt lonely increased
                          from age 11 to 15 while boys’ responses decreased or remained             Feel stressed at school
                          about the same. In a few countries, such as the Czech Republic            Be dissatisfied with their
                          and Israel, the responses of both boys and girls increased with age.      appearance
                                                                                                    Have difficulty getting to sleep
                          3. Helplessness
                                                                                                    Feel unhealthy
                          A feeling of helplessness is characterized by a sense of being            Want to change something about
                          vulnerable and powerless to influence the form and direction of           their body
                          one’s life. Students who frequently feel helpless may believe they        Have a negative attitude toward
                          cannot influence what goes on around them. They may feel alone            school
                          and unprotected. Such feelings would certainly negatively affect          Correlation coefficient:      .15 to .19     .20 to .29    .30 to .39
                          their self-image and their interactions with others.
                          A number of researchers have associated helplessness or                   something about their body. Girls and younger boys were likely to
                          powerlessness with social isolation (Robinson et al., 1991), which        feel stressed at school and younger girls to have a poor attitiude
                          was also found in this survey. Young people may feel helpless for a       toward school.
                          variety of reasons: their appearance, traumatic experiences (e.g.,
                                                                                                    Relatively few students – 10 percent or fewer in each age group –
                          the death of a loved one, the separation of parents) and stressful
                                                                                                    always or often felt helpless (Figure 6.6). In France and Belgium
                          relationships at home or at school.
                                                                                                    (Fr.), however, two to three times this number of students frequently
                          The factor most highly correlated with feeling helpless in this survey    had feelings of helplessness. This may be explained in part by a
                          is poor social integration (Figure 6.5). Helplessness was associated      different interpretation of the term helplessness in the French
                          with poor relationships with peers and parents, periods of depression     language. Thirteen and 15 year olds in Lithuania were more likely
                          and general unhappiness. Students who often felt helpless were            than most other students to feel helpless as were 11-year-old boys
                          also more likely to lack confidence, feel nervous and generally           in Greenland, 13-year-old girls in Northern Ireland and 15-year-old
                          unhealthy. Younger students were more likely to want to change            girls in Hungary and Poland.
                                                                                                                                  93
Figure 6.6 Students who felt helpless always or often (%)
               11 year olds                                           13 year olds                            15 year olds        CHAPTER 6
                                              30                                           28                                27   Psychosocial Adjustment
France*                                       28      France*                              30
                                                                                                France*                      22
                                              22                                           23                                21
Belgium Fr.                                   23      Belgium Fr.                          22
                                                                                                Belgium Fr.                  19
                                              12                                           15                                15
Wales                                         12      Lithuania                                 Lithuania                    10
                                                                                           12
                                              11                                           13                                14
Greenland                                     14      N. Ireland                                Poland                        8
                                                                                           10
                                              11                                           11                                13
N. Ireland                                    12      Hungary                                   Hungary
                                                                                            8                                 7
                                              11                                           11                                10
Hungary                                       10      Scotland                                  Greenland
                                                                                            8                                 8
                                              11                                            9                                10
Lithuania                                      9      Greenland                                 N. Ireland
                                                                                           11                                 8
                                              10                                            9                                10
Switzerland                                   11      Poland                                    Belgium Fl.
                                                                                            9                                 7
                                               9                                            9                                10
Poland                                        10      Wales                                     Germany*
                                                                                            9                                 4
                                               9                                            9                                 9
Scotland                                       9      Czech Rep.                                Austria
                                                                                            8                                 5
                                               9                                            9                                 9
Slovakia                                       9
                                                      Germany*                                  Norway
                                                                                            4                                 5
Spain                                          8                                            8   Slovakia                      8
                                              11
                                                      Spain
                                                                                            8                                 7
Austria                                        8                                            8                                 8
                                               7
                                                      Canada                                    Wales
                                                                                            6                                 6
Belgium Fl.                                    8                                            7   Spain                         8
                                               7
                                                      Switzerland
                                                                                           10                                 4
Denmark                                        8      Belgium Fl.                           7   Czech Rep.                    7
                                               5                                            8                                 5
Estonia                                        8      Slovakia                              7   Scotland                      7
                                               5                                            8                                 5
Canada                                         7      Norway                                7   Switzerland                   7
                                               7                                            6                                 5
Norway                                         7      Austria                               7   Latvia                        7
                                               7                                            5                                 4
Germany*                                       7      Latvia                                7   Canada                        6
                                               4                                            3                                 6
Czech Rep.                                     6      Estonia                               6   Israel                        5
                                               7                                            6                                 7
Latvia                                         6      Russia*                               6   Russia*                       5
                                               7                                            5                                 3
Russia*                                        6      Sweden                                6   Sweden                        5
                                               3                                            2                                 3
Israel                                         4      Denmark                               5   Denmark                       4
                                               7                                            3                                 3
Sweden                                         4      Israel                                4   Estonia                       4
                                               4                                            6                                 3    Female
Finland                                        3      Finland                               2   Finland                       3    Male
                                               4                                            3                                 2
* France, Germany and Russia are represented only by regions: see Chapter 1 for details.
                   94

        CHAPTER 6         Six percent or less of students in Finland, Sweden and Russia said          Figure 6.7     Factors associated with feeling confident
Psychosocial Adjustment   that they always or often felt helpless. Other countries with relatively
                                                                                                      Students who are confident         11 year olds     13 year olds      15 year olds
                          low proportions of youth who often felt helpless across age groups          are more likely to                  M      F          M      F          M     F
                          are Denmark, Latvia, Estonia (13 and 15 year olds), and Canada
                                                                                                      Be well integrated socially
                          and the Czech Republic (11 and 15 year olds). There was a high
                                                                                                      Like their appearance
                          degree of similarity between the responses of boys and girls. The
                          largest gender differences – only 5 to 6 percent – occurred for 15          Not feel helpless
                          year olds in France, Germany, Hungary, Lithuania, and Poland. Only          Feel happy
                          in Israel did slightly more of the male respondents in every age group      Feel healthy
                          say they often or always feel helpless. There were only small
                                                                                                      Have good communication
                          differences by age.                                                         with their parents
                                                                                                      Not feel stressed at school
                          4. Confidence
                                                                                                      Have a postitive attitude
                                                                                                      toward school
                          Researchers have studied confidence as a component of self-esteem
                          or self-concept. The literature presents evidence for strong                Not feel depressed
                          associations between confidence and friendship (Torres Rivas &              Achieve well in school
                          Fernandez Fernandez, 1995; Connolly & Konarski, 1994; Connor,               Not be irritable
                          1994) and between confidence and perceptions of appearance (Fox
                                                                                                      Not feel nervous
                          et al., 1994). The latter association was found to be particularly strong
                          among girls. These findings, including the gender differences noted,        Say parents are willing
                                                                                                      to help them with problems at
                          are borne out in this study: for the students surveyed, the main factors    school
                          that contribute to a sense of confidence included good friends with         Correlation coefficient:      .15 to .19   .20 to .29    .30 to .39
                          whom they can communicate effectively and satisfaction with their
                          looks (Figure 6.7). The findings also showed that confident children        between the genders is most pronounced by age 15 when, in the
                          are more likely to have a positive attitude toward home and school,         majority of countries, between 10 and 22 percent more boys than
                          and a good relationship with parents, and they are less likely to           girls always feel confident.
                          manifest problems associated with depression, nervousness and
                                                                                                      In general, the proportion of students’ who always feel confident
                          irritability.
                                                                                                      decreased as they got older: 13 and 15 year olds were less likely
                          The greatest proportion of students who said they always feel               than 11 year olds to always feel confident. Although the proportions
                          confident were from France and Spain (Figure 6.8). Students in              of both boys and girls tended to decrease with age, the decrease
                          Belgium (Fr.), Germany, Poland and Sweden were also more inclined           was more pronounced for girls. The exception is in Greenland where
                          to say they were always confident. Estonia, Northern Ireland,               15-year-old boys and girls were more likely than either of the other
                          Scotland, Slovakia and Wales were among the countries whose                 age groups surveyed to have confidence in themselves. The
                          students were less likely to always feel confident. Girls were              responses of Danish girls were similar at age 11 and 15. The decrease
                          substantially less likely than boys to always feel confident with           in the proportion of girls who always felt confident was substantial
                          differences up to 25 percent for 11 year olds in France. The difference     in Canada, France, Poland, Spain and Sweden.
                                                                                                                                  95
Figure 6.8 Students who always felt confident (%)
               11 year olds                                           13 year olds                            15 year olds        CHAPTER 6
                                              12                                            6                                 4   Psychosocial Adjustment
Slovakia                                      21      Estonia                              18
                                                                                                Estonia                      12
                                              16                                           10                                 5
Czech Rep.                                    21      Slovakia                             18
                                                                                                Slovakia                     16
                                              17                                            8                                 8
Estonia                                       24      Wales                                     Scotland                     20
                                                                                           19
                                              14                                            8                                 8
Finland                                       26      N. Ireland                                N. Ireland                   21
                                                                                           21
                                              20                                            7                                 8
Austria                                       26      Finland                                   Wales
                                                                                           22                                21
                                              17                                           10                                 8
N. Ireland                                    27      Scotland                                  Belgium Fl.
                                                                                           23                                22
                                              17                                           14                                10
Scotland                                      28      Czech Rep.                                Russia*
                                                                                           23                                22
                                              16                                           17                                15
Wales                                         29      Russia*                                   Hungary
                                                                                           24                                22
                                              26                                           15                                12
Russia*                                       29      Norway                                    Czech Rep.
                                                                                           26                                24
                                              17                                           15                                12
Denmark                                       31
                                                      Belgium Fl.                               Norway
                                                                                           27                                25
                                              27                                           11                                11
Latvia                                        31
                                                      Austria                                   Finland
                                                                                           28                                26
Hungary                                       23                                           18   Austria                      13
                                              33
                                                      Hungary
                                                                                           28                                26
Greenland                                     27                                           14                                18
                                              33
                                                      Denmark                                   Latvia
                                                                                           29                                26
Switzerland                                   21                                           30   Switzerland                  17
                                              34
                                                      Greenland
                                                                                           29                                28
Belgium Fl.                                   22      Latvia                               23   Canada                       14
                                              36                                           30                                30
Norway                                        26      Lithuania                            25   Lithuania                    21
                                              36                                           33                                31
Lithuania                                     35      Switzerland                          15   Israel                       20
                                              37                                           34                                33
Israel                                        37      Canada                               21   Denmark                      16
                                              41                                           39                                34
Belgium Fr.                                   33      Germany*                             22   Poland                       22
                                              44                                           39                                37
Germany*                                      33      Israel                               28   Sweden                       18
                                              45                                           41                                38
Canada                                        35      Poland                               31   Belgium Fr.                  19
                                              47                                           42                                38
Poland                                        43      Sweden                               25   Germany*                     19
                                              49                                           42                                41
Sweden                                        34      Belgium Fr.                          26   France*                      20
                                              50                                           43                                41
France*                                       36      France*                              26   Greenland                    34
                                              51                                           49                                41    Female
Spain                                         62      Spain                                49   Spain                        33    Male
                                              68                                           60                                52
* France, Germany and Russia are represented only by regions: see Chapter 1 for details.
                   96

        CHAPTER 6         5. Depression (feeling low)                                                Figure 6.9 Factors associated with feeling depressed
Psychosocial Adjustment
                          Depression among young people is frequently linked to other problems       Students who feel depressed     11 year olds           13 year olds       15 year olds
                          such as insomnia, poor self-image and a lack of achievement in             are more likely to               M      F               M      F           M     F

                          school (Morrison et al., 1985). Depression can occur in varying            Be irritable
                          degrees of intensity, from a general feeling of “sadness” to a mental      Feel nervous
                          state characterized by thoughts of suicide (Dixon, 1987). Some             Feel lonely
                          studies have found over a quarter of young teens suffer from
                                                                                                     Feel dizzy
                          depression at some level, although relatively few are severely
                                                                                                     Not feel happy
                          depressed (Connelly et al., 1993). Boys and girls who are depressed
                          appear to react differently (Baron & Campbell, 1993). While boys           Have headaches
                          may be irritable, withdraw socially and suffer from insomnia, girls        Have stomachaches
                          become less positive about their body image; they lose their appetite,     Have backaches
                          and consequently lose weight and become sad and unhappy.
                                                                                                     Have difficulty getting to
                                                                                                     sleep
                          In this study the students who described themselves as depressed
                          tended to have other problems as well, with gender differences similar     Feel left out of things
                          to those reported in other studies (Figure 6.9). At all grade levels       Feel helpless
                          and for both genders, they were more likely to have headaches,             Feel tired in the morning
                          backaches and stomachaches, and be irritable, nervous, dizzy and
                                                                                                     Feel alone at school
                          tired in the morning. They tended to feel isolated from other students
                                                                                                     Feel stressed at school
                          and to be unhappy overall. The relationships were stronger for
                          females. This combination of physical and emotional problems is            Not feel healthy
                          clearly a serious issue that requires the attention of health educators    Have a negative attitude
                          and health professionals.                                                  toward school
                                                                                                     Lack confidence
                          Students in Canada, France, Finland, Israel and Northern Ireland
                                                                                                     Have been bullied
                          were consistently among those more likely to report being depressed
                          once a week or more (Figure 6.10). Eleven and 13 year olds in              Want to change something
                                                                                                     about their body
                          Denmark and 13 and 15 year olds in Hungary and Sweden were
                          also more likely than most other students to feel depressed frequently.    Correlation coefficient:      .15 to .19       .20 to .29    .30 to .39    .40+

                          Across the three age groups, students in Austria, Germany, Greenland,      age groups. Girls in almost every age group in every country were
                          Poland and Switzerland were the least likely to feel depressed. There      more likely than boys to feel depressed, with the difference widening
                          is a wide range of responses for different groups of students. For         as age increased. In Denmark, for example, three times as many
                          girls, there is a difference of 35 percent between the countries ranking   15-year-old girls as boys said they were depressed at least once a
                          highest and lowest for each age group. For boys, the differences           week. Minor exceptions were found among 11-year-old respondents.
                          between highest and lowest are 31, 29 and 28 percent for the three
                                                                                                                                    97
Figure 6.10    Students who felt low or depressed once a week or more* (%)
                11 year olds                                          13 year olds                              15 year olds        CHAPTER 6
                                               44                                            46                                54   Psychosocial Adjustment
Denmark                                        32     Israel                                 38
                                                                                                  Hungary                      34
                                               40                                            41                                52
Israel                                         42     Hungary                                28
                                                                                                  Israel                       38
                                               31                                            41                                50
Finland                                        28     N. Ireland                                  France**                     37
                                                                                             28
                                               31                                            39                                42
N. Ireland                                     26
                                                      Finland                                     N. Ireland                   30
                                                                                             31
                                               30                                            37                                40
France**                                       28
                                                      France**                                    Sweden
                                                                                             36                                21
                                               28                                            36                                39
Lithuania                                      16
                                                      Denmark                                     Canada
                                                                                             19                                25
                                               27                                            35                                39
Canada                                         25
                                                      Sweden                                      Finland
                                                                                             17                                24
                                               26                                            32                                38
Slovakia                                       22
                                                      Canada                                      Wales
                                                                                             22                                21
Russia**                                       26                                            32                                35
                                               16
                                                      Russia**                                    Russia**
                                                                                             18                                17
Latvia                                         26     Wales                                  30   Denmark                      34
                                               15                                            19                                10
Hungary                                        25     Scotland                               27   Belgium Fl.                  33
                                               20                                            17                                25
Wales                                          23     Lithuania                              27   Belgium Fr.                  33
                                               19                                            15                                22
Estonia                                        23     Belgium Fl.                            24   Estonia                      32
                                               15                                            20                                17
Norway                                         21     Slovakia                               24   Lithuania                    31
                                               15                                            17                                17
Sweden                                         21     Estonia                                24   Latvia                       31
                                               13                                            13                                17
Belgium Fl.                                    19     Latvia                                 23   Scotland                     31
                                               21                                            17                                17
Scotland                                       19     Norway                                 23   Norway                       29
                                               16                                            16                                15
Germany**                                      15     Belgium Fr.                            23   Poland                       29
                                                9                                            15                                12
Belgium Fr.                                    14     Switzerland                            22   Slovakia                     25
                                               16                                            14                                20
Poland                                         13     Poland                                 20   Greenland                    24
                                                8                                             9                                14
Austria                                        12     Greenland                              18   Switzerland                  19
                                                9                                            12                                18
Switzerland                                     9     Germany**                              15   Austria                      19
                                               13                                             9                                10
                                                                                                                                     Female
Greenland                                       9     Austria                                11   Germany**                    19
                                               11                                             9                                10    Male

* The Czech Republic and Spain did not include this item.
** France, Germany and Russia are represented only by regions: see Chapter 1 for details..
                   98

        CHAPTER 6         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. In only Denmark and Slovakia did more 11 year olds             in Israel, Northern Ireland and Sweden in each age group found
                          than 15 year olds report being depressed among both boys and girls.       making new friends easy, as did almost 90 percent of Spanish
                          In the majority of countries, the proportion of girls who said they       students. Less than 70 percent of students in Estonia, Lithuania and
                          were depressed increased with age; in 18 countries, the increases         Russia in each age group said they find it easy to make friends. In
                          were 7 percent or more with Hungarian girls registering a 29 percent      Russia, the country ranked lowest, about 60 percent of students or
                          increase between age 11 and 15. Boys’ responses tended to increase        less made friends easily.
                          slightly or remain about the same, the most notable exception being
                          Hungary where they increased 14 percent and in Denmark where              Overall, boys were slightly more likely than girls to feel that they
                          they dropped 22 percent.                                                  could make new friends easily. The difference in the responses of
                                                                                                    boys and girls by country is typically small; only in the Czech Republic
                          C. Peer relationships                                                     and Wales did a substantially higher proportion of 11-year-old girls
                                                                                                    say they made friends easily. The general tendency is for students’
                          A number of dimensions of peer relationships are examined in this
                                                                                                    responses to increase slightly from age 11 to 15; however, differences
                          section, including friendships, time spent with friends and whether
                                                                                                    are not great.
                          young people feel they are included or excluded from their peer
                          group. Studies of peer relationships suggest that having friends and
                          having supportive friends are associated with a good self-concept, a
                          sense of belonging, a positive outlook and success in future
                          relationships (Hartup, 1993). Other aspects of peer relationships,
                          including bullying behaviour, are examined in Chapter 8, The School
                          Experience.
                          1. Friendships
                          For many young people, having friends indicates that they are
                          accepted; it is an important indicator of their self-worth. Friends can
                          shape the lives of some young people as much as family members,
                          and they can help move them toward or away from health-promoting
                          behaviour (Connolly & Konarski, 1994; Hartup, 1993; Shulman, 1993;
                          Parkhurst & Asher, 1992; Youniss & Haynie, 1992).
                          a. Making new friends
                          The proportion of students who responded that they find it easy to
                          make new friends is below three-quarters in only a very few countries;
                          however, there were interesting differences from country to country
                          (Figure 6.11). For example, students in most eastern European
                          countries were less likely to find it easy to make friends, while
                          students in other European regions and in Israel were more likely to
                                                                                                                                  99
Figure 6.11   Students who found it easy or very easy to make new friends (%)
               11 year olds                                           13 year olds                            15 year olds        CHAPTER 6
                                              57                                           62                                64   Psychosocial Adjustment
Russia*                                       54      Estonia                              60   Russia*                      60
                                              59                                           64                                63
Estonia                                       61      Russia*                              60   Lithuania                    65
                                              67                                           60                                65
Switzerland                                   61      Lithuania                            63
                                                                                                Estonia                      65
                                              69                                           70                                71
Czech Rep.                                    61
                                                      Latvia                               70
                                                                                                Latvia                       72
                                              67                                           71                                68
Lithuania                                     68
                                                      Germany*                             74
                                                                                                Czech Rep.
                                                                                                                             73
                                              72                                           72                                75
Latvia                                        68
                                                      Czech Rep.                                Belgium Fr.
                                                                                           74                                77
                                              70                                           81                                70
Belgium Fr.                                   72
                                                      Switzerland                          76
                                                                                                Greenland
                                                                                                                             78
                                              71                                           75                                76
Belgium Fl.                                   76
                                                      Belgium Fr.                               Finland
                                                                                           78                                78
Germany*                                      73      Belgium Fl.                          76                                76
                                              76
                                                                                                Germany*
                                                                                           79                                78
Scotland                                      74      Hungary                              76   Hungary                      78
                                              76                                           79                                78
Hungary                                       75      Finland                              75   Norway                       77
                                              76                                           80                                80
Canada                                        79      Canada                               82   Switzerland                  78
                                              76                                           80                                80
France*                                       74      Greenland                            72   Denmark                      80
                                              77                                           81                                80
Finland                                       76      Denmark                              78   Slovakia                     80
                                              77                                           81                                80
Wales                                         84      N. Ireland                           83   Belgium Fl.                  70
                                              77                                           81                                81
Slovakia                                      76      France*                              76   Canada                       82
                                              78                                           82                                81
Austria                                       80      Norway                               79   Poland                       80
                                              78                                           82                                82
N. Ireland                                    81      Wales                                82   Sweden                       82
                                              79                                           82                                82
Norway                                        77      Austria                              80   Scotland                     83
                                              80                                           83                                82
Sweden                                        83      Scotland                             81   Israel                       84
                                              82                                           83                                82
Israel                                        87      Slovakia                             82   Wales                        84
                                              82                                           83                                83
Greenland                                     76      Poland                               78   Austria                      84
                                              83                                           84                                84
Denmark                                       78      Sweden                               82   N. Ireland                   83
                                              83                                           85                                85
Poland                                        79      Israel                               85   France*                      79
                                              83                                           87                                87    Female
Spain                                         88      Spain                                85   Spain                        86    Male
                                              90                                           91                                90
* France, Germany and Russia are represented only by regions: see Chapter 1 for details.
                  100

        CHAPTER 6
Psychosocial Adjustment




                                                                                                                                                                       Spain

                          b. Close friends                                                          In most countries, boys were more likely than girls to have a number
                          The vast majority of students had two or more close friends (Figure       of close friends, but gender differences are small. The greatest
                          6.12). The students most likely to have more than one close friend        gender difference is in Poland where 15 percent or more male than
                          were from Austria, Germany, Slovakia, Sweden and Wales. In some           female students in each age group had more than one close friend.
                          of these countries, 90 percent or more students had more than one         There was no clear age pattern in students’ responses. In some
                          close friend. In the Czech Republic, Lithuania, Poland, Russia and        countries – Austria, the Czech Republic, Hungary and Israel – the
                          Spain, fewer students than in most other countries reported having        three age groups are within a few percentage points of each other. The
                          two or more close friendships. Interestingly, although Spanish students   largest decrease from age 11 to 15 is in Lithuania – about 10 percent
                          were the most likely to feel they could make new friends easily, they     for both girls and boys. The responses of girls increased from age 11 to
                          were the least likely to have more than one close friend.                 15 in Norway by 15 percent and in Scotland by 11 percent.
                                                                                                                                  101
Figure 6.12 Students who had two or more close friends (%)
               11 year olds                                           13 year olds                            15 year olds        CHAPTER 6
                                              64                                           65                                64   Psychosocial Adjustment
Spain                                         75      Spain                                72   Spain                        69
                                              79                                           64                                61
Czech Rep.                                    79      Lithuania                            75   Lithuania                    73
                                              73                                           66                                65
Norway                                        81      Russia*                              76   Russia*                      73
                                              80                                           79                                77
Greenland                                     81
                                                      Czech Rep.                           80   Czech Rep.                   78
                                              63                                           64                                70
Poland                                        82
                                                      Poland                               82   Latvia
                                                                                                                             79
                                              72                                           77                                80
Lithuania                                     83
                                                      Finland                              82
                                                                                                Finland
                                                                                                                             81
                                              72                                           87                                67
Russia*                                       83
                                                      Canada                               83   Poland
                                                                                                                             82
                                              80                                           74                                72
Latvia                                        83
                                                      Latvia                               84   Estonia
                                                                                                                             83
                                              72                                           79                                82
Finland                                               Estonia                              85
                                                                                                Belgium Fl.
                                              84                                                                             83
                                              78                                           80                                87
Belgium Fl.                                           Norway                               85
                                                                                                Canada
                                              84                                                                             84
                                              85                                           82                                88
Canada                                                Switzerland                          86
                                                                                                Norway
                                              85                                                                             86
Switzerland                                   79      Belgium Fl.                          80   Belgium Fr.                  84
                                              87                                           87                                87
Scotland                                      81      France*                              82   France*                      79
                                              87                                           87                                90
Belgium Fr.                                   82      Belgium Fr.                          86   Greenland                    83
                                              87                                           88                                90
Estonia                                       81      Israel                               88   Switzerland                  83
                                              88                                           88                                90
Denmark                                       82      Denmark                              89   Hungary                      85
                                              88                                           90                                90
N. Ireland                                    85      N. Ireland                           90   Israel                       85
                                              88                                           90                                90
Hungary                                       85      Hungary                              85   Scotland                     92
                                              89                                           91                                90
Israel                                        87      Scotland                             90   Denmark                      90
                                              89                                           91                                91
Germany*                                      89      Austria                              91   Sweden                       91
                                              89                                           92                                91
France*                                       82      Wales                                92   Austria                      90
                                              90                                           92                                92
Wales                                         84      Greenland                            83   N. Ireland                   91
                                              90                                           93                                92
Sweden                                        90      Germany*                             92   Germany*                     92
                                              91                                           93                                95
Austria                                       91      Sweden                               92   Wales                        92
                                              93                                           93                                95    Female
Slovakia                                      93      Slovakia                             90   Slovakia                     93    Male
                                              95                                           95                                95
* France, Germany and Russia are represented only by regions: see Chapter 1 for details.
                  102

        CHAPTER 6         c. Talking to friends of the same gender                                   Figure 6.13       Factors associated with ease of talking to same-
Psychosocial Adjustment   It is difficult for some young people to share their thoughts and                            gender friends
                          feelings with their friends, even those of the same gender. For boys,      Students who find it easy to        11 year olds         13 year olds      15 year olds
                          ease in talking to friends of the opposite gender was more strongly        talk to same-gender friends          M       F            M       F         M      F
                                                                                                     are more likely to
                          correlated with ease in talking to friends of the same gender than
                                                                                                     Find it easy to talk to friends
                          was the case for girls (Figure 6.13). These findings reinforce those       of the opposite gender
                          from other studies that show an association between good social            Find it easy to make new friends
                          skills and a sense of belonging (Hartup, 1993). At all grades, ease
                                                                                                     Feel that other students accept
                          in talking with friends was linked to acceptance by others and for         them as they are
                          females in all age groups it is linked with not feeling alone at school.
                                                                                                     Spend time with friends after
                          For the younger students, it was correlated with effective                 school
                          communication with parents.                                                Have good communication with
                                                                                                     their parents
                          Belgian (Fr.) and Estonian students at all ages were the most likely
                                                                                                     Spend evenings away from home
                          to report difficulty talking to their same-gender friends (Figure 6.14).   with friends
                          Girls in France and Greenland and boys in Norway were also more            Not feel alone at school
                          likely than most other students to say they find it difficult to talk
                                                                                                     Have more close friends
                          with friends of the same gender.
                                                                                                     Correlation coefficient:    .15 to .19      .20 to .29        .30 to .39      .40+
                          Countries in the United Kingdom – Scotland, Northern Ireland and
                          Wales – as well as Finland had higher proportions of girls who said
                          they found it easy to talk with friends of the same gender in all age      The proportions of boys and girls in all countries who replied that
                          groups. Thirteen and 15-year-old girls in Canada, Spain and                they found it easy to talk with friends of the same gender rose
                          Switzerland and 15 year olds in Sweden were also more likely than          between age 11 and 15 and, in almost all countries, there was a
                          most others in their age group to indicate that they have little           gradual increase from 11 to 13 to 15 years of age. The greatest
                          difficulty, but in Hungary, Lithuania, Russia and Spain, boys found it     increases for boys and girls between age 11 and 15 were in Belgium
                          easier to talk to same-gender friends.                                     (Fr.), France, Switzerland and Wales and, for girls, in Denmark and
                                                                                                     Norway.
                          Girls obviously found it easier to talk with their female friends than
                          boys did with their male friends. At age 11, only in Spain did
                          substantially more boys (8%) find it easier to talk with their male
                          friends. By age 15, the same proportion of boys as girls in Greenland
                          and Spain could do so, but in no country did the proportion of boys
                          who found it easy to talk with same-gender friends exceed that of
                          the girls.
                                                                                                                                   103
Figure 6.14    Students who found it very easy or easy to talk to friends of the same gender* (%)
               11 year olds                                           13 year olds                             15 year olds        CHAPTER 6
                                              60                                            68                                74   Psychosocial Adjustment
France**                                      57      Estonia                               62
                                                                                                 Greenland                    74
                                              61                                            69                                76
Belgium Fr.                                   55      Greenland                                  Estonia                      63
                                                                                            68
                                              66                                            75                                80
Estonia                                       62      Belgium Fr.                                Belgium Fr.                  70
                                                                                            60
                                              67                                            75                                83
Greenland                                     69      Latvia                                     Poland
                                                                                            78                                80
                                              69                                            78                                84
Poland                                        70      France**                                   France**                     78
                                                                                            66
                                              69                                            79                                84
Latvia                                        71      Czech Rep.                                 Russia**
                                                                                            70                                81
                                              70                                            81                                85
Denmark                                       62      Poland                                     Latvia
                                                                                            71                                79
                                              72                                            82                                87
Czech Rep.                                    61      Russia**                                   Czech Rep.
                                                                                            78                                75
                                              72                                            82                                87
Norway                                        61      Lithuania                                  Israel
                                                                                            86                                79
                                              74                                            83                                89
Russia**                                      74
                                                      Slovakia                                   Hungary
                                                                                            71                                86
                                              75                                            84                                89
Switzerland                                   66
                                                      Denmark                                    Lithuania
                                                                                            71                                87
                                              77                                            85                                90
Germany**                                     64
                                                      Norway                                     Denmark
                                                                                            65                                71
                                              77                                            86                                91
Canada                                        69
                                                      Hungary                                    Germany**
                                                                                            83                                75
Spain                                         77      Sweden                                87                                91
                                              85
                                                                                                 Slovakia
                                                                                            69                                76
Sweden                                        79      Israel                                87   Spain                        91
                                              66                                            70                                91
Wales                                         80      Germany**                             87   Norway                       92
                                              65                                            73                                65
                                              80                                            88                                93
Finland                                       69
                                                      Spain                                      Sweden
                                                                                            84                                72
                                              80                                            89                                93
Hungary                                       80
                                                      Switzerland                                N. Ireland
                                                                                            71                                75
N. Ireland                                    81      Finland                               90   Scotland                     93
                                              62                                            70                                76
Scotland                                      81      Scotland                              90   Canada                       94
                                              72                                            72                                78
Israel                                        82      Canada                                90   Switzerland                  94
                                              65                                            74                                81
Lithuania                                     82      N. Ireland                            93   Finland                      95
                                              86                                            68                                75
Slovakia                                      83      Wales                                 94   Wales                        95    Female
                                              74                                            71                                80    Male

* Austria and Belgium (Fl.) did not include this item.
** France, Germany and Russia are represented only by regions: see Chapter 1 for details.
                  104

        CHAPTER 6         d. Talking to friends of the opposite gender                                  Figure 6.15 Factors associated with ease of talking to opposite-
Psychosocial Adjustment   Becoming comfortable conversing with friends of the opposite sex                          gender friends
                          is one of the main challenges of adolescence and a sign of growing            Students who find it easy         11 year olds        13 year olds     15 year olds
                          self-confidence and the development of important social skills. Like          to talk to opposite-gender         M     F              M      F         M      F
                                                                                                        friends are more likely to
                          finding it easy to talk with same-gender friends, it was associated
                          with sociability and sense of acceptance or belonging (Figure 6.15).          Find it easy to talk to friends
                                                                                                        of the same gender
                          However, ease of talking to opposite-gender friends was also
                                                                                                        Find it easy to make new
                          associated with drinking to excess and, among older students,                 friends
                          smoking. Both males and females were more likely to spend time
                                                                                                        Spend evenings away from
                          after school and in the evening with friends. Several studies show            home with friends
                          adolescent friends are very similar in attitudes and behaviours that          Spend time with friends
                          are important to teenage culture, such as smoking and drinking                after school
                          (Hartup, 1993).                                                               Feel other students accept
                                                                                                        them as they are
                          Boys and girls from all three age groups in the Czech Republic,
                                                                                                        Have been drunk
                          Estonia and France were the least likely to find it easy to talk to
                                                                                                        Smoke cigarettes
                          friends of the opposite gender (Figure 6.16). In Hungary and Spain,
                          students in each age group were among the most likely to feel                 Have more close friends
                          comfortable talking to friends of the other gender. Thirteen and 15           Correlation coefficient:      .15 to .19         .20 to .29    .30 to .39    .40+
                          year olds in Canada were also more likely than most other students
                          in their age group to find it easy to talk to opposite-gender friends.
                          In contrast to the pattern for same-gender friends, boys were more
                          likely to find it easy to talk to female friends than girls were to talk to
                          male friends. However, by age 15, differences were not pronounced.
                          Only in France, Lithuania and Poland did the differences exceed 10
                          percent. In Denmark this pattern was reversed, as 10 percent more
                          girls than boys found it easy to talk to opposite-gender friends. Most
                          11-year-old girls tended to be reticent about talking with friends of
                          the opposite sex. By age 15, girls were most likely to report ease in
                          talking to opposite-gender friends in Canada, Spain and Wales.
                          Students’ capacity to talk easily with the opposite gender generally
                          increased steadily from age 11 to 13 to 15, especially in Wales which
                          showed an increase of 38 and 47 percent for males and females,
                          respectively.
                                                                                                                                   105
Figure 6.16    Students who found it very easy or easy to talk to friends of the opposite gender* (%)
               11 year olds                                           13 year olds                             15 year olds        CHAPTER 6
                                              18                                            21                                34   Psychosocial Adjustment
Denmark                                       28      Estonia                               33   Estonia                      40
                                              23                                            30                                57
Czech Rep.                                    29      Belgium Fr.                                Denmark                      47
                                                                                            37
                                              16                                            34                                47
France**                                      31      Czech Rep.                                 Czech Rep.                   48
                                                                                            37
                                              14                                            36                                46
Estonia                                       32
                                                      Denmark                                    Russia**                     49
                                                                                            38
                                              23                                            35                                52
Wales                                         32
                                                      Norway                                     Norway                       49
                                                                                            40
                                              24                                            31                                48
Norway                                        33
                                                      Latvia                                     Latvia                       53
                                                                                            43
                                              19                                            29                                55
Scotland                                              France**                                   Germany**                    53
                                              34                                            44
                                              19                                            35                                50
Belgium Fr.                                   34
                                                      Russia**                                   Belgium Fr.                  55
                                                                                            44
                                              24                                            40                                57
Finland                                       34
                                                      Finland                                    Finland                      55
                                                                                            44
Russia**                                      30      Greenland                             38   France**                     45
                                              35                                            45                                56
Latvia                                        26      Israel                                44   Slovakia                     52
                                              36                                            45                                57
Germany**                                     34      Wales                                 45   Greenland                    59
                                              36                                            45                                58
Canada                                        27      Poland                                35   Sweden                       60
                                              38                                            47                                58
N. Ireland                                    20      Germany**                             41   Israel                       60
                                              39                                            47                                59
Sweden                                        25      Sweden                                41   Switzerland                  56
                                              39                                            47                                60
Israel                                        35      Scotland                              42   Lithuania                    46
                                              40                                            47                                61
Poland                                        26      Switzerland                           40   Poland                       49
                                              41                                            50                                62
Slovakia                                      45      Slovakia                              43   N. Ireland                   64
                                              46                                            54                                64
Greenland                                     48      N. Ireland                            46   Scotland                     65
                                              47                                            54                                64
Hungary                                       34      Lithuania                             37   Spain                        70
                                              49                                            55                                65
Switzerland                                   34      Canada                                49   Canada                       71
                                              51                                            56                                65
Lithuania                                     46      Spain                                 50   Wales                        70
                                              54                                            58                                70
                                              39                                                                                    Female
Spain                                                 Hungary                               47   Hungary                      65
                                              55                                            60                                71    Male

* Austria and Belgium (Fl.) did not include this item.
** France, Germany and Russia are represented only by regions: see Chapter 1 for details.
                  106

        CHAPTER 6         2. Time spent with friends                                               In general, more of the boys than the girls reported spending time
Psychosocial Adjustment                                                                            with friends after school several days a week. In several countries
                          Spending time with friends is a common pastime for young people
                                                                                                   there is a substantial difference between the responses of girls and
                          and the amount of time spent in the company of friends typically
                                                                                                   those of boys; that is, 10 percent or more boys than girls spent time
                          increases through adolescence (Larson & Richards, 1991; Brown,
                                                                                                   with friends after school four or five days a week. This occurred
                          1990). The amount of time young people spend together outside of
                                                                                                   across the age groups in Belgium (Fr.), Estonia, Finland, France
                          school time gives an indication of their level of socialization and
                                                                                                   and Sweden.
                          may indicate whether or not the time they spend with friends
                          interferes with other aspects of their life, such as time with family    Although many students’ responses were similar from age to age
                          members and homework. Here, the focus is on those who spend              by country (e.g., Canada, Germany, Israel), there is no consistent
                          time with friends after school and during the evening most days of       pattern. The greatest decrease in response between age 11 and 15
                          the week.                                                                among girls was in Sweden (12% fewer 15 year olds than 11 year
                                                                                                   olds); in Denmark, 16 percent fewer 15-year-old boys than 11-
                          a. Time spent with friends after school
                                                                                                   year-old boys spent four to five days a week with friends after
                          Almost all students surveyed spent time after school with their
                                                                                                   school.
                          friends at least once a week. Figure 6.17 shows the proportion of
                          students who spent almost every day – four or five days a week –
                          with their friends after school.
                          The responses of students in most of the countries are clustered in
                          the 40 to 50 percent range for boys and the 30 to 40 percent range
                          for girls. Over half of students in Greenland and Norway spent
                          time with friends after school most days. Girls in Israel at all three
                          age levels, and 13- and 15-year-old French boys were also highly
                          likely to socialize with friends almost daily after school. The least
                          likely students to spend four or five days a week with friends after
                          school were from Belgium (Fr.), the Czech Republic and Lithuania.
                                                                                                                                   107
Figure 6.17 Students who spent time with friends after school four or five days a week* (%)
               11 year olds                                           13 year olds                             15 year olds        CHAPTER 6
                                              51                                            54                                52   Psychosocial Adjustment
Norway                                        64      Norway                                58
                                                                                                 Norway                       57
                                              52                                            56                                60
Greenland                                     52      Greenland                             57
                                                                                                 Greenland                    56
                                              39                                            37                                37
Scotland                                      51      France**                                   France**                     53
                                                                                            54
                                              36                                            42                                44
Finland                                       51
                                                      Spain                                      Germany**                    48
                                                                                            53
                                              39                                            39                                32
Sweden                                        49
                                                      Scotland                                   Canada
                                                                                            52                                48
                                              38                                            38                                27
Canada                                        49
                                                      Poland                                     Sweden
                                                                                            48                                48
                                              36                                            35                                43
Spain                                         49
                                                      Latvia                                     Israel
                                                                                            48                                47
                                              35                                            40                                42
France**                                      48
                                                      Germany**                                  Spain
                                                                                            46                                47
Wales                                         32      Wales                                 38                                40
                                              48
                                                                                                 Austria
                                                                                            46                                47
Germany**                                     42      Finland                               36                                38
                                              47
                                                                                                 Slovakia
                                                                                            46                                46
Austria                                       37      Austria                               30   Hungary                      37
                                              47                                            46                                46
Poland                                        39      Canada                                36   Latvia                       36
                                              45                                            45                                45
Israel                                        43      N. Ireland                            36   Poland                       33
                                              44                                            45                                45
Hungary                                       32      Israel                                45   Scotland                     35
                                              43                                            44                                44
Estonia                                       28      Hungary                               29   Wales                        30
                                              43                                            43                                44
Denmark                                       36      Russia**                              36   Belgium Fl.                  28
                                              42                                            42                                42
N. Ireland                                    33      Sweden                                31   Finland                      30
                                              42                                            41                                41
Russia**                                      37      Estonia                               25   Russia**                     40
                                              41                                            40                                39
Latvia                                        32      Belgium Fl.                           30   N. Ireland                   27
                                              40                                            38                                37
Slovakia                                      39      Denmark                               33   Estonia                      23
                                              37                                            35                                37
Belgium Fl.                                   23      Slovakia                              31   Belgium Fr.                  23
                                              33                                            34                                33
Czech Rep.                                    26      Belgium Fr.                           22   Lithuania                    21
                                              30                                            33                                27
Lithuania                                     19      Czech Rep.                            28   Czech Rep.                   30
                                              30                                            32                                26    Female
Belgium Fr.                                   16      Lithuania                             19   Denmark                      28    Male
                                              26                                            27                                26
* Switzerland did not include this item.
** France, Germany and Russia are represented only by regions: see Chapter 1 for details.
                  108

        CHAPTER 6         b. Time spent with friends in the evenings                                Figure 6.18     Factors associated with spending evenings away
Psychosocial Adjustment   Again and again in this report it has been noted that a significant                       from home with friends
                          amount of time spent with friends in the evenings appears associated      Students who spend evenings       11 year olds    13 year olds     15 year olds
                          with health-risk behaviours. Figure 6.18 summarizes these                 away from home with friends         M     F        M      F         M     F
                                                                                                    are more likely to
                          relationships. While the student who spends a great deal of time
                                                                                                    Be well integrated socially
                          with friends was more likely to have good communication skills, he/
                          she was also more likely to smoke and drink to excess. Other              Eat potato chips
                          relationships involved poor eating habits, watching videos and playing    Watch videos
                          computer games. Parents should be concerned when their teenagers          Eat hamburgers/hot dogs
                          begin to spend a great deal of time with their friends in the evenings.
                                                                                                    Smoke cigarettes
                          Figure 6.19 presents the proportions of students in each country          Have been drunk
                          who said they spend five or more evenings a week with friends.
                                                                                                    Drink sweet soft drinks
                          Some countries stand out as having high proportions of students
                                                                                                    Play computer games
                          who reported this behaviour across age groups: Finland, Greenland,
                          Northern Ireland, Norway, Scotland and Wales. Far fewer students          Correlation coefficient:      .15 to .19    .20 to .29    .30 to .39
                          in Austria, Belgium (Fr.), the Czech Republic, France, Lithuania
                          and Switzerland reported that they spent five evenings or more a
                          week with friends – fewer than five percent of Belgian (Fr.)
                          students.
                          Similar to after-school socializing, more boys than girls spent five
                          or more evenings a week with friends in almost every country.
                          Fifteen year olds were more likely than younger students to spend
                          at least five evenings a week with friends. The largest difference
                          is in Denmark where between ages 11 and 15, 25 percent more
                          girls and 16 percent more boys spent five to seven evenings a week
                          with friends. There were also notable increases in Greenland,
                          Hungary, Latvia, Poland and Slovakia (boys and girls), and in Norway
                          (girls). In Northern Ireland, Scotland and Spain, the responses of
                          both boys and girls actually decreased as age increased.
                                                                                                                                  109
Figure 6.19 Students who spent five to seven evenings per week with friends away from home (%)
            11 year olds                                 13 year olds                                         15 year olds        CHAPTER 6
                                               32                                          38                                46
Scotland                                       42     Scotland                             48   Greenland                    54   Psychosocial Adjustment
                                               34                                          36                                40
Finland                                        41     Finland                              45   Finland                      47
                                               27                                          30                                31
N. Ireland                                     40     Greenland                            45
                                                                                                Scotland                     40
                                               35                                          29                                33
Greenland                                      39
                                                      N. Ireland                           40
                                                                                                Norway                       36
                                               20                                          30                                25
Wales                                          34
                                                      Wales                                39
                                                                                                Wales                        34
                                               21                                          26                                18
Spain                                          33
                                                      Norway                                    N. Ireland                   34
                                                                                           28
                                               18                                          23                                23
Norway                                         31
                                                      Canada                               28
                                                                                                Slovakia                     32
                                               19                                          20                                20
Canada                                         24
                                                      Spain                                27
                                                                                                Latvia                       30
                                               16                                          21                                34
Russia*                                               Russia*                                   Denmark                      29
                                               19                                          24
                                               13                                          13                                14
Slovakia                                              Latvia                                    Sweden                       28
                                               19                                          22
                                               10                                          24                                22
Sweden                                                Denmark                                   Canada                       27
                                               18                                          21
                                                9                                          13                                22
Latvia                                                Slovakia                                  Poland                       27
                                               16                                          19
                                                9                                          14                                25
Denmark                                               Sweden                                    Russia*                      26
                                               13                                          18
                                                7                                          18                                17
Estonia                                               Poland                                    Hungary                      24
                                               13                                          16
Israel                                         12     Israel                               14   Spain                        16
                                               12                                          16                                23
Germany*                                        7     Germany*                              9   Belgium Fl.                  12
                                               11                                          14                                20
Poland                                         11     Belgium Fl.                          10   Estonia                      11
                                               10                                          12                                20
Belgium Fl.                                     7     Lithuania                             9   Israel                       20
                                               10                                          12                                19
Lithuania                                       6     Estonia                               8                                17
                                                                                                Germany*                     19
                                               10                                          12
Austria                                         6     Hungary                               8   Lithuania                     9
                                                9                                          11                                15
France*                                         3     France*                               4   Austria                      11
                                                7                                           9                                14
Czech Rep.                                      4     Austria                               6   Switzerland                   6
                                                5                                           8                                11
Hungary                                         4     Czech Rep.                            6   Czech Rep.                    9
                                                5                                           7                                10
Switzerland                                     3     Switzerland                           3   France*                       4
                                                4                                           6                                 8    Female
Belgium Fr.                                     1     Belgium Fr.                           1   Belgium Fr.                   4    Male
                                                4                                           4                                 4
* France, Germany and Russia are represented only by regions: see Chapter 1 for details.
                   110

        CHAPTER 6         D. Relationship with parents                                              Figure 6.20 Factors associated with parent-child communication
Psychosocial Adjustment                                                                             Students who communicate           11 year olds     13 year olds     15 year olds
                          In studies of adolescents, among the variables shown to be related        well with their parents are          M      F         M      F         M     F
                          to positive relationships with parents are higher self-esteem, less       more likely to
                          depression, lower risk-taking scores (Field et al., 1995; Ryan et al.,    Say parents are willing to help
                          1994), greater involvement in school and community activities             them with problems at school

                          (Chubb & Fertman, 1992) and better school performance (Ryan et            Be well integrated socially
                          al., 1994). The basis of an effective parent-child relationship is open   Feel happy
                          communication. The quality of the relationship in families where          Have a positive attitude
                          children find it easy to talk with their parents will almost certainly    toward school
                          be better than those where children find communicating difficult.         Not feel helpless

                          For the items on communication with mother and father, students           Feel confident
                          had four response choices: very easy; easy; difficult; and very           Believe their family is well off
                          difficult. The very easy and easy responses have been combined            Not be tired in the morning
                          for this analysis. These data reinforce other researchers’ findings
                                                                                                    Say parents encourage them to
                          that young people tend to find it easier to communicate with their        do well at school
                          mother (Shulman, 1993).                                                   Not have difficulty sleeping
                          A parent communication scale was developed that included items            Not be irritable
                          related to ease of talking to mother and ease of talking to father.       Be satisfied with their
                          Scale scores were correlated with the other survey items and the          appearance
                          results are summarized in Figure 6.20. In comparison with other           Say parents are willing to come
                          research, these findings tend to show a similar relationship with         to school to talk to teachers

                          attitude toward school and other sound relationships, but not the         Not feel depressed
                          same associations with risk-taking behaviours. Perhaps the most           Not feel stressed at school
                          important factors found to be associated with effective
                                                                                                    Correlation coefficient:       .15 to .19     .20 to .29     .30 to .39    .40+
                          communication with parents were good relationships with peers
                          and satisfaction with school. Poor relationships with parents were
                          associated with loneliness, a lack of confidence, helplessness,           1. Communicating with mother
                          irritability, sleep problems and, among girls, depression. For the
                                                                                                    The majority of students reported communicating easily with their
                          younger two groups of students, perceived family economic status
                                                                                                    mother about things that really bother them; the percentage is above
                          was associated with effective parent-student relationships.
                                                                                                    60 for all age groups in all countries and the variation in responses
                                                                                                    across countries was not great. Across all age groups, more students
                                                                                                    in Finland, Greenland, Hungary, Israel and Sweden than in other
                                                                                                    countries said they found it easy to communicate with their mother
                                                                                                    (Figure 6.21).
                                                                                                                                  111
Figure 6.21    Students who found it very easy or easy to talk to their mother about things that really bother them* (%)
               11 year olds                                   13 year olds                                    15 year olds        CHAPTER 6
                                               68                                                        63                  61
Belgium Fr.                                    69      Belgium Fr.                                       68   Belgium Fr.    65   Psychosocial Adjustment
                                               75                                                        79                  64
France**                                       78      Czech Rep.                                        70   Canada         67
                                               83                                                        74                  76
Czech Rep.                                     78      France**                                          72   Norway         67
                                               82                                                        71                  73
Austria                                        80      Canada                                            73   Scotland       68
                                               80                                                        79                  78
Canada                                         82
                                                       N. Ireland                                        73   N. Ireland     69
                                               82                                                        77                  73
Denmark                                        82
                                                       Scotland                                          74
                                                                                                              Czech Rep.
                                                                                                                             70
                                               84                                                        75                  70
Scotland                                       83
                                                       Austria                                           75   France**       71
                                               85                                                        77                  72
Estonia                                        83
                                                       Estonia                                           75   Russia**       72
                                               87                                                        76                  69
Belgium Fl.                                            Denmark                                           77
                                                                                                              Austria
                                               84                                                                            73
                                               87                                                        79                  75
Slovakia                                               Switzerland                                       77
                                                                                                              Slovakia
                                               84                                                                            73
                                               87                                                        85                  77
Switzerland                                            Slovakia                                          78
                                                                                                              Denmark
                                               84                                                                            73
N. Ireland                                     88      Germany**                                         75   Estonia        65
                                               84                                                        79                  74
Norway                                         86      Wales                                             80   Belgium Fl.    75
                                               86                                                        79                  76
Germany**                                      88      Belgium Fl.                                       83   Germany**      75
                                               87                                                        79                  76
Latvia                                         89      Norway                                            84   Wales          75
                                               87                                                        79                  76
Russia**                                       86      Russia**                                          74   Switzerland    76
                                               88                                                        80                  77
Spain                                          88      Lithuania                                         84   Latvia         74
                                               88                                                        81                  79
Wales                                          92      Poland                                            85   Israel         80
                                               89                                                        83                  80
Israel                                         93      Spain                                             82   Lithuania      80
                                               89                                                        84                  80
Hungary                                        89      Greenland                                         77   Spain          77
                                               90                                                        85                  81
Poland                                         92      Latvia                                            86   Greenland      71
                                               90                                                        87                  82
Lithuania                                      92      Finland                                           87   Sweden         80
                                               91                                                        87                  83
Finland                                        92      Hungary                                           85   Hungary        83
                                               92                                                        88                  83
Greenland                                      91      Israel                                            88   Poland         81
                                               93                                                        89                  84    Female
Sweden                                         92      Sweden                                            88   Finland        83    Male
                                               93                                                        90                  85
* These figures are based on totals that do not include the response, “Don't have or see this person”.
** France, Germany and Russia are represented only by regions: see Chapter 1 for details.
                   112

        CHAPTER 6         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   difficult to talk with their mother. Eleven and 13 year olds in France     parent items. Countries, such as Finland, Sweden, Israel and
                          and the Czech Republic, and 13 and 15 year olds in Canada, also            Hungary, tended to rank high on talking with both mother and father;
                          tended to have more trouble than others talking with their mother.         Belgium (Fr.), the Czech Republic and France were low on both
                          Other students who did not find communication easy were from               measures.
                          Austria and Northern Ireland.
                          Gender differences were remarkably small for all three age groups.
                          The proportion of students who found it easy to talk with their mother
                          decreased from age 11 to 15 in every country.
                          2. Communicating with father
                          Far fewer students felt they could talk easily with their father about
                          things that really bother them (Figure 6.22) than felt they could do
                          so with their mother. Swedish students were the most likely to find
                          it easy to talk with their father. The responses of students in Finland,
                          Greenland, Hungary, Israel and Lithuania also indicated a high level
                          of ease in child-father communication.
                          In general, students in Austria, Belgium (Fr.), the Czech Republic
                          and Estonia were less likely to communicate easily with their father.
                          Fifteen year olds in Northern Ireland and Scotland, 11 and 13 year
                          olds in France, and 13 and 15 year olds in Canada were also less
                          likely than many others to do so.
                          In all countries and at all age levels (with one exception – 11-year-
                          old Lithuanians), boys were more likely than girls to find it easy to
                          talk with their father. There were substantial differences between
                          15-year-old boys and girls in most countries, with the largest in
                          Estonia (26 percent) and France (27 percent).
                          The proportion of students who found it easy to talk with their father
                          decreased from age 11 to 13 to 15 in the majority of countries. The
                          proportion of girls decreased at a far higher rate than that of boys
                          from age 11 to 15. In Estonia, for example, there was a 33 percent
                          decrease for girls while that of boys was only 12 percent.
                                                                                                                                 113
Figure 6.22 Students who found it very easy or easy to talk to their father about things that really bother them* (%)
            11 year olds                                   13 year olds                                     15 year olds         CHAPTER 6
                                               41                                                        32                 28
Belgium Fr.                                    52      Belgium Fr.                                       51   Belgium Fr.   44   Psychosocial Adjustment
                                               55                                                        39                 34
Czech Rep.                                     58      Austria                                           57   Canada        49
                                               45                                                        41                 45
France**                                       62      Canada                                            58   N. Ireland    49
                                               56                                                        41                 42
Austria                                        67      Estonia                                           58   Scotland      52
                                               63                                                        44                 30
Estonia                                        68
                                                       Czech Rep.                                        58   Austria       53
                                               56                                                        37                 39
Scotland                                       70
                                                       France**                                          59
                                                                                                              Czech Rep.
                                                                                                                            55
                                               61                                                        46                 45
Slovakia                                       71
                                                       N. Ireland                                        60   Norway
                                                                                                                            55
                                               65                                                        46                 30
Belgium Fl.                                    71
                                                       Scotland                                          61   Estonia       56
                                               56                                                        51                 37
Canada                                                 Wales                                             62
                                                                                                              Slovakia
                                               72                                                                           56
                                               63                                                        53                 30
Denmark                                                Belgium Fl.                                       63
                                                                                                              France**
                                               72                                                                           57
                                               63                                                        46                 43
N. Ireland                                             Slovakia                                          65
                                                                                                              Denmark
                                               72                                                                           57
Spain                                          67      Denmark                                           48   Wales         49
                                               76                                                        65                 57
Wales                                          64      Switzerland                                       51   Belgium Fl.   42
                                               77                                                        66                 59
Switzerland                                    65      Germany**                                         45   Switzerland   43
                                               77                                                        67                 59
Norway                                         69      Norway                                            56   Spain         46
                                               77                                                        67                 62
Germany**                                      70      Poland                                            49   Germany**     39
                                               77                                                        68                 63
Poland                                         70      Spain                                             51   Poland        40
                                               77                                                        69                 63
Latvia                                         71      Lithuania                                         62   Russia**      41
                                               77                                                        69                 64
Russia**                                       70      Russia**                                          48   Latvia        42
                                               78                                                        70                 64
Lithuania                                      81      Latvia                                            56   Lithuania     47
                                               80                                                        74                 66
Hungary                                        72      Finland                                           55   Finland       52
                                               82                                                        75                 69
Israel                                         75      Greenland                                         56   Israel        53
                                               83                                                        77                 69
Sweden                                         73      Israel                                            63   Sweden        53
                                               84                                                        77                 69
Finland                                        75      Hungary                                           55   Greenland     51
                                               84                                                        78                 72    Female
Greenland                                      77      Sweden                                            61   Hungary       51    Male
                                               90                                                        79                 72
* These figures are based on totals that do not include the response, “Don’t have or see this person”.
** France, Germany and Russia are represented only by regions: see Chapter 1 for details.
                   114

        CHAPTER 6         E. Summary
Psychosocial Adjustment
                          There were substantial differences across countries among young
                          people in the areas of mental health and relationships with parents
                          and peers. The majority of students do not describe themselves as
                          very happy. The youngest students tend to have the most optimistic
                          outlook and, in most countries, slightly more boys than girls feel
                          very happy. Younger students are less likely to feel lonely and
                          depressed, and more likely to feel a sense of confidence. Boys are
                          far more likely to feel confident, while girls are more likely to feel
                          lonely, depressed and helpless. It appears that, as children reach
                          their adolescent years, they feel less secure, both psychologically
                          and in their social environment.
                          Although the majority of students make friends easily and have at
                          least two close friends, the complexities of friendship are clearly
                          difficult for a small minority. These students feel excluded from
                          their peer group. Most of the young people surveyed seem to spend
                          a reasonable number of days and evenings with friends; some,
                          however, spend excessive amounts of time with friends – almost
                          every day after school and every evening. For youth who are
                          seeking recognition and acceptance, the influence of peers can
                          sometimes negate that of parents, particularly with respect to the
                          use of tobacco, alcohol and drugs.
                          Boys and girls are almost equally likely to find it easy to make new
                          friends and to have two or more close friends. Boys, however,
                          spend far more time than girls with their friends after school and in
                          the evening. The differences in students’ responses to peer-
                          relationship items across age groups indicate that social skills develop
                          rapidly from age 11 to 15.
                          Students are able to communicate more easily with their mother
                          than with their father but some students have difficulty
                          communicating with both parents.
        7
        C H A P T E R




Spain
 7
C H A P T E R                                   A. Introduction
                Injuries
                                                Injuries are the greatest health problem facing school children in
                A. Introduction
                                                the western world (Harel, 1988; Scheidt, 1988; Committee on
                B. All injuries
                                                Trauma Research, 1985; Gordon, 1949; Wheatly, 1949). The
                C. Severe injuries
                                                majority of deaths from injury throughout the world are among
                D. Where injuries occur
                                                children and youth; injuries represent the leading cause of death in
                E. Context of injuries
                                                the first half of the human life span (Barss et al., 1991). Nonfatal
                F. Type of injury
                                                injuries account for a large proportion of hospital and school-loss
                G. Injury prevention programs
                                                days as well as an unacceptable amount of lifetime disability (Scheidt
                H. Summary
                                                et al., 1995; Baker et al., 1992; Rodriquez, 1990; Harel, 1988).
                                                Although the risk of injury is so great that most people sustain a
                                                significant injury at some time during their life, little attention is
                                                given to injuries in the research on children’s health. The absence of
                                                objective information on injuries has inhibited the development and
                                                implementation of injury prevention initiatives. This report provides
                                                the type of information that can be used to monitor patterns of injury
                                                across three age groups.
                                                There is a tendency among the general public to believe that most
                                                injuries occur by chance, but in fact the occurrence of injuries is to
                                                a great extent determined by the characteristics of the environment
                                                in which people live and play and the products they use. Effective
                                                prevention strategies are based on an understanding of the
                                                circumstances in which injuries can occur and the risk behaviours
                                                that cause them (Harel, 1988; Scheidt, 1988; Rivara, 1985).
                                                Environmental changes can be made to playing fields, arenas and
                                                homes to reduce the risk of injury. Equipment used in play and
                                                sport can be adapted to reduce risks. Protective equipment for use
                                                in sport can be improved. Supervision and education of young people,
                                                especially in school settings, can also reduce the risk of injury. And
                                                of course, legislation regarding such things as seat belt use and
                                                bicycle helmets can play an important role in prevention.
                                                                                                                                                117

In this chapter, the types of injuries that require medical treatment    Respondents named the place where the injury occurred (home,           CHAPTER 7

are considered, as well as the places they occur and the activities in   school, sport facility, for example), what they were doing when the    Injuries
which those injured are engaged when they are hurt. The use of           injury occurred (riding a bicycle, playing, engaged in a sport), and
seat belts as an example of preventive behaviour is also examined.       the type of injury (broken bone, cuts, concussion or other head
                                                                         injury). Respondents also indicated the month of the year in which
It is probably advisable to be cautious when comparing injury rates
                                                                         they were injured.
across the participating countries because of a number of factors.
The data were collected at different times during the school year        The injury questions were not used on the survey in the Czech
across countries (see Chapter 1 for details) and injuries tend to vary   Republic and Germany.
by season. There are differences across countries in the availability
and utilization of medical services and the extent to which people
define an injury as requiring medical attention. Therefore, it is more
useful to look at the types of injuries by age group and gender and
the situations in which they occur.
Seven items on the survey were directly concerned with injuries.
These items were derived from the questions used in several national
and international studies on childhood and adolescent injuries
(Scheidt et al., 1995; Harel et al., 1994; National Center for Health
Statistics, 1989).
Respondents were first asked how many injuries they had incurred
during the past 12 months which had been treated by a doctor or a
nurse. If students reported an injury, they were asked to respond to
six additional questions; if they reported more than one injury, they
were asked to answer the same six questions focusing on the most
serious injury they had experienced.
The severity of the injury was indicated by two measures: 1) an
injury that needed medical treatment such as the placement of a
cast, stitches, surgery, or an overnight stay in hospital; and 2) an
injury that caused the respondent to miss at least one full day of
school or other usual activity.
       118

CHAPTER 7      B. All injuries
    Injuries
               There is very little data describing the characteristics of youth who
               are more inclined to be involved in accidents. Generally speaking,
               the concepts of inexperience, risk-taking, sensation-seeking,
               impulsiveness and drug abuse are used to describe those behaviours
               that may contribute to injury (Robertson, 1992). A preliminary
               analysis using aggregated data from this survey yielded correlation
               coefficients of over 0.15 between alcohol abuse and injury among
               13- and 15-year-old boys. Further analyses of these data are
               underway to investigate psychosocial and behavioural factors
               associated with injuries among school-aged children in various
               countries.
               Figure 7.1 presents the percentage of youth who reported at least
               one injury requiring medical attention in the previous 12 months.
               The figure, therefore, indicates the proportion of students who
               sustained such an injury and does not represent the total number of
               injuries requiring medical attention sustained by the respondents
               during the year before the survey was conducted.
               Overall, boys in all countries surveyed reported a higher injury rate
               than girls. In about half of the countries, over one-third of boys and
               over one-quarter of girls reported at least one injury during the
               previous year. The highest rates of injury were among 13- and 15-
               year-old boys in Canada, France and Wales. In most countries, gender
               differences are greater among older students surveyed. Denmark is
               an exception; there, boys and girls in all age groups reported similar
               rates of injury.
               The results also indicate that for all age groups countries such as
               Canada, France, Scotland and Wales show high injury rates when
               compared with Greenland, Poland, Russia, Slovakia and Sweden.
                                                                                                                            119

Figure 7.1 Students who reported injuries during the past year* (%)                                                         CHAPTER 7
                                                                                                                            Injuries
               11 year olds                                           13 year olds                      15 year olds
                                              34                                     40                                38
France**                                      43      France**                       47   France**                     45
                                              31                                     32                                31
Israel                                        43      Wales                          47   Wales                        45
                                              30                                     33                                32
Scotland                                      37      Canada                         42   Canada                       44
                                              29                                     31                                27
Belgium Fl.                                   37
                                                      Scotland                       42   Belgium Fr.                  39
                                              32                                     32                                26
Belgium Fr.                                   36
                                                      N. Ireland                     41   N. Ireland                   39
                                              31                                     24                                25
Wales                                         36
                                                      Israel                         39   Belgium Fl.                  38
                                              31                                     35                                25
Canada                                        34
                                                      Austria                        37   Scotland                     37
                                              29                                     25                                23
Austria                                       33
                                                      Spain                          35   Israel                       36
                                              28      Switzerland                    29                                29
N. Ireland                                    33                                     33   Austria
                                                                                                                       35
                                              25                                     29                                29
Spain                                                 Belgium Fl.                    32   Switzerland
                                              32                                                                       34
                                              23                                     23                                22
Switzerland                                           Belgium Fr.                    31   Spain
                                              26                                                                       34
                                              19      Denmark                        27                                29
Finland                                                                              30   Denmark
                                              26                                                                       31
                                              16      Norway                         22                                26
Estonia                                                                              28   Norway
                                              26                                                                       30
                                              20      Estonia                        14                                21
Lithuania                                                                            25   Finland
                                              25                                                                       29
                                              19      Hungary                        18
Norway                                                                               24   Sweden                       16
                                              25                                                                       25
                                              26      Lithuania                      18
Denmark                                                                              24   Latvia                       11
                                              25                                                                       25
Hungary                                       17      Finland                        17                                13
                                                                                     22
                                                                                          Estonia
                                              25                                                                       24
Latvia                                        15      Poland                         14
                                                                                     22
                                                                                          Hungary                      18
                                              24                                                                       22
                                              18      Latvia                         12                                15
Russia**                                                                             22   Lithuania
                                              22                                                                       22
Slovakia                                      14      Greenland                      13                                18
                                              21                                     21
                                                                                          Greenland
                                                                                                                       19
Poland                                        12      Russia**                       15                                12
                                                                                     20
                                                                                          Slovakia
                                              20                                                                       19
Greenland                                     14      Slovakia                       12                                13
                                                                                     19
                                                                                          Poland
                                              19                                                                       18    Female
Sweden                                        13      Sweden                         16                                10
                                                                                     16
                                                                                          Russia**                           Male
                                              19                                                                       18

* The Czech Republic and Germany did not include this item.
** France and Russia are represented only by regions: see Chapter 1 for details.
       120

CHAPTER 7      C. Severe injuries                                                      while severe injury rates for girls ranged from about 7 to 33 percent.
    Injuries
               Figure 7.2 presents the proportion of young people who reported a       Although these data relate only to severe injuries, the effects of
               serious injury, i.e., an injury that caused them to miss at least one   gender, age group and, most notably, cross-national differences are
               day of school or required medical procedures such as placement of       almost identical to the data presented in Figure 7.1. In countries
               a cast, stitches, surgery or hospitalization. To give some indication   with high injury rates, such as Canada, France, Northern Ireland,
               of the magnitude of the database employed in this study, the figure     Scotland and Wales, more than one of four boys and one of five
               is based on 21,807 injuries from 95,939 total students. In general,     girls experienced a severe injury during the past year, while among
               about two-thirds of the injuries reported by students in the previous   low injury rate countries such as Greenland, Latvia, Poland, Russia
               year were classified as severe using these criteria. Severe injury      and Sweden, fewer than one of five boys and one of seven girls
               rates for boys ranged from 10 to 38 percent across all age groups,      experienced a severe injury.




                                                                                                                                                      Canada
                                                                                                                            121

Figure 7.2 Students who reported severe injuries during the past year* (%)                                                  CHAPTER 7
                                                                                                                            Injuries
               11 year olds                                           13 year olds                      15 year olds
                                              25                                     33                                23
France**                                      34      France**                       37   Wales                        38
                                              23                                     23                                30
Belgium Fr.                                   27      Wales                          37   France**
                                                                                                                       37
                                              18                                     23                                23
Israel                                        27      N. Ireland                     33
                                                                                          Canada
                                                                                                                       33
                                              23                                     24                                20
Wales                                         26
                                                      Canada                         32
                                                                                          Belgium Fr.
                                                                                                                       32
                                              21                                     21                                19
Scotland                                      26
                                                      Scotland                       32
                                                                                          N. Ireland
                                                                                                                       32
                                              21                                     25   Scotland                     18
Canada                                        25
                                                      Austria                        30                                30
                                              20                                     11                                24
N. Ireland                                    25
                                                      Israel                         25
                                                                                          Austria
                                                                                                                       28
                                              20                                     16                                22
Austria                                       24
                                                      Belgium Fr.                    23
                                                                                          Denmark
                                                                                                                       22
                                              16      Denmark                        18   Israel                       13
Lithuania                                     20                                     22                                22
                                              13                                     15                                11
Spain                                                 Lithuania                      21
                                                                                          Belgium Fl.
                                              20                                                                       20
                                              10                                     13
Estonia                                               Spain                          21
                                                                                          Finland                      11
                                              19                                                                       20
                                              12      Hungary                        14   Lithuania                    13
Hungary                                                                              19
                                              18                                                                       18
                                              17      Norway                         13   Spain                        12
Denmark                                                                              17
                                              16                                                                       18
                                              13      Poland                         11   Norway                       14
Belgium Fl.                                                                          17
                                              16                                                                       17
                                              11      Estonia                         8   Latvia
Finland                                                                              16
                                                                                                                        9
                                              16                                                                       17
Norway                                        11      Greenland                       9   Sweden                        9
                                              16                                     15                                17
Poland                                        10      Latvia                          8   Hungary                      13
                                              16                                     15                                16
Slovakia                                      10      Slovakia                        8   Poland                       12
                                              15                                     15                                15
                                              12      Belgium Fl.                    12   Estonia                       8
Russia**                                                                             14
                                              14                                                                       15
Latvia                                        10      Russia**                       11   Slovakia                      9
                                              14                                     14                                14
Sweden                                         8      Finland                         9   Russia**                      7
                                              13                                     14                                13
Greenland                                      8      Sweden                          8   Greenland                    11     Female
                                              10                                     11                                11     Male

* The Czech Republic, Germany and Switzerland did not include this item.
** France and Russia are represented only by regions: see Chapter 1 for details.
       122

CHAPTER 7      D. Where injuries occur                                                    Injuries at school are presented, by country, in Figure 7.4. The
    Injuries                                                                              numbers in this figure represent the proportion of young people
               Identifying where injuries occur is the first step in developing
                                                                                          whose most serious injury during the last 12 months occurred at
               prevention programs. Students were asked where their most serious
                                                                                          school. Generally speaking, boys were more likely than girls to have
               injury occurred and that information is summarized in Figure 7.3.
                                                                                          been injured seriously at school in the past year. Israeli 11- and 13-
               A significant shift was evident from age 11 to 15 in the proportion        year-old boys and Canadian 15-year-old girls reported the highest
               of injuries that took place in each setting. There was a decline in the    proportion of injuries at school. School injury rates were lowest in
               proportion of injuries occurring in and around the home and an             Greenland, Latvia, Slovakia and Sweden.
               increase in the proportion occurring at sport facilities. The proportion
               of street-related injuries was similar across genders and age groups.
               Girls were more likely to be injured at home than boys, but both
               males and females became less likely over time to be injured at
               home. The proportion of injuries occurring at school was substantial
               and was similar for all age groups and genders. The category “Other”
               in Figure 7.3 included injuries experienced in parks or recreational
               areas, on a farm or at work.




               Figure 7.3 Place most serious injury occurred (%)
                   Female          Male
                                          11 year olds                     13 year olds                     15 year olds
                                                                30                             27                                 23
               Home                                             27                             20                                 16
                                                                25                             23                                 20
               School                                           21                             21                                 17
                                                                12                             17                                 24
               Sport facility                                   18                             24                                 31
                                                                14                             12                                 13
               Street                                           15                             16                                 14
                                                                19                             20                                 21
               Other*                                           20                             20                                 22

               * “Other” was a response choice for this item.
                                                                                                                            123

Figure 7.4 Injuries at school* (%)                                                                                          CHAPTER 7
                                                                                                                            Injuries
                11 year olds                                          13 year olds                      15 year olds
                                               8                                      6                                 6
Israel                                        10      Israel                         11
                                                                                          Wales                         8
                                               9                                      8                                 4
Belgium Fr.                                    8      Spain                           9
                                                                                          Israel
                                                                                                                        8
                                               6                                      7                                 7
France**                                       8      Wales                               Belgium Fr.
                                                                                      9                                 7
                                               9                                      7                                 4
Spain                                          7      France**                            Norway
                                                                                      8                                 7
                                               8                                      6                                11
Belgium Fl.                                    7      Scotland                            Canada
                                                                                      8                                 6
                                               7                                      8                                 8
Canada                                         7
                                                      N. Ireland                          Spain
                                                                                      7                                 6
                                               7                                      4                                 7
Scotland                                       7      Denmark                             France**
                                                                                      7                                 6
                                               6                                      7                                 5
N. Ireland                                     6      Canada                              Belgium Fl.
                                                                                      6                                 6
                                               5                                      6
Finland                                        6
                                                      Belgium Fr.                         N. Ireland                    5
                                                                                      6                                 6
                                               6                                      5
Austria                                        5
                                                      Belgium Fl.                         Scotland                      3
                                                                                      6                                 6
                                               6                                      5
Denmark                                        5
                                                      Norway                              Latvia                        1
                                                                                      6                                 6
Norway                                         6      Russia**                        3   Austria                       4
                                               5                                      6                                 5
Wales                                          6                                      7   Denmark
                                               5
                                                      Austria                                                           4
                                                                                      5                                 5
Lithuania                                      3      Poland                          4   Estonia                       2
                                               5                                      5                                 4
Hungary                                        3      Estonia                         3   Russia**                      1
                                               5                                      5                                 4
Russia**                                       4      Finland                         4   Hungary                       4
                                               4                                      4                                 3
Poland                                         3      Hungary                         4   Finland                       3
                                               4                                      4                                 3
Estonia                                        2      Lithuania                       3   Poland                        3
                                               4                                      4                                 3
Latvia                                         2      Sweden                          3   Lithuania                     2
                                               4                                      3                                 3
Sweden                                         4      Slovakia                        2   Slovakia                      2
                                               3                                      3                                 3
Slovakia                                       2      Latvia                          1   Sweden                        2
                                               3                                      3                                 2
Greenland                                      0      Greenland                       0   Greenland                     1     Female
                                               3                                      2                                 2     Male

* The Czech Republic, Germany and Switzerland did not include this item.
** France and Russia are represented only by regions: see Chapter 1 for details.
       124

CHAPTER 7      E. Context of injuries                                                     Sport Medicine, 1993; Abraham, 1992; Micheli & Klein, 1991).
    Injuries                                                                              The figures are surprisingly high for some countries. A quarter of
               The second step in developing interventions is to examine the type         the Welsh and Canadian 15-year-old boys had experienced one such
               of activity in which a young person was involved at the time the           injury. Overall, boys were far more likely than girls to be injured in
               injury occurred. The activities in which the students were involved        a sporting event. Countries in which sport-related injuries were least
               when they sustained their most serious injury are presented in Figure      likely to occur include Estonia, Greenland and Lithuania.
               7.5.
                                                                                          Analysis of causes of injuries within each type of environment
               The largest group of injuries occurred during some sporting activity       provides an important insight into the modifiable risk factors that
               or play. The second largest group of injuries occurred when young          can be addressed to prevent childhood injuries. Figure 7.7 indicates
               people tripped over or fell off something. A number of injuries            the context of the injuries that occurred in the home, on the street
               occurred while students were bicycling or roller skating. The              and at school. Over half of injuries occurring at school involved
               proportion of young people who were injured by an automobile was           play in sports and playground activities, while a substantial
               comparatively small, but still significant and particularly important,     proportion involved being struck, cut or falling. At home the fall/
               because such injuries are more likely to be fatal.                         struck/cut category was most prominent. Street-related injuries
               Figure 7.6 presents the proportion of young people who indicated           typically involve bicycles, roller skates and, of course, automobiles,
               their most serious injury requiring medical attention during the past      but also include a significant number of falls/being struck by an
               year occurred while they were participating in a sport. Young athletes     object, and cuts. Each setting requires its own particular prevention
               are particularly at risk for fractures, cuts and overuse injuries which    programs.
               are in part related to poor training procedures and aggressive attitudes
               encouraged by adults (Cook & Leit, 1995; American College of


               Figure 7.5 Context of most serious injury (%)
                  Female          Male
                                                          11 year olds                       13 year olds                    15 year olds
                                                                                25                               31                                 35
               Sport or playground injury                                       31                               37                                 41
                                                                                27                               23                                 21
               Falling off something or tripping                                19                               16                                 12
                                                                                14                               10                                  6
               Bicycling or roller skating                                      17                               15                                 10
                                                                                 8                                9                                  8
               Being struck or cut by an object                                  9                                8                                  8
                                                                                 4                                3                                  6
               Automobile accident                                                                                5                                  7
                                                                                 4
                                                                                 3                                4                                  4
               Fighting                                                                                           6                                  7
                                                                                 4
                                                                                21                               21                                 20
               Other*                                                                                            15                                 15
                                                                                16
               * “Other” was a response choice for this item.
                                                                                                                            125

Figure 7.6 Sport injuries* (%)                                                                                              CHAPTER 7
                                                                                                                            Injuries
               11 year olds                                           13 year olds                      15 year olds
                                              12                                     12                                11
France**                                      19      Wales                          25   Wales                        25
                                              10                                     13                                14
Israel                                        17      N. Ireland                     21   Canada                       24
                                              11                                     15                                17
Scotland                                      16      Canada                         21   France**                     22
                                              10                                     20                                11
Belgium Fl.                                   16      France**                       20   Belgium Fl.                  22
                                              10                                     12                                11
Spain                                         16      Scotland                       20   N. Ireland                   22
                                               9                                     11                                10
N. Ireland                                    16
                                                      Spain                          19   Spain
                                                                                                                       19
                                              12                                      5                                 8
Belgium Fr.                                   15      Israel                         15   Scotland                     18
                                              11                                     14                                17
Canada                                        15      Denmark                        14   Denmark
                                                                                                                       17
                                              11                                     11                                10
Wales                                         15
                                                      Austria                        13
                                                                                          Belgium Fr.
                                                                                                                       17
                                              10                                     11                                12
Austria                                       12
                                                      Belgium Fl.                    13
                                                                                          Norway
                                                                                                                       14
                                              12                                      9                                 8
Denmark                                       11
                                                      Belgium Fr.                    13
                                                                                          Finland
                                                                                                                       14
                                               5                                      8                                11
Finland                                       10
                                                      Hungary                             Austria
                                                                                     12                                13
Hungary                                        5                                      8                                 4
                                                      Norway                         12
                                                                                          Israel                       13
                                               9
Slovakia                                       5      Poland                          4                                 9
                                               9                                     11
                                                                                          Sweden
                                                                                                                       12
Norway                                         6      Sweden                          8   Estonia                       5
                                               8                                      9                                10
Russia**                                       6      Russia**                        4   Latvia                        3
                                               8                                      9                                10
Latvia                                         4      Slovakia                        4   Russia**                      2
                                               8                                      9                                10
Poland                                         3      Latvia                          2   Hungary                       7
                                               8                                      8                                 9
Sweden                                         7      Finland                         6   Slovakia                      6
                                               7                                      7                                 9
Estonia                                        4      Estonia                         4   Poland                        5
                                               6                                      7                                 8
Lithuania                                      3      Lithuania                       3   Greenland                     8
                                               5                                      7                                 7
Greenland                                      1      Greenland                       5   Lithuania                     4     Female
                                               4                                      6                                 7     Male

* The Czech Republic, Germany and Switzerland did not include this item.
** France and Russia are represented only by regions: see Chapter 1 for details.
       126

CHAPTER 7      Figure 7.7 School, home, and street injuries, by cause (%)                                     G. Injury prevention programs
    Injuries
                         School                       Home                               Street               There are many prevention programs in place in the various countries
                    53                           43
                                                                                                  26          in this study. Traffic safety guards and playground supervisors are
                                                                                                              examples. There is no question that protective equipment acts to
                                                                      12                                  6   reduce the risk of injury both in sport and in play. For example, the
                                                                                40                        9   use of helmets has been demonstrated to be remarkably effective in
                                       14
                                              13                     29                                       reducing head injuries among cyclists (Thompson et al., 1989). An
                    29            31                  3                                           19
                                                                                                              advertising campaign designed to increase the use of bicycle helmets
                          sport and playground     struck/fall/cut        bicycling/roller skating            during 1982 to 1985 contributed to a 20 percent reduction in head
                          automobile               other
                                                                                                              injuries to bicyclists in Australia (Wood & Milne, 1988).
                                                                                                              Another injury prevention program that has been demonstrated to
                                                                                                              be effective is the legislation requiring both automobile drivers and
               F. Type of injury                                                                              their passengers to wear seat belts. Many of the countries
               Figure 7.8 summarizes the types of injuries that fall into the most                            participating in this study have enacted such legislation but others
               serious injury category. For girls, sprains and strains were the most                          have not. In some countries, particularly eastern European countries,
               common while for 11- and 13-year-old boys broken and dislocated                                many automobiles are not equipped with seat belts. The students in
               bones occurred most often.                                                                     the study were asked how often they wore a seat belt when in an
                                                                                                              automobile and Figure 7.9 summarizes the proportion who said they
                                                                                                              always wear one. In those countries where using seat belts was the
                                                                                                              norm, girls were slightly more likely than boys to always wear seat
                                                                                                              belts. In countries such as Canada, Finland, France and Germany,
               Figure 7.8 Type of most serious injury (%)
                  Female               Male
                                                                11 year olds                                  13 year olds                       15 year olds
                                                                                                     27                            30                                 33
               Sprain, strain or pulled muscle                                                       20                            23                                 28
                                                                                                     25                            25                                 23
               Broken or dislocated bone                                                             24                            30                                 28
                                                                                                     15                            14                                 12
               Cut or puncture wound                                                                 21                            19                                 18
                                                                                                      6                             5                                  6
               Concussion/head/neck injury                                                            8                             6                                  6
                                                                                                      6                             6                                  6
               Bruises or internal bleeding                                                           7                             6                                  5
                                                                                                      2                             2                                  2
               Burns                                                                                                                                                   2
                                                                                                      3                             2
                                                                                                     19                            18                                 19
               Other*                                                                                                                                                 14
                                                                                                     17                            15

               * “Other” was a response choice for this item.
                                                                                                                                   127
Figure 7.9 Students who always used a seat belt * (%)
                                                                                                                                   CHAPTER 7
               11 year olds                                          13 year olds                              15 year olds
                                              9                                              9                                 4
                                                                                                                                   Injuries
Greenland                                    10      Greenland                              13   Greenland                    10
                                             16                                             16                                19
Russia**                                     22      Russia**                               20   Russia**                     19
                                             17                                             20                                20
Slovakia                                     27      Slovakia                               25   Lithuania
                                                                                                                              21
                                             19                                             22                                21
Latvia                                       21
                                                     Lithuania                              24   Latvia
                                                                                                                              23
                                             21                                             25                                22
Estonia                                      29
                                                     Latvia                                 25   Slovakia
                                                                                                                              24
                                             24                                             29                                27
Lithuania                                    28
                                                     Estonia                                27
                                                                                                 Estonia
                                                                                                                              24
                                             27                                             35                                29
Czech Rep.                                   29
                                                     Czech Rep.                             39   Czech Rep.
                                                                                                                              31
                                             36                                             39                                38
Belgium Fr.                                  37
                                                     Spain                                  50
                                                                                                 Belgium Fr.
                                                                                                                              34
                                             37      Belgium Fr.                            41                                42
Spain                                        43
                                                                                                 Spain
                                                                                            39                                49
                                             40                                             43                                46
Belgium Fl.                                  39
                                                     Hungary                                41
                                                                                                 Scotland
                                                                                                                              42
                                             40                                             45                                47
Hungary                                              Switzerland                            41
                                                                                                 Belgium Fl.
                                             40                                                                               41
Switzerland                                  42      Denmark                                51   Hungary                      48
                                             30                                             52                                42
Poland                                       48      Poland                                 51   Denmark                      48
                                             51                                             57                                52
                                             56      Belgium Fl.                            52   Switzerland                  49
Israel                                                                                      45
                                             53                                                                               44
                                             58      Israel                                 57   Poland
Austria                                                                                     55
                                                                                                                              58
                                             51                                                                               55
Denmark                                      63      Scotland                               58   Norway                       61
                                             63                                             54                                58
N. Ireland                                   66      N. Ireland                             61   Sweden                       63
                                             56                                             53                                54
Scotland                                     66      Austria                                63   N. Ireland                   64
                                             63                                             58                                57
                                             71      Finland                                69   Austria                      64
France**                                                                                    62
                                             75                                                                               60
Finland                                      75      Norway                                 69   France**                     65
                                             71                                             63                                62
Germany**                                    75      Canada                                 70   Finland                      67
                                             72                                             62                                65
Sweden                                       76      Sweden                                 72   Israel                       67
                                             69                                             66                                67
Norway                                       76      France**                               72   Canada                       69
                                             70                                             70                                64     Female
Canada                                       77      Germany**                              74   Germany**                    69     Male
                                             68                                             68                                70
* Wales did not include this item.
** France, Germany and Russia are represented only by regions: see Chapter 1 for details.
       128

CHAPTER 7      approximately two-thirds or more of the students in all three age          The sport injury literature includes many suggestions for prevention
    Injuries   groups said they always wear a seat belt. Students in the eastern          programs that address specific types of sport activities (for example,
               European countries of the Czech Republic, Estonia, Latvia,                 wearing protective clothing) or more general approaches (for
               Lithuania, Russia and Slovakia were far less likely to always wear         example, multi-cause community intervention programs) that address
               a seat belt and very few Greenlandic youth use a seatbelt when in a        a wider spectrum of activities. Greater use of seat belts is clearly
               vehicle.                                                                   needed in some countries. Not only legislative support, but making
                                                                                          sure vehicles have the necessary equipment is fundamental.
               H. Summary
               This chapter presents an overview of the incidence of nonfatal injuries
               in school-aged children. In all countries, injury rates are sufficiently
               great to indicate a serious health problem requiring prevention
               initiatives. Boys tend to be injured more frequently than girls, yet,
               among girls, injury rates are also substantial. About two-thirds of
               all injuries requiring contact with a doctor or nurse result in one or
               more days lost from school or in a medical procedure such as the
               placement of a cast, stitches, surgery or hospitalization. Over 40
               percent of all injuries occur in school or at home, two environments
               that can be directly targeted for intervention. Injuries most frequently
               occur during sport and playground activities, and when young people
               fall and are struck or cut by objects.
               If the school systems in the participating countries can develop
               effective prevention strategies aimed at (a) reducing sport and
               playground activity-related injuries, and (b) improving the safety of
               school environments, then 80 percent of all school injuries will be
               addressed by primary prevention intervention. Also, schools can be
               used as a vehicle to provide safety education designed to reduce
               injuries that occur outside the school environment. As to home
               injuries, a community-based approach to enhance the safety of the
               home environment to prevent falls and cuts might be an effective
               strategy to address adolescent home injuries.

				
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