HBSC England National report

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HBSC England National Report
Health Behaviour in School-aged Children (HBSC):
World Health Organization Collaborative Cross National Study
Findings from the 2014 HBSC study for England
family life health
school well-being
community life
healthy behaviours
peer relationships, friends and leisure activities

Authors
Professor Fiona Brooks
Josefine Magnusson
Dr Ellen Klemera
Kayleigh Chester
Dr Neil Spencer
Nigel Smeeton
Address for Correspondence
CRIPACC
University of Hertfordshire
College Lane Campus
Hatfield, AL10 9AB
www.hbscengland.com
Published by University of Her tfordshire, Hatf ield. September 2015.
This report should be cited as: Brooks, F., Magnusson, J., Klemera, E., Chester, K., Spencer, N., and Smeeton, N. (2015) HBSC
England National Report 2014. University of Hertfordshire; Hatfield, UK.
Young people’s reference group
Amelia (age 12)
Anna (age 16)
Ellise (age 12)
Felix (age 11)
Katie (age 16)
Katie-Lou (age 16)
Pippa (age 13)
Roman (age 14)
Sam (age 15)
Tara (age 14)
Tom (age 15)
Vato (age 15)
William (age 11)
Acknowledgements
The team owe a debt of gratitude to all the schools, teachers and especially the young people who participated in this study.
We are extremely grateful for the time and help they gave to this project.
Many thanks also go to our coders who worked so hard to enter all the data: Laura Hamilton, Rebecca Walker-Haynes, Lucy
Burton, Joshua Scott, Holly Brooks, Julie Mace, and William Kendall.
We would like to thank our funders the Department of Health for their financial support for the study. Special thanks go to
Richard Sangster, Elizabeth Kendall, Rachel Conner, Sarah Randall, Geoff Dessent and Danielle De Feo at the Department of
Health, and Claire Robson at Public Health England for their continued guidance and support.

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Foreword by Jane Ellison
Since 1997, the Health Behaviour in School-Aged Children study (HBSC) has provided key
insights to help us better understand the health-related behaviour of our young people.
The study examines a wide range of health, education, social and family measures that are
determinants of young people’s health and well-being.
I welcome the findings in this report and the survey results identify that many health trends
for young people are going in the right direction. I am very encouraged to see decreasing
levels of participation in risky behaviours including significant reductions in levels of smoking,
regular alcohol consumption, and drunkenness. It is also positive to see that the proportion of
15 year olds reporting very early sexual activity has decreased significantly since 2002.
The findings relating to primary health care service use was predominantly positive with over 75% of young people saying
they felt at ease with their GP. It was also encouraging to see that the proportion of young people reporting eating sweets
daily has fallen since 2002 and the proportions eating breakfast on a school day and participating in family meal times with
their parents have both increased since 2010.
However, this report does also highlight areas for concern.
While the majority of young people said that their physical health was either excellent or good, girls reported lower levels
of life satisfaction than boys and higher symptoms of stress. The report suggests that girls feel more pressure to do well at
school and to be popular but we need to look carefully at the underlying reasons and not speculate. It is of particular concern
that new figures on self-harm show high rates among our young people with 32% of 15 year old girls reporting they had
self-harmed. We have also yet to see widespread improvements in levels of physical activity with only 15% of girls and 22%
of boys meeting the Chief Medical Officer’s recommended daily amount of at least sixty minutes of activity per day. We need
to look carefully across Government to consider what more we might do to address these issues so that young people feel
better equipped to make the transition to adult life and to make a full contribution to society.
I am concerned to see that 22% of young people reported not having enough sleep to feel awake and concentrate on school
work during the day. Lack of sleep can influence mental health and wellbeing and the report shows this is a factor. This
suggests we need to build in opportunities for young people to learn techniques for managing stress and again emphasise the
importance of physical activity.
We know that adolescence is a period when our approach to health and wellbeing begins to take shape and habits develop –
good and bad - which will have an impact on our health in later years. There are some really positive trends in this report but
the report also highlights specific areas where we need to do more to help young people to make informed, healthy choices
which develop into positive, lifelong habits.
Jane Ellison
Public Health Minister
Foreward

4HBSC England National Report
Contents
Acknowledgements Inside front cover
Foreword 3
Chapter 1. Contexts: The HBSC study, methods and demographics 7
Why adolescents? 7
Note on terminology 7
The HBSC study 7
What aspects of young people’s lives does HBSC ask about? 8
Collaborations and England-only questions 8
Methodology 9
Recruitment strategy 9
Conduct of the survey 9
Ethics and consent 9
Participation of young people 9
Characteristics of pupils 10
Response rates 10
Grade and gender 10
Ethnicity 10
Free school meals 11
Weighting 11
Presentation of findings 12
References 12
Chapter 2. Health and well-being 13
Key messages 13
Introduction 13
Perceived health 13
Self-rated health 13
Life satisfaction 14
Health complaints 18
Multiple health complaints 19
Emotional well-being 20
Primary health care use 21
Visited GP last year 21
Feeling at ease with GP 22
Respect from GP 22
GP’s explanations 23
Discussing personal issues 23
Long term condition or disability 24
Type of condition or disability 24
Taking medication 24
School attendance 25
Summary 25
Young people’s thoughts on health and well-being 26
References 26

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HBSC England National Report
Chapter 3. Health behaviours 27
Key messages 27
Introduction 28
Diet and nutrition 29
Eating breakfast 29
Fruit and vegetable intake 31
Consumption of sweets, sugary drinks and fast food 34
Sleep 38
Body image 40
Physical activity 44
Summary 46
Young people’s thoughts on health behaviours 46
References 47
Chapter 4 Substance use 49
Key messages 49
Introduction 49
Smoking 50
Alcohol 52
Cannabis 54
Summary 56
Young people’s thoughts about substance use 56
References 57
Chapter 5. Sexual health and well-being 58
Key messages 58
Introduction 59
Love 59
Sex 61
Summary 64
Young people’s thoughts on sex and relationships 64
References 65
Chapter 6. Injuries and Physical fighting 66
Key messages 66
Introduction 66
Injuries 67
Fighting 69
Self-harm 70
Summary 70
References 71
Chapter 7. Family and community life 72
Key messages 72
Introduction 72
Parental employment and family structure 73
Parental employment 73

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Family structure 73
Community life 74
Family life communication 76
Talking to father 76
Talking to mother 77
Family life, parental support and monitoring 78
Parental support 78
Parental involvement and support for education and school 79
Parental monitoring and levels of young people’s autonomy 80
Family activities 82
Family evening meal 82
Sports and exercise 83
Computer games 83
Summary 84
Young people’s thoughts on family life 84
References 85
Chapter 8 School life 86
Key messages 86
Introduction 86
Perception of school 87
Liking school 87
Academic achievement 89
Feeling pressured by schoolwork 90
Feeling safe at school 92
School belonging 93
Peer and teacher relationship 94
Students like being together 94
Other students are kind and helpful 94
Teachers care about me as a person 94
Having a teacher to talk to 96
PSHE 97
Attending PSHE 97
PSHE lessons improving skills and abilities to care for other people’s health 97
PSHE classes improving skills and abilities to consider the importance of own health 98
Summary 99
Young people’s thoughts about school 100
References 100
Chapter 9. Peer relationships, friends and leisure time 101
Key messages 101
Introduction 101
Friendships 102
Leisure time 104
Bullying 108
Summary 112
Young people’s thoughts about peer relationships 112
References 113
HBSC England National Report

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The HBSC study, methods and demographics
This report presents the findings for England from the 2014
Health Behaviour in School-aged Children (HBSC) World
Health Organization (WHO) collaborative study. It provides
an up to date view of adolescent health and well-being in
England, and provides an overview of trends in these areas
spanning more than a decade (2002-2014).
HBSC continues to provide evidence on young people’s lives
and the broad determinants of their health and well-being,
including their experiences of friendships, school, family,
and community life. In addition, this report also presents
new measures that are increasingly being seen as influential
health determinants and behaviours for the current
generation of young people, including sleep, self-harm,
health service use, love and relationships, and spirituality.
Why adolescents?
There are 7.4 million adolescents aged 10-19 living in the UK,
accounting for 12% of the population and forming part of 4.8
million UK households (Hagell, Coleman, & Brooks, 2013).
Adolescence is a key period of transition within the life
course, the navigation of which provides a secure basis for
future adult life. The developmental tasks of adolescence
are by definition those that mark profound physical,
psychological and social changes (Christie & Viner, 2005).
Research also indicates that brain development continues
throughout adolescence and early adulthood until around
25 years of age (Giedd, 2004). During this period of cognitive
development young people develop skills in weighing up
risk, moral thinking, political thought and learning from their
experiences (Coleman, 2011). Adolescence is also a time of
emotional development in terms of identity formation, self-
esteem and resilience (Coleman, 2011) and how emotional
health and well-being is constructed during adolescence has
important consequences for future life chances.
During this second decade of life the challenges faced by
young people in England are considerable, and within the
UK there are differences in health and well-being between
regions, age groups and the genders that warrant further
exploration (Brooks et al., 2009). Poor health in the first
two decades of life, possibly more than at any time in the
life course, can have a highly detrimental effect on overall
life chances, impacting on educational achievement and
the attainment of life goals as well as restricting social and
emotional development (Currie, Nic Gabhainn, et al., 2008).
Prior to 2005, indicators of young people’s health had
remained fairly static despite considerable improvements
in health outcomes of infants and older people (Viner &
Barker, 2005). However in the last decade interest in young
people’s health has grown, with “momentum gathering to
put adolescents into the centre of global health policies”
(Wessely, 2012, p. 1). The increased focus on the health
of young people has been mirrored by a number of
health improvements, including a reduction in teenage
pregnancies, alcohol consumption and tobacco smoking
(Hagell et al., 2013). While these changes are positive,
Coleman and Hagell (2015) highlight that adolescent health
goes beyond simply risk behaviours, and the absence of risk
does not necessarily indicate positive health and well-being
(Magnusson, Klemera, & Brooks, 2013).
Young people also hold their own generation-specific
attitudes and definitions relating to health and well-being
which greatly influence how they perceive and act in relation
to health behaviours, and which can be very different from
adult perspectives (Brooks & Magnusson, 2006; Wills,
Appleton, Magnusson, & Brooks, 2008). Consequently,
understanding how young people subjectively view their
own health, health risks, and quality of life becomes a vital
task if effective health promotion and health policies are to
be developed.
The health and well-being of children and adolescents in
England has attracted increasing attention over the past four
years since the publication of the 2010 HBSC England report;
notably the Chief Medical Officer dedicated the CMO’s
annual report 2012 to young people (Department of Health,
2013).
Note on Terminology
The terms adolescence and young people are variously
defined and even contested. Merriam-Webster1 defines
adolescence as “the period of life from puberty to maturity
terminating legally at the age of majority”, while the World
Health Organization2 considers adolescence to occur “after
childhood and before adulthood, from ages 10-19”. The
term ‘young people’ is seen to be a broader term and
encompasses a social dimension as well as a biological
definition and can be taken to include individuals aged from
10 to 24. This report is concerned with the experiences and
views of young people in early to mid-adolescence (11-15
years) living in England.
The HBSC study
Health Behaviour in School-aged Children (HBSC) is a cross-
national research study conducted in collaboration with the
WHO Regional Office for Europe. The study aims to gain
new insight into, and increase our understanding of, young
people’s health and well-being, health behaviours, and their
social context.
HBSC is the longest running international study focusing on
the health behaviours and social context of young people.
The study was initiated in 1982 by researchers from England,
Finland and Norway, and shortly afterwards the project
was adopted by the World Health Organization as a WHO
collaborative study. There are now 44 participating countries
and regions. England has been represented in the past
four survey cycles (since 1997). Time trends in this report
are based on the 2002, 2006, 2010 and 2014 data sets as
these surveys represent the period in which HBSC questions
Chapter 1 Contexts: The HBSC study, methods and demographics
1 http://www.merriam-webster.com/dictionary/adolescence (Accessed 04/08/15)
2 http://www.who.int/maternal_child_adolescent/topics/adolescence/dev/en/ (Accessed 04/08/15)

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within the mandatory international questionnaire were
standardised.
5335 young people aged 11, 13, and 15 years participated in
the 2014 HBSC cycle for England (see Table 1.2).
The health of young people is a complex arena with great
amounts of diversity between individual young people
and their peers. By examining the broader social context
of young people in England that is their family, school and
community life, the HBSC study moves beyond simply
monitoring prevalence of risk behaviours to offering a means
to understand and respond to the social determinants of
health and well-being.
The study enables identification of different risk and
protective factors operating in relation to health risks among
young people. It also offers policy makers and practitioners
an understanding of exactly which social and developmental
factors need to be addressed in any prevention/ intervention
programmes. Finally the study enables lessons to be usefully
drawn through comparison with other countries.
The HBSC International Research Network comprises
member country Principal Investigators and their research
teams. There are currently over 450 individual researchers
in the network from a range of disciplines. Each member
country needs to secure national funding to carry out
the survey and to contribute to the management and
development of the international study.
The Centre for Research in Primary and Community Care
(CRIPACC) hosts the England HBSC study. CRIPACC, based
at the University of Hertfordshire, is a multi-disciplinary
team with over 40 staff. The Child and Adolescent Health
Research Unit (CAHRU), University of St Andrews, is
currently the International Coordinating Centre (ICC) of
HBSC internationally.
What aspects of young people’s lives does
HBSC ask about?
The HBSC study consists of a mandatory set of questions
that all participating countries include. In addition, groups
of countries may choose to collaborate for comparative
purposes on optional HBSC packages, and finally countries
can include specific national questions.
Specific details of the items covered by the questionnaire are
presented in the relevant subsections of the data chapters.
Core questions on the mandatory questionnaire are
concerned with the health behaviour and the social and
developmental context of young people. This includes
individual and social resources, health behaviours and health
outcomes:
1. Individual and social resources
• Family culture (ease of communication with mother /
father /siblings, family support)
• Peers (time spent with friends after school / in the
evening; communication with friends)
• School environment (liking school; perception of
academic performance; school-related stress; classmate
support)
• Body image (perception of body being too fat or too thin)
2. Health behaviours
• Physical activity (frequency of moderate-to-vigorous
activity)
• Sedentary behaviour (frequency of watching TV;
frequency of computer use)
• Eating behaviour (consumption frequency of fruit,
vegetables, soft drinks, breakfast, evening meal)
• Dental health (frequency of tooth brushing)
• Weight control behaviour (dieting to control weight)
• Tobacco use (ever smoked; frequency of current
smoking; age first smoked)
• Alcohol use (consumption frequency of beer, wine,
spirits; age first drank alcohol; frequency of drunkenness;
age first got drunk)
• Cannabis use (lifetime use; use in past year) – asked only
of 15 year olds.
• Sexual behaviour (prevalence of sexual intercourse;
contraception use; age of onset) – asked only of 15 year
olds.
• Violence and bullying (physical fighting; being bullied;
bullying others)
• Injuries (number of medically attended injuries in past
year)
3. Health outcomes
• Health complaints (a ‘checklist’ of physical and
psychological symptoms, e.g. headache, stomach-ache,
feeling low, feeling nervous)
• Life satisfaction (adapted version of the Cantril ladder
(Cantril, 1965))
• Self-reported health status
• Body Mass Index (BMI; height & weight)
Collaboration and England-only questions
In 2014 the England team collaborated with the Canadian
HBSC team to match all the questions relating to bullying.
The Canadian team also developed the questions on
spirituality used in HBSC England in 2014.
The questionnaire for England also included items specific
to England including measures on support from teachers,
relational bullying, self-harm, sleep, views of PSHE lessons,
and experiences of primary health care services.
HBSC England National Report

9
Methodology
Prior to the commencement of the fieldwork contextual
work was undertaken to identify the most appropriate
method of survey delivery for the English school context
(assisted by reference groups and advisory panels including
school representation). This included consultation with
head teachers and young people. The study is conducted
according to the HBSC international protocol which
determines the methodology and conduct of the study.
The survey is carried out with a nationally representative
sample in each country, using the class or school as the
primary sampling unit. Each country sample consists of
approximately 1500 respondents in each age group. This
ensures a confidence interval of +/- 3% around a proportion
of 50%, taking account of the complex sampling design
(Currie et al., 2010; Roberts et al., 2009).
Recruitment strategy
A random sample of all secondary schools in England was
drawn (state and independent schools), stratified by region
and type of school to ensure representative participation.
The original sample consisted of 100 schools. Sampling was
done by replacement, so that if/ when one school from the
original sample refused to participate, a matched school
from a second list was contacted instead. If this school also
refused, a second matched school was contacted. Following
this procedure, 48 schools (a total of 261 classes) were
recruited. All sampled schools were contacted by letter,
follow-up letter and by personal phone call.
Final recruited schools were broadly representative in terms
of geographical spread and type of school. The majority of
classes participating were in either years 7, 9 or 11 however
in a small number of schools where the survey was carried
out towards the end of the school year, year 10 were used
in place of 11 to ensure student ages fell within the target
range (11.5, 13.5 and 15.5 years respectively).
Conduct of the survey
Questionnaires were administered in schools either by
teachers or members of the research team depending
on the preferred procedures determined by each school
and board of governors. In order to maintain young
people’s confidentiality and help ensure that pupils were
comfortable with answering personal questions in a reliable
way within the school setting, young people were asked
to fill in the questionnaire under exam type conditions
i.e. at individual desks and without discussion with other
pupils. On completion, each pupil individually placed the
questionnaire in an envelope and sealed it. The completed
questionnaires were then collected by teachers or members
of the research team. In cases where schools administered
the questionnaire, school teachers were given precise
instructions on how to conduct the survey. Teachers in
schools also completed a questionnaire detailing pupil
absence, number of refusal (parental or pupil) and additional
information on the school.
Ethics and consent
The study gained ethics approval via the University of
Hertfordshire Ethics committee for Health and Human
Sciences (HSK/SF/UH/00007). Ethical sensitivity was also
enhanced through the work of reference groups with young
people (see below), which informed the conduct of the study
within schools. Once permission was gained from schools,
consent letters were sent to all pupils in participating classes
with information asking them to pass on consent letters
to their parents unless they objected to taking part. Pupils
were therefore able to make the initial decision over their
participation. Pupils were provided with information sheets
about the study prior to the survey day and again on the
survey day. It was explained to the pupils that they could
withdraw from the study at any point up to returning the
sealed envelope after which their individual questionnaire
could no longer be identified (pupils were asked not to put
their name on the questionnaires or envelopes). They could
also choose to not answer any specific question that they did
not feel comfortable with.
Participation of young people
The active participation of young people beyond survey
completion in the HBSC international study is evolving. The
English team has adopted a participatory approach for the
conduct of the study, with young people from local schools
taking part in reference groups. Work with the reference
groups remains ongoing but their contribution focuses on
the following: questionnaire development (specific England
only questions), ethical sensitivity, design of the delivery
method of the survey, and interpretation of the analysis and
dissemination, especially to young people. Commentary
by young people on their meaning and interpretation of
the data is included in this report alongside the statistical
commentary.
The HBSC study, methods and demographics

10
Characteristics of pupils
Response rates
In total, there were 6181 eligible pupils registered in the
participating classes. Of those, 5679 returned at least
partially completed questionnaires resulting in a response
Table 1.1: Reasons for non-participation
rate of 92% at the pupil level. The reasons for non-
completion are recorded in table 1.1.
Grade and gender
After data cleaning and removal of invalid questionnaires
(i.e. spoiled or under completed), a total of 5335 pupils
remained in the survey. Table 1.2 shows a breakdown by
Table 1.2: Participating pupils by age and gender
gender and age for those for whom that information is not
missing.
Ethnicity
Table 1.3 show the proportions of participating pupils by
self-reported ethnicity against the population census data
for 2011.The age group 8 – 14 was used from the 2011
census as the 11, 13 and 15 year olds pupils who completed
the survey in 2013/14 would have fallen into this category
when the census was conducted in 2011. Overall, 90%
of the 2014 HBSC England sample reported being born in
England.
Pupil/ Parent refusals
135
Age
11 year olds
13 year olds
15 year olds
Total
Returned blank
25
Boy
1180 (56%)
759 (48%)
816 (51%)
2755 (52%)
Sickness
180
Girl
936 (44%)
834 (52%)
792 (49%)
2592 (48%)
Gender
Absent for other reasons
162
Total
2116 (100%)
1593 (100%)
1608 (100%)
5317 (100%)
N.B. 18 missing responses
HBSC England National Report

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Free school meals
Whether or not a young person is entitled to, and receives,
free school meals can be used as a proxy measure of
affluence. In the UK as a whole, around 15% of secondary
school pupils receive free school meals (Department for
Education, 2014). In HBSC England 2014, 13% of children in
state-funded schools reported receiving free school meals.
Weighting
Weighting was applied to the data to account for deviances
in gender and ethnicity proportions in our sample compared
to the national census.
Ethnicity
White British
Irish
Traveller of Irish heritage/
Gypsy/Roma
Any other white back ground
White and Black Caribbean
White and Black African
White and Asian
Any other mixed background
Indian
Pakistani
Bangladeshi
Any other Asian background
Black Caribbean
Black African
Any other black background
Chinese
Any other ethnic background
Don’t want to say
Don’t know
Boy
76.3%
0.3%
0.2%
3.0%
1.7%
0.6%
1.3%
1.0%
2.5%
3.5%
1.5%
1.8%
1.1%
2.6%
0.9%
0.4%
1.2%
n/a
n/a
Girls
76.2%
0.3%
0.2%
3.1%
1.8%
0.6%
1.3%
1.0%
2.5%
3.5%
1.5%
1.7%
1.1%
2.7%
1.0%
0.5%
1.2%
n/a
n/a
From 2011 census From HBSC England survey
Boy
66.6%
1.3%
0.5%
3.3%
7.0%
4.9%
1.5%
2.2%
1.5%
2.7%
13 (0.5%)
0%
1.1%
0.7%
1.8%
2.3%
0.5%
0.6%
1.0%
Girl
74.8%
0.6%
0.3%
2.9%
2.9%
3.4%
1.8%
1.4%
1.8%
2.2%
20 (0.8%)
0%
1.7%
0.7%
1.1%
1.8%
0.7%
0.3%
0.7%
Table 1.3: Participating pupils by age and ethnicity
N.B. 253 missing responses
The HBSC study, methods and demographics

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Presentation of findings
The report is made up of 9 chapters, including the context to
the study and introduction. The first chapters describe the
prevalence of significant health indicators and health related
behaviours. Subsequent chapters provide an overview of
the multiple environments of young people in England; their
family life, views on their community, experience of school
and relationships with peers.
Young people’s views and perspectives are also embedded
into this report, as the HBSC England team has worked
alongside young people to further our understanding of
the meaning of health and well-being for young people, as
well as expand our insights on the interpretation of the data
presented in this report.
References
Brooks, F., & Magnusson, J. (2006). Taking part counts: adolescents’ experiences of the transition from inactivity to active
participation in school-based physical education. Health Education Research, 21(6), 872–883.
Brooks, F., van der Sluijs, W., Klemera, E., Morgan, A., Magnusson, J., Nic Gabhainn, S., … Currie, C. (2009). Young people’s
health in Great Britain and Ireland. Findings from the health behaviour in school-aged children survey 2006. Hatfield:
University of Hertfordshire.
Cantril, H. (1965). The pattern of human concerns. New Brunswich, NJ: Rutgers University Press.
Christie, D., & Viner, R. (2005). Adolescent development. BMJ, 330(7486), 301–304.
Coleman, J. (2011). The nature of adolescence. East Sussex: Routledge.
Coleman, J., & Hagell, A. (2015). Young people , health and youth policy. Youth & Policy, 114, 17–30.
Currie, C., Griebler, R., Inchley, J., Theunissen, A., Molcho, M., Samdal, O., & Dur, W. (Eds.). (2010). Health Behaviour in
School-Aged Children (HBSC) Study protocol: Background, methodology and mandatory items for the 2009/10 survey.
Edinburgh & Vienna: CAHRU & LBIHPR.
Currie, C., Molcho, M., Boyce, W., Holstein, B., Torsheim, T., & Richter, M. (2008). Researching health inequalities in
adolescents: The development of the Health Behaviour in School-Aged Children (HBSC) Family Affluence Scale. Social Science
and Medicine, 66(6), 1429–1436.
Currie, C., Nic Gabhainn, S., Godeau, E., Roberts, C., Smith, R., Currie, D., … Barnekow, V. (Eds.). (2008). Inequalities in young
people’s health. HBSC international report from the 2005/2006 survey. Copenhagen: WHO Regional Office for Europe.
Department for Education. (2014). Schools, pupils, and their characteristics: January 2014. London: Department for
Education.
Department of Health. (2013). Annual report of the Chief Medical Officer 2012. Our children deserve better: Prevention pays.
Giedd, J. N. (2004). Structural magnetic resonance imaging of the adolescent brain. Annals of the New York Academy of
Sciences, 1021, 77–85.
Hagell, A., Coleman, J., & Brooks, F. (2013). Key data on adolescence 2013. London: Association for Young People’s Health.
Magnusson, J., Klemera, E., & Brooks, F. (2013). Life satisfaction in children and young people: meaning and measures. The
Child and Family Clinical Psychology Review, 1, 118–126.
Roberts, C., Freeman, J., Samdal, O., Schnohr, C. W., Looze, M. E., Nic Gabhainn, S., … Rasmussen, M. (2009). The Health
Behaviour in School-aged Children (HBSC) study: Methodological developments and current tensions. International Journal of
Public Health, 54(SUPPL. 2), 140–150.
Viner, R. M., & Barker, M. (2005). Young people’s health: the need for action. BMJ, 330(7496), 901–903.
Wessely, S. (2012). Putting adolescents at the centre of health and development. The Lancet, 379(9826), 1563–1564.
Wills, W. J., Appleton, J. V, Magnusson, J., & Brooks, F. (2008). Exploring the limitations of an adult-led agenda for
understanding the health behaviours of young people. Health & Social Care in the Community, 16(3), 244–252.
HBSC England National Report

13
Key messages
74% of all young people reported having high life
satisfaction and therefore could be considered as
thriving (score of 7-10 on a scale from 0-10).
There has been a significant decrease in the
proportions of older girls who can be said to be
thriving (i.e. report high life satisfaction) since
2002.
86% said that their physical health to be either
‘excellent’ or ‘good’.
Girls were more likely than their male peers to
report lower life satisfaction and a greater level
of symptoms that indicate high levels of stress.
22% of young people reported having a long
term illness, disability or medical condition.
Among young people with a disability or LTC
24% reported that their condition or disability
impacted negatively on their participation in
education.
Over 80% of young people reported that they
had visited their GP in the previous year. 75% of
young people agreed that at their last visit they
felt at ease with their GP. 52% of young people
felt that they are able to talk to their GP about
personal things.
Introduction
The World Health Organization defined health as
encompassing complete physical, social and mental well-
being3, however health policy for children and young people
has traditionally focused more on problem and health risk
behaviours than on positive aspects of health and well-
being (Ben-Arieh, 2008; Casas, 2011). For adolescents in
particular, the traditional risk behaviours such as substance
use and risky sexual practices are still very much a policy
priority (Department of Health, 2010). However, adolescent
health is effected by a wide variety of health issues which
can have a significant impact on day to day functioning and
overall well-being. For example, in 2010 almost half of 15
year old girls in England reported multiple health complaints
more than once a week (Currie et al., 2012). Further,
overall life satisfaction is an important indicator of general
well-being in young people (Magnusson et al., 2013), but
tends to decrease from early to mid-adolescence (Brooks,
Magnusson, Klemera, Spencer, & Morgan, 2011; Currie et
al., 2012).
Perceived health
Self-rated health
Measure
• Wouldyousayyourhealthis…?(Excellent,good,
fair, poor)
Overall, 86% of young people reported their physical health
to be currently ‘good’ or ‘excellent’. Boys were more likely
than girls to report their health as ‘good’ or ‘excellent’ (88%
v. 83%), although the proportions decline with age for both
genders (Figure 2.1).
Chapter 2 Health and Well-being
3 Preamble to the Constitution of the World Health Organization as adopted by the International Health Conference, New York, 19-22 June, 1946; signed on 22 July
1946 by the representatives of 61 States (Official Records of the World Health Organization, no. 2, p. 100) and entered into force on 7 April 1948.
“
I think 15 year olds are a lot less likely to
rate their health as good or excellent as in
general they are less physically active due to
school stress and other factors. ”
Tom, age 15
Health and Well-being

14
Figure 2.1: Young people who report their physical health to be ‘good’ or ‘excellent’
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Boys
Girls
11 years
91% 87% 85%
90%
80% 78%
13 years 15 years
Base: All respondents in 2014
Life satisfaction
Measure
• LifesatisfactionwasmeasuredusingtheCantril
Ladder (Cantril, 1965), where young people are
asked to pick a number from 0 (‘worst possible
life’) to 10 (‘best possible life’) presented as
steps on a ladder.
In previous use of the Cantril Ladder as a measure of life
satisfaction, high life satisfaction has been analysed on
the basis of a score on the Cantril ladder of 6 or above. In
this report the analysis has been adjusted to reflect new
research concerning the measurement of life satisfaction.
This new analysis is now considered to more accurately
reflect how subjective life satisfaction is experienced and
understood.4 Consequently, the following cut-off points
were applied to the life satisfaction data:
0 to 4 = Low life satisfaction, defined as suffering
5 to 6 = Medium life satisfaction, defined as potentially
struggling
7 to 10 = High life satisfaction, defined as thriving.
Overall, 74% of young people rated their life satisfaction
between 7 and 10 (high life satisfaction and were within the
thriving category.
Gender:
79% of boys and 69% of girls rated their life satisfaction as
high. Across all ages the proportion of girls who rated their
life satisfaction as 7 or above was lower than for boys and
this gendered difference becomes more pronounced with
age (Figure 2.2).
Age:
Younger adolescents were more likely to rate their life
satisfaction as 7 and above (Figure 2.2). Generally, 15 year
olds (remaining consistent with previous surveys) have the
lowest life satisfaction among all groups with both boys and
girls reporting a decrease since 2010 (Figure 2.3).
4 http://www.gallup.com/poll/122453/understanding-gallup-uses-cantril-scale.aspx (Accessed 04/08/2015)
HBSC England National Report

15
Figure 2.2: Thriving: Proportions of young people rating their life satisfaction as high (score 7-10)
Figure 2.3: Thriving 2002-2014: 15 year olds who rate their life satisfaction as high (score 7-10)
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Boys
Girls
Boys
Girls
11 years
2002
73%
65%
81%
67%
81%
69%
74%
55%
83% 80% 74%
81%
69%
55%
13 years
2006 2010
15 years
2014
Base: All respondents in 2014
Base: Respondents aged 15 years in 2002, 2006, 2010 and 2014
Health and Well-being

16
Figure 2.4: Potentially struggling: Proportions of young people who rate their life satisfaction as
medium (5-6)
50%
45%
40%
35%
30%
25%
20%
15%
10%
5%
0%
Boys
Girls
11 years
11%
16% 19%
14%
20%
29%
13 years 15 years
Base: All respondents in 2014
Older young people and girls of all ages were more likely than their younger peers to rate their life satisfaction as 5 or 6
(potentially struggling (Figure 2.4)).
Girls were more likely than boys to rate their life satisfaction as low (0-4). This gender difference also increased with age,
with 15 year olds much more likely to report low life satisfaction (between 0 and 4)
“
As you get older life seems to get more
depressing. You become more aware of
things in the world and have more pressure
put on you. Also people start getting pressure
to know about their future which can be very
stressful and scary.”
Katie-Lou, age 16
HBSC England National Report

17
50%
45%
40%
35%
30%
25%
20%
15%
10%
5%
0%
Boys
Girls
11 years 13 years 15 years
Base: All respondents in 2014
Figure 2.5: suffering: Proportions of young people rating their life satisfaction as low (score 0-4)
6% 5% 7%
5%
11%
16%
“
The increasing commitments make many
teenagers more stressed in their daily lives,
as they have many things to do and think
about, as well as the stress of being constant-
ly reminded that their GCSE’s should basically
become their lives, as they will decide their
lives further on. This leave very little free time
for them, and therefore they have no chance
to just relax and clear
their mind.”
Vato, age 15
Health and Well-being

18
Health complaints
Measures
• Inthelast6months:howoftenhaveyouhad
the following? (About every day, more than
once a week, about every week, about every
month, rarely or never)
o Headache
o Stomach ache
o Back ache
o Feeling low
o Irritability
o Feeling nervous
o Sleeping difficulties
o Feeling dizzy
o Headache
Overall, 65% of young people (59% of boys and 71% of girls) reported experiencing at least one health complaint on a weekly
basis. Among all young people the incidence of reported health complaints tended to increase by age, and was higher among
girls than boys. The increase by age was also higher among girls for all types of symptoms (Table 2.1).
Health complaint
Headache
Stomach ache
Backache
Feeling low
Irritability
Feeling nervous
Sleeping difficulties
Feeling dizzy
Boys
22%
12%
15%
18%
32%
25%
29%
14%
Boys
19%
12%
10%
14%
26%
22%
29%
13%
Boys
24%
11%
15%
15%
32%
25%
28%
13%
Boys
24%
12%
22%
25%
41%
29%
30%
16%
Girls
35%
23%
20%
34%
38%
37%
39%
22%
Girls
24%
19%
11%
18%
22%
26%
31%
15%
Girls
38%
24%
22%
36%
41%
40%
37%
24%
Girls
48%
28%
30%
54%
56%
47%
49%
28%
Total
29%
18%
18%
26%
35%
31%
34%
18%
All ages 11 year olds 13 year olds 15 year olds
Table 2.1 Young people reporting experiencing health complaints at least once a week
HBSC England National Report

19
Multiple health complaints
Half of all young people (50%) reported experiencing 2 or
more health complaints at least once a week. Girls were
more likely than boys to report multiple health complaints
(57% v. 44%). The proportion of young people who reported
experiencing 2 or more health complaints at least once a
week increased with age among both boys and girls (Figure
2.6).
The proportion of young people reporting 2 or more health complaints at least once a week has decreased since 2002. In all
surveys girls were more likely to report multiple health complaints than boys (Figure 2.7).
Figure 2.6: Young people who experience 2 or more health complaints at least once a week
Figure 2.7: Young people who reported experiencing 2 or more health complaints at least once a week:
2002-2014
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Boys
Girls
Boys
Girls
11 years
2002
67%
62% 58%
51%
60%
50%
57%
44%
41% 43% 49%
44%
59%
72%
13 years
2006 2010
15 years
2014
Base: All respondents in 2014
Base: All respondents in 2002, 2006, 2010 and 2014
Health and Well-being

20
Emotional well-being
Measures
• Thinkingaboutthelastweek…(Never,Rarely,
Quite often, Very often, Always)
o Have you felt full of energy?
o Have you felt lonely?
o Have you been able to pay attention?
Young people were asked about a number of issues relating
to emotional well-being including feeling full of energy,
feeling able to pay attention and feeling lonely (table 2.2).
Nearly two thirds (65%) of young people reported good
concentration and focus and had been able to pay attention
“very often” or “always” during the last week. Overall,
gender differences were small; 66% of boys compared
with 63% of girls. Feeling able to pay attention was most
commonly reported among younger adolescents (Table 2.2).
Around half (51%) of young people said they felt full of
energy “very often” or “always” during the previous week.
Girls were less likely to report high levels of energy (feeling
full of energy); 57% of boys compared with 45% of girls.
Feeling energised decreased with age among both boys and
girls; however among girls the decline is steeper, with the
gender difference being considerably more prominent at 15
years old (Table 2.2).
8% of young people said they had felt lonely in the last week.
Feelings of loneliness increased only slightly with age among
boys, whereas girls’ reports of loneliness show a more
dramatic increase across the three age categories (Table 2.2)
Felt able to pay
attention
Felt full of energy
Felt lonely
Boys
66%
57%
5%
Boys
76%
67%
4%
Boys
65%
55%
5%
Boys
54%
45%
7%
Girls
63%
45%
11%
Girls
80%
63%
5%
Girls
62%
44%
11%
Girls
44%
23%
19%
Total
65%
51%
8%
All ages 11 year olds 13 year olds 15 year olds
Table 2.2: Self-reported emotions and feelings (during past week)
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21
Primary health care service use
Measure
• HaveyouvisitedyourGP/doctorinthelast
year? (Yes/no)
• Herearesomestatementsaboutyourlastvisit
to your GP/doctor. Please show how much you
agree or disagree with each one. Please tick
one box for each line
o I felt at ease with my GP/doctor
o My GP/doctor treated me with respect
o The explanations my GP/Doctor gave me
were of good quality
• DoyoufeelabletotalktoyourGP/doctor
about personal things? (Yes/no)
Questions on young people’s experience of
primary health care services were included for the
first time in 2014
Visited GP last year
Overall, 80% of young people reported that they had visited their GP in the last year (78% of boys and 82% of girls) although
this decreased with age indicating possibly a transition from parental accompanied visits to independent appointments. Girls
were more likely than boys to have visited a GP at all ages (Figure 2.8).
Figure 2.8: Young people who have visited their GP in the last year
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Boys
Girls
11 years
80% 78% 76%
83% 82% 81%
13 years 15 years
Base: All respondents in 2014
Health and Well-being

22
Feeling at ease with GP
Overall, the majority (75%) of young people reported feeling
at ease with their GP at the last visit (78% of boys and 72%
of girls). The proportion of young people who reported
feeling at ease with their GP did however decrease with age,
and girls were less likely to report feeling at ease with their
GP than boys across all ages (Figure 2.9).
Respect from GP
Overall 89% of young people reported that they felt their GP
treated them with respect at their last visit (89% of boys and
90% of girls). No age or gender differences were observed
(Figure 2.10).
Figure 2.9: Young people who reported feeling at ease with their GP (last visit)
100%
80%
60%
40%
20%
0%
Boys
Girls
11 years
82% 76% 75%
77% 71% 67%
13 years 15 years
Base: All respondents in 2014
Figure 2.10: Young people who reported that their GP treated them with respect
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Boys
Girls
11 years
90% 89% 87%
90% 90% 89%
13 years 15 years
Base: All respondents in 2014
HBSC England National Report

23
GP’s explanations
Overall, 83% of young people reported they were happy
with the quality of explanations provided by their GP (84% of
boys and 82% of girls) although this decreased with age and
was smaller among girls than boys at all ages (Figure 2.11).
Discussing personal issues
Just over half (52%) of young people said that they are able to talk to their GP about personal issues (53% of boys and
50% of girls). (Figure 2.12).
Figure 2.11: Young people who reported they were happy with the quality of the GP’s explanations (at
last visit)
Figure 2.12: Proportions of young people who said that they were able to talk to their GP about personal
issues
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Boys
Girls
Boys
Girls
11 years
11 years
86%
55%
86%
51%
80%
52%
85%
50%
83%
51%
77%
49%
13 years
13 years
15 years
15 years
Base: All respondents in 2014
Base: All respondents in 2014
Health and Well-being

24
Long term condition or disability
Measures
• Doyouhavealongtermillness,disabilityor
medical condition that has lasted for 6 months
or longer (like diabetes, asthma, arthritis,
allergy or epilepsy) that has been diagnosed
 byadoctor?(Yes/No)
• Ifyouhavealongtermillness,disability 
or medical condition, do you have any of the
following..? (I do not have a long term illness,
asthma, diabetes, epilepsy, ADHD/ADD,
Physical disability, other...)
• Doyoutakemedicineforyourlong-term
illness, disability or medical condition? (I do
 nothave/Yes/No)
• Doesyourlongtermillness,disabilityor
medical condition affect your attendance
and participation at school? (I do not have/
 Yes/No)
Overall, 23% of young people reported having long term illness or disability (23% of boys and 22% of girls).
Type of condition or disability
About half (49%) of those young people who reported that they have a long term disability or condition described their
condition as Asthma (Table 2.3).
Taking medication
Of those who reported having a long term condition, 59% of young people reported taking some kind of medication (58% of
boys and 60% of girls).
Asthma
Diabetes
Epilepsy
ADHD
Physical disability
Other disability
Boys
50%
2%
2%
8%
3%
32%
Boys
49%
1%
2%
8%
1%
31%
Boys
50%
2%
1%
5%
5%
33%
Boys
52%
2%
2%
11%
4%
33%
Girls
47%
3%
2%
4%
2%
40%
Girls
43%
1%
2%
2%
2%
38%
Girls
46%
6%
2%
7%
3%
45%
Girls
54%
2%
2%
5%
2%
35%
Total
49%
2%
2%
6%
3%
36%
All ages 11 year olds 13 year olds 15 year olds
Table 2.3 Type of condition or disability
HBSC England National Report

25
School attendance
Of those who reported having a long-term illness or
disability, 24% said that their condition affected their ability
to attend and participate in school (24% of boys v. 25% of
girls). Some age and gender differences were observed;
among the youngest group boys were more likely to report
having a long term condition that impacted negatively on
their participation in education whereas among 13 and 15
year olds girls were slightly more likely to report a negative
impact on their ability to access education (Figure 2.13).
Summary
The majority of young people rated their health as good or
excellent, although the proportions doing so decreased with
age, and among older adolescents boys were more likely
than girls to rate their health as high.
The majority of 11 year olds also rated their life satisfaction
as high, but again this decreased with age and particularly
among girls, so that by age 15 only slightly more than half of
the girls rated their life satisfaction as high.
While the proportion of boys that rated their life satisfaction
in the lowest third remained similar from age 11 to 15,
the proportion substantially with age among girls. The
proportion of young people rating their life satisfaction in
the highest third has also decreased among girls, but not
boys, from 2002 to 2014.
A similar pattern was found for experience of weekly health
complaints; older adolescents (and girls in particular)
were more likely to report experiencing multiple health
complaints. Taken together, this supports previous evidence
that both physical and emotional well-being declines during
the course of adolescence, and that girls are particularly
affected (Currie et al., 2012). However, while girls were less
likely to rate their life satisfaction as high in 2014 compared
to 2002, both boys and girls showed a decrease in reports of
multiple health complaints from 2002-2014. This suggests
that emotional well-being may be decreasing while physical
health is improving. Consequently emotional health should
be of particular concern to policy makers.
A majority of the young people reported having been to see
their GP in the past year, and most said they felt at ease with
their GP, that they were treated with respect, and that they
were given good explanations by their GPs. Only around half
however felt able to discuss personal matters with their GP,
suggesting that some things might not be brought up during
a consultation. This could be particularly true for issues
related to emotional well-being since adolescents tend to
see their health care providers as being there for purely
physical, rather than social or emotional, health (Booth et
al., 2004).
Among those young people that reported suffering from
some form of long term condition or disability, around
a quarter said that their condition affected their school
attendance or participation, indicating that there is a need
for ensuring those young people are well supported by both
the health care and school community.
Figure 2.13: Young people reporting that their disability or longterm condition impacted negatively on
school attendance/participation
50%
45%
40%
35%
30%
25%
20%
15%
10%
5%
0%
Boys
Girls
11 years
25% 23% 23%
17%
29% 29%
13 years 15 years
Health and Well-being

26
Young people who participated in the reference groups and
who discussed the findings thought that students may rate
their life satisfaction lower as they got older because with
age life becomes increasingly stressful; in particular because
there is more pressure from school and the responsibility
of making decisions that will affect you in the future. Both
boys and girls thought that the reason girls report lower life
satisfaction is because there is more pressure on girls to do
well in school and to be popular- girls are subject to harsher
judgement by their peers and in some cases teachers.
The young people who participated in the reference groups
also saw stress as a reason why health complaints are more
prominent among girls and increase with age, as stress could
lead to headaches, trouble sleeping etc. Some of the boys
felt that boys were more likely to rate their health as good
because they tend to do more sports and physical activity
that provided a sense of body confidence and physical
fitness.
References
Ben-Arieh, A. (2008). The child indicators movement: Past, present, and future. Child Indicators Research, 1(1), 3–16.
Booth, M. L., Bernard, D., Quine, S., Kang, M. S., Usherwood, T., Alperstein, G., & Bennett, D. L. (2004). Access to health care
among Australian adolescents young people’s perspectives and their sociodemographic distribution. Journal of Adolescent
Health, 34(1), 97–103.
Brooks, F., Magnusson, J., Klemera, E., Spencer, N., & Morgan, A. (2011). HBSC England national report: Findings from the
2010 HBSC study for England. Hatfield: University of Hertfordshire.
Cantril, H. (1965). The pattern of human concerns. New Brunswich, NJ: Rutgers University Press.
Casas, F. (2011). Subjective social indicators and child and adolescent well-being. Child Indicators Research, 4(4), 555–575.
Currie, C., Zanotti, C., Morgan, A., Currie, D., de Looze, M., Roberts, C., … Barnekow, V. (Eds.). (2012). Social determinants of
health and well-being among young people. Health Behaviour in School-aged Children (HBSC) study: international report from
the 2009/2010 survey. Copenhagen: WHO Regional Office for Europe.
Department of Health. (2010). Healthy lives, healthy people: our strategy for public health in England. London: Department of
Health.
Magnusson, J., Klemera, E., & Brooks, F. (2013). Life satisfaction in children and young people: meaning and measures. The
Child and Family Clinical Psychology Review, 1, 118–126.
Young people’s thoughts and comments on health and well-being
HBSC England National Report

27
Key messages
The overall proportion of young people who
report eating breakfast everyday has increased
among both boys and girls from 2002 to 2014.
Around 13% report never eating breakfast on
school days and gender differences persist with
fewer girls eating breakfast into 2014.
38% of respondents reported meeting the
government recommendations of eating five
portions of fruit and vegetables every day.
46% of 11 year olds, 35% of 13 year olds and 31%
of 15 year olds reported eating five portions of
fruit and vegetables a day.
22% of young people reported eating sweets
every day. Older adolescents are more likely to
report eating sweets daily.
21% of young people reported drinking squash
that contains sugar at least once a day.
14% of young people aged 11-15 reported
consuming energy drinks at least 2-4 times a
week and 5 % of all young people reported
drinking energy drinks at least daily.
Across all age groups a higher proportion of boys
than girls reported consuming energy drinks,
either once a day or at least 2-4 times a week.
17% of young people reported eating at a fast
food restaurant at least once week.
Boys are more likely to eat in fast food outlets
than girls
22% of young people reported not having
enough sleep to feel awake and concentrate
on school work during the day, 25% of girls
compared with 19% of boys
60% of boys and 52% of girls reported they felt
their body was about the right size.
Girls were more likely than boys to report
engaging in weight reducing behaviour; 17% of
girls compared with 11% of boys said they were
doing something to lose weight. The proportions
of girls reporting they are on a diet has declined
since 2002.
Overall 19% of young people meet the
recommended guidelines for physical activity,
22% of boys compared to 15% of girls. This figure
for girls has remained relatively unchanged since
2002, but has decreased slightly for boys since
2010.
Chapter 3 Health Behaviours
Healthy Behaviours

28
Introduction
A balanced diet during childhood and adolescence is
important for good health and development, and can
prevent both immediate and long term health problems
such as obesity and heart disease. As young people move
from childhood through to adolescence they begin to
have more control over their own food and drink choices
(Cooke et al., 2005) and the eating habits young people
adopt are often carried through to adulthood (Lien, Lytle,
& Klepp, 2001), so it is important healthy eating habits are
established. A healthy diet should include eating breakfast
regularly since breakfast eating has been associated with
healthy body weight, good school performance and life
satisfaction (Rampersaud, Pereira, Girard, Adams, & Metzl,
2005).
A number of studies have identified high prevalence of
dieting and attempted weight loss among adolescents,
even among those of normal weight and particularly among
girls (Balding & Regis, 2010). The connection between
body image, body confidence, and dietary patterns is an
important issue for girls’ health and may be associated with,
for example, the low levels of breakfast consumption and
the slightly higher prevalence of regular smoking among
teenage girls (Austin & Gortmaker, 2001).
Being physically active has proven physical health, emotional
well-being and social benefits (Brooks, Smeeton, Chester,
Spencer, & Klemera, 2014). Extensive research on young
people’s physical activity demonstrates that an active
lifestyle is associated with improved cardiovascular health,
muscle and bone strength, maintenance of a healthy
body weight and positive mental health (Strong et al.,
2005). Adopting an active lifestyle during childhood and
adolescence is important as these behaviours have been
shown to track into adulthood (Telama, 2009). The World
Health Organization recommends young people engage in at
least one hour of moderate physical activity per day (World
Health Organization, 2010). Despite the proven benefits of
an active lifestyle, only a minority of young people across
Europe and North America meet the recommended levels
of physical activity (Currie et al., 2012). Moreover, physical
activity levels are known to decline with age (Dumith,
Gigante, Domingues, & Kohl, 2011) and be particularly low
among adolescent girls (Hallal et al., 2012).
Lack of sleep, or poor sleep, has been associated with poorer
health and well-being, including increased risk of obesity
(Cappuccio et al., 2008) and reduced memory skills (Steenari
et al., 2003). Research indicates sufficient sleep is also
important for school performance (Perkinson-Gloor, Lemola,
& Grob, 2013). Sleep duration during adolescence often
decreases due to biological maturation and environmental
influences such as increased autonomy (Crowley, Acebo, &
Carskadon, 2007). The amount of sleep needed for optimal
functioning varies by age, but a minimum of 8.5 hours per
night has been recommended for teenagers5.
5 http://sleepfoundation.org/sleep-topics/teens-and-sleep (Accessed 04/08/15)
HBSC England National Report

29
Diet and nutrition
Measure
• Howoftendoyouusuallyhavebreakfast
(more than a glass of milk or fruit juice) on
 weekdays?(Never/1dayaweek/2days/3
days/4 days/5 days)
• Howmanytimesaweekdoyouusuallyeat
and drink: fruits, vegetables, sweets (candy
or chocolate), fizzy drinks, squash, energy
 drinks,vegetable(Never/lessthanoncea
week/ once a week. 2-4 days a week/ 5-6 days
a week/ once a day, every day/ every day,
more than once)
• Doyoueatatleast5portionsoffruitor 
 vegetablesaday?(Yes/No)
• Howoftendoyoueatinafastfoodrestaurant?
E.g. McDonalds, Burger King, Subway, KFC
 (Never/lessthanonceamonth/oncea 
month/ 2-3 times a month/ once a week/ 2-4
days/5 or more days a week)
Eating breakfast
Around two thirds (67%) of young people reported eating
breakfast every day during the week. Eating breakfast
every day during the week was more common in younger
adolescents; 78% of 11 year olds, 61% of 13 year olds and
57% of 15 year olds. Boys of all ages were more likely than
girls to report eating breakfast every day during the week
(74% v. 60%), but both boys and girls showed a similar
pattern of decline as they get older (Figure 3.1). This
gendered pattern has been consistently evident since 2002,
with girls much less likely to eat breakfast every day during
the week (Figure 3.2). However, the overall proportion of
young people who report eating breakfast every day has
increased among both boys and girls over the period 2002 to
2014 (Figure 3.2).
Figure 3.1: Young people who said they eat breakfast every day during the week
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Boys
Girls
11 years
83%
71% 65%
74%
50% 49%
13 years 15 years
Base: All respondents in 2014
“
I think that, generally, boys have fewer
things to do in the morning so they have
more time to eat breakfast, whereas girls will
spend more time in the morning doing make
up or other similar things.”
Sam, age 15
Healthy Behaviours

30
Figure 3.2: Young people who eat breakfast every day during the week 2002 - 2014
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Boys
Girls
2002
64%
49%
71%
59%
67%
55%
74%
60%
2006 2010 2014
Base: All respondents in 2002, 2006, 2010 and 2014
Overall 13% of young people said they never eat breakfast
during the week. Never eating breakfast was more common
in older adolescents; 6% of 11 year olds, 17% of 13 year olds
and 19% of 15 year olds. Girls were more likely than boys to
report never eating breakfast during the week (17% v. 9%).
Never eating breakfast was more common among girls than
boys across all three age categories, and for both genders
the proportion of young people reporting they never eat
breakfast increased with age (Figure 3.3). Since 2002 there
appears to be a slight decreasing trend among boys saying
they never eat breakfast, but girls’ reporting has remained
stable across the past three survey rounds (Figure 3.4).
Figure 3.3: Young people who said they never eat breakfast during the week
50%
45%
40%
35%
30%
25%
20%
15%
10%
5%
0%
Boys
Girls
11 years
4%
11% 14%
8%
22% 24%
13 years 15 years
Base: All respondents in 2014
HBSC England National Report

31
Figure 3.4: Young people who report never eating breakfast during the week: 2002 - 2014
50%
45%
40%
35%
30%
25%
20%
15%
10%
5%
0%
Boys
Girls
2002
25%
17%
17%
11%
17%
12%
17%
9%
2006 2010 2014
Base: All respondents in 2002, 2006, 2010 and 2014
Fruit and vegetable intake
Overall, 38% of young people reported eating fruit at least
once every day. There were small differences between boys
and girls; 37% of boys compared to 40% of girls said they
eat fruit at least once a day. 11 year olds were most likely to
report eating fruit every day; 42% of 11 year olds, 36% of 13
year olds and 36% of 15 year olds. For both genders
younger adolescents were most likely to report daily fruit
consumption; however eating fruit at least once a day
decreased consistently with age for boys only (Figure 3.5).
Since 2006 there has been a gradual decline in girls’ daily
fruit consumption (Figure 3.6).
Figure 3.5: Young people who report eating fruit every day
50%
45%
40%
35%
30%
25%
20%
15%
10%
5%
0%
Boys
Girls
11 years
41%
35% 33%
42%
37% 39%
13 years 15 years
Base: All respondents in 2014
Healthy Behaviours

32
Figure 3.6: Eating fruit every day 2002 - 2014
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Boys
Girls
2002
29%
25%
48%
39%
44%
36%
40%
37%
2006 2010 2014
Base: All respondents in 2002, 2006, 2010 and 2014
Overall 43% of young people said they eat vegetables at
least once every day. Similarly to fruit, girls were more likely
than boys to report eating vegetables daily (46% v. 40%).
There were minimal differences across the three ages,
however older adolescents were somewhat less likely to eat
vegetables every day; 44% of 11 year olds, 44% of 13 year
olds and 41% of 15 year olds. Across all three age categories
girls were more likely than boys to report daily vegetable
consumption (Figure 3.7). There were no consistent trends
in vegetable consumption between 2002 and 2014, however
across the four time points girls were consistently more
likely than boys to eat vegetables at least once a day (Figure
3.8).
“
[11-year olds] are more likely to eat with
their parents and listen to them than 15 year
olds. They are also a lot less independent so
won’t go to the shops to get food or make
their own tea or lunch meaning that they
have to eat what their parents give them
which is likely to be more healthy.”
Tom, age 15
HBSC England National Report

33
Figure 3.8: Eating vegetables every day 2002 - 2014
50%
45%
40%
35%
30%
25%
20%
15%
10%
5%
0%
Boys
Girls
2002
31%
26%
46%
39%
44%
37%
46%
40%
2006 2010 2014
Base: All respondents in 2002, 2006, 2010 and 2014
Figure 3.7: Young people who report eating vegetables every day
50%
45%
40%
35%
30%
25%
20%
15%
10%
5%
0%
Boys
Girls
11 years
42% 40% 38%
47% 48% 45%
13 years 15 years
Base: All respondents in 2014
38% of respondents reported meeting the government
recommendations of eating five portions of fruit and
vegetables every day. There were minimal gender
differences; 38% of boys and 39% of girls reported meeting
the government recommendation. 11 year olds were
considerably more likely to report eating five portions of
fruit and vegetables a day; overall 46% of 11 year olds, 35%
of 13 year olds and 31% of 15 year olds. The age difference
was evident for both genders; likelihood of meeting the
government recommendation decreased with age (Figure
3.9).
Healthy Behaviours

34
Figure 3.9: Young people who report eating 5 portions of fruit /vegetables a day
Figure 3.10: Young people who eat sweets every day
50%
45%
40%
35%
30%
25%
20%
15%
10%
5%
0%
50%
45%
40%
35%
30%
25%
20%
15%
10%
5%
0%
Boys
Girls
Boys
Girls
11 years
11 years
45%
20%
35% 35%
23%
30%
23%
47%
20%
27%
32%
23%
13 years
13 years
15 years
15 years
Base: All respondents in 2014
Base: All respondents in 2014
Consumption of sweets, sugary drinks and fast food
About one fifth (22%) of young people reported eating
sweets every day. Younger adolescents were least likely
to report eating sweets daily; 20% of 11 year olds, 25% of
13 year olds and 23% of 15 year olds. Overall there were
minimal differences between boys and girls (22% of boys
v. 23% of girls); however at age 13 girls were somewhat
more likely than boys to report daily sweet consumption
(Figure 3.10). Daily sweet consumption has decreased in
both boys and girls from 2002 to 2014 (Figure 3.11).
HBSC England National Report

35
Figure 3.12: Young people who drink sugary carbonated drinks daily
50%
45%
40%
35%
30%
25%
20%
15%
10%
5%
0%
Boys
Girls
11 years
12% 15% 17%
9%
16%
12%
13 years 15 years
Base: All respondents in 2014
Figure 3.11: Eating sweets daily 2002 - 2014
50%
45%
40%
35%
30%
25%
20%
15%
10%
5%
0%
Boys
Girls
2002
32%
31% 25%
23%
27%
24% 23%
22%
2006 2010 2014
Base: All respondents in 2002, 2006, 2010 and 2014
13% of young people reported daily consumption of sugary
carbonated drinks (e.g. Cola or Lemonade). Overall there
were small gender differences; 14% of boys compared with
12% of girls reported drinking sugary carbonated drinks at
least once a day. Younger adolescents were less likely to
drink sugary carbonated drinks every day; 11% of 11 year
olds, 16% of 13 year olds and 15% of 15 year olds (Figure
3.12).
Healthy Behaviours

36
21% of young people reported drinking squash that contains
sugar at least once a day. There were no overall differences
between boys and girls reporting drinking squash daily.
There were minimal overall differences across the age
groups; 21% of 11 year olds, 22% of 13 year olds and 20% of
15 year olds (Figure 3.13).
In terms of consumption of drinks collectively known as
energy drinks (Red Bull, Monster etc), 14% of young people
aged 11-15 reported consuming energy drinks at least 2-4
times a week and 5% of all young people reported drinking
energy drinks at least daily. Just over half (53%) reported
that they never consumed energy drinks.
Boys were more likely to consume energy drinks every day
than girls, and girls were more likely to report they never
consumed energy drinks. Across all age groups a higher
proportion of boys than girls reported consuming energy
drinks, either once a day or at least 2-4 times a week (table
3.1).
Figure 3.13: Young people who consume squash that contains sugar daily
50%
45%
40%
35%
30%
25%
20%
15%
10%
5%
0%
Boys
Girls
11 years
21% 21% 22%22% 24%
18%
13 years 15 years
Base: All respondents in 2014
Never
At least 2 – 4 days
a week
At least once a day
Boys
44%
18%
5%
Boys
54%
15%
5%
Boys
42%
20%
5%
Boys
35%
19%
6%
Girls
62%
10%
3%
Girls
70%
7%
2%
Girls
59%
12%
5%
Girls
55%
12%
4%
Total
53%
14%
5%
All ages 11 year olds 13 year olds 15 year olds
Table 3.1 Energy drink consumption patterns by age and gender
HBSC England National Report

37
17% of young people reported eating at a fast food outlet
at least once week. Overall, boys were slightly more likely
than girls to report eating at a fast food restaurant weekly
(18% v. 16%). For both genders younger adolescents were
less likely to report eating in a fast food restaurant; 14% of
11 year olds, 19% of 13 year olds and 19% of 15 year olds.
For boys the likelihood of weekly dining at a fast food outlet
increases with age, whereas reports of eating at a fast food
restaurant weekly peak at 13 years old in girls (Figure 3.14).
4% of young people reported eating at a fast food outlet at
least twice a week, with minimal overall gender differences
(5% of boys v. 4% of girls).
Figure 3.14: Young people who eat in a fast food outlet at least once a week
50%
45%
40%
35%
30%
25%
20%
15%
10%
5%
0%
Boys
Girls
11 years
16% 18% 22%
13%
21% 17%
13 years 15 years
Base: All respondents in 2014
Healthy Behaviours

38
Sleep
Measure
• Whattimedoyouusuallygotosleepona
school night? (open ended)
• Whattimedoyouusuallywakeupona 
school day? (open ended)
• Istheamountofsleepyounormallyget 
enough for you to feel awake and concentrate
 onyourschoolwork?(Yes/No)
Nearly three quarters (73%) of young people reported
having at least 8.5 hours sleep on school nights. There
were minimal gender differences; 74% of boys compared
with 72% of girls. However there were considerable age
differences; with 11 year olds nearly twice as likely as 15
year olds to sleep for 8.5 hours on school nights. Reports of
sleeping for 8.5 hours decreased with age for both genders
(Figure 3.15).
Around one fifth (22%) of young people reported not
having enough sleep to feel awake and concentrate on their
school work during the day. Overall, girls were more likely
to report not having enough sleep (25% of girls v. 19% of
boys). Younger adolescents were least likely to say they
do not have enough sleep to feel awake and concentrate
on their school work; 12% of 11 year olds, 22% of 13 year
olds and 36% of 15 year olds. Reports of not having enough
sleep increased with age for both genders, however girls
demonstrated the largest increase (Figure 3.16).
Figure 3.15: Young people who have at least 8.5 hours sleep on school nights
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Boys
Girls
11 years
93%
74%
48%
93%
73%
46%
13 years 15 years
Base: All respondents in 2014
“
Loss of sleep affects your concentration
levels and motivation in class, you will know if
you can’t focus right.”
Tara, age 14
HBSC England National Report

39
Figure 3.16: Young people who do not have enough sleep to be able to concentrate on school work
50%
45%
40%
35%
30%
25%
20%
15%
10%
5%
0%
Boys
Girls
11 years
13%
19%
29%
11%
25%
43%
13 years 15 years
Base: All respondents in 2014
“
15 year olds are most likely to say they
don’t have enough sleep because they
worry and stress about their future, and
mainly exams. However, some parents
allow their children phones and other
electronic devices upstairs, and this is
what also keeps them up.”
Pippa, age 13
Healthy Behaviours

40
Body image
Measure
• Doyouthinkyourbodyis…?(muchtoothin/a
bit too thin/ about the right size/a bit too fat/
much too fat)
• Atpresentareyouonadietofdoing 
 somethingelsetoloseweight?(No,myweight
 isfine/No,butIshouldlostsomeweight/No,
because I need to put on weight/Yes)
Just over half (56%) of young people reported their body
weight was “about the right size”. Overall, boys were more
likely to report their body being “about the right size” (60%
of boys v. 52% of girls). Younger adolescents were more
likely to say their body weight was “about the right size”;
64% of 11 year olds, 55% of 13 year olds and 47% of 15 year
olds. This age difference was present for both boys and
girls – the likelihood of believing your body is the “right size”
decreased with age in both boys and girls, and across all
three age groups girls were less likely to report their body to
be the right size (Figure 3.17).
Around 15% of all young people reported their body was
“too thin”. Overall, boys were more likely than girls to say
they thought their body was “too thin” (18% of boys v.
11% of girls). Boys and girls show different patterns across
the three age groups; for boys the likelihood of reporting
their body was “too thin” increased with age, but for girls it
decreased with age (Figure 3.18).
Figure 3.17: Young people who feel their body is “about the right size”
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Boys
Girls
11 years
66% 60% 53%
62%
49% 41%
13 years 15 years
Base: All respondents in 2014
HBSC England National Report

41
30% of young people reported their body was “too fat”.
Overall, girls were more likely to report their body shape
as being “too fat”; 38% of girls compared with 22% of boys.
Perceiving current body shape as “too fat” increased with
age for both boys and girls, but the increase among girls was
more dramatic (Figure 3.19).
Figure 3.18: Young people who feel their body is “too thin”
Figure 3.19: Young people who feel their body is “too fat”
50%
45%
40%
35%
30%
25%
20%
15%
10%
5%
0%
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Boys
Girls
Boys
Girls
11 years
11 years
15%
20%
18%
23%
23%
24%
12%
26%
11%
40%
9%
50%
13 years
13 years
15 years
15 years
Base: All respondents in 2014
Base: All respondents in 2014
Healthy Behaviours

42
Since 2002, the proportion of boys and girls who report that their body is “too fat” has remained relatively stable; across all
four time periods girls were more likely to report their body as being “too fat” (Figure 3.20).
Overall, 14% of young people reported that they were
currently on a diet or doing something to lose weight. Girls
were more likely than boys to report engaging in weight
reducing behaviour (17% of girls v. 11% of boys). The
proportion of girls who reported being on a diet or doing
something to lose weight increased with age, and the gender
difference is most pronounced at the age of 15 years (Figure
3.21).
Since 2002 girls have been up to twice as likely as boys
to report currently being on a diet or engaging in weight
reducing behaviour, however girls’ dieting reports in 2014
are the lowest they have been since 2002 (Figure 3.22).
Interestingly, this decrease in girls reporting that they are on
a diet or doing something to lose weight was not mirrored
by a decrease in girls who think their body is “too fat”
(Figure 3.20).
Figure 3.20: Young people who feel they are “too fat” 2002 - 2014
50%
45%
40%
35%
30%
25%
20%
15%
10%
5%
0%
Boys
Girls
2002
40%
25%
36%
24%
39%
22%
38%
22%
2006 2010 2014
Base: All respondents in 2002, 2006, 2010 and 2014
Figure 3.21: Young people currently on a diet or doing something to lose weight
50%
45%
40%
35%
30%
25%
20%
15%
10%
5%
0%
Boys
Girls
11 years
12% 12% 9%
12% 15%
25%
13 years 15 years
Base: All respondents in 2014
HBSC England National Report

43
Figure 3.22: Young people on a diet or doing something to lose weight 2002 - 2014
50%
45%
40%
35%
30%
25%
20%
15%
10%
5%
0%
Boys
Girls
2002
19%
9%
18%
9%
21%
10%
17%
11%
2006 2010 2014
Base: All respondents in 2002, 2006, 2010 and 2014
“
There is so much pressure on teenage
girls to look perfect especially from the media
and other girls. Magazines show you how
to look and try to “improve” your image
constantly, and are mostly, if not always
aimed at girls.”
Katie-Lou, age 16
Healthy Behaviours

44
Physical activity
Measures
• Overthepast7days,onhowmanydayswere
you physically active for a total of at least 1
hour (60 minutes) per day? (0/1/2/3/4/5/6/7
• Howoftendoyouusuallyexerciseinyourfree
time so much that you get out of breath or
sweat? (Every day/ 4-6 times/ 2- 3 times/ once
a week/ once a month/ less than once a
month/ never)
Young people are recommended to do at least one hour of
moderate physical activity per day. Overall 19% of young
people meet this guideline for physical activity. Boys were
more likely to report being physically active for at least
an hour every day of the week (22% of boys v. 15% of
girls). Younger adolescents were more likely to meet the
recommended levels of physical activity; 23% of 11 year
olds, 18% of 13 year olds and 14% of 15 year olds. The
likelihood of meeting the guidelines declined with age for
both boys and girls, and across all age groups boys were
more likely to be physically active for at least one hour every
day (Figure 3.23). The proportion of girls being physically
active for at least an hour every day of the week has
remained relatively stable since 2002, however boys physical
activity levels have fluctuated with a decline between 2010
and 2014 (Figure 3.24).
Figure 3.23: Young people who meet the recommended level of physical activity
50%
45%
40%
35%
30%
25%
20%
15%
10%
5%
0%
Boys
Girls
11 years
25% 23%
18%
20%
13% 10%
13 years 15 years
Base: All respondents in 2014
“
To encourage girls to do more physical
activities you could show them the benefits of
doing exercise.”
Ellise, age 12
“
For young people, I don’t think enough
are doing 1 hour of physical activity per day.
I think it is a good recommendation, but
somehow not very realistic, as school, then
homework takes priority for most young
children.”
Pippa, age 13
HBSC England National Report

45
65% of young people reported vigorous physical activity
at least 2 – 3 times a week. Overall, boys were more likely
than girls to take part in this type of activity 2 – 3 times a
week or more often; 73% of boys compared with 57% of
girls. Reporting vigorous activity at least 2 – 3 times a week
declined with age for both boys and girls, although the drop
among girls was more dramatic than among boys (Figure
3.25).
Figure 3.24: Young people meeting recommendations for physical activity 2002-2014
50%
45%
40%
35%
30%
25%
20%
15%
10%
5%
0%
Boys
Girls
2002
29%
16%
23%
14%
28%
15%
22%
15%
2006 2010 2014
Base: All respondents in 2002, 2006, 2010 and 2014
Figure 3.25: Young people vigorously active at least 2 -3 times a week
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Boys
Girls
11 years
76% 73% 70%
68%
52% 50%
13 years 15 years
Base: All respondents in 2014
Healthy Behaviours

46
Summary
The majority of young people eat breakfast every day during
the week, however regular breakfast eating was more
common among boys than girls. Nearly a quarter of 15 year
old girls report never eating breakfast during the week,
which is of concern considering the positive benefits regular
breakfast eating has been proven to have on physical health,
emotional well-being and school performance (Rampersaud
et al., 2005). While girls are less likely to eat breakfast than
boys, they are more likely to eat fruit and vegetables every
day.
Only a minority of young people reported consuming sweets
and sugary soft drinks on a daily basis. Younger adolescents
appear to be the least likely to eat sugary foods every day
– consumption of sugary foods may increase with age as
parental control decreases and they begin to make their own
decisions about what to eat (Cooke et al., 2005).
The potential impact on health and well-being of energy
drink consumption requires more research, especially in
terms of consumption by children and younger adolescents.
However a recent Canadian study identified associations
between energy drink consumption and other health risk
behaviours during adolescence including substance misuse
and increased depression, suggesting that they may be
‘a marker for other activities that may negatively affect
adolescent development, health and well-being’ (Sunday,
Langillec et al. 2014)’. Other studies have suggested
increased links with higher levels of alcohol consumption in
young people (Patrick and Maggs 2014) and regular (weekly
consumption) by young adults is also associated with being
overweight (Karina, Lyng et al. 2014). The soft drinks
industry in the UK currently operates a voluntary
code which requires a warning on labels that energy drinks
are not suitable for children and should not be promoted or
marketed to those under 16. The findings presented here
indicate that energy drinks are consumed by some young
people in this age group, notably boys, and this increases
with age.
Only a fifth of young people reported being physically
active for at least one hour every day. Both boys and girls
activity levels decrease between the ages of 11 and 15 years,
however girls show a sharper decline suggesting more girls
are opting out of physical activity. This finding is reinforced
by research which suggests boys are more likely to spend
their leisure time playing sports, whereas girls prefer to hang
out and talk (Brooks & Magnusson, 2007).
How young people perceive their body image is important
for emotional well-being (Brooks et al., 2011), and
worryingly only just over half of young people are happy
with their body size and report it being “about right”.
Younger adolescents and boys are least likely to have
concerns about their body image. 15 year old girls are most
likely to perceive their body negatively; with only 41% saying
their body is “about right” and half reporting they are “too
fat”.
Just over a fifth of young people reported that they do not
get adequate sleep to be alert and concentrate on school
work during the day. In line with research by the Schools
Health Education Unit (Balding & Regis, 2012) concerns
surrounding sleep vary greatly by age and gender, 15 year
olds are three times more likely than 11 year olds to say they
are not getting enough sleep to feel awake during the day.
The young people in the reference groups recognised the
benefits of many of the positive health behaviours, and
especially the importance of getting adequate sleep and
eating breakfast every morning for being able to concentrate
in classes during the day. When asked about barriers to
engaging in such health behaviours, most of the young
people mentioned technology (internet/ social media) and
homework as reasons for adolescents not getting enough
sleep. The girls felt that one reason girls were less likely
to eat breakfast than boys was because they were more
worried about being fat, and so might skip breakfast in
order to get thin. Both boys and girls seemed to see boys
as naturally more sporty and active than girls suggesting
that gender stereotyping in relation to physical prowess
and activity remains pervasive. The young people also felt
that there were fewer opportunities for girls, and fewer
clubs providing the types of sports and activities that might
support girls in terms of increasing their physical activity
levels. With regards to why many of the health behaviours
decline as adolescents get older, all of the young people
thought this would be largely to do with older adolescents
being busier with school work, and therefore having less
time to exercise or eat breakfast in the morning. They also
thought that increased school pressure could be why older
adolescents get less sleep; both because they would be busy
with homework, but also because they may be unable to
sleep properly because of stress and worrying.
Young people’s thoughts on health behaviours
HBSC England National Report

47
References
Austin, S. B., & Gortmaker, S. L. (2001). Dieting and smoking initiation in early adolescent girls and boys: a prospective study.
American Journal of Public Health, 91(3), 446–450.
Balding, A., & Regis, D. (2010). Young people into 2010. Exeter: Schools Health Education Unit.
Balding, A., & Regis, D. (2012). Young people into 2012. Exeter: Schools Health Education Unit.
Brooks, F. M., Smeeton, N. C., Chester, K., Spencer, N., & Klemera, E. (2014). Associations between physical activity in
adolescence and health behaviours, well-being, family and social relations. International Journal of Health Promotion and
Education, 52(5), 271–282.
Brooks, F., & Magnusson, J. (2007). Physical activity as leisure: the meaning of physical activity for the health and well-being
of adolescent women. Health Care for Women International: Special Edition, Health and Leisure, 28(1), 69–87.
Brooks, F., Magnusson, J., Klemera, E., Spencer, N., & Morgan, A. (2011). HBSC England national report: Findings from the
2010 HBSC study for England. Hatfield: University of Hertfordshire.
Cappuccio, F. P., Taggart, F. M., Kandala, N.-B., Currie, A., Peile, E., Stranges, S., & Miller, M. A. (2008). Meta-analysis of short
sleep duration and obesity in children and adults. Sleep, 31(5), 619–626.
Cole, T. J., Freeman, J. V, & Preece, M. A. (1995). Body mass index reference curves for the UK, 1990. Archives of Disease in
Childhood, 73(1), 25–29.
Cooke, C., Currie, C., Higginson, C., Inchley, J., Mathieson, A., Merson, M., & Young, I. (Eds.). (2005). Growing through
adolescence: Evidence and overview. Edinburgh: NHS Health Scotland.
Crowley, S. J., Acebo, C., & Carskadon, M. A. (2007). Sleep, circadian rhythms, and delayed phase in adolesence. Sleep
Medicine, 8, 602–612.
Currie, C., Zanotti, C., Morgan, A., Currie, D., de Looze, M., Roberts, C., Barnekow, V. (Eds.). (2012). Social determinants of
health and well-being among young people. Health Behaviour in School-aged Children (HBSC) study: international report from
the 2009/2010 survey. Copenhagen: WHO Regional Office for Europe.
Dumith, S. C., Gigante, D. P., Domingues, M. R., & Kohl, H. W. (2011). Physical activity change during adolescence: a
systematic review and a pooled analysis. International Journal of Epidemiology, 40(3), 685–698.
Hallal, P. C., Andersen, L. B., Bull, F. C., Guthold, R., Haskell, W., & Ekelund, U. (2012). Global physical activity levels:
surveillance progress, pitfalls, and prospects. The Lancet, 380(9838), 247–257.
Karina, F., Jeppe, I. L., Lasgaard, M. & Larsen, F. B. (2014). Energy drink consumption and the relation to socio-demographic
factors and health behaviour among young adults in Denmark. A population-based study. The European Journal of Public
Health, 24(5), 840-844.
Lien, N., Lytle, L. A., & Klepp, K.-I. (2001). Stability in consumption of fruit, vegetables, and sugary foods in a cohort from age
14 to age 21. Preventive Medicine, 33(3), 217–226.
Patrick, M. and J. Maggs (2014). “Energy Drinks and Alcohol: Links to Alcohol Behaviors and Consequences Across 56 Days.”
Journal of Adolescent Health, 54(4):, 454–459.
Perkinson-Gloor, N., Lemola, S., & Grob, A. (2013). Sleep duration, positive attitude toward life, and academic achievement:
the role of daytime tiredness, behavioral persistence, and school start times. Journal of Adolescence, 36(2), 311–318.
Rampersaud, G. C., Pereira, M. A., Girard, B. L., Adams, J., & Metzl, J. D. (2005). Breakfast habits, nutritional status, body
weight, and academic performance in children and adolescents. Journal of the American Dietetic Association, 105(5),
743–760.
Healthy Behaviours

48
Steenari, M.-R., Vuontela, V., Paavonen, E. J., Carlson, S., Fjallberg, M., & Aronen, E. T. (2003). Working memory and sleep in
6- to 13-year-old schoolchildren. Journal of the American Academy of Child & Adolescent Psychiatry, 42(1), 85–92.
Strong, W. B., Malina, R. M., Blimkie, C. J. R., Daniels, S. R., Dishman, R. K., Gutin, B., … Trudeau, F. (2005). Evidence based
physical activity for school-age youth. The Journal of Pediatrics, 146(6), 732–737.
Seifert, S., et al. (2011). Health Effects of Energy Drinks on Children, Adolescents, and Young Adults. Pediatrics, 127(3), 511-
528.
Sunday, A., et al. (2014). “n emerging adolescent health risk: Caffeinated energy drink consumption patterns among high
school students. Preventive Medicine, 62(May), 54-59.
Telama, R. (2009). Tracking of physical activity from childhood to adulthood: A review. Obesity Facts, 2(3), 187–195.
World Health Organization. (2010). Global recommendations on physical activity for health. Geneva: World Health
Organization.
HBSC England National Report

49
Key messages
Smoking:
3% of young people reported smoking at least
once a week (2% of boys and 3% of girls).
Smoking prevalence is highest among 15 year
old girls (8%).
Smoking rates show a steady decline since 2002.
For the first time in the HBSC England survey
weekly smoking rates were reported as zero
among 11 year olds.
Alcohol:
weekly alcohol consumption decreased across
all ages from 2002 to 2014, with reported rates
in 2014 being less than a quarter of those in 2002
among 15 year olds.
A third of 15 year olds said that they had been
drunk twice or more in their life.
Among the 15 year olds who consume alcohol
regularly (9% of girls and 12% of boys), 83% of
boys and 57% of girls reported being drunk more
than 10 times during the last 30 days.
Cannabis:
Reported cannabis use decreased between 2002
and 2014 from 43% for boys and 38% for girls in
2002 to 21% for boys and 20% for girls.
Introduction
Substance use is a major public health concern for
adolescent health, and rates of both smoking and drinking
alcohol has decreased among young people over the last
decade (Brooks et al., 2011). England still has a relatively
high incidence of regular drinking, drunkenness and cannabis
use among 15 year olds compared to other European
countries (Currie et al., 2012). Among adults, smoking is
“the primary cause of preventable morbidity and premature
death” in England (Department of Health, 2011, p. 15) and
while major health consequences such as lung cancer do not
usually present until later in life, adolescents who smoke
tobacco have be found to be less physically fit, have more
respiratory problems and experience more coughing and
wheezing that their non-smoking peers (U.S. Department of
Health and Human Services, 2004). Further, onset of tobacco
smoking occurs during adolescence in the majority of cases
(World Health Organization, 2005).
Similarly to tobacco use, onset of drinking alcohol often
occurs first during adolescence, and while to some extent
a normative aspect of adolescent development, drinking
and drunkenness during this time period (and particularly
early initiation) has been associated with increased risk of
injury (Hingson, Assailly, & Williams, 2004), unplanned and
unprotected sex (Hingson, Heeren, Winter, & Wechsler,
2003), and alcohol disorders and dependency (DeWit,
Adlaf, Offord, & Ogborne, 2000). Work from HBSC England
suggested that drinking sub-cultures may also be a
determinant for some young people, for example “sporty”
physically active boys were found to be more likely to have
drunk alcohol to excess (Brooks et al., 2014).
Cannabis use during adolescence has been associated
with decreased performance on learning and memory
tasks (Solowij et al., 2011), lower academic attainment
and completion, other illicit drug dependency, and suicide
attempts (Silins et al., 2014). For these reasons, a reduction
in such risk behaviours has been suggested as indicators
of increased well-being in the population (Department of
Health, 2010).
Chapter 4 Substance Use
Substance Use

50
Smoking
Measure
• Howoftendoyousmoketobaccoatpresent?
(every day, at least once a week, less than
once a week, I do not smoke).
Weekly smoking by age and gender
Across all age groups, 3% of young people reported smoking
at least once a week, (2% of boys and 3% of girls). Weekly
smoking increased with age and was higher among girls
than boys (Figure 4.1). For the first time in the HBSC England
survey weekly smoking rates were reported as zero among
11 year olds.
The proportion of regular smokers decreased during the period from 2002 to 2014, with girls more likely to report smoking
regularly than boys across all time points (Figure 4.2).
Figure 4.1: Young people who smoke weekly
25%
20%
15%
10%
5%
0%
Boys
Girls
11 years
0% 2%
6%
0%
3%
8%
13 years 15 years
Base: All respondents in 2014
Figure 4.2: Young people who smoke at least once a week, by gender 2002-2014
25%
20%
15%
10%
5%
0%
Boys
Girls
2002
15%
11% 9%
7%
7%
4% 3%
2%
2006 2010 2014
Base: All respondents in 2002, 2006, 2010 and 2014
HBSC England National Report

51
Age of first cigarette for 15 year olds (only those who reported smoking at least once a week)
- by gender
Measures
• Atwhatagedidyoufirstsmokeacigarette?
 (Never,11yearsoldoryounger,12yearsold,
13 years old, 14 years old, 15 years old, 16
years old or older)
Among 15 year olds who reported smoking at least once a
week, 66% reported that they started to smoke at age 13 or
younger.
Trends of weekly smoking among 15 year olds
The proportion of 15 year olds who reported smoking at
least once a week decreased from 2002 to 2014. Girls were
more likely than boys to report regular smoking across all
time points, although the gender gap appears to be closing
(Figure 4.3).
Figure 4.3: 15 year old young people who smoke weekly, by gender 2002-2014
50%
45%
40%
35%
30%
25%
20%
15%
10%
5%
0%
Boys
Girls
2002
28%
21% 18%
13%
14%
10%
8%
6%
2006 2010 2014
Base: All respondents in 2002, 2006, 2010 and 2014
Substance Use

52
Alcohol
Weekly alcohol consumption, by age and gender
Measures
• Atpresent,howoftendoyoudrinkanything
alcoholic, such as beer, wine, or spirits like
vodka, gin or rum? (Every day, every week,
every month, rarely, never)
Overall, 5% of young people reported that they drink
alcohol on a weekly basis (6% of boys and 4% of girls).
The proportion of those who consume alcohol regularly
(weekly) increased with age with boys having slightly higher
proportions at all ages (Figure 4.4).
“
Boys generally drink beer as a more social
thing whereas girls drink to get drunk.”
Katie, age 16
Figure 4.4: Young people who drink alcohol weekly
25%
20%
15%
10%
5%
0%
Boys
Girls
11 years
4%
2%
12%
3%
1%
9%
13 years 15 years
Base: All respondents in 2014
Figure 4.5: 15 year olds who drink alcohol at least weekly 2002-2014
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Boys
Girls
2002
52%
48% 41%
36% 32%
23%
12%
9%
2006 2010 2014
Base: All respondents in 2002, 2006, 2010 and 2014
Trends for weekly alcohol consumption from 2002 - 2014.
The prevalence of weekly drinking has decreased across all ages from 2002 to 2014, with reported rates in 2014 being
less than a quarter of those in 2002 among 15 year olds (Figure 4.5).
HBSC England National Report

53
Drinking to Excess
Measures
• Haveyoueverhadsomuchalcoholthat
you were really drunk? (never, once, 2-3
times, 4-10 times, more than 10 times)
Across all age groups, 11% of young people (11% of boys and
12% of girls) reported that they had ever been drunk two or
more times. The prevalence of drinking to excess increased
with age; very few 11 year olds reported having ever been
drunk, but almost a third of all 15 year olds said that they
had been drunk twice or more (Figure 4.6). Among 15 year
olds who report drinking regularly (weekly), 83% of boys and
57% of girls reported being drunk more than 10 times during
last 30 days.
Trends for drinking to excess
The proportion of 15 year olds that reported having been drunk two or more times has decreased substantially from 2002 to
2014 (Figure 4.7).
Figure 4.6: Young people who have been drunk two or more times (consumed alcohol to excess)
50%
40%
30%
20%
10%
0%
Boys
Girls
11 years
1% 1% 5%
29%
7%
32%
13 years 15 years
Base: All respondents in 2014
Figure 4.7: 15 year old young people who have been drunk two or more times by gender 2002-2014
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Boys
Girls
2002
55%
55% 50%
44%
45%
39% 32%
29%
2006 2010 2014
Base: All respondents in 2002, 2006, 2010 and 2014
“
I think another reason [adolescents
drink a lot less compared with 2002] is that
adolescents have more to do now due to new
technology so don’t have to result to drinking
for entertainment.”
Tom, age 15
Substance Use

54
Age of first drunkenness (15 year olds only by gender)
Measures
• Atwhatagedidyoufirstdrinkalcohol(more        
 thanasmallamount)?(Never,11yearsoldor        
younger, 12 years old, 13 years old, 14 years
old, 15 years old, 16 years old or older)
Boys reported a slightly lower age of onset than girls for their first time being drunk; around 34% of boys and 28% of girls
were 13 years old or younger when they were first drunk.
Cannabis Use
Lifetime cannabis use
Measure
• Haveyouevertakencannabisinyourlifetime?        
(never, once or twice, 3-5 times, 6-9 times,
10-19 times, 20-39 times, 40 times and more)
The question about cannabis use was asked only of the
eldest age group. For both boys and girls, 20% said that they
had tried cannabis at least once in their life. Of those that
had tried it, 41% reported that they had used it only once
or twice. Boys were more likely than girls to report higher
frequency of cannabis use; among those that had ever used,
22% of boys compared to 12% of girls reported having used
cannabis 40 times or more in their life.
HBSC England National Report

55
Cannabis use in last 30 days
Measure
• Haveyouevertakencannabisinlast30days?        
(never, once or twice, 3-5 times, 6-9 times,
10-19 times, 20-39 times, 40 times and more)
Of those that had ever used cannabis, 45% of boys and 42%
of girls reported having used it at least once in the last 30
days.
Life time cannabis use 2002-2014
Overall, the proportion of young people who reported
having ever used cannabis in their lifetime decreased
between 2002 and 2014 from 43% for boys and 38% for girls
in 2002 to 21% for boys and 20% for girls (Figure 4.8).
Figure 4.8: Young people who have ever used cannabis during their life time by gender 2002-2014
50%
45%
40%
35%
30%
25%
20%
15%
10%
5%
0%
Boys
Girls
2002
43%
38%
26%
23%
25%
25% 21%
20%
2006 2010 2014
Base: All respondents in 2002, 2006, 2010 and 2014
Age of first cannabis, by gender
Measure
• Atwhatagedidyoufirstusecannabis?
(never, 11 years old or younger, 12 years old,
13 years old, 14 years old, 15 years old, 16
years old or older)
Of those that reported having ever used cannabis, 20% said they had first tried it aged 13 or younger. The largest proportion
(45%) said they had first tried it at age 15.
Substance Use

56
Summary
Fewer than 10% of all young people reported smoking
tobacco on a regular basis, and the incidence of regular
smoking has decreased consistently and substantially since
2002. Very few of the 11 and 13-year olds reported regular
weekly smoking, and the same was true for weekly drinking
alcohol. Also similarly to tobacco smoking, weekly alcohol
drinking shows a steady decline from 2002-2014. Close to
a third of 15 year olds report having consumed alcohol to
excess (drunkenness) at least twice in their life, but again
this is a considerable decrease compared to 2002. Girls are
somewhat more likely than boys to report both regular
smoking and drunkenness twice or more, but boys were
more likely to report high frequency cannabis use. Cannabis
use in general is lower in 2014 compared to 2002, but only
minor changes have been observed since 2006.
Young people’s thoughts on substance use
The young people thought there might be some differences
in boys’ and girls’ reasons for drinking alcohol. The girls
perceived boys as drinking more socially, something to do
when they got together with their friends, whereas they
thought girls were more likely to drink just to get drunk,
suggesting that targeting gendered attitudes to alcohol
consumption are likely to be important for further reducing
the prevalence of consuming alcohol to excess. Some of
the boys on the other hand thought boys drank to be seen
as ‘cool’ and impress their friends. With regards to the
reasons for why drinking has decreased among adolescents
over the last decade, some of the boys thought there had
been increased awareness campaigns about the dangers of
drinking and that it was now more difficult for young people
to obtain alcohol than it used to be (notably enforcing
of age checks on purchase). More frequent drinking was
thought to lead to increased amounts of alcohol because of
a desensitising effect; if you drink frequently it is not such a
big deal and therefore you can drink more.
Measure
• Atwhatagedidyoufirstusecannabis?
(never, 11 years old or younger, 12 years old,
13 years old, 14 years old, 15 years old, 16
years
old or older)
HBSC England National Report

57
References
Brooks, F. M., Smeeton, N. C., Chester, K., Spencer, N., & Klemera, E. (2014). Associations between physical activity in
adolescence and health behaviours, well-being, family and social relations. International Journal of Health Promotion and
Education, 52(5), 271–282.
Brooks, F., Magnusson, J., Klemera, E., Spencer, N., & Morgan, A. (2011). HBSC England national report: Findings from the
2010 HBSC study for England. Hatfield: University of Hertfordshire.
Currie, C., Zanotti, C., Morgan, A., Currie, D., de Looze, M., Roberts, C., … Barnekow, V. (Eds.). (2012). Social determinants of
health and well-being among young people. Health Behaviour in School-aged Children (HBSC) study: international report from
the 2009/2010 survey. Copenhagen: WHO Regional Office for Europe.
Department of Health. (2010). Healthy lives, healthy people: our strategy for public health in England. London: Department of
Health.
Department of Health. (2011). Healthy lives, healthy people: A tobacco control plan for England. London: Department of
Health.
DeWit, D. J., Adlaf, E. M., Offord, D. R., & Ogborne, A. C. (2000). Age at first alcohol use: A risk factor for the development of
alcohol disorders. American Journal of Psychiatry, 157(5), 745–750.
Hingson, R., Assailly, J.-P., & Williams, A. F. (2004). Underage drinking: frequency, consequences, and interventions. Traffic
Injury Prevention, 5(3), 228–236.
Hingson, R., Heeren, T., Winter, M. R., & Wechsler, H. (2003). Early age of first drunkenness as a factor in college students’
unplanned and unprotected sex attributable to drinking. Pediatrics, 111(1), 34–41.
Silins, E., Horwood, L. J., Patton, G. C., Fergusson, D. M., Olsson, C. A., Hutchinson, D. M., … Mattick, R. P. (2014). Young adult
sequelae of adolescent cannabis use: an integrative analysis. The Lancet Psychiatry, 1(4), 286–293.
Solowij, N., Jones, K. A., Rozman, M. E., Davis, S. M., Ciarrochi, J., Heaven, P. C. L., … Yücel, M. (2011). Verbal learning and
memory in adolescent cannabis users, alcohol users and non-users. Psychopharmacology, 216(1), 131–144.
U.S. Department of Health and Human Services. (2004). The health consequences of smoking: A report of the Surgeon
General. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National
Centre for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health.
World Health Organization. (2005). The European health report 2005: Public health action for healthier children and
populations. Copenhagen: WHO Regional Office for Europe.
Substance Use

58
Key messages
21% of 15 year olds respondents reported having
had sexual intercourse, (19% of boys and 24% of
girls).
Young people reporting having had sexual
intercourse has decreased for both boys and
girls from 2002 – 2014.
59% of young people reported that they had
been in love. More boys than girls said they had
been in love; 64% of boys compared with 54% of
girls.
5% of respondents reported that they had been
in love with a member of the same sex or both
sexes.
Early reported initiation (12 years or younger) of
sexual intercourse has decreased among boys
and girls from 2002 (17% for boys and 9% for
girls) in 2014 the figures are 11% for boys and
4% for girls.
Introduction
The emergence of romantic relationships is an important
aspect of adolescent development, and many people
have their first sexual experience at this time. Sexual and
reproductive health form an integral part of the Millenium
Development Goals (United Nations, 2014) and improving
sexual health outcomes is a policy focus of the Department
of Health in England (Department of Health, 2013). English
adolescents have reported relatively high levels of sexual
intercourse experience, and relatively low levels of condom
use, compared to other European countries (Currie et
al., 2012). The incidence of teenage pregnancy has fallen
substantially in England over the last couple of decades, but
is still one of the highest in Europe6. Further, young people
(aged 15-24) are the group most likely to be diagnosed with
a sexually transmitted infection (Public Health England,
2014), and very early sexual initiation is associated with
increased risk for engaging in risk and problem behaviour
(Madkour, Farhat, Halpern, Godeau, & Gabhainn, 2010).
Awareness of, and access to, adequate contraceptive
services is paramount to enable sexually active young people
to protect themselves from STIs and unwanted pregnancy,
however young people themselves have reported a lack of
information in this area as well as a lack of discussion of sex
in the context of relationships, particularly in relation to
same-sex relationships (Blake, Emmerson, Hayman, & Lees,
2014).
Questions relating to love and sex were asked only of the
fifteen year old respondents.
Chapter 5 Sexual Health and Well-being
6 http://www.ons.gov.uk/ons/rel/vsob1/births-by-area-of-usual-residence-of-mother--england-and-wales/2012/sty-international-comparisons-of-teenage-pregnancy.html
(Accessed 04/08/15)
HBSC England National Report

59
Love
Measures
• Haveyoueverbeeninlovewithsomeone?
(Yes, with a girl or girls/ Yes, with a boy or
 boys/Yes,withgirlsandboys/No,never)
• Haveyoueverhadarelationshipwith 
someone (sometimes called going out with or
seeing someone)? (Yes, with a girls or girls/
Yes, with a boy or boys/ Yes, with girls and
 boys/No,never)
Being in love was asked for the first time in this round of
HBSC as it is indicative of emotional development, as well
as being a proxy measure of sexual orientation. Moreover,
by considering emotional states sexual behaviour is able to
be located in the context of broader peer relationships for
young people.
Overall, 59% of young people reported that they had been
in love. More boys than girls said they had been in love; 64%
of boys compared with 54% of girls. The majority of young
people reported being in love with the opposite sex; 60% of
boys and 48% of girls (Figure 5.1). Overall, approximately 5%
of respondents reported that they had been in love with a
member of the same sex or both sexes.
Figure 5.1: Reports of being in love
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Boys
Girls
Opposite sex
60%
2% 2%
37%
48%
2% 4%
46%
Same sex Both sexes Never been in love
Base: Respondents aged 15 years in 2014
Sexual Health and Well-being

60
More young people reported having had a relationship than
having been in love; over two thirds (69%) of young people
said they had been in a relationship with someone. The
difference between boys and girls was small; 68% of boys
reported being in a relationship compared with 70% of girls.
The majority of young people reported they had been in
an opposite sex relationship (Figure 5.2). As with reports of
being in love, around 5% of respondents saying they had a
same sex relationship or relationships with both sexes.
Figure 5.2: Reports of being in a relationship
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Boys
Girls
Opposite sex
65%
1% 2%
32%
64%
2% 5%
30%
Same sex Both sexes Never been in love
Base: All respondents aged 15 years in 2014
HBSC England National Report

61
Sex
Measures
• Haveyoueverhadsexualintercourse 
(sometimes this is called ‘making love’,
 ‘havingsex’or‘goingalltheway’)?(Yes/No)
• Thelasttimeyouhadsexualintercourse;did
 youoryourpartneruseacondom?(Yes/No/
Don’t know)
• Thelasttimeyouhadsexualintercourse,did
you or your partner use birth control pills?
 (Yes/No/Don’tknow)
• Thelasttimeyouhadsexualintercourse,did
you or your partner use the morning after pill?
 (Yes/No/Don’tknow)
• Thelasttimeyouhassexualintercourse,did
you or your partner use any other method(s)?
 (Yes/No/Don’tknow)
• Howoldwereyouwhenyouhadsexual 
intercourse for the first time? (11 years old or
younger/ 12 years old/ 13 years old/ 14 years
old/ 15 years old/16 years old/ 17 years old
or older)
Overall, 21% of 15 year old respondents reported having
had sexual intercourse; 19% of boys and 24% of girls.
Young people reporting having had sexual intercourse
has decreased for both boys and girls from 2002 – 2014,
although gender differences are apparent across all four
time periods (Figure 5.3).
Figure 5.3: Sexual intercourse 2002 - 2014
50%
45%
40%
35%
30%
25%
20%
15%
10%
5%
0%
Boys
Girls
2002
40%
36%
31%
26%
34%
27% 24%
19%
2006 2010 2014
Base: All respondents aged 15 years in 2002, 2006, 2010 and 2014
Only the young people who reported having had sexual intercourse are included in subsequent analysis.
Sexual Health and Well-being

62
Of those 15 year olds who have ever had sexual intercourse,
81% of young people say they first had sexual intercourse at
age 14 or older. Boys are more likely to report early onset
of sexual activity; 11% of boys compared with 4% of girls
reported their first sexual experience was at 12 years or
younger (Figure 5.4). Reports of early onset initiation (12
years or younger) has decreased among boys and girls from
2002 (Figure 5.5).
Figure 5.4: Age of onset for sexual intercourse among sexually active 15 year olds
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Boys
Girls
11 years or
younger
12 years 13 years 14 years 15 years or
older
8%
3%
13% 32%
30%
53%
2%2%
11%
47%
Base: All respondents aged 15 years in 2014 who had sexual intercourse
Figure 5.5: Early sexual initiation 2002 - 2014
25%
20%
15%
10%
5%
0%
Boys
Girls
2002
17%
9%
12%
7%
10%
4%
11%
4%
2006 2010 2014
Base: All respondents aged 15 years in 2002, 2006, 2010 and 2014 who had sexual intercourse
Of those who said they have had intercourse, the majority
of young people (84%) reported using some form of
contraception at the last time of sexual intercourse. There
were small gender differences; 84% of boys reported using
contraception at last intercourse compared with 82% of girls.
Overall, 27% of young people reported using more than one
form of contraception. Using a condom at last intercourse
was the most common form of contraception reported
for both boys and girls, with 61% of boys and 57% of girls
reporting a condom was used (Figure 5.6).
HBSC England National Report

63
Figure 5.6: Contraceptive method used at last intercourse
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Boys
Girls
Condom
61%
28%
13%
57%
31%
15% 10%
17%
Contraceptive pill Morning after pill Other method
Base: All respondents aged 15 years in 2014 who had sexual intercourse
Figure 5.7: 15 year olds using condom at last intercourse 2002-2014
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Boys
Girls
2002
67%
69%
80%
74%
80%
67% 61%
57%
2006 2010 2014
Base: 15 year old respondents in 2002, 2006, 2010 and 2014
Sexual Health and Well-being

64
Summary
More young people reported having been in a relationship
than said they had been in love, suggesting that ‘being in
love’ is not necessarily a pre-requisite for entering into
relationships for these adolescents. A small but notable
proportion of 15 year olds said that they had been in love
with a person of the same sex.
A fifth of all 15 year olds said that they had had sexual
intercourse, with a slightly higher proportion of girls
reporting so. The number of young people who say that they
have had sexual intercourse has decreased substantially
since 2002 among both boys and girls, although across
all surveys during this time period girls have had a higher
incidence than boys. Similarly, the proportion of young
people who report very early onset of sexual intercourse
(age 12 or younger) has decreased since 2002.
The majority of young people who reported having had
sexual intercourse also said that they had used some
method of contraception last time they had intercourse,
with condoms being the most popular choice. Around 40%
of young people did not use a condom at last intercourse,
and although some of those young people will be adequately
protected against pregnancy through use of other methods,
a notable minority of sexually active adolescents are at risk
for STIs, unplanned pregnancy, or both.
Young people’s thoughts on sex and
relationships
The young people felt that there was a need for sex
education to focus less on the issues of pregnancy and STIs –
which they already knew about – and more on relationships
and issues to do with consent. In particular, they felt that
there needed to be more discussions with young people
about technology and social media, and about the potential
consequences of sharing pictures within relationships
and online. Other issues they felt were not addressed
were sexuality and gender identity, which were seen to
be important to young people’s lives but an area where
information was lacking. Straightforward and honest advice
and information was seen as desirable, and the older girls
cited websites as the best place to get this.
HBSC England National Report

65
References
Blake, S., Emmerson, L., Hayman, J., & Lees, J. (2014). Sex and relationships education (SRE) for the 21 century: supplementary
advice to the Sex and Relationship Education Guidance DfEE (0116/2000). London: Brook, PSHE Association & Sex Education
Forum.
Currie, C., Zanotti, C., Morgan, A., Currie, D., de Looze, M., Roberts, C., … Barnekow, V. (Eds.). (2012). Social determinants of
health and well-being among young people. Health Behaviour in School-aged Children (HBSC) study: international report from
the 2009/2010 survey. Copenhagen: WHO Regional Office for Europe.
Department of Health. (2013). A framework for sexual health improvement in England. London: Department of Health.
Madkour, A. S., Farhat, T., Halpern, C. T., Godeau, E., & Gabhainn, S. N. (2010). Early adolescent sexual initiation as a problem
behavior: a comparative study of five nations. Journal of Adolescent Health, 47(4), 389–398.
Public Health England. (2014). Health protection report. Declines in genital warts since start of the HPV immunisation
programme (Vol. 8).
United Nations. (2014). The millennium development goals report 2014. New York: United Nations.
Sexual Health and Well-being

66
Key messages
21% of young people reported they had been
injured two or more times in the last 12 months
and had to be treated by a doctor or nurse.
In 2002 29% of boys and 20% of girls reported
two or more injuries; in 2014 these figures were
similar with prevalence of 26% for boys and 17%
for girls.
17% of young people reported having been
involved in a physical fight two or more times in
the last 12 months, which represents a
continuing downward trend since 2002.
Just over one fifth (22%) of 15 year olds reported
that they had ever self-harmed.
Nearly three times as many girls as boys
reported that they had self-harmed, 11% of
boys said they had self-harmed compared with
32% of 15 year girls.
Introduction
Injuries present a serious public health concern globally,
and represent a significant health risk to young people.
Mortality rates among children and young people beyond
infancy are highest between 15 and 19 years. In the UK in
2012 there were 340 deaths per 100 000 from all causes
among young people aged 10-14 years compared with 959
deaths per 100 000 among young people aged 15-19 years
(Wolfe, Macfarlane, Donkin, Marmot, & Viner, 2014). This
increase with age is due primarily to preventable deaths such
as injury, self-poisoning and road traffic accidents. Injuries
contribute to overall rates of death progressively from the
age of one year until adulthood (Peden et al., 2008). During
2012, 25% of deaths among young people aged 10 – 14
years were attributed to external causes and risk behaviours
such as injuries, poisoning and traffic accidents; however at
age 15-19 the number more than doubles to 55% of deaths
(Wolfe et al., 2014). The majority of injuries are non-fatal
(Lescohier & Scavo-Gallagher, 1996) but they still carry
with them health and well-being consequences as well as
imposing demands on health services. Injuries often occur as
a result of multiple risk taking behaviour (Chiolero & Schmid,
2002) and is associated with the most vulnerable and poorest
young people (Pickett et al., 2005; Simpson, Janssen, Craig, &
Pickett, 2005). Moreover evidence indicates that the issue of
injury is gender-driven, with greater levels of morbidity and
mortality among teenage boys (Scheidt et al., 1995).
Media reports abound with concerns relating to young
people as a risk to others. However, in reality young people
are as likely to be victims of violence as the perpetrators
of harm to others. The 2013/14 Crime Survey for England
and Wales identified young people aged 16-24 were twice
as likely as any other age group to be a victim of violent
crime (Office for National Statistics, 2015). Moreover,
it was estimated 6.5% of children aged 10 – 15 years
had been a victim of crime in the 12 months prior to the
survey7. However, physical violence between peers during
adolescence has been recognized as a major cause of injury
among young people, especially among young males (Krug,
Dahlberg, Mercy, Zwi, & Lozano, 2002). Physical fighting is
the most common manifestation of interpersonal violence
in adolescence and has been chosen by expert consensus as
one of the highest-priority behaviours associated with youth
violence and intentional injury (Krug et al., 2002). In line with
trends in other risk behaviours, HBSC international findings
reveal that the prevalence of violence and physical fighting
among young people has declined in the last decade across
the majority of European and North American countries
Pickett et al., 2013). Self-harm is an intentional injury, and is
defined as the harming of one’s own body resulting in tissue
damage (Fliege, Lee, Grimm, & Klapp, 2009). Self-harm can
include actions such as cutting, burning, biting or ingesting
toxic substances. The behaviour is predominantly carried out
during adolescence, and is more common among girls than
boys (Hawton, Saunders, & O’Connor, 2012). Self-harm is
reported to be primarily a coping strategy which helps young
people deal with negative emotions (Hagell, 2013).
Chapter 6 Injuries and Physical Fighting
7 http://www.ons.gov.uk/ons/rel/crime-stats/crime-statistics/focus-on-violent-crime-and-sexual-offences--2013-14/rpt-chapter-1.html#tab-Extent-of-violent-crime (Accessed
04/08/15)
HBSC England National Report

67
Injuries
Measures
• Duringthepast12months,howmanytimes
were you injured and had to be treated by a
doctor or nurse? (I was not injured in the
past 12 months/ 1 time/ 2 times/ 3 times/
4 times or more)
Overall 21% of young people reported they had been injured
two or more times in the last 12 months and had to be
treated by a doctor or nurse. Boys were more likely to report
at least two injuries in the past year (26% of boys v. 17%
of girls). Boys were more likely than girls to report being
injured across all three age groups (Figure 6.1).
The proportions of young people reporting at least two
injuries in the last twelve months has decreased among
boys but remained relatively stable among girls since 2002
(Figure 6.2).
Figure 6.1: Injured at least twice in the last 12 months
50%
45%
40%
35%
30%
25%
20%
15%
10%
5%
0%
Boys
Girls
11 years
25% 27% 26%
15%
21%
16%
13 years 15 years
Base: All respondents in 2014
Injuries and Physical Fighting

68
Figure 6.2: Reports of two or more injuries in last 12 months, 2002 - 2014
50%
45%
40%
35%
30%
25%
20%
15%
10%
5%
0%
Boys
Girls
2002
35%
20%
29%
18%
30%
20%
26%
17%
2006 2010 2014
Base: All respondents in 2002, 2006, 2010 and 2014
HBSC England National Report

69
Fighting
Measure
• Duringthepast12months,howmanytimes
were you in a physical fight? (I have not been
in a physical fight in the last 12 months/ 1
time/ 2 times/ 3 times/ 4 times or more)
Overall 17% of young people reported having been involved
in a physical fight two or more times in the last 12 months.
Boys were considerably more likely to report being involved
in a fight (25% of boys v. 9% of girls). Involvement in physical
fighting decreased with age for boys, but remained relatively
stable across the age categories for girls (Figure 6.3).
Between 2002 and 2014 the proportion of boys and girls
who reported being involved in a physical fight two or more
times in the past twelve months has decreased, with a larger
decrease evident among boys (Figure 6.4).
Figure 6.3: Young people involved in a physical fight at least twice over the last 12 months
35%
30%
25%
20%
15%
10%
5%
0%
Boys
Girls
11 years
30%
22% 19%
8% 10% 9%
13 years 15 years
Base: All respondents in 2014
Figure 6.4: Young people involved in a physical fight at least twice over last 12 months 2002 - 2014
40%
35%
30%
25%
20%
15%
10%
5%
0%
Boys
Girls
2002
34%
14%
35%
13%
28%
9%
25%
9%
2006 2010 2014
Base: All respondents in 2002, 2006, 2010 and 2014
Injuries and Physical Fighting

70
Self-harm
Measures
• Haveyouweredeliberatelyhurtyourselfin
some way, such as cut or hit yourself on
 purposeortakeanoverdose?(Yes/No)
• Howoftendoyouself-harm?(Everyday/
 Severaltimesaweek/Onceaweek/Afew
 timesamonth/Onceamonth/Severaltimes
a year)
Questions relating to self-harm were asked only of the
fifteen year old respondents. Just over one fifth (22%) of this
age group reported that they had ever self-harmed. Nearly
three times as many girls as boys reported that they had
self-harmed; 11% of boys compared to 32% of girls.
Out of those young people who reported they had self-
harmed, the majority (43%) said they self-harmed once
a month. Girls were more likely than boys to report self-
harming on a more frequent basis (Figure 6.5).
Figure 6.5: Frequency of self-harming
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Boys
Girls
Everyday Several times
a week
Once a
week
A few times
a month
Once a
month
10%
5% 6%
39%
7%
15% 15%
16% 16%
54%
Base: All respondents aged 15 years in 2014 who reported ever self-harming
Summary
Around a fifth of young people reported having an injury
at least twice over the last 12 months that required some
form of medical attention – that could have involved health
care professionals such as GP’s, nurses or A&E staff. In line
with existing research (Currie et al., 2012), boys were more
likely to report being injured than girls. Encouragingly, young
people’s reports of injuries are the lowest they have been
since 2002.
Physical fighting is a predominantly male behaviour, with
nearly three times as many boys as girls reporting they
had been in a physical fight two or more times in the past
twelve months. The number of young people who say they
have been in a physical fight at least twice in the last twelve
months has been decreasing since 2002.
Just over a fifth of 15 year olds reported that they had ever
self-harmed, in line with other recent research (Kidger,
Heron, Lewis, Evans, & Gunnell, 2012). Although temporal
trends in self-harm cannot be established from the HBSC
England data, comparison with an earlier study suggests
rates of self-harm may have increased (Hawton et al., 2012).
Girls were three times more likely to report self-harming
than boys, replicating results from a recent school based
survey conducted in Scotland (O’Connor, Rasmussen, Miles,
& Hawton, 2009).
HBSC England National Report

71
References
Chiolero, A., & Schmid, H. (2002). Repeated self-reported injuries and substance use among young adolescents: the case of
Switzerland. Sozial- Und Präventivmedizin, 47(5), 289–297.
Currie, C., Zanotti, C., Morgan, A., Currie, D., de Looze, M., Roberts, C., … Barnekow, V. (Eds.). (2012). Social determinants of
health and well-being among young people. Health Behaviour in School-aged Children (HBSC) study: international report from
the 2009/2010 survey. Copenhagen: WHO Regional Office for Europe.
Fliege, H., Lee, J. R., Grimm, A., & Klapp, B. F. (2009). Risk factors and correlates of deliberate self-harm behavior: A
systematic review. Journal of Psychosomatic Research, 66(6), 477–493.
Hagell, A. (2013). Adolescent self-harm. AYPH research summary No. 13. London: Association for Young People’s Health.
Hawton, K., Saunders, K. E. A., & O’Connor, R. C. (2012). Self-harm and suicide in adolescents. The Lancet, 379(9834), 2373–
2382.
Kidger, J., Heron, J., Lewis, G., Evans, J., & Gunnell, D. (2012). Adolescent self-harm and suicidal thoughts in the ALSPAC
cohort: a self-report survey in England. BMC Psychiatry, 12(69), 1–12.
Krug, E. G., Dahlberg, L. L., Mercy, J. A., Zwi, A. B., & Lozano, R. (Eds.). (2002). World report on violence and health. Geneva:
World Health Organization.
Lescohier, I., & Scavo-Gallagher, S. (1996). Unintentional injury. In R. J. DiClemente, W. B. Hansen, & L. E. Ponton (Eds.),
Handbook of adolescent health-risk behaviour (pp. 225–258). New York: Plenum Press.
O’Connor, R. C., Rasmussen, S., Miles, J., & Hawton, K. (2009). Self-harm in adolescents: Self-report survey in schools in
Scotland. British Journal of Psychiatry, 194(1), 68–72.
Office for National Statistics. (2015). Statistical bulletin: Crime in England and Wales, year ending September 2013. London:
ONS.
Peden, M., Oyegbite, K., Ozanne-Smith, J., Hyder, A. A., Branche, C., Fazlur Rahman, A., … Bartolomeos, K. (Eds.). (2008).
World report on child injury prevention. Geneva: World Health Organization.
Pickett, W., Molcho, M., Elgar, F. J., Brooks, F., de Looze, M., Rathmann, K., … Currie, C. (2013). Trends and socioeconomic
correlates of adolescent physical fighting in 30 countries. Pediatrics, 131(1), e18–26.
Pickett, W., Molcho, M., Simpson, K., Janssen, I., Kuntsche, E., Mazur, J., … Boyce, W. F. (2005). Cross national study of injury
and social determinants in adolescents. Injury Prevention, 11(4), 213–218.
Scheidt, P. C., Harel, Y., Trumble, A. C., Jones, D. H., Overpeck, M. D., & Bijur, P. E. (1995). The epidemiology of nonfatal
injuries among US children and youth. American Journal of Public Health, 85(7), 932–938.
Simpson, K., Janssen, I., Craig, W. M., & Pickett, W. (2005). Multilevel analysis of associations between socioeconomic status
and injury among Canadian adolescents. Journal of Epidemiology and Community Health, 59(12), 1072–1077.
Wolfe, I., Macfarlane, A., Donkin, A., Marmot, M., & Viner, R. (2014). Why children die: death in infants, children and young
people in the UK (Part A). London: Royal College of Paediatrics and Child Health & National Children’s Bureau.
Injuries and Physical Fighting

72
Key messages
64% of young people reported living with both
parents in their main home. This has decreased
since both 2006 (70%) and 2010 (67%).
90% have at least one parent who is employed.
Young people of both genders, are more likely to
report it is easier to talk to their mothers (83%)
than fathers (66%).
Fewer than half of 15 year old girls (48%) find it
easy to talk to their fathers.
The majority of young people (across a range
of measures) report feeling well-supported
emotionally by their families (60-70-%)
The majority of young people (around 90%)
report that they feel well supported by their
parents in relation to school and education.
96% of young people appear to have been given
an age appropriate level of autonomy in terms
of how they spend their free time.
6% of young people never eat an evening meal
with their family
Introduction
There is an extensive body of research that highlights the
significance of family life for adolescent health outcomes.
The recent UNICEF report on the most disadvantaged
children in OECD (Organisation for Economic Co-operation
and Development) countries identified weak parental
support as a key dimension of child poverty and as a major
determinant of young people’s health and well-being
(UNICEF, 2010). In England over the last 30 years there has
been a major social change in the composition and structure
of family households that have significant implications for
the adolescent population. For example, in 2010 21% of all
families with dependent children in the UK were headed
by a lone parent compared to only 8% in 1971 (Coleman
& Brooks, 2009; Hagell et al., 2013). Stress and conflict
within families and the experience of family break up can
have highly negative impacts on young people’s well-being
(Rees, Pople, & Goswami, 2011). However the quality of
relationships within the family unit and particularly how a
family communicates may be as important an influence on
young people’s well-being as family structure (Pedersen,
Granado-Alcón, & Moreno-Rodriguez, 2004). Central to the
developmental tasks of adolescence is the navigation of
health related behaviours and health risks that form part of
the adult world. Parental support and a strong family bond
are associated with reduced levels of health-risk behaviours
(Bell, Forthun, & Sun, 2015) and improved mental health
and emotional well-being (Moreno et al., 2009). Parental
communication also functions as a protective health asset,
supporting young people to maintain high life satisfaction
and a positive body image even during late adolescence
(Fenton, Brooks, Spencer, & Morgan, 2010). Family support
in terms of the provision of emotional support has been
correlated with depression, anxiety, and resilience (Tabak &
Radiukiewicz, 2009)
The quality of parent-child communication represents a key
indicator of family functioning (Sweeting & West, 1995).
The ease with which young people feel that they can discuss
issues that really matter to them with their parents is a
marker of both the level of parental support and overall
family connectedness (Laursen, 1995).
Factors that facilitate ease of communication with parents
have been linked to a mutually interactive communication
style, where both the mother and child feel free to raise
issues, effective nonjudgmental listening by the parent and
the parent proving to be trustworthy from the perspective of
the young person (Afifi, Joseph, & Aldeis, 2008)
Parental monitoring is also a core element of the familial
environment, how and to what extent parents set
boundaries and are able to enforce, negotiate and agree
those with their adolescent children has been related to
the development of self-control, decision-making skills and
autonomy on the part of the young person (Kerr & Stattin,
2000).
Chapter 7 Family Life and Community Life
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73
Parental employment and family structure
Measure
• Doyourparentshaveajob?(Yes,no,don’t
know)
• Tickthepeoplewholiveinahomewhere
you live all or most of the time (Mother,
father, stepmother, and stepfather).
Parental employment
Overall, 67% of young people reported having both parents
employed; 86% of young people reported having an
employed father and 77% of young people said that their
mothers have a job.
Family structure
Overall, 64% of young people reported living with both
parents in their main home. Up to 25% of all young people
reported living in a household headed by a lone mother and
3% reported living in a household with a lone father. 8% of
all young people reported that they live with a step parent
(Table 7.1).
The proportions of young people who live with both parents
has decreased since both 2006 (70%) and 2010 (67%), while
the proportion of young people who live with lone parents
increased from 16% in 2006 and 20% in 2010 to 27% in 2014.
Both parents
Only father
Only mother
Step-family
Boys
66%
3%
22%
9%
Boys
64%
2%
20%
14%
Boys
70%
3%
21%
6%
Boys
64%
3%
25%
8%
Girls
62%
3%
28%
7%
Girls
63%
2%
26%
9%
Girls
65%
3%
27%
5%
Girls
59%
3%
32%
6%
Total
64%
3%
25%
8%
All ages 11 year olds 13 year olds 15 year olds
Table 7.1 Family Structure
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74
Community life
Feeling safe in my community
Measure
• Communitysafety(stronglyagree,agree,
neither agree nor disagree, disagree, strongly
disagree)
• IfeelsafeintheareawhereIlive
• Itissafeforyoungerchildrentoplayoutside
during the day
The proportions of young people who feel safe in the area
where they live increased from 70% in 2010 to 77% in 2014.
Boys were more likely than girls to report feeling safe (79%
v. 74%). Young people were more likely to feel safe during
early adolescence: 84% of boys v. 81% of girls at age 11; 78%
of boys v.73% of girls at age 13; and 75% of boys v. 66% of
girls at age 15 reported that they feel safe in the area where
they live.
Overall, 72% of young people agreed that it is safe for
children to play outside during the day in the area where
they live. Boys were more likely than girls to report that it
is safe for children to play outside (75% v. 69%). Younger
adolescents were more likely than their older peers to report
that it is safe for children to play outside during the day: 76%
of boys v. 71% of girls in 11 year olds, 76% of boys v. 69% of
girls in 13 year olds and 72% of boys v. 66% of girls in 15 year
olds.
The proportion of young people who reported that it is
safe to play outside has increased from 2002 to 2014. A
consistent gender difference is evident, with girls less likely
to report that it is safe for younger children to play outside
(Figure 7.1)
Figure 7.1: Young people who said it is safe for younger children to play outside in their area, 2002-2014
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Boys
Girls
2002
70%
67%
69%
67%
75%
69%
2010 2014
Base: All respondents in 2002, 2010 and 2014
Note: Question not asked in 2006.
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75
Young people’s view of neighbourhood
Measure
Strongly agree, agree, neither agree nor disagree,
disagree, strongly disagree
• Peoplesayhelloandstoptotalkinthestreet
• Youcantrustpeoplearoundhere
• Icouldaskforahelporafavourfrom 
neighbours
• Peoplearoundherewouldtakeadvantageof
you if they got the chance
Young people were asked about the area where they live.
Overall the majority of young people were positive about
their neighbourhood. 11 year olds were most likely to
be positive about the area where they live, and gender
differences can be seen across the different age groups
(Table 7. 2).
People say hello and
stop and talk in the
street
You can trust people
around here
I could ask for
a favour from
neighbours
People around
here would take
advantage of you if
they got the chance
Boys
59%
59%
70%
19%
Boys
65%
64%
75%
20%
Boys
58%
58%
69%
18%
Boys
52%
55%
66%
18%
Girls
62%
54%
71%
17%
Girls
69%
61%
76%
17%
Girls
61%
54%
69%
16%
Girls
54%
46%
67%
18%
Total
60%
57%
71%
18%
All ages 11 year olds 13 year olds 15 year olds
Table 7.2: Young people who agree with the following statements concerning the area they live
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76
Family life communication
Measure
• Howeasyisitforyoutotalktomother/father
about things that really bother you? (Very
easy, easy, difficult, very difficult)
• Inmyfamily:
• Ithinktheimportantthingsaretalkedabout
(strongly agree, agree, neither agree nor
disagree, disagree, strongly disagree)
• WhenIspeaksomeonelistenstowhatIsay
(strongly agree, agree, neither agree nor
disagree, disagree, strongly disagree)
Talking to father
Overall, 66% of young people reported that they find it easy
to talk to their father about the things that really bothered
them. Boys were more likely to find it easy to talk to their
fathers than girls (74% v. 59%). Younger adolescents (both
boys and girls) reported that they find it easier than their
older peers to talk to their father (Figure 7.2).
Across all age groups, the proportion of young people who
report finding it easy to talk to their father has increased
among both boys and girls from 2002 to 2014. However a
consistent gender difference is evident since 2002, with girls
less likely to find it easy to talk to their father (Figure 7.3)
Figure 7.2: Young people who say talking to their father is easy or very easy
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Boys
Girls
11 years
82%
72% 66%
68%
57%
48%
13 years 15 years
Base: All respondents in 2014
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77
Figure 7.3: Young people who find it easy to talk to their father by gender 2002-2014
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Boys
Girls
2002
68%
49%
68%
52%
70%
56%
74%
59%
2006 2010 2014
Base: All respondents in 2002, 2006, 2010 and 2014
Talking to mother
The majority of young people (83%) said that they find it
easy or very easy to talk to their mothers regarding the
things that really bother them. Boys were more likely than
girls to find it easy to talk to their mothers (86% v. 81%). The
proportion of young people who found it easy to
communicate with their mothers decreased with age with
the girls having lower proportions across all ages compared
to boys (Figure 7.4).
Figure 7.4: Young people who say talking to their mother is easy or very easy
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Boys
Girls
11 years
94%
83% 79%
90%
78% 71%
13 years 15 years
Base: All respondents in 2014
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78
Family life, parental support and monitoring
Measures
In 2014 a scale considering the quality of family
support and interaction was also included as part
of the mandatory questionnaire as a means of
trying to gain a more sophisticated measure of
family communication and interaction primarily
as a means to assess how different dimensions
of family life contribute to adolescents well-
being and the development of coping skills and
resilience.
In my family:
• Ithinktheimportantthingsaretalkedabout
(strongly agree, agree, neither agree nor
disagree, disagree, strongly disagree)
• WhenIspeaksomeonelistenstowhatIsay
(strongly agree, agree, neither agree nor
disagree, disagree, strongly disagree)
To measure how young people feel about a family
help and an emotional support, we have used the
7 point scale where the point 1 indicated ‘a very
strongly disagree’ and the point 7 indicated ‘a
very strongly agree’ with the following statements
• Myfamilyreallytriestohelpme
• Igettheemotionalsupportfrommyfamily
Overall, 77% of young people agreed that the important
things are talked about in their families and when they talk
someone always listens to them. However, boys were more
likely than girls to agree that the important things are talked
about in their families and seemed to feel listened to more
than girls (81% v. 74%). Younger adolescents were more
likely than their older peers to report that the important
things are talked about in their families and that someone
listens to them (Table 7.3).
Overall, more than 68% of young people reported that their
families really try to help them. Boys reported a slightly
higher proportion than girls (70% v. 65%). Around 59% of
all young people reported having an emotional support
from their families (60% boys v. 58% girls). However the
proportion of students who reported feeling that their family
really tries to help them decreased with age; young people
feel less supported emotionally by their parents as they get
older (Table 7.3).
My family really
tries to help me
I get emotional
support from my
family
Important things are
talked about in my
family
My family listen
when I speak
Boys
69%
60%
80%
81%
Boys
78%
71%
87%
85%
Boys
69%
58%
81%
81%
Boys
61%
50%
72%
77%
Girls
65%
58%
74%
74%
Girls
75%
70%
84%
81%
Girls
63%
58%
71%
71%
Girls
56%
45%
64%
67%
Total
67%
59%
77%
77%
All ages 11 year olds 13 year olds 15 year olds
Table 7.3 Parental support
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79
Parental involvement and support for education and school
Measure
Please show how much you agree or disagree with
following statements (strongly agree, agree,
neither agree nor disagree, disagree, strongly
disagree)
• Myparentsarewillingtocometoschoolto
talk to teachers
• IfIhaveaproblematschool,myparentsare
ready to help me
• Myparentsencouragemetodowellatschool
• Myparentsareinterestedwhathappensto
me at school
The majority of young people reported that their parents
(89%) were happy to come to school and to talk to teachers.
90% of young people (91% boys v. 88% girls) reported that if
they had problems at school, their parents would be ready
to help them. Overall 96% of young people (both boys and
girls) reported that their parents encourage them to do well
at school. 90% of young people reported that their parents
are interested in what happens to them at school. Boys were
somewhat more likely than girls to report that their parents
are interested in what happens with them at school (92% v.
88%). Younger adolescents were more likely to rate higher
levels of parental support and educational involvement than
their older peers. 15 year old girls had the lowest proportion
rating positive parental support in school across all age and
gender groups (Table 7.4).
My parents are
willing to come to
school to talk to
teachers
If I have problems at
school my parents
are ready to help
My parents
encourage me to do
well at school
My parents are
interested what
happens to me at
school
Boys
89%
91%
96%
92%
Boys
91%
93%
98%
96%
Boys
89%
91%
96%
91%
Boys
88%
88%
95%
89%
Girls
89%
88%
96%
88%
Girls
92%
93%
97%
93%
Girls
88%
90%
97%
91%
Girls
85%
81%
93%
80%
Total
89%
90%
96%
90%
All ages 11 year olds 13 year olds 15 year olds
Table 7.4 Parental support in school
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80
Parental monitoring and levels of young people’s autonomy
Measure
• Howmuchsaydoyouhavewhenyouand    
your parents are deciding how you should
spend your free time outside the school?
(I decide, both decide, my parents decide)
43% of young people reported that they usually decide,
independently from their parents, how to spend their free
time. Overall, boys were more likely than girls to report that
they usually make decisions about how to spend their free
time (48% v. 38%). The proportion of young people who
make independent decisions increased with age, with lower
proportions of girls exercising high level of autonomy than
boys in all age groups (Figure 7.5).
The proportion of young people who reported that they
usually decide how to spend their free time has decreased
from 2002 to 2014. A consistent gender difference is
evident, with girls less likely to make independent decisions
compared to boys (Figure 7.6).
Figure 7.5: Young people say they decide how to spend their free time outside school
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Boys
Girls
11 years
38%
48%
59%
29%
39% 47%
13 years 15 years
Base: All respondents in 2014
“
Teenagers tend to want to be more
independent as they grow older, they want to
be able to rely on themselves and sort things
out without help from their parents.”
Vato, age 15
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81
Figure 7.6: Young people who make decisions about their free time by themselves, by gender 2002-2014
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Boys
Girls
2002
58%
49%
56%
46% 48%
38%
2010 2014
Base: all respondents in 2002, 2010 and 2014
Note: Question not asked in 2006.
Overall, only 4% of young people (both boys and girls)
reported that their parents usually make decisions about
how they should spend their free time.
More than half of all young people (53 %) reported that they
make a decision together with their parents. Girls were more
likely to make a joint decision with their parents than boys
(58% v. 49%).
The proportion of young people who reported that they
decide together with their parents how to spend their free
time has increased from 2002 to 2014 from 43% to 53%. A
gender difference is consistent, with girls reporting higher
proportions than boys in 2002 (48% v. 39 %) as well as in the
2014 survey.
Family Life and Community Life

82
Family activities
Measure
• Howoftendoyoueataneveningmealtogether    
 withyourmumordad?(Never,lessthanonce    
a week, 1-2 days a week, 3-4 days a week,
5-6 days a week, every day, don’t have or don’t
see this person).
How often do you and your family usually do
each of these things all together (every day,
most days, about once a week, less often, never)
• Playcomputergames
• Playsportstogetherandexercise
Family evening meal
A very minor proportion of young people (6%) reported
never eating an evening meal with their family. Overall,
around half of all young people (49%) eat an evening meal
with their family every day. Just over three quarters (77%) of
young people reported that they usually have a family meal
at least 3-4 times during the week. The proportion of young
people who reported having a family meal at least 3-4 times
a week decreased with age (Figure 7.7).
Figure 7.7: Young people who eat an evening meal at least 3-4 times per week with their families
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Boys
Girls
11 years
78% 79% 74%
80% 76% 75%
13 years 15 years
Base: All respondents in 2014
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83
Sports and exercise
Overall, 41% of young people reported that they undertake
physical activity as a family, at least once a week. Boys and
younger adolescents were more likely than girls to report
doing sporting activities with their families (46% v. 37%;
Figure 7.8).
Computer games
Overall, 32% of young people reported that they play
computer games with their families at least once a week.
Boys were more likely than girls to report playing computer
games with their families weekly (37% v. 27%). Younger
adolescents were more likely to be engaged in computer
game activities with their families than their older peers
(Figure 7.9).
Figure 7.8: Young people who do family sports activities at least once a week
Figure 7.9: Young people playing computer games with their family at least once a week
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
50%
45%
40%
35%
30%
25%
20%
15%
10%
5%
0%
Boys
Girls
Boys
Girls
11 years
11 years
60%
46%
44%
37%
31%
27%
50%
35%
34%
27%
22%
15%
13 years
13 years
15 years
15 years
Base: All respondents in 2014
Base: All the respondents in 2014
Family Life and Community Life

84
Summary
HBSC findings provide a snapshot of family life in England in
2014 and explores various dimensions from family structure
and affluence to the character of family interaction.
While there is a rich body of evidence relating to parenting
in early years, young people’s own experience of being
parented during adolescence has been given relatively
less attention and HBSC remains the only international
studying considering family life from the perspective of
the adolescent and with measures that allow for trends
analysis.
The majority of young people report that they are well
supported by their parents especially in relation to their
school life and studies and their families really try to
help and give them emotional support as well. However,
the latter varies by age and gender and overall, boys are
more likely than girls to report that they have been given
appropriate help and emotional support from their families.
Likewise, younger adolescents of both genders reported
this more than older adolescents. Young people also report
that they are jointly involved with their parents in making
decisions about their use of free time and the majority
appear to be given age appropriate level of autonomy by
their parents in relation to use of their time outside of
school.
The ability of young people to talk to their parents about
the things that really matter to them varies considerably
according age and gender. Communication with mothers
appears to be relatively easy for young people, and
especially for boys. However communication with fathers
appears to be less easy for many young people, and girls in
particular.
Until this survey round, the proportion of young
people who felt they experienced good quality and
easy communication with their parents had showed a
steady upward trend, especially in relation to quality of
communication with fathers, a pattern that was also found
across Europe and North America (Brooks et al 2015). It will
be important to identify if this is a changed trend possibly
due to the altered economic position and/or unique to
England.
Sharing meal times has been associated with positive
well-being for young people as well as improved nutrition.
Families in many instances appear to be sharing meal
times, and engaging in other activities together, although
this declines with age probably as young people become
increasingly autonomous.
Young people’s thoughts on family life
The young people felt that parents and family was an
important source of support for adolescents, but that it
would become more difficult to discuss things with parents
as you became older. This was partly because some things
were felt to be more personal as you got older, but young
people also spoke a lot about wanting to feel independent
and therefore discussing problems with parents less in
order to feel autonomous. This desire for autonomy was
also seen as an important reason for adolescents doing
fewer activities with their families, including eating meals
together with them, as they got older. Some thought the
reason girls are less likely to find it easy to discuss personal
things with parents was because girls were more likely to
feel embarrassed and worried about being judged whereas
boys were more confident.
HBSC England National Report

85
References
Afifi, T. D., Joseph, A., & Aldeis, D. (2008). Why can’t we just talk about it?: An observational study of parents’ and
adolescents’ conversations about sex. Journal of Adolescent Research, 23(6), 689–721.
Bell, N. J., Forthun, L. F., & Sun, S.-W. (2015). Attachment, adolescent competencies, and substance use: developmental
considerations in the study of risk behaviors. Substance Use & Misuse, 35(9), 1177–1206.
Brooks, F., Zaborskis, A., Tabak, I., del Carmen Granado-Alcón, M., Zemaitiene, N., de Roos, S., & Klemera, E. (2015). Trends
in adolescents’ perceived parental communication across 32 countries in Europe and North America from 2002 to 2010.
European Journal of Public Health, 25(Suppl 2), 46–50.
Coleman, J., & Brooks, F. (2009). Key data on adolescence (7th ed.). Brighton: Trust for the Study of Adolescence.
Fenton, C., Brooks, F., Spencer, N. H., & Morgan, A. (2010). Sustaining a positive body image in adolescence: An assets-based
analysis. Health and Social Care in the Community, 18(2), 189–198.
Hagell, A., Coleman, J., & Brooks, F. (2013). Key data on adolescence 2013. London: Association for Young People’s Health.
Kerr, M., & Stattin, H. (2000). What parents know, how they know it, and several forms of adolescent adjustment: Further
support for a reinterpretation of monitoring. Developmental Psychology, 36(3), 366–380.
Laursen, B. (1995). Conflict and social interaction in adolescent relationships. Journal of Research on Adolescence, 5(1),
55–70.
Moreno, C., Sánchez-Queija, I., Muñoz-Tinoco, V., de Matos, M. G., Dallago, L., Bogt, T. Ter, … Rivera, F. (2009). Cross-national
associations between parent and peer communication and psychological complaints. International Journal of Public Health,
54(Suppl 2), 235–542.
Pedersen, M., Granado-Alcón, M. C., & Moreno-Rodriguez, C. (2004). Family and health. In C. E. Currie, C. Roberts, A. Morgan,
R. Smith, W. Settertobulte, O. Samdal, & V. Barnekow Rasmussen (Eds.), Young people’s health in context: Health Behaviour
in School-aged Children (HBSC) study: International report from the 2001/2002 survey (pp. 173–177). Copenhagen: WHO
Regional Office for Europe.
Rees, G., Pople, L., & Goswami, H. (2011). Understanding children’s well-being. Links between family economic factors and
children’s subjective well-being: initial findings from Wave 2 and Wave 3 quarterly surveys. London: The Children’s Society.
Sweeting, H., & West, P. (1995). Family life and health in adolescence: A role for culture in the health inequalities debate.
Social Science & Medicine, 40(2), 163–175.
Tabak, I., & Radiukiewicz, K. (2009). Polska rodzina oczami nastolatków i ich rodziców. Adaptacja skali Family Dynamics
Measure II (FDM II). Warszawa: Instytut Matki i Dziecka.
UNICEF. (2010). Innocenti Report Card 9. The children left behind: A league table of inequality in child well-being in the world’s
rich countries. Florence: UNICEF Innocenti Reseach Centre.
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Key messages
Around 33% of young people reported that they
‘like school a lot’.
The proportion of boys who reported that they
like a school a lot increased from 25% to 32%
since 2010, but remained unchanged among
girls.
A substantial proportion of young people
reported feeling high levels of pressure at school
- nearly half of 15 year old girls (41%) reported
feeling pressured ‘a lot’.
The proportion of young people who feel safe at
school increased since 2010 from 60% to 82%.
80% reported that they have at least one teacher
to whom they can go in case of any problem.
83% of young people said that they have
attended PSHE lessons at school.
70% of young people think that PSHE lessons
improved their skills and abilities in relation to
health and well-being.
Over 50% said that personal and social issues, as
well as issues of health & well-being, and ‘staying
safe’ had been well covered by PSHE classes.
Just under 50% thought that sexual health issues
are well covered.
Introduction
Outside of the home, school is arguably the most important
context for young people’s lives. It is where they spend a
majority of their time, where friendships are often formed,
and where they learn the skills needed to prepare for
employment and adult life.
School and homework can also be a source of stress,
and many young people may be concerned about their
academic performance relative to their peers if the school
environment is strongly focused on achievements and
targets. Conversely, good perceived academic performance
may be indicative of confidence and self-esteem.
The relationship between students and teachers forms an
important basis for young people to learn how to relate to
adults outside of the family, and supportive relationships
with teachers have a positive impact on young people’s well-
being and self-esteem. School connectedness refers to an
academic environment in which students believe that adults
in the school care about their learning and about them as
individuals (Blum & Libbey, 2004). School connectedness in
relation to liking school, and feeling safe in school appears to
function as a protective asset for sustaining life satisfaction
and high self-efficacy. When facilitated by teachers, feeling
connected to school has been shown to have direct positive
outcomes in terms of the reduction of violence, substance
use and teenage pregnancy rates, and has been suggested
to be more cost effective than targeted interventions
(Blum, 2005; Blum & Libbey, 2004). Having a teacher you
can connect with on a personal level and who cares about
you as a person is also a key protective health asset which
has been demonstrated nationally and internationally
to be a protective health factor for young people’s well-
being (Garcia-Moya, Brooks, Morgan, & Moreno, 2014).
Moreover teacher connectedness also appears to function
in a compensatory way to protect health and well-being
even when young people lack parental support (Brooks,
Magnusson, Spencer, & Morgan, 2012). Consequently the
HBSC survey included a number of questions that set out to
explore school connectedness.
Academic achievement as measured by qualifications
attained has improved considerably in England over the past
two decades, with the numbers of students attaining 5 or
more GCSEs grades A*-C more than doubling since the early
1990’s (Hagell et al., 2013). A young person’s subjective
sense of their academic achievement or academic self-
efficacy is associated with final education outcomes and a
predictor of future life chances (Currie, Nic Gabhainn, et al.,
2008). HBSC asks young people a number of questions about
how they perceive their academic performance and how
they are perceived by their teachers.
Chapter 8 School Life
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87
Feeling pressured by schoolwork relates to school
adjustment and is akin to job strain in the workplace.
However feeling pressured by school work is not simply a
reflection of individual characteristics; the level of school
related stress is also a characteristic of the wider context
of the school and classroom culture. However a reasonable
amount of pressure can be positive in terms of developing
coping strategies to manage exams and workload (Torsheim
& Wold, 2001).
One way of promoting health and well-being in children in
England is through personal, social, health and economic
(PSHE) education. PSHE is a “planned programme of learning
opportunities and experiences that help children and young
people grow and develop as individuals and as members
of families and of social and economic communities”8 It is
a non-statutory subject in English schools, although most
schools chose to provide it (Ofsted, 2013). PSHE includes
learning about health and well-being (e.g. healthy lifestyles),
sex and relationships, staying safe (e.g. road safety,
substance use), economic well-being and careers education,
and personal and social skills, end enables young people
to better understand themselves and their role in, and
contribution towards, wider society (McWhirter, 2009).
Health education has been shown to have a positive impact
on young people’s health behaviours (Langford et al., 2014),
but it has been argued that PSHE is an undervalued subject
(Hayward, 2012) that doesn’t receive the same status and
level of assessment as other subjects (Ofsted, 2013).
8 http://www.pshe-association.org.uk (Accessed 04/08/15)
Perception of school
Measure
• Howdoyoufeelaboutschoolatpresent?
(like it a lot, like it a bit, don’t like it very
much, don’t like it at all)
Liking school
Overall, 32% of young people reported that they like school
‘a lot ‘(32% of boys and 33% of girls). 48% of young people
said that they like school a ’bit’. Girls were more likely than
boys to report liking school a lot during early adolescence,
however boys were more likely than girls to report the same
at older ages Liking school ‘a lot’ decreased with age among
both boys and girls (Figure 8.1).
Figure 8.1: Young people who like school ‘a lot’
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Boys
Girls
11 years
45%
24% 21%
51%
27%
15%
13 years 15 years
Base: All respondents in 2014
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88
Across all age groups, the proportion of young people
who report liking school a lot has increased since 2002.
A consistent gender difference is evident, with girls more
likely than boys to report liking school ‘a lot’ (Figure 8.2).
Figure 8.2: Young people who like a school ‘a lot’, by gender 2002- 2014
50%
45%
40%
35%
30%
25%
20%
15%
10%
5%
0%
Boys
Girls
2002
20%
18%
38%
36% 30%
25%
33%
32%
2006 2010 2014
Base: All respondents in 2002, 2006, 2010 and 2014
HBSC England National Report

89
Academic achievement
Measure
• Inyouropinion,whatdoesyourclass 
teacher(s) think of your school performance
compared to your classmates? (Very good,
good, average, below average)
Overall, 76% of students of all ages rated their academic
achievement in school as ‘good ‘or ‘very good’. More
girls than boys rated their academic achievement as good
(81% v.71%), and younger adolescents rate their academic
achievements higher than their older peers (Figure 8.3).
Figure 8.3: Young people who rated their academic achievement as good or very good
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Boys
Girls
11 years
73% 69% 69%
85% 78% 79%
13 years 15 years
Base: All respondents in 2014
School Life

90
Feeling pressured by school work
Measure
• Howpressureddoyoufeelbytheschoolwork
 youhavetodo?(Notatall,alittle,some,alot)
Overall, 17% of young people reported feeling pressured
‘a lot’ by schoolwork. Girls were more likely than boys to
report feeling pressured (21% v.13%), and both boys and
girls reported feeling more pressured by school work the
older they got (Figure 8. 4).
The proportion of boys who reported feeling pressured by
schoolwork decreased from 2002 to 2014, while among
girls it remained unchanged. There is a consistent gender
difference across time points, which appears to be widening
(Figure 8.5).
Figure 8.4: Young people pressured ‘a lot’ by school work
50%
45%
40%
35%
30%
25%
20%
15%
10%
5%
0%
Boys
Girls
11 years
9% 12%
19%
9%
16%
41%
13 years 15 years
Base: All respondents in 2014
“
Secondary school can be much “harsher”
than primary school.”
Roman, age 14
HBSC England National Report

91
Figure 8.5: Young people who said that they are pressured by schoolwork ‘a lot’, by gender 2002-2014
50%
45%
40%
35%
30%
25%
20%
15%
10%
5%
0%
Boys
Girls
2002
21%
18%
24%
21%
19%
14%
21%
13%
2006 2010 2014
Base: All respondents in 2002, 2006, 2010 and 2014
“
Since 2010 the tests have been made
more difficult and because of the removal of
AS levels they are even more important for
trying to get a position in a university or an
apprenticeship. Because of this young people
will feel more stressed by their
GCSE exams.”
Sam, age 15
School Life

92
Feeling safe at school
Measure
• Herearesomestatementsaboutyourschool
and the students and teachers in your school.
Please show how much you agree or disagree
with each one (strongly agree, agree, neither
agree nor disagree, disagree, strongly disagree)
• Ifeelsafeinthisschool
Feeling safe at school
Overall, 82% of young of young people (83% of boys and
82% of girls) reported that they feel safe at school. There
were slight age differences with 11 year olds generally
feeling safer than 13 or 15 year olds. 11 year old girls felt
safer at their school than the same age boys (91% of girls v.
86% of boys); this changes in older groups with 13 and 15
year old boys feeling safer than girls (Figure 8.6).
The proportion of young people who reported that they feel safe at school has increased since 2002 (Figure 8.7)
Figure 8.6: Young people who feel safe at their school
100%
80%
60%
40%
20%
0%
Boys
Girls
11 years
86% 79% 82%
91%
75% 77%
13 years 15 years
Base: All respondents in 2014
Figure 8.7: Young people who feel safe at their school, by gender 2002-2014
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Boys
Girls
2002
55%
54%
70%
67%
82%
83%
2010 2014
Base: All respondents in 2002, 2010 and 2014
Note: Question not asked in 2006
HBSC England National Report

93
School belonging
Measure
• Herearesomestatementsaboutyourschool
and the students and teachers in your school.
Please show how much you agree or disagree
with each one (strongly agree, agree, neither
agree nor disagree, disagree, strongly disagree)
o I feel like belong in this school
Overall, 75% of young people (76% of boys and 74% of
girls) reported that they felt like they belong in their school.
Younger adolescents were more likely than their older peers
to say so, with some gender difference noted across all age
groups (Figure 8.8). The proportion of young people who
said that they feel like they belong in their school increased
from 2002-2014 (Figure 8.9).
Figure 8.8: Young people who feel that they belong in their school
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Boys
Girls
11 years
82%
73% 72%
85%
67% 65%
13 years 15 years
Base: All respondents in 2014
Figure 8.9 : Young people who feel that they belong in their school 2002-2014
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Boys
Girls
2002
60%
58%
61%
62%
76%
74%
2010 2014
Base: All respondents in 2002, 2010 and 2014
Note: Question not asked in 2006 School Life

94
Peer and teacher relationship
Measure
• Herearesomestatementsaboutyourschool
and the students and teachers in your school.
Please show how much you agree or disagree
with each one (strongly agree, agree, neither
agree nor disagree, disagree, strongly disagree)
o Students like being together
  o Otherstudentsarekindandhelpful
o Teachers care about me as a person
o There is at least one teacher I can go to if
I have a problem
Students like being together
Overall, the majority of young people were positive
regarding the atmosphere between students at school,
in terms of feeling liked, supported and accepted. 70% of
students agreed or strongly agreed that the students in their
school ‘like being together’. Boys were more likely than girls
to report that students like being together (74% v. 66%)
The proportion of students that responded ‘agree’ or
‘strongly agree’ that students ‘like to be together’ decreased
with age from 79% at age 11 to 64% at age 15, and the
gender differences increased with age (Table 8.1).
Other students are kind and helpful
Overall, 68% of young people, both boys and girls, agreed or
strongly agreed that ‘other students are kind and helpful’.
Younger adolescents were more likely to report that other
students are kind and helpful in their school than their older
peers, but no gender differences were found (Table 8.1).
Teachers care about me as a person
In general, young people reported that they are well
supported and connected to their teachers; 71% of students
agreed or strongly agreed that their teachers care about
them as a person. Overall, boys were slightly more likely to
report that their teachers care about them than girls (73%
v.70%); this gender difference increased with age. Overall,
younger adolescents were more likely than their older peers
to report that their teachers care about them as a person
(Table 8.1). The proportion of young people reporting
that teachers care about them as a person has increased
substantially from 2002-2014 (Figure 8.10).
Students like being
together
Other students are
kind and helpful
Teachers care
about me as a
person
Boys
74%
68%
73%
Boys
80%
79%
84%
Boys
70%
61%
63%
Boys
69%
61%
68%
Girls
66%
68%
70%
Girls
77%
81%
87%
Girls
61%
61%
60%
Girls
58%
59%
57%
Total
70%
68%
71%
All ages 11 year olds 13 year olds 15 year olds
Table 8.1 School relationships
HBSC England National Report

95
Figure 8.10 : Young people who agree their teacher cares about them as a person
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Boys
Girls
2002
38%
37%
44%
44%
73%
70%
2010 2014
Base: All respondents in 2002, 2010 and 2014
Note: Question not asked in 2006
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96
Having a teacher to talk to
Overall, 80% of young people (79% of boys and 81% of girls)
reported that they have at least one teacher they can go to if
they have a problem. Younger adolescents were more likely
than their older peers to report that they have at least one
teacher they can go to, and girls were slightly more likely
to say so than boys with the exception of 15 year old boys
(Figure 8.11).
“
It is important that there is someone
you can talk to in case you have some
problems such as being stressed or
bullying/friendship problems.”
Felix, age 11
“
At school we have a nurse who comes in,
so if you feel like you can’t talk to anyone you
know you can talk to this lady.”
Amelia, age 12
Figure 8.11: Young people who have at least one teacher they can go to in case of problem
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Boys
Girls
11 years
87%
72% 77%
90%
75% 74%
13 years 15 years
Base: All respondents are in 2014
HBSC England National Report

97
“
I think [PSHE] should cover: mental
health, sexual identity, consent, sexuality,
gender identity and dealing with stress.”
Katie-Lou, age 16
PSHE
Measures
• Haveyouattendedschoolhealtheducation
(PSHE) classes in school?
• Howstronglydoyouagreeordisagreewith
the following (range from strongly agree to
strongly disagree)
o PSHE lessons improved their skills and
abilities to care for other people’s health
o PSHE classes improved their skills and
abilities to consider the importance of
their own health
• Howwellhavethefollowingsubjectsbeen
covered in PSHE? (From very well covered to
 verypoorlycovered,N/A).
o Health and well-being (e.g. learning about
diet, physical activity, alcohol, tobacco
and drugs)
o Sex and relationships (including puberty,
pregnancy and contraception)
o Staying safe (e.g. road safety, personal
safety, and internet safety).
o Economics and careers education (e.g.
saving and looking after money,
understanding different types of jobs)