Compared to adolescents in other parts of the industrialized world, U.S. students are less likely to watch television. Moreover, although 15 year old U.S. adolescents were among the least likely to smoke, U.S. 11 year olds began smoking at rates as high as those of 11 year olds in other countries. U.S. adolescents were also less likely to exercise frequently, and less likely to have a good diet than were students in other countries, according to a new report issued by the World Health Organization (WHO). Coordinated by the WHO, the Health Behaviors in School-Aged Children (HBSC) Study looked at 11, 13, and 15-year old children's attitudes and experiences concerning a wide range of health related behaviors and lifestyle issues in 26 European countries and regions, Canada, and the United States. The U.S. component of the study was funded and coordinated by the National Institute of Child Health and Human Development (NICHD). A copy of the report will be posted on the WHO website at www.ruhbc.ed.ac.uk/hbsc.
"The study's findings are of crucial importance for the development of timely and relevant health promotion and health education initiatives at local, national, and international levels," said NICHD Director Duane Alexander, M.D. "The information will be helpful to U.S. policy makers in designing a variety of local, state, and national programs."
The findings were derived from a 1997-98 survey of more than 120,000 students in: Belgium (both Flemish and French), Canada, the Czech Republic, Denmark, England, Estonia, Finland, France, Germany, Greece, Greenland, Hungary, Republic of Ireland, Israel, Latvia, Lithuania, Northern Ireland, Norway, Poland, Portugal, the Russian Federation, Scotland, the Slovak Republic, Spain, Sweden, Switzerland, the United States, and Wales.
The study is conducted every four years, and this marks the first year of full U.S. participation. Specifically, the study focuses on the period of transition from preadolescence into mid-adolescence, said the NICHD epidemiologist, Mary Overpeck, Dr.P.H. By conducting the survey every four years, she said, patterns and trends can be identified and related to national policies and other influences on health behaviors of youth.
Smoking and alcohol use
Smoking on a daily basis is common in the youth of all countries in the study and increases dramatically between ages 11 and 15. However, the U.S. ranks only 24th out of 28 for daily smoking, with 12 percent of 15 year olds smoking daily. Austria, France, Germany, Hungary and Greenland report the highest smoking rates, with more than 25 percent of 15 year olds smoking daily. U.S. students ranked in the middle for alcohol consumption. About 23 percent of U.S. 15 year olds reported drinking weekly, as compared with 53 percent in Wales, 52 percent in Greece, 47 percent in England and 46 percent in Denmark. The percentage of children who reported having been drunk at least twice in their lives was lowest in Switzerland, Israel, Portugal, Greece and France, ranging from 16 percent to 29 percent, with the U.S. around the middle at 34 percent.
Health and Well Being
According to the report, 91.8 percent of all 11, 13, and 15 year olds consider themselves healthy, with U.S. children ranking 21st in this survey category. Students in the U.S. and Israel reported the highest frequency of health-related problems and symptoms and were more likely to take medications for these symptoms. For the symptoms surveyed--among them headache, stomachache, backache, nervousness, feeling tired, feeling lonely, and feeling "low"--U.S. students ranked among the top four countries for seven of the nine symptoms. For all countries, young adolescent girls consistently reported a higher frequency of general health problems, recurrent pain symptoms, and negative feelings (such as feeling low or lonely) than did young adolescent boys. On the other hand, boys were more likely to report feeling tired in the morning than were girls. Also, U.S. children were the 3rd most likely of all groups to report feeling tired in the morning for four or more times a week.
Family Relationships
The study also found that family living arrangements and relationships varied according to national grouping. For example, while more than 90 percent of students in Greece, Israel, Portugal, Switzerland, Finland, and Slovakia live with both parents, only 64 percent of U.S. students reported living with both parents--lower than for all other countries except Greenland. In addition, along with youth in two other countries, U.S. youth at all three ages were among those most frequently reporting that they have difficulty talking to their mothers. In all countries, children were more likely to report more difficulty communicating with their fathers than with their mothers. (Compared to the children from the other countries, U.S. children ranked in the middle on these measures.) For all countries, difficulty with parental communication was strongly associated with feeling less happy, with smoking, and with drinking alcohol.
School Relationships
Regarding their relationship with their schools, the study also found that students who felt involved in school, and who received support from their teachers and other students, were more likely to feel healthier, be physically active, and were less likely to smoke.
Student satisfaction with school decreased with age among most countries. For most countries, girls tended to like school better than did boys. Students in the U.S. were among those least likely to feel that they took part in decision making at school, together with parts of the Russian Federation, Flemish Belgium, the Czech Republic and Finland. Students from Switzerland, Greece, France and Germany were among those who felt best about participation in rule making. Along with Flemish Belgium, Israel, and Northern Ireland, students in the U.S. also were among those who most felt that rules were too strict. For all countries, boys consistently were more likely to find the rules too strict than were girls.
Expectations and demands by teachers and parents were not considered excessive by the majority of U.S. students, even though U.S. students were most likely to feel a lot of pressure from their school work. Along with students in the Czech Republic and Lithuania, U.S. students were among those least likely to feel that their fellow students were kind and helpful. Students in Portugal, Denmark, Sweden, and Switzerland felt best about the supportiveness of other students.
Physical Fitness
Students in the U.S. were less likely to exercise frequently than were students in most other countries, with about two-thirds of U.S. students exercising two or more times a week or for more than two hours a week. By comparison, 80 percent of students in Austria, Germany and the Slovak Republic reported exercising regularly. For all countries, boys were more likely to exercise regularly than were girls. Similarly, students in all the countries were more likely to report that regular exercise was associated with feeling healthier, confidence, making friends, and higher measures of affluence.
In contrast to students in all the countries, 15 year olds in the U.S. were less likely to watch television-with one fourth reporting they watched TV more than 4 hours a day. Younger U.S. children were more likely to watch television, with about one-third of 11 year olds watching more than four hours a day-- higher than for 22 of the other 28 countries and regions surveyed on this question. Boys were more likely to watch TV this often than were girls. Students who watched more television were more likely to eat junk food than were students who spent less time TV viewing.
For the most part, U.S. students were less likely to have a good diet than were children in other countries. U.S. students were less likely to eat fruit and vegetables each day than were students in the majority of other countries. They also were more likely to eat potato chips and French fries than were students in most other countries. For students age 15, the U.S. ranked among the top three countries for consuming sweets, chocolate, and soft drinks every day. For all countries, girls were more likely to eat fruit and vegetables each day, while boys were more likely to drink more milk but also to eat more junk foods and fried foods. Fruit and vegetable consumption, however, was found to decrease with age.
Dieting behavior and concerns about body size increased with age for girls in all countries, while decreasing for boys. U.S. students were more likely than students in any other country to report that they were dieting or to feel that they should be on a diet (almost half of 11 year old U.S. girls and two-thirds of U.S. 15 year old girls.)
The NICHD is one of the Institutes comprising the National Institutes of Health, the Federal government's premier biomedical research agency. NICHD supports and conducts research on the reproductive, neurobiological, developmental, and behavioral processes that determine and maintain the health of children, adults, families, and populations. The NICHD website, www.nichd.nih.gov, contains additional information about the Institute and its mission.
This is the second international report on the HBSC study. The first, The Health of Youth, reported the findings of the 1993-1994 Survey. The current report is part of a new WHO document series, "Health Policy for Children and Adolescents," targeting experts in all parts of the world who are concerned with health-related issues or whose area of work directly or indirectly affects the health of young people. Press releases from the WHO are available at www.who.dk/cpa/cpa.htm.
The survey was conducted in the U.S. schools by Macro International Inc., which also is participating with the NICHD in the analysis.