Adolescent Health Research from National to International Levels

Adolescent health is a global public health concern, with increasing recognition of the importance of the second decade of life as a critical stage of development. Adolescents now make up 16.6% of the world’s population, the largest population of adolescents in human history, and account for 6% of the global burden of disease and injury. More than 3,000 adolescents die every day from largely preventable causes.

The work led by researchers from the School of Medicine has been critical to understanding and reducing the risks to adolescent health. Alongside furthering understandings of adolescent health and its determinants, the group have created and utilised indicators to measure changes in the health behaviour of school-aged children over time compared to national targets for health behaviours and outcomes. Their work has contributed to health improvement activities through policy and strategy development at national and international levels, giving their research a profound physical impact.

Health Behaviour of School-aged Children (HBSC), co-led by researchers at the University of St Andrews and the University of Glasgow, is the largest cross-national study of adolescent health and wellbeing in Europe. Conducted in collaboration with the World Health Organisation (WHO), it now spans 51 member countries and regions across Europe and North America. Surveys conducted every 4 years provide data that help national and international agencies to develop strategies aimed at improving the health of young people and addressing health inequalities they may face.

Hosted at the School of Medicine between 2011 and 2019, the HBSC has been used extensively to prioritise policies, reduce gender and socio-economic inequalities and improve healthcare generally. The School, with leading roles taken by Prof. Candace Currie, Dr Jo Inchley and Dorothy Currie, was key to overseeing the work of the HBSC’s international research network, comprised of over 400 researchers, and continues to co-lead the scientific and methodological development of the study.

The HBSC surveys offer a valuable opportunity to reach a large sample size, with participation in recent versions reaching into the multiple hundreds of thousands. Cross-national findings show high levels of life satisfaction and recent improvements, notably in a reduction in substance use and soft drink consumption. Overall, younger adolescents report high levels of social support from family, friends and classmates, but this decreases with age. Key challenges are low levels of physical activity, with less than 25% of adolescents meeting the WHO guidelines, and increasing prevalence of poor mental well-being, especially among older adolescent girls. 

Marked gender inequalities exist for many health indicators, such as eating behaviours, and these often increase with age. There are clear social inequalities, with young people from less affluent families doing worse on a wide range of outcomes including mental health, oral health and screen time. The group’s research has shown that exposure to socio-economic inequality, particularly in early childhood, plays a major role in explaining health differences in adolescence.

Under the leadership of Prof. D. Currie and Prof. Humphris, the School of Medicine was charged with hosting the WHO Collaborating Centre (WHO CC) focusing on International Child and Adolescent Health Policy between 2014-2021. All European WHO CCs meet annually to work with WHO developing strategy for the region, including adopting major HBSC findings to indicate new intervention priorities and policy changes. The HBSC International Coordinating Centre and WHO CCs work with national governments and international bodies (WHO, UNICEF, OECD, Eurochild, the EC, Schools for Health in Europe Network (SHE), and Excellence in Paediatrics) to ensure their research shapes and supports international agendas targeting adolescent health.

The HBSC has a series of varied outputs, including national and international reports, scientific papers, policy briefs and activities. As a result, the study has achieved widespread reach through the Scottish, UK, and international media. By providing expert advice, St Andrews researchers brought the health needs and priorities of adolescents in Scotland and beyond to the attention of those in a position to enact concrete healthcare improvements.

Supporting strategic monitoring of adolescent health within the European Region

The HBSC has been raising the profile of adolescent health globally through its international reporting for over 25 years. The group’s surveys and research have provided a unique data source to inform policy and practice across Europe, and the value of the resources they provide has been recognised by institutions around the world. The findings from HBSC have been used in several high-profile outputs from the WHO, including their 2013 Review of social determinants and the health divide in the WHO European Region, and Investing in Children: the European Child and Adolescent Health Strategy, 2015-2020.

The group are also helping to develop the ways we measure adolescent health on a more fundamental level. Several HBSC indicators have been adopted by WHO, and ratified by the 53 countries that comprise its European Region, as key indicators for monitoring health across the region. The WHO makes use of even more of the HBSC’s indicators to provide monitoring data and online country profiles through the WHO European Health Information Gateway.

Monitoring and promoting international adolescent health

Additional research by UNICEF has used data from HBSC research in its contribution to the international debate around inequalities in adolescent health. 

One example of the HBSC’s contribution to UNICEF work is the Innocenti report card series, which is designed to monitor and compare progress in child welfare across the European Union. These report cards have raised the profile of adolescent health globally and address key adolescent issues including sexual health, obesity, alcohol use, poverty and mental health, providing evidence that UNICEF has used to lobby governments internationally to promote adolescent health.

HBSC data is included in several report cards published by UNICEF, including Innocenti Report Card 16: Worlds of Influence Understanding What Shapes Child Well-being in Rich Countries. J Inchley and D Currie were members of the International Steering Group for Report Card 16, while C Currie and D Currie were members of the International Steering Group for Innocenti Report Card 13: Fairness for Children: A league table of inequality in child well-being in rich countries and Innocenti Report Card 14: Building the Future: Children and the Sustainable Development Goals in Rich Countries

The HBSC offers a rich variety of resources to institutions around the world who seek to improve adolescent health. As the largest cross-national study of adolescent health and wellbeing in Europe, HBSC is a critical tool in the struggle to reduce healthcare inequalities, advance our understanding of healthcare determinants and, ultimately, improve the welfare of children across the world.

This work contributed to the University of St Andrews’ REF 2021 submission.

The Research Excellence Framework (REF) is a system which assesses research at UK Higher Education Institutions by discipline, based on three elements: outputs, impact and environment. This blogpost is based upon an impact case study that contributed to St Andrews’ outstanding results this REF cycle. Visit REF to view the submitted case study in the UKRI’s impact case study database.

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