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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. The study in England is funded by the Department of Health and Social Care and the Department for Education.

HBSC represents the longest running international study that focuses on the health behaviour and social context of young people. The study was initiated in 1982 by researchers from three countries and shortly afterwards the project was adopted by the World Health Organization as a WHO collaborative study. There are now 51 participating countries and regions with over 450 researchers in the network; England has been represented in the study since 1997. The last wave of data collection took place in 2017/18, when 4733 young people aged 11, 13 and 15 years participated in the English study. Our current survey cycle for 2021/22 has data from 5377 participants from 37 schools across England.

The health of young people is a complex arena with great amounts of diversity. By examining the broader social context of young people in England, including their family, school and community life, HBSC moves beyond simply monitoring incidence and prevalence of health and risk behaviours towards an understanding of, and means to respond to, the social determinants of health and well-being. It also offers policy makers and practitioners an understanding of exactly what social and developmental factors need to be addressed in any prevention and intervention programmes. Finally, the study enables lessons to be usefully drawn through comparison with other countries.

The HBSC study collects data using a survey methodology. The survey consists of a mandatory set of questions that all participating countries must 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.

The mandatory questionnaire covers aspects of health and well-being, including self-reported health and life satisfaction, as well as information on family affluence. More information about the broad topic areas covered by HBSC (as well as questions specific to HBSC England) can be found below:

Individual and Social Resources

  • Body image (perception of body being too fat or too thin)
  • Family culture (ease of communication with mother /father; family support)
  • Peers (time spent with friends after school / in the evening; friend support)
  • School environment (liking school; perception of academic performance; school-related stress; classmate support)

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)
  • Dental health (frequency of tooth brushing)
  • Weight control behaviour (frequency of dieting to control weight)
  • Tobacco use (ever smoked; age first smoked)
  • Alcohol use (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; cyberbullying)
  • Injuries (number of medically attended injuries in past year)

Health Outcomes

  • Health complaints (a ‘checklist’ of health complaints e.g. headache, stomach-ache, feeling low, feeling nervous)
  • Life satisfaction (adapted version of the Cantril ladder (Cantril 1965))
  • Self-reported health status

Family Affluence Measure

The Family Affluence Scale (FAS) is a validated measure derived from following items and young people are classified as having Low, Medium or High affluence depending on (Roberts et al. 2007; Roberts et al. 2004):

  • The number of computers at home
  • The number of cars in the family
  • The number of family holidays taken in the previous 12 months
  • If young people have their own bedroom
  • The number of bathrooms at home
  • If there is a dishwasher at home

Children and young people are often unable to give sufficient information about their parents’ occupational status and therefore it is difficult to assign a socio-economic status (SES) score. As an alternative, the Family Affluence Scale can be used as a proxy measure of SES. Fewer children are unclassifiable using FAS than SES (Currie et al., 1997; 2008a).

England Only Questions

In 2018 the England team collaborated with the Spanish team to match questions relating to student-teacher relationships and support. The English team also collaborated with the Canadian team to explore the role of spirituality in young people’s health and wellbeing.

The questionnaire for England also included national only questions and measures on; free school meal eligibility, consumption of energy drinks, Personal Social Health and Economic (PSHE) education and young carers.