Risk and protective factors for health behaviour in adolescence in Europe
The purpose of the analysis was to identify the risk and protective factors for health behaviour in European adolescents from population health status and expenditure, mental health status, sexual life, social life and education indices and the existence of national strategies, programmes.
National and international databases providing information on the presumed health behaviour predictors were used in the analysis.
The existence of national health strategies, the level of health expenditure, the socioeconomic conditions, the level of education and literacy had significant influence on the health-risk behaviour of adolescents in the European societies.
Six clusters of European countries were extracted by considering the health behaviour risks and health protection strategies.
National health strategies combined with governmental support for health prevention and action plans have the most effective impact on the health-risk behaviour of adolescents.
European countries clustering by children’s health behaviour risks and health protection strategies
By considering the health behaviour risks (suicide prevalence, adolescent pregnancies, alcohol consumption, other drug dependence, smoking, physical activity level) and health protection strategies in the studied countries (data were available for only 15 countries, WHO Global eHealth Survey 2015) 6 clusters of countries were extracted.
Denmark, Sweden, Norway and Finland formed the first cluster (‘Nordic’ cluster), they had national strategies on health promoting and sexual education in schools, their countries could allocate a budget for these strategies and had remarkable funding contribution for eHealth programmes provided by both public sources and public–private partnership sources. These health investments resulted in very low level of adolescent pregnancies, low level of alcohol consumption in youths, low level of suicide and intentional self-harm in adolescents under the age of 15 and a very high ratio adolescents doing physical activity regularly. The level of suicide and intentional self-harm in older adolescents, proportion of adolescents smoking daily, the ratio of adolescents with drug dependence were also very low in these countries except for Finland, where these health behavioural indicators were worser than in the other members of the cluster.
The second cluster was formed by the Czech Republic, Estonia and Croatia (East-Central European countries I cluster). The health promotion and education strategies were not as strong and frequent as in the Nordic cluster countries, but still stronger than in the other clusters (had sex education both in primary and secondary education systems, had national strategies for health and sex education in schools, but the funding contribution for eHealth programmes was lower both from the public and private sectors). The level of adolescent pregnancies, the level of smoking and alcohol consumption in adolescents were higher, while the level of physical activity in adolescents was lower than in the cluster of countries from the Scandinavian region.
Switzerland formed a cluster (‘Swiss’ cluster) by having health and sex education programmes in the schools, but not having budget for these programmes. The health behaviour metrics were very good in this country except for the low level of physical activity in adolescents.
In the clusters of Lithuania, Latvia and Hungary (East-Central European countries II cluster) and Ireland and Portugal (Western European cluster) the countries had mixed types of national health strategies and health education programmes, had worse health behaviour metrics than in the Nordic, East-Central European and Swiss clusters. These two clusters were very close not only by considering their health behaviour metrics but also in the dendrogram.
The East-Central European countries III cluster consisted of Russian and Serbia, where the health behaviour metrics were similar to the countries’ metrics in East-Central European countries I cluster (these 2 clusters were close to each other in the dendrogram) – with the exception of higher level of adolescent pregnancies and higher level of suicide and intentional self-harm among adolescents and young adults. The missing of health and sex education programmes and strategies in Russian and Serbia might explain these differences between the 2 clusters.
Table 8 Clusters of countries by the health behaviour risks and health protection strategies
|Country||Nat strat prom||Nat strat health||Budget strat||Sexed||Ed sex viol||Health pub-priv||Health pub||Suicide -14||Suicide 15-||Adol pregn||Alcohol||Drug||Smok||Phys act||Leisure act|
Explanation of table
- Nat strat prom: national strategy on health promoting schools,
- Sex ed: policy of having sex education in schools,
- ED sex viol: country undertakes age- and gender-appropriate education on sexual partner violence,
- Health pub-priv: the proportion of funding contribution for eHealth programmes provided by public–private partnership funding sources over the previous 2 years,
- Health pub: the proportion of funding contribution for eHealth programmes provided by public funding sources over the previous 2 years,
- Nat strat health: the country had a national strategy for child and adolescent health and development that has been adopted within the last 5 years,
- Budget strat: having a budget allocated for these strategies,
- Suicide -14: suicide and intentional self-harm, 0–14 years, per 100,000 population,
- Suicide 15-: suicide and intentional self-harm, 15–29 years, per 100,000 population,
- Adol pregn: adolescent pregnancy rate (per 1000 women),
- Alcohol: pure alcohol consumption, litres per capita, age 15–29 years, Drug: drug dependence and toxicomania, 15–29 years, per 100,000 population,
- Smok: proportion of 15-year-old adolescents smoking daily,
- Phys act: performing health-enhancing aerobic and muscle-strengthening physical activity 15–19 years at least once a week,
- Leisure act: Percentage of adolescents in households where at least one child does not participate in a “regular leisure activity” and/or “go on holiday away from home at least one week per year.
- P + S: in primary and secondary schools, P: only in primary schools, S: only in secondary schools, v high: very high.
Note: not all the 27 studied countries had data for health strategies in the WHO Global eHealth Survey 2015) – the clusters are ordered by considering the national health strategies and education programmes in the cluster countries.
The existence of national health strategies, the level of health expenditure, the poverty in the micro- or macro-environment, the level of education and literacy had significant influence on the health-risk behaviour of adolescents in the European societies.
Health prevention strategies are intentions taken at national and international levels to prevent the onset or the complications of manifested diseases, injuries, impaired health statuses by targeting healthy and not healthy individuals. Health prevention programmes aim to serve guidelines on risk reduction to individuals and groups of individuals. The results of the present analysis highlight the importance of appropriate prevention and education strategies, especially for children and adolescents living in high-risk groups (in poverty, institutional care). Individual health decisions of adolescents are not made in social isolation but rather in interaction with others, in early stages with family members and experts, and in a later age-interval with a bigger influence of friends.
The existence of national health strategies combined with significant health expenditures and budget allocated for health prevention and action plans revealed to be the most effective impact on the health-risk behaviour of adolescents and young adults.
Nowadays the arsenal of eHealth services (digital technologies) and mHealth services (mobile technology) support health prevention programmes. Online, electronic education materials serve as effective training tools for health education.
The main aim of the presented analysis was to reveal similarities and differences among the European societies, to identify groups of societies by considering the health risk behaviour indicators, the studied health, social, education indices and national health strategy indicators.
The analysis of the relationship between health risk behaviour indicators and the studied health status, health expenditures, mental health status, sexual life, reproductive life, lifestyle, healthy behaviour, social life, education indices revealed that the existence of national health strategies, the level of health expenditure, the socioeconomic conditions, the level of education and literacy had significant influence on the health-risk behaviour of adolescents in the European societies.
6 clusters of European countries were extracted by considering the health behaviour risks and health protection strategies among Belgium, Croatia, Czech Republic, Denmark, Estonia, Finland, France, Germany, Great Britain, Greece, Hungary, Ireland, Italy, Latvia, Lithuania, The Netherlands, Norway, Poland, Portugal, Russia, Serbia, Slovakia, Slovenia, Spain, Sweden, Switzerland, Ukraine.