A National Assessment of Effects of School Experiences on Health Outcomes and Behaviours of Children : Technical Report

Table of Contents

Executive Summary

Objectives

Central to the concept of schooling is the recognition that students' positive social bonds with schools are highly related to their well-being in terms of (a) academic performance, (b) social behaviours, and (c) physical and mental health. With the availability of the data from the Cross-National Survey on Health Behaviours in School-Aged Children (HBSC), we examined the effects of school experiences on a number of health outcomes and behaviours of Canadian youth. 

Method

The HBSC data contain students enrolled in Grades 6 to 10 at the time of the survey. Canadian sample sizes were 2,112 students in the sixth grade, 2,056 students in the seventh grade, 2,225 students in the eighth grade, 2,362 students in the ninth grade, and 2,517 students in the tenth grade. We identified 24 health outcomes and behaviours as dependent variables in our analysis. These dependent variables formed eight categories: substance use (use of drugs, use of alcohol, frequency of drinking, drunkenness, use of tobacco, frequency of smoking and amount of smoking), injury (injury with medical treatment and injury without medical treatment), leisure activities (time spent on television and computer games, frequency of exercise, and hours of exercise) nutrition (more healthy food, less healthy food, and breakfast), dental hygiene (brushing teeth and flossing teeth), self (self-esteem, helplessness and body image), interpersonal relationship (number of close friends and making friends), and health (physical health and mental health). 

Independent variables included a number of student-level and school-level variables (used as predictors of health outcomes and behaviours of students). Student-level variables included gender, age, mother's socio-economic status (SES), father's SES, number of parents, and academic status. We constructed 12 school-level variables in two categories. School context variables included school mean mother's SES and school mean father's SES. School climate variables included presence of positive circle of friends, presence of negative circle of friends, peer environment, academic press (expectations), fair school rules, student skipping class, school safety, child-parent relationship, parental involvement, and sense of belonging to school. Because most health outcome measures were dichotomous, we employed multilevel logistic models in our analysis. The first-level model was the student model, and the second-level model was the school model. 

Recent Health Status of Canadian Students

Concerns have arisen about Canadian students' substance use (seven outcome measures on use of drugs, alcohol and tobacco). An obvious increasing trend toward substance use has been observed in each and every outcome measure on substance use (seven in total) across grade levels. Canadian students' substance use increases as they grow older. 

Injury (both serious and minor) shows a slight growth with the peak in Grade 9. All three measures of leisure activities peak in Grade 7. Canadian students spend less time watching display screens when they grow older, but also spend less time on physical activities - Canadian students are living an inactive life. 

Nutrition status of Canadian students highlights the obvious decline in eating breakfast across grade levels. Students' intake of more healthy food and less healthy food basically remains moderate and consistent across grade levels. Canadian students' dental hygiene remains positive and basically consistent across grade levels on brushing teeth, but the use of dental floss is rare among Canadian students across grade levels. 

Canadian students show increasing concerns about their body image - an obvious growth of worrying across grade levels. Meanwhile, their self-esteem declines slightly across grade levels. There is no serious concern about feeling helplessness among Canadian students. 

Interpersonal relationship is satisfactory among Canadian students. Their chance of having more than two close friends and making new friends looks positive and consistent across grade levels. One of the serious concerns about Canadian students is their health. Both their physical and mental health declines across grade levels. 

Factors That Affect Substance Use

Number of parents and academic status emerge as the single most important predictors of use of alcohol. Students from single-parent families or with lower academic status are more likely to drink alcohol than students from both-parent families or with higher academic status. Academic status emerges as the single most important predictor of smoking. Lower academic status is related to higher likelihood of smoking. Number of parents and gender are also critical predictors of smoking, with concerns about students from single-parent families and female students. Substance use is much more strongly related to school experiences. Characteristics of schools in which students are less likely to use substances can be described as (a) positive circle of friends, (b) positive sense of belonging to school and (c) positive parental support. The single most important school experience that dominates all seven outcome measures on substance use is the circle of friends, crucial in all grade levels. 

Factors That Affect Injury

Overall, student injury (either serious or minor) is not closely associated with either their individual characteristics or their school experiences. Safety education is necessary regardless of students' individual and school background. 

Factors That Affect Leisure Activities

At the student level, gender emerges as the single strongest predictor of leisure activities. Male students spend more time watching display screens than female students. On the other hand, female students spend less time in physical activities than male students. There is the public concern about students' watching display screens excessively. We suggest that schools can help alter this unhealthy lifestyle. Characteristics of schools in which students spend less time on display screens can be described as (a) positive peer influence, (b) fair school rules and (c) positive sense of belonging to school.

Factors That Affect Nutrition

At the student level, gender emerges as the single strongest predictor of eating breakfast. Male students are more likely to eat breakfast than female students. Student background characteristics are not important predictors of "more healthy food" intake, but gender emerges as the single strongest predictor of "less healthy food" intake. Male students consume more "less healthy food" than female students. Effective schools where students report better nutrition can be characterized as having (a) strong parental support and (b) positive peer influence. 

Factors That Affect Dental Hygiene

At the student level, gender emerges as the single strongest predictor of dental hygiene. Female students are more likely to brush and floss teeth than male students, with the gender gap increasing consistently across grade levels. School experiences positively promoted dental hygiene. Characteristics of schools in which students showed better dental hygiene can be described as (a) positive disciplinary climate, (b) positive peer environment and (c) positive sense of belonging to school. 

Factors That Affect Self 

At the student level, academic status is the single strongest predictor of feeling helpless. Lower academic status is related to stronger feeling of helplessness. Students from single-parent households also experience more helplessness than students from both-parent households. Gender turns out to be the single strongest predictor of worrying about body image. Female students are more likely to worry about body image than male students, with the gender gap increasing consistently across grade levels. Gender also turns out to be the single strongest predictor of self-esteem. Male students shows higher self-esteem than female students. Characteristics of schools in which students develop healthier self-perceptions can be described as (a) strong parental support, (b) high academic press (expectations) and (c) positive peer influence. 

Factors That Affect Interpersonal Relationships

There is a lack of effects of student-level variables on the well-being of student interpersonal relationships. In contrast, school experiences have major impact on student interpersonal relationships. Effective schools where students report more positive interpersonal relationships can be characterized as having (a) positive sense of belonging to school, (b) high academic press (expectations) and (c) strong parental involvement. Parental involvement and academic press show more important effects on interpersonal relationships than sense of belonging to school. 

Factors That Affect Health

At the student level, gender emerges as the single strongest predictor of both physical and mental health, in favour of male students in both cases. Characteristics of schools in which students are healthier physically and mentally can be described as (a) positive disciplinary climate, (b) positive child-parent relationship and (c) positive peer environment.

Recommendations for Parents

• Parents participate in the school-wide, long-term, parent-involved campaign against the use of drugs, alcohol and tobacco.

• Parents educate their children and monitor their children's activities outside school to prevent injury.

• Parents convince female children to have breakfast regularly and offer healthy snacks directly (rather than provide snack allowance) to male children to reduce their intake of less healthy food.

• Parents praise their children's school accomplishment (e.g. academic achievement, athletic awards, special talents and prosocial behaviours) to help them reduce the feeling of helplessness, alleviate the worrying about body image and develop positive self-esteem. 

• Parents help their children develop interpersonal relationship (e.g. creating opportunities for their children to meet others and instructing their children in interpersonal relationship skills). 

• Parents develop harmony relationships with their children to help improve their physical and mental health.

Recommendations for Schools

• School staff target students with low academic status to reduce the use of drugs, alcohol and tobacco and alleviate the feeling of helplessness. 

• School staff target students from single-parent families to reduce the use of drugs, alcohol and tobacco and alleviate the feeling of helplessness. 

• School staff target male students to reduce the time spent on watching display screens and improve dental hygiene. 

• School staff target female students to reduce the use of tobacco, increase the amount of physical activities, have breakfast regularly, reduce the feeling of helplessness, alleviate the worrying about body image, develop positive self-esteem and improve physical and mental health.

• School staff influence peer groups and create a positive peer environment (with measures such as awareness programs, close adult supervision of negative social circles, reward programs, tough sanctions with the support of families and communities, and counselling of the leading members of a negative social circle). 

• School staff improve students' sense of belonging to school (with measures such as performing lunch duties, collecting homework assignments, arranging field trips, supervising younger students in lower grade levels and contributing special talents to school events).

• School staff work toward a safe school disciplinary environment with clear and fair rules.

• School staff involve students in the development of school rules.

• School staff monitor students' activities inside school to prevent injury.

• School staff develop extracurricular programs to reduce students' time watching display screens. 

• School staff make age-appropriate and gender-appropriate physical activities available to female students and attract them to participate. 

• School staff work with school nurses and nutrition experts to develop healthy lunch menus in school (including snacks available in school). 

• School staff work closely with parents to improve health outcomes and behaviours of students (with measures such as parent council, workshops for parents on health issues, regular formal teacher-parent conferences and regular informal teacher-parent contacts). 

• School staff hold high academic expectations for students and provide appropriate support for students to achieve them (with measures such as more relevant homework assignments, individual tutoring by teachers, qualified parents and advanced capable students, study buddies programs and cooperative learning among students).

Recommendations for Education Policy

• Restore school health education curriculum to develop adequate health literacy among students - the knowledge, values, attitudes and beliefs necessary for health supportive decision making. 

• Provide adequate training for school staff on health promotion and intervention. 

• Create (at least) mobile school nurses positions to provide guidance and assistance to school health promotion and intervention. 

Recommendations for Public Health Policy

• A family health strategy (focusing on parental awareness, training for parents, and parental involvement) is needed to target specific vulnerable groups of students (e.g. students with low academic status and students from single-parent families) to improve health outcomes and behaviours of students. 

• A school health strategy (with strong commitment of school staff) is needed to utilize school experiences (e.g. circles of friends, sense of belonging to school, extracurricular activities, and academic expectations) to influence health outcomes and behaviours of students. 

Recommendations for Social Services Policy (Social Support Systems)

• Involve parents and schools in the prevention and intervention of adverse health outcomes and behaviours of students. 

• Provide professional resources to assist parents and schools in their use of family and school experiences to influence health outcomes and behaviours of students.

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