Health Behaviour in School-aged Children

Organisation responsible: Health Behaviour in School-aged Children (HBSC) is a cross-national research study conducted in collaboration with the WHO Regional Office for Europe. The Scottish survey is commissioned by Public Health Scotland and carried out by MRC/CSO Social and Public Health Sciences Unit at the University of Glasgow in collaboration with the School of Medicine at the University of St Andrews.. The University of Glasgow also hosts the International Coordinating Centre (ICC) for the HBSC study and research network.

Background and purpose: HBSC aims to gain new insight into, and increase understanding of, young people's health and wellbeing, health behaviours and their social context. The findings from the HBSC surveys are used to inform and influence health promotion and health education policy, programmes and practice targeted at young people at both national and international levels. There are now 50 participating countries and regions, mainly within Europe and North America.

Survey years / frequency: The first cross-national survey was conducted in 1983/84, the second in 1985/86; since then data collection has been carried out every four years using a common research protocol. Scotland became a member country in 1986; this first survey was conducted on a regional sample. The first national HBSC survey was conducted in Scotland in 1990, giving a total of nine points in the time series: 1990, 1994, 1998, 2002, 2006, 2010,2014, 2018, and 2022.

Survey content: Each survey questionnaire contains a core set of questions looking at the following:

Background factors: demographics and maturation, social background (family structure, socio-economic status);
Individual and social resources: body image, family support, peers, school environment;
Health behaviours: physical activity, eating and dieting, smoking, alcohol use, cannabis use, sexual behaviour, violence and bullying, injuries;
Health outcomes: symptoms, life satisfaction, self-reported health, Body Mass Index;
Many countries also include additional items in their national questionnaire that are of particular interest on a national level.
New topics included in the national report for Scotland for the first time in 2022 include: GAD 7 anxiety score, self-efficacy, leisure activities, gaming, gender identity, sexual orientation and school-related stress. New questions on COVID-19 were also included to measure the impact of the pandemic on different aspects of young people’s lives.

Target population: School children in the final year of primary school (P7) and in the second (S2) and fourth (S4) years of secondary education (average ages 11.5, 13.5 and 15.5 years respectively).

Sample size: The HBSC International Protocol specifies a nationally representative sample of approximately 1,500 pupils from each age group in each participating country, giving a total national sample size of approximately 4,500 children. The calculation assumes a 95% confidence interval of +/-3% around a proportion of 50% and a design factor of 1.2, based on analyses of existing HBSC data. Class is used as the sampling unit with all pupils in selected classes being asked to complete the questionnaire.

In 2010, Scotland increased its desired sample size to 2000 pupils per grade in order to allow more scope for subgroup analysis. The final achieved sample was 6771 pupils. In 2014, the achieved sample size across all age groups (P7, S2 & S4) after the addition of boost areas to allow for sub-group analysis, was 10,839 pupils (4091 in P7, 3765 in S2 and 2983 in S4). In 2022, the sample size to be achieved in each age group was set at 1500, to give the level of precision required by the HBSC international protocol. This is a smaller sample than previously used in Scotland as the HBSC survey was being carried out at the same time as the schools ‘Health and Wellbeing Census Scotland 2021/2022’ (HWB Census). In order to minimise the burden on schools and pupils, HBSC Scotland restricted the sample size to the minimum required by the international protocol.

Response rate: In 2022, 360 schools (comprising 608 classes) were asked to participate in the HBSC 2022 survey, 137 schools and 234 classes (38%) took part.. The overall response rate was 31%, i.e. 31% of all sampled pupils completed a questionnaire. The response rates at school (and therefore class) level were much lower than in previous survey rounds. Schools who refused to participate were asked their reasons, and the main reasons given were too busy, undertaking the HWB Census and impact of COVID-19. Prior to recruitment it had been anticipated that response rates would be substantially lower in this survey round due to COVID-19 pressures in schools, and the concurrent HWB Census, and therefore a higher number of schools were originally approached.

Method of data collection: Data are collected through self-completion questionnaires administered in the classroom. All participating countries use a standard questionnaire. Scottish fieldwork is usually undertaken in February-March although it has been slightly accelerated or delayed in specific years. In 1994, questionnaires were re-issued with slight changes to content and data collection was therefore extended until June. In 2022, questionnaires were administered in schools between the end of February and June.

Smallest geographical unit reported: Individual country / region (including Scotland).

Availability of results and further information: All survey outputs (international and national reports, briefing papers, journal articles, books/book chapters) and further information about the survey is available from the Health Behaviour in School-aged Children (HBSC) survey website. Access to the survey data is restricted to HBSC research teams for a period of three years from survey completion. After this time the data are available for external use by agreement with the International Coordinator and Principal Investigators. For further information about the survey, see the HBSC website at: http://www.hbsc.org/contact/.