Growing up unequal: gender and socioeconomic differences in young people’s health and well-being

health behaviour in school-aged children

Table of Contents


Health Behaviour in School-aged Children (HBSC), a WHO collaborative cross-national study, has provided information about the health, well-being, social environment, and of 11-, 13- and 15-year-old boys and girls for over 30 years. This latest international report from the study presents findings from the 2013/2014 survey, which collected data from almost 220 000 young people in 42 countries in Europe and North America. The data focus on social context (relations with family, peers, and school), health outcomes (subjective health, injuries, obesity, and mental health), health behaviors (patterns of eating, toothbrushing, and physical activity) and risk behaviors (use of tobacco, alcohol, and cannabis, sexual behavior, fighting, and bullying) relevant to young people’s health and well-being. New items on family and peer support, migration, cyberbullying, and serious injuries are also reflected in the report.



HBSC, a WHO collaborative cross-national study, asks 11-, 13- and 15-year-old boys and girls about their health and well-being, social environments, and health behaviors every four years using a self-report survey. Full contact details for the international survey and national teams can be found on the HBSC website (1).

HBSC uses findings at national and international levels to:

  • gain new insight into young people’s1 health and well-being
  • understand the social determinants of health
  • inform policy and practice to improve young people’s lives.

The first HBSC survey was conducted in 1983/1984 in five countries. The study has now grown to include 44 countries and regions across Europe and North America. The table shows the growth in the international network over the nine survey rounds



Young people are regarded as being healthy relative to other population groups, but adolescence is now recognized as a critical stage of the life-course during which many behavioral patterns that help determine current health status and future health outcomes are established. Emerging evidence suggests that adolescents are particularly sensitive to environmental influences, which emphasizes the importance of adopting a social determinants approach to understanding adolescent health and well-being.

The HBSC study provides a unique insight into the lives of young people across Europe and North America. This latest report presents key findings from the 2013/2014 survey about health behaviors, risk behaviors and health outcomes, and the social context in which young people live.

The data show that family relationships change during the adolescent years, especially for girls, and that the role of the family as a protective factor may diminish during this time. In contrast, perceived support from friends remains relatively stable, potentially providing an important resource at a time when many changes are taking place. The quotes from young people featured throughout the report demonstrate the essential role that friendships play in supporting young people through the challenges they face.

The way young people interact and communicate has changed in recent years, with the growth of social and other forms of electronic media. Technological developments over past decades present benefits and risks for young people. Most of the adolescents surveyed engage in daily EMC with their peers, with an increasing trend compared to previous years.

Increased use of mobile devices and media technology has the potential to facilitate the development of online/electronic aggression, so questions on cyberbullying were included for the first time in the 2013/2014 survey. Interest in this new phenomenon is growing, as exposure to cyberbullying has been associated with a wide range of negative outcomes for those victimized. Overall, young people reported being victims of cyberbullying less often than traditional bullying, but this balance may shift in the future.

Evidence that electronic media use can have positive and negative effects on young people’s health highlights the importance of continuing to monitor the changing nature of peer relations to better understand their impact. The large variation in the prevalence of face-to-face contact time and the use of social media exists between countries and regions, highlighting the role of wider cultural factors in determining social norms and practices.

The school has an important influence on young people’s lives, and health and learning are closely linked. There is considerable cross-national variation in young people’s experiences at school, particularly about how much they like school and feel pressured by schoolwork. This is not surprising, given the diversity of school systems across countries and regions and differences in the way the school day is organized. Younger children tend to have more positive experiences, although younger boys are more likely than girls to experience school-related stress. The opposite relationship is seen for older students, where stress is higher among girls. This may be a contributing factor to the lower levels of mental well-being experienced by girls of this age. The findings show a marked decline in subjective well-being among girls during the adolescent years. On average, one in five girls reports fair or poor health by age 15 and a half experience multiple health complaints more than once a week. Body dissatisfaction also increases significantly during this period for girls, particularly in western and central European countries, despite actual levels of overweight and obesity remaining stable. Indeed, the data indicate that older female adolescents have a different trajectory about the main health and well-being indicators. In addition to poorer mental health, 15-year-old girls also report the lowest levels of life satisfaction, daily breakfast consumption, and physical activity.

Many positive behaviors appear to be influenced by gender. Girls are more likely to include fruit and vegetables in their diet and brush their teeth, while boys are more likely to be physically active. Negative health outcomes and risk behaviors are also HEALTH BEHAVIOUR IN SCHOOL-AGED CHILDREN (HBSC) STUDY: 233 INTERNATIONAL REPORT FROM THE 2013/2014 SURVEY GROWING UP UNEQUAL: GENDER AND SOCIOECONOMIC DIFFERENCES IN YOUNG PEOPLE’S HEALTH AND WELL-BEING PART 3. DISCUSSION | CHAPTER 9. CONCLUSION 9 strongly gendered. Boys, for example, are more likely to experience injury and be involved in physical fights. They drink alcohol and smoke tobacco more often, although the gender gap has been closing in some countries in recent years as girls adopt behaviors typically regarded as masculine. Despite this, encouraging trends in risk behavior are seen compared with previous surveys, with substantial reductions in substance use, fighting (2), and bullying victimization (3) among boys and girls in many countries and regions (4,5). Differences in family affluence continue to have a strong effect on young people’s health and well-being.

The findings show that adolescents from low-affluence families tend to have poorer health, lower life satisfaction, higher levels of obesity and sedentary behaviors, poorer communication with their parents, less social interaction via social media, and lower levels of support from friends and family. In contrast, those from high-affluence families tend to report better outcomes. Many of these inequalities are persistent and evidence suggests they may be increasing, with widening gaps in several key domains of adolescent health (6). Socioeconomic patterning of behaviors is less evident for risk behaviors and school experience, which suggests that schools can provide a supportive environment for young people’s health and development regardless of family circumstances.

Health-related behaviors in adolescence are affected by structural determinants of health (such as national wealth and income inequality, and employment opportunities) and proximal or intermediate determinants (including the connectedness of adolescents to family and school) (7). The large variation in prevalence between countries and regions observed for many indicators reinforces the importance of country-level factors and cultural norms in determining young people’s health and wellbeing. As Sawyer et al. (7) note:

The complex interaction of social determinants of health and risk and protective factors with the biological and social-role transitions of adolescence explains the growing disparities between the health of adolescents in different regions and countries. These same factors also affect the experience of growing up within the same country, where adolescents can have highly heterogeneous life experiences and diverse health outcomes.

HBSC is in a unique position to be able to describe and explain the patterning of health among this age group within and between countries and regions, and to identify the main influences on young people’s engagement in health-related behaviors within a risk- and protective-factors framework. The findings in this report should be addressed through a positive youth-development approach (8) in which the focus is adolescents’ assets and developmental strengths, whether internal to the young person (resilience, for example) or external (such as peers and school).

About KSRA

The Kavian Scientific Research Association (KSRA) is a non-profit research organization to provide research / educational services in December 2013. The members of the community had formed a virtual group on the Viber social network. The core of the Kavian Scientific Association was formed with these members as founders. These individuals, led by Professor Siavosh Kaviani, decided to launch a scientific / research association with an emphasis on education.

KSRA research association, as a non-profit research firm, is committed to providing research services in the field of knowledge. The main beneficiaries of this association are public or private knowledge-based companies, students, researchers, researchers, professors, universities, and industrial and semi-industrial centers around the world.

Our main services Based on Education for all Spectrum people in the world. We want to make an integration between researches and educations. We believe education is the main right of Human beings. So our services should be concentrated on inclusive education.

The KSRA team partners with local under-served communities around the world to improve the access to and quality of knowledge based on education, amplify and augment learning programs where they exist, and create new opportunities for e-learning where traditional education systems are lacking or non-existent.

FULL Paper PDF file:


ISBN 978 92 890 5136 1

Data presented in this report can be accessed at the WHO Regional Office for Europe’s health information gateway ( and via the WHO European health statistics mobile application (
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Health Behaviour in School-aged Children (HBSC), a WHO collaborative cross-national study, involves a wide network of researchers from all participating countries and regions.

The data collection in each country or region was funded at the national level. The editorial board is grateful for the financial support and guidance offered by government ministries, research foundations, and other funding bodies in the participating countries and regions. We particularly thank NHS (National Health Service) Health Scotland (WHO Collaborating Centre for Health Promotion), which contributed funding to the HBSC International Coordinating Centre (until 2013) and to support printing of this report, and the Norwegian Directorate of Health, which contributed funding to the HBSC Data Management Centre. The report’s production was supported by a generous contribution from the WHO Regional Office for Europe.
We are grateful for support from staff at the Norwegian Social Science Data Services, Bergen, for their assistance in preparing the international data file.

We would like to thank: our valued partners, particularly WHO Regional Office for Europe, for their continuing support; the young people who were willing to share their experiences with us and those who kindly allowed us to include some of their comments in this report; schools and education authorities in each participating country and region for making the survey possible; and all members of national HBSC teams involved in the research.

We are also grateful to Dr. Peter Donnelly, President and Chief Executive Officer, Public Health Ontario, and Professor Bjorn Holstein, University of Southern Denmark, for providing very helpful feedback on an earlier draft.

Jo Inchley, Dorothy Currie, Taryn Young, Oddrun Samdal, Torbjørn Torsheim, Lise Augustson, Frida Mathison, Aixa Aleman-Diaz, Michal Molcho, Martin Weber, and Vivian Barnekow

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Professor Siavosh Kaviani was born in 1961 in Tehran. He had a professorship. He holds a Ph.D. in Software Engineering from the QL University of Software Development Methodology and an honorary Ph.D. from the University of Chelsea.

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Nasim Gazerani was born in 1983 in Arak. She holds a Master's degree in Software Engineering from UM University of Malaysia.

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Maryam kakaei was born in 1984 in Arak. She holds a Master's degree in Software Engineering from Azad University of Arak.