Friday, 27 April 2018

Experiences of love and dating among young people in Europe

Love and dating are important aspects of adolescent development; it is during this time that romantic relationships are often initiated, and many people have their first sexual experience during adolescence. Sexual relationships and use of contraception has been the focus of much research, often because of the health implications of early or unprotected sex among young people. However, romantic feelings and relationships are important aspects of adolescent emotional well-being that are often overlooked in the focus on sexual risk-taking. In the 2014 HBSC study for England, 63% of boys and 54% of girls said that they had ever been in love, and around 60% said that they had been involved in a relationship with someone, compared to 21% who said they had ever had sex.1 Romantic interest and attraction may be for a person of the opposite gender, someone of the same gender, or both.

Last week, a paper on patterns of same and both-gender love and dating among adolescents across Europe was published by members of the HBSC Sexual Health group2. This shows that the proportion of 15-year olds who say they have been in love with, or dated, people of the same gender or people of both genders was similar across eight countries in Europe. Girls were more likely than boys to say that they had ever been in love with people of both genders, and although sexual orientation has been found to be fluid during adolescence3, this mirrors findings from research with adults which suggests that women are more likely to identify as bisexual than are men4.

The paper also highlights some findings that are particularly relevant to English young people. First, although patterns for same- and both-gender love and dating were similar across countries, boys and girls in England were the most likely out of the eight countries to say that they had been in love with people of both genders. English girls were also most likely to report having had romantic relationships with both boys and girls. Secondly, 15-year olds in England were significantly less likely to say that they had ever been in love with a person of the opposite gender compared to young people in other countries, and significantly more likely to say that they had never been in love with anyone. Among English boys, 39% said they had never been in love, while in the other countries no more than 10% of boys said they had never been in love. Among girls, 45% in England had never been in love, which is more than twice the proportion of the country (FYR Macedonia) with the second highest proportion (21%) of girls saying they had never been in love.

Research with adults show that there are cultural differences in how love is perceived and expressed5, and the data from HBSC suggests that this difference exist also among adolescents. Since the experience of being in love can be such an important aspect of overall health and well-being, we hope to soon find out more about why young people in England appear to experience this less than their peers in other countries!

1.      Brooks, F., Magnusson, J., Klemera, E., Chester, K., Spencer, N. & Smeeton, N. (2015). HBSC England National Report. Hatfield, UK: University of Hertfordshire

2.      Költő, A., Young, H., Burke, L., Moreau, N., Cosma, A., Magnusson, J., Windlin, B., Reis, M., Saewyc, E.M., Godeau, E. & Nic Gabhainn, S. (2018). Love and Dating Patterns for Same and BothGender Attracted Adolescents Across Europe. Journal of Research on Adolescence. Published online 15 April 2018.

3.      Ott, M. Q., Corliss, H. L., Wypij, D., Rosario, M., & Austin, S. B. (2011). Stability and change in self-reported sexual orientation identity in young people: Application of mobility metrics. Archives of Sexual Behavior, 40, 519–532.

4.      Gates, G.J. (2011)  How Many People are Lesbian, Gay, Bisexual and Transgender? The Williams Institute, UCLA

5.      Wilkins, R. & Gareis, E. (2006). Emotion expression and the locution “I love you”: A cross-cultural study. International Journal of Intercultural Relations. 30, 51-75

Wednesday, 21 March 2018

Self-harm in adolescence

Self-harm is an intentional injury to one’s own body resulting in tissue damage. Self-harm can include a wider range of self-harming behaviours such as cutting, burning, biting oneself and ingesting toxic substances (Bifulco et al., 2014; Claes et al., 2015).

Around 13%-18% of adolescents in the world experience a lifetime risk of self-harm. Self-harm becomes increasingly common between the ages of 12 and 15 years, at which stage rates among adolescent girls are higher than boys. Over the past decade, rates of self-harm have been increasing among adolescents (Burton, 2014; Hawton, 2012).

Recent findings from the Health Behaviour in School-aged Children (HBSC) study showed that 22% of young people in England aged 15 have experienced self-harming behaviour in their lives. Nearly three times as many girls as boys reported that they had self-harmed, 11% of boys compared to 32% of girls (Brooks et al., 2015). Most of those young people who were self-harming reported engaging in self-harm once a month or more.

Self-harming behaviour is more often seen among young people living in one parent households and is more common in young people from lower family affluence. Young people receiving free school meals were more likely to report self-harming behaviour; 29% girls and 21% boys who were in receipt of free school meals reported ever having self-harmed (Brooks et al., 2017).

Self-harm in adolescence is usually associated with emotional distress and adolescents usually describe it as being accompanied by negative feelings, such as self-loathing, disgust and shame. Young people who reported ever self-harming had lower life satisfaction compared to those who reported never having self-harmed (Brooks et al., 2017).

Adolescents who experience self-harming behaviour in their life are more likely to be at risk of developing mental illness in their later life; also, they are at higher risk to be engaged in risky behaviours in late adolescence and young adulthood; including increased likelihood of suicidal thoughts.

Recent findings showed that adolescents who have a positive relationship and open communication with their parents, sense of belonging and connectedness to school and the wider neighbourhood, are less likely to be engaged in self-harming behaviour (Klemera et al., 2016). These findings suggest that having easy and open communication with parents could be even more protective for young people than communication with their peers. Quality parenting seems to be very valuable for the promotion and maintenance of emotional well-being and health during adolescence.

The school environment is strongly associated with adolescents’ health and emotional wellbeing; recent HBSC findings showed that young people who reported ever self-harming were less likely to trust their teachers, feel safe, and feel like they belong in their school.

The community environment where young people live can also have a significant impact on health and wellbeing, as according to the HBSC England study young people with a positive perception of their neighbourhood (including issues relating to feeling safe in their community, having positive relationships with neighbours and having good places for young people to go in their community) were less likely to report having self-harmed compared with those who held negative opinions about how supportive and safe they perceived their community to be (Brooks et al., 2017).

The protective nature of adolescents’ multiple environments (the family, the learning environment and the wider community) can help adolescents develop coping strategies to prevent self-harming behaviour among adolescents.

Bifulco A, Schimmenti A, Moran P et al (2014) Problem parental care and teenage deliberate self-harm in young community adults. Bull Menninger Clin 78(2):95–114. doi: 10.1521/bumc.2014.78.2.95

Brooks F, Magnusson J, Klemera E et al (2015) Health Behaviour in School Aged Children, HBSC England National Report: Findings from the 2014 HBSC Study for England. Hatfield, University of Hertfordshire.

Brooks, F., Chester, K., Klemera, E., & Magnusson, J. (2017). Intentional self-harm in adolescence: An analysis of data from the Health Behaviour in School-aged Children (HBSC) survey for England, 2014.

Burton M (2014) Self-harm: working with vulnerable adolescents. Pract Nurs 25(5):245–251. doi: 10.12968/pnur.2014.25.5.245

Claes L, Luyckx K, Baetens I et al (2015) Bullying and Victimization, Depressive Mood, and Non-Suicidal Self-Injury in Adolescents: The Moderating Role of Parental Support. J Child Fam Stud 24(11):3363–3371. doi: 10.1007/s10826-015-0138-2

Hawton K, Saunders KEA, O’Connor RC (2012) Self-harm and suicide in adolescents. The Lancet. 379(9834):2373–2382. doi: 10.1016/S0140-6736(12)60322-5

Klemera, E., Brooks, F. M., Chester, K. L., Magnusson, J., & Spencer, N. (2017). Self-harm in adolescence: protective health assets in the family, school and community. International journal of public health62(6), 631-638.

Tuesday, 13 March 2018

Don’t forget the “hidden” forms of bullying

Bullying is a widespread concern across schools, with around 1 in 3 young people being victimised1. It is widely viewed as a public health issue. Longitudinal research has shown the detrimental and long lasting effects of bullying on young people’s health and wellbeing2, with negative outcomes reported for both the victim and the perpetrator3.

Bullying behaviours can be broadly broken down into physical, verbal, cyber and relational bullying. Relational bullying behaviours upset the victim by damaging their peer relationships, friendships and social status4. Sometimes it is described as “indirect bullying” and can include actions which are harder to spot like social exclusion and the spreading of rumours.

The study of relational bullying specifically is warranted because it is the least understood form of bullying, and has seen little attention in a UK context. Also, teachers have been shown to respond with less empathy and concern to instances of relational bullying among students5.

The study examined the association between relational bullying specifically and adolescent health related quality of life, whilst controlling for the effect of demographic variables and other forms of bullying. Health related quality of life was measured with KIDSCREEN-10 – a measure created for young people which provides an overall score.

Young people who experienced relational bullying had lower KIDSCREEN-10 scores than those who were not bullied. Interestingly, the decrease in score which was linked to relational bullying was larger than the decrease for physical or verbal bullying.

The full paper can be found by clicking here. If you are interested in the topic of bullying you may also like to read our publications on cyberbullying and cross-national trends in bullying victimisation.

1.       Chester KL, Callaghan M, Cosma A, et al. Cross-national time trends in bullying victimization in 33 countries among children aged 11, 13 and 15 from 2002 to 2010. Eur J Public Health. 2015;25(suppl 2):61-64. doi:10.1093/eurpub/ckv029.
2.       Bowes L, Joinson C, Wolke D, Lewis G. Peer victimisation during adolescence and its impact on depression in early adulthood: prospective cohort study in the United Kingdom. BMJ. 2015;350(January 2016):h2469. doi:10.1136/bmj.h2469.
3.       Wolke D, Copeland WE, Angold A, Costello EJ. Impact of bullying in childhood on adult health, wealth, crime, and social outcomes. Psychol Sci. 2013;24:1958-70. doi:10.1177/0956797613481608.
4.       Crick NR. The role of overt aggression, relational aggression, and prosocial behavior in the prediction of children’s future social adjustment. Child Dev. 1996;67(5):2317-2327. doi:10.2307/1131625.
5.       Kahn JH, Jones JL, Wieland AL. Preservice teachers’ coping styles and their responses to bullying. Psychol Sch. 2012;49(8):784-793. doi:10.1002/pits.21632.


Next week (18-24 March) is Teen Health Week!!!

Teen Health Week is an initiative to raise awareness of the unique health issues facing teenagers. 2018 marks the first year of this initiative going global - bringing together young people across the world to increase recognition of the health and wellbeing concerns of teenagers today. 

During Teen Health Week each day has a specific theme:
Sunday, March 18: Violence Prevention
Monday, March 19: Preventive Care and Vaccines
Tuesday, March 20: Healthy Diet and Exercise
Wednesday, March 21: Mental Health
Thursday, March 22: Sexual Development and Health
Friday, March 23: Substance Use and Abuse
Saturday, March 24: Oral Health 

The HBSC England team will be raising awareness of Teen Health Week with lots of tweeting and blogging! We will be sharing data and key findings from the latest HBSC survey carried out in England. We will also share key messages from other projects within our department, including The Teacher Connectedness Project and Beyond the School Gate, which focus on teen health.

We hope Teen Health Week will help raise the profile of adolescent health!

Remember to follow us on twitter @HBSCEngland, and join the conversation using #2018TeenHealth. 

Monday, 12 December 2016

Young people’s experience of visiting their GP: Summary of our publication in the Journal of Adolescent Health

Our recent publication is based on a collaborative project between researchers and practitioners to explore the health measures associated with young people’s use of general practitioner (GP) services in England. The findings have been published in the Journal of Adolescent Health in a paper entitled “Experience of primary care services among early adolescents in England and association with health measures”.

There is a gap in knowledge surrounding young people’s experience of GP services in England, with national surveys limited to capturing the experience of patients aged 18 years and over1. For that reason, questions on young people’s use of GP services were added to the 2014 HBSC England survey. The survey initially asks a question on service use – identifying whether young people have had visited their GP in the last year. This is followed up with a number of questions which concern young people’s experience of their last visit to their GP (Figure 1). 

Figure 1. Questions measuring GP service use in the 2014 HBSC England survey

The majority (80%) of young people said they had visited their GP in the last year. Respondents reported a largely positive experience of GP service use; 75% of respondents felt at ease with the GP during their last visit, 89% felt their GP treated them with respect from GP and 83% reported they were satisfied with the explanations their GP provided. However, only just over half (52%) of respondents stated they felt comfortable talking to their GP about personal things, a finding which seemed fairly consistent across gender and age (Figure 2). The 2014 HBSC England national report provides a comprehensive account of data on GP service use2.

 Figure 2. Young people who reported they were able to talk to their GP about personal things, by age and gender (graph originates from Brooks et al. 2015)

One of the aims of our recent analysis sought to explore whether young people’s perception of GP visits is related to different health measures; is poor experience of GP service use associated with worse reports of emotional wellbeing and physical health? The paper examined five health measures: headaches, sleeping problems, low mood, general self-rated health and self-harm (among 15 year olds only).

The analysis focussed on the 80% (4149) young people who reported visiting their GP in the last year. Binary logistic regression identified respondents who reported poor GP experience were more likely to report poor health measures, whilst controlling for ethnicity, age, gender and family affluence. For example, poor ratings on all indicators of GP experience (Figure 1) were significantly associated with an increased risk of self-harm, feeling low and sleep problems among young people.

The data collected through HBSC surveys is cross-sectional and as such we cannot determine the direction of this relationship. Having poor health may result in a more negative perception of GP services, or it could be that a poor perception of GP services influences young people’s health through disengagement and a reduction in use of health care services.

The findings highlight the important role GPs may play in young people’s health and wellbeing, and emphasise the need for health care services to be understanding of the different skills required for working with young people.

For a through discussion of our findings the full paper can be accessed by clicking here.

  1. Ipsos_Mori (2016). GP Patient Survey - National summary report. NHS England. Retrieved October, 12, 2016 from http://gp-survey 
  1. Brooks, F., Magnusson, J., Klemera, E., Chester, K., Spencer, N., & Smeeton, N. (2015). HBSC England national report: Findings from the 2014 HBSC study for England. Hatfield, UK: University of Hertfordshire. Retrieved October, 12, 2016 from

Wednesday, 9 November 2016

The Teacher Connectedness Project

The Teacher Connectedness Project started on 4th July 2016 and represents a very exciting collaboration between the HBSC Spain and HBSC England teams. During the next 2 years, the Teacher Connectedness Project team will work to get a better understanding of relationships between young people and their teachers and how they can improve young people’s wellbeing.

But what does connectedness mean and why should we pay attention to it? Connectedness comes from the word ‘connection’ and therefore we used the term teacher connectedness to refer to meaningful relationships with teachers. Previous research shows that supportive and trusting relationships with teachers have very positive effects on young people’s wellbeing in and outside the school 1,2. In an earlier study we found that teacher connectedness is very important for the emotional wellbeing of both Spanish and English adolescents of all ages and regardless of how well or not so well they thought they did at school3 (read our earlier blog post for a summary). Unfortunately, research also shows that relationships with teachers tend to become more distant during secondary school – HBSC data below can serve to illustrate this.

Figure 1. Percentage of adolescents who agree or strongly agree with the statement "teachers care about me as a person".
Source: HBSC England and HBSC Spain, 2014

In the Teacher Connectedness Project, we want to know more about what the key ingredients are that make it possible to establish and maintain meaningful student-teacher connections.

And because nobody can know better about teacher-student relationships than teachers and students themselves we are looking forward to having the opportunity to hear from them directly. We will be going to schools in Hertfordshire to have chats with groups of young people and interviews with their teachers from January 2017 onwards, so any local secondary school that want to share their views with us is more than welcome. Just let us know!

If you’d like, you can find further information about the project and its team at our website. You can also follow us on Twitter @TeachConProject to keep track of all the new findings and activities linked to the Teacher Connectedness Project.

Teachers, students, your views and feedback are very much appreciated!

1.  Kidger, J., Araya, R., Donovab, J., & Gunnel, D. (2012). The effect of the school environment on the emotional health of adolescents: A systematic review. Pediatrics 129(5): 925-949. DOI: 10.1542/peds.2011-2248

2. Shochet, I. M., Dadds, M. R., Ham, D. & Montague, R. (2006). School connectedness is an underemphasized parameter in adolescent mental health: Results of a community prediction study. Journal of Clinical Child and Adolescent Psychology 35(2): 170-179. doi: 10.1207/s15374424jccp3502_1

3. García-Moya, I., Brooks, F., Morgan, A., & Moreno, C. (2015). Subjective well-being in adolescence and teacher connectedness. A health asset analysis. Health Education Journal, 74(6), 641-654. doi: 10.1177/0017896914555039.


Monday, 31 October 2016

A Nuffield Foundation placement student joined HBSC England

During summer 2016 the Centre for Research in Primary and Community Care (CRIPACC) at the University of Hertfordshire hosted two Nuffield Foundation research placements. Nuffield Foundation placements are awarded to gifted and talented students who have just finished their AS levels and are interested in pursuing careers in STEMM subjects. The placement allows the student to undertake an independent research project. La-Dantai joined the HBSC England team to conduct her research project on self-harm in adolescence, while Umme's research evaluated online dietary information available for people with type 2 diabetes.

We are pleased to report that both La-Dantai and Umme were awarded Gold Crest 1 awards for their independent research projects. Many congratulations to both of them! 

La-Dantai has written the following blog post reflecting on her time in the department...

I would first like to start by showing a great appreciation towards everybody in the CRIPACC department of the University of Hertfordshire. Not only were they really welcoming, but they also offered a hand whenever I required a little bit of help to make this project even better

My project included research into associated factors with self-harming in adolescence, this involved identifying both protective and risk factors, as well as using the HBSC survey that is produced nationally to gather data.

Immediately I was introduced to new concepts, such as a literature search - it may sound easy, but there are a few minute details that you must really remember to find the best sources of literature - and literature reviews. Thankfully my mentor was extremely helpful when she saw me struggling and, after helping, set up for me to have a meeting with someone who could show me in the in’s and out’s of literature reviews.

After that, reviewing and structuring my report was fairly easy. There was a hiccup when I was required to process the data, as the program that University of Hertfordshire uses in this department to analyse data, I hadn’t used before. Again, my mentor was very helpful and took me through step by step on how to get the most accurate and reliable results from the data.

The placement, which took place over 4 weeks in the summer, was a very informative and fun experience. Not only was there a picnic within the department - I was super happy about that - but it exposed me to what research is, how aims and hypothesises are produced, the work required to find literature to support or disprove a statement. It gave me a look into what being a researcher is and has contributed towards my decision on the degree I wish to do.

These skills I have gained - the ability to literature search, to analyse data with great accuracy, being able to produce a standardised method to carry out research to form reliable results and writing a report (the most important one!) - will be ever so important in University.

I am very grateful for the testing of my time management skills by having to be on time every morning and complete tasks by a specific time and date - for example, meetings with my mentor would be planned and a specific task such as my introduction would have to be completed by then.

Alongside this, my organisational skills and communication skills were tested, it was important to be clear when asking a question and important to write fluently, as well as have all my information designated to a specific folder in order to not get confused!

The placement has contributed to my development by testing my abilities and proving that I am capable of anything new if I put my mind to it. I am very grateful for that.


CRIPACC has hosted a number of Nuffield Foundation placements since 2013. Chelsea, Marium and Susanna have each written a blog post about their placements during summer 2015.