The WHO Cross-National Study of Health Behavior in School-Aged Children from 35 Countries: Findings from 2001-2002

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World Health Organization

The Health Behavior in School-Aged Children Study (HBSC) originated in 1982 as a collaborative project among researchers from Finland, Norway, and England (United Kingdom). Subsequently, the World Health Organization (WHO) adopted the project. Since 1985, surveys have been conducted at four-year intervals, with the 2001-2002 survey marking the fifth administration in the series.

The 2001-2002 cross-national survey involved more than 162,000 young people aged 11, 13, and 15 years in 35 countries and regions including Austria, Belgium (the Flemish-speaking and French-speaking areas), Canada, Croatia, the Czech Republic, Denmark, England (the United Kingdom), Estonia, Finland, France, Germany, Greece, Greenland (Denmark), Hungary, Ireland, Israel, Italy, Latvia, Lithuania, Malta, the Netherlands, Norway, Poland, Portugal, the Russian Federation, Scotland (the United Kingdom), Slovenia, Spain, Sweden, Switzerland, the former Yugoslav Republic of Macedonia, Ukraine, the United States of America, and Wales (the United Kingdom).

Health and Well-Being

Young people's rating of their health varied widely among countries and regions. Among 15-year-olds, 8% to 32% of boys and 13% to 63% of girls reported their health as fair or poor, with girls more likely than boys to report poorer health in all countries and regions. Levels of poorer health among 15-year-old girls were highest (>42%) in Latvia, Lithuania, the Russian Federation, and Ukraine.


All three age groups showed large cross-national differences in weekly smoking rates. At age 15, 11% to 57% of boys and 12% to 67% of girls were weekly smokers (most smoked dally). Gender patterns split geographically, with girls reporting higher rates in the western European countries and regions, and boys reporting higher rates in the eastern European countries and regions. For example, girls' weekly smoking was lowest (<15%) among girls in Canada, Poland, Sweden, the United States, the Baltic states, and parts of southern Europe. Levels generally were higher in northern and central Europe.


Weekly drinking was more widespread among boys than girls, except in a few countries where rates were similar at age 15, such as Norway and the United Kingdom. Levels among 15-year-olds averaged 34% for boys and 24% for girls.

Weekly drinking among boys increased with age: to more than one-tenth in six countries at age 11, to one-fifth in eight countries at age 13, and to more than one-third in 19 countries at age 15. In Denmark, Malta, the Netherlands, and the United Kingdom, about one-half of 15-year-old boys drank weekly. Among 15-year-old girls, drinking was especially high in Denmark, the Netherlands, and the United Kingdom.

Having been drunk two or more times occurred most commonly among young people in Canada and northern European countries such as Denmark, Finland, the United Kingdom, and the Baltic states, and least commonly in southern Europe. Levels of drunkenness on two or more occasions varied among 15-year-olds from 17% to 68% for boys and 6% to 65% for girls.

Cannabis Use

Cannabis use varied among 15-year-olds: those who ever used it ranged from 3% to 46%. Boys were more likely to use cannabis than girls. Some 22% and 16%, respectively, used it the previous 12 months. Regular cannabis use (3 to 39 times the previous 12 months) was highest (> 15%) in Canada, Spain, and Switzerland.

Sexual Health

Percent of young people reporting sexual intercourse ranged from 20% for girls to 28% for boys, but levels varied by country and regions from 4% to 79% of girls and 18% to 71% of boys. Rates generally were lower in eastern and central Europe, and Spain, and higher in Greenland, Ukraine, and the United Kingdom.

Reported sexual intercourse rates varied by gender. In most countries and regions, rates were higher among boys. …