The WHO Cross-National Study on Health Behavior in School-Aged Children from 28 Countries: Findings from the United States

Journal of School Health, August 2000 | Go to article overview

The WHO Cross-National Study on Health Behavior in School-Aged Children from 28 Countries: Findings from the United States


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, and the first WHO-sponsored survey was conducted in 1983-1984 with the three original countries plus Austria. Since 1985, surveys have been conducted at four-year intervals in a growing number of countries.

The 1997-1998 survey involved more than 128,000 students in 28 countries. The survey examined the attitudes and experiences of 11-, 13-, and 15-year-old children concerning a variety of health behavior and lifestyle issues. Participating countries included Austria, Flemish- and French-speaking Belgium, Canada, the Czech Republic, Denmark, England, Estonia, Finland, France, Germany, Greece, Greenland, Hungary, Ireland, Israel, Latvia, Lithuania, Northern Ireland, Norway, Poland, Portugal, the Russian Federation, Scotland, Slovakia, Sweden, Switzerland, the United States, and Wales. The next international survey will be conducted in 2001-2002.

The United States joined the HBSC in 1998. The following summary data concerning US students were collected during the 1997-1998 survey. The US component of the study was funded and coordinated by the National Institute of Child Health and Human Development (NICHD) at the National Institutes of Health. The survey was conducted in US schools by Macro International, Inc.

Health and Well-Being

According to the HBSC, 91.8% of 11-, 13-, and 15-year-olds consider themselves healthy, with US children ranking 21st in this survey category, compared to the other countries. Students in the United States and Israel report the highest frequency of health-related problems and symptoms, and they were more likely to take medications for these symptoms, For the symptoms surveyed including headache, stomachache, backache, nervousness, feeling tired, feeling lonely, and feeling "low," US students ranked among the top four countries for seven of nine symptoms. Young adolescent girls consistently reported a higher frequency of general health problems, recurrent pain symptoms, and negative feelings, such as feeling low or lonely, than did young adolescent boys. Yet, boys were more likely to report feeling tired in the morning than were girls. Also, US children were the most likely of all groups to report feeling tired in the morning for four or more times a week.

Family Relationships

The study found that family living arrangements and relationships varied according to national grouping. For example, while more than 90% of students in Greece, Israel, Portugal, Switzerland, Finland, and Slovakia live with both parents, only 64% of US students reported living with both parents -- lower than for all other countries except Greenland. In addition, US youth at all three ages were among the three countries most frequently reporting that they have difficulty talking to their mothers. In all countries, children were more likely to report more difficulty communicating with their fathers than with their mothers. Compared to the children from the other countries, US children ranked in the middle on these measures. For all countries, difficulty with parental communication was strongly associated with feeling less happy, with smoking, and with drinking alcohol.

School Relationships

Regarding the relationship with their schools, the study found that students who feel involved in school, and who received support from their teachers and other students, are more likely to feel healthier, be physically active, and are less likely to smoke.

Student satisfaction with school decreased with age among most countries. For most countries, girls tended to like school better than did boys. Students in the United States were among those least likely to feel that they took part in decision making at school, together with parts of the Russian Federation, Flemish Belgium, the Czech Republic, and Finland. …

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