Youth Risk Behaviour Survey

Transcription

1 [Type text] Youth Risk Behaviour Survey 2011 An Analysis of Risk Behaviours among Youth in Eastern Ontario [Type text]

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3 Contents INTRODUCTION & PURPOSE... 1 METHODOLOGY... 1 PERSONAL INFORMATION... 2 INJURY PREVENTION... 2 BULLYING... 4 MENTAL HEALTH... 5 NUTRITION... 6 PHYSICAL ACTIVITIES... 7 BODY WEIGHT... 8 TOBACCO... 9 ALCOHOL USE MARIJUANA AND DRUGS SEXUAL HEALTH HEALTH UNIT SERVICE ASSOCIATIONS Associations related to bullying Associations related to skipping breakfast Associations between body weight and mental health Associations between sedentary behaviours and mental health outcomes Associations between mental health and other risk behaviours Associations related to EOHU presentations DISCUSSION CONCLUSION i P a g e

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5 Youth Risk Behaviour Survey 2011 INTRODUCTION & PURPOSE Adolescence is an important stage of life for establishing healthy behaviours and youth in the Eastern Ontario Health Unit (EOHU) region are not spared from health-risk behaviours. 12 As its mission is to promote and protect the health and wellness of its community by preventing diseases and injuries, EOHU is mandated by the Ontario Public Health Standards 3 to conduct an epidemiologic analysis of health risk behaviours for priority populations, which includes adolescents. The purpose of this study was to provide an updated assessment of the health risk behaviours and practices of adolescents in the Eastern Ontario Health Unit region. Specifically, we wanted to determine the prevalence of health risk behaviours among middle and high school students, to assess whether there are any new trends in health-risk behaviours, and finally, to generate reliable data to be used for program planning and evaluation. METHODOLOGY The 2011 YRBS is a repetition of the 2007 survey in order to measure any change or progress since the last survey, and to assess any new trends in health-risk behaviours among high school students. It was given to students in selected grade 7 to 12 classes across the five counties of eastern Ontario. The survey was modeled after the CDC YRBS which monitors six types of health-risk behaviours that contribute to the leading causes of death and disability among youth and adults, including: injury prevention, nutrition, physical activity and body weight, tobacco use, alcohol, marijuana and other drug use, and sexual health. Moreover, the current survey included questions on bullying, sad feelings and attempted suicide, and EOHU services. Unlike the 2007 YRBS, these additions to the current YRBS were incorporated to enhance and to broaden the scope of risk behaviours evaluated. Data were collected from November, 2010 to March, 2011 through school-based surveys, in which a random sample of two classes from each grade was selected in each school for administration of the survey to all students who consented to participate, unless only one grade was available. Students in selected classes were eligible to participate and participation was voluntary and anonymous. A total of 49 schools participated to the study, with the final 1 EOHU (2008). Youth risk behaviour survey. Available at: 2 Springer AE, Selwyn BJ and Kelder SH. A descriptive study of youth risk behavior in urban and rural secondary school students in El Salvador. BMC International Health and Human Rights 2006, 6:3 3 Ministry of Health and Long-Term Care (2008). Ontario Public Health Standards P a g e

6 sample including 3509 respondents from grades 7 to 12. In order to get a more representative survey sample, the data were weighted (adjusted) by grade, sex, school board. PERSONAL INFORMATION The proportion of male and female respondents was nearly equal (51% and 49%, respectively). The sex and grade distributions (Figures 1 and 2, respectively) show the expected distributions of respondents corresponding to the proportions in the population. Figure 1: Sex distribution Figure 2: Grade distribution Grade12 18% Grade7 14% 49% 51% Grade11 18% Grade8 15% Grade10 18% Grade9 17% In addition, nearly 60% of respondents reported speaking English at home, compared with 26% speaking French and 12% for both English and French. INJURY PREVENTION 60% of all respondents reported that they rarely or never wear a helmet when bicycling (Figure 3). More males (62%) than females (58%) rarely or never use a helmet. The lack of helmet utilization increases with the age (grade) of participants. Older students don t wear bicycle helmets more often than the younger students when bicycling. Figure 3: Frequency of helmet use when bicycling, by Grade and Sex 100% 80% 60% 40% 20% 0% Grade 7 Grade 8 Grade 9 Grade 10 Grade 11 Grade 12 Total Rarely/Never 33% 45% 58% 67% 81% 73% 62% 58% 60% 2 P a g e

7 Youth Risk Behaviour Survey 2011 Even if the large majority of students (95%) admit to wearing their seat belts always or most of the time, younger students do so more often than older students. There remain 1% to 3% of students who rarely or never wear seat belts when riding in a car. Moreover, males don t wear seat belts more often than females (Figure 4). Figure 4: Frequency of seat belt while riding in a car driven by someone else, by grade and sex 10% 5% 0% Grade 7 Grade 8 Grade 9 Grade 10 Grade 11 Grade 12 Total Sometimes 1% 2% 5% 3% 3% 3% 4% 2% 3% Rarely/Never 1% 1% 3% 3% 3% 2% 3% 1% 2% When asked about seat belt use while driving a car, most of the students from grades 7 to 10 were not yet driving car. But, among those who have started driving a car, most use a seat belt. Overall, the rate of students who use a seat belt sometimes, rarely or never ranged from 1% to 3% for the whole population. In this survey, we found that younger respondents were less likely to ride in a vehicle driven by someone who had been drinking alcohol or with a driver under the influence of marijuana or other illicit drugs than their older counterparts. While females were less likely to be a passenger in a vehicle with a driver who had been drinking alcohol than their male counterparts (Figure 5), there was no difference between the sexes for marijuana or other illicit drugs. Figure 5: Frequency of riding in a car or other vehicle driven by someone who had been drinking alcohol, by grade and sex 30% 20% 10% 0% Grade 7 Grade 8 Grade 9 Grade 10 Grade 11 Grade 12 Total 1-5 times 10% 9% 10% 13% 17% 16% 13% 12% 13% 6 or more times 3% 3% 4% 4% 4% 3% 5% 2% 3% 3 P a g e

8 BULLYING Bullying is when someone teases, threatens, spreads rumors about, hits, shoves, or hurts another person on purpose and the person being bullied has a hard time defending themselves. 1 About 25% of our youth reported having been bullied on school property (Figure 6). There was no significant difference between the proportions of males and females (24% versus 26% respectively). Respondents in grade 12, both males and females, were least likely to have been bullied than students in other grades. Figure 6: Been bullied or threatened by someone while on school property, by grade by sex 25% 26% 28% 29% 26% 23% 28% 30% 27% 24% 19% 18% 24% 26% Grade 7 Grade 8 Grade 9 Grade 10 Grade 11 Grade 12 Total Figure 7 shows the proportion of youth experiencing cyber-bullying, such as being bullied by , text message, social networking or another website. According to this survey, females were much more likely to be cyber-bullied than males (24% and 12% respectively). Among different grades, the rate for females in Grade 10 was the highest (31%). Figure 7: Cyber-bullying, by grade by sex 19% 9% 8% 31% 27% 22% 21% 15% 13% 14% 23% 24% 12% 12% Grade 7 Grade 8 Grade 9 Grade 10 Grade 11 Grade 12 Total P a g e

9 Youth Risk Behaviour Survey 2011 MENTAL HEALTH Results from this survey indicate that a large proportion (more than a quarter) of the middle and high school student population in Eastern Ontario report depressive symptoms and are at risk for depression in response to the question During the past 12 months, did you ever feel so sad or hopeless that you stopped doing some of your usual activities almost every day for two weeks or more in a row? (Figure 8). The prevalence of all mental health outcomes is higher in females than in males. Figure 8: Prevalence of mental health outcomes by sex 32.6% 18.8% 7.9% 14.0% 9.4% 4.6% 2.8% 6.1% 0.5% 1.1% Sadness Suicidal ideation Suicide Planning Suicide attempt_do not require treatment Suicide attempt_requiring treatment When considering mental health outcomes by grade and sex, it appears that levels of suicidal ideation ranged between 7% and 15% overall from grades 7 to 12, and were reported by more females than males. Similarly, levels of suicide planning ranged between 4% and 10% overall during these years, with females also being more likely to report this experience than males. s were more likely to attempt both suicides that did not require medical attention and that did require such attention (Figure 9). Figure 9: Prevalence of Suicide attempts, by grade and sex 4% 1% Suicide attempt that did not require treatment 9% 8% 6% 2% 3% 2% 2% 0% 1% 1% 1% 0% Suicide attempt requiring treatment 6% 4% 4% 4% 2% 0% 1% 1% 1% 0% Grade 7 Grade 8 Grade 9 Grade 10 Grade 11 Grade 12 5 P a g e

10 NUTRITION 10% of the students reported never or almost never eating breakfast. On the other hand, 48% of the students reported eating breakfast every day (Figure 10). For lunch, only 3% of respondents reported that they never or almost never eat lunch. 65% of students eat lunch on a daily basis (Figure 11). Figure 10: Frequency of eating breakfast Figure 11: Frequency of eating lunch Never/a lmost never 10% Every day 48% BF 1-2 times/w eek 15% 3-4 times/w eek 14% >=5 times/w eek 13% Never/ almost never 3% Every day 65% 1-2 times/ week 5% 3-4 times/ week 10% >=5 times/ week 17% In Figure 12, the proportions of never or almost never eat breakfast for students within different grades and sex are displayed. Students in grade 11 and grade 12 are more likely to never eat breakfast (13%). The proportion for females in all grades combined is 11%, higher than the 9% for males. Figure 12: Never or almost never eat breakfast, by grade and sex 6% 9% 9% 5% 12% 10% 6% 11% 14% 13% 12% 13% 9% 11% Grade 7 Grade 8 Grade 9 Grade 10 Grade 11 Grade 12 Total When asked whether there were healthy food options in the school cafeteria, 49% of participants gave a positive answer, while 17% reported no healthy food options in the school cafeteria. 6 P a g e

11 Youth Risk Behaviour Survey 2011 PHYSICAL ACTIVITIES Categorization of time spent doing physical activity is based on last cycle s YRBS (2007) and Canada s Physical Activity Guide to Healthy Active Living. 1 Coding is as follows: no physical activity = 0 hours per day; below recommended = less than 1.5 hours per day; met or exceeded recommended = 1.5 to 7 hours per day; improper reporting = over 7 hours per day. In this survey, the top three most popular physical activities were hockey, volleyball and walking/brisk walking. Figure 13 reveals that males are more likely to meet or exceed the recommended level than females (42% and 39% respectively). Also males are more likely than females to report an improper answer, which means exceeding seven hours of exercise per day. Figure 13: Time spent doing physical activities, by sex 33% 42% 42% 39% 12% 12% 13% 7% Never Below recommended level Met or Exceeded recommended level Improper reporting When it comes to sedentary activities (i.e. using a computer, playing video games, watching television, reading not for school or work), Figure 14 shows that 58% of youth in Eastern Ontario usually spend 3 to 7 hours on sedentary activities. s are more likely to report an improper answer (i.e. more than seven hours per day) than females. Figure 14: Time spent doing sedentary activities, by sex 57% 59% 3% 2% 13% 16% 27% 23% <1 hour/day 1-3 hours/day 3-7 hours/day Improper reporting P a g e

12 BODY WEIGHT Participants were asked to give the perception of their body weight. In this self-assessment, 63% replied that they are about the right weight (Figure 15). 24% of students described themselves as being slightly or very overweight, and a surprising 14% said that they are slightly or very underweight. Girls were more likely to report themselves as being slightly or very overweight (27%) than boys (20%) Figure 15: Self-reported body weight, by sex 64% 61% 1% 1% 14% 10% 18% 24% 2% 3% Very underweight Slightly underweight About the right weight Slightly overweight Very overweight These self-reported perceptions of body weight differ slightly from the calculated body mass index (BMI) using the WHO classification scheme, based on self-reported height and weight (Figure 16). There is a large variation in the perception of being underweight (13%, Figure 15) and the BMI measure of being underweight (3%, Figure 16). Interestingly, although more females view themselves as being slightly or very overweight (27% female vs. 20% male, Figure 15), it is the males who are more overweight or obese (34% male vs. 26% female, Figure 16). These results suggest that girls are often more likely to be dissatisfied with their bodies than boys by having a negative body image. Figure 16: Calculated body mass index (BMI) from WHO, by sex 62% 71% 3% 2% 22% 16% 12% 10% Underweight Normal weight Overweight Obesity 8 P a g e

13 Youth Risk Behaviour Survey 2011 When asked if they were trying to do anything about their weight, males and females differed significantly in their body weight goals. While females were more likely than males to respond that they were trying to lose weight (46% vs. 22%), males were more likely than females to reply that they wanted to gain weight (24% vs. 5%). TOBACCO Participants were asked if they had ever smoked a whole cigarette. While most students have never smoked, 19% of the students responded affirmatively. The age at which most of these had first smoked a whole cigarette varies between years old (37%) and 15 years old or older (32%) (Figure 17). Figure 17: Proportion of students who have ever smoked and age first smoked Never smoked 79% Have smoked 19% years 37% 15 years 32% Missing 2% years 16% 9-10 years 5% 8 years 5% When asked about their frequency of smoking during the past 30 days, 50% of students reported being current smokers (either daily or occasional smokers) (Figure 18). s were more likely to be current smokers than their female counterparts. Younger students were more likely to be occasional smokers (48% in Grade 7) while older students were more likely to be daily smokers (grade 11: 25%; grade 12: 21%). Figure 18: On how many days did you smoke cigarettes during the past 30 days? Among ever smokers only Daily smoker(>=20 days in last 30 days) Occasional smoker(1~19 days) 48% 10% 8% 34% 40% 29% 17% 19% 25% 24% 31% 32% 28% 30% 21% 22% 18% 20% Grade 7 Grade 8 Grade 9 Grade 10 Grade 11 Grade 12 Total 9 P a g e

14 The means by which students procure their cigarettes is a topic of great interest. s were more likely to buy them in a store, while females were more likely to borrow them from someone, and to receive or to take them from a family member. When asked if someone had ever refused to sell them cigarettes, only 5% of smokers replied yes (17% of those who tried). All students were asked about the smoking status of their friends and family members. Results showed that current smokers were more likely to have friends who smoke than non-smokers. Similarly, smokers also tended to have more family members who smoke than non-smokers. Moreover, parents and siblings seemed to have a greater impact on smoking behaviours than more distant relatives (grandparent, aunts and uncles). Current smokers were asked about their desire to quit smoking. The majority (58%) indicated that they did want to stop smoking. When asked why they wanted to quit smoking, interestingly, nearly half of respondents (53% of males and 54% of females) indicated that their choice was based on improvement of their health. Furthermore, males were more likely to indicate that they want to save money than females. Finally, students were asked about their exposure to second-hand smoke at home and in public places. Results varied by smoking status, where a higher proportion of second-hand smoke exposure at home was found among students who smoked cigarettes (Figure 19). This is not surprising since more smokers also reported having immediate family members who also smoke. Figure 19: Proportion exposed to second-hand smoke at home in the previous week 73% 67% Have smoked Never smoked Total 41% 19% 11% 13% 9% 4% 5% 28% 9% 13% 3% 3% 3% 0 day 1 to 2 days 3 to 4 days 5 to 7 days Not sure ALCOHOL USE There were a higher proportion of alcohol users (63%) than non-users (37%). Other alcoholrelated drinking behaviours reported include having ever had an alcoholic drink on school property (15%) and having ever driven a car after drinking alcohol (7%). 10 P a g e

15 Youth Risk Behaviour Survey 2011 Slightly more males (65%) than females (61%) ever had at least one alcoholic drink (Figure 20). Each increase in grade is associated with an increase in the proportion of yes responses to each alcohol-related drinking behaviour in both males and females. In particular, most students have had a drink prior to the legal drinking age, by grade 12. Figure 20: Ever had at least one alcoholic drink, by grade and sex 26% 16% 38% 33% 60% 51% 88% 91% 90% 73% 78% 83% 65% 61% Grade 7 Grade 8 Grade 9 Grade 10 Grade 11 Grade 12 Total The most common age to start drinking alcohol has not changed since 2008, with the peak age of onset at years (28% in 2011 and in 2007). Binge drinking is defined as having five or more drinks of alcohol in a row. In the last 30 days, 40% of drinkers had at least one episode of binge drinking while 60% had no occasion of binge drinking in the last month (Figure 21). Figure 21: Frequency of binge drinking the last 30 days No 60% Yes 40% 1-2 times 23% 3-5 times 9% 6-9 times 5% 10+ times 3% 11 P a g e

16 MARIJUANA AND DRUGS With the inclusion of greater numbers of middle school youth in this cycle of the YRBS, a larger proportion of the population (75% vs. 65%) had also never tried using marijuana in their lifetime compared with the population in 2007 (Figure 22). Of the remaining 25% of marijuana users, students who had used marijuana on 20 or more occasions made up 40% of the population. Among students who reported any frequency of marijuana use, or at least one time in their life, the majority (48%) described themselves as occasional users, while a high proportion (36%) self-identified as non-users and the remainder (16%) as regular users (Figure 23). Figure 22: Ever use marijuana in life Never, 75% Ever, 25% times, 12% 3-9 times, 24% 20+ times, 40% 1-2 times, 24% Figure 23: Type of marijuana user 36% 16% 48% A regular marijuana user An occasional marijuana user A non-user The age at which most students started smoking marijuana was 15 (28%), where girls were more likely than boys to start between the ages of 14 and 15 years and boys are more likely than girls to start earlier at 13 years of age. The methods of acquiring marijuana among users are ranked, with the top three being through friends, through purchasing it, or though borrowing or bumming it from someone else (Figure 24). 12 P a g e

17 Youth Risk Behaviour Survey 2011 Figure 24: Method of acquiring marijuana (among users) 57% 40% 19% 12% 6% 7% A friend gave it to me I bought it I borrowed (or bummed) it from someone else Someone bought it for me I took it from a family member I got it some other way The location of marijuana use revealed a similar trend to last cycle s data, with most use (66%) occurring at a friend s house and use at work (7%) occurring near the bottom of the list (Figure 25). Figure 25: Location of marijuana use (among users) 66% 39% 33% 27% 20% 7% 11% At a friend s house At social events In public spaces (e.g. park, street) At home At school At work Other Amphetamine/methamphetamines and ecstasy were the top two drugs used other than marijuana. Between 2007 and 2011, Oxycontin use increased from 1.0% to 1.9%, Rohypnol use increased from 0.3% to 1.0% and Ketamine use increased from 0.4% to 0.8%. SEXUAL HEALTH Catholic schools were exempt from completing this portion of the survey. Eighty percent of students reported ever being taught about sexually transmitted infections (STIs) including HIV at school while another 8% were not sure (Figure 26). While it initially appears that fewer students are acquiring their sexual health information at school in 2011 than in 2007, it is more likely that this trend is as a result of the inclusion of greater numbers of younger students (in grades 7 and 8) in this cycle of the survey. A smaller proportion of the student population in 13 P a g e

18 this study (30%) also reported ever having had sexual intercourse than in 2007 (42%) (Figure 27). Figure 26: Ever been taught about STIs at school Figure 27: Ever had sexual intercourse 8% 12% 80% Yes No Not Sure 70% 30% Yes No There was a consistent increase in the proportion of students reporting sexual activity with 4% reporting having had intercourse by grade 7 compared with 54% by grade 12 (Figure 28). Only respondents who answered yes to this question were included in the analysis of the remaining questions. Figure 28: Proportion having had sexual intercourse, by grade and sex 5% 3% 11% 22% 9% 12% 52% 57% 51% 44% 29% 28% 31% 29% Grade 7 Grade 8 Grade 9 Grade 10 Grade 11 Grade 12 Total The most common age to initiate sexual intercourse was 16 years old, where males most often started at 16 (31%) while females most often started at 15 (30%) and there were slightly more males (23%) than females (19%) experiencing sexual intercourse for the first time at 14 years. Most sexually active students had had sexual intercourse with one partner, either in their lifetime (56%) or in the last three months (70%). One exception was in grade 8, where most students (40%) had had intercourse with two partners in their life, exceeding the 37% who had had one sexual partner in this grade and the 19% who had had two partners by grade P a g e

19 Youth Risk Behaviour Survey 2011 When examining the use of alcohol or drugs prior to sexual intercourse, most never did while the smallest proportion engaged in these high risk activities always/most of the time. In terms of the frequency with which students had ever been pregnant or gotten someone pregnant, the highest proportion of respondents with zero pregnancies was in grade 7 (100%), with one pregnancy was in grade 10 (11%) and with two or more pregnancies was in grade 8 (9%) (Figure 29). Figure 29: Frequency ever been or gotten someone pregnant (among sexually active students) by grade % 0.0% 8.8% 5.9% 4.2% 0.0% 11.4% 6.9% 2.1% 2.1% 2.7% 3.0% 0.0% 0.0% Grade 7 Grade 8 Grade 9 Grade 10 Grade 11 Grade 12 Total The top three methods used to prevent pregnancy of STIs the last time one had sexual intercourse were consistent with last cycle: condoms (77%), birth control pills (50%), and the withdrawal method (12%). HEALTH UNIT SERVICE All participants were asked about their attendance to and opinions of EOHU presentations or activities. Only those students who responded yes to having attended to an activity or a presentation answered the questions related to the usefulness of these activities/presentations. Overall, 74% of students have attended any of the EOHU activities/presentations. Among them, 55% found the presentations useful. Attendance rates to EOHU presentations ranged from 9% to 44%. The highest rates have been registered for the presentations on tobacco (44%), physical activity (39%), healthy sexuality (38%) and self esteem (35%). In contrast, the lowest rates of less than 10% on the attendance have been encountered for the Healthy School Committee (9%) and the Safe Grad Activity (9%). 15 P a g e

20 ASSOCIATIONS Associations related to bullying Figure 30 and 31 show the association between cyber-bullying and mental health (including sad feelings and suicide). We can see that cyber-bullying has a significant influence on mental health for both girls and boys. For instance, 58% of girls who have experienced cyber-bullying reported feeling so sad or hopeless that they stopped doing some of their usual activities almost every day for two weeks or more in a row. The rate is 25% for girls without cyberbullying experience (Figure 31). We can also see that cyber-bullying has a more serious influence on mental health for girls than for boys. Figure 30: Cyber-bullying and mental health, boys Figure 31: Cyber-bullying and mental health, girls 40.0% 30.0% 20.0% 10.0% 0.0% 37.9% 16.4% Feeling sad 17.3% 6.5% Suicidal ideation 11.1% 3.7% Suicide planning 1.3% 0.4% Suicide attempt treated by a doctor or nurse 70.0% 60.0% 50.0% 40.0% 30.0% 20.0% 10.0% 0.0% 57.7% 24.8% Feeling sad 27.5% 9.7% Suicidal ideation 17.5% 6.9% Suicide planning 3.0% 0.5% Suicide attempt treated by a doctor or nurse Experienced bullying No Experienced bullying No The influences of bullying on school property on mental health are quite similar to that of cyber-bullying. Students who experienced either cyber-bullying or bullying on school property were more likely to skip breakfast than those who did not experience bullying (Figure 32). The effect is quite similar between both types of bullying, but females are more seriously affected than males. 16 P a g e

21 Youth Risk Behaviour Survey 2011 Figure 32: Bullying and skipping breakfast 12% Experienced bullying No 16% 16% 12% 8% 9% 9% 10% M F M F Bullying, on school property Cyber-bullying The experience of bullying has a strong relationship with some risk behaviours, including smoking, drinking alcohol, marijuana, other drugs and sexual intercourse. Figure 33 and 34 show the influence of cyber-bullying on risk behaviours. For girls who experienced cyberbullying, 36% of them have used marijuana and 43% of them have reported having had sexual intercourse. These rates are much higher than the 18% and 24%, respectively, for girls who had no cyber-bullying experience (Figure 33). The difference is also significant for boys (Figure 34). Figure 33: Prevalence of risk behaviours by cyber-bullying, girls Experienced bullying No 16% 6% 42% 35% 36% 18% 15% 5% 43% 24% Current smoker Binge drinking in past 30 days among drinkers Lifetime marijuana user Ever use drugs(other than marijuana) Ever have sex intercourse Figure 34: Prevalence of risk behaviours by cyber-bullying, boys 17% 10% 47% 41% Experienced bullying 34% 25% No 12% 8% 38% 30% Current smoker Binge drinking in past 30 days among drinkers Lifetime marijuana user Ever use drugs(other than marijuana) Ever have sex intercourse 17 P a g e

22 Bullying on school property is different from cyber-bullying. For girls, the prevalence of risk behaviours are associated with bullying on school property, but for boys, there were no significant differences (Figure 35 and Figure 36). Figure 35: Prevalence of risk behaviours by bullying on school property, girls Experienced bullying No 14% 6% 41% 36% 30% 20% 13% 5% 37% 26% Current smoker Binge drinking in past 30 days among drinkers Lifetime marijuana user Ever use drugs(other than marijuana) Ever have sex intercourse Figure 36: Prevalence of risk behaviours by bullying on school property, boys Experienced bullying No 38% 43% 29% 26% 28% 32% 11% 10% 8% 8% Current smoker Binge drinking in past 30 days among drinkers Lifetime marijuana user Ever use drugs(other than marijuana) Ever have sex intercourse In Figure 37, we can see that BMI has little influence on the prevalence of cyber-bullying in both girls and boys. When it comes to bullying on school property, the rate increased with BMI for girls but decreased for boys. Figure 37: Prevalence of bullying, by BMI categories 10% 24% 26% 26% 24% 24% 26% 22% 16% 12% 19% 32% Normal weight Overweight Obesity Normal weight Overweight Obesity Cyber-bullying Bullying on school property 18 P a g e

23 Youth Risk Behaviour Survey 2011 Figure 38 shows the prevalence of cyber-bullying, related to using computers. For both girls and boys, the rate of experiencing cyber-bullying increased with increased time spent using computers. Figure 38: Prevalence of Cyber-bullying by time spend using a computer 21% 10% 15% 12% 13% 36% 23% 43% <1 Hour/Day 1~3 Hours/Day 3~7 Hours/Day Improper reporting Associations related to skipping breakfast Students who skip breakfast almost every day were more likely to participate in any of the following risk behaviours: more likely to consume fast foods and snacks and less likely to consume less grains, fruits & vegetables and dairy products; more likely to be overweight or obese and less likely to meet the recommended level of physical activity; more likely to smoke, consume alcohol, use any illicit drug and participate in sexual activities. The prevalence of mental health outcomes are all significantly associated with skipping breakfast as shown in Table 1. Table 1: Associations between breakfast skipping and mental health Never /almost never eat breakfast Eat breakfast Feeling sad or hopeless 41% 24% Suicidal ideation 23% 10% Suicide Planning 17% 6% Suicide attempt requiring treatment 1.5% 0.7% Associations between body weight and mental health Obese participants were more likely to feel sad or hopeless (31.8%), more likely to seriously consider attempting suicide (15%), more likely to make a plan about how they would attempt suicide (9.8%), and more likely to attempt suicide that required treatment (1.6%) than any of other categories of BMI. The gradient between BMI and suicidal ideation is shown in Figure P a g e

24 Figure 39: Association between body weight and suicidal ideation 20.0% 15.0% 10.0% 5.0% 0.0% Underweight Normal weight Overweight Obesity Suicidal ideation 6.0% 10.2% 10.3% 15.1% Associations between sedentary behaviours and mental health outcomes A summary score was calculated based on four sedentary activities (video game use, computer use, reading and watching television or movies) to determine whether this correlated with mental health outcomes. There was a statistically significant relationship between the combined sedentary activity score and sadness, overall and within each sex, with a greater proportion of respondents feeling sad with greater amounts of time spent on non-physical activities and a greater proportion of females reporting sadness at all levels of sedentary activity longer than an hour (Figure 40). Figure 40: Prevalence of sadness, by avg. hrs all sedentary activities (per day) and sex 16.2% 14.1% 24.2% 23.5% 17.2% 9.5% 26.7% 28.3% 10.2% 13.5% 21.2% 32.2% <1 hour/day 1~2 hrs/day 2~3 hrs/day 3~4 hrs/day 4~5 hrs/day 5+ hrs/day For the associations between combined sedentary activities and suicide outcomes, the relationships are not as clear. Among males, there were increased levels of suicidal ideation and suicide planning with the lowest level of sedentary activity, <1 hour/day, while females showed a modest increase in the proportion responding yes to suicide planning up to 5 or more hours per day (Figure 41). 20 P a g e

25 Youth Risk Behaviour Survey 2011 Figure 41: Prevalence of suicide planning, by avg. hrs all sedentary activities (per day) and sex 13.2% 3.8% 1.4% 3.0% 0.3% 6.8% 7.4% 6.9% 4.5% 2.1% 3.9% 8.1% <1 hour/day 1~2 hrs/day 2~3 hrs/day 3~4 hrs/day 4~5 hrs/day 5+ hrs/day Associations between mental health and other risk behaviours Figure 42 and 43 show the influence of smoking and binge drinking on mental health. For both girls and boys, current smokers were more likely to have mental health problems, especially for girls. But there was no significant difference for binge drinking. Mental health status was not associated with regular drinking either. Other risk behaviours, including marijuana using, consuming other drugs and sexual activities have a similar influence on mental health as smoking. Figure 42: Influence of smoking on mental health 31% 17% 56% 31% Current smoker 33% 18% 7% 12% Non-smoker 24% 10% 4% 8% 2% 0% 7% 1% Feeling sad Suicidal ideation Suicide planning Suicide attempt requiring treatment Figure 43: Influence of binge drinking on mental health, among students who ever used alcohol 23% 23% 1+ time binge drinking in last 30 days no binge drinking in last 30 days 47% 40% 11% 21% 9% 17% 7% 5% 14% 11% 1% 1% 2% 2% Feeling sad Suicidal ideation Suicide planning Suicide attempt requiring treatment 21 P a g e

26 Associations related to EOHU presentations The EOHU presentations about tobacco, physical activities and body image all had a positive influence on students behaviours. For example, for the self-esteem presentation and the healthy sexuality presentation, Figure 44 shows that students with these risk behaviours were more likely to attend those related presentations. Figure 44: The associations related with Health Unit Presentations 65.8% 52.4% Attended Presentation 59.0% 46.6% 29.5% 23.5% Did not attend 37.3% 26.6% 60.2% 55.5% Quit smoking Vs. Tobacco Presentation Feel sad Vs. Self- Esteem Presentation High level PhA Vs. Physical activity(pha) Presentation Had sexual intercourse Vs. Healthy Sexuality Presentation Planning to lose weight Vs.Body Image Presentation DISCUSSION The age of initiation of many health risk behaviours (tobacco, alcohol, drugs and sexual activity) was between 13 and 16 years, frequently between grades 8 and 11. This study took a preliminary look at the association of many risk behaviours concurrently. Limitations associated with the use of cross-sectional data include not being able to infer temporality (a causality assumption) from these relationships. Furthermore, despite demonstrated test-retest reliability in students from across these grades, there are potential reliability issues associated with self-report data from this age group. 1 CONCLUSION The results presented herein suggest that there is still work to be done to increase student s sensibilities towards safe and healthy behaviours, particularly among older students. We hope that these data will help to strengthen and support the work of Public Health Nurses, Health Educator Promoters, teachers and administrators working with students in the schools. This 1 Messias E, Castro J, Saini A, Usman M, Peeples D. Sadness, Suicide, and Their Association with Video Game and Internet Overuse among Teens: Results from the Youth Risk Behavior Survey 2007 and Suicide and Life- Threatening Behavior 2011; 41(3): P a g e

27 Youth Risk Behaviour Survey 2011 work may also be used to inform parents who encounter these attitudes, behaviours and practices at home, program planners and evaluators who are designing services to address the current needs of students, members or groups in the community at large as well as the students themselves. 23 P a g e