School Health: Health Behaviour in School-Aged Children

Survey Questionnaires and Data Tables

In 1997/98 the Health Behaviours in School-Aged Children Study was conducted using a cluster sample drawn from grades 6, 7, 8, 9, and 10. The data which compares with the previous cycles of the survey (i.e. the data from grades 6, 8 and 10 or young people aged 11, 13 and 15) are included here. The data from the full sample are also available from Health Canada upon request.

In order to obtain the 1997-1998 Statistical Table - Five Grades , please send your request to

To obtain a copy of the 2005-2006 dataset, please send your request to


In 1982, a Cross-National Survey on Health Behaviours in School-Aged Children (HBSC) was initiated by researchers from three countries: England , Finland , and Norway . Shortly thereafter, the project was adopted by thes World Health Organization (WHO) Regional Office for Europe as a WHO Collaborative study. Between 1983/84 and 1989/90 three more surveys were conducted and the number of participants climbed to 16 countries, including Canada . HBSC surveys are now administered every four years. Currently, Canada has participated in the 1989/90, 1993/94, 1997/98 and 2001/02 survey cycles and the number of participating countries has climbed to 35.

A major goal of this international approach is to influence health promotion and health education policies and programs in schools and among young people in general. Data is collected through surveys among 11, 13 and 15 year olds. All participating countries use a common methodology and pool their data to form the cross-national data file. By analysing trends over time, it is will be possible to show changes in health behaviours in a particular country can be followed.


The Health Behaviour in School-Aged Children (HBSC) Study is a World Health Organization (Regional Office for Europe ) collaborative cross-national study. It aims to:

  • increase understanding of and monitor over time young people's health and health related behaviours;
  • gain insights into the influences the school, family and other social contexts have on young people's lifestyles;
  • increase understanding of how young people perceive health;
  • influence the development of programmes and policies to promote the health of young people;
  • promote cross-disciplinary research into young people's health and lifestyles through international networking of health researchers.


The HBSC study was initiated in 1982 by researchers from England , Finland and Norway . The first round of data collection took place in these three countries and Austria in the 1983/84 school year and . Subsequent surveys have taken place in 1985/86, 1989/90, 1993/94, and 1997/98 and 2001/02.

Canada was invited to join the team in 1987 and participated in the survey the first time in 1989/90. The report from this survey was entitled The Health of Canada's Youth. Canada produced and WHO Euro Region published the report, The Health of Youth, based on the cross-national results from the 1993/94 survey. The last Canadian report, Trends in the Health of Canadian Youth, was released in 1999 and summarized Canadian data across three survey cycles, and on selected topics, compared Canadian findings with those of ten European countries.

The international report from the 2001/02 survey, entitled Young People's Health in Context, was released in June 2004. The Canadian report, Young People in Canada : Their Health and Well-being , released in October 2004, examines patterns in the factors that influence the health of young people aged 11 to 15. It examines the influence of factors such as family relationships, peer relationships, school climate and self-concept on health behaviours. Behaviours covered by the survey include smoking, alcohol and drug use, physical activity/body image, emotional health, eating patterns, bullying and injuries. The findings will be of interest to professionals in the education, health and social service systems, non-governmental organizations, independent researchers, parents, caregivers and young people themselves.

Dr . Will Boyce of Queen's University was contracted by Health Canada to carry out the survey Canadian and is as the Principal Investigator for Canada . Both Health Canada and Queens University have been actively involved in the planning, design and dissemination task groups necessary for the management and support of the HBSC Study on a long term basis.

The following countries participated in the 2001/02 HBSC study:

  • Austria
  • Belgium (Flemish)
  • Belgium (French)
  • Canada
  • Croatia
  • Czech Republic
  • Denmark
  • England
  • Estonia
  • Finland
  • France
  • Germany
  • Greece
  • Greenland
  • Hungary
  • Israel
  • Italy
  • Latvia
  • Lithuania
  • Malta
  • Netherlands
  • Norway
  • Poland
  • Portugal
  • Russia
  • Scotland
  • Slovak Republic
  • Slovenia
  • Spain
  • Sweden
  • Switzerland
  • Ukraine
  • Wales

Conceptual Framework

The HBSC study is rooted in the social and behavioural sciences rather than in classical medical epidemiology. It has not been restricted to the concepts and frameworks of any one theoretical model; researchers with differing theoretical orientations are encouraged to use the data to examine different perspectives of young people's health-related behaviour and its determinants. Nevertheless, a common conceptual framework for the development of the HBSC study has been adopted. This has been termed "the socialisation perspective" in which the influence of various "arenas" (eg, the family, school, friends and media) on young people's health and health related behaviours are systematically explored.


Each country conducts the HBSC study according to quality standards set out in the international research protocol. The key elements are:

  • 1,500 children in each of three age groups - 11, 13 and 15 years old - are surveyed in each participating country;
  • samples are randomly selected from schools and/or classes to be nationally or regionally (with a population at least 1 million) representative;
  • the data are collected through anonymous self-completion questionnaires administered in the classroom under "examination" conditions;
  • an international standard questionnaire, which is designed to minimise reporting error, is used in all participating countries;
  • all HBSC data are cleaned and re-ordered to a consistent format for inclusion in an international data file held at the University of Bergen, Norway.

Topics Covered

Each HBSC survey includes a core set of questions covering:

  • health related behaviours such as tobacco use, alcohol consumption, exercise patterns, leisure-time activities, dietary habits and dental hygiene;
  • general health, physical ailments and medication use;
  • psycho-social adjustment including mental health, and peer and parental relationships;
  • demographic characteristics such as age, gender, household composition and perceptions of socioeconomic circumstances.

In addition, each HBSC survey explores at least one health related topic in greater depth, as follows:

  • 1983-1984: Tobacco use
  • 1985-1986: Physical activity and psycho-social aspects of health.
  • 1989-1990: Healthy sexuality, knowledge of HIV/AIDS, social integration, self-esteem, addictive behaviours, physical activity, diet and injuries (all optional).
  • 1993-1994: School experiences, injuries, body image and social inequalities.
  • 1997-1998: School experiences, injuries, body image and social inequalities.
  • 2001-2002: School experiences, injuries, risk-taking behaviours, social inequalities.

Future Surveys

The next survey is planned for the 2005/2006 school year. Several new countries have applied to be admitted to the network as Associate Members. New HBSC study networks are also being established in the South Pacific and Eastern Mediterranean regions.


Findings from the HBSC study have been published in a variety of national reports and scientific publications. These are listed on the HBSC study page.

Wold B, Aaro LE, Smith C (1994) Health Behaviour in Schoo l-Aged Children. A WHO Cross-National Study. Research protocol for the 1993/94 survey. Bergen : Research Centre for Health Promotion, University of Bergen (HEMIL rapport: 4).

Currie, C., Editor, Health Behaviour in School-Aged Children. A WHO Cross-Nationa l Study. Research protocol for the 1997/98 Survey, Research Unit in Health and Behavioural Change (1998), University of Edinburgh .

King A, Wold B, Tudor-Smith C, Harel Y (1996) The Health of Youth. A cross-national survey. Copenhagen : WHO (Regional Public ations, European Series No. 69).

Coppieters Y, Piette D, Kohn L, de Smet P. (2002) Health inequalities: self-reported complaints and their predictors in pupils from Belgium . Revue d'Epidémiologie et de Santé Publique, 50 :135-146.

Haugland S, Wold B. (200 1) Subjective health in adolescence - Reliability and validity of the HBSC symptom check list. Journal of Adolescence, 24: 611-624.

Holstein BE, Hansen EH, Due P (2004) Social class variation in medicine use among adolescents. The European Journal of Public Health, 14 (1): 49-52

Maes L, Lievens J. (2003) Can the school make a difference? A multilevel analysis of adolescent risk and health behaviour. Social Science and Medicine, 56, Issue 3, pages 517-529.

Mazur J, Scheidt PC, Overpeck MD, Harel Y, Molcho M . (2001) Adolescent injuries in relation to economic status : An international perspective. Injury Control and Safety Promotion, 8 (3): 179-182

Uses of HBSC Study Findings

HBSC study findings have been used in the development of health promotion policy, programmes and practice across Europe . Examples include:

  • guiding the development of, and providing baseline and monitoring data for Health for All targets in Wales ;
  • raising issues of national concern, such as the relatively high use of medication by young people in Belgium ;
  • the development of a computer-based learning package in Norway which provides information on factors influencing health and enables pupils to analyze data on the health related behaviours of their age group;
  • making a contribution to the development and evaluation of the European Network of Health Promoting Schools which is a joint WHO, European Union, Council of Europe project;
  • acting as a catalyst for building a health policy, education and practice infrastructure in Latvia .
  • disseminating data by CD-ROM and Internet to schools, teachers and students through the Statistics Canada's E-STAT program;

International Coordinator
Dr Candace Currie

The University of Edinburgh
Medical School , Teviot Place
Edinburgh EH8 9AG , SCOTLAND
Tel: +44 131 650 6192/5
Fax: +44 131 650 6902

For more information on the Canadian
component and its findings please contact:

Public Health Agency of Canada
Division of Childhood and Adolescence
200 Eglantine Driveway, Tunney's Pasture
Address Locator: 1909C2
Ottawa, ON K1A 1B4
Tel: 1-613-952-1220
Fax: (613) 952-1556

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