Section 1: Healthy settings for young people in Canada – Introduction

1 Introduction


Knowledge about young people’s health behaviours and health outcomes – and the factors that influence them – is essential to the development of effective health education and school health promotion policy, programs, and practice. In accordance with the perspective of the World Health Organization (WHO), health must be acknowledged as a resource for everyday living and not just as the absence of disease. Further, young people’s health should be considered in its broadest sense, encompassing physical, social, and emotional well-being.Footnote 1 Research needs to investigate positive and protective factors that lead to good or improved health in young people as well as risk factors that may precipitate their future ill-health and disease. The behaviours in which young people engage may support or impinge upon their health in the short or long term; for this reason, we need to measure a wide range of youth behaviours. Positive or health-promoting behaviours need to be studied, as well as negative or health-damaging behaviours (including health risk behaviours). Certain behaviours may be initiated in the adolescent years, such as dating patterns and alcohol use, whereas other behaviours, for example eating habits, may have been established in earlier childhood.

Taking a social research perspective, as opposed to one that is purely biomedical, means studying the psychosocial and environmental influences on child and adolescent health and health behaviours. Thus, the influences of home and school settings, peer relationships, and the socio-economic environment need to be explored if we are to fully understand the health and health behaviour patterns of school-aged young people.

A number of essential principles need to be addressed when studying the health of young people. First, we need to assume a life-course perspective that portrays adolescence as a stage between childhood and adulthood, not as a separate population. Second, we need to examine relationships between various dimensions of social inequality (i.e., gender, ethnicity, disability, sexual orientation) and youth behavioural and psychosocial risk/resiliency factors; and between these same dimensions of inequality and youth physical and mental health outcomes. Third, the contexts in which young people operate (such as the home and school settings, peer environments, and socio-economic conditions) need to be examined to identify possible loci for interventions or remediation.

Canada’s school systems

School structure. In Canada, education falls under provincial and territorial jurisdiction, with each province and territory establishing its own curriculum, general structure, and organization. The most common Canadian education model is from kindergarten to Grade 12, separated into elementary and secondary schools, although middle schools are found in many jurisdictions.

Number of teachers. In elementary school, students have primarily one teacher for all of their school subjects for the entire year. In middle school, there is often a mixture of primary teacher and specialist teachers for certain subjects (e.g., French). In secondary school, students have a separate teacher for each subject according to the specialization of the teacher. As a result, secondary students have several teachers over a given year and may provide an influence on some of the HBSC findings.

Support services. In terms of support services for students, elementary schools often share counselling services with other nearby elementary schools. Some limited learning support is generally available in each school, although many of these services are provided by itinerant staff who are responsible for multiple schools. Secondary schools are more likely to have counselling services and expanded learning support services within the school, although specialized itinerant staff may also be used. The level of such support is often related to school or district size.

Student career development. Most jurisdictions provide academic and less applied programs in foundational courses (most commonly in language arts, mathematics, and science). In an attempt to introduce students to the world of work, emphasis on career exploration and workplace experiences is growing, especially at the secondary school level.

How do Canadian students compare? Although curricular commonalities exist across the provinces and territories, there is no single national curriculum in Canada. While national and international assessments have identified regional differences in Canadian student achievement, overall, our students continue to do well on international assessments, such as the Trends in Mathematics and Science Study (TIMSS) and the Programme for International Student Assessment (PISA). In the most recent administration of PISA, which is based on a test written by 15-year-olds in 41 countries, Canadian students earned high rankings: they averaged second in reading, third in mathematics, and fifth in science.Footnote 2

Gender differences in achievement. National and international studies have consistently found that in upper-elementary and secondary schools, girls outperform boys in measures of reading and writing, while boys tend to outperform girls in science. Gender differences in mathematics are less pronounced.Footnote 3 Footnote 4

The HBSC study in Canada

The Health Behaviour in School-aged Children study is a continuing, cross-national research project conducted in collaboration with the WHO Regional Office for Europe. The study aims to contribute to new insight and increased understanding with regards to the health, well-being, and health behaviours of young people (aged 11 to 15 years) and their social contexts, especially the school environment.

The HBSC study was initiated in 1982 by researchers from three countries; shortly thereafter, it was adopted as a WHO collaborative study. There are now 41 research teams from WHO Europe countries and regions and from North America (Table 1.1). The HBSC researchers come from a variety of disciplines, and theoretical perspectives. For example, the Canadian team based at Queen’s University includes researchers from the areas of community health, physical education, epidemiology, education, and psychology. The federal government has supported the Canadian HBSC study since 1988.

1.1 HBSC participating countries

  • Austria
  • Belgium (French-speaking)
  • Belgium (Flemish-speaking)
  • Bulgaria
  • Canada
  • Croatia
  • Czech Republic
  • Denmark
  • England
  • Estonia
  • Finland
  • France
  • Germany
  • Greece
  • Greenland
  • Hungary
  • Iceland
  • Ireland
  • Israel
  • Italy
  • Latvia
  • Lithuania
  • Luxembourg
  • TFYR Macedonia
  • Malta
  • Netherlands
  • Norway
  • Poland
  • Portugal
  • Romania
  • Russia
  • Republic of Scotland
  • Slovak Republic
  • Slovenia
  • Spain
  • Sweden
  • Switzerland
  • Turkey
  • Ukraine
  • United States
  • Wales

The conceptual framework for the Canadian HBSC survey uses the three principles described in the preamble at the beginning of this chapter. First, in the developmental perspective, the study’s age groups of 11, 13, and 15 years (i.e., Canadian students in Grades 6 through 10) are selected to examine significant changes that occur in health behaviours and attitudes from the onset of puberty to the middle of adolescence. Second, the social perspective recognizes the importance of gender, disability, cultural diversity, and socio-economic elements in explaining the data. Third, the contextual perspective incorporates health determinants of home, school, and peers that may shape or influence a variety of health behaviours and outcomes for young people (e.g., smoking, alcohol use, physical activity, psychosocial states such as happiness and loneliness, physical problems such as headaches, and relationships with others).

The purposes of the 2006 HBSC study in Canada are as follows:

  • Collect data on school-aged young people to: a) gain insights into their health attitudes, behaviours, and lifestyles; b) record changes and document trends; c) examine relationships between contextual factors and health behaviours; and d) draw international comparisons.
  • Contribute to: a) theoretical, conceptual, and methodological development; b) the knowledge base in the area of research on health behaviour and the social contexts of health in school-aged youths; c) the establishment of international expertise in the field; and d) a national information system on the health and lifestyles of young people in Canada.
  • Disseminate findings to relevant audiences, including researchers, health and education policy-makers, health promotion practitioners, teachers, parents, and young people.
  • Promote and strengthen national and international research on health behaviour and the social context of health in youth and the network of experts in this field.

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