New ESRI research, based on Growing up in Ireland, examines the role of schools in shaping clusters of health behaviours among adolescents

Download an infographic highlighting key findings from the research. 

New ESRI research funded by HSE Health and Wellbeing examines how 4 key risk factors for disease (smoking, alcohol consumption, physical activity, diet) cluster together among young adults. Using data from the Growing up in Ireland ’98 Cohort at 17 years of age, the research identified 3 distinct health behaviour clusters among young adults in Ireland:

• A  ‘healthy’ group (43 per cent) who did not smoke, drank rarely, engaged in exercise on six or more days in the previous fortnight and had the best quality diet;
• An ‘unhealthy diet and physical activity’ group (36 per cent of 17-year-olds), who did not smoke, drank alcohol rarely (monthly or less) but had the worst levels of physical activity (just 1-2 days in the previous fortnight) and had the poorest dietary quality;
• The remainder comprised an ‘unhealthy smokers and drinkers’ group (21 per cent of 17-year-olds), who had the highest level of alcohol consumption, were daily or occasional smokers, had moderate to low levels of physical activity and poor to moderate dietary quality.

A number of individual- and family-level factors were associated with cluster group membership:

• Young women were more likely to fall into the unhealthy smoker/drinker and, especially, the unhealthy diet/activity groups;
• Young people from working-class backgrounds were more likely to be a smoker/drinker while those whose mothers had lower levels of education (Leaving Certificate or less) were more likely to have poor diet/physical activity levels;
• Parental health behaviour also made a difference with higher rates of drinking/smoking among young people whose parents are occasional or regular smokers.

The potential for schools to promote healthy behaviour has long been recognised. The research found that:

• Young people’s health behaviours were found to vary significantly by the second-level school and, to a lesser extent, the primary school attended;
• The measures of school policy examined had little impact on cluster group membership (school policies included the provision of physical education and sports facilities, having a healthy eating policy). Instead, the socioeconomic composition of students and school climate emerged as more important influences on health behaviour;
• A key feature was the interface between the young person and the school environment, with negative interaction with teachers and disaffection from school associated with greater levels of drinking/smoking in particular.

Anne Nolan, one of the authors of the report, commented: “The study findings show us that health behaviours are interconnected. They suggest that a multi-faceted approach is needed to promote positive health behaviours. The increasing emphasis on wellbeing as an area of learning at second-level offers further opportunities for  promoting positive health behaviours during adolescence. The research findings show that measures to promote both school engagement and a more positive school climate, while important for educational outcomes, are likely to have positive spill-overs for other aspects of young people’s lives, including health behaviours.”

HSE Health and Wellbeing funded this research as part of their work to promote health under the Healthy Ireland Framework.

Helen Deely, Interim Programme Lead for HSE Health and Wellbeing said: “We know that patterns of health behaviour that can lead to chronic illness can be formed at a young age. This research is telling us that a positive school environment makes it more likely that young people will experience a sense of belonging and connection and less likely that young people will turn to risky health behaviours, such as using tobacco and alcohol or engaging in unhealthy eating patterns, to cope with their feelings of isolation and disconnection. In that context, we welcome the publication of the Wellbeing Policy Statement and Framework for Practice by the Department of Education and Skills which supports a whole school approach to wellbeing, and encourages school communities to reflect on their social environment and to consider how they might increase the proportion of young people that feel a sense of belonging and connection to the school."

She continued: “The HSE will continue to work in partnership with the Department of Education in relation to teacher training and resource development, to support wellbeing promotion in the school setting.  However, it is clear that schools are not the only influences on adolescent health.  The intergenerational transmission of smoking and drinking alcohol identified in this study reinforces the importance of supporting parents with managing their own health behaviours.  Preventing unhealthy behaviours taking hold in adolescence is more cost-effective to the State and life-enhancing for citizens, than dealing with chronic disease in adulthood. While policy and practice is moving in the right direction, redoubling efforts to ensure preventative interventions are in place in school and home settings is critically important.”