Launch of HBSC report on Scottish adolescents: Unraveling health trends and lifestyle choices

New insights into Scottish adolescents’ health and lifestyle trends were unveiled in HBSC Scotland’s latest national report, published today at an event in Edinburgh. The 2021/22 survey results highlight key patterns in areas such as general health, mental well-being, eating habits, physical activity, electronic media usage, substance use, sexual health, experiences at school, bullying incidents, and familial `and peer relationships.

Since 1990 the HBSC survey in Scotland has played a crucial role in assessing adolescent health. With the world grappling with the ongoing repercussions of the COVID-19 pandemic, the 2022 survey placed a particular emphasis on mental health and enables a comparison of adolescent health and well-being before and after the COVID-19 pandemic. A selection of key findings is provided below:

General health and sleep

• Approximately 23% of adolescents rated their health as ‘excellent’, with 15-year-old girls the least likely to report this (13%). Boys’ reports of ‘excellent’ health increased from 22% in 2018 to 27% in 2022.
• Nearly half (49%) of young people reported experiencing multiple health complaints weekly, with prevalence being higher in girls aged 13 and 15. The prevalence of multiple health complaints reached its highest since 1994 for both boys and girls, seeing a significant increase from 35% in 2018, especially in girls (41% to 61%).
• Young people from more affluent families were more likely to report excellent health and fewer health complaints.
• Average sleep duration on weekdays was 8.0 hours for 13-year-olds and 7.7 hours for 15-year-olds, extending to 9.3 and 9.1 hours respectively on weekends. The proportion of young people reporting sleep difficulties more than once a week rose from 30% in 2018 to 37% in 2022.

Mental health and well-being

• Just over a quarter (27%) of young people reported feeling very happy with their life, with boys more likely to report this than girls (34% versus 21%). For girls, this marked the lowest prevalence of feeling very happy since 1994.
• Overall, 42% of young people reported feeling confident always or often. In all age groups, boys were more likely to report this than girls. The year 2022 saw the lowest levels of confidence in 28 years for both boys and girls.
• Nearly a quarter (23%) of young people reported feeling left out often or always, compared with 11% in 2018. This increase was observed among both boys and girls. Specifically, the proportion of girls reporting feeling left out often or always more than doubled from 2018, increasing from 13% to 30%.
• Over a third (35%) of young people were classified as having low mood or at risk of depression.
• Around a third (32%) of young people reported anxiety, with higher levels among girls than boys at ages 13 and 15.
• Nearly all mental health indicators were significantly associated with family affluence, with poorer outcomes for young people from less affluent families, except for anxiety and feeling left out, which did not vary by family affluence.

Eating behaviours and oral health

• Just over half (53%) of young people reported eating breakfast every day on weekdays, with boys more likely than girls to do so (61% boys, 46% girls). Daily breakfast consumption decreased among boys and girls in 2022, particularly in the younger age groups.
• Overall, 44% of adolescents reported eating fruit every day. Unlike previous survey results, fruit consumption did not vary by gender, and an increase was observed among boys between 2018 and 2022 (30% to 43%). Fruit consumption levels are now at their highest in 20 years.
• Four in ten (40%) young people ate vegetables every day, a figure that did not vary significantly by age or gender. Daily vegetable consumption among boys in 2022 reached its highest level since 2002.
• Almost one in ten (9%) young people reported daily consumption of energy drinks, up from 5% in 2018.
• Over a third (36%) of young people reported having a meal with their family every day, while a further 38% reported eating a meal with their family most days.
• Three-quarters (74%) of adolescents reported brushing their teeth at least twice daily. This practice was more common among girls than boys at all ages.

Physical activity and leisure time

• Less than a quarter (23%) of adolescents achieved 60 minutes of moderate to vigorous physical activity (MVPA) daily. The MVPA level has increased since 2018, particularly for boys (19% to 28%).
• Participation in leisure time vigorous physical activity at least three times per week was higher among boys than girls (69% versus 54%), with the greatest gender difference at age 15.
• Boys were more likely to participate in team sports, and girls were more likely to participate in individual sports and artistic activities.
• Young people spent, on average, 3 hours a day gaming, 2.8 hours on social media, 2.4 hours watching TV, and 1.2 hours browsing the internet. Some of these activities could co-occur.
• Young people from low-affluence families were less likely to participate in organised leisure activities and spent more time gaming and watching TV.

Electronic media use

• The vast majority (85%) of adolescents reported keeping their smartphone in their bedroom at night, and 73% also reported having a television in their bedroom.
• Almost one in seven (14%) adolescents reported problematic social media use. Gender differences were observed, with girls more likely to report problematic social media use than boys (20% versus 8%).
• There was an increase in problematic social media use among girls in all age groups between 2018 and 2022, but not among boys.
• Just under a third (30%) of 13- and 15-year-olds reported playing games for more than 4 hours per day, but this was more common among boys (41% versus 14% of girls).
• Young people from low-affluence families were more likely to have a TV in their bedrooms and play computer games (weekly and daily).
• Intense online communication, problematic social media use, and problematic gaming did not vary by family affluence.

Substance use 

• Just under one in ten (9%) adolescents reported that they had ever smoked cigarettes, with the prevalence increasing with age: 1% of 11-year-olds, 6% of 13-year-olds, and 20% of 15-year-olds. Lifetime cigarette smoking is at its lowest level in 32 years.
• Vaping has now surpassed cigarette smoking, with almost one in five (18%) adolescents reporting having used an e-cigarette at least once in their lifetime. The rates were higher among older adolescents: 4% of 11-year-olds, 16% of 13-year-olds, and 36% of 15-year-olds.
• There have been substantial increases in e-cigarette use since 2018, especially for girls. In 2022, 40% of 15-year-old girls had used an e-cigarette in their lifetime, compared to 20% in 2018.
• Overall, 12% of young people reported having been drunk two or more times in their life, with the prevalence of drunkenness increasing with age. Since 1998, levels of drunkenness have steadily declined and are now at their lowest in 32 years.
• Around a fifth (19%) of 15-year-olds had used cannabis at least once in their lifetime, and one in ten (10%) 15-year-olds reported using cannabis in the last 30 days. Levels were similar for boys and girls.
• Adolescent substance use was not strongly patterned by family affluence. Only current cigarette smoking was found to have a significant association with higher prevalence among young people from less affluent families.

Sexual health

• Of 15-year-olds surveyed, 71% described themselves as heterosexual, 5% as mostly heterosexual, 11% as bisexual, 3% as gay or lesbian, and 6% as not sure yet.
• A similar proportion of 15-year-old boys and girls (22% and 21%, respectively) reported having had sexual intercourse.
• Among those who had sex, 31% used a condom only, 26% used birth control pills only, 9% used both, and 34% used neither during their last intercourse.
• The age at first intercourse did not vary by family affluence.

Bullying and fighting

• Just under a fifth (18%) of young people reported being bullied at least 2–3 times a month, an increase from 14% in 2018.
• Around 7% of young people reported being cyberbullied at least 2 to 3 times a month.
• Over one-fifth (22%) of young people reported experiencing multiple forms of bullying in the last 2–3 months, up from 15% in 2018.
• One in ten (10%) young people reported being in a physical fight 3 or more times in the past year, which was more common among boys.
• No differences in experiences of bullying and fighting were observed by family affluence.

Relationships and support

• The majority (69%) of young people lived with both parents, while 20% resided in a single-parent family, 10% in a stepfamily, and 2% in another type of home environment.
• Over half of the participants (56%) reported high levels of family support, though this perception tended to decrease with age.
• Young people generally found it easier to talk about their problems with their mothers (76%) than with their fathers (67%). Levels of easy communication with parents remained stable among boys but saw a decrease among girls in 2022 compared to 2018.
• Around half of the participants (50%) reported high levels of support from their friends. Though this perception remained stable among boys since 2014, a decline was observed among girls from 65% in 2014 to 54% in 2022.
• Most participants (61%) reported having a trusted adult to confide in, but 9% said they did not have such a figure in their lives.
• Young people from higher affluence families reported more positive perceptions across relationship and support measures.

School experience

• Approximately one in six young people (16%) reported liking school a lot. Although girls have historically been more positive about school than boys, in 2022, 13-year-old girls reported liking school less than boys did.
• An increase in schoolwork pressure was reported among 15-year-olds compared to 11- and 13-year-olds, with the highest pressure felt by 15-year-old girls (79%). The proportion of adolescents feeling some or a lot of schoolwork pressure has been rising since 2006, especially for girls, creating a wider gap between boys and girls.
• Overall, 28% of students reported high levels of teacher support. However, this perception significantly decreased with age, with 48% of 11-year-olds reporting high teacher support compared to only 19% of 15-year-olds.
• Around one in six adolescents (17%) reported high levels of support from their classmates. Younger adolescents were more likely to report high levels of support than older adolescents.
• Young people from more affluent families were more likely to say they liked school a lot and to report high support from classmates. However, family affluence showed no association with schoolwork pressure, school-related stress, or teacher support.

The impact of COVID-19

In 2022, adolescents were asked to rate the impact of the COVID-19 pandemic and its associated restrictions on nine different aspects of life as well as their overall life.

• Across all age and gender groups, the three aspects of life most positively affected by the pandemic were family relations (54%), friendships (50%), and physical activity (43%).
• The three aspects most negatively affected were mental health (38%), school performance (34%), and physical activity (29%).
• At age 11, there were no significant gender differences in the perceived impact of the pandemic. However, among older adolescents, girls were generally more likely to report negative impacts than boys.
• Across all aspects of life, those from higher-affluence families were more likely to report a positive impact and generally less likely to report a negative impact compared to those from lower-affluence families.