Publication - Research and analysis

Child and adolescent health and wellbeing: evidence review

Published: 11 Sep 2018

Maps available national data on child health and wellbeing against the SHANNARI domains, to produce a full and detailed picture of ‘where we are now’ on child health and wellbeing in Scotland.

90 page PDF

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90 page PDF

1.3 MB

Contents
Child and adolescent health and wellbeing: evidence review
2. Safe

90 page PDF

1.3 MB

2. Safe

2.1 Elements within the Safe domain

The Safe SHANARRI domain is defined as 'Protected from abuse, neglect or harm at home, at school and in the community'. The measures identified for the Safe domain are around child protection, including accidental injury and assault, experience of bullying and physical fighting; and neighbourhood safety.

Care and protection

Most children in Scotland grow up feeling safe, but where this is not the case the implications for the child are far reaching. The issues relating to care and protection (including neglect, mental, physical or emotional abuse, parental substance misuse or poor parenting) are closely related to negative health and wellbeing outcomes ( i). For example, children's experiences of domestic violence has been found to have a harmful impact on a range of outcomes, including impaired physical, mental and emotional development and, in some studies, increased risk of aggression in adolescence or early adulthood ( ii). Many care and protection issues are classed as ACEs, which are associated with a range of negative health and wellbeing outcomes in adulthood, particularly when multiple ACEs are experienced. For example, those with 4 or more ACEs have been found to be more likely to have been in prison, developed heart disease and type 2 diabetes, have committed violence in the last 12 months and display health-harming behaviours (high-risk drinking, smoking, drug use) ( iii).

Where care and protection issues are the most serious, children may become 'looked after' by the local authority. There is evidence of particularly poor outcomes for young people who are looked after or care leavers. Care leavers are at increased risk of having experienced multiple ACEs which is also associated with poor outcomes.

Looked after young people tend to have lower levels of educational attainment than those who are not looked after. These differences are, in part, linked to the fact that looked after young people tend to leave school at younger ages. Looked after children are less likely than school leavers in general to go on to 'positive destinations', particularly higher education. Care leavers are also at a higher risk of experiencing long term unemployment or fractured employment routes and are overrepresented in the homeless population. Looked after children and care leavers generally experience poorer health than their peers. Young female care leavers are more likely to experience early pregnancy than those who are not care leavers. A third of young offenders reported having been in care at some point in their life ( iv).

An increase in children on the child protection register, referred to Scottish Children's Reporter Administration ( SCRA) and looked after by the local authority may be both due to greater family instability and an increase in the prevalence of child protection needs, but may also be due to better identification of existing cases through early intervention policies. Similarly, any differences in rates between Scotland and England are likely to be the result of different child protection systems as much as any underlying differences in prevalence of issues between countries. While it is crucial to monitor these statistics and understand the experience of this highly vulnerable group of children and young people, it is not possible to identify a desired direction of travel for these three indicators.

This lack of clarity applies equally to indicators that are proxies for some of the care and protection issues: namely hospital admissions due to accidental injuries and assault. Accidental injuries may occur due to neglect, but also a number of other reasons. For example, young people from lower socio-economic groups are more likely to be injured due to fighting, while those from higher socio-economic groups are more likely to be injured through sport. For both injuries and assault, a decrease in admissions may be the result of fewer underlying issues, or a smaller proportion of cases where the child is taken to hospital and admitted.

Bullying and fighting

Bullying is a particular problem among children and adolescents and has a high prevalence across this age group as a whole. It has been linked to many short and long-term negative outcomes: for example, adolescent victims of bullying show reduced attendance and performance at school, poor social adjustment, increased medicine use, increased physical injury and higher levels of both physical and psychological health problems ( v), ( vi), ( vii), ( viii), ( ix).

Bullying is related to factors both within schools and within families which are discussed in the Included and Nurtured chapters. Both bullies and victims tend to report low levels of attachment to, and engagement with, their school ( x). Attitudes within a young person's peer group are also strong determinants of the prevalence of bullying and interventions that promote awareness and attitudinal change within the wider peer group context may be most effective in reducing bullying ( xi), ( xii). Within families, supportive parental attitudes have been shown to protect children from being both victims and perpetrators of bullying; whereas problems in family communication are associated with increased risk of becoming a bully ( xiii).

Physical fighting is the most visible form of violent behaviour among adolescents, and is also associated with participation in other activities that pose serious health risks, such as substance misuse ( xiv). Unlike bullying, physical fighting does not necessarily involve a power imbalance between a perpetrator and victim. In extreme cases, fighting involving weapons can result in serious injury and death among young people ( xv).

Neighbourhood safety

It is widely recognised within Scottish Government policy making that neighbourhood environment can impact the health of young people over and above individual factors. This includes aspects of both the social environment such as local social networks, and the physical environment such as crowding, pollutants, access to facilities and greenspace. Neighbourhood safety indicators cut across both social and physical aspects and low feelings of safety have been shown to adversely affect health outcomes in young people ( xvi).

For example, less affluent areas are often associated with physical dilapidation and unsafe recreation spaces compared with more prosperous neighbourhoods. This is, in turn, associated with lower physical activity levels as well as fewer opportunities for social interaction, leading to a lack of social support and an increase in loneliness for adolescents ( xvii). Even where there is good access to recreation spaces, negative perceptions of the area ( e.g. high crime rate) can lead to low use. Perceptions of neighbourhood safety among both parents and young people themselves have been shown to be an important determinant of children's activity levels ( xviii).

Consultation with young people has shown that they consider a secure environment, including feeling safe in their area, to be a prerequisite for health and wellbeing ( xix). Research with children and young people in disadvantaged areas found that the need to avoid certain routes at certain times to avoid areas occupied by people perceived to be aggressive due to alcohol and drug use can mean that access to recreational or other resources is restricted. This, in turn, impacts on young people's current wellbeing and potentially their future development ( xx).

Measures relating to young people's area discussed in this section relate specifically to perceptions of neighbourhood safety. Measures around access to greenspace and play areas are considered under Active, while relationships with neighbours are considered under Included. However, it is important to note the complex connections between all these factors.

2.2 Current position

Indicator

Headline figure

Date

Data source

Next data

Time trend

Key inequalities

International comparisons

Child protection and 'looked after' status

Children on the Child Protection Register; rate per 1,000 children under 16 years

2.9/1,000

2016/17

EAS

2017/18

General upwards trend with a high level of fluctuation until 2014. Slight decrease in the last three years, which may be the start of a longer term decline

* Age 53% of children were under five

* Gender No gender pattern

Comparisons with other UK countries are not meaningful due to different CP systems

Children 'looked after' by the local authority; rate per 1,000 population aged under 18 years

14.44/1,000

2017

EAS

2018

Numbers have decreased from a peak in 2012, and levels now stabilising

* Gender Slightly more males than females

Comparisons with other UK countries are not meaningful due to different definitions of 'looked after' children.

Children referred to SCRA for reasons of care and protection; rate per 1,000 children aged 0-15 years

14.5/1,000

2016/17

SCRA

2017/18

Substantial drop from a high of 48.1 in 2006/07 with a relatively stable rate since 2014/15

* Gender More males than females

* Age higher number at older ages

/

Accidental injury

Emergency hospital admissions for unintentional injury in children under 15 years; age-sex standardised rate per 100,000 population

829.3/100,000

2016/17

ISD

2017/18

Decreasing admission rates over the last ten years for both males and females

* Gender Higher admissions for males than females

* SIMD Those from SIMD1 were more likely to be admitted than those from the less deprived areas

/

Assault

General acute inpatient and day case admissions in young people aged 15-25 years due to assault; age-sex standardised rate per 100,000 population

108.2/100,000

2016/17

ISD

2017/18

The rate has decreased consistently and very substantially from 331.4 in 2007/08

* Gender Males are very substantially more likely to be admitted due to assault - a rate of 178.4, compared with 19.4 among females

* SIMD Young people in SIMD1 are 6 times as likely to be admitted as those from SIMD5 (198.1 vs 32.9)

/

Experience of Bullying and fighting

Percentage of 11, 13 and 15 year olds who report having been bullied at school at least two times a month in the past two months

14%

2014

HBSC

2018

There was little change between 2002 and 2010, but an increase between 2010 and 2014 (from 9% to 15% for girls, and 10% to 13% for boys)

* Gender Girls were more likely to be bullied than boys (15% vs 13%). At ages 11 and 15 there was little gender difference. At age 13, girls were more likely than boys to report being bullied (19% vs 14%)

* Age 15 year olds were less likely to report being bullied (9%) than younger age groups (14-19%)

Scotland performed worse than the average in international comparison for girls aged 11 (16% Scotland; 11% HBSC average); and girls aged 13 (18% Scotland; 11% HBSC average); it performed average for girls aged 15 and boys at all ages

Percentage of 11, 13 and 15 year olds who report having been bullied in writing via electronic media at least two times a month in the past two months

5%

2014

HBSC

2018

No time series, new question

* Age/gender Little age variation for boys, but 13-year old girls were more likely than 11 and 15 year olds to be bullied via electronic media messages (9% vs 4%)

For girls, Scotland reported worse than the international average at age 11 (4% Scotland, 3% HBSC average); age 13 (9% Scotland, 4% HBSC average); and age 15 (4% Scotland, 3% HBSC average); For boys, Scotland performed average at all ages.

Percentage of 11, 13 and 15 year olds who report having been bullied by someone posting unflattering or inappropriate pictures of them online at least twice a month in the past two months

3%

2014

HBSC

2018

No time series, new question

* Age/gender For boys, a slight increase between the ages of 11 and 15 (from 1% to 4%). Among girls, the prevalence was lower at 11 years than at 13 (2% and 6%)

Scotland performed average for all age/gender group except 13 year old girls, where it performed worse (6% Scotland, 2% HBSC average)

Percentage of 11, 13 and 15 year olds involved in a physical fight 3 times or more in the last year

10%

2014

HBSC

2018

Between 2002 and 2014, fighting declined from 15% to 10%. This was driven by a decline among boys (23% to 15%), with little change among girls

* Gender Substantially more prevalent among boys (15%) than girls (5%)

* Age Percentage declined with age from 14% at 11 to 7% at 15

Scotland performed worse for 11 year old boys (21% Scotland, 18% HBSC average) and 11 year old girls (7% Scotland, 5% HBSC average), around international average for 13 year old girls, and 15 year olds, but better than average for 13 year old boys (10% Scotland, 15% HBSC average).

Area factors

Percentage of 13 and 15 year olds who always feel safe in the area they live in

59%

2014

HBSC

2018

The percentage has increased consistently since 1998 (40%)

* Gender girls were slightly less likely to always feel safe (57% vs 60%)

* Age For girls, the percentage declined between age 13 and 15 (61% to 52%), while there was little age difference for boys (62% and 58% at age 15)

Scotland only question

Percentage of 13 and 15 year olds who agree that it is safe for younger children to play outside during the day in the area where they live

80%

2014

HBSC

2018

There was little change over time

* Gender No gender difference

* Age For boys, 15 year olds were less likely to say it is safe than 13 year olds (75% vs 84%)

Scotland only question

Percentage of households with children aged 6 to 12 that think it is very or fairly safe for children to go to a local playground with 2 or 3 friends

66%

2016

SHS [1]

/

/

* Urban/rural those in rural areas were generally more likely to say it is safe than those living in urban areas (78% vs 64%)

* SIMD within urban areas, those from SIMD1 were less likely to feel it is safe than those from other urban areas (59% vs 66%)

/

Percentage of households who are very or fairly concerned of bullying by children in playgrounds

37%

2016

SHS

/

/

* Urban/rural Those from rural areas were less concerned compared with those from urban areas (27% vs 39%)

* SIMD in urban areas, those from SIMD1 were more concerned than those in other urban areas (53% vs 34%)

/

Percentage of households who are very or fairly concerned of children being harmed by adults in playgrounds

36%

2016

SHS

/

/

* Urban/rural Those from rural areas were less concerned than those from urban areas (27% vs 37%)

* SIMD in urban areas, those from SIMD1 were more concerned than those in other urban areas (53% vs 32%)

/

2.3 Key points

  • There has been a substantial drop in hospital admissions due to both accidental injury and assault over the last decade, as well as a reduction in the percentage of young people involved in fights.
  • However, there has been a slight increase in the number of young people who say they have been bullied at least twice in the last two months and the prevalence was relatively high in the population at 10-15% over the last decade. Among 13 year old girls, the prevalence was significantly higher than the international average.
  • Experience of physical harm and bullying is highly gendered. Boys were substantially more likely to be hospitalised due to both accidental injury or assault, and to be involved in fighting. Experience of bullying was more prevalent among girls than boys.
  • Looking at perceptions of neighbourhood safety, six in ten young people reported always feeling safe in the area they live in. Rates were substantially higher in rural than urban areas and were also strongly patterned by area deprivation. People in households with children in the most deprived urban areas were around 20 percentage points more likely to be concerned about children being bullied or harmed by adults in playgrounds than those in other areas.

Contact

Franca Macleod