Key Priority: Improvement in children and young people's health and wellbeing
One of the aims of the National Improvement Framework is to improve children's and young people's health and wellbeing. There are many aspects to children's health and wellbeing, which the Getting it Right for Every Child approach defines as the SHANARRI indicators: Safe, Healthy, Achieving, Nurtured, Active, Respected, Responsible, and Included.
Families, communities and schools all influence these aspects. This chapter shows some of the main findings from recent data on aspects of children and young people's wellbeing that closely relate to the school environment: general health, mental wellbeing, social, emotional and behavioural development, physical health, diet, obesity, injuries/accidents, lifestyle and substance use, and experience of the learning environment.
This data is drawn from a range of surveys. The Scottish Government is currently working with stakeholders to review the existing health and wellbeing data collections and investigate the possibility of a new Scottish children and young people's health and wellbeing survey. It is anticipated that in future years this survey will be used as a key source for evaluating progress in health and wellbeing and for monitoring differences between those from the most and least deprived areas.
Each year in the Scottish Health Survey, participants aged 13 and over are asked to rate their health in general with answer options ranging from 'very good' to 'very bad'. For children under the age of 13 the question is answered by the parent or guardian completing the interview on their behalf.
Results from combining data from the Scottish Health Surveys conducted in 2014 and 2015 show that:
95% Nearly all (95%) of children self-assessed their general health as either 'very good' or 'good' health.
General health was broadly similar for boys and girls, with 65% of boys and 67% of girls having ‘very good’ reported general health
Levels of 'very good' health ranged between 65% and 73% for those aged 0‑11 but declined from 63% for those aged 12-13 to 52% for those aged 14‑15. This may in part reflect differences in the way parents report their child's health (for those aged 0-12), and the way children (aged 13-15) report their own health.
The decline in 'very good' health as children aged was steeper for girls than boys. Around three-quarters (76%) of girls aged 0-1 were described as being in 'very good' health in general with this declining to 47% of those aged 14-15. A shallower decline was seen for boys, from 70% of those aged 0-1 to 56% of those aged 14-15.
In the Scottish Health Survey, mental wellbeing is measured using the Warwick-Edinburgh Mental Wellbeing Scale ( WEMWBS) questionnaire. It has 14 items designed to assess: positive effect (optimism, cheerfulness, relaxation) and satisfying interpersonal relationships and positive functioning (energy, clear thinking, self-acceptance, personal development, mastery and autonomy). The scale uses positively worded statements with a five-item scale ranging from '1 - none of the time' to '5 - all of the time'. The lowest score possible is therefore 14 and the highest score possible is 70; the tables present mean scores.
Mental wellbeing among 13 to 15 year olds decreased with age for all children (52.3 for those aged 13 compared with 50.0 for those aged 15).
The average score for 13- to 15-year-old boys (52.0) was significantly higher than for girls of the same age (49.9).
Age-standardised mean scores for children aged 13-15 did not differ significantly by area deprivation (varying from 50.1 to 51.5 across the deprivation quintiles).
Social, emotional and behavioural development
The social, emotional and behavioural development of children aged 4-12 has been measured in the Scottish Health Survey via the Strengths and Difficulties Questionnaire ( SDQ). The SDQ is a brief behavioural screening questionnaire designed for use with the 3-16 age group. In the Scottish Health Survey, the SDQ was completed by a parent on behalf of all children aged 4-12.
The SDQ comprises 25 questions covering themes such as consideration, hyperactivity, malaise, mood, sociability, obedience, anxiety and unhappiness. It is used to measure five aspects of children's development: emotional symptoms; conduct problems; hyperactivity/inattention; peer relationship problems; and pro-social behaviour.
A score was calculated for each of the five aspects, as well as an overall 'total difficulties' score which was generated by summing the scores from all the domains except pro-social behaviour. The total difficulties score ranged from 0 to 40 with a higher score indicating greater evidence of difficulties. There are established thresholds indicating 'normal' (score of 13 or less), 'borderline' (14-16) or 'abnormal' scores (17 or above).
The proportion of children aged 4-12 who had a borderline or abnormal total difficulties score decreased from 2003 (17%) to 2014/15 (14%).
Children in the most deprived areas were more likely to have a borderline or abnormal total difficulties score (22%) than those in the least deprived (6%) in 2012/2015, with prevalence for boys much higher than for girls (18% compared with 10%).
98% of all primary and secondary schools were meeting the target level of physical education provision in 2016, the same as 2015 and an increase from 96% in 2014. More information can be found in the 2016 Summary Statistics for Attainment, Leaver Destinations and Healthy Living publication.
The Scottish Health Survey provides information in relation to children's physical activity and weight levels.
In 2015, just under three-quarters (73%) of children met the guideline on physical activity (including school-based activity), a similar proportion to that seen in 2008 (71%).
Boys (77%) were more likely to meet the guideline than girls (69%)
The proportion of children meeting the guideline in 2012-2015 was significantly higher if their mother was active at the recommended level than if their mother was not. There was no significant difference according to whether their father met the recommendations or not.
68% of children had participated in sport in the prior week, a similar level to 2014 (67%) but lower than in 2008 (71%). Sports participation levels were comparable for boys (69%) and girls (66%).
Children were sedentary for an average of 3.3 hours on weekdays and 4.5 hours on weekend days, excluding time at school or early learning and childcare setting.
The Scottish Health Survey provides information on fruit and vegetable consumption among adults and children.
In 2015, 12% of children aged 2-15 met the 5-a-day fruit and vegetables recommendations on the previous day.
The proportion of children consuming no fruit and vegetables on the previous day in 2015 (7%) was significantly lower than that in 2012 (11%) and 2013 (10%)
There were no significant differences by age or gender in the proportion of children meeting the 5-a-day recommendations.
Eating no fruit and vegetables tended to increase with age for both boys (4% for those aged 2-4 to 16% for those aged 13-15) and girls (2% for those aged 2-4 to 8-9% for those aged 11-15).
In total, 43% of children whose parents did not eat any fruit and vegetables on the previous day also ate none themselves, compared with 2% of children whose parents met the 5-a-day recommendations.
The Healthy Living Survey conducted in 2016 showed that:
37% of pupils were registered for free school meals (38.7% in 2015)
81.5% of those registered for free school meals and present on the survey day took a free meal (80.1% in 2015).
58.1% of those pupils present on the survey day took a meal (free or paid for) supplied by the school (56.5% in 2015).
The Scottish Health Survey provides information on obesity among adults and children.
The proportion of boys of healthy weight (73% in 2015) has increased year on year since 2011 (63%) and is comparable to the level seen in 1998 (70%).
The proportion of girls who were a healthy weight in 2015 was 70%, a level which has remained relatively steady since 1998.
- Just over one in four (28%) children were at risk of overweight in 2015, with no significant difference between boys and girls (26% of boys and 29% of girls).
- In 2015, 15% of boys and 14% of girls were at risk of obesity, figures which were identical to those in 1998.
- Compared to a child with parents of a healthy weight, a child with an obese parent was significantly more likely to be at risk of overweight, including obesity (40% compared with 22%), or at risk of obesity (23% compared with 11%).
The Scottish Health Survey provides information on injuries/accidents among adults and children.
In order to concentrate on events which are most salient to those monitoring health in Scotland, the definition of 'accident' used in the Scottish Health Survey ( SHeS) is any which resulted in injury or physical harm where advice was sought from a doctor, nurse or other health professional, or which caused time to be taken off work or school.
Participants were asked to recall any accidents they had had in the 12 months prior to the interview which fitted this definition. Figures shown within the report, however, are based only on those accidents about which advice was sought from a doctor or which required a visit to hospital.
The survey covers most, but not all, accidents. Since SHeS collects data directly from participants, fatal accidents are excluded. In addition, there will be under-representation of accidents that lead to long-term hospitalisation. For these reasons, the accident data presented in this chapter can best be described as non-fatal accident prevalence for the household population. Reported prevalence will most likely slightly under-estimate true accident prevalence because of the exclusions. However, since the great majority of accidents do not lead to long-term stays in hospitals, any downward bias should be small.
The proportion of children aged 0-15 having had an accident in the previous 12 months was similar in 2003 (16%), 2009/2011 (14%) and 2013/2015 (15%).
- The proportion of boys (17%) having had an accident in the last 12 months in 2013/2015 was significantly higher than the proportion of girls (12%).
- Prevalence of accidents tended to increase with age, from 9% among those aged 0-1 to 20-22% among those aged 12-15.
- The main cause of accidents for children was a fall, slip or trip (53% of children who had had an accident in the last 12 months), followed by sports or recreational accidents (21% of children).
Lifestyle and substance use
The Scottish Schools Adolescent Lifestyle and Substance Use Survey (SALSUS) provides information about the prevalence of smoking, drinking and drug use. It also looks at the risk factors and protective factors associated with substance use, source of substances, attitudes towards substance use, and views on the support and advice provided by schools.
Substance use prevalence has remained largely stable since 2013, but it remains the case that prevalence has declined considerably over the last couple of decades.
Among 13 year olds, prevalence of use across all three substances has remained unchanged since 2013, but there were some differences among 15 year olds.
Drinking in the last week remains more common than smoking regularly or having used drugs in the last month.
- Close to two thirds of pupils reported that they had received lessons, videos/ DVDs or discussion in class on each of the three substances in the last 12 months.
- Overall, receiving lessons on a substance was not correlated with lower levels of use. wThe exception was 15 year olds who had received a lesson on drugs.
- Just over two-thirds of pupils thought that their school was providing them with enough advice and support about smoking, drinking alcohol and taking drugs.
- Those that agreed that their school provided enough advice and support about smoking, drinking alcohol or taking drugs were less likely to be regular users of that substance
Confidence about making choices
The majority of pupils of both age groups reported that they felt confident about their health and wellbeing choices. 13 year olds were slightly more likely than 15 year olds to feel confident that they know where to go for information and support about substance related issues.
Feeling confident about health and wellbeing choices was associated with lower substance use behaviour.
Across all five statements, pupils who felt confident were less likely to smoke regularly, have drunk in the last week or have used drugs in the last month.
Risk factors: School variables
All of the school-related variables in the survey were associated with all forms of substance use. Overall, the more engaged a pupil is with school (e.g. if they like it or if they haven't been excluded etc.) the less likely they are to use substances.
The relationship between feeling pressure from schoolwork and substance use was more complex. Among 13 year olds, the more pressure they felt due to schoolwork, the more likely they were to use substances. However, among 15 year olds, those who never felt pressured by schoolwork were the most likely to use substances.
Proportion of pupils using drugs in the last month by how often they feel strained or pressured by the schoolwork they have to do (2015).
Risk factors: Deprivation
Living in a deprived area (as measured by SIMD) was associated with higher levels of regular smoking and drug use in 15 year olds. But area deprivation was not linked with drinking for either age group.
Experience of the learning environment
Enjoyment of learning
In the 2015 SSLN pupil questionnaire, 9.5% of pupils in P4 agreed they enjoy learning, 93% in P7 and 8.8% in S2.
In the 2015 SSLN pupil questionnaire, enjoyment of learning was high throughout the survey stages, though the strength of this agreement reduced slightly at S2.
Sixty per cent of pupils in P4, 64% in P7 and 37% of S2 pupils strongly agreed that what they are learning in school is useful to them outside of school. This rises to over 90% for both primary stages and 80% for S2 stages when including pupils who also agreed a little.
School environment and use of
In the 2015 SSLN pupil questionnaire, a higher proportion of P4 (83%) and P7 (82%) pupils report that 'most pupils behave well in my class' than is the case at S2 (66%).
72% of P4 and 67% of P7 and S2 pupils agreed a lot or a little to the statement 'I am often distracted from my work by other pupils talking or misbehaving'.
Pupils were asked what they would do if they didn't understand what they were learning. For P4 (42%) and P7 (52%) pupils the most common response was to 'ask a teacher or classroom assistant'. However, S2 (51%) pupils were more likely to 'ask another pupil to help me'.
Only 15% of S2 pupils felt they were included in decisions that related to their class/school very often. Whereas, 25% of P4 pupils and 36% of P7 pupils felt this.
When asked about their engagement in cultural and local activities pupils in S2 were less likely to be involved across all measures than was the case for both P4 and P7. In particular the proportion of pupils who said they or their class had engaged in 'activities related to the environment' decreased from 66% in P4 and 72% in P7 to just 26% in S2.
Similarly, when asked about 'activities that involve people in your local area' 43% of S2 pupils said they had been involved in the current school year compared to 70% in P4 and 77% in P7.
Over 90% of pupils were confident in using a computer or tablet to find out information or carry out research. Large majorities at all stages reported being confident typing and editing work, creating tables, graphs or charts and making presentations.
Pupils also reported enjoying using computers and tablets and doing well in computer based tasks, at all stages. The use made of them for literacy and numeracy work was highest at P4 and lowest at S2. At P4, 32% of pupils reported using computers or tablets to complete literacy work and 38% numeracy work. In P7, this was 24% for literacy and 26% for numeracy; for S2 this was 20% for literacy and 18% for numeracy.
The latest PISA 2015 Scotland report shows that Scottish students were more likely to report high levels of support from their teachers than across the OECD, and teachers were more likely to be persistent (i.e. 'teacher continues teaching until the students understand'). However, the report shows that students were more similar to the OECD on the question of whether 'The teacher gives students an opportunity to express opinions'.