Domestic Environment. Children and their health are
initially significantly influenced by their immediate family environment.
Three factors in particular are well-known as influencing health, well-being
and development. These are housing (including modern sanitation and
appropriate heating), family income, and maternal education (see above). Data
on the first two are available in most countries from national sources.
Whilst in general deficiencies of housing are being addressed, it is clear
from studies from UNICEF and others that great inequalities in income remain,
and indeed are increasing. Some of the richest European countries still have
major pockets of children living in poverty (UNICEF, 2005). Data on maternal
education is more difficult to obtain other than by special studies. It has
been shown that children of mothers educated only to primary school level
have a higher risk of health problems that children of more educated mothers
(European Commission, 2003). Poor health behaviour in a mother can influence
the future health of her child. There is a direct relation between low birth
weight, poor nutrition in the mother during pregnancy and the
child’s vulnerability to several conditions in childhood (Middle et al, 1996;
Matharu and Ozanne, 2004; Ozanne et al, 2004).
Smoking. Smoking is argued to be
driven predominantly by psychosocial motives such as wanting to look older,
needing to relax, feeling rebellious, boredom, or the idea that it might
control weight gain. In many cases it is reported that children who smoke
frequently have low self esteem, impaired psychological wellbeing, or are
poor achievers at school, and tend not to be succeeding according to their
own or society's terms (Jarvis, 2004). Data from ESPAD from 16 year olds
shows a range of persons who had smoked within the last 30 days between 49%
in Austria and 22% in Cyprus (1993 data).
Alcohol. Despite Europeans being
among the world’s highest consumers of alcohol, most national and
cross-cultural studies of drinking in Europe have been of a quantitative,
epidemiological nature and provide little or no insight into the social
contexts and cultural roles of drinking. Cross-cultural variation in the way
people behave when they drink cannot be attributed solely to different levels
of consumption or genetic difference. The consumption of alcohol in society
is related to different cultural beliefs about alcohol itself, expectancies
regarding its effects, and social norms regarding drunken comportment.
Societies which hold generally positive beliefs and expectancies about
alcohol experience significantly fewer alcohol-related problems. Higher
levels of alcohol-related problems are associated with negative or
inconsistent beliefs and expectancies (Social Issues Research Centre, 1998).
Regular consumption of alcohol is increasing in young people, often beginning
at an early age. Weekly drinking is more widespread among boys than girls and
rises with age from over a tenth of 11 year old boys in six countries to a
fifth of 13 year old boys in eight countries and to over a third in nineteen
countries by age 15. In a few countries the rates for boys and girls are very
similar at age 15, such as Norway and the United Kingdom. Weekly drinking
among 15-year-old girls is especially high in Denmark, the Netherlands and
the United Kingdom, whilst having got drunk in the last 12 months peaks in
Denmark (WHO/HSBC, 2004; www.espad.org
interactive data) (see also Section 10.2).
Cannabis use. Cannabis use varies widely among
15-year-olds with reports of those who have ever used it ranging from 3% to
46%. On average, boys are more likely to use cannabis than girls: 22% and
16%, respectively, and have used it in the previous 12 months. Regular use of
cannabis (3–39 times in the previous 12 months) is highest (15% or over) in
Spain and Switzerland (WHO/HSBC, 2004), though in ESPAD data the Czech
Republic and Ireland also fare badly (www.espad.org interactive data). Looking at other drugs also
brings Estonia, Germany, and the United Kingdom into the worst group (www.espad.org interactive data) (see also Section 10.2).
Sexual health and behaviour. Sexual behaviour is an important determinant
of physical and mental well-being. Unsafe sex can have implications for
unwanted teenage pregnancies, fertility, infectious diseases and other
reproductive health problems. Several risk factors have been identified for
cervical cancer, such as early sexual activity, sexually transmitted
infections (STIs) and human papilloma virus (HPV). Risk factors for STIs can
include multiple sex partners and a weakened attention to protect their
health and their lives because of feelings of invincibility, combined with a
lack of awareness of the consequences of risky behaviour (WHO, 2005c).
Sexually transmitted infections are an important health problem for young
girls because of the risk of infertility, ectopic pregnancy, pelvic
inflammatory disease, and chronic pelvic pain. There is a significant demand
for abortion among teenagers. In Northern countries men and women have their
first sexual intercourse at about the same age. Belgium and Germany are
characterised by a comparatively late sexual initiation for both sexes
(European Commission, 2003). In conducting the research for the WHO/HSBC
report Young People’s Health in Context, only the 15 year olds were asked to
respond to the survey on sexual health, as the questions were considered too
sensitive for younger age groups. The ranges of reported condom use during
the 15 year olds’ last intercourse are quite large: 58–89% for girls and
69–91% for boys. Rates are highest in some southern European countries, and
lowest in Finland, Germany, Sweden and the United Kingdom. On average, 85% of
girls and 86% of boys report using at least one form of contraception during
their last sexual intercourse. However, several countries and regions did not
include questions on sexual health (WHO/HSBC, 2004).
than half of young people in Europe participate in a recommended one hour or
more of at least moderate physical activity on five or
more days a week (European Commission, 2005b). Across all countries and
regions and all age groups, girls are less active than boys and the gender
gap increases with age. The countries with the highest percentages (over 40%)
of boys achieving the recommended amount of physical
activity are the Czech Republic, England,
Ireland, and Lithuania. The Netherlands have the highest rates of physical
activity for 15-year-old girls, with over 36% meeting the
guidelines (WHO, 2005a).
Eating habits. The eating habits of young people
may be a reflection of the weakening influence of parents, and the
strengthening influence of peer and media pressure (WHO/HSBC 2004). Although
varying widely across countries and regions, it is observed that less than
two fifths of young people eat fruit daily, while about a third eat
vegetables each day. The daily consumption of sweets and soft drinks reaches
a high of 40–50% in Belgium (French), Ireland, Italy, Malta, Scotland and the
Former Yugoslav Republic of Macedonia. Those who choose not to eat breakfast
are more likely to eat snacks with high fat and low fibre content during the
day (WHO/HSBC 2004).
Disability. Regrettably, the incidence of
physical disability in children, or of mental disability, is not known at the
population level across Europe. Such disabilities can be either present from
birth, or acquired by illness or by trauma at a subsequent stage. A physical
or mental impairment clearly can affect normal development and play,
education, mental wellbeing, and ultimately work and lifestyle opportunities.
Some conditions such as autism only become manifest as the child matures.
Though congenital abnormalities are well recorded within Europe, later
acquisitions and manifestations are not, nor are the related special needs in
the educational and other settings if disability is not to become a major
handicap for the individual.
References cited in this table are listed in Chapter 9.2