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9.2. Children and adolescents (age 1-18)

9.2.4. Risk factors

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9.2.4. Risk factors


A number of first-level risk factors have been identified for children health (see Table 9.1b.). Equally important - indeed arguably more important – is the identification of the relative importance of their determinants. These include family circumstances, parental education, housing and family income, advertising as well as wider societal trends and peer pressures – all risk factors of locally varying significance that can be influenced or modified by different policies and legislation.



Table 9.1b. Main risk factors for children and adolescents


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).


SmokingSmoking 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 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; 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 (339 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 ( interactive data). Looking at other drugs also brings Estonia, Germany, and the United Kingdom into the worst group ( 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: 5889% for girls and 6991% 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).


Inadequate physical activity. Less 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 4050% 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