ARCHIVED: Chapter 7: Young people in Canada: their health and well-being – Healthy Living

Healthy eating habits, good dental hygiene, and involvement in physical activity contribute to the physical and emotional health and well-being of youth. Some of those behaviours might be compromised in adolescents, because they are less dependent on their parents for some meals, spend more time away from home, and consume greater quantities of fast foods and snacks (Neumark-Sztainer et al., 1998; 2003).

It is recognized that dietary patterns in childhood and adolescence not only influence the immediate well-being of children but may also have an impact on their long-term health. In addition, dieting behaviour may have a bearing on the health status of adolescents; widespread concern about excessive dieting among young girls in Canadian society accompanies the awareness of the effects of obesity on long-term health.

Physical activity may be defined both in terms of organized sports and pursuits, as well as unstructured activities related to active living. Active living has been described as an integrated lifestyle that brings about a general state of physical, mental, spiritual, and emotional well-being (Frankish, Milligan, and

Reid, 1998). Under this concept, individuals interact with their environment through relatively unstructured physical activities, such as playing outdoors, skating, skiing, skateboard-ing, and bicycling (Stewart, 1995). Regular physical activity can benefit adolescents in many ways: the achievement and maintenance of a healthy weight; the promotion of skeletal health; the improvement of sleep quality; and the enhancement of self-esteem. Inappropriate physical activity may also, however, result in injuries. Lack of, or limited, physical activity is a result of more time spent in passive leisure pursuits, such as watching television or playing video games. The duration and type of sedentary leisure time influences the extent of social integration and has been linked to some risk behaviours.

The first section of this chapter describes healthy and unhealthy eating patterns, dieting behaviours, and dental hygiene practices of Canadian youth. Next is a description of the physical activity and leisure behaviours of students, followed by an outline of the prevalence of asthma and patterns of medication used among Canadian adolescents.

Eating Patterns

A healthy diet is one that includes a variety of foods and emphasizes cereals, breads and other grain products, vegetables and fruit, and low-fat products. Following a healthy diet and exercising are crucial to achieving and maintaining a healthy body weight (Health Canada, 1990).

Questions that asked students about their eating habits were included in the HBSC survey. It is important to note that the items focused on the frequency, rather than the quantity, of food intake. While frequent consumption of certain foods may be related to the overall volume eaten, this relationship cannot be inferred directly through the results of this study.

Fruits and Vegetables

It has been suggested that home availability of fruits and vegetables influences taste preferences and increases the consumption of these foods (Neumark-Sztainer, Wall, Perry, and Story, 2003). A series of questions addressed the consumption of nutritious foods, such as fruits and vegetables, cereals and breads, low-fat milk and others, by using a range of response options, from "never" to "everyday more than once."

In Grades 6 to 8, over half of boys and about two-thirds of girls ate fruits five days a week or more. The proportion of students of both genders who ate fruits frequently decreased in the higher grades (Figure 7.1). Although significantly more girls than boys in all grades consumed vegetables five days a week or more, vegetable consumption for both genders decreased in Grade 10 (Figure 7.2). Despite the decline in the consumption of both fruits and vegetables among students in Grade 10, vegetables were more popular than fruits among those students.

Figure 7.1 Students who ate fruits five days a week or more (%)

Figure 7.2 Students who ate vegetables five days a week or more (%)

Milk Products

Generally, about two-thirds of students across the five grades drank low-fat or skim milk five days a week or more, with no significant gender differences (Figure 7.3). Less than one-fifth of students drank whole milk five days a week or more, yet significantly more boys than girls in Grades 8 to 10 frequently drank whole milk.

Figure 7.3 Students who drank low-fat or skim milk five days a week or more (%)

Figure 7.4 Students who drank whole milk five days a week or more (%)

On average, a third of all students across the five grades reported eating cheese five days a week or more (Figure 7.5).

Figure 7.5 Students who ate cheese five days a week or more (%)

Grains and Cereals

A quarter of students in all grades reported eating brown bread five days a week or more (Figure 7.6). Over half of students between Grades 6 and 8 indicated that they ate white bread five days a week or more. In Grades 9 and 10, significantly more boys than girls reported eating white bread (Figure 7.7).

Figure 7.6 Students who ate brown bread five days a week or more (%)

Figure 7.7 Students who ate white bread five days a week or more (%)

The consumption of cereal decreased for both genders in Grade 10 compared with Grade 6, and significantly more boys than girls across the five grades reported having cereal five days a week or more (Figure 7.8). This difference could be because more boys than girls ate breakfast on all five weekdays (Figure 7.15).

Figure 7.8 Students who ate cereal five days a week or more (%)

Foods High in Sugar, Salt, and Caffeine

Students were also asked about their intake of foods high in sugar, salt, and caffeine. A sharp increase in the consumption of coke or other soft drinks that contain sugar and caffeine was evident for boys between Grades 6 and 10, whereas soft drink consumption peaked for girls in Grade 8 but dropped again in Grades 9 and 10 (Figure 7.9). In general, the frequency of diet soft drink consumption was quite low for both genders, with less than a tenth of students across the five grades drinking diet soft drinks five days a week or more (Figure 7.10).

Figure 7.9 Students who drank coke or other soft drinks that contain sugar and caffeine five days a week or more (%)

Figure 7.10 Students who drank diet coke or other diet soft drinks five days a week or more (%)

Potato chips and french fries form a central part of youth food culture. Health Canada's dietary guidelines recommend choosing lower-fat and lower-salt snack foods (Health Canada, 2003). The consumption of potato chips and french fries was examined using a lower threshold of twice a week or more, rather than five days a week or more. Figures 7.11 and 7.12 indicate that boys ate potato chips and french fries more often than did girls; by Grade 10, the gender difference for both food items was quite pronounced. The consumption of sweets (candy or chocolate) five days a week or more increased gradually to peak by Grade 9 but dropped again for Grade 10 students (Figure 7.13). The consumption of cake and pastries was much less for both genders and across grades than intake of sweets. Significantly more boys than girls in the higher grades frequently ate cake or pastries (Figure 7.14).

Figure 7.11 Students who ate potato chips twice a week or more (%)

Figure 7.12 Students who ate french fries twice a week or more (%)

Figure 7.13 Students who ate sweets (candy or chocolate) five days a week or more (%)

Figure 7.14 Students who ate cake or pastries five days a week or more (%)

Dietary Habits and Body Weight

Young people are showing a growing tendency to eat at various times during the day, rather than to eat meals at set times (Anderson, Macintyre, and West, 1993). While frequent snacking may not necessarily be an indicator of poor diet and nutrition (Drummond, Crombie, and Kirk, 1996), skipping meals has been associated with the intake of high-fat snacks among youth and with difficulties in concentration at school (Miles and Eid, 1997). Figure 7.15 outlines adolescent patterns of breakfast consumption on weekdays. Older students, especially girls, tended to skip breakfast more often.

While adolescents often go on diets to achieve desired body weight, dieting in youth has been associated with risk factors such as anorexia and bulimia nervosa. Figure 7.16 illustrates trends among students who responded to an item about being on a diet or doing something to lose weight. A far greater proportion of older girls than boys indicated that they were on a diet or that they needed to lose weight. By comparison, boys across grades were more likely than girls were to indicate that they needed to gain weight rather than lose it.

Figure 7.15 Students who ate breakfast (more than a glass of milk or fruit juice) on all five weekdays (%)

Figure 7.16 Students who reported being on a diet or doing something else to lose weight (%)

The total proportion of girls who made the attempt to lose weight over a period of at least a week increased from Grades 6 to 10 (Figure 7.17). Girls in the higher grades were also much more diligent in their efforts to control weight. Almost two-thirds of girls in Grade 10 reported some measure of weight control in the past 12 months. Research indicates that the increased proportion of body fat in early adolescence among girls, along with their preoccupation with body image, influences their dieting behaviours (Chapman, 1994).

Figure 7.17 Students who reported going on a diet, changing their eating habits, or doing something else to control their weight in the past 12 months (%)

To gain information about obesity, students were asked to report their height and weight. Eighty percent of students provided data on these two measures. The height and weight data were standardized to metric measurements, and a Body Mass Index (BMI) score was calculated as weight (kg) / height2 (m2). International age-and gender-specific cut-offs were employed to determine normal weight, overweight, and obese categories as defined by the Childhood Obesity Working Group of the International Obesity Task Force* (Cole, Bellizzi, Flegel, and Deitz, 2000). Since the cut-off points are age-specific, the results are presented in Figures 7.18 and 7.19 by age group, rather than by grade. Between one-fifth and one-quarter of boys in each age group were classified as overweight or obese; the obese group ranged from 5 to 7 percent across the age groups. Proportionately fewer girls than boys were overweight or obese, with less than one-fifth being overweight or obese in each of the age groups. Similar to boys, the girls' BMI scores did not differ significantly across age groups.

Figure 7.18 Mass Index results for boys (%)

Figure 7.19 Body Mass Index results for girls (%)

Dental Hygiene

Honkala and colleagues (2000) indicate there is evidence to suggest that the incidence of dental caries in industrialized countries is decreasing, yet poor dental health remains a problem among some adolescents and may be linked to decreased social opportunities, fewer life choices, and diminished life satisfaction (Currie, Samdal, Boyce, and Smith, 2001). Figures 7.20 and 7.21 illustrate that significantly more girls than boys across the five grades brushed their teeth at least twice a day. This dental hygiene practice by girls grew by grade and year of survey. More boys in Grades 6 and 8 reported brushing their teeth twice a day or more in the 2002 survey compared with boys of the same grades in the previous three surveys.

Figure 7.20 Students who brushed their teeth twice a day or more (%)

Figure 7.21 Students who brushed their teeth twice a day or more, by year of survey (%)

Figure 7.22 Students who were physically active five days or more over the past seven days for a total of at least 60 minutes a day (%)

Figure 7.23 Students who were physically active five days or more over a typical week for a total of at least 60 minutes a day (%)

The gender difference for physical activity was less observable for students in Grades 9 and 10, where over a third of both boys and girls reported spending five or more hours a week doing vigorous physical activity as part of their class time (Figure 7.24). This change may reflect an increased emphasis on physical education courses, as well as increased opportunities for participation, at the secondary level. Although spending five or more hours being physically active during free time at school was similar for both boys and girls in the lower grades, activity levels decreased significantly for girls in the upper grades, who may be less inclined to be active outdoors during their free time (Figure 7.25).

Figure 7.24 Students who spent five or more hours a week doing vigorous physical activity in their class time at school (%)

Figure 7.25 Students who spent five or more hours a week doing vigorous physical activity in their free time at school (%)

An analysis of data from the 1996-1997 National Population Health Survey (NPHS) of Canadian youth 12 to 24 years old indicates that boys were more physically active than girls were and that physical activity decreased with age for both genders (Higgins, Gaul, Gibbons, and Van Gyn, 2003). Findings from a study in Ontario also point to the decline in the participation of daily vigorous physical activity for girls in Grades 7 to 11 and for boys in Grade 11 between 1997 and 2001, which suggests that interventions and policies to promote participation of these groups should be addressed (Irving, Adlaf, Allison, Paglia, Dwyer, and Goodman, 2003).

A third of adolescents, both boys and girls, indicated that they spent five or more hours a week engaging in vigorous exercise in structured activities outside of school (Figure 7.26). Figure 7.27 shows that similar proportions spent five or more hours doing unstructured physical activity outside of school, the boys slightly more. Garcia, Broda, Frenn, Coviak, Pender, and Ronis (1995) suggest that girls perceive themselves as less athletic than boys do, which affects their participation in leisure time exercise activities.

Figure 7.26 Students who spent five or more hours a week doing vigorous physical activity while participating in lessons or team sports outside of school (%)

Figure 7.27 Students who spent five or more hours a week doing vigorous physical activity while participating in informal activities outside of school (%)

McHale, Crouter, and Tucker (2001) and Mahoney and Stattin (2000) suggest that youth who reported participating in structured sports and hobbies were more likely to exhibit superior patterns of adjustment. Figure 7.28 illustrates that about two-thirds of boys across grades said that they took part in some type of structured club or organization at least one day a week. On average, over 70 percent of younger girls in elementary school were involved in such organizations, but their numbers declined in the higher grades.

Figure 7.28 Students who spent at least one day a week involved in a club or organization (%)

Adolescents in the HBSC sample were also asked about their participation in sedentary activities, such as watching television, doing homework, and using the Internet to chat with friends, play games, or surf websites. Over 40 percent of younger students (in Grades 6 to 9) reported that they spent three or more hours a day watching television during the school week (Figure 7.29). Almost two-thirds of students reported this level of watching television on weekends (data not shown). Findings from research done in the United States show that watching television may also be a cue for eating in some children and that children who watch five or more hours of television a day consume 175 calories more daily than those who watch television no more than an hour a day (Crespo, Smit, Troiano, Bartlett, Macera, and Andersen, 2001).

Figure 7.29 Hours per day that students watched television during the school week (%)

Across all grades, boys were less likely than girls to spend one or more hours doing homework on weekdays, and this difference increased over the grades (Figure 7.30). However, Figure 7.31 shows that over a quarter of students across grades spent two or more hours doing homework on school days.

Figure 7.30 Students who spent one or more hours a day doing homework on weekdays (%)

Figure 7.31 Hours per day that students did homework on weekdays (%)

Over four-fifths of Grade 10 students indicated that they had first used the Internet between the ages of 9 and 13 (data not shown). Half of younger students (Grades 6 and 7) surveyed and two-thirds of older students reported spending one or more hours a day playing on the computer during the school week. Boys were more likely than girls to be involved in this leisure activity (Figure 7.32).

Figure 7.32 Students who spent one or more hours a day playing on the computer on weekdays (%)

Factors Associated With Physical Activity

Table 7.1 refers to factors associated with students of both genders in Grades 6, 8, and 10 being typically physically active for a total of at least 60 minutes a day over the past seven days.

The results indicate that along with being involved in clubs or organizations, and being well integrated socially (except for Grade 10 girls), physical activity increased with feeling healthy and rating one's life positively, as well as consuming a healthy diet of fruits, and of vegetables (except for Grade 8 boys).

The relationship between physical activity and the other factors examined appeared to be weaker or absent. Living in a two-parent household, for example, did not seem to have a connection with physical activity levels, yet family affluence was associated with an increase in physical activity for girls in Grades 6, 8, and 10 and for boys in Grade 10. Positive relationships with parents were related to increased physical activity only for Grade 6 girls and Grade 10 boys. Being satisfied at school was linked to physical activity to some degree, but only for boys in Grade 6 and for girls in Grades 8 and 10. Weight, as assessed by BMI, was tied to physical activity levels for boys in Grade 6 and boys and girls in Grade 8.

Other factors examined had an inverse relationship with physical activity. For example, having friends involved in risk behaviours was associated with decreased physical activity for Grade 10 boys and girls. Physical activity also declined with the following pursuits: watching television during weekdays for Grade 10 boys and girls and Grade 8 girls; watching television during weekends for Grade 8 girls; doing homework during weekdays and weekends for Grade 6 boys; and using a computer (for playing games, emailing, chatting, or surfing the Internet) during free time on weekdays for Grade 10 boys, and on weekends for boys in Grades 8 and 10.

Asthma

Some of the behaviours discussed in this chapter, such as exercising and eating healthy foods, may influence physical health outcomes. Asthma represents a common chronic condition that may also affect an adolescent's health, because the disorder may have a bearing on the ability to exercise. About 20 percent of both boys and girls in Grades 7 to 10 reported that they had been diagnosed with asthma by a doctor (Figure 7.33). However, girls generally showed a higher prevalence of asthma-related symptoms. For example, Figure 7.34 illustrates that older girls reported more episodes of wheezing than did boys over the past 12 months. Girls were also more likely than boys to report having dry coughs during the night (Figure 7.35). It was interesting to note, though, that roughly equal proportions of girls and boys within grades reported that they went to the doctor or emergency room for wheezing within the past year (Figure 7.36).

Figure 7.33 Students who were told by a doctor that they had asthma (%)

Figure 7.34 Students who had episodes of wheezing in the past 12 months (%)

Figure 7.35 Students who had a dry cough during the night, other than a cold, in the past 12 months (%)

Figure 7.36 Students who had been to the doctor or emergency room for wheezing in the past month (%)

Medication Use

Measures of emotional health used in the HBSC study (see Chapter 10, Emotional Health) included a host of physical and somatic complaints: headache, stomach ache, backache, depression, irritability, nervousness, difficulty sleeping, and dizziness. The type and extent of medication used to manage these ailments serve as indicators of health and well-being. Students were asked about medications which they took to alleviate such problems. Figure 7.37 illustrates that less than a fifth of students reported weekly use of cough medicine within the previous month, whereas Figure 7.38 suggests that taking medicine for headaches was more prevalent, especially among older girls. Between a quarter to a third of girls in Grades 7 to 10 reported taking medicine for headaches once a week or more. Taking medications for sleeping and nervousness was very low, with less than a tenth of students of both genders and across grades reporting the use of medicine for these symptoms (Figures 7.39 and 7.40).

Figure 7.37 Students who took medicine for cough once a week or more in the past month (%)

Figure 7.38 Students who took medicine for headache once a week or more in the past month (%)

Figure 7.39 Students who took medicine for difficulty sleeping once a week or more in the past month (%)

Figure 7.40 Students who took medicine for nervousness once a week or more in the past month (%)

Major Findings

• Girls ate more nutritious foods, fruits and vegetables, than did boys.
• More girls than boys skipped breakfast, and the trend was greater in older students.
• Boys, more than girls, consumed foods high in sugar, salt, and caffeine, such as soft drinks, diet soft drinks, potato chips, french fries, and cake or pastries.
• Dieting or doing something else to control weight was most prevalent in older girls, who also did so for longer periods of time than did younger girls.
• Boys were more physically active outside of school than were girls.
• Girls were more active than boys were in clubs and organizations.
• Playing computer games during weekdays was quite frequent, especially among boys.
• Although boys and girls were equally diagnosed with asthma, girls, particularly in the higher grades, reported asthma symptoms more often.
• Girls reported more use of medications for headaches, but there were no gender differences in the use of medications for sleeping difficulties and nervousness.

* Classification of weight in children and adolescents is complicated, because height and body composition are continually changing. These changes in adolescence occur at different rates in different populations and therefore are more variable compared with adult populations and are subject to different types of error and validity concerns (Cole, Bellizzi, Flegel, and Deitz, 2000).