NATIONAL

HEALTH BEHAVIOUR IN SCHOOL-AGED CHILDREN:
WHO COLLABORATIVE CROSS-NATIONAL STUDY (HBSC)
2014 SURVEY IN SCOTLAND NATIONAL REPORT
FAMILY LIFE
INTRODUCTION
For adolescents, the family provides an important context in which many health behaviours are established, allowing
for fundamental development during the adolescent years and whose influence continues throughout their adolescence
and into adulthood 1 . Family composition (e.g. biological parents, stepfamilies or single parents) has changed significantly
over recent decades, with young people growing up in increasingly diverse living arrangements. The proportion of young
people living in single parent and step-parent families in Britain has increased, while the proportion of young people living
with both biological parents has decreased 2 . Previous research has identified that both the family structure and certain
processes of family dynamics, specifically communication with parents, have a clear influence on adolescent development,
life chances and health behaviours 3,4 . During adolescence, young people typically start to spend less time with their family,
more time with peers 5 , with joint family activities showing a decline 6 . Family socio-economic status can also have an
important impact on young people’s health and development. The HBSC study uses the Family Affluence Scale 7,8 to
categorise young people as having low, medium or high family affluence. In 2014, in addition to family car and computer
ownership, family holidays and own bedroom occupancy, the scale was extended to include two new items: dishwasher
ownership and number of bathrooms in the home.
A considerable body of research has linked adolescent outcomes and health with family structure, affluence, cohesion
and communication 8,9,10,11 . However, different cultural and social norms may result in variations in the association between
family structure and health 12 . It has been suggested that living in a two-parent family facilitates the positive development
of children and adolescents, while living in other family compositions, especially those in which multiple family transitions
are experienced, are linked with a higher risk of psychological, behavioural, social and academic problems 13, 14, 15, 16 . Family
dynamics based on interpersonal relationships between family members also impact on adolescent health 17 . Many studies
have suggested healthier behaviours in children and adolescents who have an open communication with their parents 18
and perceive them as emotionally and physically accessible 19 . According to previous research, a strong family relationship
is evidenced by an adolescent’s sharing of parental and societal norms and values, protecting them against taking up
specific risk behaviours. For example, time spent with family has been shown to limit excessive drinking in adolescents 20
and improve diet quality 21, 22 . Family affluence has been shown to have a strong association with a wide variety of health
behaviours and outcomes, for example, self-rated health, life satisfaction, health complaints, injuries, body weight, diet,
toothbrushing, physical activity, sedentary behaviour, and substance use 23,24 .
The important influence that family life has on the many elements of an adolescent’s health has been acknowledged
by the Scottish Government in the Scottish action framework Delivering a Healthy Future 25 , and in the National Parenting
Strategy 26 , which focuses on promoting positive parent-child relationships.
HBSC FINDINGS
A number of aspects of family life are measured by the Scottish HBSC study, including family structure, family affluence,
perceived wealth, parent-child communication and family support. Family structure and communication with parents
have been recorded since 1990, and perceived wealth since 1998. A new measure of family support was introduced in 2014.
FAMILY STRUCTURE
In 2014, 65% of young people in Scotland reported that they live with both their parents, 21% with a single parent (19% with
mother and 2% with father) and 12% in a stepfamily. A minority (2%) reported living in another home environment, such as
a foster home, children’s home or with members of their extended family (Figure 2.1).
Whilst there was little change in family structure between 2010 and 2014, the proportion of young people living with
both parents has gradually declined since 1990, and the proportion living in single parent and stepfamily households has
increased (Figure 2.2), as in many other European countries 27 .
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