The potential for current policy reforms in England to affect adolescent health : evidence from a national cross-sectional survey

Background Many of the foundations of lifelong health are laid in adolescence. In 2010, the English Department of Health launched a radical new public health strategy that aimed to improve all aspects of young people's health by promoting self-esteem, confidence, and personal responsibility. Previous research has emphasised the importance of social factors in adolescence, although finding no consistent relation between self-esteem and most health outcomes. We investigated the associations between health outcomes in adolescence and various individual and social factors. Methods Data from the UK national 2008 Healthy Foundations survey were accessed through the Department of Health. We analysed data for 452 participants aged 12–15 years, weighted to be nationally representative. From the survey we selected six individual-level factors, reflecting self-esteem, confidence, and personal responsibility; and seven societal factors, including measures of school, parental, home, peer, and community influence. For each factor, single-variable logistic regression models were used to calculate the odds ratios of seven health outcomes, adjusting for sex, age, and socioeconomic position (measured by Index of Multiple Deprivation score). Multivariable models were then created for each outcome, containing age, sex, deprivation, and all factors significant in the partially adjusted models. The health outcomes were self-reported general health, physical activity, healthy diet, healthy weight, and absence of smoking, alcohol use, and illicit drug use (all assessed with national guidelines for adolescents or standard definitions). Findings In the single-factor models, individual factors were linked to physical activity and healthy eating, but were not consistently linked to healthy weight and substance misuse. Positive social factors were associated with improved outcomes in all areas apart from alcohol use. In the multivariable model, improved general health was associated with living in a safe neighbourhood (adjusted odds ratio 1·4, 95% CI 1·0–1·9) as well as the individual factors of self-esteem (1·4, 1·0–1·8) and involvement in health (1·9, 1·3–2·6). Physical activity was similarly associated with self-esteem (1·5, 1·1–2·1) and involvement in health (1·4, 1·1–1·9), but with social participation in terms of social factors (1·9, 1·4–2·7). Healthy eating was associated only with the individual factor confidence (1·4, 1·1–1·7), with a trend for an association with school environment (1·3, 1·0–1·6). Being a healthy weight was not associated with any individual factors, and associated only with safe neighbourhood in terms of social factors (1·3, 1·1–1·7). Being a non-smoker was associated only with social factors, including parents not smoking (14·9, 4·5–49·4), ability to talk with parents (1·6, 1·1–2·5), living in a safe neighbourhood (1·7, 1·1–2·7), and school environment (2·3, 1·4–3·8). Drug use was associated with drug use at home (395, 9–16 918) and friends not being concerned about health (2·6, 1·7–4·0). Interpretation Individual factors such as self-esteem were associated with general health, physical activity, and healthy eating. However, the influence of family, peers, school, and local community seem to be equally important for these outcomes and more important for smoking, drug use, and healthy weight. Self-esteem interventions alone are unlikely to be successful in improving adolescent health, particularly in tackling obesity and reducing substance misuse. Funding The original survey was funded by the Department of Health; no specific funding was associated with the analysis and drafting of this study.