Abstract

The adolescent population of Glasgow, the city with the highest mortality in the UK, has a higher prevalence of risk behaviours than elsewhere in Scotland. Previous research has highlighted the importance of social context in interpreting such differences. Contextual variables from the 2010 Health Behaviour in School-aged Children Scotland survey were analysed. Glaswegian adolescents were more likely to live in low socioeconomic status, single-parent or step-families, or with neither parent in employment, less likely to share family meals, more likely to buy lunch outside school, and spend time with friends after school and in the evenings. They also had a poorer perception of their local neighbourhood. Family affluence only partially explained these differences.

Introduction

The poor health status of Scotland, and in particular Glasgow, is well documented, 1 with life expectancy at birth in Glasgow more than 6 years below the UK average for men (71.6 years, compared with a UK average of 78.2 years), and more than 4 years below the average for women (78.0 years, compared with 82.3 years). In a previous study, Levin et al. 2 showed that Glaswegian adolescents also reported poorer health outcomes and a higher prevalence of some risk behaviours, particularly in relation to eating, sedentary behaviour, subjective health, mental health and aggressive behaviour. Adjustment for family affluence and school type explained only a small part of this; effect sizes were attenuated but on the whole, significant relationships remained so.

Adolescence is a critical time in a person’s life when both protective and adverse risk behaviours are adopted, often tracking into adult life. It is therefore a pivotal period for identifying and addressing negative influences on health. The importance of social context during adolescence has been described extensively. 3 This study aimed to identify possible factors that might contribute to the poor health of Glasgow, by identifying contextual factors more prevalent in Glasgow than elsewhere, above and beyond deprivation. The findings are relevant not only to the study of Glasgow, but more generally to the field of social context and social determinants of health. The overall objectives of the study were to (i) determine the main differences in social context in adolescence between Glasgow and the rest of Scotland and (ii) examine whether these differences are independent of family affluence.

Methods

Study design

Scottish data from the 2010 Health Behaviour in School-aged Children (HBSC) survey were examined. The research protocol was approved by University of Edinburgh Ethics Committee. Nationally representative samples of school years Primary 7 (P7; on average 11.5 years), Secondary 2 (S2; 13.5 years) and Secondary 4 (S4; 15.5 years) were selected using systematic random sampling. The Glasgow City authority had a large enough sample to be representative, selected from 25 schools (eight primary and 17 secondary). Response rate of schools across Scotland was 74%, and of pupils 89%. More information regarding sampling, recruitment, data collection and a full description of the variables below is available elsewhere. 4

Data

Outcome variables

Binary outcome variables are listed under four headings of social context: Home environment, School, Peers and Local neighbourhood. Individual items for each variable are presented in table 1 and are described in Supplementary Appendix 1 .

Table 1

Prevalence (% and SE) and odds ratios for Glasgow vs. the rest of Scotland (parameter estimates from logistic regression models) for contextual variables previously associated with adolescent health and risk behaviours

 Glasgow Rest of Scotland     
Demographics       
N 633 5960     
Sex: Male 300 (47.4%) 2931 (49.2%)     
Sex: Female 333 (52.6%) 3029 (50.8%)     
Grade: P7 102 (31.1%) 912 (31.1%)     
Grade: S2 82 (27.3%) 946 (32.3%)     
Grade: S4 116 (38.7%) 1073 (36.6%)     
FAS: Low FAS 145 (48.3%) 920 (31.4%)     
FAS: Medium FAS 87 (29.0%) 960 (32.8%)     
FAS: High FAS 68 (22.7%) 1051 (35.9%)     
 Glasgow Rest of Scotland     
Demographics       
N 633 5960     
Sex: Male 300 (47.4%) 2931 (49.2%)     
Sex: Female 333 (52.6%) 3029 (50.8%)     
Grade: P7 102 (31.1%) 912 (31.1%)     
Grade: S2 82 (27.3%) 946 (32.3%)     
Grade: S4 116 (38.7%) 1073 (36.6%)     
FAS: Low FAS 145 (48.3%) 920 (31.4%)     
FAS: Medium FAS 87 (29.0%) 960 (32.8%)     
FAS: High FAS 68 (22.7%) 1051 (35.9%)     
Outcome measure  % (se) a
 
Model 1 b
 
Model 2 c
 
Glasgow Rest of Scotland OR 95% CI OR 95% CI 
Family 
Family structure: both parents family 59.2 (2.3) 67.4 (0.8) 0.70 (0.55, 0.89) 0.82  (0.65, 1.02) d 
Family SES 4 or 5 37.3 (0.9) 28.2 (2.6) 1.56 (1.17, 2.06) 1.32 (1.01, 1.73) 
Neither parent in employment 13.4 (2.1) 5.8 (0.4) 2.49 (1.68, 3.69) 1.93 (1.35, 2.74) 
Easy to talk to mother 83.2 (1.9) 80.0 (0.7) 1.20 (0.94, 1.52) 1.26  (0.99, 1.60) d 
Easy to talk to father 68.6 (2.8) 62.6 (0.9) 1.13 (0.92, 1.39) 1.24 (1.01, 1.53) 
Own a pet 63.7 (2.7) 71.6 (0.7) 0.67 (0.53, 0.85) 0.70 (0.55, 0.88) 
Go to bed hungry often 5.0 (0.9) 4.2 (0.3) 1.11 (0.75, 1.64) 1.03 (0.69, 1.53) 
Family meals eaten on > 4 days/wk  67.3 (2.9) d  72.7 (0.7) d 0.77 (0.63, 0.95) 0.82  (0.67, 1.00) d 
Breakfast consumed on every weekday 58.1 (3.3) 63.7 (1.1) 0.81  (0.64, 1.03) d 0.84 (0.67, 1.06) 
School 
Enjoy school 25.8 (3.6) 24.9 (1.0) 1.04 (0.79, 1.38) 1.08 (0.82, 1.42) 
Academic achievement 69.7 (2.2) 69.7 (0.8) 1.01 (0.79, 1.29) 1.03 (0.81, 1.32) 
Feel pressured by schoolwork 37.3 (3.2) 34.0 (1.1) 1.12 (0.89, 1.40) 1.11 (0.89, 1.40) 
Classmates kind and helpful 60.1 (4.2) 64.0 (1.0) 0.83 (0.65, 1.07) 0.87 (0.68, 1.12) 
School is the main source of sex education 26.5 (4.3) 33.1 (1.6) 0.74 (0.46, 1.19) 0.75 (0.46, 1.21) 
Walk to school 49.6 (3.6) 48.2 (1.3) 1.06 (0.76, 1.48) 0.99 (0.71, 1.38) 
Eat school lunch 27.2 (4.7) 33.4 (1.4) 0.68 (0.47, 0.98) 0.65 (0.44, 0.94) 
Buy lunch from shop, café or van on school days  39.4 (6.5) d  27.2 (1.8) d 1.98 (1.22, 3.21) 2.07 (1.28, 3.37) 
Never truant from school 80.5 (2.8) 82.9 (0.9) 0.87 (0.66, 1.16) 0.91 (0.68, 1.20) 
Peers 
Three or more close friends 89.1 (1.2) 90.2 (0.5) 0.89 (0.65, 1.23) 0.95 (0.69, 1.31) 
Contact with friends after school 34.9 (2.8) 30.7 (0.8) 1.24  (0.97, 1.57) d 1.23 (0.97, 1.56) 
Contact with friends in the evening 41.2 (3.1) 36.0 (0.9) 1.24  (0.98, 1.58) d 1.23 (0.97, 1.56) 
Can talk easily with best friend 85.5 (1.0) 86.8 (0.5) 0.89 (0.69, 1.14) 0.93 (0.73, 1.19) 
Daily electronic media contact with friends 48.0 (3.9) 47.9 (1.2) 0.94 (0.75, 1.17) 1.00 (0.80, 1.25) 
Can talk easily with friends of same sex 80.3 (1.5) 82.7 (0.6) 0.82 (0.65, 1.04) 0.87 (0.69, 1.10) 
Can talk easily with friends of opposite sex 57.7 (3.7) 56.5 (1.1) 1.00 (0.82, 1.23) 1.06 (0.86, 1.30) 
Talk to friends about sexual matters 74.9 (3.1) 74.3 (1.1) 1.01 (0.71, 1.44) 1.06 (0.74, 1.51) 
Most of my peers smoke cigarettes 5.6 (1.3) 6.0 (0.5) 0.83 (0.52, 1.33) 0.78 (0.49, 1.25) 
Most of my peers drink alcohol 21.6 (4.2) 21.8 (1.3) 0.83 (0.61, 1.12) 0.87 (0.64, 1.18) 
Most of my peers have been drunk 14.4 (3.3) 10.2 (0.8) 1.35 (0.91, 1.99) 1.35 (0.92, 2.00) 
Most of my peers use cannabis 2.9 (0.7) 2.4 (0.3) 1.10 (0.59, 2.06) 1.00 (0.53, 1.89) 
Friends in group are different ages 13.4 (1.8) 10.9 (0.5) 1.22 (0.92, 1.61) 1.16 (0.88, 1.54) 
Local neighbourhood e 
Feel safe in local area 81.3 (2.4) 89.4 (0.6) 0.49 (0.34, 0.69) 0.56 (0.40, 0.78) 
Local area is a good place to live 54.8 (2.9) 68.8 (1.0) 0.58 (0.44, 0.77) 0.66 (0.50, 0.87) 
People say hello in the street 61.7 (2.9) 74.9 (0.7) 0.55 (0.43, 0.70) 0.59 (0.46, 0.76) 
Safe for children to play outside 71.8 (2.2) 80.2 (0.8) 0.59 (0.44, 0.79) 0.64 (0.48, 0.85) 
You can trust people in local area 51.0 (3.2) 65.1 (0.9) 0.55 (0.43, 0.72) 0.61 (0.48, 0.79) 
There are good places to spend free time 51.5 (2.8) 51.5 (1.2) 1.06 (0.80, 1.40) 1.09 (0.82, 1.45) 
Can ask for help or a favour from neighbours 70.0 (2.6) 71.0 (0.8) 0.90 (0.70, 1.15) 0.98 (0.77, 1.25) 
People would try to take advantage of you given the chance  22.4 (2.3) d  18.2 (0.8) d 1.30 (0.94, 1.80) 1.20 (0.87, 1.65) 
Use local greenspace at least once a week 62.1 (2.3) 71.7 (0.9) 0.63 (0.49, 0.81) 0.67 (0.52, 0.87) 
Use local greenspace >2 h a week 53.1 (2.6) 58.7 (1.0) 0.75 (0.59, 0.95) 0.80  (0.63, 1.02) d 
There is trouble with gangs in the local area 20.1 (2.3) 14.6 (0.7) 1.34  (0.96, 1.88) d 1.23 (0.88, 1.71) 
There is a lot of litter in local area 20.7 (2.3) 14.4 (0.8) 1.43  (0.98, 2.08) d 1.29 (0.89, 1.87) 
There are a lot of run-down houses in local area 7.3 (1.2) 4.7 (0.5) 1.49 (0.87, 2.56) 1.38 (0.80, 2.35) 
Outcome measure  % (se) a
 
Model 1 b
 
Model 2 c
 
Glasgow Rest of Scotland OR 95% CI OR 95% CI 
Family 
Family structure: both parents family 59.2 (2.3) 67.4 (0.8) 0.70 (0.55, 0.89) 0.82  (0.65, 1.02) d 
Family SES 4 or 5 37.3 (0.9) 28.2 (2.6) 1.56 (1.17, 2.06) 1.32 (1.01, 1.73) 
Neither parent in employment 13.4 (2.1) 5.8 (0.4) 2.49 (1.68, 3.69) 1.93 (1.35, 2.74) 
Easy to talk to mother 83.2 (1.9) 80.0 (0.7) 1.20 (0.94, 1.52) 1.26  (0.99, 1.60) d 
Easy to talk to father 68.6 (2.8) 62.6 (0.9) 1.13 (0.92, 1.39) 1.24 (1.01, 1.53) 
Own a pet 63.7 (2.7) 71.6 (0.7) 0.67 (0.53, 0.85) 0.70 (0.55, 0.88) 
Go to bed hungry often 5.0 (0.9) 4.2 (0.3) 1.11 (0.75, 1.64) 1.03 (0.69, 1.53) 
Family meals eaten on > 4 days/wk  67.3 (2.9) d  72.7 (0.7) d 0.77 (0.63, 0.95) 0.82  (0.67, 1.00) d 
Breakfast consumed on every weekday 58.1 (3.3) 63.7 (1.1) 0.81  (0.64, 1.03) d 0.84 (0.67, 1.06) 
School 
Enjoy school 25.8 (3.6) 24.9 (1.0) 1.04 (0.79, 1.38) 1.08 (0.82, 1.42) 
Academic achievement 69.7 (2.2) 69.7 (0.8) 1.01 (0.79, 1.29) 1.03 (0.81, 1.32) 
Feel pressured by schoolwork 37.3 (3.2) 34.0 (1.1) 1.12 (0.89, 1.40) 1.11 (0.89, 1.40) 
Classmates kind and helpful 60.1 (4.2) 64.0 (1.0) 0.83 (0.65, 1.07) 0.87 (0.68, 1.12) 
School is the main source of sex education 26.5 (4.3) 33.1 (1.6) 0.74 (0.46, 1.19) 0.75 (0.46, 1.21) 
Walk to school 49.6 (3.6) 48.2 (1.3) 1.06 (0.76, 1.48) 0.99 (0.71, 1.38) 
Eat school lunch 27.2 (4.7) 33.4 (1.4) 0.68 (0.47, 0.98) 0.65 (0.44, 0.94) 
Buy lunch from shop, café or van on school days  39.4 (6.5) d  27.2 (1.8) d 1.98 (1.22, 3.21) 2.07 (1.28, 3.37) 
Never truant from school 80.5 (2.8) 82.9 (0.9) 0.87 (0.66, 1.16) 0.91 (0.68, 1.20) 
Peers 
Three or more close friends 89.1 (1.2) 90.2 (0.5) 0.89 (0.65, 1.23) 0.95 (0.69, 1.31) 
Contact with friends after school 34.9 (2.8) 30.7 (0.8) 1.24  (0.97, 1.57) d 1.23 (0.97, 1.56) 
Contact with friends in the evening 41.2 (3.1) 36.0 (0.9) 1.24  (0.98, 1.58) d 1.23 (0.97, 1.56) 
Can talk easily with best friend 85.5 (1.0) 86.8 (0.5) 0.89 (0.69, 1.14) 0.93 (0.73, 1.19) 
Daily electronic media contact with friends 48.0 (3.9) 47.9 (1.2) 0.94 (0.75, 1.17) 1.00 (0.80, 1.25) 
Can talk easily with friends of same sex 80.3 (1.5) 82.7 (0.6) 0.82 (0.65, 1.04) 0.87 (0.69, 1.10) 
Can talk easily with friends of opposite sex 57.7 (3.7) 56.5 (1.1) 1.00 (0.82, 1.23) 1.06 (0.86, 1.30) 
Talk to friends about sexual matters 74.9 (3.1) 74.3 (1.1) 1.01 (0.71, 1.44) 1.06 (0.74, 1.51) 
Most of my peers smoke cigarettes 5.6 (1.3) 6.0 (0.5) 0.83 (0.52, 1.33) 0.78 (0.49, 1.25) 
Most of my peers drink alcohol 21.6 (4.2) 21.8 (1.3) 0.83 (0.61, 1.12) 0.87 (0.64, 1.18) 
Most of my peers have been drunk 14.4 (3.3) 10.2 (0.8) 1.35 (0.91, 1.99) 1.35 (0.92, 2.00) 
Most of my peers use cannabis 2.9 (0.7) 2.4 (0.3) 1.10 (0.59, 2.06) 1.00 (0.53, 1.89) 
Friends in group are different ages 13.4 (1.8) 10.9 (0.5) 1.22 (0.92, 1.61) 1.16 (0.88, 1.54) 
Local neighbourhood e 
Feel safe in local area 81.3 (2.4) 89.4 (0.6) 0.49 (0.34, 0.69) 0.56 (0.40, 0.78) 
Local area is a good place to live 54.8 (2.9) 68.8 (1.0) 0.58 (0.44, 0.77) 0.66 (0.50, 0.87) 
People say hello in the street 61.7 (2.9) 74.9 (0.7) 0.55 (0.43, 0.70) 0.59 (0.46, 0.76) 
Safe for children to play outside 71.8 (2.2) 80.2 (0.8) 0.59 (0.44, 0.79) 0.64 (0.48, 0.85) 
You can trust people in local area 51.0 (3.2) 65.1 (0.9) 0.55 (0.43, 0.72) 0.61 (0.48, 0.79) 
There are good places to spend free time 51.5 (2.8) 51.5 (1.2) 1.06 (0.80, 1.40) 1.09 (0.82, 1.45) 
Can ask for help or a favour from neighbours 70.0 (2.6) 71.0 (0.8) 0.90 (0.70, 1.15) 0.98 (0.77, 1.25) 
People would try to take advantage of you given the chance  22.4 (2.3) d  18.2 (0.8) d 1.30 (0.94, 1.80) 1.20 (0.87, 1.65) 
Use local greenspace at least once a week 62.1 (2.3) 71.7 (0.9) 0.63 (0.49, 0.81) 0.67 (0.52, 0.87) 
Use local greenspace >2 h a week 53.1 (2.6) 58.7 (1.0) 0.75 (0.59, 0.95) 0.80  (0.63, 1.02) d 
There is trouble with gangs in the local area 20.1 (2.3) 14.6 (0.7) 1.34  (0.96, 1.88) d 1.23 (0.88, 1.71) 
There is a lot of litter in local area 20.7 (2.3) 14.4 (0.8) 1.43  (0.98, 2.08) d 1.29 (0.89, 1.87) 
There are a lot of run-down houses in local area 7.3 (1.2) 4.7 (0.5) 1.49 (0.87, 2.56) 1.38 (0.80, 2.35) 

Figures in bold denote significance at 95% level.

a: Weighted by grade and school type; χ2 test of proportions comparing Glasgow with the rest of Scotland.

b: Adjusting for age, sex, school type.

c: Adjusting for age, sex, school type and family affluence.

d: Significant at 90% level.

e: Data were only collected from S2 and S4 pupils.

Explanatory variables

A binary variable was created indicating Glasgow/the Rest of Scotland, based on school of attendance. Age and school type (private versus state) were included in analyses. The Family Affluence Scale (FAS), which combines information on car ownership, computer ownership, family holidays and own room, 5 was included as a measure of material wealth.

Statistical analysis

After omission of 148 cases with missing data, the final sample size was N = 6593, 633 from Glasgow and 5960 from the rest of Scotland. School roll statistics suggested good representation. 2

Logistic multilevel regression models were fitted for the binary outcome variables, using reweighted iterative generalized least squares in MLwiN 2.27. 6 Fixed parameter estimates were tabulated, highlighting significant associations with Glasgow residence. The models had two levels: school and individual child. The models adjusted for sex, age, school type and geography (Glasgow/Rest of Scotland). FAS was added and the models re-run. A sensitivity analysis examined the impact of rurality on associations, as urban–rural differences have been shown previously for adolescent health outcomes, 7 by (1) adjusting for rurality by school postcode, and (2) modelling data for children attending schools in cities only.

Results

Differences between Glasgow and the rest of Scotland were apparent in the contexts of family and local neighbourhood in particular ( table 1 ). Young people attending Glasgow City schools were more likely to come from single or step families of low socioeconomic status (SES) and with neither parent in employment. They were less likely to own a pet, or share a family meal on ≥ 4 days a week, but more likely to find it easy to communicate with their father. For the most part these associations persisted after adjustment for family affluence. Easy communication with mother was also significantly more likely among young people living in Glasgow, after adjustment for FAS (at the 93% level of significance). Young people were additionally less likely to have positive perception of their local neighbourhood and less likely to use their local greenspace. They were also more likely to report trouble with gangs, litter and run-down houses in their local area, although these associations became insignificant on adjustment for family affluence. Among the variables related to peers and school, only buying lunch off school premises was significant.

Adjusting for rurality or restricting the sample to residents of cities only produced similar results. The main differences were that pet ownership, use of local greenspace and communication with father no longer differed significantly between Glasgow and the rest of Scotland, while contact with friends after school and in the evenings and drunkenness among peers were significantly more prevalent in Glasgow in these analyses. School level variance ranged from small and insignificant ( < 0.03) for outcomes going to bed hungry and easy communication with friends, to ≥ 0.5 for variables walk to school, lunch on school days and peer risk behaviour.

Discussion

Glasgow, the largest city in Scotland and the fourth largest city in the UK, has the highest population density of any other settlement in Scotland. The history of Glasgow in recent times has been one characterized by deindustrialization and associated high levels of poverty. It remains by far the most deprived city in Scotland: almost half of the city’s residents reside in the 20% most deprived areas in Scotland. 8 It is perhaps unsurprising, therefore, that differences were found in family circumstances, with fewer young people living with both parents and reporting parents in employment and, among those employed, a larger proportion in lower SES occupations. However, the majority of associations were independent of family affluence, suggesting the influence of other, broader, aspects of deprivation, over and above that of material affluence per se.

When comparing urban children only, adolescents in Glasgow were more likely to spend time with their peers after school and in the evenings. In addition, drunkenness among peers was more prevalent in Glasgow than in other cities, but not in Glasgow compared with the rest of Scotland. This suggests that the peer context varies by geography and reinforces the need to take account of rurality in future spatial studies of health, particularly in relation to peers. 9

Differences in neighbourhood perceptions were apparent and remained after adjustment for rurality. Young people were less likely to describe their local area as safe or to trust locals—this despite the local authority’s slogan branding Glasgow as ‘the Friendly City’. This echoes results of a study of adults which found trust to be lower in Glasgow than in the socioeconomically similar cities of Liverpool and Manchester. 10 Overall, the results suggest the need for a greater focus on wider aspects of context, particularly in relation to the different facets of SES, peer relations and local neighbourhood, as potential explanatory factors for previously noted differences in the health and wellbeing profile of adolescents in Glasgow. 2

Supplementary data

Supplementary data are available at EURPUB online.

Funding

This work was supported by NHS Health Scotland and the Ludwig Boltzmann Institute.

Conflicts of interest : None declared.

Key points

  • Contextual differences between Glasgow and the rest of Scotland are apparent, particularly in relation to SES, peers and neighbourhood factors.

  • The majority of associations are independent of family affluence.

  • Glaswegian adolescents have a poorer perception of their local area and reduced social capital compared with those from the rest of Scotland.

  • Wider aspects of SES should be considered as potential explanatory factors for health differences between Glasgow and the rest of Scotland.

Acknowledgements

HBSC study is an international survey conducted in collaboration with the WHO Regional Office for Europe. The authors would like to acknowledge the HBSC international research network in 43 countries that developed the study’s research protocol.

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