Abstract

Background

The adult population of Glasgow has worse health than in the rest of Scotland, only partially explained by deprivation. Little is known about the health of young Glaswegians.

Methods

The 2010 Health Behaviour in School-aged Children survey data were analysed using multilevel modelling to compare outcomes in Glasgow relative to the rest of Scotland.

Results

Glasgow adolescents had similar or better self-reported health on some measures—e.g. adjusting for age and sex, OR for ‘very happy’ was 0.93 (95% CI = (0.75, 1.14))—and the beta coefficient for positive GHQ-12 was 2.79 (0.72, 4.85) compared with the rest of Scotland. However, many health aspects were worse in Glasgow especially for eating and sedentary behaviour, subjective health and aggression, e.g. the OR for ‘daily consumption of vegetables’ was 0.59 (0.46, 0.77), of reporting ‘excellent health’ was 0.66 (0.50, 0.87); headaches was 1.40 (1.09, 1.80); however drinking alcohol in the past week was lower (OR 0.71 (0.50, 0.99)) and smoking, similar. Adjustment for family affluence and school type marginally attenuated the association with Glasgow.

Conclusions

The worse health experienced by Glasgow adults is only partially seen among young people in Glasgow; however, these are seen at the youngest ages in the study.

Introduction

The poor health of people in Scotland is well documented, being labelled the ‘Sick Man of Europe’ on account of having the lowest, and most slowly improving, life expectancy in Western Europe.1,2 Scotland also has the largest inequalities in premature mortality within the UK3 and Western Europe.4,5 In particular, the city of Glasgow has the worst health in Scotland with life expectancy at birth of >6 years below the UK average for men (71.6 years, compared with a UK average of 78.2 years), and >4 years below the average for women (78.0 years, compared with a UK average of 82.3 years).6 Although traditional explanations have focussed on material deprivation and deindustrialization, a considerable amount of recent research has highlighted ‘excess’ levels of poor health ‘over and above that’ attributable to differences in socioeconomic characteristics and post-industrial decline. This has been shown nationally (Scotland compared with the rest of GB), regionally (West Central Scotland compared with similar post-industrial European regions), at a city level (Glasgow relative to Liverpool and Manchester) and measured in terms of both area deprivation and individual socioeconomic status (SES).7–10 The ‘excess’ has been shown to be ubiquitous in Scotland, but most concentrated in and around the city of Glasgow. Indeed, an excess has also been shown for Glasgow itself compared with the rest of Scotland.11,12

This excess mortality has been shown to be most pronounced among those of working age, with childhood mortality either no worse (in the case of national and regional comparisons) or better (in the case of Glasgow compared with Liverpool and Manchester).13 Nevertheless, it is likely that poor health in mid-life reflects experiences and influences from earlier in the life course. Recent research has, however, shown little difference in the home environment of children aged 3–7 years living in the Glasgow conurbation relative to those living in similar areas elsewhere.14 The health and health behaviour of adolescents in Glasgow compared with the rest of Scotland is only partially understood15 and is likely to be an important determinant of future adult health.16

The overall objectives of the proposed study are to: (i) assess whether there is evidence of ‘excess’ levels of poor health and risk behaviour in adolescence in Glasgow compared with the rest of Scotland, (ii) identify differences independent of material deprivation and (iii) determine whether these emerge during adolescence.

Methods

Study design

Data from the 2010 Scottish Health Behaviour in School-aged Children (HBSC) survey were used. Full details of the sampling, recruitment and data collection are described elsewhere.17 Briefly, representative samples of children in school years Primary 7 (P7), Secondary 2 (S2) and Secondary 4 (S4) (ages 11, 13 and 15 years, respectively) were recruited using stratified (at education authority level) random sampling. The Glasgow authority sample was large enough to be representative (comprising 8 primary and 17 secondary schools), enabling comparison with the rest of Scotland. Response rate of schools across Scotland was 74%, and of pupils 89%. The questionnaire was completed anonymously by children in class under teacher supervision. The research protocol was approved by University of Edinburgh ethics committee.

Data

Outcome variables

Data were collected on eating habits, physical activity and sedentary behaviour, weight control behaviour and body image, puberty, tooth-brushing, mental well-being, subjective health and medicine use, substance use, sexual health, bullying and fighting, injuries and aspirations. A full description of each outcome, including questionnaire items and responses, can be found in the 2010 HBSC National report.17 Items not described in the report have relevant references attached below. The following outcome variables were examined under each of these topics:

  • Eating habits—nine items: daily consumption of fruit, vegetables, sweets, crisps, chips, sugary drinks and diet soft drinks; family meals eaten on ≥4 days per week; breakfast consumed daily on weekdays.

  • Physical activity and sedentary behaviour—10 items: at least 1 h of moderate physical activity daily; vigorous physical activity outside school daily; watch TV for >2/4 h a day; play computer games for >2 h a day; use of computer for something other than computer games for >2 h; sedentary for >2 h a day; number of days per week when TV/computers/computer games are used for 2 h or more.

  • Weight control behaviour and body image—three items: currently on a diet; report too fat; report good looks.

  • Tooth-brushing—one item: brush teeth at least twice a day.

  • Mental well-being—eight items: very happy; always happy; always confident; never left out; life satisfaction score; health related quality of life (HRQoL), using the KIDSCREEN-10 score;18 GHQ-1219 measure of social functioning (‘positive scores’) and GHQ-12 measure of anxiety and depression (‘negative scores’).

  • Subjective health and medicine use—14 items: excellent health; headaches/stomach ache/nerves/difficulty sleeping/back ache/feeling low/bad temper/dizzy occurring more than once a week in the last 6 months; multiple health complaints (MHC), defined as more than one health complaint occurring more than once a week; taken medicine for headaches/stomach ache/nerves/sleeping difficulties in the last month.

  • Substance use—six items: smoke tobacco; weekly smoking; daily smoking; drink alcohol at least once a week; been drunk at least twice; used cannabis three or more times in the last 12 months.

  • Sexual health—one item: has had sexual intercourse.

  • Bullying and fighting—three items: been bullied twice in the last two months; bullied in the last 2 months; been in a physical fight three times or more in the last 12 months.

  • Injuries—one item: injured at least once in the last 12 months requiring medical attention.

  • Aspirations—one item: plan to go onto further/higher education.

Explanatory variables

Age was included as a continuous variable in the analyses. Glasgow City education authority school pupils were defined as being from Glasgow. The Family Affluence Scale (FAS), a measure of material wealth, was calculated using responses to questions about having own bedroom, the number of cars and computers in the home and the number of family holidays in the previous 12 months.20 The four items were combined using categorical principal component analysis, a method recommended by Batista-Foguet et al.21 to produce tertiles of low, medium and high family affluence.

Data set representativeness

Respondents with missing data for age or family affluence were excluded (33 cases, 1 from Glasgow and 32 from the rest of Scotland with missing age; 148, 12 from Glasgow and 136 from elsewhere with missing FAS), leaving a sample of 6593, of which 633 were from Glasgow. Where outcome data were missing, participants were only excluded from relevant analyses. The proportion of missing cases per variable was generally <5% with the majority of <2% for both Glasgow and the rest of Scotland, with no discernible pattern difference between Glasgow and the rest of Scotland. The only exception was for the survey item on sexual activity, which had a higher proportion of missing data in Glasgow (18% compared with 6% in the rest of Scotland).

Model procedures adjusting only for age described below were re-run including the 148 coded as ‘missing’ FAS data, with results suggesting no obvious bias arising from the omission of these cases. Comparison with school roll statistics22 showed that there was over-representation of children attending independent schools in P7 in the sample. Primary schools in Glasgow in 2010 had on average 39% of pupils receiving free school meals (FSM) (with a range of 2–76%), whereas secondary schools had 32% with FSM (2–51%). In the study sample, these figures were 32% (with a range of 3–65%) and 27% (2–44%), a slightly lower proportion of low SES children than that of the population of Glasgow. For the rest of Scotland sample, the average proportion of children receiving FSM (20% in primary and 12% in secondary) was in line with population figures although the range also suggested a higher SES bias in the sample.

Statistical analysis

Preliminary analyses presented frequencies for each binary variable and means for each continuous variable, for Glasgow and the rest of Scotland, weighting by school grade and type. Logistic multilevel regression models were fitted for each of the binary outcome variables, using reweighted iterative generalized least squares (RIGLS) in MLwiN 2.27.23 Linear multilevel regression models in MLwiN 2.27 were fitted for continuous outcomes such as life satisfaction and KIDSCREEN scores, also using RIGLS estimation. Wald tests were carried out to identify the precision of parameter estimates and associations with Glasgow. The models had three levels: education authority, school and individual child and were fitted for boys and girls separately, adjusting for age and geography (Glasgow/rest of Scotland). The education authority level was insignificant and was therefore removed. Family Affluence Scale was then added and the models re-run. Interaction terms between age and Glasgow were included to examine whether an association between living in Glasgow and health emerged during adolescence. Additional analyses were carried out adjusting for school type (state/independent), to reduce the possibility of bias, although these are not presented. These showed only very slight differences for some outcome measures and did not change the conclusions of the study. A sensitivity analysis with independent school children in Glasgow schools coded as living outside Glasgow is available from the authors on request.

Results

There was a greater proportion of S4 pupils, and particularly girls, and a smaller proportion of S2 pupils in the Glasgow City sample relative to the rest of Scotland (Table 1). A greater proportion of respondents from Glasgow were of low FAS, and a smaller proportion were of high FAS (under a chi-squared test, P < 0.01). After weighting by school grade and school type, there was a greater proportion of Glasgow pupils eating more unhealthy foods (sweets, chips, crisps and sugary drinks) and fewer eating fruit and vegetables. There was also more television viewing and computer use among Glasgow pupils (Tables 1 and 2). Excellent health was more prevalent among girls living outside Glasgow: 17.5% compared with 10.5% (Table 1) and Glaswegian boys were more likely to report having headaches (16.6% compared with 11.2%) and dizziness (12.5% compared with 8.5%).

Table 1

Prevalence of adolescent health and risk behaviours for boys and girls in Glasgow and the rest of Scotland

  Boys
 
  Girls
 
  
Glasgow Rest of Scotland Glasgow Rest of Scotland 
Demographics 
N 300 2931  333 3029  
 Grade: P7 102 (31.1%) 912 (31.1%)  90 (27.0%) 948 (31.3%)  
 Grade: S2 82 (27.3%) 946 (32.3%)  80 (24.0%) 933 (30.8%)  
 Grade: S4 116 (38.7%) 1073 (36.6%)  163 (48.9%) 1148 (37.9%)  
 FAS: Low FAS 145 (48.3%) 920 (31.4%)  167 (50.2%) 936 (30.9%)  
 FAS: Medium FAS 87 (29.0%) 960 (32.8%)  98 (29.4%) 1011 (33.4%)  
 FAS: High FAS 68 (22.7%) 1051 (35.9%)  68 (20.4%) 1082 (35.7%)  
Outcome measures % (SE)a P-valueb % (SE)a P-valueb 
Eating habits 
 Daily consumption of fruit 30.6 (4.5) 33.9 (1.2) 0.469 31.2 (3.1) 40.4 (1.2) 0.006 
 Daily consumption of vegetables 24.1 (3.1) 34.4 (1.1) 0.002 28.8 (2.7) 40.5 (1.1) <0.001 
 Daily consumption of sweets 39.6 (3.6) 28.4 (0.9) 0.002 33.4 (3.0) 28.6 (1.0) 0.123 
 Daily consumption of crisps 22.4 (3.4) 19.8 (0.8) 0.468 28.0 (3.1) 20.5 (0.9) 0.020 
 Daily consumption of chips 13.8 (2.6) 8.6 (0.5) 0.046 11.1 (2.3) 6.9 (0.6) 0.078 
 Daily consumption of sugary drinks 37.1 (5.1) 23.5 (1.0) 0.008 31.6 (4.0) 16.4 (0.8) <0.001 
 Daily consumption of diet soft drinks 17.0 (2.5) 11.8 (0.7) 0.045 18.7 (3.1) 13.4 (0.7) 0.097 
 Family meals eaten on ≥4 days/week 66.6 (4.0) 72.1 (0.9) 0.177 67.9 (2.8) 73.2 (0.9) 0.080 
 Breakfast consumed on every weekday 63.6 (3.6) 68.9 (1.1) 0.283 52.7 (4.5) 58.5 (1.4) 0.191 
Physical activity and sedentary behaviour 
 Vigorous physical activity outside school daily 24.2 (3.1) 23.6 (0.9) 0.859 13.9 (2.9) 14.6 (0.7) 0.818 
 At least 1 h of moderate physical activity daily 19.1 (2.9) 18.5 (0.9) 0.843 8.6 (2.8) 11.3 (0.7) 0.349 
 Watch TV >2 h/day 71.4 (2.3) 64.8 (1.0) 0.008 71.1 (2.6) 63.2 (1.1) 0.005 
 Watch TV >4 h/day 29.5 (3.8) 22.5 (0.9) 0.070 28.6 (3.1) 20.5 (0.9) 0.010 
 Play computer games >2 h/day 70.7 (3.5) 64.4 (1.1) 0.088 36.3 (3.8) 27.9 (0.9) 0.029 
 Use computer for something other than computer games >2 h/day 51.0 (1.3) 56.0 (3.8) 0.211 60.7 (1.4) 69.6 (4.0) 0.036 
 Sedentary for >2 h/day 84.6 (2.2) 79.7 (1.0) 0.037 66.8 (3.5) 60.6 (1.1) 0.092 
Weight control behaviour and body image 
 Currently on a diet 12.1 (1.7) 10.1 (0.6) 0.267 21.1 (2.9) 21.4 (1.0) 0.944 
 Report too fat 26.4 (3.2) 26.2 (0.9) 0.954 39.3 (3.2) 40.6 (1.3) 0.714 
 Report good looks 32.2 (2.8) 36.9 (1.2) 0.126 20.7 (2.7) 24.4 (1.3) 0.216 
Tooth-brushing 
 Brush teeth at least twice a day 65.7 (3.0) 66.4 (1.0) 0.825 78.9 (2.6) 81.8 (0.9) 0.292 
Mental well-being 
 Very happy 48.5 (4.1) 48.0 (1.1) 0.913 35.7 (3.6) 39.5 (1.2) 0.311 
 Always happy 26.7 (3.2) 25.8 (0.9) 0.792 20.9 (2.5) 24.5 (0.9) 0.178 
 Always confident 22.2 (2.4) 22.6 (0.8) 0.874 10.8 (2.1) 11.3 (0.7) 0.823 
 Never left out 28.9 (2.6) 26.2 (0.8) 0.329 20.7 (2.6) 17.1 (0.9) 0.180 
Subjective health and medicine use 
 Excellent health 20.7 (3.8) 25.9 (1.0) 0.191 10.5 (1.9) 17.5 (1.0) 0.001 
 Headache >1/week in last 6 months 16.6 (2.3) 11.2 (0.7) 0.022 23.0 (2.5) 18.2 (0.9) 0.074 
 Stomach ache >1/week in last 6 months 8.0 (1.6) 6.0 (0.5) 0.214 9.7 (2.0) 11.8 (0.7) 0.328 
 Nerves >1/week in last 6 months 10.7 (1.5) 11.0 (0.6) 0.891 21.0 (1.9) 18.3 (0.8) 0.196 
 Difficulty sleeping >1/week in last 6 months 22.8 (2.6) 20.6 (0.7) 0.417 27.7 (3.0) 25.7 (1.0) 0.525 
 Back ache >1/week in the last 6 months 10.5 (2.2) 7.9 (0.6) 0.229 8.2 (1.7) 9.8 (0.6) 0.364 
 Feeling low >1/week in the last 6 months 9.4 (1.7) 10.0 (0.6) 0.774 18.4 (2.8) 15.0 (0.8) 0.241 
 Bad temper >1/week in the last 6 months 24.8 (2.6) 20.4 (0.9) 0.102 29.3 (3.0) 23.6 (1.1) 0.080 
 Dizzy >1/week in the last 6 months 12.5 (1.6) 8.5 (0.6) 0.018 15.0 (2.1) 12.7 (0.7) 0.298 
 MHC 26.7 (3.0) 23.2 (0.9) 0.263 36.0 (3.2) 32.7 (1.1) 0.338 
 Taken medicine for headaches in last month 38.2 (2.9) 39.9 (1.1) 0.577 56.2 (3.6) 53.0 (1.3) 0.401 
 Taken medicine for stomach ache in last month 17.6 (2.4) 16.1 (0.7) 0.551 40.7 (3.4) 39.7 (1.2) 0.795 
 Taken medicine for nerves in last month 1.9 (0.8) 3.6 (0.4) 0.041 6.1 (1.8) 3.8 (0.4) 0.207 
 Taken medicine for sleeping difficulties in last month 5.1 (1.6) 6.6 (0.5) 0.340 7.3 (1.0) 6.3 (0.5) 0.386 
 Taken any medicine in last month 47.3 (3.4) 45.9 (1.2) 0.690 63.6 (4.4) 64.7 (1.4) 0.804 
Substance use 
 Smoke tobacco 8.2 (2.2) 8.0 (0.7) 0.930 9.1 (2.0) 9.1 (0.8) 0.989 
 Weekly smoking 5.2 (1.6) 6.0 (0.6) 0.684 7.0 (1.9) 6.6 (0.7) 0.836 
 Daily smoking 4.1 (1.5) 4.8 (0.6) 0.631 4.3 (1.6) 4.8 (0.5) 0.753 
 Drink alcohol at least once a week 11.4 (2.6) 14.5 (0.9) 0.280 10.6 (2.7) 12.3 (0.9) 0.558 
 Been drunk on at least two occasions 18.4 (4.3) 19.3 (1.2) 0.847 21.0 (1.4) 22.2 (4.2) 0.790 
 Used cannabis 3+ times in last 12 months 6.8 (2.4) 6.8 (0.7) 0.983 4.3 (1.9) 3.4 (0.4) 0.642 
Sexual health 
 Has had sexual intercourse 20.0 (3.3) 27.5 (1.6) 0.041 35.6 (5.5) 35.3 (2.0) 0.953 
Bullying and fighting 
 Been bullied twice in last 2 months 7.3 (1.9) 10.2 (0.6) 0.158 6.4 (1.6) 9.3 (0.7) 0.089 
 Bullied in last 2 months 9.8 (2.4) 6.9 (0.6) 0.237 1.5 (0.6) 2.4 (0.3) 0.151 
 Been in a physical fight >2 times last 12 months 21.4 (3.0) 16.6 (0.8) 0.113 7.2 (1.4) 5.1 (0.4) 0.142 
Injuries 
 Injured in last 12 months requiring medical attention 54.6 (2.3) 39.6 (2.8) 0.444 52.7 (1.1) 42.2 (1.0) 0.396 
Aspirations 
 Plan to go to further/higher education 68.9 (5.8) 64.8 (1.9) 0.502 75.7 (3.0) 85.0 (1.3) 0.004 
  Boys
 
  Girls
 
  
Glasgow Rest of Scotland Glasgow Rest of Scotland 
Demographics 
N 300 2931  333 3029  
 Grade: P7 102 (31.1%) 912 (31.1%)  90 (27.0%) 948 (31.3%)  
 Grade: S2 82 (27.3%) 946 (32.3%)  80 (24.0%) 933 (30.8%)  
 Grade: S4 116 (38.7%) 1073 (36.6%)  163 (48.9%) 1148 (37.9%)  
 FAS: Low FAS 145 (48.3%) 920 (31.4%)  167 (50.2%) 936 (30.9%)  
 FAS: Medium FAS 87 (29.0%) 960 (32.8%)  98 (29.4%) 1011 (33.4%)  
 FAS: High FAS 68 (22.7%) 1051 (35.9%)  68 (20.4%) 1082 (35.7%)  
Outcome measures % (SE)a P-valueb % (SE)a P-valueb 
Eating habits 
 Daily consumption of fruit 30.6 (4.5) 33.9 (1.2) 0.469 31.2 (3.1) 40.4 (1.2) 0.006 
 Daily consumption of vegetables 24.1 (3.1) 34.4 (1.1) 0.002 28.8 (2.7) 40.5 (1.1) <0.001 
 Daily consumption of sweets 39.6 (3.6) 28.4 (0.9) 0.002 33.4 (3.0) 28.6 (1.0) 0.123 
 Daily consumption of crisps 22.4 (3.4) 19.8 (0.8) 0.468 28.0 (3.1) 20.5 (0.9) 0.020 
 Daily consumption of chips 13.8 (2.6) 8.6 (0.5) 0.046 11.1 (2.3) 6.9 (0.6) 0.078 
 Daily consumption of sugary drinks 37.1 (5.1) 23.5 (1.0) 0.008 31.6 (4.0) 16.4 (0.8) <0.001 
 Daily consumption of diet soft drinks 17.0 (2.5) 11.8 (0.7) 0.045 18.7 (3.1) 13.4 (0.7) 0.097 
 Family meals eaten on ≥4 days/week 66.6 (4.0) 72.1 (0.9) 0.177 67.9 (2.8) 73.2 (0.9) 0.080 
 Breakfast consumed on every weekday 63.6 (3.6) 68.9 (1.1) 0.283 52.7 (4.5) 58.5 (1.4) 0.191 
Physical activity and sedentary behaviour 
 Vigorous physical activity outside school daily 24.2 (3.1) 23.6 (0.9) 0.859 13.9 (2.9) 14.6 (0.7) 0.818 
 At least 1 h of moderate physical activity daily 19.1 (2.9) 18.5 (0.9) 0.843 8.6 (2.8) 11.3 (0.7) 0.349 
 Watch TV >2 h/day 71.4 (2.3) 64.8 (1.0) 0.008 71.1 (2.6) 63.2 (1.1) 0.005 
 Watch TV >4 h/day 29.5 (3.8) 22.5 (0.9) 0.070 28.6 (3.1) 20.5 (0.9) 0.010 
 Play computer games >2 h/day 70.7 (3.5) 64.4 (1.1) 0.088 36.3 (3.8) 27.9 (0.9) 0.029 
 Use computer for something other than computer games >2 h/day 51.0 (1.3) 56.0 (3.8) 0.211 60.7 (1.4) 69.6 (4.0) 0.036 
 Sedentary for >2 h/day 84.6 (2.2) 79.7 (1.0) 0.037 66.8 (3.5) 60.6 (1.1) 0.092 
Weight control behaviour and body image 
 Currently on a diet 12.1 (1.7) 10.1 (0.6) 0.267 21.1 (2.9) 21.4 (1.0) 0.944 
 Report too fat 26.4 (3.2) 26.2 (0.9) 0.954 39.3 (3.2) 40.6 (1.3) 0.714 
 Report good looks 32.2 (2.8) 36.9 (1.2) 0.126 20.7 (2.7) 24.4 (1.3) 0.216 
Tooth-brushing 
 Brush teeth at least twice a day 65.7 (3.0) 66.4 (1.0) 0.825 78.9 (2.6) 81.8 (0.9) 0.292 
Mental well-being 
 Very happy 48.5 (4.1) 48.0 (1.1) 0.913 35.7 (3.6) 39.5 (1.2) 0.311 
 Always happy 26.7 (3.2) 25.8 (0.9) 0.792 20.9 (2.5) 24.5 (0.9) 0.178 
 Always confident 22.2 (2.4) 22.6 (0.8) 0.874 10.8 (2.1) 11.3 (0.7) 0.823 
 Never left out 28.9 (2.6) 26.2 (0.8) 0.329 20.7 (2.6) 17.1 (0.9) 0.180 
Subjective health and medicine use 
 Excellent health 20.7 (3.8) 25.9 (1.0) 0.191 10.5 (1.9) 17.5 (1.0) 0.001 
 Headache >1/week in last 6 months 16.6 (2.3) 11.2 (0.7) 0.022 23.0 (2.5) 18.2 (0.9) 0.074 
 Stomach ache >1/week in last 6 months 8.0 (1.6) 6.0 (0.5) 0.214 9.7 (2.0) 11.8 (0.7) 0.328 
 Nerves >1/week in last 6 months 10.7 (1.5) 11.0 (0.6) 0.891 21.0 (1.9) 18.3 (0.8) 0.196 
 Difficulty sleeping >1/week in last 6 months 22.8 (2.6) 20.6 (0.7) 0.417 27.7 (3.0) 25.7 (1.0) 0.525 
 Back ache >1/week in the last 6 months 10.5 (2.2) 7.9 (0.6) 0.229 8.2 (1.7) 9.8 (0.6) 0.364 
 Feeling low >1/week in the last 6 months 9.4 (1.7) 10.0 (0.6) 0.774 18.4 (2.8) 15.0 (0.8) 0.241 
 Bad temper >1/week in the last 6 months 24.8 (2.6) 20.4 (0.9) 0.102 29.3 (3.0) 23.6 (1.1) 0.080 
 Dizzy >1/week in the last 6 months 12.5 (1.6) 8.5 (0.6) 0.018 15.0 (2.1) 12.7 (0.7) 0.298 
 MHC 26.7 (3.0) 23.2 (0.9) 0.263 36.0 (3.2) 32.7 (1.1) 0.338 
 Taken medicine for headaches in last month 38.2 (2.9) 39.9 (1.1) 0.577 56.2 (3.6) 53.0 (1.3) 0.401 
 Taken medicine for stomach ache in last month 17.6 (2.4) 16.1 (0.7) 0.551 40.7 (3.4) 39.7 (1.2) 0.795 
 Taken medicine for nerves in last month 1.9 (0.8) 3.6 (0.4) 0.041 6.1 (1.8) 3.8 (0.4) 0.207 
 Taken medicine for sleeping difficulties in last month 5.1 (1.6) 6.6 (0.5) 0.340 7.3 (1.0) 6.3 (0.5) 0.386 
 Taken any medicine in last month 47.3 (3.4) 45.9 (1.2) 0.690 63.6 (4.4) 64.7 (1.4) 0.804 
Substance use 
 Smoke tobacco 8.2 (2.2) 8.0 (0.7) 0.930 9.1 (2.0) 9.1 (0.8) 0.989 
 Weekly smoking 5.2 (1.6) 6.0 (0.6) 0.684 7.0 (1.9) 6.6 (0.7) 0.836 
 Daily smoking 4.1 (1.5) 4.8 (0.6) 0.631 4.3 (1.6) 4.8 (0.5) 0.753 
 Drink alcohol at least once a week 11.4 (2.6) 14.5 (0.9) 0.280 10.6 (2.7) 12.3 (0.9) 0.558 
 Been drunk on at least two occasions 18.4 (4.3) 19.3 (1.2) 0.847 21.0 (1.4) 22.2 (4.2) 0.790 
 Used cannabis 3+ times in last 12 months 6.8 (2.4) 6.8 (0.7) 0.983 4.3 (1.9) 3.4 (0.4) 0.642 
Sexual health 
 Has had sexual intercourse 20.0 (3.3) 27.5 (1.6) 0.041 35.6 (5.5) 35.3 (2.0) 0.953 
Bullying and fighting 
 Been bullied twice in last 2 months 7.3 (1.9) 10.2 (0.6) 0.158 6.4 (1.6) 9.3 (0.7) 0.089 
 Bullied in last 2 months 9.8 (2.4) 6.9 (0.6) 0.237 1.5 (0.6) 2.4 (0.3) 0.151 
 Been in a physical fight >2 times last 12 months 21.4 (3.0) 16.6 (0.8) 0.113 7.2 (1.4) 5.1 (0.4) 0.142 
Injuries 
 Injured in last 12 months requiring medical attention 54.6 (2.3) 39.6 (2.8) 0.444 52.7 (1.1) 42.2 (1.0) 0.396 
Aspirations 
 Plan to go to further/higher education 68.9 (5.8) 64.8 (1.9) 0.502 75.7 (3.0) 85.0 (1.3) 0.004 

aWeighted by grade and school type.

bChi-squared test of proportions comparing Glasgow with the rest of Scotland.

Bold denotes P-values <0.050.

Table 2

Means (and SD) of continuous measures of adolescent health and risk behaviour for boys and girls in Glasgow and the rest of Scotland

  Boys
 
  Girls
 
  
Glasgow Rest of Scotland Glasgow Rest of Scotland 
Demographics 
N 300 2931  333 3029  
Outcome Mean (SD)a P-valueb Mean (SD)a P-valueb 
Physical activity and sedentary behaviour 
 No. of days/week watching TV for 2 h or more 2.79 (0.15) 2.43 (0.04) 0.020 2.64 (0.12) 2.32 (0.04) 0.027 
 No. of days/week playing computer games for 2 h or more 2.90 (0.18) 2.56 (0.05) 0.083 1.52 (0.14) 1.21 (0.03) <0.001 
 No. of days/week using computer for 2 h or more 2.09 (0.19) 1.89 (0.05) 0.121 2.61 (0.22) 2.21 (0.05) 0.013 
Mental well-being 
 Life satisfaction 7.73 (0.14) 7.81 (0.04) 0.218 7.45 (0.16) 7.57 (0.05) 0.935 
 HRQoL: KIDSCREEN score 49.06 (0.96) 48.23 (0.26) 0.610 45.51 (0.81) 46.50 (0.28) 0.019 
 GHQ-12: positive score 8.00 (0.38) 7.81 (0.11) 0.521 7.58 (0.31) 7.33 (0.11) 0.469 
 GHQ-12: negative score 12.99 (0.41) 13.00 (0.12) 0.350 12.13 (0.59) 11.63 (0.12) 0.907 
  Boys
 
  Girls
 
  
Glasgow Rest of Scotland Glasgow Rest of Scotland 
Demographics 
N 300 2931  333 3029  
Outcome Mean (SD)a P-valueb Mean (SD)a P-valueb 
Physical activity and sedentary behaviour 
 No. of days/week watching TV for 2 h or more 2.79 (0.15) 2.43 (0.04) 0.020 2.64 (0.12) 2.32 (0.04) 0.027 
 No. of days/week playing computer games for 2 h or more 2.90 (0.18) 2.56 (0.05) 0.083 1.52 (0.14) 1.21 (0.03) <0.001 
 No. of days/week using computer for 2 h or more 2.09 (0.19) 1.89 (0.05) 0.121 2.61 (0.22) 2.21 (0.05) 0.013 
Mental well-being 
 Life satisfaction 7.73 (0.14) 7.81 (0.04) 0.218 7.45 (0.16) 7.57 (0.05) 0.935 
 HRQoL: KIDSCREEN score 49.06 (0.96) 48.23 (0.26) 0.610 45.51 (0.81) 46.50 (0.28) 0.019 
 GHQ-12: positive score 8.00 (0.38) 7.81 (0.11) 0.521 7.58 (0.31) 7.33 (0.11) 0.469 
 GHQ-12: negative score 12.99 (0.41) 13.00 (0.12) 0.350 12.13 (0.59) 11.63 (0.12) 0.907 

aWeighted by grade and school type.

bt-test of means, comparing Glasgow with the rest of Scotland.

Bold denotes P-values <0.050.

When the data were modelled, adjusting for age and sex (Tables 3 and 4), 8 of the 9 eating behaviour items, 5 of the 8 sedentary behaviour items and 4 of the 14 subjective health items were significant across the pooled gender data set, indicating a greater prevalence of poor health and unhealthy living in Glasgow. In particular, the odds of drinking sugary drinks were over two times those of young people living in the rest of Scotland. Furthermore, the odds of sharing a family meal on four or more days a week were lower among Glaswegian youth. Odds of being in a physical fight were also greater (1.40) among those from Glasgow, whereas Glaswegian girls were less likely to plan to go onto further or higher education. However, the odds of weekly alcohol consumption were lower among those living in Glasgow. In addition, Glaswegian girls reported watching 2 h or more of TV on one more day a week than those living outside Glasgow and played computer games for >2 h on 0.73 days more per week (Table 4). Girls from Glasgow had an average GHQ-12 negative score of 2.45 greater than elsewhere (indicating illness); however, young people from Glasgow also had a GHQ-12 positive score of 2.79 greater than those from elsewhere.

Table 3

Logistic models for binary outcomes of adolescent health and risk behaviours; OR (and 95% CI) for Glasgow versus the rest of Scotland

Outcome Boys
 
Girls
 
Both
 
Model 1a
 
Model 2b
 
Model 1a
 
Model 2b
 
Model 1c
 
Model 2d
 
OR 95% CI OR 95% CI OR 95% CI OR 95% CI OR 95% CI OR 95% CI 
Eating habits 
 Daily consumption of fruit 0.85 (0.62, 1.18) 0.91 (0.66, 1.26) 0.70 (0.51, 0.96) 0.75 (0.55, 1.02) 0.78 (0.60, 0.99) 0.81 (0.63, 1.04) 
 Daily consumption of vegetables 0.60 (0.43, 0.84) 0.63 (0.45, 0.88) 0.59 (0.43, 0.81) 0.62 (0.45, 0.84) 0.59 (0.46, 0.77) 0.62 (0.48, 0.80) 
 Daily consumption of sweets 1.67 (1.24, 2.24) 1.68 (1.25, 2.25) 1.24 (0.93, 1.66) 1.20 (0.90, 1.61) 1.44 (1.13, 1.84) 1.42 (1.12, 1.81) 
 Daily consumption of crisps 1.13 (0.80, 1.60) 1.12 (0.79, 1.58) 1.54 (1.10, 2.16) 1.41 (1.01, 1.98) 1.34 (1.01, 1.76) 1.17 (0.97, 1.67) 
 Daily consumption of chips 1.65 (1.10, 2.46) 1.57 (1.06, 2.34) 1.80 (1.14, 2.85) 1.47 (0.94, 2.31) 1.68 (1.19, 2.36) 1.51 (1.09, 2.11) 
 Daily consumption of sugary drinks 2.01 (1.43, 2.83) 1.94 (1.39, 2.72) 2.38 (1.70, 3.34) 2.17 (1.55, 3.04) 2.17 (1.61, 2.93) 2.05 (1.54, 2.75) 
 Daily consumption of diet soft drinks 1.58 (1.08, 2.31) 1.56 (1.06, 2.28) 1.44 (0.99, 2.10) 1.40 (0.95, 2.06) 1.50 (1.10, 2.04) 1.48 (1.09, 2.02) 
 Family meals eaten on ≥4 days/week 0.75 (0.56, 1.02) 0.80 (0.59, 1.07) 0.78 (0.61, 1.00) 0.84 (0.65, 1.08) 0.77 (0.62, 0.94) 0.82 (0.67, 1.00) 
 Breakfast consumed on every weekday 0.81 (0.60, 1.10) 0.81 (0.60, 1.10) 0.80 (0.60, 1.09) 0.88 (0.65, 1.18) 0.81 (0.63, 1.03) 0.84 (0.66, 1.07) 
Physical activity and sedentary behaviour 
 Vigorous physical activity outside school daily 1.01 (0.74, 1.39) 1.04 (0.76, 1.43) 0.98 (0.69, 1.39) 0.98 (0.68, 1.39) 0.99 (0.78, 1.26) 1.01 (0.79, 1.29) 
 At least 1 h of moderate physical activity daily 1.04 (0.73, 1.49) 1.04 (0.77, 1.40) 0.71 (0.44, 1.13) 0.72 (0.45, 1.16) 0.90 (0.66, 1.22) 0.94 (0.69, 1.28) 
 Watch TV >2 h/day 1.34 (0.99, 1.82) 1.31 (0.97, 1.77) 1.38 (1.02, 1.86) 1.29 (0.96, 1.74) 1.34 (1.05, 1.70) 1.29 (1.02, 1.63) 
 Watch TV >4 h/day 1.41 (1.01, 1.96) 1.37 (0.99, 1.91) 1.53 (1.12, 2.09) 1.44 (1.06, 1.96) 1.44 (1.12, 1.86) 1.39 (1.08, 1.79) 
 Play computer games >2 h/day 1.34 (0.94, 1.91) 1.31 (0.93, 1.86) 1.53 (1.14, 2.06) 1.49 (1.11, 2.00) 1.45 (1.11, 1.89) 1.41 (1.09, 1.84) 
 Use computer for something other than computer games >2 h/day 1.30 (0.95, 1.76) 1.38 (1.01, 1.89) 1.39 (1.03, 1.88) 1.41 (1.04, 1.91) 1.34 (1.06, 1.69) 1.39 (1.09, 1.77) 
 Sedentary for >2 h/day 1.39 (0.91, 2.14) 1.38 (0.90, 2.11) 1.32 (0.97, 1.79) 1.26 (0.93, 1.70) 1.35 (1.01, 1.79) 1.31 (0.98, 1.73) 
Weight control behaviour and body image 
 Currently on a diet 1.17 (0.80, 1.72) 1.25 (0.84, 1.85) 0.95 (0.70, 1.29) 0.95 (0.70, 1.30) 1.05 (0.83, 1.32) 1.06 (0.84, 1.33) 
 Report too fat 1.00 (0.76, 1.32) 1.00 (0.75, 1.32) 0.88 (0.68, 1.15) 0.85 (0.65, 1.11) 0.95 (0.79, 1.15) 0.94 (0.77, 1.13) 
 Report good looks 0.82 (0.61, 1.09) 0.87 (0.65, 1.17) 0.89 (0.63, 1.24) 0.90 (0.64, 1.27) 0.85 (0.67, 1.07) 0.89 (0.70, 1.13) 
Tooth-brushing 
 Brush teeth at least twice a day 1.01 (0.74, 1.36) 1.02 (0.76, 1.38) 0.87 (0.62, 1.23) 0.91 (0.65, 1.27) 0.92 (0.72, 1.18) 0.98 (0.76, 1.25) 
Mental well-being 
 Very happy 0.98 (0.76, 1.27) 1.02 (0.78, 1.34) 0.87 (0.66, 1.15) 0.94 (0.72, 1.25) 0.93 (0.75, 1.14) 0.97 (0.79, 1.19) 
 Always happy 1.04 (0.78, 1.38) 1.06 (0.79, 1.42) 0.85 (0.63, 1.15) 0.89 (0.66, 1.22) 0.92 (0.73, 1.15) 0.96 (0.76, 1.21) 
 Always confident 0.98 (0.72, 1.32) 0.97 (0.72, 1.32) 1.03 (0.70, 1.51) 1.10 (0.74, 1.63) 0.95 (0.74, 1.22) 0.98 (0.76, 1.26) 
 Never left out 1.12 (0.86, 1.46) 1.13 (0.86, 1.48) 1.31 (0.93, 1.83) 1.30 (0.91, 1.84) 1.23 (0.97, 1.56) 1.22 (0.96, 1.55) 
Subjective health and medicine use 
 Excellent health 0.74 (0.52, 1.03) 0.76 (0.54, 1.08) 0.61 (0.41, 0.92) 0.64 (0.43, 0.97) 0.66 (0.50, 0.87) 0.70 (0.53, 0.92) 
 Headache >1/week in last 6 months 1.55 (1.06, 2.27) 1.48 (1.01, 2.18) 1.28 (0.95, 1.73) 1.22 (0.90, 1.65) 1.40 (1.09, 1.80) 1.34 (1.05, 1.72) 
 Stomach ache >1/week in last 6 months 1.32 (0.82, 2.13) 1.31 (0.81, 2.11) 0.82 (0.54, 1.23) 0.72 (0.48, 1.08) 0.96 (0.69, 1.33) 0.90 (0.65, 1.24) 
 Nerves >1/week in last 6 months 0.94 (0.62, 1.41) 0.92 (0.61, 1.39) 1.15 (0.87, 1.52) 1.07 (0.80, 1.41) 1.08 (0.85, 1.37) 1.02 (0.81, 1.29) 
 Difficulty sleeping >1/week in last 6 months 1.08 (0.81, 1.44) 1.09 (0.81, 1.46) 1.09 (0.80, 1.50) 1.04 (0.76, 1.42) 1.11 (0.89, 1.38) 1.06 (0.85, 1.33) 
 Back ache >1/week in the last 6 months 1.38 (0.89, 2.13) 1.40 (0.90, 2.17) 0.74 (0.48, 1.12) 0.72 (0.47, 1.10) 0.97 (0.71, 1.33) 0.96 (0.70, 1.32) 
 Feeling low >1/week in the last 6 months 0.88 (0.57, 1.38) 0.85 (0.54, 1.34) 1.18 (0.86, 1.63) 1.07 (0.78, 1.47) 1.13 (0.86, 1.47) 1.02 (0.78, 1.33) 
 Bad temper >1/week in the last 6 months 1.21 (0.90, 1.62) 1.21 (0.90, 1.62) 1.29 (0.95, 1.74) 1.18 (0.87, 1.60) 1.27 (1.01, 1.60) 1.22 (0.97, 1.53) 
 Dizzy >1/week in the last 6 months 1.48 (1.01, 2.17) 1.45 (0.97, 2.15) 1.20 (0.84, 1.72) 1.12 (0.78, 1.61) 1.33 (1.00, 1.77) 1.26 (0.95, 1.67) 
 MHC 1.13 (0.85, 1.50) 1.12 (0.84, 1.50) 1.10 (0.84, 1.45) 1.02 (0.77, 1.33) 1.14 (0.92, 1.42) 1.07 (0.86, 1.33) 
 Taken medicine for headaches in last month 0.91 (0.69, 1.19) 0.93 (0.70, 1.23) 1.11 (0.85, 1.45) 1.12 (0.85, 1.48) 1.03 (0.84, 1.26) 1.04 (0.85, 1.28) 
 Taken medicine for stomach ache in last month 1.06 (0.76, 1.49) 1.12 (0.81, 1.55) 0.99 (0.75, 1.30) 1.00 (0.76, 1.33) 1.05 (0.84, 1.31) 1.07 (0.86, 1.35) 
 Taken medicine for nerves in last month 0.44 (0.17, 1.10) 0.48 (0.19, 1.21) 1.63 (0.96, 2.77) 1.53 (0.88, 2.65) 1.05 (0.65, 1.70) 1.04 (0.64, 1.69) 
 Taken medicine for sleeping difficulties in last month 0.67 (0.37, 1.21) 0.74 (0.41, 1.34) 1.19 (0.74, 1.89) 1.13 (0.69, 1.83) 0.93 (0.62, 1.38) 0.94 (0.63, 1.40) 
 Taken any medicine in last month 1.02 (0.76, 1.37) 1.06 (0.79, 1.44) 0.93 (0.67, 1.30) 0.97 (0.69, 1.35) 1.00 (0.79,1.27) 1.02 (0.81,1.30) 
Substance use 
 Smoke tobacco 1.04 (0.60, 1.80) 1.06 (0.61, 1.85) 0.85 (0.52, 1.37) 0.81 (0.50, 1.32) 0.96 (0.66, 1.41) 0.91 (0.63, 1.33) 
 Weekly smoking 0.79 (0.42, 1.50) 0.80 (0.42, 1.53) 0.90 (0.52, 1.54) 0.85 (0.49, 1.47) 0.91 (0.59, 1.40) 0.84 (0.55, 1.30) 
 Daily smoking 0.76 (0.37, 1.59) 0.76 (0.36, 1.60) 0.67 (0.34, 1.30) 0.61 (0.31, 1.19) 0.76 (0.45, 1.27) 0.69 (0.41, 1.15) 
 Drink alcohol at least once a week 0.71 (0.46, 1.09) 0.73 (0.47, 1.13) 0.72 (0.46, 1.15) 0.72 (0.45, 1.15) 0.71 (0.50, 0.99) 0.72 (0.51, 1.01) 
 Been drunk on at least one occasion 0.94 (0.63, 1.40) 0.95 (0.63, 1.41) 0.88 (0.60, 1.27) 0.91 (0.62, 1.33) 0.93 (0.69, 1.25) 0.95 (0.70, 1.29) 
 Used cannabis 3+ times in last 12 months 0.93 (0.47, 1.83) 0.91 (0.46, 1.78) 1.00 (0.48, 2.07) 0.98 (0.46, 2.07) 0.96 (0.54, 1.71) 0.91 (0.51, 1.63) 
Sexual health 
 Has had sexual intercourse 0.69 (0.39,1.20) 0.61 (0.35, 1.07) 1.05 (0.61, 1.82) 1.02 (0.59, 1.77) 0.88 (0.58, 1.33) 0.83 (0.55, 1.26) 
Bullying and fighting 
 Been bullied twice in last 2 months 0.70 (0.42, 1.15) 0.67 (0.41, 1.10) 0.73 (0.43, 1.23) 0.68 (0.40, 1.15) 0.70 (0.47, 1.04) 0.67 (0.45, 0.99) 
 Bullied in last 2 months 1.47 (0.88, 2.47) 1.49 (0.89, 2.51) 0.62 (0.25, 1.56) 0.58 (0.23, 1.45) 1.18 (0.75, 1.85) 1.17 (0.74, 1.84) 
 Been in a physical fight >2 times last 12 months 1.36 (0.98, 1.89) 1.37 (0.98, 1.91) 1.47 (0.89, 2.43) 1.35 (0.82, 2.22) 1.40 (1.05, 1.86) 1.37 (1.03, 1.83) 
Injuries 
 Injured in last 12 months requiring medical attention 1.09 (0.84, 1.42) 1.14 (0.87, 1.48) 0.90 (0.70, 1.17) 0.91 (0.70, 1.18) 0.99 (0.82, 1.19) 1.02 (0.84, 1.22) 
Aspirations 
 Plan to go to further/higher education 1.24 (0.71, 2.16) 1.38 (0.79, 2.41) 0.54 (0.33, 0.90) 0.55 (0.33, 0.92) 0.83 (0.56, 1.22) 0.89 (0.61, 1.31) 
Outcome Boys
 
Girls
 
Both
 
Model 1a
 
Model 2b
 
Model 1a
 
Model 2b
 
Model 1c
 
Model 2d
 
OR 95% CI OR 95% CI OR 95% CI OR 95% CI OR 95% CI OR 95% CI 
Eating habits 
 Daily consumption of fruit 0.85 (0.62, 1.18) 0.91 (0.66, 1.26) 0.70 (0.51, 0.96) 0.75 (0.55, 1.02) 0.78 (0.60, 0.99) 0.81 (0.63, 1.04) 
 Daily consumption of vegetables 0.60 (0.43, 0.84) 0.63 (0.45, 0.88) 0.59 (0.43, 0.81) 0.62 (0.45, 0.84) 0.59 (0.46, 0.77) 0.62 (0.48, 0.80) 
 Daily consumption of sweets 1.67 (1.24, 2.24) 1.68 (1.25, 2.25) 1.24 (0.93, 1.66) 1.20 (0.90, 1.61) 1.44 (1.13, 1.84) 1.42 (1.12, 1.81) 
 Daily consumption of crisps 1.13 (0.80, 1.60) 1.12 (0.79, 1.58) 1.54 (1.10, 2.16) 1.41 (1.01, 1.98) 1.34 (1.01, 1.76) 1.17 (0.97, 1.67) 
 Daily consumption of chips 1.65 (1.10, 2.46) 1.57 (1.06, 2.34) 1.80 (1.14, 2.85) 1.47 (0.94, 2.31) 1.68 (1.19, 2.36) 1.51 (1.09, 2.11) 
 Daily consumption of sugary drinks 2.01 (1.43, 2.83) 1.94 (1.39, 2.72) 2.38 (1.70, 3.34) 2.17 (1.55, 3.04) 2.17 (1.61, 2.93) 2.05 (1.54, 2.75) 
 Daily consumption of diet soft drinks 1.58 (1.08, 2.31) 1.56 (1.06, 2.28) 1.44 (0.99, 2.10) 1.40 (0.95, 2.06) 1.50 (1.10, 2.04) 1.48 (1.09, 2.02) 
 Family meals eaten on ≥4 days/week 0.75 (0.56, 1.02) 0.80 (0.59, 1.07) 0.78 (0.61, 1.00) 0.84 (0.65, 1.08) 0.77 (0.62, 0.94) 0.82 (0.67, 1.00) 
 Breakfast consumed on every weekday 0.81 (0.60, 1.10) 0.81 (0.60, 1.10) 0.80 (0.60, 1.09) 0.88 (0.65, 1.18) 0.81 (0.63, 1.03) 0.84 (0.66, 1.07) 
Physical activity and sedentary behaviour 
 Vigorous physical activity outside school daily 1.01 (0.74, 1.39) 1.04 (0.76, 1.43) 0.98 (0.69, 1.39) 0.98 (0.68, 1.39) 0.99 (0.78, 1.26) 1.01 (0.79, 1.29) 
 At least 1 h of moderate physical activity daily 1.04 (0.73, 1.49) 1.04 (0.77, 1.40) 0.71 (0.44, 1.13) 0.72 (0.45, 1.16) 0.90 (0.66, 1.22) 0.94 (0.69, 1.28) 
 Watch TV >2 h/day 1.34 (0.99, 1.82) 1.31 (0.97, 1.77) 1.38 (1.02, 1.86) 1.29 (0.96, 1.74) 1.34 (1.05, 1.70) 1.29 (1.02, 1.63) 
 Watch TV >4 h/day 1.41 (1.01, 1.96) 1.37 (0.99, 1.91) 1.53 (1.12, 2.09) 1.44 (1.06, 1.96) 1.44 (1.12, 1.86) 1.39 (1.08, 1.79) 
 Play computer games >2 h/day 1.34 (0.94, 1.91) 1.31 (0.93, 1.86) 1.53 (1.14, 2.06) 1.49 (1.11, 2.00) 1.45 (1.11, 1.89) 1.41 (1.09, 1.84) 
 Use computer for something other than computer games >2 h/day 1.30 (0.95, 1.76) 1.38 (1.01, 1.89) 1.39 (1.03, 1.88) 1.41 (1.04, 1.91) 1.34 (1.06, 1.69) 1.39 (1.09, 1.77) 
 Sedentary for >2 h/day 1.39 (0.91, 2.14) 1.38 (0.90, 2.11) 1.32 (0.97, 1.79) 1.26 (0.93, 1.70) 1.35 (1.01, 1.79) 1.31 (0.98, 1.73) 
Weight control behaviour and body image 
 Currently on a diet 1.17 (0.80, 1.72) 1.25 (0.84, 1.85) 0.95 (0.70, 1.29) 0.95 (0.70, 1.30) 1.05 (0.83, 1.32) 1.06 (0.84, 1.33) 
 Report too fat 1.00 (0.76, 1.32) 1.00 (0.75, 1.32) 0.88 (0.68, 1.15) 0.85 (0.65, 1.11) 0.95 (0.79, 1.15) 0.94 (0.77, 1.13) 
 Report good looks 0.82 (0.61, 1.09) 0.87 (0.65, 1.17) 0.89 (0.63, 1.24) 0.90 (0.64, 1.27) 0.85 (0.67, 1.07) 0.89 (0.70, 1.13) 
Tooth-brushing 
 Brush teeth at least twice a day 1.01 (0.74, 1.36) 1.02 (0.76, 1.38) 0.87 (0.62, 1.23) 0.91 (0.65, 1.27) 0.92 (0.72, 1.18) 0.98 (0.76, 1.25) 
Mental well-being 
 Very happy 0.98 (0.76, 1.27) 1.02 (0.78, 1.34) 0.87 (0.66, 1.15) 0.94 (0.72, 1.25) 0.93 (0.75, 1.14) 0.97 (0.79, 1.19) 
 Always happy 1.04 (0.78, 1.38) 1.06 (0.79, 1.42) 0.85 (0.63, 1.15) 0.89 (0.66, 1.22) 0.92 (0.73, 1.15) 0.96 (0.76, 1.21) 
 Always confident 0.98 (0.72, 1.32) 0.97 (0.72, 1.32) 1.03 (0.70, 1.51) 1.10 (0.74, 1.63) 0.95 (0.74, 1.22) 0.98 (0.76, 1.26) 
 Never left out 1.12 (0.86, 1.46) 1.13 (0.86, 1.48) 1.31 (0.93, 1.83) 1.30 (0.91, 1.84) 1.23 (0.97, 1.56) 1.22 (0.96, 1.55) 
Subjective health and medicine use 
 Excellent health 0.74 (0.52, 1.03) 0.76 (0.54, 1.08) 0.61 (0.41, 0.92) 0.64 (0.43, 0.97) 0.66 (0.50, 0.87) 0.70 (0.53, 0.92) 
 Headache >1/week in last 6 months 1.55 (1.06, 2.27) 1.48 (1.01, 2.18) 1.28 (0.95, 1.73) 1.22 (0.90, 1.65) 1.40 (1.09, 1.80) 1.34 (1.05, 1.72) 
 Stomach ache >1/week in last 6 months 1.32 (0.82, 2.13) 1.31 (0.81, 2.11) 0.82 (0.54, 1.23) 0.72 (0.48, 1.08) 0.96 (0.69, 1.33) 0.90 (0.65, 1.24) 
 Nerves >1/week in last 6 months 0.94 (0.62, 1.41) 0.92 (0.61, 1.39) 1.15 (0.87, 1.52) 1.07 (0.80, 1.41) 1.08 (0.85, 1.37) 1.02 (0.81, 1.29) 
 Difficulty sleeping >1/week in last 6 months 1.08 (0.81, 1.44) 1.09 (0.81, 1.46) 1.09 (0.80, 1.50) 1.04 (0.76, 1.42) 1.11 (0.89, 1.38) 1.06 (0.85, 1.33) 
 Back ache >1/week in the last 6 months 1.38 (0.89, 2.13) 1.40 (0.90, 2.17) 0.74 (0.48, 1.12) 0.72 (0.47, 1.10) 0.97 (0.71, 1.33) 0.96 (0.70, 1.32) 
 Feeling low >1/week in the last 6 months 0.88 (0.57, 1.38) 0.85 (0.54, 1.34) 1.18 (0.86, 1.63) 1.07 (0.78, 1.47) 1.13 (0.86, 1.47) 1.02 (0.78, 1.33) 
 Bad temper >1/week in the last 6 months 1.21 (0.90, 1.62) 1.21 (0.90, 1.62) 1.29 (0.95, 1.74) 1.18 (0.87, 1.60) 1.27 (1.01, 1.60) 1.22 (0.97, 1.53) 
 Dizzy >1/week in the last 6 months 1.48 (1.01, 2.17) 1.45 (0.97, 2.15) 1.20 (0.84, 1.72) 1.12 (0.78, 1.61) 1.33 (1.00, 1.77) 1.26 (0.95, 1.67) 
 MHC 1.13 (0.85, 1.50) 1.12 (0.84, 1.50) 1.10 (0.84, 1.45) 1.02 (0.77, 1.33) 1.14 (0.92, 1.42) 1.07 (0.86, 1.33) 
 Taken medicine for headaches in last month 0.91 (0.69, 1.19) 0.93 (0.70, 1.23) 1.11 (0.85, 1.45) 1.12 (0.85, 1.48) 1.03 (0.84, 1.26) 1.04 (0.85, 1.28) 
 Taken medicine for stomach ache in last month 1.06 (0.76, 1.49) 1.12 (0.81, 1.55) 0.99 (0.75, 1.30) 1.00 (0.76, 1.33) 1.05 (0.84, 1.31) 1.07 (0.86, 1.35) 
 Taken medicine for nerves in last month 0.44 (0.17, 1.10) 0.48 (0.19, 1.21) 1.63 (0.96, 2.77) 1.53 (0.88, 2.65) 1.05 (0.65, 1.70) 1.04 (0.64, 1.69) 
 Taken medicine for sleeping difficulties in last month 0.67 (0.37, 1.21) 0.74 (0.41, 1.34) 1.19 (0.74, 1.89) 1.13 (0.69, 1.83) 0.93 (0.62, 1.38) 0.94 (0.63, 1.40) 
 Taken any medicine in last month 1.02 (0.76, 1.37) 1.06 (0.79, 1.44) 0.93 (0.67, 1.30) 0.97 (0.69, 1.35) 1.00 (0.79,1.27) 1.02 (0.81,1.30) 
Substance use 
 Smoke tobacco 1.04 (0.60, 1.80) 1.06 (0.61, 1.85) 0.85 (0.52, 1.37) 0.81 (0.50, 1.32) 0.96 (0.66, 1.41) 0.91 (0.63, 1.33) 
 Weekly smoking 0.79 (0.42, 1.50) 0.80 (0.42, 1.53) 0.90 (0.52, 1.54) 0.85 (0.49, 1.47) 0.91 (0.59, 1.40) 0.84 (0.55, 1.30) 
 Daily smoking 0.76 (0.37, 1.59) 0.76 (0.36, 1.60) 0.67 (0.34, 1.30) 0.61 (0.31, 1.19) 0.76 (0.45, 1.27) 0.69 (0.41, 1.15) 
 Drink alcohol at least once a week 0.71 (0.46, 1.09) 0.73 (0.47, 1.13) 0.72 (0.46, 1.15) 0.72 (0.45, 1.15) 0.71 (0.50, 0.99) 0.72 (0.51, 1.01) 
 Been drunk on at least one occasion 0.94 (0.63, 1.40) 0.95 (0.63, 1.41) 0.88 (0.60, 1.27) 0.91 (0.62, 1.33) 0.93 (0.69, 1.25) 0.95 (0.70, 1.29) 
 Used cannabis 3+ times in last 12 months 0.93 (0.47, 1.83) 0.91 (0.46, 1.78) 1.00 (0.48, 2.07) 0.98 (0.46, 2.07) 0.96 (0.54, 1.71) 0.91 (0.51, 1.63) 
Sexual health 
 Has had sexual intercourse 0.69 (0.39,1.20) 0.61 (0.35, 1.07) 1.05 (0.61, 1.82) 1.02 (0.59, 1.77) 0.88 (0.58, 1.33) 0.83 (0.55, 1.26) 
Bullying and fighting 
 Been bullied twice in last 2 months 0.70 (0.42, 1.15) 0.67 (0.41, 1.10) 0.73 (0.43, 1.23) 0.68 (0.40, 1.15) 0.70 (0.47, 1.04) 0.67 (0.45, 0.99) 
 Bullied in last 2 months 1.47 (0.88, 2.47) 1.49 (0.89, 2.51) 0.62 (0.25, 1.56) 0.58 (0.23, 1.45) 1.18 (0.75, 1.85) 1.17 (0.74, 1.84) 
 Been in a physical fight >2 times last 12 months 1.36 (0.98, 1.89) 1.37 (0.98, 1.91) 1.47 (0.89, 2.43) 1.35 (0.82, 2.22) 1.40 (1.05, 1.86) 1.37 (1.03, 1.83) 
Injuries 
 Injured in last 12 months requiring medical attention 1.09 (0.84, 1.42) 1.14 (0.87, 1.48) 0.90 (0.70, 1.17) 0.91 (0.70, 1.18) 0.99 (0.82, 1.19) 1.02 (0.84, 1.22) 
Aspirations 
 Plan to go to further/higher education 1.24 (0.71, 2.16) 1.38 (0.79, 2.41) 0.54 (0.33, 0.90) 0.55 (0.33, 0.92) 0.83 (0.56, 1.22) 0.89 (0.61, 1.31) 

aAdjusting for age.

bAdjusting for age and FAS.

cAdjusting for sex and age.

dAdjusting for sex, age and FAS.

Bold values denote ORs significant at 95% level.

Table 4

Linear models for continuous outcomes of adolescent health and risk behaviours; Beta (and 95% CI) for Glasgow versus the rest of Scotland

Outcome Boys
 
Girls
 
Both
 
Model 1a
 
Model 2b
 
Model 1a
 
Model 2b
 
Model 1c
 
Model 2d
 
Beta 95% CI Beta 95% CI Beta 95% CI Beta 95% CI Beta 95% CI Beta 95% CI 
Physical activity and sedentary behaviour 
 No. of days/week watch TV for 2 h or more −0.18 (−0.97, 0.62) −0.21 (−1.01, 0.59) 0.95 (0.31, 1.58) 0.88 (0.23, 1.52) 0.71 (−0.03, 1.46) 0.66 (−0.09, 1.42) 
 No. of days/week play computer games for 2 h or more 0.25 (−0.59, 1.09) 0.21 (−0.63, 1.06) 0.73 (0.00, 1.45) 0.71 (−0.03, 1.44) 0.56 (−0.27, 1.32) 0.52 (−0.27, 1.32) 
 No. of days/week use computer for 2 h or more 0.12 (−0.65, 0.89) 0.25 (−0.52, 1.01) 0.46 (−0.29, 1.20) 0.41 (−0.35, 1.16) 0.35 (−0.41, 1.11) 0.42 (−0.35, 1.19) 
Mental well-being 
 Life satisfaction −0.20 (−0.93, 0.53) −0.05 (−0.78, 0.67) 0.08 (−0.68, 0.85) 0.29 (−0.48, 1.06) −0.11 (−0.85, 0.63) −0.01 (−0.75, 0.74) 
 HRQoL: KIDSCREEN score −1.90 (−6.10, 2.31) −1.62 (−5.87, 2.63) 1.29 (−2.81, 5.39) 2.48 (−1.53, 6.49) 0.14 (−4.01, 4.28) 0.38 (−3.80, 4.56) 
 GHQ-12: positive score 0.14 (−1.98, 2.26) 0.12 (−2.06, 2.31) 1.81 (−0.14, 3.76) 1.71 (−0.21, 3.63) 2.79 (0.72, 4.85) 2.82 (0.74, 4.89) 
 GHQ-12: negative score −0.35 (−2.53, 1.82) −0.33 (−2.56, 1.91) 2.45 (0.05, 4.84) 2.59 (0.20, 4.98) 1.10 (−1.19, 3.39) 1.16 (−1.13, 3.45) 
Outcome Boys
 
Girls
 
Both
 
Model 1a
 
Model 2b
 
Model 1a
 
Model 2b
 
Model 1c
 
Model 2d
 
Beta 95% CI Beta 95% CI Beta 95% CI Beta 95% CI Beta 95% CI Beta 95% CI 
Physical activity and sedentary behaviour 
 No. of days/week watch TV for 2 h or more −0.18 (−0.97, 0.62) −0.21 (−1.01, 0.59) 0.95 (0.31, 1.58) 0.88 (0.23, 1.52) 0.71 (−0.03, 1.46) 0.66 (−0.09, 1.42) 
 No. of days/week play computer games for 2 h or more 0.25 (−0.59, 1.09) 0.21 (−0.63, 1.06) 0.73 (0.00, 1.45) 0.71 (−0.03, 1.44) 0.56 (−0.27, 1.32) 0.52 (−0.27, 1.32) 
 No. of days/week use computer for 2 h or more 0.12 (−0.65, 0.89) 0.25 (−0.52, 1.01) 0.46 (−0.29, 1.20) 0.41 (−0.35, 1.16) 0.35 (−0.41, 1.11) 0.42 (−0.35, 1.19) 
Mental well-being 
 Life satisfaction −0.20 (−0.93, 0.53) −0.05 (−0.78, 0.67) 0.08 (−0.68, 0.85) 0.29 (−0.48, 1.06) −0.11 (−0.85, 0.63) −0.01 (−0.75, 0.74) 
 HRQoL: KIDSCREEN score −1.90 (−6.10, 2.31) −1.62 (−5.87, 2.63) 1.29 (−2.81, 5.39) 2.48 (−1.53, 6.49) 0.14 (−4.01, 4.28) 0.38 (−3.80, 4.56) 
 GHQ-12: positive score 0.14 (−1.98, 2.26) 0.12 (−2.06, 2.31) 1.81 (−0.14, 3.76) 1.71 (−0.21, 3.63) 2.79 (0.72, 4.85) 2.82 (0.74, 4.89) 
 GHQ-12: negative score −0.35 (−2.53, 1.82) −0.33 (−2.56, 1.91) 2.45 (0.05, 4.84) 2.59 (0.20, 4.98) 1.10 (−1.19, 3.39) 1.16 (−1.13, 3.45) 

aAdjusting for age.

bAdjusting for age and FAS.

cAdjusting for sex and age.

dAdjusting for sex, age and FAS.

Bold values denote betas significant at 95% level.

Further adjustment for family affluence for the most part reduced the odds ratios, but only marginally (Tables 3 and 4). Odds of girls' daily consumption of fruit and chips and of boys' TV viewing, however, became insignificant on addition of FAS, as did sharing a family meal and sedentary behaviour for >2 h a day for the pooled data set (Table 3). Additionally, the lowered odds of weekly alcohol consumption became insignificant after adjustment for FAS, whereas being bullied became less likely in Glasgow relative to the rest of Scotland (OR = 0.67).

When an interaction term between age and Glasgow was introduced to the models (not shown, estimates from models with interactions for the pooled and gender-stratified data set are not presented here as these are somewhat cumbersome but are available from the author on request), this was only significant at the 95% level for: smoking, daily vigorous activity, medicine for stomach ache, sharing a family meal and the number of days per week young people play computer games for 2 h or more. However, there were insignificant but potentially important differences for other outcomes: having a bad temper (P = 0.07) and medicine use for sleeping difficulties (P = 0.06). When stratified by gender, the interaction between age and Glasgow was associated with the number of days a week girls play computer games for 2 h or more, and for P = 0.06, girls' subjective health and moderate daily activity (P = 0.09). Among boys, an interaction between age and Glasgow was associated with feeling very happy, tooth-brushing, medicine for sleeping difficulties and having a bad temper, and for P = 0.07, sleeping difficulties and MHC. These interactions generally showed that the excess levels of poor health and risk behaviours in Glasgow decreased with increasing age. The only exceptions to this were boys feeling very happy, sharing a family meal and daily vigorous activity (as well as girls' moderate activity); the latter three all showed a strengthening of a negative association with Glasgow residence as age increased.

Discussion

Main findings of the study

Glasgow adolescents had worse self-reported health on some measures (reported ‘excellent health’, headaches and negative GHQ-12 (illness)) but similar or better health on others (reported happiness, confidence and positive GHQ-12) compared with the rest of Scotland. Many health behaviours were worse in Glasgow, including eating habits, sedentary behaviour and aggressive behaviour, but self-reported alcohol use was less prevalent and smoking similar. Adjustment for family affluence generally attenuated the association with Glasgow, but only marginally. Most of the poor associations were present from age 11 years, and the hypothesized ‘emergence’ of negative health during adolescence was not shown for any health outcome, with the only exception being girls' physical activity, which was seen to reduce with age in Glasgow at a faster rate than elsewhere.

What is already known on this topic

The city of Glasgow has the worst health in Scotland, which in turn has the lowest life expectancy in Western Europe.1,2 This excess mortality has been shown to be most pronounced among those of working age.13 Adolescence lies between early childhood, a period where there is seemingly no health difference between Glasgow and the rest of Scotland, and adulthood, where a significant health difference is apparent. Furthermore, adolescence is a life-stage where many risk behaviours such as alcohol consumption and smoking are initiated, and where people achieve autonomy over preventative behaviours such as healthy eating and physical activity. Recent examination of cause-specific mortality has identified risk behaviour to be central to the excess in Glasgow and in particular behaviours related to alcohol, drugs, suicide and violence.9,11 Adolescence may therefore be a pivotal period for identifying and addressing factors that might explain the adverse health effects of growing up in Scotland, and particularly in Glasgow. Only one previous study has looked at health related issues in adolescence for Glasgow compared with elsewhere in Scotland15: this showed the possible emergence of a negative effect on subjective health during this life-stage.

What this study adds

This study has some similarities to findings for adults living in Glasgow relative to the rest of Scotland.11 However, excessive levels of alcohol consumption and negative aspects of sexual health and body image reported for adults were not seen here. Happiness and confidence, previously found to be more prevalent in Glasgow,15,17 were equivalent to the rest of Scotland in the current study. There has, however, been a noted national reduction in recent years in adolescent wellbeing outcomes, including happiness, confidence and feeling left out.17 This decrease, which occurred between 2006 and 2010, following an upward trend between 1994 and 2006,24 may be due to the recent financial crisis. Indeed, it has been suggested that Glasgow residents may been disproportionately affected by the subsequent changes to the welfare system,25 and higher increases in unemployment than elsewhere in Scotland26 may have impacted on child and adolescent health. In accordance, comparisons of the results of this study with Levin's15 analysis of the 2006 HBSC data suggest that the reduction in happiness and confidence observed in Glasgow, from 58% and 28%, respectively, in 2006 to 42% and 17% in 2010, explain the reductions occurring across all of Scotland, and in fact that outwith Glasgow no reduction was observed, rather a levelling off. More generally, although the worse health experienced by Glasgow adults is only partially seen among young people in Glasgow, the findings highlight the need to explore the social context of growing up in Glasgow in order to identify possible mediators of this association.

Limitations of this study

It is likely that of those attending private schools, there was a small proportion of children who were misclassified as living in Glasgow when they did not, although the adjustment for school type will have minimized that bias. A further sensitivity analysis classifying all private schools pupils as living outside Glasgow showed little difference to the results. The Glasgow sample was also skewed towards higher SES state schools, so that the associations with worse health described may be somewhat conservative. There are some issues around multiple testing. Some would be disinclined, for example, to set much store in a few significant differences at the 0.05 level among so many non-significant differences within a single domain of items. Others would have used a more stringent significance threshold for so many comparisons. We have chosen to present the P-values for comparison of proportions to give a more complete picture and have focussed on the broad areas where several indicators differ between Glasgow and the rest of Scotland. A further consideration in interpretation of the findings is that the interaction between age and Glasgow may be confounded by a cohort effect. Finally, although FAS has been validated for use with adolescent samples19 and adjustments were made for private schooling, there may be residual confounding by SES unaccounted for in the analyses performed.

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