School differences in adolescent health and wellbeing: findings from the Canadian Health Behaviour in School-aged Children Study.

The goal of this study was to assess the relationship between student- and school-level factors and student health and wellbeing outcomes, and to estimate the variability present at each of the student and school levels for each of three selected health-related outcomes. The data are from the 2006 Canadian Health Behaviour in School-aged children (HBSC) study in which Grades 6-10 students (N=9670) and administrators (N=187) were surveyed. The three outcome measures are Self-Rated Health (SRH), Emotional Wellbeing (EWB), and Subjective Health Complaints (SHC). Individual and school-level effects on the three outcomes were estimated using multi-level modeling. Both individual and school-level factors were associated with students' health. Gender, family wealth, family structure, academic achievement and neighbourhood were significant student-level predictors. We identified random associations between the student-level variables and reported health outcomes. These random effects indicate that the relationships between these student variables and health are not consistent across schools. Student Problem Behaviours at the school were significant predictors of SRH and SHC, while Student Aggression and the school's average socioeconomic standing were significant school-level predictors of EWB. Findings suggest that the environment and disciplinary climate in schools can predict student health and wellbeing outcomes, and may have important implications for school initiatives aimed at students who are struggling both emotionally and academically. Copyright 2009 Elsevier Ltd. All rights reserved.