Global Schoolbased Student Health Survey Short Report Ministry of Health and Social Development Republic of Seychelles Bharathi Viswanathan (1) Aurélie M. Lasserre (2) Julita William (1) George Madeleine (1) Pascal Bovet (1,2) (1) Unit for Prevention and Control of Cardiovascular Disease, Ministry of Health and Social Development, Republic of Seychelles (2) University Institute of Social and Preventive Medicine, University of Lausanne, Switzerland Ministry of Health and Social Development, PO Box 52, Victoria, Seychelles vbharathyy@hotmail.com Tel: +248 388 387 Fax: +248 224 792 3 September 2008 GSHS Country Short Report Seychelles 2007 Table of Contents Introduction, Methods and Demographics .......................................................... 3 Results .......................................................................................................................... 3 1. Overweight and Dietary Behaviours ..............................................................4 2. Physical Activity .................................................................................................6 3. Cigarette Smoking..............................................................................................7 4. Alcohol and Other Drugs Use .........................................................................8 5. Sexual Behaviours that Contribute to HIV Infection, Other Sexually Transmitted Infections and Unintended Pregnancy .....................................................................................10 6. Bullying................................................................................................................ 11 7. Mental Health ...................................................................................................12 8. Protective Factors ...........................................................................................13 Acknowledgments..................................................................................................... 14 References................................................................................................................. 15 Appendix I- 2007 Seychelles Fact Sheet, Age 13-15 years Appendix II - Tables of Prevalence of Risk Behaviours, Age 11-17 years Appendix III - Correlations Between Selected Risk Behaviours, Age 13-15 Appendix IV - 2007 Seychelles GSHS Questionnaire 2007 Seychelles GSHS Short Report Page 1 Executive Summary Introduction Risk behaviours in children such as unhealthy dietary patterns, sedentary behaviours, cigarette smoking, alcohol and drugs use, sexual behaviours that contribute to sexually transmitted diseases and bullying can have large impact on current and later health status. The prevalence of such behaviours has not been assessed recently in Seychelles. The purpose of this survey was to assess the prevalence of several risk behaviours and protective factors, and related characteristics, amongst students aged 11 to 17 years in Seychelles. Methods The Global School-based Student Health Survey (GSHS) was based on a standard methodology, developed by the World Health Organisation in collaboration with the Centres of Disease Prevention and Control (Atlanta) and other international agencies, which was applied in all participating countries. The GSHS was conducted in Seychelles in October 2007. A two-stage cluster sampling strategy was used to produce a representative sample of the students attending all S1-S5 classes. The self-administered and anonymous questionnaire was completed by 1432 of the 1747 eligible students (participation rate of 82%). Results are provided for both students aged 13-15 years (see Appendix I, Appendix III) and 1117 years (most results in this report and Appendix II). Main results among students aged 11-17 years • Overweight and dietary behaviours: 22% of all students were overweight or obese (boys 19%, girls 24%). Less than half (45%) of all students reported to eat the recommended amount of 5 or more portions of fruits or vegetables per day. • Physical activity: Only 15% of all students spent 30 minutes or more per day walking or riding a bicycle to and from school. More than half of all students (54%) reported sitting activities during at least 3 hours per day. • Tobacco use: 17% of all students smoked cigarettes on at least one day during the past 30 days. The prevalence was higher in boys than in girls (23% vs. 11%, respectively). • Alcohol and other drugs use: 58% of all students drank alcohol on at least one day during the past 30 days. 25% of boys and 7% girls ever tried cannabis. 10% of all students reported to have ever tried cocaine, heroine, or ecstasy (12% of boys and 7% of girls). • Sexual behaviours that contribute to HIV infection, other sexually transmitted infections and unintended pregnancy: 26% of all students ever had sexual intercourse. Among sexually active students, 57% reported to have used a condom the last time they has sexual intercourse. • Bullying: 47% of all students reported to have been bullied during the past 30 days. • Mental health: 17% of all students reported to have seriously considered attempting suicide during the past 12 months. • Protective factors: 33% of all students reported to have missed school or class without permission during the past 30 days. Conclusion The substantial prevalence of several risk behaviours among adolescents indicates a need to further design and implement programs and policies, in schools and in other pertinent settings, in order to promote healthy lifestyles among children and adolescents. 2007 Seychelles GSHS Short Report Page 2 Introduction, Methods and Demographics Introduction Background Few surveys using a standard methodology have assessed risk behaviours among children and adolescents in Seychelles. In the past decade, an adapted version of the Health Behaviour in School-aged Children (HBSC) was administered to all 534 students of all S3 classes of 4 secondary schools in Seychelles in 2001 (1). The Global Youth Tobacco Survey (GYTS) was conducted among 13-15 years students in 2002 and in 2007 (2-5). A few questions on selected behaviours (smoking, drinking, etc) are also part of an ongoing school based surveillance system applied in all ~6000 students in 4 grades examined every year since 1998 (6). This Global School-based Student Health Survey (GSHS) conducted in 2007 is the most recent attempt to collect information on the prevalence of a wide range of risk behaviours in adolescents and related characteristics in Seychelles. Purpose The purpose of the GSHS is to provide accurate data on the prevalence of a wide range of health behaviours and protective factors among adolescents, and related characteristics, in order: • To develop priorities, establish programs and policies in schools and in other pertinent settings, and advocate for relevant resources to promote health of adolescents, • To assess trends over time in risk behaviours and protective factors for use in evaluation of such programs and policies. General framework of the GSHS The GSHS is a school-based survey conducted among students aged 13-15 years, developed by the World Health Organization, in collaboration with UNAIDS, UNESCO and UNICEF and with technical assistance from the Centres for Disease Control and Prevention (CDC) (7). To date, 32 countries have implemented the GSHS. Several countries have extended the age range of the eligible students participating in the GSHS in consideration that the prevalence of several considered risk behaviours change substantially during adolescence. Methods Sampling In Seychelles, almost all children attend school up to the S4 grade (10th year of school, excluding kindergarten) and around 80% attend school up to the S5 grade. A two-stage sampling strategy based on all schools in the country (13 public and private schools) and all S1-S5 classes were used to produce a sample representative of all students attending S1 to S5 grades. 2007 Seychelles GSHS Short Report Participation Of the 1747 eligible students, 1432 completed the questionnaire (participation rate of 82%). Five students present in school (0.3%) refused to complete the questionnaire. All other non-participants were not in class on the day of the survey. Data collection Thirty-three survey administrators were trained for the conduct of the survey. Before the administration of the questionnaire, survey administrators measured weight and height of the students with a standard equipment and wrote down the values on a register. During the administration of the questionnaire, one survey administrator was present in each class, he or she asked the students to report their weight and height values on the answer sheet of the questionnaire. The 2007 Seychelles GSHS questionnaire (Appendix IV, 8) was anonymous, self-administered at school and contained 70 close-ended questions (41 core questions and 29 additional questions) about dietary behaviours and overweight, physical activity, cigarette use, alcohol and drugs use, sexual behaviours, bullying, mental health, and protective factors. Analyses Data were weighted for non-response and for the varying probabilities of selection. Analyses were made using EPI INFO and STATA 10. 95% confidence intervals were calculated. Results Results are presented by sex and age groups (11-12, 13-15 and 16-17 years). The answers were missing in as few as 5 students (0.3%) for questions about fruits consumption and about age and in as many as 261 students (18%) for questions about alcohol consumption. Appendices I and II tabulate results with 95% confidence intervals for boys and girls aged 13-15 and 11-17, respectively. Appendix III shows Spearman correlation coefficients between selected risk behaviours among boys and girls aged 13-15 years. This restricted age range was chosen in order to decrease confounding by age. Demographics Table 1. Distribution of participants and weighted percentage by sex and age groups Total N % 11-12 257 18.3 13-15 922 60.4 16-17 236 21.4 Missing 17 Total 1432 100.0 Age Boys N % 131 9.2 430 30.3 116 10.3 Girls N % 126 9.0 492 30.2 120 11.0 677 738 49.7 50.3 Page 3 1. Overweight and Dietary Behaviours Background Intake of fruits and vegetables Overweight in childhood is associated with several physiologic, metabolic, and psychological detrimental effects. In addition, overweight during childhood and adolescence tends to track into adulthood and increases the lifetime risk of cardiovascular, endocrine and osteoarticular diseases, and some types of cancer (10-13). Figure 1-2. Prevalence of students who ate five or more fruits or vegetables per day during the past 30 days 100 90 80 70 Percent Prevalence of overweight and obesity Figure 1-1. Prevalence of overweight and obesity by sex and age (bars show the upper 95% confidence interval) 60 50 40 30 20 45 45 44 45 47 39 47 48 32 10 0 Total 50 obese overw eight 45 M F M M M 11-12 13-15 16-17 F F F 11-12 13-15 16-17 40 Percent 35 • 30 25 20 7 15 8 10 5 14 13 11 3 8 7 6 16 6 19 13 16 16 7 14 Consumption of water and soft drinks 7 0 Total B G B B B 11-12 13-15 16-17 G G G 11-12 13-15 16-17 • • • • • 45% of all students reported to eat fruits or vegetables five or more times per day during the past 30 days. Overweight and obesity were defined along the International Obesity Task Force definition (14). 21% of all students (19% of boys and 24% of girls) were overweight or obese. 14% of all, 13% of boys and 16% of girls were overweight but not obese and respectively 7%, 6% and 8% were obese. The prevalence was larger in this study than in previous data from a national examination survey in 2004 (6) in which 16% of boys and 21% of girls were overweight or obese. The higher prevalence in 2007 than in 2004 may be consistent with a secular increase in the prevalence of overweight (15-17) or with the possibility that some obese children avoided participating in the examination surveillance system (which would lead to underestimate the true prevalence of overweight in 2004). 2007 Seychelles GSHS Short Report 78% of all students reported to drink one or more glasses or small bottles of water per day. 55% of all students reported to drink one or more glasses or small bottles of carbonated soft drink per day. Education about healthy eating behaviours • 53% of students recalled to have been taught in any of their classes on the benefits of healthy eating. Page 4 Overweight and Dietary Behaviours (continued) Comparison of overweight prevalence between countries and obesity • Only few data about excess weight were available in the African region. In order to compare obesity and overweight prevalence of Seychelles with other countries, we used all national data available on the GSHS website on September 2nd, 2008 (29). These prevalence have been measured with the same methodology as in Seychelles. • • Overweight and obesity were defined along the International Obesity Task Force definition (14). Seychelles was in the higher range compared to other countries. The prevalence of overweight and obesity in Seychelles was closer to the prevalence in the Eastern Mediterranean region than to the African region. Conclusion Figure 1-3. Prevalence of overweight and obesity among students aged 13-15 years in Seychelles and in other countries that participated to GSHS United Arab Emirates 2005 21 15 8 Libya 2007 16 6 Egypt 2006 16 5 Chile (Metro) 2004 17 2 Argentina 2007 17 2 Lebanon 2005 16 3 Jordan 2007 13 4 Uruguay 2006 15 2 Macedonia 2007 14 China (Beijing) 2003 2 11 Djibouti 2007 4 9 4 Philippines 2007 6 2 India (CBSE) 2007 7 1 Indonesia 2007 • Further shape a favourable environment that facilitates the consumption of healthy foods, • Build social norms that promote the consumption of fruits and vegetables, • Strengthen health education programs and policies on healthy nutrition in schools and other settings, • Further develop the school canteens and supply healthy meals to more children. 12 Seychelles 2007 These findings suggest the need to: 6 1 China (Hangzhou) 2003 4 2 Uganda 2003 5 Ghana 2007 4 1 Overw eight Obesity Myanmar 2007 3 Sri Lanka 2008 3 0 10 20 Percent 2007 Seychelles GSHS Short Report 30 Page 5 2. Physical Activity Background Adequate physical activity throughout life span and maintaining a normal weight are highly effective means of promoting health and preventing a broad range of chronic diseases. Early adoption of an active physical activity pattern increases the chance of maintaining physical activity during adulthood (12,13,18,19). Physical activity • Overall, 54% of students spent at least 3 hours per day doing sitting activities. • The frequency of sitting activities increased with age. Physical education classes Figure 2-3. Prevalence of students who reported to have participated in physical education classes at least 2 days per week during this school year Figure 2-1. Prevalence of students who spent 30 minutes or more walking or riding a bicycle to and from school per weekday during the past 7 days 100 90 80 70 Percent 100 90 Percent 80 60 50 40 70 30 60 20 50 10 40 39 40 37 Total B G 42 38 37 38 35 0 30 20 10 37 15 15 15 Total B G 13 15 15 0 B B B 11-12 13-15 16-17 9 15 B B B 11-12 13-15 16-17 G G G 11-12 13-15 16-17 18 G G G 11-12 13-15 16-17 • Only 39% of all students reported to have participated in physical education classes on 2 or more days per week during this school year. • Only 15% of all students spent 30 minutes or more walking or bicycling to and from school per weekday. Education Sitting activities • Overall, 60% of all students were taught in any of their classes during this school year on the benefits of physical activity. Sitting activities were defined as “sitting or watching television, playing computer games, talking with friends, or doing other sitting activities such as watching DVD videos.” Figure 2-2. Prevalence of students who were doing sitting activities for at least 3 hours per day 100 Conclusion These findings suggest the need to: • • 90 80 • Percent 70 60 50 40 30 Further develop facilities and programs for physical exercise and activities during and outside school hours, Ensure that regular classes of physical activity are actually given to all students, Further develop structures and conditions that promote walking, cycling or any other form of physical activity (e.g. cycling lanes, sidewalks, etc). 68 54 51 55 53 57 41 20 56 36 10 0 Total B G B B B 11-12 13-15 16-17 2007 Seychelles GSHS Short Report G G G 11-12 13-15 16-17 Page 6 3. Cigarette Smoking Background Exposure to environmental tobacco smoke Smoking is the first preventable cause of morbidity and mortality worldwide and 5 million deaths are currently related to tobacco use each year. Smoking markedly increases the risk of multiple cancers (particularly lung cancer), cardiovascular disease (particularly heart attack and stroke), pulmonary disease and many other fatal and non-fatal diseases. Most smokers start smoking during childhood and adolescence. This underlies the critical importance of measures to prevent smoking uptake in children and adolescents (20,21). • 63% of all students reported that people smoked in their presence during the past 7 days. Correlation between smoking and other characteristics, age 13-15 (see Appendix III) Cigarettes smoking was associated with environmental smoke, alcohol drinking (both frequency and volume), cannabis use (Figure 3-2), elevated number of sexual partners, missing school, bullying, and poor knowledge by parents of what their child was doing with his/her free time. • Prevalence of cigarette smoking Figure 3-1. Prevalence of cigarette smoking during the past 30 days, by frequencies 50 45 1-5 70 25 3 3 20 2 4 7 11 12 2 7 8 2 3 6 7 2 8 8 12 0 Total B G B B B 11-12 13-15 16-17 4 9 0 G G G 11-12 13-15 16-17 Total 2007 Seychelles GSHS Short Report B G B B B 11-12 13-15 16-17 G G G 11-12 13-15 16-17 Conclusion These findings emphasize the need to: • Age of smoking initiation among smokers Among current smokers, 45% had tried a cigarette at the age of 11 years or younger. 40 10 • • 50 20 12 Current smoking in children is often defined as smoking cigarettes on at least one day during the past 30 days. 17% of all students (i.e. 11%+4%+2%, first column in Figure 3-1) reported to have smoked cigarettes on one or more day during the past 30 days. The prevalence of cigarette smoking was larger in boys than in girls (23% vs. 11%, respectively). 60 30 2 14 Non current cigarette smokers Current cigarette smokers 90 80 5 • 100 30 10 • 30 35 15 • 6-29 Percent Percent 40 Number of days during the past 30 days on which students have smoked cigarettes Figure 3-2. Prevalence of cannabis use during the past 30 days, among current cigarette smokers and non-smokers • Tighten relevant regulations and legislation related to tobacco use, e.g. legislation to ban smoking in enclosed public places, including bars and discotheques, Strengthen school-based education programs to further raise awareness on tobacco use and to build resistance skills among children, Provide smoking cessation programs to young smokers who want to quit. Page 7 4. Alcohol and Other Drugs Use Background 10% of all students reported a pattern of binge drinking during the past 30 days. The prevalence of binge drinking did not differ between boys and girls (10% vs. 11%, respectively). The frequency of binge drinking increased with age among boys and girls. • Compared to non-drinkers, young people who drink alcohol are more likely to engage in other risk behaviours, such as smoking, use of other drugs, and risky sexual behaviours. Alcohol drinking can also impair psychological development and negatively influence a child’s performance at both school time and leisure time (22-28). • • Education Prevalence of alcohol use 48% of all students reported to have been taught in any of their classes during this school year about the dangers of alcohol use. • Figure 4-1. Prevalence of alcohol drinking during the past 30 days, by frequencies 100 Number of drinking days during the past 30 days 90 1-2 3-9 10-30 80 Age of drinking initiation among drinkers Among students who ever drank alcohol more than a few sips, 83% had their first drink before the age of 14. • Percent 70 60 50 40 8 15 11 14 18 30 20 12 5 12 9 36 20 14 18 6 41 30 6 9 20 14 10 5 31 37 42 51 B G B B B 11-12 13-15 16-17 G G G 11-12 13-15 16-17 59% of all students (i.e. 36%+15%+8%, first column in Figure 4-1) had at least one drink on at least one day during the past 30 days. The overall prevalence was similar in boys and girls (overall 59% boys and 58% girls). Drinking frequency increased with age. • • • of Binge drinking was defined as the consumption of 5 or more dinks for boys (4 or more for girls) on at least one day during the past 30 days. Uganda 2003 13 Kenya 2003 15 18 Zimbabw e 2003 20 Botsw ana 2005 21 24 Rodrigues 2007 Figure 4-2. Prevalence of binge drinking during the past 30 days Ghana 2007 45 33 42 Zambia 2004 40 35 Percent 28 Namibia 2004 50 Seychelles 2007 30 25 62 0 20 15 10 10 11 8 0 Total B G B B B 11-12 13-15 16-17 2007 Seychelles GSHS Short Report 10 20 30 40 Percent 50 60 70 19 15 8 between Senegal 2005 3 Mauritius 2007 10 drinking Figure 4-3. Prevalence of alcohol drinking among students aged 13-15 years in Seychelles and in selected African countries (GSHS data, 29) Binge drinking 5 alcohol 21 0 Total Comparison countries 3 9 G G G 11-12 13-15 16-17 • Drinking frequency was higher in Seychelles than in several other African countries. Page 8 Alcohol and Other Drugs Use (continued) Correlation between drinking and other characteristics, age 13-15 (see Appendix III) • • Drinking frequency and volume were strongly associated. Drinking was associated with cigarette smoking, environmental smoke, cannabis use, number of sexual partners, missing school, bullying, and poor knowledge by parents of what their child was really doing during his/her free time. • • Cannabis use • Cocaine, heroine or ecstasy use Cannabis was defined as “marijuana, cannabis, hashish, ‘lapay’, ‘tyalas’, steam, stuff, or joint”. • Figure 4-4. Prevalence of cannabis use in lifetime, by frequencies 50 Number of times the students used cannabis in lifetime 45 1-2 3-9 ≥ 10 • Percent 35 30 14 25 15 10 5 • 3 7 6 4 3 8 4 12 4 2 1 14 16 10 2 4 0 Total 3 6 B G 4 B B B 11-12 13-15 16-17 2 1 1 4 10% of all students aged 11-17 reported to have ever tried cocaine, heroine, or ecstasy (12% boys, 7% girls). Correlation between cannabis use and other characteristics, age 13-15 (see Appendix III) 40 20 The prevalence of cannabis use was markedly higher in boys than in girls. This prevalence was already high in the youngest category (11-12 years old). No significant difference was observed between the prevalence of students who had ever tried cannabis and the prevalence of students who had tried cannabis during the past 30 days. This may suggest that experimenters tend to sustain their habit or that the questions were not well understood. 1 Cannabis use was strongly associated with an elevated number of sexual partners, cigarette smoking, drinking, and missing school. Among boys, cannabis use was also associated with a lower number of close friends and poor knowledge by the parents of what their child was really doing with his/her free time. 6 Conclusion G G G 11-12 13-15 16-17 These findings suggest the need to: 15% of all students (i.e. 8%+3%+4%, first column in Figure 4-4) used cannabis at least once in their life. • Figure 4-5. Prevalence of cannabis use during the past 30 days, by cannabis use frequency • 50 45 40 Number of times the students used cannabis during the past 30 days 1-2 3-9 ≥ 10 • Percent 35 30 25 4 20 6 15 10 5 3 3 6 Total 7 5 13 11 5 4 3 9 10 1 1 2 9 B G B B B 11-12 13-15 16-17 0 • Conduct further studies, e.g. focus group and other types of qualitative research to examine the significance of these risk behaviours among adolescents, Sustain school-based education programs by providing students with quality information on drinking and substance use issues, Further develop and implement appropriate prevention programs in children and adolescents to raise resilience to substance use. 2 3 1 1 2 1 3 G G G 11-12 13-15 16-17 12% of all students (6%+3%+3%, first column in Figure 4-5) used cannabis during the past 30 days. 2007 Seychelles GSHS Short Report Page 9 5. Sexual Behaviours that Contribute to HIV Infection, Other Sexually Transmitted Infections and Unintended Pregnancy Background • Approximately 33 million people have HIV/AIDS worldwide. Young people aged 15-24 are particularly at risk of contracting sexually transmitted infections (STI). Adolescents who begin sexual activity early are more likely to have sex with multiple partners and are less likely to use condoms, which increases their risk of being infected with STIs (30-33). Sexual intercourse • • Figure 5-1. Prevalence of students who ever had sexual intercourse 100 19% of all students reported sexual intercourse with two or more partners during their lifetime. The (slight) discrepancy between the prevalence of sexual intercourse based on questions on intercourse during time (Figure 5-1) and number of sexual partners (Figure 5-2) could suggest differences in understanding of the questions despite the fact that the questions provided an explicit definition of sexual intercourse. Bragging and sexual abuse may also be issues to be considered when interpreting the data. Correlation between number of sexual partners and other characteristics, age 13-15 (see Appendix III) 90 80 • Percent 70 60 50 40 30 56 46 20 10 26 33 21 Total B G 15 16 6 B B B 11-12 13-15 16-17 • G G G 11-12 13-15 16-17 26% of all students ever had sexual intercourse. More boys (33%) than girls (21%) reported that they ever had sexual intercourse. At the age of 13-15, 29% of boys and 16% of girls reported that they ever had sexual intercourse. • Age of initiation of sexual intercourse among sexually active students 29 0 • • The number of sexual partners was associated with cigarette smoking, drinking, cannabis use, and missing school. Among all students who had sexual intercourse, 56% said they had sex for the first time before the age of 14. Condom use • Among the students who had sexual intercourse during the past 12 months, 57% reported to have used a condom the last time they had sexual intercourse. Sexual partners Education Figure 5-2. Prevalence of students who had one or more sexual partners during their life time • 60% of students recalled to have been taught in any of their classes during this school year on how to avoid HIV or AIDS. 100 90 Number of sexual partners in lifetime 1 Conclusion ≥2 80 Percent 70 These findings suggest the need to: 60 50 40 41 30 20 10 21 25 12 16 Total B Strengthen and sustain school-based education programs on safe sex and STI, • Conduct such education programs at an early age, including primary school. 25 27 19 14 • 12 9 17 15 19 0 G B B B 11-12 13-15 16-17 2007 Seychelles GSHS Short Report 5 22 10 G G G 11-12 13-15 16-17 Page 10 6. Bullying Background Comparison of bullying between countries Children who are victims of bullying have increased stress and a reduced ability to concentrate at school. They also are at increased risk for substance abuse, aggressive behaviours, and suicide attempts (34-37). Figure 6-2. Prevalence of bullying during the past 30 days among adolescents aged 13-15 in Seychelles and in selected African countries (GSHS data, 29) Mauritius 2007 Prevalence of bullying Bullying was defined as “when a student or group of students say or do bad and unpleasant things to another student, when a student is teased a lot in an unpleasant way or when a student is left out of things on purpose. It is not bullying when two students of about the same strength or power argue or fight or when teasing is done in a friendly and fun way.” 1-2 3-9 46 Rodrigues 2007 46 51 Namibia 2004 52 Botsw ana 2005 52 100 90 Uganda 2003 Seychelles 2007 Figure 6-1. Prevalence of students who were bullied during the past 30 days, by bullying frequency Number of days the students were bullied during past the 30 days 40 10-30 Kenya 2003 57 Ghana 2007 59 Zimbabw e 2003 60 65 Zambia 2004 80 Percent 70 0 60 30 12 11 15 11 9 16 60 80 12 21 26 21 • 11 13 36 24 10 19 18 11 20 10 40 Percent 12 50 40 20 3 5 8 5 24 27 24 10 0 Total B G B B B 11-12 13-15 16-17 The prevalence of bullying was rather low in Seychelles compared to the other considered African countries. G G G 11-12 13-15 16-17 Conclusion The findings suggest the following: • • 47% of all students (i.e. 31%+8%+8%, first column in Figure 6-1) reported to have been bullied at least once during the past 30 days. Younger students reported bullying more frequently than older students. Correlation between bullying and other characteristics, age 13-15 (see Appendix 2) • • Among boys, bullying was associated with cigarette smoking, alcohol drinking, cannabis use, younger age and low number of close friends. Among girls, bullying was associated with an elevated number of sexual partners. 2007 Seychelles GSHS Short Report • • • Further studies should examine the scope and extent of bullying in school children in view of the apparent substantial prevalence of this behaviour, School-based education programs addressing specifically bullying should be considered, Peer counsellors could have an important role in the prevention of bullying among their peer fellows and relevant training programs should be considered. Page 11 7. Mental Health Background • Anxiety disorders, depression and other mood disorders, as well as behavioural and cognitive disorders, are among the most common mental health problems found among adolescents. Worldwide, approximately 20% of children and adolescents suffer from these disabling conditions. Half of all lifetime cases of mental disorders start by the age of 14. In particular, suicide is a leading cause of death among adolescents (38-41). Depression 17% of all students seriously considered attempting suicide during the past 12 months. Comparison countries of suicidal behaviour between Figure 7-3. Prevalence of students aged 13-15 who seriously considered attempting suicide during the past 12 months in Seychelles and in selected African countries (29) 17.5 Seychelles 2007 Figure 7-1. Prevalence of students who felt so sad or hopeless almost every day for two weeks or more in a row that they stopped doing their usual activities, during the past 12 months Uganda 2003 100 18.8 Botsw ana 2005 22.4 Zimbabw e 2003 22.9 28.1 Kenya 2003 90 80 Zambia 2004 31.1 Percent 70 0 60 50 10 20 Percent 30 40 40 30 20 32 28 Total B 10 35 36 27 • 38 36 28 22 0 G B B B 11-12 13-15 16-17 The prevalence of suicidal behaviour was lower in Seychelles than in several other African countries. G G G 11-12 13-15 16-17 Close friends 32% of all students reported to have had sustained episodes of sadness or hopelessness. Sadness or hopelessness was slightly more frequent in girls than in boys. • • Suicidal behaviour • 6% of all students aged 11-17 years declared having no close friends. Conclusion These findings suggest the need to: Figure 7-2. Prevalence of students who seriously considered attempting suicide during the past 12 months • • Strengthen school-based counselling programs, Provide more quality information to students on these issues and motivate them to come forward to talk about their problems. 100 90 80 Percent 70 60 50 40 30 20 10 17 16 19 Total B G 0 25 16 9 B B B 11-12 13-15 16-17 2007 Seychelles GSHS Short Report 15 19 19 G G G 11-12 13-15 16-17 Page 12 8. Protective Factors Background Parents or guardians knowing the content of students’ free time (as reported by students) For most adolescents, school is the most important setting outside of the family. School attendance is related to several health risk behaviours including violence and sexual risk behaviours. Good parental bonding and connection is associated with lower levels of depression and suicidal ideation, alcohol use, sexual risk behaviours, and violence (42-46). Figure 8-2. Prevalence of students whose parents or guardians never or rarely really knew what they were doing with their free time during the past 30 days 100 90 Never Rarely 80 Missing classes Percent 70 Figure 8-1. Prevalence of missing school or class without permission during the past 30 days 60 50 40 30 15 90 10 Number of days the students missed school during the past 30 days 1-2 ≥3 19 22 Total B Percent 70 17 25 23 16 12 14 16 18 18 G B B B 11-12 13-15 16-17 G G G 11-12 13-15 16-17 60 • 50 40 30 14 20 8 20 10 19 20 18 Total B G 18 18 22 22 12 27 8 12 27 13 16 0 • 19 0 80 • 17 13 20 100 13 16 B B B 11-12 13-15 16-17 G G G 11-12 13-15 16-17 33% of all students missed school or class without permission on one or more days during the past 30 days. Missing school or class without permission was more frequent in boys (40%) than in girls (26%). • 34% of all students (i.e. 19%+15%, first column in Figure 8-2) reported that their parents or guardians never or rarely really knew what they were doing with their free during the past 30 days. Boys (38%) reported this characteristic more frequently than girls (30%). Correlation between knowledge by parents of what their child was really doing with his or her free time and other characteristics, age 13-15 (see Appendix III) • • Poor knowledge by parents of what their child was doing with his or her free time was associated with drinking and elevated number of sexual partners. Among boys, poor knowledge by parents of what their child was doing during his or her free time was associated with cigarette smoking, cannabis use, and school missing. Conclusion These findings suggest the need to: • • 2007 Seychelles GSHS Short Report Provide more information to students on the importance of regular school attendance, Provide more information to parents on the need to develop bonding and connection in order to promote healthy behaviours amongst their children. Page 13 Acknowledgments Ministry of Health and Social Development, Seychelles Administration MacSuzy Mondon, Minister Jude Gedeon, Principal Secretary Anne Gabriel, Director, Non Communicable Diseases Section Unit of Prevention and Control of Cardiovascular Disease Pascal Bovet, Head Julita William, Coordinator Bharathi Viswanathan, Coordinator GSHS Seychelles George Madeleine, Nursing Officer Vanessa Lafortune, Secretary Survey administrators Sheila Bacco, Sarh Brutus, Diana Cesra, Nicole Dinah, Jude Faure, Merna Figaro, Saviona Hardy, Nathasha Itar, Corina Jean-Baptiste, Purvis Ladouce, Vanessa Lafortune, Jeanne Leggaie, George Madeleine, Suzel Maillet, Veronique Maillet, Nanette Monty, Georgiana Marie, Marie-Cécile Marie, Sibilla Mathiot, Linda Maturin, Myra Nicholas, Ginette Pierre, Rose Mary Ravignia, Kerina Savy, Nicholas Shamlaye, Noeline Vel, Marthy Vidot, Mendy Vidot, Sheila Vidot, Bharathi Viswanathan, Julita William, Garry Woodcock. Ministry of Education, Seychelles Administration Jeanne Simeon, Principal Secretary Marida Delcy, Director General, Schools Division Michel Commettant, Statistics Division Head teachers of the participating secondary schools Anse Boileau School, Anse Royale School, Belonie School, Beau Vallon School, Ecole Française, English River School, Grand Anse Praslin, International School, Independent School, La Digue School, Mont Fleuri School, Plaisance School, Pointe Larue School. World Health Organization Leanne Riley, WHO HQ, Geneva, Switzerland Fernando da Silveira, WHO Liaison Officer, Seychelles Agnes Memee, Administrative Assistant, WHO Liaison Office, Seychelles Centres for Disease Control and Prevention, Atlanta, USA Laura Khan, CDC University Institute of Social and Preventive Medicine, University of Lausanne, Switzerland Fred Paccaud, Chairman Pascal Bovet, Senior lecturer Aurélie M. Lasserre, Research fellow 2007 Seychelles GSHS Short Report Page 14 References 1. 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Swiss Med Wkly 2007; 137:157-8. 18. Warburton DER, Nicol CW, Bredin SSD. Health benefits of physical activity: the evidence. Can Med Assoc J 2006;174: 801-9. 19. WHO. Information Sheet on Physical Activity. Geneva, Switzerland, 2003. http://www.who.int/dietphysicalactivity/media/en/gsfs_pa.pdf. 20. WHO. World No Tobacco Day, 2006 Brochure: Tobacco: deadly in any form or disguise. Geneva, Switzerland, 2006. Available on-line at: http://www.who.int/tobacco/communications/events/wntd/2006/Report_v8_4May06.pdf. 21. WHO. The Tobacco Atlas. WHO, Geneva, 2002: http://www.who.int/tobacco/resources/publications/tobacco_atlas/en/index.html. 22. WHO. World Health Report 2002. WHO, Geneva, 2002. 23. WHO. Global Status Report on Alcohol. WHO, Geneva, 2004. 24. Poikolainen K, Tuulio-Henriksson A, Aalto-Setala T, Marttunen M, Lonnqvist J. Predictors of alcohol intake and heavy drinking in early adulthood: a 5-year follow-up of 15-19 year-old Finnish adolescents. Alcohol Alcoholism 2001;36: 85-8. 25. Facy F. La place de l’alcool dans la morbidité et mortalité des jeunes [Place of alcohol morbidity and mortality of young people] in: Actes du colloque les jeunes et l’alcool en Europe. Eds: Navarro F, Godeau E, Vialas C. In: Universitaires du Sud, Toulouse, 2000. 26. Hibell B, Andersson B, Ahlstrom S, Balakireva O, Bjarnason T, Kokkevi A, Morgan M. The 1999 ESPAD Report: Alcohol and Other Drug Use Among Students in 30 European Countries. Stockholm, Sweden: Council of Europe, 2000. 27. Bonomo Y, Coffey C, Wolfe R, Lynskey M, Bowes G, Patton G. Adverse outcomes of alcohol use in adolescents. Addiction 2001;96: 1485-96. 28. Health and Health Behaviour Among Young People. Eds: Currie C, Hurrelmann K, Settertobulte W, Smith R, Todd J. Copenhagen, Denmark: WHO Regional Office for Europe, 2000. 29. WHO. GSHS, country fact sheets: http://www.who.int/chp/gshs/factsheets/en/index.html. 30. UNAIDS & WHO. 2005 AIDS Epidemic Update. Geneva, Switzerland, 2005. http://www.who.int/hiv/epi-update2005_en.pdf. 2007 Seychelles GSHS Short Report Page 15 31. UNAIDS. Report on the Global HIV/AIDS Epidemic. WHO, Geneva, 2004. http://www.unaids.org/bangkok2004/GAR2004_html/GAR2004_00_en.htm. 32. WHO. Sexually transmitted and other reproductive tract infections. WHO, Geneva, 2005. http://www.who.int/reproductivehealth/publications/rtis_gep/index.htm. 33. WHO. Sexually Transmitted Infections Among Adolescents: The Need for Adequate Health Services. WHO, Geneva, 2004. http://www.who.int/child-adolescent-health/New_Publications/ADH/ISBN_92_4_156288_9.pdf. 34. WHO and UNICEF. Child and adolescent injury prevention: a global call to action. WHO, Geneva, 2005. 35. WHO. Global Estimates of Health Consequences due to Violence against Children. 2005. Background paper to the UN Secretary-General's Study on Violence against Children. WHO, Geneva, unpublished. 36. WHO. World Report on Violence and Health. Chapter on youth violence. WHO, Geneva, 2002. 37. School Bullying: Key Facts. Anti-Bullying Centre, Dublin, 2002. www.abc.tcd.ie/school.htm. 38. WHO. Child Mental Health Atlas. WHO, Geneva, 2005. http://www.who.int/mental_health/resources/Child_ado_atlas.pdf. 39. Kessler RC, Berglund PMBA, Demler O, et al. Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Study Replication. Arch Gen Psychiatry 62(6):593-602, 2005. 40. WHO. Mental Health Fact Sheet. WHO, Geneva, 2001. http://www.who.int/child-adolescenthealth/New_Publications/ADH/mental_health_factsheet.pdf. 41. WHO. The World Health Report 2001 – Mental Health: New Understanding, New Hope. WHO, Geneva, 2001. 42. WHO. Protective Factors Affecting Adolescent Reproductive Health in Developing Countries. WHO, Geneva, 2004. http://www.who.int/child-adolescent-health/New_Publications/ADH/ISBN_92_4_159227_3.pdf. 43. Kimberly HL, Who’s Skipping School: Characteristics of Truants in 8th and 10th Grade. J School Health 2007;77:29-35. 44. WHO. Broadening the horizon: Balancing protection and risk for adolescents. WHO, Geneva, 2002. http://www.who.int/childadolescent-health/New_Publications/ADH/WHO_FCH_CAH_01_20.pdf. 45. WHO. Young people’s health in context Health Behaviour in School-aged Children (HBSC) study: international report from the 2001/2002 survey. WHO Regional Office for Europe, Copenhagen, 2004. http://www.hbsc.org/publications/reports.html. 46. Barber BK. Regulation, connection, and psychological autonomy: Evidence from the Cross-National Adolescent Project (CNAP). Paper presented at the WHO-sponsored meeting Regulation as a Concept and Construct for Adolescent Health and Development. WHO, Geneva, April 16-18, 2002. 2007 Seychelles GSHS Short Report Page 16 Appendix I – 2007 Seychelles Fact Sheet, age 13-15 2007 Seychelles GSHS Short Report Appendix I Page 1 2007 Seychelles GSHS Short Report Appendix I Page 2 Appendix II - Tables of Prevalence of Risk Behaviours, age 11-17 Table 2. Body mass index (BMI) and dietary behaviours, by sex, age 11-17, Seychelles, 2007 Sex Question Total % (95%CI) Overweight* Obesity* 14.2 (12.1-16.4) 7.3 (5.6-8.9) 44.5 (41.8-47.2) 77.7 (75.4-79.9) Ate fruits and vegetables on five or more times per day during the past 30 days On average, drunk one or more glass or small bottle of water, every day On average, drunk one or more small bottle or glass of carbonated soft drink, such as Coke, Fanta, Sprite, Bitter Lemon, Yacenthe lemonade, 55.5 every day (52.8-58.1) During this school year, were taught in any of 52.5 their classes of the benefits of healthy eating (49.8-55.2) *Overweight and obesity were assessed along standard definition (14). Boys % (95%CI) 12.7 (9.7-15.7) 6.3 (4.1-8.6) 44.9 (41.1-48.7) 78.6 (75.4-81.7) Girls % (95%CI) 15.6 (12.6-18.7) 8.1 (5.8-10.5) 44.1 (40.4-47.8) 77.1 (73.9-80.2) 56.8 (53-60.7) 52.1 (48.2-56.0) 53.9 (50.1-57.6) 52.8 (49-56.5) Table 3. Physical activity among students, by sex, age 11-17, Seychelles, 2007 Question Sex Total % (95%CI) Spent 30 minutes or more total walking and bicycle to and from school during the past 7 days Doing sitting activities for more than 3 hours per day Participated in physical education classes on 2 or more days per week During this school year, were taught on any of their classes the benefits of physical activity 14.6 (12.6-16.6) 53.6 (50.8-56.3) 38.7 (36.0-41.4) 59.7 (57.0-62.4) Boys % (95%CI) 14.5 (11-6-17.4) 51.5 (47.5-55.5) 40.4 (36.4-44.3) 59.2 (55.1-63.2) Girls % (95%CI) 14.6 (11.8-17.3) 55.3 (51.6-59.1) 37.0 (33.3-40.7) 60.5 (56.8-64.2) Table 4. Tobacco use among students, by sex, age 11-17, Seychelles, 2007 Question Sex Total % (95%CI) Smoked cigarettes on one or more days during the past 30 days Among students who smoked cigarettes during the past 30 days, those who tried their first cigarette at age 11 or younger People smoked in their presence on one or more days during the past seven days 2007 Seychelles GSHS Short Report 17.0 (14.9-19.1) Boys % (95%CI) 23.0 (19.5-26.5) Girls % (95%CI) 10.8 (8.5-13.2) 44.8 (40.5-49.0) 63.3 (60.7-65.9) 48.7 (43-54.4) 65.9 (62.2-69.6) 39.0 (32.6-45.4) 60.5 (56.8-64.2) Appendix II Page 1 Table 5. Alcohol use and other drugs use among students, age 11-17, by sex, Seychelles, 2007 Questions Sex Total % (95%CI) Had at least one drink containing alcohol on one or more days during the past 30 days Among students who had a drink of alcohol other than a few sips, have had their first drink of alcohol before age 14 years Had five or more drinks for males, respectively four or more drinks for females, on the days they drank alcohol during the past 30 days During this school year, were taught on any of their classes of the dangers of alcohol use Used cannabis on one or more days during the past 30 days Had ever tried cocaine, heroine or ecstasy 58.4 (55.5-61.3) Boys % (95%CI) 60.1 (55.8-64.4) Girls % (95%CI) 56.9 (52.9-60.9) 82.9 (80.5-85.4) 83 0 (79.4-86.5) 83.4 (80.0-86.7) 10.1 (8.3-12.0) 48.3 (45.6-51) 12.1 (10.3-13.9) 9.7 (8.0-11.3) 9.6 (6.9-12.2) 46.2 (42.2-50.2) 20.3 (17.1-23.6) 11.9 (9.2-14.6) 10.7 (8.0-13.3) 50.2 (46.4-54) 3.9 (2.4-5.4) 7.4 (5.4-9.3) Table 6. Sexual behaviours that contribute to HIV infection, other sexually transmitted infections, and unintended pregnancy among students, by sex, age 11-17, Seychelles, 2007 Question Had ever had sexual intercourse Had sexual intercourse with two or more partners during their life time Among sexually active students, initiated sexual intercourse before age 14 years Among students who had sexual intercourse during the past 12 months, those who used a condom at last sexual intercourse During this school year, were taught how to avoid HIV or AIDS during this school year Sex Total % (95%CI) 26.1 (23.5-28.8) 19.3 (17.0-21.6) 55.5 (50.4-60.7) Boys % (95%CI) 32.6 (28.5-36.7) 27.5 (23.8-31.2) 64.1 (57.8-70.5) Girls % (95%CI) 20.6 (17.3-23.9) 11.7 (9.1-14.3) 41.8 (33.7-49.8) 57.2 (50.4-64) 59.8 (57.1-62.5) 63.4 (54.8-72.1) 54.3 (50.3-58.4) 48.5 (38-59.1) 65.2 (61.6-68.8) Table 7. Violence and unintentional injury among students, age 11-17, by sex, Seychelles, 2007 Question Sex Total % (95%CI) Were bullied one or more days during the past 30 days 2007 Seychelles GSHS Short Report 46.8 (43.8-49.8) Boys % (95%CI) 47.7 (43.3-52) Girls % (95%CI) 45.7 (41.7-49.8) Appendix II Page 2 Table 8. Mental health issues among students, by sex, age 11-17, Seychelles, 2007 Question Felt so sad or hopeless almost every day for two weeks or more in a row that they stopped doing their usual activities during the past 12 months Made a plan about how they would attempt suicide during the past 12 months Had no close friends Sex Total % (95%CI) Boys % (95%CI) Girls % (95%CI) 31.8 (29.2-34.3) 17.6 (15.5-19.7) 5.8 (4.6-7.1) 27.9 (24.3-31.4) 15.2 (12.3-18) 6.6 (4.6-8.5) 35.4 (31.7-39) 19.9 (16.9-23) 5.1 (3.4-6.7) Table 9. Protective factors among students, by sex, age 11-17, Seychelles, 2007 Question Sex Total % (95%CI) Missed class or school without permission on one or more days during the past 30 days Parents or guardians never or rarely really knew what the students were doing with their free time during the past 30 days 2007 Seychelles GSHS Short Report 33.3 (30.7-36.0) Boys % (95%CI) 40.3 (36.3-44.3) Girls % (95%CI) 26.6 (23.1-30.0) 33.8 (31.2-36.4) 38.2 (34.2-42.1) 29.9 (26.4-33.5) Appendix II Page 3 Appendix III - Correlations Between Selected Risk Behaviours, age 13-15 We calculated the Spearman's correlation coefficients between the following variables among boys and girls aged 13-15 years. Table 10. Description of the variables Name of the variable Age Weight status Fruits and vegetables Water Soft drinks Walk/bike to/from school Sitting activities Cigarette smoking Smoking initiation age Environmental smoke Alcohol: frequency Alcohol: volume Alcohol initiation Cannabis Sexual initiation Bullying Close friends Missing school Parents/guardians Definition Age of the student Weight status of the student after IOTF definition (14) Number times the student ate fruits or vegetables per day during the past 30 days Number of glasses or small bottles or water the student drank on average Categories 13; 14; 15 Normal weight; overweight; obese 0; 1; 2; 3; 4; 5 or more Do not drink; 1-2/week; several/week; 1/day; 2/day; 3/day; 4/day; 5 or more /day Number of glasses or small bottles or carbonated soft drinks the student drank on Do not drink; 1-2/week; several/week; 1/day; 2/day; average 3/day; 4/day; 5 or more /day Number of days the student walk or ride a bicycle during the past 7 days 0; 1; 2; 3; 4; 5; 6; 7 Hours per day the student spent doing sitting activities during a typical or usual day Less than 1; 1 to 2; 3 to 4; 5 to 6; 7 to 8; more than 8 Number of days the student smoked cigarettes during the past 30 days 0; 1-2; 3-5; 6-9; 10-19; 20-29; 30 Among students who have tried cigarette, age of first try 7 or younger; 8-9; 10-11;12-13;14-15 Number of days people smoked in presence of the student during the past 7 days 0; 1-2; 3-4; 5-6; 7 Number of days the student drank alcohol during the past 30 days 0; 1-2; 3-5; 6-9; 10-19; 20-29; 30 Number of drinks, on the days the student drank alcohol during the past 30 days Among students who have drunk alcohol other than a few sips, age of first try Number of times the student used cannabis during the past 30 days Among students who have ever had sex, age of first sexual intercourse Number of days the student has been bullied during the past 30 days Number of close friends the student has Number of days the student missed classes or school without permission during the past 30 days Frequency of knowing by the parents or guardians’ student what he or she was really doing during his or her free time 2007 Seychelles GSHS Short Report Did not drink; 1; 2; 3; 4; 5 or more 7 or younger; 8-9; 10-11; 12-13; 14-15 0; 1-2; 3-9; 10 or more 11 or younger; 12; 13; 14; 15 0; 1-2; 3-5; 6-9; 10-19; 20-29; 30 0; 1; 2; 3 or more 0; 1-2; 3-5; 10 or more Never; rarely; sometimes; most of the time; always Appendix III Page 1 Spearman’s correlation coefficients (r) among boys aged 13-15 years (N=430) Sexual initiation age Bullying Close friends Missing school Parents/guardians 1.00 0.00 -0.08 0.04 0.04 -0.04 0.03 -0.05 -0.01 0.07 0.08 -0.08 0.00 0.16 0.07 0.07 -0.09 0.04 1.00 0.00 0.17 0.05 0.07 -0.13 0.12 0.18 0.19 0.03 -0.01 0.12 -0.07 0.06 -0.07 0.10 -0.02 1.00 0.11 0.20 0.08 -0.01 0.07 0.14 0.10 -0.04 0.07 0.15 0.13 -0.02 0.03 0.06 0.02 1.00 0.10 0.19 0.01 0.14 0.13 0.15 -0.13 0.06 0.25 0.16 0.05 -0.03 0.12 -0.07 1.00 0.12 0.10 0.04 0.04 0.07 0.05 0.07 0.10 0.11 -0.04 0.05 0.05 0.07 1.00 0.18 0.32 0.42 0.37 -0.07 0.55 0.35 0.05 0.22 -0.08 0.28 -0.17 1.00 0.05 0.01 0.05 0.34 0.04 -0.09 0.20 -0.05 0.18 -0.01 0.04 1.00 0.29 0.27 -0.09 0.24 0.24 0.11 0.13 0.00 0.18 -0.04 1.00 0.83 -0.28 0.32 0.37 0.13 0.22 -0.03 0.24 -0.17 1.00 -0.23 0.21 0.27 0.17 0.16 -0.05 0.19 -0.11 1.00 -0.09 -0.17 0.05 -0.06 0.09 -0.02 0.09 1.00 0.43 0.00 0.16 -0.18 0.33 -0.15 1.00 0.19 0.01 -0.06 0.26 -0.19 1.00 0.09 0.16 0.00 0.24 2007 Seychelles GSHS Short Report Parents/guardians 1.00 0.17 0.12 0.00 0.06 -0.03 0.01 -0.14 0.13 0.06 0.11 -0.03 0.05 0.07 0.01 0.04 -0.02 0.01 0.03 Missing school 1.00 0.06 0.21 -0.05 -0.07 -0.01 -0.06 -0.06 0.04 -0.03 0.03 0.03 0.04 -0.07 -0.04 0.11 0.02 0.11 -0.11 0.14 Close friends 1.00 -0.05 -0.09 0.06 0.01 0.02 0.02 0.03 0.03 0.23 0.06 -0.04 0.00 0.22 0.00 0.09 0.34 -0.16 -0.10 -0.02 -0.05 Bullying Sexual initiation age Sexual partners Sexual partners Cannabis Cannabis Acohol initiation age Acohol initiation age Alcohol: volume Alcohol: volume Alcohol: frequency Alcohol: frequency Environmental smoke Environmental smoke Smoking initiation age Smoking initiation age Cigarette Cigarette Physical education Physical education Sitting activities Sitting activities Walk or ride a bicycle Walk or ride a bicycle Soft drinks Soft drinks Water Water Fruits and vegetables Fruits and vegetables Weight status Weight status Age Age Red: large positive correlation (r > 0.5); Orange: medium positive correlation (r between 0.3 and 0.5); Yellow: small positive correlation (r between 0.1 and 0.3); Light blue: small negative correlation (r between –0.3 and –0.1). R= 1 means perfect correlation; R=0 means no correlation at all. 1.00 -0.13 1.00 0.10 -0.09 1.00 -0.03 0.10 -0.14 1.00 Appendix III Page 2 Spearman’s correlation coefficients (r) among girls aged 13-15 years (N=492) Sexual initiation age Bullying Close friends Missing school Parents/guardians 1.00 -0.01 -0.07 0.00 0.05 -0.04 -0.11 0.00 -0.11 -0.06 0.02 -0.02 -0.08 -0.15 -0.06 0.05 -0.14 0.09 1.00 -0.05 0.11 0.05 0.12 0.07 0.10 0.17 0.20 -0.07 0.11 0.14 0.07 0.09 -0.02 0.15 -0.08 1.00 0.07 0.09 0.05 0.08 0.13 0.04 0.09 0.04 0.04 -0.02 0.12 0.03 0.04 0.06 0.00 1.00 0.02 0.00 0.00 0.05 0.10 0.10 -0.14 0.13 0.00 0.08 -0.07 0.02 0.04 0.03 1.00 -0.04 -0.03 0.09 -0.05 -0.02 -0.10 0.00 -0.05 0.13 0.04 0.05 -0.04 0.05 1.00 0.17 0.20 0.25 0.28 0.05 0.29 0.27 0.04 0.04 0.03 0.25 -0.08 1.00 0.07 0.20 0.22 0.34 -0.04 0.03 0.46 -0.19 -0.11 0.04 -0.06 1.00 0.21 0.24 -0.04 0.08 0.10 0.01 0.20 -0.06 0.16 -0.08 1.00 0.88 -0.07 0.16 0.29 -0.09 0.06 -0.05 0.22 -0.16 1.00 -0.04 0.12 0.21 -0.10 0.03 -0.08 0.24 -0.15 1.00 0.01 -0.10 0.46 -0.09 0.02 0.02 0.11 1.00 0.30 -0.04 0.05 0.03 0.20 -0.05 1.00 0.00 0.13 -0.08 0.26 -0.11 1.00 -0.14 -0.31 0.08 -0.03 2007 Seychelles GSHS Short Report Parents/guardians 1.00 0.20 0.03 0.00 0.02 0.05 0.04 -0.19 0.05 0.03 0.07 0.02 0.04 -0.09 0.07 0.06 0.01 0.08 0.10 Missing school 1.00 -0.01 0.05 -0.08 -0.09 -0.08 0.01 -0.01 -0.10 -0.03 -0.06 -0.05 0.05 0.02 0.03 -0.11 0.01 0.06 -0.06 -0.10 Close friends 1.00 0.01 -0.08 -0.03 0.00 0.11 0.03 0.00 0.04 0.43 0.07 0.17 0.19 0.21 -0.06 0.09 0.45 -0.09 0.01 0.05 -0.09 Bullying Sexual initiation age Sexual partners Sexual partners Cannabis Cannabis Acohol initiation age Acohol initiation age Alcohol: volume Alcohol: volume Alcohol: frequency Alcohol: frequency Environmental smoke Environmental smoke Smoking initiation age Smoking initiation age Cigarette Cigarette Physical education Physical education Sitting activities Sitting activities Walk or ride a bicycle Walk or ride a bicycle Soft drinks Soft drinks Water Water Fruits and vegetables Fruits and vegetables Weight status Weight status Age Age Red: large positive correlation (r > 0.5); Orange: medium positive correlation (r between 0.3 and 0.5); Yellow: small positive correlation (r between 0.1 and 0.3); Light blue: Small negative correlation (r between –0.3 and –0.1); Dark blue: medium negative correlation (r between –0.5 and –0.3). 1.00 -0.10 1.00 0.08 -0.05 1.00 -0.06 0.09 -0.05 1.00 Appendix III Page 3 Appendix IV – 2007 Seychelles GSHS Questionnaire The questionnaire is displayed here with a smaller font and reformatted, as compared to the questionnaire actually given to students, in order to be shown on less pages. 2007 SEYCHELLES GLOBAL SCHOOL-BASED STUDENT HEALTH SURVEY This survey is about your health and the things you do that may affect your health. Students like you all over your country are doing this survey. Students in many other countries around the world also are doing this survey. The information you give will be used to develop better health programs for young people like yourself. DO NOT write your name on this survey or the answer sheet. The answers you give will be kept private. No one will know how you answer. Answer the questions based on what you really know or do. There are no right or wrong answers. Completing the survey is voluntary. Your grade or mark in this class will not be affected whether or not you answer the questions. If you do not want to answer a question, just leave it blank. Make sure to read every question. Fill in the circles on your answer sheet that match your answer. Use only the pencil you are given. When you are done, do what the person who is giving you the survey says to do. Here is an example of how to fill in the circles: Fill in the circles like this Not like this or Survey 1. Do fish live in water? A. Yes B. No Answer sheet 1. A B C D E F G H Thank you very much for your help. 1. How old are you? A. B. C. D. E. F. G. H. 11 years old or younger 12 years old 13 years old 14 years old 15 years old 16 years old 17 years old 18 years old or older 2. What is your sex? A. B. Male Female 3. In what grade are you? A. B. C. D. E. S1 S2 S3 S4 S5 The next 6 questions ask about your height, weight, going hungry, and where you get your lunch. 2007 Seychelles GSHS Short Report 4. How tall are you without your shoes on? ON THE ANSWER SHEET, WRITE YOUR HEIGHT IN THE SHADED BOXES AT THE TOP OF THE GRID. THEN FILL IN THE OVAL BELOW EACH NUMBER. 5. How much do you weigh without your shoes on? ON THE ANSWER SHEET, WRITE YOUR WEIGHT IN THE SHADED BOXES AT THE TOP OF THE GRID. THEN FILL IN THE OVAL BELOW EACH NUMBER. 6. How do you describe your weight? A. B. C. D. E. Very underweight Slightly underweight About the right weight Slightly overweight Very overweight 7. Which of the following are you trying to do about your weight? A. B. C. D. I am not trying to do anything about my weight Lose weight Gain weight Stay the same weight Appendix IV Page 1 8. During the past 30 days, how often did you go hungry because there was not enough food in your home? A. B. C. D. E. The next 2 questions ask about foods you might eat. 12. During the past 30 days, how many times per day did you usually eat fruit, such as apples, oranges, banana, avocado, mango, papay, zanmalak, frisiter, karanbol, or any other local or imported fruits? Never Rarely Sometimes Most of the time Always 9. Where do you get your lunch most often during school time? A. B. C. D. E. F. I generally do not take lunch School meal Take away bought inside school Take away bought outside school Home made food Snacks from tuck shop such as samosa, kato piman, etc. G. Other manner A. B. C. D. E. F. G. I did not eat fruit during the past 30 days Less than one time per day 1 time per day 2 times per day 3 times per day 4 times per day 5 or more times per day 13. During the past 30 days, how many times per day did you usually eat vegetables, such as carrots, lettuce, tomato, cabbage, cucumber, kreson, bred, zariko, or any other local or imported vegetables? 10. Chose the figure that best reflects how you think you look? A. B. C. D. E. F. G. I did not eat vegetables during the past 30 days Less than one time per day 1 time per day 2 times per day 3 times per day 4 times per day 5 or more times per day The next 5 questions ask about drinks or beverages you might consume. A B C D E F G H 14. On average, how many glasses or small bottles (3 dl) of carbonated soft drinks do you drink, such as Coke, Fanta, Sprite, Bitter Lemon, Cocktail, Pepsi, Mirenda, Yacinthe lemonade, or any similar sweetened drink? (Do not include water, fresh or packet fruit juice, or milk) A. B. A B A. B. C. D. E. F. G. H. C D E F G Drawing A Drawing B Drawing C Drawing D Drawing E Drawing F Drawing G Drawing H 11. Choose your ideal figure (how you would like to look)? A. B. C. D. E. F. G. H. Drawing A Drawing B Drawing C Drawing D Drawing E Drawing F Drawing G Drawing H 2007 Seychelles GSHS Short Report H I do not drink carbonated soft drinks 1-2 small bottles or glasses per week but not every day C. Several bottles or glasses per week but not every day D. 1 small bottle or glass per day (on most days of the week) E. 2 small bottles or glasses per day (on most days of the week) F. 3 small bottles or glasses per day (on most days of the week) G. 4 small bottles or glasses per day (on most days of the week) H. 5 small bottles or glasses per day or more (on most days of the week) 15. When you wish to drink a soft drink, what would you choose usually? A. B. C. D. Diet Coke Regular Coke I prefer other types of soft drinks (Sprite, Bitter Lemon, lemonade, Yacinthe lemonade, etc.) I rarely drink any soft drink Appendix IV Page 2 16. On average, how many glasses or small packets of fruit juice do you drink? (Do not include soft drinks or milk) A. B. I do not drink fruit juice 1-2 small packets or glasses of fruit juice per week but not every day C. Several small packets or glasses of fruit juice per week but not every day D. 1 small packets or glass of fruit juice per day (on most days of the week) E. 2 small packets or glasses of fruit juice per day (on most days of the week) F. 3 small packets or glasses of fruit juice per day (on most days of the week) G. 4 small packets or glasses of fruit juice per day (on most days of the week) H. 5 small packets or glasses of fruit juice per day or more (on most days of the week) 17. On average, how many glasses or small bottles of water do you drink? (do not include soft drinks or milk) A. B. I do not drink water 1-2 glasses of water per week but not every day C. Several glasses of water per week but not every day D. 1 glass of water per day (on most days of the week) E. 2 small glasses of water per day (on most days of the week) F. 3 glasses of water per day (on most days of the week) G. 4 glasses of water per day (on most days of the week) H. 5 glasses of water per day or more (on most days of the week) 18. On average, how many cups (tas) of tea do you drink? (Do not include water, soft drinks, or milk) A. B. C. D. I do not drink tea 1-2 cups of tea per week but not every day Several cups of tea per week but not every day 1 cup of tea per day (on most days of the week) E. 2 cups of tea per day (on most days of the week) F. 3 cups of tea per day (on most days of the week) G. 4 cups of tea per day (on most days of the week) H. 5 cups of tea per day or more (on most days of the week) The next 2 questions ask about the benefits of healthy eating and benefits of eating more fruits and vegetables. 19. During this school year, were you taught in any of your classes of the benefits of healthy eating? A. B. C. Yes No I do not know 2007 Seychelles GSHS Short Report 20. During this school year, were you taught in any of your classes of the benefits of eating more fruits and vegetables? A. B. C. Yes No I do not know The next 3 questions ask about bullying. Bullying occurs when a student or group of students say or do bad and unpleasant things to another student. It is also bullying when a student is teased a lot in an unpleasant way or when a student is left out of things on purpose. It is not bullying when two students of about the same strength or power argue or fight or when teasing is done in a friendly and fun way. 21. During the past 30 days, on how many days were you bullied? A. B. C. D. E. F. G. 0 days 1 or 2 days 3 to 5 days 6 to 9 days 10 to 19 days 20 to 29 days All 30 days 22. During the past 30 days, how often were you bullied by students? A. B. C. D. I was never bullied I was bullied a few times I was bullied several times I was bullied very often 23. During the past 30 days, how were you bullied most often? A. B. I was not bullied during the past 30 days I was hit, kicked, pushed, shoved around, or locked indoors C. I was made fun of because of my race or color D. I was made fun of because of my religion E. I was made fun of with sexual jokes, comments, or gestures F. I was left out of activities on purpose or completely ignored G. I was made fun of because of how my body or face looks H. I was bullied in some other way The next 6 questions ask about your feelings and friendships. The term “suicide” means trying to kill yourself. 24. During the past 12 months, how often have you felt lonely? A. B. C. D. E. Never Rarely Sometimes Most of the time Always Appendix IV Page 3 25. During the past 12 months, how often have you been so worried about something that you could not sleep at night? A. B. C. D. E. Never Rarely Sometimes Most of the time Always 26. During the past 12 months, did you ever feel so sad or hopeless almost every day for two weeks or more in a row that you stopped doing your usual activities? A. B. Yes No 27. During the past 12 months, did you ever seriously consider attempting suicide? A. B. Yes No 28. During the past 12 months, did you make a plan about how you would attempt suicide? A. B. Yes No 29. How many close friends do you have? A. B. C. D. 0 1 2 3 or more The next 6 questions ask about cigarette and other tobacco use. 33. During the past 12 months, have you ever tried to stop smoking cigarettes? A. B. C. D. I have never smoked cigarettes I did not smoke cigarettes during the past 12 months Yes No 34. During the past 7 days, on how many days have people smoked in your presence? A. B. C. D. E. 0 days 1 or 2 days 3 or 4 days 5 or 6 days All 7 days 35. Which of your parents or guardians use any form of tobacco? A. B. C. D. E. Neither My father or male guardian My mother or female guardian Both I do not know The next 8 questions ask about drinking alcohol. This includes drinking beer, Guinness, wine, spirits (whiskey, rum, vodka, takamaka, or tropical), vermouth, porto, martini, liquors, baka, kalu, or lapire. Drinking alcohol does not include drinking a few sips of wine for religious purposes. 36. How old were you when you had your first drink of alcohol other than a few sips? A. 30. How old were you when you first tried a cigarette? A. B. C. D. E. F. G. H. I have never smoked cigarettes 7 years old or younger 8 or 9 years old 10 or 11 years old 12 or 13 years old 14 or 15 years old 16 or 17 years old 18 years old or older 31. During the past 30 days, on how many days did you smoke cigarettes? A. B. C. D. E. F. G. 0 days 1 or 2 days 3 to 5 days 6 to 9 days 10 to 19 days 20 to 29 days All 30 days 32. During the past 30 days, on how many days did you use any other form of tobacco, such as snuff (sike)? A. B. C. D. E. F. G. 0 days 1 or 2 days 3 to 5 days 6 to 9 days 10 to 19 days 20 to 29 days All 30 days 2007 Seychelles GSHS Short Report I have never had a drink of alcohol other than a few sips B. 7 years old or younger C. 8 or 9 years old D. 10 or 11 years old E. 12 or 13 years old F. 14 or 15 years old G. 16 years old or 17 years old H. 18 years old or older 37. During the past 30 days, on how many days did you have at least one drink containing alcohol? A. B. C. D. E. F. G. 0 days 1 or 2 days 3 to 5 days 6 to 9 days 10 to 19 days 20 to 29 days All 30 days 38. During the past 30 days, on the days you drank alcohol, how many drinks did you usually drink per day? A. B. C. D. E. F. G. I did not drink alcohol during the past 30 days Less than one drink 1 drink 2 drinks 3 drinks 4 drinks 5 or more drinks Appendix IV Page 4 39. What type of alcohol do you prefer to drink? (Select only one answer) A. B. C. D. I do not drink alcohol Beer or Guinness Wine Imported spirits, such as whiskey, rum, vodka, or Old Brown Cherry E. Locally made spirits such as Tropical, Takamaka, Smironoff, Black ice, or Island Magic F. Baka, kalu, or lapire G. Liquor such as brandy, martini, porto, or vermouth, or Irish Cream H. Other type 40. During the past 30 days, how did you usually get the alcohol you drank? SELECT ONLY ONE RESPONSE. A. B. I did not drink alcohol during the past 30 days I bought it in a store, shop, or from a street vendor C. I gave someone else money to buy it for me D. I got it from my friends E. I got it from home F. I stole it G. I made it myself H. I got it some other way 41. During your life, how many times did you drink so much alcohol that you were really drunk? A. 0 times B. 1 or 2 times C. 3 to 9 times D. 10 or more times 42. During your life, how many times have you ever had a hang-over, felt sick, got into trouble with your family or friends, missed school, or got into fights, as a result of drinking alcohol? A. B. C. D. 0 times 1 or 2 times 3 to 9 times 10 or more times 43. During this school year, were you taught in any of your classes of the dangers of alcohol use? A. B. C. Yes No I do not know A. B. C. D. 0 times 1 or 2 times 3 to 9 times 10 or more times 46. Have you ever tried cocaine, heroine, lapoud, sache, nof, or ecstasy? A. B. C. Yes No I do not know The next 5 questions ask about sexual intercourse. This includes vaginal intercourse (when a man puts his penis into a woman’s vagina) and anal intercourse (when a man puts his penis into his partner’s anus). 47. Have you ever had sexual intercourse? A. B. Yes No 48. How old were you when you had sexual intercourse for the first time? A. B. C. D. E. F. G. H. I have never had sexual intercourse 11 years old or younger 12 years old 13 years old 14 years old 15 years old 16 years old 17 years old or older 49. During your life, with how many people have you had sexual intercourse? A. B. C. D. E. F. G. I have never had sexual intercourse 1 person 2 people 3 people 4 people 5 people 6 or more people 50. During the past 12 months, have you had sexual intercourse? A. B. Yes No 51. The last time you had sexual intercourse, did you or your partner use a condom or kapot? The next question asks about drugs. 44. During your life, how many times have you used drugs, such as marijuana, cannabis or hashish, lapay, steam, stuff, joint, or tyalas? (do not include heroine, cocaine, or ecstasy) A. B. C. D. 0 times 1 or 2 times 3 to 9 times 10 or more times 45. During the past 30 days, how many times have you used drugs, such as marijuana, cannabis or hashish, lapay, steam, stuff, joint, or tyalas? (do not include heroine, cocaine, or ecstasy) 2007 Seychelles GSHS Short Report A. B. C. I have never had sexual intercourse Yes No The next question asks about learning how to avoid HIV infection or AIDS. 52. During this school year, were you taught in any of your classes how to avoid HIV infection or AIDS? A. B. C. Yes No I do not know Appendix IV Page 5 The next 2 questions ask about physical activity. Physical activity is any activity that increases your heart rate and makes you get out of breath some of the time. Physical activity can be done in sports, playing with friends, or walking to school. Some examples of physical activity are running, fast walking, biking, dancing, football, basketball and swimming etc... ADD UP ALL THE TIME YOU SPEND IN PHYSICAL ACTIVITY EACH DAY. DO NOT INCLUDE YOUR PHYSICAL EDUCATION OR GYM CLASS. 53. During the past 7 days, on how many days were you physically active for a total of at least 60 minutes per day? A. B. C. D. E. F. G. H. 0 days 1 day 2 days 3 days 4 days 5 days 6 days 7 days 54. During a typical or usual week, on how many days are you physically active for a total of at least 60 minutes per day? A. B. C. D. E. F. G. H. 0 days 1 day 2 days 3 days 4 days 5 days 6 days 7 days The next question asks about the time you spend mostly sitting when you are not in school or doing homework. 55. How much time do you spend during a typical or usual day sitting and watching television, playing computer games, talking with friends, or doing other sitting activities, such as watching DVD videos? A. B. C. D. E. F. Less than 1 hour per day 1 to 2 hours per day 3 to 4 hours per day 5 to 6 hours per day 7 to 8 hours per day More than 8 hours per day The next 3 questions ask about hours per day or week you watch TV or videos, or play computer games. 56. How many hours per DAY do you usually watch TV or videos on week days? A. B. C. D. E. F. G. Not at all Less than 1 hour per day ½ to 1 hour per day 1 to 2 hours per day 2-3 hours per day 4-5 hours per day 6 hours or more per day 2007 Seychelles GSHS Short Report 57. How many hours per DAY do you usually watch TV or videos on week ends? A. B. C. D. E. F. G. Not at all Less than 1 hour per day ½ to 1 hour per day 1 to 2 hours per day 2-3 hours per day 4-5 hours per day 6 hours or more per day 58. How many hours per WEEK do you usually play computer games? (e.g. on your television, computer, Game Boy, X-box, Nintendo, or Playstation) A. B. C. D. E. F. Not at all Less than 1 hour per week 1 to 3 hours per week 4 to 6 hours per week 7 to 9 hours per week 10 hours or more per week The next 2 questions ask about going to and coming home from school. 59. During the past 7 days, on how many days did you walk or ride a bicycle to and from school? A. B. C. D. E. F. G. H. 0 days 1 day 2 days 3 days 4 days 5 days 6 days 7 days 60. During the past 7 days, how long did it usually take for you to get to and from school each day? ADD UP THE TIME YOU SPEND GOING TO AND COMING HOME FROM SCHOOL. A. B. C. D. E. F. G. Less than 10 minutes per day 10 to 19 minutes per day 20 to 29 minutes per day 30 to 39 minutes per day 40 to 49 minutes per day 50 to 59 minutes per day 60 or more minutes per day The next 4 questions ask about physical education, playing on sports teams, benefits of physical activity, and extra curricular activities. 61. During this school year, on how many days did you go to physical education class each week? A. B. C. D. E. F. 0 days 1 day 2 days 3 days 4 days 5 or more days 62. During the past 12 months, on how many sports teams did you play outside of school hours? A. B. C. D. 0 teams 1 team 2 teams 3 or more teams Appendix IV Page 6 The next question asks about pocket money. 63. During this school year, were you taught in any of your classes of the benefits of physical activity? A. B. C. Yes No I do not know 64. Did you take part in any extra curricular activities that was related to physical activity such as basketball, football, hiking, swimming, or dancing? A. B. C. 70. How much pocket money do you get every day on average? A. B. C. D. E. F. G. I do not receive any pocket money Less that 5 rupees per day 5 - 9 rupees per day 10 - 14 rupees per day 15 – 19 rupees per day 20 – 25 rupees per day More than 25 rupees per day I did not take part in any extra curricular activities I took part in extra curricular activities, but not related to physical activity I took part in extra curricular activities related to physical activity The next 5 questions ask about your experiences at school and at home. 65. During the past 30 days, on how many days did you miss classes or school without permission? A. B. C. D. E. 0 days 1 or 2 days 3 to 5 days 6 to 9 days 10 or more days 66. During the past 30 days, how often were most of the students in your school kind and helpful? A. B. C. D. E. Never Rarely Sometimes Most of the time Always 67. During the past 30 days, how often did your parents or guardians check to see if your homework was done? A. B. C. D. E. Never Rarely Sometimes Most of the time Always 68. During the past 30 days, how often did your parents or guardians understand your problems and worries? A. B. C. D. E. Never Rarely Sometimes Most of the time Always 69. During the past 30 days, how often did your parents or guardians really know what you were doing with your free time? A. B. C. D. E. Never Rarely Sometimes Most of the time Always 2007 Seychelles GSHS Short Report Appendix IV Page 7