The State of Health Behaviour and Lifestyle of

Pacific Youth

Vanuatu Report

2

The State of Health Behaviour and Lifestyle of Pacific Youth. Vanuatu Report © UNICEF, 2001 UNICEF Pacific (Regional Co-ordinator) Dr. Ayoade Olatunbosun-Alakija, Youth Officer (HBLPY Project Co-ordinator)* Dr. Philayrath Phongsavan, Nutrition Officer* WHO/WPRO Dr. Gauden Galea Regional Advisor in Health Promotion WHO Western Pacific Regional Office (WPRO) Australian Centre for Health Promotion (Regional Data Management Centre) Professor Adrian Bauman, Director of Research* Dr. Jack Chen, Lecturer, Senior Statistician* Mr. Ben Smith, Lecturer* Mr. Roberto Forero, Behavioural Epidemiologist Administration of survey Vanuatu Youth Peace Corps Vanuatu UNICEF Pacific For more information or additional copies of the report: Write to us: Visit us: UNICEF Pacific 3rd Floor Private Mail Bag Fiji Development Bank Building Suva, Fiji 360 Victoria Parade Telephone: (679) 300 439 Suva, Fiji Facsimile: (679) 301 667 Email: suva@unicef.org * Authors of this report.

This document may be freely reviewed, abstracted, reproduced, disseminated, or translated in part or in whole, but not for sale or for use for commercial purposes. Referencing of any part of this report should be cited. All rights are reserved by UNICEF Pacific.

The following citation should be used when quoting or reproducing any part of this report: UNICEF. The State of Health Behaviour and Lifestyle of Pacific Youth. Vanuatu Report. UNICEF Pacific. Suva, Fiji, 2001.

3

Acknowledgements This survey was supported by funds provided by UNICEF Pacific under the Youth Health and Development project; this is in part funded through NZODA and this contribution is gratefully acknowledged. We gratefully recognize the support of all schools (Appendix A), communities and the Vanuatu Department of Education with a special mention for the Director of School Education Mr. Kalmele Metai. This study would not be possible without the full participation of the Vanuatu youth. Our sincere thanks to the youth who contributed to the conduct of the needs assessment, to the development and testing of the questionnaires, and for their enthusiasm and leadership in the field. Analyses of the survey data, interpretation of the results and preparation of the report were carried out by the Australian Centre for Health Promotion, in Sydney. UNICEF Pacific personnel made a substantial contribution to the report writing, management and compilation of the report. Mr. Roberto Forero and Dr. Gauden Galea also made valuable comments and contributed to the write-up in parts of the report. The European HBSC experience and model have contributed substantially to the Pacific efforts; this sharing of information and expertise are gratefully acknowledged. Administrative support Ms. Christine Calo-oy Programme Assistant UNICEF Pacific Ms. Maria Coady UNICEF Field Co-ordinator UNICEF Vanuatu Office Ms. Tracey Coles Administrative Assistant Epidemiology Unit South Western Sydney Area Health Service

4

Vanuatu HBLPY Team Members Survey Administration Team Efate Team Ms. Annette Daniel Mr. Winch Dick Mr. Obed Melven Pastor Brown Sope Ms. Odina Lala Ms. Josephine Peter Mr. Tom Spangler Mr. Manu Nafi Mr. Bernard Saploan Epi Team Mr. John Valia Ms. Rosalinda Omawa Mr. Josh Eaton Ambrym Team Ms. Saletta Leingkone Mr. Gregoire Tasso Ms. Jennie Brehl Tanna Team Ms. Limar Isaac Mr. Joeleh Sewus Mr. Andy Halseth Santo Team Ms. Prisilla Jimmy Mr. Vira Leo Mr. Mike Henrich Vanuatu Technical Advisory Group Professor Adrian Bauman, Director of Research (Australian Centre for Health Promotion) Dr. Philayrath Phongsavan, Nutrition Officer (UNICEF Pacific) Dr. Ayoade Olatunbosun-Alakija, Youth Officer (UNICEF Pacific) Dr. Gauden Galea, Regional Advisor in Health Promotion (WHO/WPRO)

5

Preface [To be confirmed]

Executive Summary This survey of health and lifestyle behaviours of young people in Vanuatu is the first in a series of surveys planned to examine needs and issues among young people in the Pacific nations. It is part of an endeavor by UNICEF Pacific to obtain evidence to assist the effective delivery of programs for young people in this region. The planning and implementation of the Health Behaviour and Lifestyle of Pacific Youth (HBLPY) study was a collaborative initiative between UNICEF Pacific, non-government youth organizations in Vanuatu, the government of Vanuatu and its relevant Ministries and the Australian Centre for Health Promotion (a WHO collaborating centre in Health Promotion). Local young people played a critical role in the development and testing of the survey instrument and its administration in the field. This participatory approach not only contributed to the relevance and effectiveness of the study, but also helped to enhance the capacity of local young people to identify and address their needs in the future. A representative sample of 4,596 students from across Vanuatu was surveyed. In order to gain an indication of health and lifestyle issues among out-of-school youth a convenience sample of 424 young people in the province of Shefa were also surveyed. The survey instrument consisted of core questions from the WHO European Health Behaviour in School Children (HBSC) surveys that have been conducted in European countries since 1982, as well as some additional questions that were of specific relevance to young people in Vanuatu. The health and lifestyle issues covered in this instrument included: substance use; dietary habits; physical activity; mental well-being and social support; trust in adults and social institutions; injury and bullying; personal hygiene habits, and; sexual health (measured among out-of-school youth only). School students self-completed the survey in their classroom under the supervision of members of the survey team while the out-of-school youth completed the questionnaire in a group-interview format. Substance use The proportions of young people using tobacco, alcohol and other drugs regularly were relatively low compared to Australian or European youth, although these rates increased gradually with age. A little less than one quarter of students had ever tried tobacco or alcohol, while about 1 in 8 had ever tried kava. Tobacco was the drug most likely to be used on a weekly or more regular basis, with about 5% of students reporting this. Almost 3% drank kava or sniffed solvents this regularly. About 10% of students said that they had been drunk at least once, and a little over 3% that they had been drunk 2 or more times. The use of all types of substances was higher among boys than girls and the usage increased between the ages of 12 and 17 years. The rates of substance use were higher in Shefa than other provinces. Out-of-school youth were significantly more likely to report ever being drunk or ever using most types of drug. The use of tobacco and alcohol by young people in Vanuatu was lower than that observed in similar surveys in Europe.

6

Nutrition Data about dietary habits indicated that nutrition is an area of health concern. More than half of school students and over two thirds of out-of-school youth did not report eating important foods such as fruit and vegetables more than once per day. All students reported eating sweets at least once per day. Shefa had the lowest proportions of students who reported eating fruits, vegetables or taro on a daily basis, but the highest prevalence of daily bread consumption. Young people at school were more likely than those out-of-school to eat vegetables more than once per day. The drink most regularly consumed by students was water, which was followed in popularity by tea and coconut juice. The majority of young people reported seldom or never drinking coffee or soft drinks. Compared to European students those in Vanuatu were less likely to consume soft drinks on a daily basis but more likely to eat sweets regularly. Physical activity Physical activity levels were low among both in-school and out-of-school youth. About one quarter of students reported that they undertook 2 or more hours of physical activity per week, and about 1 in 5 that they participated in 4 or more sessions of exercise. About 1 in 8 students watched 4 or more hours of television per day, with a general decline in the proportion watching this amount between the ages of 12 and 17 years. Among the in-school youth, girls were less likely to be active than boys, and those at younger ages were less likely to be active than older youth. The provinces of Malampa and Tafea had the lowest proportions of students reporting regular physical activity. In addition, young people at school were less active than those out-of-school. The proportions of young people in Vanuatu who reported participating in regular physical activity were below the levels observed in the European HBSC surveys. As found in Europe, however, physical activity levels declined with age in Vanuatu. Personal well-being and development While the measures of mental health and social support showed that some young people in Vanuatu were experiencing unhappiness and difficulties in communicating their concerns to others, these rates were within the range of what is usually observed in other countries. A little over one quarter of students reported that they were generally not happy, while a slightly lower proportion reported that they rarely or never felt confident. Around 1 in 8 reported that they often felt lonely. Feelings of severe sadness or depression were experienced by around 1 in 8 students. Students most often identified mothers, siblings, fathers and friends as people that they could easily talk to about personal difficulties. Among school students the prevalence of reported unhappiness and loneliness increased between the ages of 12 and 17 years. School students were significantly more likely than out-of-school youth to report feeling unhappy, or that they had experienced severe sadness or depression. On the other hand, out-of-school youth were significantly more likely to report that they often felt lonely. Those out-of-school were less likely to consider it easy to discuss problems with parents, but more likely to identify youth workers, friends or other adults as approachable. Among out-of-school youth, 46% of those surveyed indicated that they left school involuntarily. With respect to their perceived future prospects in employment and education, at least 80% reported that they would be likely or very likely to be working in a year’s time. About 70% stated that they would be likely or

7

would be likely or very likely to be working in a year’s time. About 70% stated that they would be likely or very likely to undertake future training. School environment The majority of students considered school a nice place to be and felt that they belonged at school. About half of the students surveyed considered their schools to be clean and safe, while one third held an opposite viewpoint. While more than two thirds thought that the rules at school were fair, a little over one half felt that students were treated too strictly. Generally students were positive about their teachers and peers at school, but had more divided views about the school environment overall. Students in Vanuatu were more likely than those in Europe to report that they were treated too strictly at school. Community participation The home, peer and church settings were identified by in-school and out-of-school youth as the contexts in which they were most likely to be encouraged to express their views. Most, however, did not indicate that they felt such encouragement in the community context. Among school students, boys were more likely than girls to feel encouraged to express their views in the community or church contexts. Out-of-school youth were about half as likely as those in-school to indicate that they were encouraged to express their views by their parents. About 80% of students considered their local community to be important to them, and those in-school were more likely than those out-of-school to consider their community to be very important. Around one third of students and out-of-school youth felt strongly involved in their community. Trust in adults and social institutions The vast majority of students rated the credibility of the church and their national leaders highly. Adults and elders generally were the next most likely to be rated as credible. Out-of-school youth were more likely than those in-school to consider figures in the public sphere, such as those in governmental or civic leadership, as credible. Students on the other hand placed greater trust in parents and the church. Physical injury, bullying and violence Injuries deliberately inflicted by others were a prominent health issue among young people. Almost one third of students reported that they had a deliberate injury inflicted by another person in the past 12 months. Unidentified “other people” were the major source of these injuries, followed by boyfriends or girlfriends and fathers. Deliberate injury was reported more often by boys than girls at school, and more frequently by students in younger age groups. The highest proportion of students who reported that they had been deliberately injured was in the province of Malampa. Out-of-school youth reporting rates of deliberate injury almost twice as high as those in-school. About 10% of students had been bullied at least weekly in the previous three months.

8

Personal hygiene The majority of students reported brushing their teeth 2 or more times per day and washing their hands before eating or after using the toilet. However, about one third reported that they did not brush their teeth regularly and about one quarter could improve their frequency of hand washing. Poorer hygiene practices were evident among the out-of-school youth, with significantly lower rates of regular tooth brushing and hand washing than those in-school. Sexual behaviour among out-of-school youth The information collected about the sexual health behaviour of out-of-school youth indicated that boys represent a greater risk group than girls in this regard. More out-of-school boys than girls, just under 3 in 5, reported ever having sex. Around 2 in 5 of these boys who had ever had sex reported having sex with 4 or more people in the past, and a similar proportion said that they had had unwanted sex when drunk in the past. About one quarter of girls reported having unwanted sex when drunk in the past. There was inconsistent use of contraception or safe-sex measures by the young people who were sexually active, with between one quarter to one third stating that they rarely or never took action in these areas. Summary The experience of conducting this survey in Vanuatu has demonstrated the potential to obtain population measures of health and lifestyle needs among youth in the Pacific nations. Apart from the value of this survey in fostering collaboration to address the needs of young people in Vanuatu, it has collected a wealth of data that may be used to assist the planning of programs for this population group. The unique findings among Pacific youth mean that such studies are necessary to plan local programs, as findings cannot be generalized from European or Australian surveys. The periodic implementation of such surveys can play an important role in monitoring the extent to which health and lifestyle improvements are being made among youth in Vanuatu, and provide a source of monitoring and surveillance for emerging issues. Further initiatives of this type should be encouraged and supported, and in the longer term will enable the collection of comparative data for the Pacific nations to help identify youth health issues and development priorities at the regional level.

9

Table of Contents

Acknowledgements Vanuatu HBLPY Team Members

3 & 4

Preface Executive Summary

5, 6, 7, & 8

Section 1: Youth health and development in the Pacific 1.1 Definition of youth 1.2 Major youth issues in the Pacific 1.3 Life skills for youth development 1.4 Need for local data in the Pacific region 1.5 Organisation of this report

17

Section 2: The development of the HBLPY survey 2.1 Origins of the HBLPY survey 2.2 The confluence of needs and interests that led to HBLPY 2.3 Planning for the HBLPY survey 2.4 Developing a protocol for the conduct of the HBLPY surveys 2.5 Development of the measures used in the HBLPY surveys 2.6 Mechanisms to increase the scientific quality and sustainability of the HBLPY surveys

20

Section 3: Introduction to Vanuatu 3.1 National data and demographic country profile 3.2 Education in Vanuatu

25

Section 4: Vanuatu in-country training and needs assessment 4.1 Needs assessment (qualitative survey) 4.2 Pilot phase – testing the questionnaires 4.3 Training of survey teams

29

Section 5: Methods of the study 5.1 Vanuatu survey instrument 5.2 Survey administration protocol 5.3 Sampling and data collection 5.4 Methods of analysis

31

Section 6: Health and lifestyle behaviours of school students 6.1 The characteristics of students in the sample 6.2 Substance use 6.3 Nutrition 6.4 Physical activity 6.5 Personal well-being and development 6.6 School environment 6.7 Community participation 6.8 Trust in adults and social institutions 6.9 Physical injury, bullying and violence 6.10 Personal hygiene

37

10

Section 7: Provincial differences in the health and lifestyle behaviours of young people at school 7.1 Demographic characteristics of the sample of students from each province 7.2 Substance use 7.3 Nutrition 7.4 Physical activity 7.5 Personal well-being and development 7.6 Community participation 7.7 Trust in adults and social institutions 7.8 Physical injury, bullying and violence 7.9 Personal hygiene

72

Section 8: Health and lifestyle behaviours among out-of-school youth 8.1 Characteristics of the out-of-school sample 8.2 Substance use 8.3 Nutrition 8.4 Physical activity 8.5 Personal well-being and development 8.6 Community participation 8.7 Trust in adults and social institutions 8.8 Physical injury, bullying and violence 8.9 Personal hygiene 8.10 Sexual behaviour

80

Section 9: Comparison of health and lifestyle behaviours between young people in school and out of the school 9.1 Substance use 9.2 Nutrition 9.3 Physical activity 9.4 Personal well-being and development 9.5 Community participation 9.6 Trust in adults and social institutions 9.7 Physical injury, bullying and violence 9.8 Personal hygiene

98

Section 10: Exploration of interrelationships between behavioural factors and demographic characteristics

104

Section 11: Summary and conclusions 11.1 Summary of main findings 11.2 Conclusions

108

Appendices Appendix 1. Data tables – results of student survey stratified by age and gender Appendix 2. Data tables – results of out-of-school youth survey stratified by age and gender Appendix 3. English questionnaire version of in-school survey Appendix 4. Bislama version of in-school youth survey Appendix 5. English questionnaire version of out-of-school youth survey Appendix 6. Bislama version of out-of-school youth survey

112

11

List of Tables

17

Section 1: Youth health and development in the Pacific

19

Table 1.4 Relevance of HBLPY survey questions to Articles in the UN Convention on the Rights of the Child

25

Section 3: Introduction to Vanuatu

25

Table 3.1.1 Youth population numbers and the total populations by province 26

Table 3.2.1 Educational attainment by age and gender 27

Table 3.2.2 Proportion of the population at school

Section 5: Methods of the study

Table. 5.1.1 Questionnaire used in HBLPY Vanuatu 2000: In-school and out-of-school surveys, and comparability with WHO Europe Health Behaviour in Schoolchildren surveys

31

Section 6: Health and lifestyle behaviours of school students

Table 6.1.1 The demographic characteristics of the student sample 31

Table 6.1.2 The distribution of the student sample by age and gender 37

Table 6.2.1 Frequency of substance use 37

Table 6.2.2 Tobacco and alcohol use among young people in Vanuatu and Europe 38

Table 6.3.1 The frequency of consumption of selected foods and drinks by students 44

Table 6.3.2 The frequency of consumption of selected foods and drinks by students 45

Table 6.3.3 Consumption of soft drinks and sweets by young people in Vanuatu and Europe

Table 6.4.1 Frequency of physical activity and television watching by students 49

Table 6.4.2 Levels of exercise and television watching among young people in Vanuatu and Europe

51

Table 6.5.1 The perceived ease of talking to various people about personal problems 52

Table 6.5.2 Levels of happiness, loneliness, confidence, severe sadness and optimism about future job prospects among students

55

Table 6.6.1 Perceptions of the general environment, teachers and peers at school 60

Table 6.9.1 The frequency and causes of physical injury reported by students 68

Table 6.9.2 Frequency of being bullied, deliberately ignored or bullying others in the past school term

69

Table 6.10.1 Frequency of tooth brushing and hand washing among students 71

Section 7: Provincial differences in the health and lifestyle behaviours of young people at school

72

Table 7.1.1 The gender and age distribution by province 72

Table 7.2.1 Past use (ever) of substances by province 73

Table 7.3.1 Proportions of students who consumed various foods and drinks once per day or more by province

75

Table 7.4.1 Levels of physical activity and television watching by province 75

Table 7.5.1 The proportions of students who felt that they could easily discuss problems with various others by province

76

Table 7.5.2 The proportions of students reporting frequent loneliness or low levels of confidence by province

77

Table 7.6.1 The proportions of students who felt encouraged to express their views, that their communities were important or that they were involved in their communities by province

78

12

Table 7.7.1 Proportions of students who considered various adults and social institutions to be credible by province

78

Table 7.8.1 The proportions of students who had been physically injured, bullied or been a bully towards others by province

79

Table 7.9.1 Personal hygiene habits by province 79

Section 8: Health and lifestyle behaviours among out-of-school youth

80

Table 8.1.1 The demographic characteristics of the out-of-school sample 80

Table 8.3.1 Frequency of consumption of various foods and drinks among out-of-school youth 85

Table 8.4.1 The frequency of physical activity and televisions watching among out-of-school youth 87

Table 8.5.1 Perceived ease of talking to various people about personal problems among out-of-school youth

88

Table 8.5.2 Levels of happiness, loneliness, confidence and severe sadness among out-of-school youth

89

Table 8.5.3 Perceptions among out-of-school youth about their future education and employment prospects

90

Table 8.8.1 Levels of physical injury and bullying among out-of-school youth 93

Table 8.9.1 Frequency of tooth brushing and hand washing among out-of-school youth 94

Section 9: Comparison of health and lifestyle behaviours between young people in school and out of the school

98

Table 9.2.1 Comparisons of levels of prevalence of regular consumption of various foods and drinks between in-school and out-of-school youth (showing OR and 95% CI)

100

Table 9.3.1 Comparisons of levels of physical activity and television watching among in-school and out-of-school youth (showing OR and 95% CI)

100

Table 9.4.1 Comparisons of the proportions of in-school and out-of-school youth who found it easy to discuss their difficulties with various others (showing OR and 95% CI)

101

Table 9.5.1 Comparison of proportions of in-school and out-of-school youth who feel encouraged to express their views in various contexts (showing OR and 95% CI)

102

Table 9.6.1 Comparison of proportions of in-school and out-of-school youth who rated adults and social institutions as credible (showing OR and 95% CI)

102

Section 10: Exploration of interrelationships between behavioural factors and demographic characteristics

104

Table 10.1 Associations between health and lifestyle variables and demographic characteristics in the in-school sample

105

Table 10.2 Associations between selected behavioural factors among in-school youth 106

Table 10.3 Associations between selected mental health and psychosocial variables among in-school youth

106

Table 10.4 Associations between health and lifestyle variables and demographic characteristics in the out-of-school sample

107

Appendix 1: Data tables – results of student survey stratified by gender and age

112

Table A1.1 Parent occupation and living arrangements of students by gender and age 112

Table A1.2 Religious denomination and commitment to faith of students by gender and age

113

Table A1.3 Past use of substances (ever) among students by gender and age 114

Table A1.4.1 Dietary habits of students by gender and age 115

Table A1.4.2 Dietary habits of students by gender and age 116

Table A1.5 Physical activity habits of students by gender and age 117

Table A1.6.1 Social support and mental well-being of students by gender and age 118

Table A1.6.2 Social support and mental well-being of students by gender and age 119

13

Table A1.6.3 Social support and mental well-being of students by gender and age 120

Table A1.7.1 Encouragement to express views and perceived credibility of adults and social institutions among students by gender and age

121

Table A1.7.2 Encouragement to express views and perceived credibility of adults and social institutions among students by gender and age

122

Table A1.8 The importance of, and involvement in, community among students by gender and age 123

Table A1.9 Physical injury and bullying experienced by students by gender and age 124

Table A1.10 The personal hygiene habits of students by gender and age 125

Appendix 2: Data tables – results of out-of-school youth survey stratified by gender and age

126

Table A2.1 Parental occupation and living arrangements of out-of-school youth by gender and age 126

Table A2.2 Christians denomination and commitment to faith of out-of-school by youth gender and age

127

Table A2.3 Past use of substances (ever) among out-of-school youth by gender and age 128

Table A2.4.1 Dietary habits of out-of-school youth by gender and age 129

Table A2.4.2 Dietary habits of out-of-school youth by gender and age 130

Table A2.5 Physical activity habits of out-of-school youth by gender and age 131

Table A2.6.1 Social support and mental well-being of out-of-school youth by gender and age 132

Table A2.6.2 Social support and mental well-being of out-of-school youth by gender and age 133

Table A2.6.3 Social support and mental well-being of out-of-school youth by gender and age 134

Table A2.7 Reason for leaving school, job prospects and the likelihood of future training among out-of-school youth by gender and age

135

Table A2.8.1 Encouragement to express views and perceived credibility of adults and social institutions among out-of-school youth by gender and age

136

Table A2.8.2 Encouragement to express views and perceived credibility of adults and social institutions among out-of-school youth by gender and age

137

Table A2.9 The importance of, and involvement, in community among out-of-school youth by gender and age

138

Table A2.10 Physical injury and bullying experienced by out-of-school youth by gender and age 139

Table A2.11 The personal hygiene habits of out-of-school youth by gender and age 140

List of Figures

Section 3: Introduction to Vanuatu

25

Figure 3.1.1 Level of educational attainment among the general population aged 5 years and over 26 Figure 3.2.1 Number of secondary schools by province 27 Section 6: Health and lifestyle behaviours of school students

37

Figure 6.1.1 Parental occupation of students 38 Figure 6.1.2 Proportion of students living with parents most of time 39 Figure 6.1.3 Location of parental residence if students 39 Figure 6.1.4 Number of people living with students

40

Figure 6.1.5 Religious denomination of students 40 Figure 6.1.6 Strength of commitment to faith 41 Figure 6.2.1 Students who have ever used substances or used them at least weekly 42 Figure 6.2.3 Male students who have ever used substances 43 Figure 6.2.2 Female students who have ever used substances 43

14

Figure 6.2.4 Frequency of being drunk in the past 44 Figure 6.3.1 Consumption of various foods and drinks more than once per day 47 Figure 6.3.2 Consumption of selected foods and drinks once per day or more by age and gender 47 Figure 6.3.3 Consumption of selected types of food and drink once per day or more by age and

gender 48

Figure 6.4.1 Time spent in physical activity and television watching 50 Figure 6.4.2 Time spent engaged in physical activity and television watching by boys at each age

level 50

Figure 6.4.3 Time spent engaged in physical activity and television watching by girls at each age level

51

Figure 6.5.1 Individuals that students identified as easy to approach about personal problems 53 Figure 6.5.2 Proportions of students finding it easy or very easy to communicate with parents,

siblings or other adults by age and gender 53

Figure 6.5.3 Proportions of students finding it easy or very easy to communicate with friends, youth workers or clergy by age and gender

54

Figure 6.5.4 Proportion reporting low levels of happiness, confidence or optimism about future job prospects and high levels of loneliness or sadness

55

Figure 6.5.5 Proportion reporting low levels of happiness or confidence and high levels of loneliness or sadness by age and gender

56

Figure 6.5.6 Persons turned to for support by students experiencing severe sadness or depression 57 Figure 6.5.7 Persons turned to for support by students feeling very sad or depressed by sex 58 Figure 6.6.1 Means school environment scores by gender and age (with 95% confidence intervals) 61 Figure 6.6.2 Mean ratings of teachers by gender and age (with 95% confidence intervals) 62 Figure 6.6.3 Mean ratings of the peer environment by gender and age (with 95% confidence

intervals) 63

Figure 6.7.1 Level of encouragement students received to express their views in various contexts 64 Figure 6.7.2 Proportions of students who felt encouraged to express their views in different contexts

by age and gender 64

Figure 6.7.3 Ratings of the importance of the community 65 Figure 6.7.4 Perceived level of involvement in the community 65 Figure 6.7.5 Proportions of students who rated the community as very important or who felt

strongly involved in the community by age and gender 66

Figure 6.8.1 Perceived credibility of adults and social institutions 67 Figure 6.9.1 The proportion of students who suffered any injury or a deliberate injury caused by

another person in the last 12 months, by gender and age 68

Figure 6.9.2 Proportions of students who had been bullied, deliberately ignored or who had bullied others in the past school terms by age and sex

70

Figure 6.10.1 Proportions of students who frequently brushed their teeth and washed their hands by age and gender

71

Section 7: Provincial differences in the health and lifestyle behaviours of young people at school

72

Figure 7.2.1 Proportions of students who had ever been drunk by province 73 Figure 7.5.1 Levels of unhappiness by province 76 Figure 7.5.2 Severe sadness or depression among students by province 77 Figure 7.8.1 Proportions of students who had suffered a deliberately inflicted injury by province 79 Section 8: Health and lifestyle behaviours among out-of-school youth

80

Figure 8.1.1 Parental occupation of out-of-school youth 81 Figure 8.1.2 Proportion of out-of-school youth living with patents most of the time 81 Figure 8.1.3 Location of parental residence of out-of-school youth 82 Figure 8.1.4 Number of people living with out-of-school youth 82

15

Figure 8.1.5 Religious denomination of out-of-school youth 82 Figure 8.1.6 Strength of commitment to faith among out-of-school youth 83 Figure 8.2.1 Proportions of out-of-school youth that reported ever trying substances 83 Figure 8.2.2 Proportions of out-of-school youth that reported ever trying substances by age and

gender 84

Figure 8.3.1 Consumption of various foods and drinks more than once per day among out-of-school youth

85

Figure 8.5.1 Proportions of out-of-school who identified various people as easy to approach to discuss personal problems

88

Figure 8.5.2 Proportion of out of school youth reporting low levels of happiness or confidence and high levels of loneliness or sadness

89

Figure 8.6.1 Level of encouragement out-of-school youth received to express their views in various contexts

91

Figure 8.6.2 Perceived importance of, and involvement in, community among out-of-school youth 91 Figure 8.7.1 Perceived credibility of adults and social institutions among out-of-school youth 92 Figure 8.8.1 Experience of injury, bullying and being a bully towards others among out-of-school

youth 94

Figure 8.10.1 Proportion out-of-school youth who reported ever having sex by gender 95 Figure 8.10.2 Past number of sexual partners among sexually active out-of-school youth by gender 96 Figure 8.10.3 Proportion of sexually active out-of-school youth reporting unwanted sex when drunk

or high on drugs 96

Figure 8.10.4 Use of contraception by sexually active out-of-school youth 97 Figure 8.10.5 Use of measures to protect against sexually transmitted infections by out-of-school

youth 97

Section 9: Comparison of health and lifestyle behaviours between young people in school and out of the school

98

Figure 9.0.1 Age distribution of the in-school and out-of-school samples 98 Figure 9.0.2 Gender breakdown and location of parent’s residence of the in-school and out-of-

school samples 99

Figure 9.1.1 Comparison of the use of substances between in-school and out-of school youth (showing OR and 95% CI)

99

Figure 9.4.1 Comparison of levels of mental distress between in-school and out-of-school youth (showing OR and 95% CI)

101

Figure 9.7.1 Comparisons of levels of physical injury and bullying between in-school and out-of-school youth (showing OR and 95% CI)

103

Figure 9.8.1

Comparisons of frequency of personal hygiene habits between in-school and out-of-school youth (showing OR and 95% CI)

103

Abbreviations used HBSC Health Behaviour in School Children HBLPY Health Behaviour and Lifestyle of Pacific Youth ISY In-school youth NZODA New Zealand Office of Development and Aids OOSY Out-of-school youth UNICEF United Nations Children’s Fund WHO World Health Organization

16

WPRO Western Pacific Regional Office

17

Section 1 Youth health and development in the Pacific

1.1. Definition of youth The Pacific region includes geographically and culturally diverse island nations with demographically young populations. The definition of “youth”, varies in its socio-cultural definition across the Pacific and for the purposes of this report it is important to clarify the definition of youth. The UN/WHO definitions are as follows: • young person between 10 –24 years of age;

• adolescent between 10 – 19 years of age; • youth between 15 – 24 years of age. The Health Behaviour and Lifestyle of Pacific Youth (HBLPY) survey has focused primarily on those between the ages of 11 and 19 years of age and thus is in keeping with the age focus of the UNICEF Youth Health and Development project, which is targeted to 12–18 year old Pacific Islanders. For practical reasons, the term “young people” or “youth” will be used interchangeably to refer to all the HBLPY survey participants between the ages of 11 and 19 years; these terms will be inclusive of the other general words “children” or “adolescents”. Where applicable, the terms “school students” or “students” will refer to the in-school survey sample. 1.2. Major youth issues in the Pacific Youth issues in the Pacific can be classified into three broad areas: Health and development, education, and employment. These issues and concerns of youth are often linked, and influence each other. In recent years, there has been an improvement in the health status of Pacific Islanders in general with an increasing life expectancy and reduction in infectious disease prevalence with the exception of Sexually Transmitted Infections (STIs) and HIV/AIDs. On the other hand, chronic diseases related to lifestyle behaviours are on the increase. The pattern of health and disease among young people is different to the leading causes of mortality and morbidity for adults in the general population. The principal sources of morbidity and premature mortality among young people include unwanted pregnancy, STIs, mental illnesses, injury due to motor vehicle accidents, excessive drinking or drug use, and dietary-related illnesses or eating disorders. Young people in the Pacific are increasingly being exposed to the risk factors associated with the rapidly changing social, physical and cultural environments, such as increasing urbanization, decreasing consumption of local foods, shrinking job opportunities, and the availability and accessibility of cheap cigarettes and alcohol. Educational opportunities are limited for disadvantaged youth in many Pacific Island countries. While the concept of education for all has been embraced throughout the Pacific, the reality for many young people is that the available resources are not sufficient for them to take advantage of whatever educational facilities might be present. Secondary schools are limited in number in many countries and only the most talented of students are

18

able to make the progression from primary to secondary school. A direct consequence of this is high rates of youth unemployment as the non-formal education sector is yet to be developed to a level to which these young people can be accommodated (UNICEF Pacific, State of Pacific Youth 1998)1. 1.3. Life skills for youth development UNICEF Pacific recently initiated a youth life skills project in the Pacific, a move that signified the need for targeted programming in this category and the subsequent emergence of youth as a priority age group for UNICEF worldwide. The objective of the life skills project is to involve 20% of Pacific Island youth in selected countries in gaining the life skills to build self-esteem and to enable them to lead healthier and productive lives. This is to be achieved through the design and implementation of a country specific life skills curriculum that will be disseminated through already existing youth structures outside of the school environment. This is not to say, however, that the curriculum will serve out of school youth exclusively, school students are part of this target group and will be reached through their extra curricular activities. The strategy is to involve youth in assessing their situation and participating in the design and implementation of a program that develops positive self-esteem and skills to prevent risk behaviours. The Health Behaviour and Lifestyle of Pacific Youth (HBLPY) survey has involved youth in the needs assessment phase of this life skills project, from the qualitative phases and translation of questionnaires through to the data interpretation phase, a process to be described in detail later. 1.4. Need for local data in the Pacific region Generally, there is a dearth of quality and up-to-date information available about the health status of adolescents or young people at national or regional levels in the Pacific. While Pacific island governments recognize the importance of addressing the health and developmental needs of young people, health services and campaigns to encourage young people to engage in positive health and lifestyle practices have often been based on anecdotal information. Obtaining quality information about the health and lifestyle characteristics of Pacific youth is one step forward to ensuring that every youth has the right to the highest standard of health and supportive care attainable. To develop effective youth programmes and appropriate policy for the promotion of positive youth development, it is important to identify the existing patterns and prevalence of key youth health and lifestyle characteristics, and the factors associated with substance use, nutrition, physical activities, mental health and social support. This report presents findings from the HBLPY survey conducted in Vanuatu, which has its origins in the UNICEF Pacific life skills project. This is the third HBPLY survey that has been conducted in the Pacific region; the first two were carried out in Vanuatu and Tonga. The project is linked to the Western Pacific Regional Office (WPRO) of WHO, and has links to similar surveys in European countries and in Australia in recent decades. The HBLPY survey incorporates an element of a situation analysis whereby the principal risk behaviours of youth are assessed. The intention is that the findings from the series of surveys will form an evidence base for planned interventions. Many of the behaviours investigated have direct relevance to core UNICEF concerns, that is, that the essential needs of every child and youth should be given high priority at national and international as well as at community and family levels. Governments, non-government organizations, international agencies and individuals all have a duty to ensure that every child and young person is protected from harm and has the opportunity to grow and develop to their full potential; these rights are clearly set out in the Convention on the Rights of the Child (CRC). Many of the behaviours and lifestyle issues investigated in the HBLPY survey specifically addressed selected Articles of the CRC, as shown in Table 1.4 below. The data gathered and

1 UNICEF Pacific. State of Pacific Youth Report 1998.

19

presented here represents a major step forward in galvanizing evidence to support youth rights and development in the Pacific. Table 1.4 Relevance of HBLPY survey questions to Articles in the UN Convention on the Rights

of the Child

Selected CRC Articles Relevant HBLPY Survey Items “All children have the right to their protection and care to be ensured by states as a matter of high priority.” (Article 3) “Every child has the right to freely express their opinion taking account of their age and maturity.” (Article 12) “Both parents have common responsibilities for the upbringing and development of every child.” (Article 18) “Every child or adolescent has the right to maintain personal relations and direct contact with both parents on a regular basis, even if separated from one of them.” (Articles 9, 10, 21) “Every young boy, girl and adolescent has the right to be protected against all forms of violence.” (Articles 19, 34, 37) “Every young boy, girl or adolescent has the right to freedom of association and to participate freely in cultural, artistic, recreational and leisure activities.” (Articles 15 and 31) “Every young boy, young girl and adolescent has the right to a quality education, in varied forms and structures for different levels, available under conditions of equal opportunity for all, and designed to promote the development of the individual’s personality and potential.” (Articles 28 and 29) “Every child has a right to the highest standard of health and medical care attainable.” (Article 24) “Children have the right to protection from the use of narcotics and psychotropic drugs, and from being involved in their production or distribution.” (Article 33)

• Levels of trust and credibility in adults and social institutions.

• Freedom to express opinion in schools. • Freedom to express opinion in community

and family contexts. • Ease of communication with parents and

others. • Mental health and coping techniques. • Location of parental residence. • Living with parents. • Occurrence of physical abuse, intentional

violence and injury. • Rates of bullying and physical abuse. • Preferred lines of communication. • Community involvement and community

participation. • Comparison of out-of-school and in-school

youth. • Overview of health behaviour among youth;

equity and socio-economic status dimension of youth health explored.

• Self-reported levels of mental health,

happiness, well-being. • Frequency of use of major drugs in each

country, core questions on smoking, alcohol, marijuana, and kava

1.5. Organisation of this report This first section defines the terminology used in the report and provides a brief overview of the youth health development activities auspiced by UNICEF Pacific, highlights major issues affecting youth and establishes the need for regional data on youth for programming purposes. Section 2 looks at the origins and development of the HBLPY survey within the Pacific context. This section also describes in detail the planning for the implementation of the HBLPY surveys. The background profile of the country of Vanuatu is given in Section 3. Section 4 outlines the conduct of needs assessment and in-country training of the youth survey teams. The survey instruments and methodological issues relating to the HBLPY survey are provided in Section 5. Sections 6 to 10 present findings from the HBLPY survey. Results are presented for the in-school youth, out-of-school youth and at the province level. Section 11 reviews and discusses the key findings of the survey.

20

Section 2 The development of the HBLPY survey 2.1. Origins of the HBLPY survey This section describes the origins, development and planning process of the Health Behaviour and Lifestyle of Pacific Youth (HBLPY) survey. This survey had diverse origins, which came together during 2000, and led to the planning for, and implementation of the survey. The HBLPY is a survey to assess and monitor the health and lifestyles of national samples of young people in the Pacific region. No previous attempts have systematically measured the behaviours, lifestyles, physical and social environments of youth in this region. The survey has a historical link to the Health Behaviour in School Children (HBSC) set of surveys conducted by WHO Europe since 1982. This was a collaborative endeavor to measure and monitor the physical, social and psychological health of young people in European countries, commencing with a collaboration between three countries in 1982. Since then, there have been several rounds of the HBSC surveys being conducted every four years, involving young people aged 11-15 years. The most recent surveys were in 1997/1998; 28 countries participated in this survey2. The European HBSC group has an overall coordinating centre. Over nearly two decades this group has developed methods for collecting and tracking information at a representative population level about youth health. The HBSC results have been used for research purposes to better understand youth health and development, and in national policies and programs, and more widely, as part of the WHO Europe monitoring strategy for youth health. The HBSC surveys are random samples of national populations, or at least of a large region within a nation3. The target population is school-aged students who are 11, 13 and 15 years old. It is expected in HBSC surveys that 90% of the sampled students from the classes chosen to be in the survey will be aged between 11 and 12 years, 13 and 14 years, and 15 and 16 years of age at the time of the survey. The sampling process involves the random selection of schools from which all students in the relevant school years are surveyed. As this cluster sampling approach may increase the variance around prevalence estimates, the sample size is inflated to adjust for this. The HBSC survey group recommends 1,536 students in each of these 3 age bands for sufficient precision for national estimates. The data are collected for each survey within the same defined period of time in most countries. The objectives of the HBSC analysis are to report the prevalence rates of youth health phenomena, to make cross national comparisons between countries, to explore the determinants or factors associated with positive and negative health behaviors and states among young people, and to observe changes and trends over time within and between countries. The HBSC survey has been an excellent example of international collaboration and has obtained quality data about youth in Europe over many years. Few examples have succeeded in this kind of youth survey in other

2 Health behaviour among young people. Eds. Currie C, et al. HBSC, WHO Europe 2000. Policy series for children and adolescents #1.

3 There is a standardized approach to population sampling, a standardized questionnaire, an established protocol for survey implementation and data management, and consistent approaches to analysis and interpretation. The surveys usually have a core component, which is a set of questions consistently asked among countries, and then specific focus, or supplementary areas, which are optional modules.

21

parts of the world, with the exception of the United States where the Youth Risk Behaviour Survey (YRBS) is carried out very effectively by the Centers for Disease Control. Other places where HBSC-type surveys have been conducted are Africa, Indonesia and in Malaysia, but have not been adopted in the wider region in which these countries are located. The present HBLPY initiative is based on strong partnerships and a sound understanding of the HBSC survey, and benefits from the support the HBSC group in Europe. Communication between the Pacific region and the European group has occurred for many years, and this has facilitated some of the developments of the HBLPY initiative. Some attempt has also been made in the HBLPY initiative to develop some questions in common with the HBSC group, with a view to comparing developing countries in the Pacific region with the developed countries of the European region. 2.2. The confluence of needs and interests that led to HBLPY In 2000, UNICEF Pacific initiated the life skills curriculum programme among Pacific out-of-school youth (see Section 1 for detailed discussion). This programme incorporates an element of a situation analysis whereby the principal risk behaviours of the relevant population are assessed. Youth agencies and government ministries in Vanuatu, Tonga and the Federated States of Micronesia also expressed growing interests in obtaining population-based and up to date information on the health and lifestyle status of youth for programme planning and policy development. The World Health Organisation (WHO/WPRO) is also developing an adolescent health strategy that encapsulates the northern countries of the Pacific and includes a life skills component. This interest is also related to strategic developments in Health Promoting Schools in the region. In 1999, UNICEF and WHO collaborated on the conduct of the Fiji segment of the Global Youth Tobacco Survey (GYTS)4. Important lessons have been learned about: the establishment of systems for tracking health behaviours; the desirability of such a system; its potential impact on public health; the availability of local capacity and regional data management and analysis support, and; the scope for developing local capacity for the conduct, analysis, and application of such surveys. The primary focus of GYTS, however, was on tobacco use and it was felt that a broader assessment of youth health needs to be taken. The Australian Centre for Health Promotion (ACHP), based in Sydney, had developed expertise in the conduct of surveys on the health behaviour of schoolchildren in the state of New South Wales, Australia5. During the 1990s, the Centre had also conducted several training programs for health and education professionals from Pacific Island countries, under the auspices of Health Promoting Schools movement. Here, the need for baseline national data on the health of young people was recognized. Regional health workers were aware of the HBSC surveys conducted in New South Wales since 1992, and the relevance of such data collections for national and regional initiatives to promote the health of young people. Working with UNICEF and WHO, the ACHP provided technical support to this survey and technical capacity building in the region. 2.3. Planning for the HBLPY survey

4 Meo, L and Movono I. Global Youth Tobacco Survey. Fiji Field Survey Report. July 2000. UNICEF Pacific. Suva, Fiji. July 2000

Warren LW, Riley L, Asma S, Eriksen MP, Green L, Blanton C, Loo C, Batchelor S, Yach D. Tobacco use by youth: A surveillance report from the Global Youth Tobacco project. Bulletin of the World Health Organization, 2000:78(7).

UNICEF Pacific. Substance use among adolescents in Fiji: A surveillance report from the Fiji Global Youth Tobacco Survey. UNICEF Pacific, Suva, Fiji. 2001.

5 The Centre conducted statewide and regional HBSC-like surveys in 1992 and 1996. Its research director had served as an external methodological adviser to the WHO EURO HBSC consortium since 1994.

22

In June 2000, representatives from UNICEF Pacific, WHO/WPRO and the Australian Centre for Health promotion met in Sydney to devise an HBLPY work plan for presentation to the countries participating in the UNICEF-support life skills curriculum programme. The meeting developed into a Technical Advisory Group or steering group for the ongoing planning of HBLPY, comprised of Dr. Ayoade Olatunbosun-Alakija and Dr. Philayrath Phongsavan from UNICEF Pacific, Dr. Gauden Galea from WHO (WPRO Regional Adviser, Health Promotion), and Professor Adrian Bauman (Research Director, Australian Centre for Health Promotion)6. The initial tasks of the group were to develop core principles and procedures for HBLPY. The options discussed were either to adapt the North American (Centres for Disease Control) YRBS project or to use the European HBSC model. The latter was selected as it has been used in multiple contexts, languages and cultures and was considered more flexible for adaptation to new environments. The framework was based on the HBSC experience, but adapted to a Pacific country context. The main tasks of the initial planning process were then to: § define the core questions for use in the initial Pacific Island country surveys;

§ develop a work plan around measurement development and testing;

§ develop a research design and protocol for Pacific country HBLPY surveys, which would allow comparability within countries over time, between countries in the Region, and with other countries outside the Region, especially the HBSC group, and;

§ identify the roles of a regional support centre in research capacity-building, survey analysis, data archiving, and cross-national analysis of data from multiple countries.

2.4 Developing a protocol for the conduct of the HBLPY surveys The HBLPY survey has several purposes: § to inform the development of youth health interventions, especially the life skills curriculum programme; § assist countries in tracking trends in youth health behaviour over time, in order to gauge the need for new

interventions and to monitor the net effectiveness of existing ones; § enable comparisons with similar data from different countries in the Pacific, and; § contribute to a better understanding of the factors associated with positive and negative youth health states

and behaviours. The overall design is a cross sectional analytic study, based on a representative population sample of youth in each country. As with the HBSC, the HBLPY is primarily a school-based survey. Key differences in some Pacific countries include different levels of school enrolment at different ages and different levels of literacy. Thus, each sample would differ from country to country with different needs for sampling of in-school youth and out-of-school youth. Also different methods of administration may need to be used: self-completion is preferred for international consistency, but in some contexts, interviewer administration of questions are needed. The planning group recommended that, rather than impose a definite system to be used by all Pacific countries, a high level of customization would be permitted. A central feature common to all surveys should be to ensure that all countries had at least samples of youth aged 13 and 15 that were surveyed by the same mode of administration, using at least a core set of questionsl. This would provide similarly collected data to permit inter-

6 In attendance was Dr Kaili Kepler, who was a visiting Fellow in Sydney, and who is the Estonian country coordinator of HBSC, and works

also on the Finnish HBSC program.

23

country comparisons. Other aspects of the design would be geared to each country’s special needs. Among the features of the design that might vary would be the sample size, mode of administration, and whether an out-of-school youth sample was required. For the initial countries to be surveyed in the region, a detailed protocol was developed and published in September 2000 (Phongsavan P, UNICEF Pacific)7. The main aims of the technical manual were to provide survey staff with background information on the survey, to outline procedures on how to prepare for and conduct the surveys in the field, and to provide standard information in response to queries about the questionnaire from students and young people. This manual outlined systematic approaches to the random sampling of schools, survey preparation and administration, data collection procedures and handling of data prior to data entry. Other technical issues such as consent, privacy and confidentiality were also discussed. School record-keeping and registration forms, and information for parents, teachers and young people themselves were also addressed. 2.5 Development of the measures used in the HBLPY surveys The survey instrument used in the HBLPY survey was based on the European HBSC questionnaire. Details of the final instrument for Vanuatu are shown later in Section 5. Another report produced alongside this one defines the questionnaire and research protocol in detail8. The core domains of measurement represent the high-priority areas for investigation relevant to youth across the Pacific countries. This core set of measurements has many comparable questions with the HBSC protocol and will be monitored across countries and over time in the Pacific. The core domains in the HBLPY surveys include: demographic questions such as age, school class, gender, household size, parental occupation, and religion; substance use; social and family connections; peer relationships; mental health; school environments; hygiene; physical activity, and; nutrition. Optional questions may be developed in other domains, based on local need; these domains may include sexual health, bullying and violence, physical health and somatic symptoms, future life prospects, questions on body image, weight and height, self-esteem and confidence. 2.6 Mechanisms to increase the scientific quality and sustainability of the HBLPY

surveys The long-term aim of the survey is to set up a sustainable process in which Pacific countries could participate. This would produce cross-national estimates for a range of developed and developing countries, relevant to the policy and program needs of multiple agencies including public health and education organizations across the region. In the medium term, there is a commitment on the part of UNICEF to develop a 5-country life skills curriculum programme and on the part of WHO to support youth health development in the region. Results from the HBLPY will be used to support these initiatives. To increase the scientific rigor and sustainability of the HBLPY surveys, it was decided that stable scientific and technical support at the regional level was required. In this initial phase of surveys, the Australian Centre for Health Promotion would act as regional data management centre. The centre would be involved in each country survey, and contribute to the following tasks:

§ providing technical advice in the adaptation of instruments to each country, sampling for each country and the implementation of each survey;

7 UNICEF Pacific. Health Behaviour and Lifestyle of Pacific Youth. Field Manual and Guidelines. Suva, Fiji Islands, 2000

8 Further details on the specific questions proposed, and their rationale are available from the Data Centre on request.

24

§ conducting data analysis and producing country-level reports, using standard approaches. These reports would include documentation of (i) the process and methods of the HBLPY, (ii) data analysis and methods, (iii) interpretation of results and (iv) recommendations for participating countries about the main issues for youth, and;

§ storing national datasets for comparative analyses, as well as for archiving. The longer term aim, after country-level reports have been written, is to disseminate a regional publication summarizing data regarding youth health across the Pacific region.

The steering group agreed that data collection would be the task of the in-country (national) survey teams. Data entry would be on site (if supervised by appropriately trained staff), or forwarded to the data centre for entry9.

NOTE ON DATA OWNERSHIP AND USAGE

Ownership for each dataset would reside with the country agency involved in each survey; each country will have absolute jurisdiction on whether access to its data was permitted or prohibited by any given research project. It is understood that data collected for any country will result in at least one country-specific report; each country will decide whether the report is just for local or international publication. Access to the dataset for further studies and publication would be governed by the HBLPY steering group with representatives from each participating country, UNICEF, WHO, and the regional data management centre. The HBLPY steering group would encourage dissemination of these findings through the region, as well as encouraging regional countries to participate10.

9 The survey focuses on the development of local research capacity through training activities in the conduct of surveys, data entry, and

simple approaches to data analyses, interpretation and application of results to public health action. These activities would be conducted under the supervision of staff from the Data Centre.

10 As with the European HBSC study, support of a technical and advisory nature is provided by the steering committees, but countries need to support and fund their own data collections, assist with sampling, contact schools and undertake other aspects of field work. Countries are then provided with a report and with copies of their own data sets for subsequent use.

25

Section 3 Introduction to Vanuatu 3.1. National data and demographic country profile Vanuatu is a small Pacific Island nation, which became independent (of Britain and France) in 1980. It is comprised of more than 80 islands, stretching 900km in length in the South Pacific region. It is about 800km west of Fiji, and 2,000km east of Australia. Vanuatu has 189,000 inhabitants and has a land area of 14,760km2. It is a tropical country, with most islands having rugged central volcanic mountainous regions. Less than 10% of the land area of the country can be used for habitation, farming or pastures. The majority of the population is young, with 43% less than 15 years of age. It has a high population growth rate (2.2%), and relatively low life expectancy (59.7 years). Its health profile is typical of developing countries, with an Infant Mortality Rate of 66 per 1,000 live births (compared to rates of 5-10/1000 in most developed countries). More than 90% of the population is comprised of Melanesian peoples, although within that broad grouping, more than 100 language groups are present. The remaining populations include small numbers of Europeans (English and French speaking), Chinese, Vietnamese and other Pacific Islander groups. The main languages are English, French, and the most widely spoken Pidgin, known as Bislama. Vanuatu is a religious country, with high rates of church attendance. The most prevalent religions are Presbyterian (37%), Anglican (15%), Catholic (15%), Seven Day Adventist (6%), Church of Christ (4%) and Indigenous Beliefs (8%). Overall, there is low literacy in the population with only 53% of the adult population able to read and write. There are six administrative divisions (provinces) in Vanuatu: Malampa, Penama, Sanma, Shefa, Tafea and Torba. Populations are reasonably evenly divided among the five largest provinces, but Torba is much smaller (population of 7,000). Most of the population of Vanuatu (>80%) live in rural communities and villages. Apart from the few towns, transportation routes are limited, and access to imported goods is variable, with many communities not having electricity, television or much in the way of consumer goods. There is a strong religious tradition, as well as strong roots in Melanesian culture. Apart from tourism, there is little developed industry. Most rely on subsistence farming and local materials to meet their daily needs. Access between islands may be costly or the distances quite substantial. Compared to some Pacific nations, Vanuatu is less urbanized and more geographically spread out. Demographic data cited in this report are derived from the 1999 National Census. Data are shown below for total populations, and for populations of young people, stratified by province. The key demographic characeristics of the population are listed below. § The number of households increased from 14,937 in 1967 to 36,415 in 1999.

§ The total population increased from 78,000 in 1967 to over 188,000 in 1999.

§ 43% are aged less than 15 years, compared to 20% less than 15 years in Australia, but quite similar to the estimate of 35% of the population of Fiji being aged less than 15 years.

§ Around 18% of the Vanuatu population live in two main centres, Port Vila and Luganville, with 82% living in villages or rural communities.

26

Table 3.1.1 below presents population data for Vanuatu and shows the high representation of infants, children and adolescents in the population. This trend is similar across the provinces. Table 3.1.1 Youth population numbers and the total populations by province

Age Province 0-4 yrs 5-9 yrs 10-14 yrs 15-19 yrs

Total national population

Malampa 4611 4722 4476 3149 32705 Penama 4018 3923 3501 2580 26646 Sanma 5280 5130 4461 3539 36084 Shefa 7159 7036 6231 4988 54439 Tafea 4904 4503 3843 2315 29047 Torba 1264 1258 1090 714 7757 Total country 27236 26572 23602 17285 188878 Source: Vanuatu Census, 1999 Figure 3.1.1 shows the level of education in the general population in Vanuatu. More than half had only attended primary school and a further one fifth had not attended school at all11. This indicates the general educational level of the population, but also poses specific challenges for school based surveys. For nations such as Vanuatu, there may be value in surveys of out-of-school youth, to complement in-school surveys. Figure 3.1.1 Level of educational attainment among the general population aged years

and over

21%

59%

13%

3%

3%

1%

Not attended school

Primary only

Junior secondary

Senior secondary

Vocational, post secondary

Not stated

Census estimates (Statistics Vila, 2000)

11 This poses challenges for generalizing the results of any school-based surveillance system, as many young people will

be out of school; a partial method of addressing this was to sample out-of-school as well as in-school youth in Vanuatu.

27

3.2. Education in Vanuatu Table 3.2.1 shows the level of education of young people under 19 years by age and gender. Around half achieved primary schooling, with no marked differences between boys and girls. About 37% attended secondary school, with attendance rates marginally higher among boys (38%) than girls (36%). Table 3.2.1 Educational attainment by age and gender

Age Total % never went to school

% primary schooling

% secondary schooling

Current total aged: 5 – 9 years 10 – 14 15 –19

26572 23602 17285

40.47 10.29 9.68

58.55 75.42 49.96

0

13.69 37.14

Girls aged: 5 – 9 years 10 – 14 15 –19

12902 11304 8418

40.47 10.05 9.99

58.77 74.60 50.67

0

14.73 36.42

Boys aged: 5 – 9 years 10 – 14 15 – 1 9

13670 12298 8867

40.48 10.51 9.37

58.48 76.17 49.28

0

12.81 37.81

Source: Vanuatu Census, 1999 Note: Row totals do not quite add up to 100% - the remaining few percent were ‘don’t know’ responses in the Census. Table 3.2.2 presents the proportion of young people staying at school by age and gender. It indicates a substantial drop in school attendance from 78% among 10-14 year olds to 32% in 15-19 year olds. This situation is similar in both genders. Table 3.2.2 Proportion of the population at school

Age Total % at school % attended school in the past

% never went to school

Current total: 5 – 9 10 – 14 15 –19

26572 23602 17285

63.33 78.21 32.26

0.95 12.25 58.27

18.05 9.37 9.26

Girls: 5 – 9 10 – 14 15 –19

12902 11304 8418

63.22 78.45 31.02

0

12.22 59.50

17.90 9.13 9.65

Boys: 5 – 9 10 – 14 15 – 19

13670 12298 8867

63.42 77.98 33.78

0.98 12.29 57.10

18.19 9.59 8.89

Source: Vanuatu Census, 1999 Figure 3.2.1 shows the number of secondary schools in Vanuatu. Due to low literacy levels at the primary school level, only secondary schools were included in the survey. However, two Port Vila international secondary schools were excluded from the HBLPY surveys (Shefa province), as were schools with estimated enrolments less than 10 pupils. After the exclusion of six schools 41 were eligible for inclusion, and of these 31 were surveyed. This provides a sample of schools which approaches all secondary schools in the country. The non-attendance rates at secondary school by adolescents, shown in the national Census data, prompted the need for an out-of-school survey as well.

28

Figure 3.2.1 Number of secondary schools by province

7

5

813

2

12

Tafea

Torba

Sanma

Malampa

Penama

Shefa

29

Section 4 Vanuatu in-country training and needs assessment 4.1. Needs assessment (qualitative survey) In July 2000, the UNICEF Pacific Youth Officers conducted a key stakeholder needs assessment in Vanuatu. Key informants included the government Ministries of Health, Education, and Youth, and youth leaders from various organisations. In addition, meetings with key stakeholders were held, including the Peace Corps Vanuatu, Foundation for the Peoples of the South Pacific, Wan Smolbag and other agencies. There was general endorsement of the need for the HBLPY survey and its timeliness in Vanuatu. A range of views about the feasibility of self-administered surveys and the potential to obtain a representative sample were expressed during this phase and these were used to guide the subsequent planning of the survey. While UNICEF Pacific co-ordinated and supervised on-the-ground survey activities, the strong support from the Ministry of Education and by the Peace Corps enhanced the quality of the survey implementation process. 4.2. Pilot phase – testing the questionnaires A comprehensive process of testing the draft instrument under field conditions was carried out in July 2000. The steps in this process are outlined below. § Careful translation and back translation of the questionnaire from Bislama to English. § Pilot testing of questionnaires with in-school youth and out-of-school youth, using both self-completed and

interviewer administered formats. Because of the high variability in literacy of students aged 13 years and below the feasibility of the self-completed format was not tested with this age group. Literacy was also recognised as a common problem among out-of-school youth, so interviewer administered protocols were developed for this group.

§ Final revisions were made to the instrument based on focus group discussions with pilot survey completers regarding the meaning, interpretation and likely relevance of each question.

§ During the pilot phases sampling issues were resolved for the in-school youth sample, with State lists of schools and census information obtained.

Communications among the Technical Advisory Group, and with the Data Centre facilitated this development process, and resolved most technical issues. 4.3. Training of survey teams In September 2000, the UNICEF Pacific Youth Officer conducted data collection training with 17 ni-Vanuatu youth leaders from urban and rural Vanuatu and six United States Peace Corps Volunteers (PCV). The primary goal was to train all participants in the methods of data collection and logistics management for the HBLPY survey. This training was seen as a means of enhancing the research capacity of young people in Vanuatu and increasing the potential sustainability of the HBLPY process. These activities were complementary to UNICEF priorities of life skills training and capacity building for youth in the region. The 17 youth had been identified through Provincial Youth Councils and PCV in their localities. The role of the PCV was to provide a supporting and supervisory role for these young people out in the field and to utilise their rural communication channels to provide a link between field staff in remote areas and the survey co-ordinator in the capital, Port Vila. Working through the UNICEF Vanuatu field office, the Youth Officer conducted an initial 6-day training programme addressing: the aims of the HBLPY survey; the historical context and background of the HBLPY

30

project; the collaborating organizations and institutions, and; the potential application of the data to future interventions which would impact directly on their lives. Further training focused on the development of the survey instrument, the need for confidentiality and standardization and modes of administration of the questionnaire for both in-school and out-of-school youth. For reasons of literacy the training was mainly conducted in Bislama, with most of the work being done in small group sessions to facilitate ease of understanding. The survey protocol was translated into Bislama by the field staff during the training and was used in practice sessions to simulate survey conditions in the field to ensure standardisation. Final training sessions were devoted to logistics management, in particular the delivery of questionnaires, travel arrangements to schools and communities and the management of completed surveys. At the close of the training, survey teams comprised of ni-Vanuatu youth leaders and PCV were established to carry out the surveys on each of the islands. In order to meet the established deadlines for completion of the Vanuatu survey, the UNICEF Youth Officer worked with each team to develop detailed implementation schedules for the 32 secondary schools and approximately twenty communities that would take part in the survey.

31

Section 5 Methods of the study 5.1. Vanuatu survey instrument There were several stages of the instrument development. These included the choice of questions asked, qualitative input into questionnaire design, the piloting of the questionnaire and mode of administration, and the translation (and back translation) of the final instrument. Table 5.1.1 below shows the measures used in the Vanuatu survey instrument. The first column shows the broad domains, or conceptual groupings, in which questions were asked. The second column shows the abbreviated name of the questions asked in the in-school youth sample and the third column indicates which of these questions were asked of the out-of-school youth sample. The fourth column shows whether these measures were asked in the most recent WHO Europe Health Behaviour in School Children Survey, completed in 1998. Table. 5.1.1 Questions included in the in-school and out-of-school HBLPY surveys in Vanuatu

2001, and comparability with WHO Europe HBSC surveys

Domain of questions

In-school youth

Out-of-school youth WHO Europe HBSC 97/98

Demographics Age 4 4 Date of birth 4 4 Sex 4 4 School grade Last grade 4 Live now 4 Father’s job 4 Similar Mother’s job 4 Similar Current paid job Parents 4 Similar Residence 4 No. of people at home 4 Similar Religion 4 Religiosity/conviction 4 Substance use Ever smoked 4 4 Smoke frequency 4 4 Ever tasted alcohol 4 4 Drunk frequency 4 4 Car/motorbike drinking 4 Ever drunk Kava 4 Frequency of Kava 4 Ever drunk methylated spirits 4 Frequency methylated spirits 4 Ever smoked marijuana 4 Frequency of marijuana 4 Ever sniffed glue 4 Frequency sniffed glue 4 4 presence of question

Table. 5.1.1 Continued

Domain of questions

In-school youth Out-of-school youth WHO Europe HBSC 97/98

Nutrition Tea 4 Coffee 4 4 Coconut juice 4 Fruits 4 4 Soft drinks/Coke 4 4

32

Sweets/chocolate 4 4 Fresh vegetables 4 4 White bread 4 Taro 4 Tinned fish 4 Tinned mutton/corned beef 4 Fresh mutton 4 Chicken 4 Water 4 Physical activity Out of school frequency Usually exercise 4 Out of school time Times exercise 4 TV/videos per day time 4 4 Communication Father 4 4 Mother 4 4 Other adults 4 Brothers 4 4 Sisters 4 4 Siblings of same sex 4 Friends 4 4 Youth worker 4 Pastor/Minister 4 Other 4 Mental health Feel about life (happy) 4 Feel lonely 4 Feel confident 4 Sad, depressed 4 Severity of sadness/depression 4 Been rejected by peers Similar Job prospects 4 Reason for leaving school 4 Plan to get future training Similar School School items (7) 7 4 Environment Teacher items (4) 7 4 Peers items (3) 7 4 Community/social Encouraged to express views (4) 4 Participation Think community is important 4 Feel involved in community 4 Trust in adults and Ratings of credibility of figures (8) 4 social institutions Injury 12 month injury 4 Deliberate injury/violence (6 items) 4 Been bullied by others 4 4 Bullied others 4 4 Hygiene Teeth brushing 4 4 Wash hands (2 items) 4 Sexual Ever had sex Behaviour Times past month First sexual experience (3 items) No. of sexual partners Had sex when drunk/high Use of contraception Steps to prevent HIV/STIs 4 inclusion of question The demographic questions were very similar to those from the HBSC survey, with the addition of a specific question about location of parents’ residence and questions concerning religious affiliation and conviction. The question about parents’ residence was included because many children in Vanuatu, as in many other Pacific Island countries, do not live with their parents during school time because of the need to travel to other islands for schooling. These questions concerning religious affiliation were included in recognition of the major role played by religion in Pacific Island societies. The question on parent’s occupation in the HBLPY in Vanuatu

33

differed from the HBSC survey as it only divided into four broad categories, reflecting a perception that more specific job descriptions would not be understood by respondents. In the domain of substance use questions on smoking and alcohol use were derived from the HBSC survey. Questions concerning marijuana use were included which are identical to those proposed for the HBSC survey in 2001/2002. Following the qualitative needs assessment phase questions concerning Kava consumption were included reflecting the perceived prevalence of these types of substance use in Vanuatu. Questions concerning methylated spirits and solvents use, derived from the Australian National Drug and Alcohol surveys, were also included. An additional question on riding in cars or on motorcycles with others who have been affected by alcohol or drugs was included. Many of the nutrition questions were derived from the HBSC food frequency items used in 1998. The core items derived from the HBSC survey addressed consumption of coffee, soft drinks, sweets, fresh vegetables and fruits, and bread. Additional items were added because of their relevance to Vanuatu, including consumption of taro, tinned, tinned mutton/corned beef, fresh mutton and chicken. The physical activity domain used the same questions as the HBSC survey. The television watching and video watching questions were combined in the Vanuatu survey, and a question was not asked specifically about computer games, as the prevalence of computers is fairly low in this country. Many of the questions in the mental health domain were derived from the HBSC survey, including those about general happiness, loneliness, self-confidence and ease of communication with significant others in the social network of the young person. The ease of communication question added items about youth workers and ministers of religion because of interest in the extent to which young people in Vanuatu obtain support from these figures. An additional question on sadness and depression and its severity was derived from national mental health surveys among young people in Australia. A question on job prospects and the perceived likelihood of finding work when students leave school was similar to a question included in the HBSC. The in-school youth sample were asked questions about their perceived school environments, with seven items relating to the school environment, four to the teacher environment and three to the peer environment. This was identical to the HBSC survey. Two domains of questions concerning trust in adults and social institutions and community participation were included because of an interest by UNICEF in measuring the level of affiliation that young people felt with their society and the extent to which they felt they could contribute to community life. In the domain of trust in adults and social institutions the young people were asked to rate the credibility of various figures in their social environment, including parents, siblings, teachers and government and community leaders. This last set of questions were adapted from the UNICEF-support “Voices of Children and Adolescents” study conducted recently in Latin America and the Caribbean12. In the domain of community participation they were asked to rate the extent to which they received encouragement to express their views in various contexts, the importance of their community to them, and their perceived level of involvement in their community. The physical injury and bullying questions were similar to those that have been asked in the HBSC surveys. The only addition in the Vanuatu survey was the inclusion of a question about deliberate injury, where students were

12 UNICEF. Voices of Children and Adolescents in Latin America and the Caribbean. Regional Survey. UNICEF Regional

Office for Latin America and the Caribbean. First Edition. May 2000.

This was an opinion survey of young children and adolescents (aged between 9 and 18 years). The survey was conducted by market research companies and based on a semi-structured questionnaire, with both closed and open-ended questions. Questionnaires were administered in the participant’s residence without the presence of parents or principal caregivers.

34

asked whether in the previous 12 months they had suffered a physical injury that was caused deliberately by a parent, a teacher or other adults, or their boyfriend or girlfriend. There were three hygiene questions in the Vanuatu survey; one about the frequency of tooth brushing which was derived from the HBSC survey. There were also two items relating to hand washing before eating, and after using the toilet. These were asked of both in school and out of school samples. Questions regarding sexual behaviour addressed: whether young people had ever had sex; their number of past sexual partners; the experience of having unwanted sex when drunk or high on drugs; use of contraception, and; use of measures to prevent HIV and sexually transmitted infections (STI). These questions were asked in gender specific groups of the out-of-school youth only. The average completion time for this questionnaire was around 40 minutes for the in-school sample, and varied substantially for the out of school youth, where the questionnaires were interview administered in a group setting. This caused a few problems for a small number of students in the capital city of Port Vila, who were most fluent in English or French, but still could speak Bislama well enough to complete the questionnaire. For all other students, literacy was highest in Bislama, so this was used as the language of choice for this questionnaire. A copy of the Bislama and English versions of the questionnaires are shown in appendices to this report. 5.2 Survey administration protocol A detailed protocol document was prepared by the UNICEF Pacific office (Phongsavan 200013). The manual was prepared to improve the administration and organisation of field surveys with specific relevance to the developing country context. The survey manual provided guidance for each step of the survey process. The phases of the survey process which were covered included qualitative situation analyses in each country, developing the instrument, pilot testing and the full administration of the HBLPY survey. Specific issues covered in detail in the protocol document are outlined below. § The development of a national team who will coordinate and have responsibility and ownership for the

survey.

§ Procedures for obtaining consent from the relevant authorities, schools and pupils for the survey to proceed.

§ Sampling and selection of the in-school and out-of-school youth.

§ Checklists of actions to be taken before site visits (sampling of a class, collecting data on enrolments and absenteeism and planning for storage and transportation of the data).

§ Guidelines for administering the questionnaire, either by self-completion or by interview administration. Issues covered included:

• responses to queries about survey questions;

• privacy and confidentiality;

• dealing with culturally sensitive questions, and;

• dealing with mixed cultural groups of students.

§ Provision of information sheets to schools, parents.

§ Description of school level information to be collected (enrolment numbers, classes, dates surveyed, and so on).

5.3 Sampling and data collection

13 UNICEF Pacific/WHO WPRO. Health Behaviour and Lifestyles of Pacific Youth. Field Manual and Guidelines. Suva, Fiji Islands. 2000.

35

The sampling frame was all secondary schools in Vanuatu. Low literacy levels among primary school students meant that data obtained from these students would be highly unreliable. As described earlier the province of Torba (with two schools) was removed from the sampling frame. A simple random sampling method (with replacement) was used to sample schools in the remaining provinces. Two international schools in Port Vila were excluded (Port Vila International School and Ecole Françoise) as they were mostly attended by expatriates. One further school, in Maewo Island, Penama province could not be located (a former known school on that site had been destroyed in a cyclone),and this school was replaced by one from the random sample replacement list. Apart from this, there were no refusals at the school level so the replacement list was not used14. Data were collected from 31 schools, which represented around 75% of the total eligible secondary schools in the whole country. Thus the sample was closer to a universe (all schools) than to a random sample. For this reason, cluster adjusted analyses were not performed for the Vanuatu data. Data collection for the out-of-school youth was based on geographical regions, with the aim being to mirror as closely as possible the in-school sample by selecting communities from which the school samples were drawn. Only youth in Shefa province were surveyed. Local communities were identified and survey team members then visited these, described the study to community leaders and asked for permission to survey youth in that locality. The next step was to identify youth in participating communities, and a venue for the survey. These were often local churches or community halls. Based on age criteria, the survey focused on out-of-school youth aged 15-19 years. Verbal consent was sought prior to the commencement of the survey. As a result of the lessons learnt in the pilot phase, out-of-school youth were surveyed in small groups using an interviewer administered method, such as reading aloud to each small group. The denominator in these surveys was not known, as the number of youth not available at that time to take part in the survey could not be determined. The objectives of the out-of-school youth surveys may represent a “best case” scenario, as only the most literate or interested might have taken part. There was also evidence of a gender bias, with more boys than girls willing to participate in this survey15. 5.4. Methods of analysis Questionnaires were manually entered and stored in an Epi Info Version 6.04 data file16. All analyses were conducted using Stata 7.0 and SPSS for Windows 9.0. The data were first carefully cleaned, applying checks of range and logic. Missing values were noted and examined where necessary. Taking into account theoretical relevance and the data distributions, most of the variables were recoded into appropriate and meaningful categories. Descriptive analyses were carried out for all variables. As most of the variables were categorical, the counts and percentages of the responses falling into each category were tabulated and stratified by both gender and age groups.

14 This high acceptance rate was facilitated by support obtained at a national meeting of school principals, where the study was endorsed,

which facilitated later acceptance of the survey teams in accessing the schools for the survey.

15 Part of this may have resulted from gatekeeper functions of community leaders, who may have been less prepared for girls in these local communities to participate in the surveys, compared to boys. This resulted in a gender bias for the OOSY sample, whereas none existed for the ISY sample.

16 Dean AG, Dean JA, Burton AH, Dicker RC. Epi Info, Version 6.04: A Word Processing, Database and Statistics Program for Epidemiology on Microcomputers. Stone Mountains, Georgia: USD, Inc., 1997.

36

Given the substantially smaller out-of-school sample compared to the in-school youth sample, respondents in the out-of-school youth sample were recoded into three age groups (11-14 years, 15-16 years and 17-20 years) for most of the analyses of these data. Because of the potential imprecision of certain statistics, some tables presented in the in-school youth results section were not produced for the out-of-school youth results. However, efforts have been made to present consistent results comparing the in-school and out-of-school sections where possible. For the comparison of in-school and out-of-school youth, adjusted analyses were carried out using logistic regression. As there were significant differences in the distributions of gender and age between in-school and out-of-school samples, it would be misleading to present the crude results only. Therefore, for the adjusted results, both adjusted Odds Ratios (OR) and their 95% confidence interval were presented. To examine the possible differences between provinces, a group of key variables for comparison was generated. The distributions of these key indicators were examined across the provinces. The bivariate associations between the key indicators and important demographic variables, as well as among the key indicators themselves, were explored using the Spearman coefficient, and its significance was examined using Pearson Chi-square. These bivariate associations served as the important but tentative attempt to disentangle the relationships among the key indicators and demographic variables. Further work is needed to examine the nature of these relationships using rigorous theoretical and statistical approaches.

37

Section 6 Health and lifestyle behaviours of school students 6.1 The characteristics of students in the sample Overall there were 4,596 students included in the in-school youth sample. The number of boys and girls who participated in the survey was almost identical. The age of the respondents ranged from 10 to 20 years old with mean age of 14.4 (SD=1.57). The detailed breakdown of the gender, age and geographical region of study participants is represented in Table 6.1.1. The distribution of students by province shows proportionate sampling similar to the census distribution in those provinces. In order to define a sample of young people that can be compared with similar surveys being carried out in the Pacific, and those that have already been conducted in other parts of the world, the age range of those included in the data analysis has been confined to those aged between 12 and 17 years (as shown in Table 6.1.1). Furthermore, given that there were only a small number of students outside of these age ranges their inclusion in the analysis would mean that the estimates relating to young people at these other ages would be imprecise. Table 6.1.1 The demographic characteristics of the student sample

Characteristics No. % Gender Boy 2284 50.1

Girl 2277 49.9 Age

12yrs 403 9.0 13yrs 972 21.7 14yrs 1044 23.3 15yrs 886 19.8 16yrs 718 16.0 17yrs 451 10.1

Province Shefa 1952 42.4 Sanma 1138 24.7 Malampa 477 10.4 Penama 377 8.2 Tafea 655 14.2

38

The age distribution of students in the sample was very similar for both boys and girls (Table 6.1.2). The highest proportion of participants were in the 13 to 15 year age group. Table 6.1.2 The distribution of the student sample by age and gender

Boys

Girls Age

No. % No. % 12 yrs 181 8.2 218 9.8 13 yrs 444 20.1 519 23.3 14 yrs 513 23.2 516 23.2 15 yrs 455 20.6 428 19.3 16 yrs 385 17.4 327 14.7 17 yrs 233 10.5 215 9.7

About 1 in 8 students had non-working fathers and almost one third reported that their mother was not working (Figure 6.1.1). Just over one quarter of fathers were classified by students as office workers, a similar proportion as manual laborers, and almost 30% were reported as working at home to earn money. A higher proportion of mothers were reported to be working at home to earn money compared to fathers, while a substantially lower proportion of mothers were classed as manual workers. Figure 6.1.1 Parental occupation of students

13.9

27.7 28.6 29.831.7

22.4

10.3

35.6

0

5

10

15

20

25

30

35

40

Doesn

't work

Office

work

Man

ual w

ork

Work

s at h

ome

Doesn

't work

Office

work

Man

ual w

ork

Work

s at h

ome

Father Mother

%

39

About three quarters of the respondents stated that they lived with their parents for most of the time (Figure 6.1.2). Girls were slightly more likely to report that they lived with their parents for most of the time compared to boys. The survey did not ask if the respondents lived with both parents or either one.

Figure 6.1.2 Proportion of students living with parents most of time

Less than most of time

27%

Most of time 73%

When asked where their parents lived most young people did not respond, which is most likely because there was no option for indicating that their parents lived in an urban area or township. About 1 in 6 said that their parents lived on an outer island, while smaller proportions said that they lived in rural areas or overseas (Figure 6.1.3).

Figure 6.1.3 Location of parental residence of students

Did not respond

78%

Outer islands15%

Rural village6%

Overseas1%

The majority of students stated that they lived with between 3 and 10 other people (Figure 6.1.4). The finding that about 12% of young people lived with 10 or more other people may have resulted from some respondents referring to their boarding school as their home, rather than the residence of their family.

40

Figure 6.1.4 Number of people living with students

1 to 23%

3 to 1085%

>10 people12%

The most frequently reported religious denomination was Presbyterian, followed by Catholic, Seventh Day Adventist and others (Figure 6.1.5). Figure 6.1.5 Religious denomination of students

18%

36%14%

8%

24% Catholic

Presbyterian

Seventh DayAdventist

Pentecostal

Other

41

The overwhelming majority of the respondents reported that their commitment to their faith was “strong” or “very strong” (Figure 6.1.6). There were, however, some problems in the scale used in measuring this concept, as only 2 of the 6 response options allowed students to indicate that their commitment was not very strong17. Figure 6.1.6 Strength of commitment to faith

Less than strong10%

Strong90%

6.2 Substance use • A little less than one quarter of students had ever tried tobacco or alcohol, while about 1 in 8 had ever tried

kava. Tobacco was the drug most likely to be used on a weekly or more regular basis, with about 5% of students reporting this. Almost 3% reported drinking kava or sniffing solvents with this level of frequency.

• About 10% of students said that they had been drunk at least once and a little over 3% that they had been

drunk 2 or more times. • The use of all types of substances was higher among boys than girls and most increased in use between the

ages of 12 and 17 years. • The reported levels of use of tobacco or alcohol were lower than those observed among students in

European nations. The use of tobacco and other drugs is an important issue in youth health in both developing and developed nations. Figure 6.2.1 shows the proportions of students who had ever used the various types of drugs as well as those who reported using them on at least a weekly basis. The data showed that tobacco and alcohol had been ever tried by a little less than one quarter of students and kava by 1 in 8. The reported use of substances on at least a weekly basis showed that around 5% of students smoked with this level of frequency, while almost 3% drank kava or sniffed solvents this regularly.

17 The response options for this question were: not at all; weak; strong; stronger; a bit stronger, and; very strong.

42

Figure 6.2.1 Students who have ever used substances or used them at least weekly

0.6

1.7

0.8

2.8

2.8

4.8

1.4

1.8

3.8

4.9

12.5

22.5

22.7

0 5 10 15 20 25

Marijuana

Mushroom

Methylated spirits

Solvents

Kava

Alcohol*

Tobacco

% Ever (lifetime)

Weekly

*Young people were not asked about the frequency of their alcohol consumption but about the number of times they had been drunk in the past (see Figure 6.2.4).

The rates of use of all substances were higher among boys than girls. The prevalences of boys having ever tried cigarettes increased from 16% of 12 year-old boys to 64% of 17 year old boys (Figure 6.2.2). The rates for girls ranged from 5% of 12 year old girls to almost 30% of 17 year old girls ever smoking a cigarette (Figure 6.2.3). Similarly the rates of ever tasting any alcohol were higher among boys than girls at each age level, increasing from 9% among 12 year-old boys to 71% among 17 year-old boys, and from 5% to 41% among girls. Kava use was much more frequent among boys than girls, and increased in both genders with age. Among boys and girls methylated spirit use increased gradually with age, while solvent sniffing was reported slightly more often by younger adolescents than by those in older age groups. The rates of marijuana and mushroom use were low among boys and girls at all age levels.

43

Figure 6.2.2 Male students who have ever used substances

0

10

20

30

40

50

60

70

80

12 13 14 15 16 17

Age in years

% tobacco

alcohol

marijuana

mushrooms

kava

methylatedspiritssolvents

Figure 6.2.3 Female students who have ever used substances

0

10

20

30

40

50

60

70

80

12 13 14 15 16 17

Age in years

%tobacco

alcohol

marijuana

mushrooms

kava

methylatedspiritssolvents

Table 6.2.1 presents the proportion of students who reported using tobacco, mushrooms, kava, marijuana and solvents with varying levels of frequency. The Table shows that there were low proportions of students who reported using tobacco or other drugs on a daily basis.

44

Table 6.2.1 Frequency of substance use

Frequency of use Substance Daily Weekly Occasionally Do not use*

Tobacco Mushrooms Kava Methylated spirits Marijuana Solvents

1.0 0.5 0.3 0.2 0.1 0.6

3.9 1.2 2.5 0.6 0.4 2.2

6.0 0.5 4.4 2.0 0.6 1.5

89.2 97.7 92.9 97.2 98.7 95.7

*A number of students did not provide any answer at all to the questions concerned with substance use. This is likely to have been because the behaviour simply did not apply to them, but may in some cases have stemmed from a fear about disclosing behaviour that is socially unacceptable. A conservative approach, of treating non-respondents as non-users of substances, was adopted. Approximately 11% of students reported that they had they had been drunk at least once in the past and a little over 3% reported that they had been drunk 2 or more times (Figure 6.2.4.). Figure 6.2.4 Frequency of being drunk in the past

89.1

7.62.2 0.5 0.6

0

10

20

30

40

50

60

70

80

90

100

Never once 2-3 times 4-10 times > 10 times

%

45

Comparison of the rates of usage of tobacco and alcohol among 13 and 15 years olds in Vanuatu with those measured in European countries by the HBSC survey in 1997-98 (Table 6.2.2), shows lower levels of usage of these substances by boys and girls in Vanuatu. Table 6.2.2 Tobacco and alcohol use among young people in Vanuatu and Europe*

Substance use

13 yr olds (%)

15 yr olds (%)

Vanuatu European countries#

Vanuatu European countries#

Ever smoked Boys 17.4 23-66 33.6 54-82 Girls 6.7 20-80 16.8 40-90 Daily smoking Boys 1.1 3-19 0.9 15-45 Girls 0.0 2-29 0.3 6-56 Weekly smoking Boys 3.5 7-29 6.1 24-52 Girls 1.8 2-41 3.9 10-63 Never consumed alcohol Boys 79.8 4-39 65.8 2-22 Girls 85.0 4-47 79.2 3-38 Been drunk 2 or more times Boys 1.4 6-38 3.5 18-71 Girls 0.4 3-35 1.9 10-63

*The number of students in comparable age ranges was 1,827 from this survey in Vanuatu and 123,227 from the European HBSC surveys, 1997-98. #Range of prevalence estimates across European countries. 6.3 Nutrition • The drink most regularly consumed by students was water, which was followed in popularity by tea and

coconut juice. More than 60% of students reported seldom or never drinking coffee or soft drinks. • Among the foods representing sources of fibre, vegetables were the most likely to be consumed at least

weekly, followed by white bread, fruit and taro. Data about the consumption of white and red meats showed that tinned fish was consumed by more than half of students at least weekly and by almost 2 in 5 at least daily. Chicken was the type of meat that was next most likely to be consumed this regularly.

• More than half of students reported that they did not eat important sources of fibre such as vegetables and

fruit more than once per day. • There was a decline in the proportion of young people reporting that they ate fruit at least once per day

between the ages of 12 and 17 years, but an increase in the proportions eating vegetables this regularly. There was an age-related decline in the consumption of taro, tinned fish and chicken on a daily or more frequent basis.

• All students reported eating sweets at least once per day. • Compared to European students those in Vanuatu were less likely to consume soft drinks daily but more

likely to eat sweets this regularly. Student responses about the frequency that they consumed a range of foods and drinks provides an indicator of dietary habits and nutrition. These results are shown in Table 6.3.1. This reveals that water was the drink most regularly consumed. Based on the findings about daily or more regular consumption, tea was the next most popular drink followed by coconut juice. More than 60% of students said they seldom or never consumed coffee or soft drinks such as coke.

46

The data about the consumption of fibres such as fruit, vegetables, bread and taro indicated that vegetables were the most common of these types of foods to be eaten at least daily, followed by white bread, fruit and taro. Of this group taro was the most likely to be seldom or never consumed, however it should be noted that yams, not taro, is the primary root crop in Vanuatu and the consumption of this was not measured in the survey. Data about the consumption of white and red meat (such as mutton) show that tinned fish was eaten at least weekly by more than half of students, while almost 45% of students ate chicken this frequently. It was notable also that tinned fish was eaten at least daily by almost 2 in 5 students. Tinned mutton or corned beef was eaten more frequently than fresh mutton, although there were high proportions of students who seldom or never consumed these foods. Sweets were consumed at least daily by all students. This uniformly high rate of consumption of sweets warrants further examination, particularly in terms of how young people in Vanuatu interpreted the term “sweets” in the survey. Table 6.3.1 The frequency of consumption of various foods and drinks by students Food and drinks More than

once a day Once a day At least once

a week but not daily

Seldom Never

No. % No. % No. % No. % No. % Tea 771 17.5 2749 62.2 265 6.0 509 11.5 124 2.8 Coffee 273 6.3 884 20.3 475 10.9 2178 50.0 548 12.6 Coconut juice 932 21.3 452 10.3 1060 24.3 1872 42.8 55 1.3 Fruits 1516 34.7 594 13.6 729 16.7 1456 33.4 71 1.6 Soft drinks 248 5.8 350 8.1 566 13.2 2217 51.5 924 21.5 Sweets 1130 26.2 3188 73.8 0 0 0 0 0 0 Fresh vegetables 1841 42.3 1122 25.8 603 13.9 718 16.5 64 1.5 White bread 771 18.0 1872 43.7 347 8.1 1008 23.5 284 6.6 Taro 950 21.6 630 14.3 953 21.7 1792 40.8 71 1.6 Tinned fish 920 21.0 747 17.1 722 16.5 1793 40.9 198 4.5 Tinned mutton/corned beef 354 8.2 406 9.4 559 12.9 1928 44.6 1078 24.9 Fresh mutton 70 1.7 122 2.9 247 5.9 1588 37.7 2181 51.8 Chicken 449 10.4 557 12.9 961 22.2 2148 49.7 207 4.8 Water 3794 85.1 355 8.0 128 2.9 159 3.6 24 0.5

Figure 6.3.1 shows the proportions of students who consumed various items more than once per day. While this shows that fresh food such as vegetables and fruits were eaten more regularly than tinned foods such as fish or mutton, it also reveals that more than half of students did not eat these important fresh foods more than once a day.

47

Figure 6.3.1 Consumption of various foods and drinks more than once per day

1.7

5.8

6.3

8.2

10.4

17.5

18

21

21.3

21.6

26.2

34.7

42.3

85.1

0 20 40 60 80 100

Fresh mutton

Soft drinks

Coffee

Tinned mutton

Chicken

Tea

White bread

Tinned fish

Coconut juice

Taro

Sweets

Fruits

Fresh vegetables

Water

%

Examination of trends in the consumption of various foods and drinks among boys and girls showed a decline in the proportions eating fruit once a day or more between the ages of 12 and 17 years, which was counterbalanced to some extent by an increase in the proportions reporting that they ate vegetables this regularly (Figures 6.3.2 and 6.3.3). Boys were more likely than girls to drink coconut juice at least once a day, although the prevalence of this showed a decline in both genders between the ages of 12 and 17 years. Figure 6.3.2 Consumption of selected foods and drinks once per day or more by age

and gender

0%10%20%30%40%50%60%70%80%90%

100%

12yr

s13

yrs

14yr

s15

yrs

16yr

s17

yrs

12yr

s13

yrs

14yr

s15

yrs

16yr

s17

yrs

Boys Girls

tea

coffee

coconut juice

fruits

coke

sweets

vegetables

Among both genders the consumption of bread daily or more regularly increased in prevalence between the ages of 12 and 17 years (Figure 6.3.3). The consumption of water showed a similar trend. On the other had there was

48

evidence of an age-related decline in the consumption of the several foods with age. Notable among these were taro, tinned fish and chicken. The latter appeared to be more often consumed at least daily by girls than boys. Figure 6.3.3 Consumption of selected foods and drinks once per day or more by age

and gender

0%10%20%30%40%50%60%70%80%90%

100%

12yrs

13yrs

14yrs

15yrs

16yrs

17yrs

12yrs

13yrs

14yrs

15yrs

16yrs

17yrs

Boys Girls

bread

taro

tinned fish

mutton/corned beef

fresh mutton

chicken

water

The rates of consuming soft drinks on a daily basis were lower among 13 and 15 year old boys and 13 year old girls in Vanuatu compared to European countries, while the rates of daily sweet eating were much higher in all age and sex groups in Vanuatu (Table 6.3.2). Table 6.3.2 Consumption of soft drinks and sweets by young people in Vanuatu and

Europe*

13 year olds (%)

15 year olds (%)

Vanuatu European countries

Vanuatu European countries

Consume soft drinks every day Boys 17.1 19-79 13.8 22-78

Girls 14.0 19-75 18.4 6-71

Eat sweets every day Boys 100.0 23-79 100.0 24-78

Girls 100.0 22-81 100.0 14-81

*The number of students in comparable age ranges were 1,827 from this survey in Vanuatu and 123,227 from the European HBSC, 1997-98.

49

6.4 Physical activity

• About one quarter of students reported that they undertook 2 or more hours of physical activity per week, and about 1 in 5 that they participated in 4 or more sessions of exercise each week.

• Boys showed higher rates of physical activity than girls. There was also a trend towards increased levels of

physical activity between the ages of 12 and 17 years,and this was strongest among boys. • About 1 in 8 students watched 4 or more hours of television per day, with general declines in the proportion

watching this amount of television between 12 and 17 years. • Students in Vanuatu were less likely than those in Europe to participate in 2 or more sessions, or 2 hours or

more, of physical activity per week. Table 6.4.1 shows the levels of physical activity and television watching reported by students, which are further summarized in Figure 6.4.1. Over half of students reported undertaking physical activity once a week or less, and approximately 31% once a month or less often. A little over half of students undertook at least one hour of physical activity per week, and almost one quarter did none. Television watching was reported by over 80% and a little under half indicated that they watched one hour or more a day. Table 6.4.1 Frequency of physical activity and television watching by students No. % Frequency of exercise Everyday 607 13.4 4-6 times a week 376 8.3 2-3 times a week 1013 22.3 Once a week 1145 25.2 Once a month or less

1395 30.8

Number of hours of exercise in a week None 1028 22.6 About ½ hour 1066 23.5 About 1 hour 1207 26.6 About 2-3 hours 908 20.0 About 4-6 hours 200 4.4 7 or more hours

134 2.9

Number of hours of watching TV in a day Not at all 787 17.3 Up to 1 hour 1637 35.9 1-3 hours 1550 34.0 4 hours or more 584 12.8 Figure 6.4.1 highlights the findings that just over one quarter of young people in school did 2 or more hours per week of exercise and about 1 in 5 did 4 or more sessions of exercise per week. Television or video watching for 4 or more hours per day was reported by around 1 in 8 students.

50

Figure 6.4.1 Time spent in physical activity and television watching

21.827.1

12.8

05

1015202530

Exercise 4 times/wkor more

Exercise 2-3 hrs/wk ormore

TV 4 hrs/day or more

%

Physical activity levels, which are presented for boys and girls at different ages in Figures 6.4.2 and 6.4.3 respectively, increased across age groups. Boys were more likely than girls to report 4 or more sessions of physical activity per week or at least 2-3 hours of activity. In addition both of these indicators of exercise increased more markedly with age among boys. Television or video watching patterns did not differ between boys and girls, but showed a slight decline with age between 12 and 17 years. Figure 6.4.2 Time spent engaged in physical activity and television watching by boys

at each age level

0

5

10

15

20

25

30

35

40

45

50

12 13 14 15 16 17Age in years

%

Exercise 4times/wk or more

Exercise 2 hrs/wkor more

TV 4hrs/day ormore

51

Figure 6.4.3 Time spent engaged in physical activity and television watching by girls at each age level

.

05

10152025

3035404550

12 13 14 15 16 17Age in years

%

Exercise 4times/wk or more

Exercise 2hrs/wk or more

TV 4hrs/day ormore

Thirteen and 15 year old boys and 13 year old girls in Vanuatu were less likely than their counterparts in European nations to exercise 2 or more times per week, while young people in all age and sex categories in Vanuatu were less likely to undertake 2 or more hours of exercise per week (Table 6.4.2). Girls at age 15 years in Vanuatu were less likely than those of the same age in Europe to report watching 4 or more hours of television/videos per day. Note that the European rates would have been even higher if time spent playing computer games was added to time spent watching television/videos, whereas in Vanuatu computer usage is low so the addition of computer game playing would have made little difference to this measure of time spent in sedentary activities in this country. Table 6.4.2 Levels of exercise and television watching among young people in

Vanuatu and Europe*

13 yr olds (%) 15 yr olds (%) Vanuatu European

countries Vanuatu European

countries Exercising 2 times/wk or more Boys 50.6 64-90 59.4 60-90

Girls 29.7 46-83 38.9 37-63

Exercising 2 hrs/wk or more Boys 28.3 38-86 37.9 48-85

Girls 15.6 21-75 21.9 25-70

Watching TV 4 hrs/day or more Boys 15.6 13-56 11.7 17-46

Girls 13.0 12-48 15.1 14-41

*The number of students in comparable age ranges were 1,827 from this survey in Vanuatu and 123,227 from the European HBSC, 1997-98.

52

6.5 Personal well-being and development • Mothers, followed by siblings, fathers and friends were most often identified by students as people that they

could easily talk to about personal difficulties. There was a general decline in the proportions of students between the ages of 12 and 17 years who felt it easy to discuss problems with parents, other adults or siblings.

• A little over one quarter of students did not feel happy, while a slightly lower proportion reported that they

rarely or never felt confident. Feelings of severe depression were experienced by just under 1 in 8 students, and a slightly higher proportion said that they often felt lonely.

• About one quarter of students thought they would be unlikely to get a job after school. • About 1 in 8 of those who reported severe sadness or depression talked to no one about it. Friends and pee

support groups were the sources of support most often identified by these people, followed by parents and siblings.

As an indicator of social support, students were asked how easy they felt it was to speak to various others about issues that bothered them. Table 6.5.1 shows the perceived ease of talking to a range of people who may offer social support to students. These data are further summarized as the proportions of students who reported that it was “easy or very easy” to ask various people for support in Figure 6.5.1. Table 6.5.1 The perceived ease of talking to various people about personal problems Person Very easy Easy Difficult Very difficult Don't have No. % No. % No. % No. % No. % Father 1349 30.0 1421 31.6 1119 24.9 434 9.7 169 3.8 Mother 1887 42.3 1678 37.6 560 12.5 249 5.6 91 2.0 Other grown ups 398 9.1 1200 27.5 1511 34.7 817 18.8 432 9.9 Brothers 1292 29.5 1656 37.8 794 18.1 388 8.9 255 5.8 Sisters 1529 35.1 1781 40.9 607 13.9 252 5.8 187 4.3 Friends 1048 23.9 1703 38.9 958 21.9 435 9.9 236 5.4 Youth worker 263 6.0 862 19.8 1430 32.8 875 20.1 924 21.2 Pastor/Minister/Priest 270 6.2 575 13.3 1013 23.4 1034 23.8 1446 33.3 Other person 243 5.9 471 11.3 852 20.5 946 22.8 1641 39.5

Mothers, followed by siblings, fathers and friends, were identified most commonly by students as people that they felt it easy to talk to about matters that bothered them. Rates were much lower for youth workers or clergy.

53

Figure 6.5.1 Individuals that students identified as easy to approach about personal problems

17.3

19

25.8

36.9

61.8

62

67.5

76.3

79.8

0 20 40 60 80 100

Other person

Youth worker

Father

Brother

Mother

%

There was a general decline between the ages of 12 and 17 years in the proportions of students who found it easy to discuss their problems with parents, siblings or other adults (Figure 6.5.2). It is of interest that higher proportions of boys reported that it was easy for them to go to their fathers, whereas similar proportions of both genders said that it was easy to speak with their mothers about matters that were bothering them. As might be expected, girls were more likely to consider their sisters an easy person to approach for support than did boys, while higher proportions of boys indicated that they found it easy to speak with their brothers. Furthermore, at most ages there were higher proportions of boys than girls who felt that “other adults” were easy to turn to for support. Figure 6.5.2 Proportions of students finding it easy or very easy to communicate with

parents, siblings or other adults by age and gender

0

20

40

60

80

100

12 yr

s

13 yr

s

14 yr

s

15 yr

s

16 yr

s

17 yr

s

12 yr

s

13 yr

s

14 yr

s

15 yr

s

16 yr

s

17 yr

s

Boys Girls

%

father mother other adult brother sister

Boys of all ages were more likely than girls to report that they felt it was easy for them to speak with youth workers, clergy or other people about matters that troubled them (Figure 6.5.3). Between the ages of 12 and 17

54

years there was an increase in the proportions of girls who said that they found it easy to talk with friends while there was little change in this regard among boys. Figure 6.5.3 Proportions of students finding it easy or very easy to communicate with

friends, youth workers or clergy by age and gender

0

20

40

60

80

100

12 yr

s

13 yr

s

14 yr

s

15 yr

s

16 yr

s

17 yr

s

12 yr

s

13 yr

s

14 yr

s

15 yr

s

16 yr

s

17 yr

s

Boys Girls

%

friends youth worker priest other person

Questions regarding feelings of happiness, loneliness, self-confidence, sadness and depression and optimism about future work prospects provided indicators of mental health status among students. Table 6.5.2 presents the detailed responses given by students to these questions while Figure 6.5.4 shows the proportions of students who did not feel happy, were often lonely, were rarely or never felt confident, suffered sadness that was almost more than they could take or felt that they would be unlikely to get a job after school. These show that a little over one quarter did not feel happy, while a slightly lower proportion reported that they rarely or never felt confident or that they would be unlikely to get a job after school. Feelings of severe sadness or depression were experienced by just under 1 in 8, and a slightly higher proportion said that they often felt lonely.

55

Table 6.5.2 Levels of happiness, loneliness, confidence, severe sadness and optimism about future work prospects among students

No. % Happiness I feel very happy 1211 26.6 I feel OK 2123 46.5 I don’t feel very happy 1062 23.3 I am not happy at all

165 3.6

Loneliness Yes, very often 624 13.7 Yes, sometimes 3494 76.6

No 446 9.8

Confidence Always 1034 22.7 Sometimes 2556 56.1 Rarely 834 18.3 Never

133 2.9

Felt sad or depressed during past six months No 1178 26.0 Yes, at home and at school 1247 27.6 Yes, but only at home 925 20.4 Yes, but only at school

1174 26.0

Severity of sadness/depression Almost more than I can take 508 11.3 Quite bad 1274 28.3 Worse than usual 752 16.7 About usual 785 17.5 Not sad

1178 26.2

Likelihood of getting a job after leaving school Very likely 1880 41.0 Likely 1581 34.5 Unlikely 802 17.5 Impossible 317 6.9 Figure 6.5.4 Proportion reporting low levels of happiness, confidence or optimism

about future work prospects and high levels of loneliness or sadness

24.4

13.7

11.3

23.2

26.9

0 5 10 15 20 25 30

Unlikely to get a job

Often lonely

Sad more than I can take

Rarely, never confident

Not happy

%

56

The proportions of boys and girls who reported feeling unhappy or that they had little confidence increased between the ages of 12 and 17 years (Figure 6.5.5). Feelings of unhappiness rose in prevalence more sharply among girls than boys between these ages. Frequent loneliness and severe sadness or depression were at similar levels in each gender, and showed little age-related change. Figure 6.5.5 Proportion reporting low levels of happiness or confidence and high

levels of loneliness or sadness by age and gender

0

10

20

30

40

50

12 yr

s

13 yr

s

14 yr

s

15 yr

s

16 yr

s

17 yr

s

12 yr

s

13 yr

s

14 yr

s

15 yr

s

16 yr

s

17 yr

s

Boys Girls

%

not happy often lonely rarely/never confident very sad/depressed

Figure 6.5.6 shows the various people who those students felt that they could turn to for support when they experienced severe sadness or depression, while Figure 6.5.7 shows the differences in this variable by gender. Overall, almost 14% of those who reported the highest severity of depression and sadness felt they could talk to noone about it. Friends and peer support groups were most often identified as sources of support, followed by parents and siblings. Much smaller proportions felt they could talk to their teacher, school counselor or church minister.

57

Figure 6.5.6 Persons turned to for support by students experiencing severe sadness or depression

1

2

3

6

7

8

14

20

20

22

23

26

0 5 10 15 20 25 30

School counselor

Another adult

Pastor/Priest

Other people

Teacher

Boyfriend/girlfriend

Noone

Father

Siblings

Mother

Peer support group

Friends

%

Figure 6.7.2 shows the differences in help seeking behaviours by boys and girls who reported experiencing severe sadness or depression. Notable in these comparisons were the higher proportions of girls who identified their friends, their peer support and their mothers as people that they would turn to for support. Boys were more likely than girls to indicate that they could obtain support from their father when they suffered severe sadness or depression.

58

Figure 6.5.7 Persons turned to for support by students experiencing severe sadness or depression by sex

1.6

1.9

3.9

5.8

6.2

6.2

14.5

18.6

24.1

19.4

15.1

23.3

1.2

2.1

2.9

5.4

8.7

8.8

14.5

21.2

14.9

24.9

31.1

28.2

0 5 10 15 20 25 30 35

School counselor

Another adult

Pastor/Priest

Other people

Teacher

Boyfriend/girlfriend

Noone

Siblings

Father

Mother

Peer support group

Friends

%

Girls

Boys

59

6.6. School environment • Generally students were positive about their teachers and peers at school, but had more divided views about

their school environment overall. • The majority of students considered their schools a nice place to be and felt that they belonged at school.

About one half of students considered their school to be clean and safe, while one third held an opposite viewpoint. While more than two thirds thought that the rules at school were fair, a little over one half felt that students were treated too strictly.

• Girls viewed their teachers more positively than boys, particularly in the 15-year age group. There was a

trend towards more positive ratings of the peer environment by boys than girls. • Students in Vanuatu were more likely than those in Europe to feel that they were treated too strictly at

school. In order to measure the level of connectedness with their school, and the support received from their teachers, students were asked to rate the school that they attend in terms of its qualities of fairness, security, cleanliness, teacher support and peer friendliness. A detailed summary of the results of these questions is shown in Table 6.6.1. About one half of the students agreed that students took part in making the rules in school, while about the same proportion agreed with the statement that students were treated too severely or strictly in school. It is also worth noting that there was a substantial proportion of around one third of respondents, who felt that students were not treated too strictly. More than two thirds thought that the rules in their school were fair. School was considered a nice place to be by almost two thirds of students, although only just over half felt that they belonged at school. A little over half thought that their schools were clean and safe, while around one third did not think that their school had these qualities. Perceptions of teachers were generally positive. Over 80% of students indicated that their teachers encouraged them to express their own views in class and that they could obtain extra help when they needed it. In addition, the majority of students felt that their teacher treated them fairly and was interested in them as a person. The peer environment was rated positively by the majority of students in terms of the degree to which students in their classes enjoyed being together and the level of support between peers. About a quarter did report that their peers were not helpful, or did not accept them.

60

Table 6.6.1 Perceptions of the general school environment, teachers and peers

Strongly Agree (%)

Agree (%)

Neither agree nor disagree (%)

Disagree (%)

Strongly Disagree (%)

School environment Students take part in making the rules in school

25.6 24.0 16.8 18.7 15.0

Students are treated too severely or strictly in school

26.4 25.4 15.0 21.5 11.7

Rules in school are fair 35.3 35.3 8.4 13.0 8.0 School is a nice place to be 35.4 30.5 9.5 15.5 9.1 I feel I belong at this school 22.8 32.1 20.6 13.6 10.9 School is clean 21.8 33.6 11.1 22.8 10.6 School is safe 26.8 28.0 12.5 18.9 13.9

Perception of teacher

I am encouraged to express my own views in my class(es)

53.7 29.1 4.9 7.0 5.4

Our teachers usually treat us fairly 40.2 32.0 6.3 14.9 6.6 When I need extra help, I can get it 49.2 33.4 5.5 7.3 4.7 My teachers are interested in me as a person

34.1 27.8 15.4 15.2 7.6

Peers questions

Most of the students in my class(es) enjoy being together

42.9 31.6 7.8 12.4 5.3

Most of the students in my class(es) are kind and helpful

27.0 35.4 10.1 20.9 6.6

Most other students accept me as I am 24.7 31.5 17.8 16.6 9.4

The ratings given by students regarding the attributes of their schools were summed to make 3 scales relating to school environments, perceptions of their teacher and peer perceptions. These scales were based on factor analysis which showed these items had acceptable internal consistency18. On each of these scales a lower score indicated more positive ratings of the characteristic of interest. The means scores for the whole sample of students showed that students rated each of these domains of their school quite positively. The perceptions of the school environment did not differ significantly between boys and girls at each age level (Figure 6.6.1). Girls tended to show more positive ratings of the school environment from age 14 onwards than boys at these age levels.

18 The scores for the three scales were reasonably internally consistent (reliable) with Cronbach’s alpha coefficients of around 0.70 for each.

61

Figure 6.6.1 Means school environment scores by gender and age (with 95% confidence intervals)

More marked differences in perceptions of teachers were shown by boys and girls at each age level than those concerning the school environment generally. Fifteen year old girls were significantly more likely than boys of the same age to rate their teachers positively (Figure 6.6.2). Overall there was a general trend of more positive ratings of teachers by girls than boys from age 13 onwards.

Age

12yrs

13yrs

14yrs

15yrs

16yrs

17yrs

GirlBoy

Gender

Mea

n a

nd 9

5% C

I of S

choo

l Env

ironm

ent S

cale

2.8

2.7

2.6

2.5

2.4

2.3

62

Figure 6.6.2 Mean ratings of teachers by gender and age (with 95% confidence intervals)

There was a trend towards more positive ratings of the peer environment by boys than girls at all ages (Figure 6.6.3) although there were no significant differences between the genders on this scale. Peer ratings were markedly more positive for both genders at age 17 years compared to the younger ages.

Age

12yrs

13yrs

14yrs

15yrs

16yrs

17yrsGirlBoy

Gender

Mea

n an

d 95

% C

I of T

each

er E

nviro

nmen

t Sca

le

2.8

2.6

2.4

2.2

2.0

1.8

63

Figure 6.6.3 Mean ratings of the peer environment by gender and age (with 95% confidence intervals)

6.7 Community participation • Just over two thirds of students felt that their parents encouraged them to express their views. Peers and the

church were next most likely to be identified as offering this encouragement. • About one third of students felt encouraged to express their views in the community. • Boys at all ages were more likely than girls to feel encouraged to express their views in the community or

church contexts. • The vast majority of students considered their local community to be important to them. On the other hand,

a little over one quarter of students felt strongly involved in their community, while over one third felt little or not at all involved.

An important dimension of the social environment in which students operate is the extent to which it allows them to participate through the expression of their personal opinions. Figure 6.7.1 shows the extent to which students felt they were encouraged to express their views in various contexts. The situation in which students felt most comfortable to express their views was with parents, with over two thirds believing that their parents encouraged this. Around 55% of students felt encouraged to express their views among friends or in the church context, while about one third felt encouraged to do this in their local community

Age

12yrs

13yrs

14yrs

15yrs

16yrs

17yrsGirlBoy

Gender

Mea

n an

d 95

% C

I of P

eer

Env

ironm

ent S

cale

2.3

2.2

2.1

2.0

1.9

1.8

1.7

64

Figure 6.7.1 Level of encouragement students received to express their views in various contexts

Figure 6.7.2 presents a comparison of the proportions of boys and girls between the ages of 12 and 17 years who felt encouraged to express their views in various contexts. This shows an age related decline in the proportion of girls who felt comfortable expressing their views among friends. In this context there was an increase in the proportions of boys at higher ages who felt encouraged to express their views. In all other contexts both boys and girls were more likely to feel able to express their views with increasing age. Boys at all ages were generally more likely than girls to feel encouraged to express their opinions in the church or community setting. Figure 6.7.2 Proportions of students who felt encouraged to express their views in

different contexts by age and gender

0102030405060708090

100

12 yr

s

13 yr

s

14 yr

s

15 yr

s

16 yr

s

17 yr

s

12 yr

s

13 yr

s

14 yr

s

15 yr

s

16 yr

s

17 yr

s

Boys Girls

%

by parents by friends in community by church

Figures 6.7.3 shows that the majority (about 56%) of students considered their local community to be very important to them.

36.5 31.1 12 10.9 9.6

20.2 35.5 15.5 18.4 10.4

14 20.1 26.2 21.1 18.6

26.4 27.4 18.8 15 12.4

0% 20% 40% 60% 80% 100%

parents

friends

community

church group

Strongly AgreeAgreeNeitherDisagreeStrongly Disagree

65

Figure 6.7.3 Ratings of the importance of the community

56.2

23.716.4

3.8

0

10

20

30

40

50

60

Very important Important Little bitimportant

Not important

%

About one quarter of students felt strongly involved in the community, while more than one third felt a little or not at all involved (Figure 6.7.4). Figure 6.7.4 Perceived level of involvement in the community

27.2

35.4

24.4

12.4

0

10

20

30

40

50

60

Very strongly Moderately A little involved Not involved

%

Figure 6.7.5 reveals that boys were generally more likely than girls at each age level to consider their local community as important, and to feel that they were strongly involved in their community. For both genders these community perceptions increased with aged, although more strongly among boys than girls.

66

Figure 6.7.5 Proportions of students who rated the community as very important or who felt strongly involved in the community by age and gender

010203040506070

12 yr

s

13 yr

s

14 yr

s

15 yr

s

16 yr

s

17 yr

s

12 yr

s

13 yr

s

14 yr

s

15 yr

s

16 yr

s

17 yr

s

Boys Girls

%

community very important strongly involved in community

6.8. Trust in adults and social institutions • About 80% of students indicated that they viewed the church and the national leaders as credible. Adults

and elders generally were the next most likely to be rated as credible. In order to measure perceptions of authority in their social context students were asked to rate the extent to which they considered a range of individuals and institutions as credible19. Figure 6.8.1 shows that the church and the national leaders were rated as highly credible by around 80% of students. Adults and elders were generally seen as credible by around 60% of students, fathers (68%) more than mothers (58%), and teachers less so (55%). Lower ratings of credibility were assigned to the mayor of the town or city (49%), or those who govern the land generally (39%).

19A similar set of questions was asked of 11,852 young people aged 9-18 across 20 countries in Latin America and the Caribbean. Semi-structured interviews were administered in the participant’s residence without the presence of parents. There are differences between this Caribbean study and the present HBLPY survey. Nonetheless, broad comparisons are of some interest. The findings in Latin America and the Caribbean were: [a] Less than 1/3 expressed low levels of trust and credibility in their government institutions and their representatives; [b] adolescents indicated that their mother (94%) and father (90%) were the most trusted and credible figures; [c] the Church was perceived as credible and trusted by 85%; [d] about 79% considered their teachers as trustworthy and credible, but this belief decreased among older youth aged 14-18 years old ( to 64%). UNICEF. Voices of Children and Adolescents in Latin America and the Caribbean. Regional Survey. UNICEF Regional Office for

Latin America and the Caribbean. First Edition. May 2000.

67

Figure 6.8.1 Perceived credibility of adults and social institutions

62.9 25.6 9.2 2.4

68 26.1 4.81.1

58.4 32.8 7.8 1.1

55.3 36.6 6.6 1.5

80.6 13.7 3.71.9

48.7 32.3 14.2 4.8

39.2 39.9 16.3 4.7

77.8 13.5 5.5 3.2

0% 20% 40% 60% 80% 100%

Adults/elders in general

Father

Mother

Teacher

Church

Mayor of the town/city

Those who govern the land

President/prime minister

very important more or less important not important doesn’t have in country

6.9 Physical injury, violence and bullying • Almost one third of students said that they suffered an injury deliberately inflicted by another person in the

last twelve months. Unidentified “other people” were the major source of these injuries, followed by boyfriends or girlfriends and fathers.

• Levels of reported deliberate injury were higher among boys than girls, and generally higher in younger age

groups. • About 10% of students had been bullied one or more times per week in the past school term, while a

slightly lower proportion admitted that they bullied others once per week or more. Almost three quarters of students reported that they had suffered a physical injury needing treatment in the previous 12 months (Table 6.9.1). Around 10% of all students had an injury that was deliberately caused by their father, mother, boyfriend or girlfriend in the last 12 months. Lower proportions reported injuries caused by their teacher or the police. “Other person” was identified as the cause of a deliberately inflicted injury over the past 12 months by a little over 15% of students Overall about one third of students reported at least one injury caused by another person that required medical treatment in the past 12 months.

68

Table 6.9.1 The frequency and causes of physical injury reported by students No. % Times had any physical injury that needed treatment in last 12 months Never 1220 26.7 Once 1566 34.3 2-5 times 1132 24.8 More than 5 times

643 14.1

Suffering any deliberately inflicted injury

1452 31.5

Sources of deliberate injury Father 458 10.7 Mother 374 9.0 Teacher 278 6.8 Police 178 4.3 Boyfriend 484 11.0 Another person

713 17.1

As Figure 6.9.1 shows boys were generally more likely than girls at each age level to report an injury requiring treatment or an injury deliberately caused by another person. Among both boys and girls the proportions of students reporting injuries deliberately inflicted by others declined with age. Figure 6.9.1 The proportion of students who suffered any injury or a deliberate injury

caused by another person in the last 12 months, by gender and age

Boys Girls

0102030405060708090

12 yr

s

13 yr

s

14 yr

s

15 yr

s

16 yr

s

17 yr

s

12 yr

s

13 yr

s

14 yr

s

15 yr

s

16 yr

s

17 yr

s

%

any injury treated deliberate injury

69

Almost 2 in 5 students said that they had been bullied some time in the previous school term, or that they had taken part in bullying others during that period (Table 6.9.2). About 10% had been bullied with a frequency of once or more per week, while 7% reported that they bullied others this frequently. Being deliberately ignored by others, an indirect form of bullying, was reported to have happened to 40% of students at least once in the previous three months and to around 1 in 8 students at least weekly. Table 6.9.2 Frequency of being bullied, deliberately ignored or bullying others in the

past school term

Frequency of bullying

No. %

Ever been bullied in school this term I have not been bullied in the last 3 months Once or twice Sometimes About once a week Several times a week

2815 903 394 163 273

61.9 19.9 8.7 3.6 6.0

Frequency of taking part in bullying other students in school this term I have not bullied others in the last 3 months Once or twice Sometimes About once a week Several times a week

2863 987 374 146 172

63.0 21.7 8.2 3.2 3.8

Frequency of being ignored by other students at school this term It has not happened this term Once or twice Sometimes About once a week Several times a week

2736 901 385 271 288

59.7 19.7 8.4 5.9 6.3

Boys were more likely to report that they had been bullied at least once in the last term compared to girls (Figure 6.9.2), and the experience of being bullied increased in frequency across age groups for both genders. Boys were also more likely to report that they bullied others at least once compared to girls, and this also increased in prevalence with age. Being ignored in the past term was equally common among boys and girls, and declined with age in both groups.

70

Figure 6.9.2 Proportions of students who had been bullied, deliberately ignored or who had bullied others in the past school term by age and sex

0

10

20

30

40

50

60

12 yr

s

13 yr

s

14 yr

s

15 yr

s

16 yr

s

17 yr

s

12 yr

s

13 yr

s

14 yr

s

15 yr

s

16 yr

s

17 yr

s

Boys Girls

%

bullied bully others ignored by others

6.10 Personal hygiene Personal hygiene behaviour provides an indicator of self-care and potential disease risk. Table 6.10.1 shows that that almost two thirds of students reported that they brushed their teeth more than once a day and a further quarter did this on a once a day basis. Seventy percent of students always washed their hands before eating and 80% always wash their hands after using the toilet.

• The majority of students reported brushing their teeth 2 or more times per day and washing their hands before eating or after using the toilet. There was still, however, one third who did not brush their teeth this regularly and about one-quarter who could improve their frequency of hand washing.

• Girls showed slightly higher rates of these personal hygiene habits than boys.

71

Table 6.10.1 Frequency of tooth brushing and hand washing among students No. % How often do you brush your teeth? More than once a day 2849 62.4 Once a day 1213 26.6 At least once a week but not daily 317 6.9 Less than once a week 88 1.9 Never

99 2.2

How often do you wash your hands before eating? Always 3176 69.6 Sometimes 1323 29.0 Never

62 1.4

How often do you wash your hands after using the toilet?

Always 3622 79.3 Sometimes 770 16.8 Never 178 3.9 Figure 6.10.1 shows that girls were more likely to brush their teeth regularly than boys, and older students were more likely to brush their teeth this frequently than younger ones. Girls also showed more prevalent hand washing behaviours, although these were less clearly related to age group. Figure 6.10.1 Proportions of students who frequently brushed their teeth and washed

their hands by age and gender

0

20

40

60

80

100

12 yr

s

13 yr

s

14 yr

s

15 yr

s

16 yr

s

17 yr

s

12 yr

s

13 yr

s

14 yr

s

15 yr

s

16 yr

s

17 yr

s

Boys Girls

%

brush teeth 2/daily always wash hands before eating always wash hands after using toilet

72

Section 7 Provincial differences in the health and lifestyle behaviours of young people at school While it does not have a large population, Vanuatu is a geographically dispersed Pacific nation. The provinces differ markedly in their social and cultural characteristics. This heightens the importance of examining provincial variations in behavioural, social and cultural factors that may have a bearing upon the health and lifestyle of young people. This will help in identifying areas where there may be a different interplay between factors affecting young people, and contribute to an understanding of geographical and cultural differences which should be taken into account in the development of programs for this population group.

7.1 Demographic characteristics of the sample of students from each province There was little variation in the demographic make up of the study population on a province-by-province basis. Table 7.1.1 shows that Penama had the lowest representation of boys and Malampa the lowest representation of girls, although this degree of variation may simply have been a result of the smaller samples collected from these provinces. Penama also had the highest representation of students aged 15 years or older (51.2%). Shefa was the province with the national capital (largest town), and hence, more urbanized than other provinces. Table 7.1.1 The gender and age distribution by province

Province Shefa Sanma Malampa Penama Tafea

No. % No. % No. % No. % No. % Gender Boy 958 49.4 577 51.2 250 52.9 177 46.9 321 49.9 Girl 980 50.6 550 48.8 223 47.1 200 53.1 322 50.1 Age 12 years 164 8.8 111 9.9 36 7.7 37 9.9 55 8.6 13 years 374 20.0 260 23.2 96 20.5 77 20.6 164 25.6 14 years 417 22.3 255 22.8 136 29.0 68 18.2 168 26.2 15 years 318 17.0 256 22.9 131 27.9 61 16.4 120 18.7 16 years 314 16.8 167 14.9 54 11.5 77 20.6 104 16.2 17 years 282 15.1 70 6.3 16 3.4 53 14.2 30 4.7

73

7.2 Substance use An examination of lifetime reported usage of tobacco and other drugs revealed some differences between the provinces (Table 7.2.1). Tafea and Malampa had the lowest proportions of students who had ever smoked (around 15%), while Shefa had the highest (28%). There was a similar, but even more marked trend in regard to alcohol consumption. Tafea and Malampa had 11-15% of students reporting that they had tried alcohol, while the prevalence of this behaviour was more than double this level in Shefa. There was a lesser degree of variation between provinces in the proportions of students who had ever consumed kava or methylated spirits, although in both of these cases the proportions of students who had tried these substances in the past were highest in Shefa. Past experiences of smoking marijuana or sniffing glue or petrol showed little variability between the provinces. Rates for the overall national sample are shown in the right hand column. Table 7.2.1 Past use (ever) of substances by province

Provinces (%)

SHEFA SANMA MALAMPA PENAMA TAFEA OVERALL

Tobacco 28.3 22.4 15.1 24.1 14.4 22.7

Alcohol 31.4 19.2 15.2 21.1 10.9 22.5

Mushroom 1.3 2.1 0.8 4.0 2.0 1.8

Kava 15.2 10.1 13.6 9.9 11.4 12.5

Methylated spirits 6.1 4.1 2.6 1.1 1.4 3.8

Marijuana 1.6 1.4 2.8 0.5 1.2 1.4

Solvents 4.1 5.3 6.8 3.0 6.7 4.9

As Figure 7.2.1 shows, around 11-15% of students in Sanma and Shefa reported ever getting drunk, which was a prevalence slightly higher than the other provinces. Figure 7.2.1 Proportions of students who had ever been drunk by province

14.811.1

7.3 7.2 6.4

0

5

10

15

20

Shefa

Sanma

Mala

mpa

Penam

aTafe

a

Province

%

74

7.3 Nutrition Food and drink consumption patterns among students in each of the provinces are shown in Table 7.3.1 Tea drinking on at least a daily basis ranged from prevalences of 74%, in Malampa, to 84% in Penama. There was a similar degree of variability in coffee consumption on a daily basis, which was least common in Tafea and most common in Sanma. It was notable that the provinces with highest proportions of students who consumed coconut juice at least daily (Tafea and Malampa) had the lowest proportions consuming soft drinks with this level of frequency. The reverse of this trend was shown in Shefa, which had the highest proportions of students reporting that they consumed soft drinks at least once a day (approximately 1 in 5) and the lowest proportion consuming coconut juice this regularly. Water was the most common type of drink consumed at least daily, and the prevalence of this did not vary substantially between the provinces Data about the consumption of fibres (fruits, vegetables, taro and bread) showed that the highest proportions of students eating fruit on at least a daily basis were in Malampa and Sanma (over half), while daily vegetable consumption was most common in Penama (about three quarters of students). It was notable that Shefa had the lowest proportions of students consuming fruits or vegetables on a daily basis. There was a wide variation in proportions of students in each province who reported eating Taro at least daily, ranging from less than one quarter of students in Shefa to over 60% of students in Penama. Contrary to this general trend daily bread consumption was reported most often by students in Shefa (about 70%), and least often in Tafea (about 52%). Several of these trends reflect rural compared to urban differences in access to various foods. Examination of the patterns of white and red meat consumption on a daily basis revealed that Penama had the highest proportions of students who reported that they ate tinned fish (about two thirds) or tinned mutton/corn beef (almost one third) with this level of frequency. While Shefa showed the lowest proportions of students consuming these products at least daily, it had the highest proportions who ate chicken this regularly. Penama, on the other hand, had one of the lowest prevalences of daily chicken consumption, along with Tafea. Mutton was the least common of these types of foods to be consumed by the students, and the prevalence of this did not vary greatly between provinces. All of the students in each province consumed sweets at least daily.

75

Table 7.3.1 Proportions of students who consumed various foods and drinks once per day or more by province

Provinces (%)

SHEFA SANMA MALAMPA PENAMA TAFEA OVERALL

Tea 81.6 77.2 74.4 84.2 78.9 79.8

Coffee 26.7 31.9 25.1 22.3 19.4 26.6

Coconut juice 25.9 32.0 41.9 30.4 42.1 31.6

Fruits 45.0 53.3 53.5 45.8 47.7 48.3

Soft drinks/coke 19.1 12.2 9.8 9.9 5.6 13.9

Sweets 100.0 100.0 100.0 100.0 100.0 100.0

Vegetables 65.7 69.4 69.5 73.9 68.8 68.1

Bread (white) 69.9 55.4 56.2 61.0 52.1 61.7

Taro 23.4 37.1 38.5 62.5 55.1 35.9

Tinned fish 26.6 29.4 58.9 66.7 56.7 37.1

Tinned mutton/corned beef 14.3 19.5 18.0 31.8 15.8 17.6

Fresh mutton 3.9 4.6 5.4 4.2 6.3 4.4

Chicken 29.0 22.2 19.9 14.8 14.7 23.3

Water 94.6 94.1 90.2 92.4 88.7 93.1

7.4 Physical activity While the province of Sanma had the highest proportion of students reporting that they did 4 or more sessions of physical activity per week, Shefa showed the highest proportions reporting that they did they did 2 to 3 hours of exercise a week (Table 7.4.1). The provinces of Malampa and Tafea had the lowest proportions of students reporting that they did at least 4 to 6 sessions or 2 to 3 hours of exercise each week. Television watching for at least 4 hours per day was most often reported by students in Shefa, and showed the lowest prevalence in Penama. This may reflect easier access to television in Shefa province, compared to much lower levels of access in Penama province. Table 7.4.1 Levels of physical activity and television watching by province

Provinces (%)

SHEFA SANMA MALAMPA PENAMA TAFEA OVERALL

Exercise 4-6 times/week or more 21.7 25.5 19.7 22.8 15.8 21.8

Exercise 2-3 hours/week or more 31.9 28.5 19.2 21.6 21.0 27.1

Watch TV 4 or more hrs/day 15.7 12.6 11.0 3.5 11.2 12.8

76

7.5 Personal well-being and development The responses from students in each province regarding the individuals who they considered it easy to go and talk with in times of difficulty are shown in Table 7.5.1. It was notable that students from Shefa were consistently among those least likely to report that they found it easy to approach fathers, mothers, other adults, brothers or sisters when they encountered problems. Respondents from Penama also showed the lowest proportions identifying fathers or mothers as easy people to talk to when they had problems. The province of Penama, along with Malampa, showed the highest proportions of young people reporting that they found it easy to speak with other adults. Students from Malampa were the most likely to identify brothers or sisters as people that they could easily talk to about their difficulties. There was little variation between the provinces in the proportions of respondents who nominated their friends, youth workers or “others” as easy people for them to talk with. The proportions of young people who identified clergy as easy to speak to were lowest in Tafea and highest in Sanma. Table 7.5.1 The proportions of students who felt that they could easily discuss

problems with various others by province

Provinces (%)

SHEFA SANMA MALAMPA PENAMA TAFEA OVERALL

Father 54.7 66.5 67.8 64.1 68.5 61.8

Mother 77.4 84.1 78.9 76.4 82.8 79.8

Other adult(s) 33.7 38.5 42.2 42.0 35.6 36.9

Brother(s) 63.5 70.1 78.3 67.9 66.0 67.5

Sister(s) 72.7 79.5 84.6 76.3 73.7 76.3

Friend(s) 62.7 63.7 65.7 61.5 60.4 62.0

Youth worker(s) 26.1 27.4 22.4 25.5 24.9 25.8

Clergy 18.2 24.4 17.1 22.9 14.5 19.0

Other person(s) 16.9 15.4 22.1 17.5 17.4 17.3

Figure 7.5.1 shows that there was reasonable variation between the provinces in the proportions of students reporting that they did not feel happy at present. Almost 2 in 5 students in Penama indicated that they were not happy, compared to around 1in 5 in Malampa. Figure 7.5.1 Levels of unhappiness by province

27 27.221.9

38.1

23.1 26.9

01020304050

Shefa

Sanma

Mala

mpa

Penam

aTafe

a

Overal

l

Province

%

77

Although there was little variation between the provinces, Penama showed the highest proportions of young people, reporting that they very often felt lonely and rarely or never felt confident. Table 7.5.2 The proportions of students reporting frequent loneliness or low levels of

confidence by province

Provinces (%) SHEFA SANMA MALAMPA PENAMA TAFEA OVERALL

Often feel lonely 13.2 14.4 13.7 15.7 12.7 13.7 Rarely/never confident 22.9 18.3 19.5 25.0 20.6 21.2

There was also little variation between the provinces in the proportions of students who reported experiencing sadness or depression at an intensity that was almost too hard to take in the last six months. The province of Shefa had the largest proportion of students reporting this level of sadness or depression(Figure 7.5.2). Figure 7.5.2 Severe levels of sadness and depression among students by province

17.3 16.2

11.2 12.9 12.815.3

0

5

10

15

20

Shefa

Sanma

Mala

mpa

Penam

aTafe

a

Overal

l

Province

%

7.6 Community participation and community involvement The province of Penama showed the highest proportions of young people reporting that they felt encouraged to express their views by parents, friends, the community or their church group (Table 7.6.1). On the other hand, Tafea had the lowest proportions of students who said they were encouraged to express their views in each of these contexts. The province of Malampa also showed one of the lowest proportions of students who felt encouraged to express their views by parents, friends or the community. Table 7.6.1 also shows that students in Penama and Malampa were most likely to rate their community as very important to them, while those in Sanma were least likely to rate their community in this way. Sanma also had the lowest portion of students who reported feeling strongly involved in their community, while Malampa and Tafea had the highest.

78

Table 7.6.1 The proportions of students who felt encouraged to express their views, that their communities were important or that they were involved in their communities, by province

Provinces (%)

SHEFA SANMA MALAMPA PENAMA TAFEA OVERALL

Feel encouraged to express views by:

Parents 69.3 70.3 58.4 75.7 58.8 67.6

Friends 57.9 57.5 50.1 61.0 46.1 55.7

The community 32.4 35.7 28.6 50.6 30.0 34.1

Church group 54.6 53.0 55.4 61.1 46.5 53.8

Consider the community to be very important 54.6 52.4 61.9 62.7 60.1 56.2

Feel very strongly involved in local community

27.9 25.7 30.6 22.8 30.4 27.2

7.7. Trust in adults and social institutions Table 7.7.1 shows that Tafea had markedly lower proportions of young people, compared to the other provinces, who considered fathers, mothers, the church, the mayor of their locality or those who govern the land to be credible. Students from the province of Shefa were most likely to consider their fathers, mothers, the church or the Mayor of their locality to be credible figures, although there was little variability between the provinces in many of these items. Table 7.7.1 Proportions of students who considered various adults and social

institutions to be credible by province Provinces (%)

SHEFA SANMA MALAMPA PENAMA TAFEA OVERALL

Adults/elders 65.9 63.1 55.9 67.2 55.4 62.9

Father 72.6 66.8 64.9 67.4 58.7 68.0

Mother 64.0 57.2 53.7 61.2 44.6 58.4

Teacher 55.2 52.2 60.0 60.4 54.8 55.3

Church 83.8 79.0 83.6 80.2 71.8 80.6

The mayor of the town/city 52.6 49.3 47.8 46.5 37.4 48.7

Those who govern the land 39.0 42.3 39.3 41.2 32.9 39.2

The President/Prime Minister 77.3 79.2 77.9 79.2 75.8 77.2

7.8 Physical injury, bullying and violence There was little variability across provinces in the proportions of students who reported that they suffered an injury requiring treatment in the last 12 months. Penama and Malampa had the highest levels on this indicator and Tafea and Shefa the lowest (Table 7.8.1). The lowest proportion who had been bullied was in Malampa, while the lowest proportion of students who had bullied others was in Penama.

79

Table 7.8.1 The proportions of students who had been physically injured, bullied or been a bully towards others by province

Provinces (%)

SHEFA SANMA MALAMPA PENAMA TAFEA OVERALL

Had a physical injury that needed treatment in last 12 months 70.9 74.0 78.2 79.3 71.8 73.3

Ever been bullied in school this term 36.9 39.5 42.7 37.9 36.0 38.1

Ever bullied others in school this term 38.4 36.2 34.7 41.6 33.2 37.0

There were considerable differences between the provinces in the proportions of students who reported that they had been deliberately injured by another person in the past 12 months. The highest was in Malampa, with over 45% and the lowest in Shefa, which had around 25% reporting this experience (Figure 7.8.1). Figure 7.8.1 Proportions of students who had suffered a deliberately inflicted injury by

province

25.733.7

45.7

31.6 34.8 31.5

01020304050

Shefa

Sanma

Mala

mpa

Penam

aTafe

a

Overal

l

Province

%

7.9 Personal hygiene The provinces of Malampa and Tafea had the lowest proportions of young people reporting that they brushed their teeth 2 or more times per day (Table 7.9.1). The highest proportions of students who always washed their hands before eating or after using the toilet were in Sanma. The province of Penama had the lowest proportion of students who reported washing their hands before eating, while Malampa had the lowest proportion who always washed their hands after using the toilet. Table 7.9.1 Personal hygiene habits by province Provinces (%)

SHEFA SANMA MALAMPA PENAMA TAFEA OVERALL

Brush teeth 2 or more times/day 67.9 68.1 45.6 68.1 44.9 62.4

Always wash hands before eating 67.2 78.7 70.9 60.8 65.4 69.6

Always wash hands after using the toilet 82.1 84.2 63.8 77.7 74.4 79.3

80

Section 8 Health and lifestyle behaviours among out-of-school youth 8.1 Characteristics of the out-of-school sample A sample of 424 out-of-school youth in Vanuatu completed the survey. This sample was drawn from only one province but was taken from areas in close proximity to the school that were sampled in order to increase the similarity between the in-school and out-of-school respondents. The characteristics of the out-of-school respondents are shown in Table 8.1.1. There was an overrepresentation of boys in this group (63%), and the majority of respondents were between the ages of 15 and 17 years. Due to the small sample size three age groups of out-of-school youth were constructed (11-14 years, 15-16 years and 17-20 years) for use in stratification of the results. Over half of the out-of-school youth did not have a job, and just under 9% had a full-time job. Table 8.1.1 The demographic characteristics of the out-of-school sample

No. % Gender Boy 261 62.7 Girl 155 37.3 Age 11 years 2 0.5 12 years 5 1.2 13 years 6 1.4 14 years 32 7.6 15 years 53 12.6 16 years 67 15.9 17 years 115 27.3 18 years 42 10.0 19 years 38 9.0 20 years 62 14.7 Working at present No 226 54.2 Yes, part-time 155 37.2 Yes, full-time 36 8.6 A little over 15% of fathers and 30% of mothers of the out-of-school youth were not working (Figure 8.1.1). About 40% of fathers and a little over half of mothers were described as working at home.

81

Figure 8.1.1 Parental occupation of out-of-school youth

1621 20

43

31

105.4

54

0102030405060

Not wor

king

Office

wor

k

Man

ual w

ork

Wor

ks at

home

Not wor

king

Office

wor

k

Man

ual w

ork

Wor

ks at

home

Father Mother

%

More than four fifths of these young people lived with their parents most of the time (Figure 8.1.2). Figure 8.1.2 Proportion of out-of-school youth living with parents most of the time most of

time17%

Most of time83%

More than half of the students said that their parents lived on an outer island, while about 40% said that their parents lived in a rural village (Figure 8.1.3).

82

Figure 8.1.3 Location of parental residence of out-of-school youth

Did not respond

84%

Outer islands9%

Rural village6%

Overseas1%

Almost all of the young people reported that they lived with three or more people, while about 1 in 8 said that they lived with more than 10 others (Figure 8.1.4). Figure 8.1.4 Number of people living with out-of-school youth

3 to 1084%

>10 12%

1 to 24%

The majority of out of school respondents were Presbyterian, while much smaller proportions were Pentecostal, Seventh Day Adventist or Catholic (Figure 8.1.5).

Figure 8.1.5. Religious denomination of out-of-school youth

5%

61%

6%

11%

17% Catholic

Presbyterian

Seventh DayAdventist

Pentecostal

Other

83

Similar to the in-school youth, over 80% of respondents described their commitment to their faith as strong or very strong (Figure 8.1.6). Figure 8.1.6 Strength of commitment to faith among out-of-school youth

Strong81%

Less than strong19%

8.2. Substance use Over half of youth had tried tobacco or alcohol in the past, while about one third had tried kava and about 1 in 8 had tried methylated spirits. Rates of ever having tried marijuana, solvents or mushrooms were much lower (Figure 8.2.1). Figure 8.2.1 Proportions of out-of-school youth that reported ever trying substances

4.2

4.7

7.8

16.7

34.9

50.7

51.7

0 10 20 30 40 50 60

Mushrooms

Marijuana

Solvents

Methylated spirits

Kava

Tobacco

Alcohol

%

• Alcohol and tobacco were the substances that were most likely to have been tried by out-of-school youth, followed by kava and methylated spirits.

• Boys were more likely than girls to have tried most of the substances at least once, and

at most age levels rates of use were twice as high in boys compared to girls.

84

Figure 8.2.2 shows that boys were more likely than girls to have tried most of the substances at least once, and at most age levels rates of use were twice as high among boys than girls. Those in the oldest age category (17 – 20 years) were generally more likely to have tried all substances than those aged 11-14 years, and the difference was particularly marked for alcohol, kava and methylated spirits. Figure 8.2.2 Proportions of out-of-school youth that reported ever trying substances,

by age and gender Of this out-of-school youth, 43% reported they had ever been drunk. This was reported by more boys than girls (56.7%, 21.9% respectively), and increased with age (from 18% of those aged 11-14 years, to 54% of those aged 17-20 years). 8.3 Nutrition

• The most popular drinks consumed by out-of-school youth were water, followed by tea and coconut juice.

• Bread and vegetables were the most common types of fibre consumed. However over two-

thirds of young people did not eat fresh fruit or vegetables, bread or taro more than once per day.

• Tinned fish was more often consumed than chicken, tinned mutton/corned beef or fresh

mutton, however the majority of out-of-school youth reported that they seldom or never ate these types of foods.

0 %

1 0 %

2 0 %

3 0 %

4 0 %

5 0 %

6 0 %

7 0 %

8 0 %

9 0 %

1 1 - 1 4 y r s 1 5 - 1 6 y r s 1 7 - 2 0 y r s 1 1 - 1 4 y r s 1 5 - 1 6 y r s 1 7 - 2 0 y r s

B o y s G i r l s

eve r smoked ever tas ted a lcohol

ever had a d r ink wi th magic mushroom ever t r i ed Kava

ever drunk methyla ted sp i r i t ever sn i f fed g lue or pe t ro l

85

Table 8.3.1 shows the rates of consumption of various foods and drinks among respondents. While water was the drink most often consumed more than once per day, almost three quarters of young people reported drinking tea at least once per day. Coconut juice was the next most popular type of drink, followed by coffee and soft drinks. More than 60% of young people said that they seldom or never drank coffee or soft drinks. As sources of fibre, bread and vegetables were most often consumed at least once per day, followed by fruits and taro. Over 40% of respondents said that they seldom or never ate fruit or taro, while between one quarter and one third seldom or never ate bread or vegetables. Data about the consumption of white and red meat showed than tinned fish was the item most likely to be consumed at least weekly, followed by chicken, tinned mutton or corned beef and fresh mutton. More than half of young people reported that they seldom or never ate tinned fish or chicken while over three quarters said that they seldom or never ate tinned mutton/corned beef or fresh mutton. Sweets were reportedly eaten at least daily by around one quarter of young people. Table 8.3.1 Frequency of consumption of various foods and drinks among out-of-

school youth Foods and drinks More than

once a day Once a day At least once

a week but not daily

Seldom Never

No. % No. % No. % No. % No. % Tea 121 30.6 174 43.9 40 10.1 51 12.9 10 2.5 Coffee 42 10.9 61 15.8 49 12.7 196 50.7 39 10.1

Coconut juice 79 20.5 60 15.5 81 21.0 162 42.0 4 1.0 Fruits 111 29.4 53 14.1 61 16.2 143 37.9 9 2.4 Soft drinks 40 10.5 41 10.8 51 13.4 222 58.4 26 6.8 Sweets 47 12.7 37 10.0 58 15.6 214 57.7 15 4.0 Fresh vegetables 122 32.3 84 22.2 68 18.0 100 26.5 4 1.1 Bread 78 20.6 137 36.2 45 11.9 100 26.4 19 5.0 Taro 90 23.6 75 19.6 68 17.8 143 37.4 6 1.6 Tinned fish 58 15.3 57 15.0 51 13.4 194 51.1 20 5.3 Tinned mutton/corned beef 25 6.8 31 8.4 34 9.2 190 51.6 88 23.9 Fresh mutton 13 3.6 22 6.2 24 6.7 149 41.7 149 41.7 Chicken 44 11.8 52 13.9 59 15.8 198 52.9 21 5.6

Water 277 70.1 43 10.9 41 10.4 30 7.6 4 1.0

The proportions of young people who reported consuming each of the foods and drinks more than once per day is shown in Figure 8.3.1. This further highlights that tea is the most favored type of drink after water, and is followed by coconut juice in popularity. It also shows that over two thirds of out-of-school youth do not eat fresh fruit or vegetables, bread or taro more than once per day. A little over 1 in 8 young people eat tinned fish more than once per day, and a slightly lower proportion eat chicken with this level of frequency. Tinned mutton/corned beef or fresh mutton were only consumed more than once per day by small proportions of respondents. About 1 in 8 young people ate sweets more than once per day.

86

Figure 8.3.1 Consumption of various foods and drinks more than once per day among out-of-school youth

3.6

6.8

10.5

10.9

11.8

12

15.3

20.5

20.6

23.6

29.4

30.6

32.3

70.1

0 20 40 60 80

Fresh mutton

Tinned mutton

Soft drink

Coffee

Chicken

Sweets

Tinned fish

Coconut juice

Bread

Taro

Fruits

Tea

Fresh vegetables

Water

%

8.4 Physical activity

More than 40% of young people reported that they exercised less than once per week or less. There was a similar proportion who reported undertaking at least 4 to 6 sessions of physical activity each week (Table 8.4.1). Over half of young people who reported that they undertook less than 1 hour of physical activity per week, while about 1 in 8 did 4 hours or more. About one quarter of young people did not watch television at all, and over 60% said that they watched it less than 1 hour per day.

• Over half of young people reported that they undertook less than one hour of physical activity per week, while about 1 in 8 did 4 hours or more.

• Over 60% said that they watched television for less than one hour per day.

87

Table 8.4.1 The frequency of physical activity and television watching among out-of-school youth

No. % Frequency of exercise Everyday 140 33.7 4-6 times a week 39 9.4 2-3 times a week 60 14.4 Once a week 70 16.8 Once a month or less 107 25.7 Hours of exercise in a week None 89 21.3 About ½ hour 59 14.1 About 1 hour 104 24.9 About 2-3 hours 108 25.9 About 4-6 hours 31 7.4 7 or more hours 26 6.2 Hours of watching TV/videos in a day Not at all 114 27.2 Up to 1 hour 142 33.9 1-3 hours 108 25.8 4 hours or more 55 13.1

8.5 Personal well-being and development

The level of ease with which out-of-school youth felt they could talk to various people about their problems is shown in Table 8.5.1. This is further summarized in Figure 8.5.1 as the proportions who found it easy or very easy to approach various people when they had a problem.

• Friends were the most frequently identified by young people as individuals that they could easily talk to when they had a problem, followed by mothers, sisters and brothers.

• About one quarter of young people reported that they were not happy, about 1 in 5 that they were often

lonely, 1 in 8 that they were rarely or never confident, and 1 in 12 that they had experienced sadness or depression at a level that was almost more than they could take.

• Almost half of these out-of-school youth said that they left school involuntarily. The majority thought that

they would be working or undertaking training in a year’s time.

88

Table 8.5.1 Perceived ease of talking to various people about personal problems among out-of-school youth

Very easy Easy Difficult Very difficult Don't have Person

No. % No. % No. % No. % No. % Father 83 21.3 92 23.7 145 37.3 49 12.6 20 5.1 Mother 110 28.4 139 35.8 91 23.5 35 9.0 13 3.4 Other adults 46 12.2 110 29.1 140 37.0 50 13.2 32 8.5 Brothers 96 25.1 122 31.9 102 26.7 34 8.9 28 7.3 Sisters 106 27.8 144 37.7 87 22.8 25 6.5 20 5.2 Friends 126 33.1 145 38.1 58 15.2 26 6.8 26 6.8 Youth worker 46 12.5 87 23.7 128 34.9 53 14.4 53 14.4 Clergy 24 6.7 59 16.4 115 31.9 77 21.4 85 23.6 Other person 45 13.6 45 13.6 90 27.2 52 15.7 99 29.9

Friends were the most frequently identified by young people, in over 70% of cases, as individuals that they could easily talk to when they had a problem (Figure 8.5.1). The next largest group identified as easy to approach in such situations were mothers, followed by siblings (sisters more so than brothers) and then fathers. Youth workers, clergy, “other people” and adults were the least likely to be identified as people that were easy to talk to when dealing with problems, with between one quarter and two fifths of respondents stating that they considered these people easy to approach. Figure 8.5.1 Proportions of out-of-school youth who identified various people as easy

to approach to discuss personal problems

23.1

27.2

36.2

41.3

45

57

64.2

65.5

71.2

0 20 40 60 80

Priest

Other person

Youth worker

Adult

Father

Brother

Mother

Sister

Friends

%

Over three quarters of young people said that they felt at least “OK” about their lives (Table 8.5.2). The vast majority (around 95%) reported feeling lonely at least sometimes. About one quarter of young people said that they always felt confident, while over 80% said that they were confident at least sometimes. Approximately three quarters of young people said that they had been unhappy, sad or depressed at least once in the past six months, however only about 1 in 12 reported that they experienced severe sadness or depression, that is, at a level almost more than they could take.

89

Table 8.5.2 Levels of happiness, loneliness, confidence and severe sadness among out-of-school youth

No. % Happiness I feel very happy 150 36.4 I feel OK 160 38.8 I don’t feel very happy 76 18.4 I am not happy at all 26 6.3 Loneliness Yes, very often 84 20.5 Yes, sometimes 304 74.1 No 22 5.4 Confidence Always 106 25.6 Sometimes 246 59.4 Rarely 53 12.8 Never 9 2.2 Felt sad or depressed during past six months No 108 26.9 Yes, at home and at school 59 14.7 Yes, but only at home 220 54.7 Yes, but only at school 15 3.7 Severity of sadness/depression Almost more than I can take 32 7.8 Quite bad 100 24.4 Worse than usual 65 15.9 About usual 105 25.6 Not sad 108 26.3

Figure 8.5.2 shows that about one quarter of young people reported that they were not happy, about 1 in 5 that they were often lonely, 1 in 8 that they were rarely or never confident, and 1 in 10 that they had experienced sadness or depression at a level that was almost more than they could take.

Figure 8.5.2 Proportion of out of school youth reporting low levels of happiness or confidence and high levels of loneliness or sadness

10.6

15

20.5

24.7

0 5 10 15 20 25 30

Sad more than I can take

Rarely/never confident

Often lonely

Not happy

%

Table 8.5.3 shows the perceptions among young people about their work and education circumstances. About 80% thought it likely or very likely that they would be working in a year’s time, and 37% considered this very likely. Almost half of these out-of-school youth said they left school involuntarily, while about one quarter chose to do so. Seventy percent of youth stated that it was likely that they would undertake future training, while about 10% thought this unlikely and about 20% thought it impossible.

90

Table 8.5.3 Perceptions among out-of-school youth about their future education and employment prospects

No. % Likelihood of being employed in a years time Very likely 157 37.3 Likely 183 43.5 Unlikely 64 15.2 Impossible 17 4.0 Reason for leaving school I wanted to leave, even though I could continue 95 23.4 I had to leave, even though I wanted to continue 188 46.3 I finished all compulsory schooling, and had no reasons to continue 123 30.3 Likelihood of returning to receive further training Very likely 194 46.6 Likely 96 23.1 Unlikely 46 11.1 Impossible 80 19.2

8.6 Community participation

Approximately 60% of youth felt that they were encouraged to express their views by their church group, their parents or their friends (Figure 8.6.1). A little over 40% felt that they were encouraged to express their views in the community.

• The contexts in which young people felt most encouraged to express their views were the church and among their parents or friends. The community was less frequently identified as a source of such encouragement.

• Less than half of young people rated community involvement as very important or felt that

they were strongly involved in their community.

91

Figure 8.6.1 Level of encouragement out-of-school youth received to express their views in various contexts

29.6 27.8 11.8 18 12.8

21.1 38.7 15.5 15.7 9

14 29.9 14 19.6 22.5

26.5 34.1 10.5 15.8 13.1

0 % 20% 40% 60% 80% 100%

parents

friends

community

church groups t rong ly agree

agree

ne i the r agree nord i sagreed i sagree

s t rong ly d i sag ree

Around 2 in 5 young people considered that their community was important or felt that they were strongly involved in their community (Figure 8.6.2). Figure 8.6.2 Perceived importance of, and involvement in, community among out-of-

school youth

4539

01020304050

community veryimportant

strongly involved incommunity

%

92

8.7 Trust in adults and social institutions

The out-of-school youth respondents were most likely to identify those who govern the land, the church and President/Prime Minister as credible sources of authority in their social environment (Figure 8.7.1). This was followed by adults and elders generally and the Mayor of the town/city. Fathers were more likely to be considered credible than mothers and teachers least of all. These data can be partly compared with similar questions asked of young people in a UNICEF survey in the Caribbean region. Figure 8.7.1 Perceived credibility of adults and social institutions among out-of-school youth

69 20.7 5.3 3.5

63.4 29.6 4 1.6

55.1 33.9 10.7 1.6

54.3 35.4 5.7 3.2

75.7 14.8 7 3.8

63.6 18.5 9.5 7.2

80.8 13.4 5.5 1.8

77.5 11.4 6.8 5.8

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

%

adults/elders in general

father

mother

teacher

church

Mayor of the town/city

those who govern the land

President/Prime Minister

very important more or less important not important doesn't have in country

• The most likely people to be considered as credible by out-of-school youth were those in national leadership positions or in the church. Fathers, mothers and teachers were the least likely to be considered credible.

93

8.8 Physical injury, bullying and violence

The frequency of physical injury and bullying among out-of-school youth is presented in Table 8.8.1 and further summarized in Figure 8.8.1. Almost 4 in 5 youth reported at least one physical injury that required treatment in the past 12 months, while about 2 in 5 reported two or more. A little more than 2 in 5 had suffered an injury that was deliberately inflicted by another person. About 1 in 8 said that their injury was deliberately caused by their father, while slightly smaller proportions said that they had been injured by their boyfriend or girlfriend, mother or teacher. Just under 6% said that they had been deliberately injured by the police. The most common source of deliberate injuries, reported by one quarter of youth was “other person”. Table 8.8.1 shows that just under 55% of young people reported that they had not been bullied, or had not been a bully towards another person, in the past three months. Just over 7% had been bullied once a week or more in this period, and over 12% had bullied others with this degree of frequency. Table 8.8.1 Levels of physical injury and bullying among out-of-school youth No. % Times had a physical injury that needed treatment in last 12 months Never 89 21.5 Once 160 38.7 2-5 times 101 24.5 More than 5 times 63 15.3 Suffering any deliberated inflicted injury 179 42.2 Sources of deliberate injury Father 60 15.5 Mother 39 10.6 Teacher 33 9.1 Police 21 5.8 Boyfriend/girlfriend 45 12.1 Another person 98 25.7 Ever been bullied in the last 3 months I have not been bullied in the last 3 months 224 54.1 Once or twice 60 14.5 Sometimes 100 24.2 About once a week 14 3.4 Several times a week 16 3.9 Frequency of taking part in bullying other people in the last 3 months I have not bullied others in the last 3 months 229 54.8 Once or twice 64 15.3 Sometimes 76 18.2 About once a week 27 6.5 Several times a week 22 5.3

• More than 2 in 5 young people reported that they had been deliberately injured by another person in the past year. Unidentified “other adults” were most often identified as the source of a deliberate injury, followed by fathers.

• Around 7% had been bullied at least weekly in the previous three months, while around 1 in 8 had bullied

others with this degree of frequency.

94

Figure 8.8.1 Experience of injury, bullying and being a bully towards others among

out-of-school youth

78.5

42.2 45.9 45.2

0

20

40

60

80

100

everinjured

deliberateinjury

beenbullied

bulliedothers

%

8.9 Personal hygiene

Only about 40% of young people brushed their teeth more than once per day, while just over half always washed their hands before eating and two thirds always washed their hands after using the toilet (Table 8.9.1). Table 8.9.1 Frequency of tooth brushing and hand washing among out-of-school

youth No. % How often do you brush your teeth? More than once a day 165 39.4 Once a day 131 31.3 At least once a week but not daily 75 17.9 Less than once a week 22 5.3 Never 26 6.2 How often do you wash your hands before eating? Always 228 54.5 Sometimes 173 41.4 Never 17 4.1 How often do you wash your hands after using the toilet?

Always 280 66.8 Sometimes 129 30.8 Never 10 2.4

• Two in 5 out-of-school youth reported brushing their teeth at least twice a day, while half to two thirds always washed their hands before eating or after going to the toilet.

95

8.10 Sexual behavior

Data about sexual behaviour provide an indication about possible risks of unwanted pregnancy, sexually transmitted infections (STIs) of HIV infection. This issue was only canvassed with the out-of-school youth. A substantially higher proportion of boys than girls reported ever having sex (Figure 8.10.1). Figure 8.10.1 Proportion out-of-school youth who reported ever having sex, by gender

57.4

43.2

010203040506070

Boys Girls

%

Figure 8.10.2 shows that about 80% of boys who reported ever having sex said that they had had sex with more than 1 person compared to about half of girls who had ever had sex. Boys showed a much higher prevalence of having sex with 4 or more people in the past (almost 40%) compared to girls (around 8%).

• More boys, just under 3 in 5, reported ever having sex than girls. • The majority of boys who had ever had sex reported having sex with more than one person,

while around 2 in 5 said that they had had sex with 4 or more people. • About one quarter of girls and almost 2 in 5 boys reported having unwanted sex when drunk in

the past. • About 30% of young people said that they always used contraception, while about one-quarter

sometimes used it and between one quarter and one third rarely or never used it. The reported frequencies of undertaking measures to prevent STIs were very similar to these.

96

Figure 8.10.2 Past number of sexual partners among sexually active out-of-school youth, by gender

19 17.7 19

37.449.3

17.9 17.97.5

0

20

40

60

1 partner 2 partners 3 partners 4 partners

%

Boys Girls

About one quarter of girls and almost 2 in 5 boys reported having unwanted sex when drunk in the past (Figure 8.10.3). Figure 8.10.3 Proportion of sexually active out-of-school youth reporting unwanted sex

when drunk or high on drugs

36.1

22.4

0

10

20

30

40

Boys Girls

%

Figure 8.10.4 shows that about 30% of sexually active boys and girls said that they always used contraception, while just over one third of boys and around one quarter of girls said that they never used it.

97

Figure 8.10.4 Use of contraception by sexually active out-of-school youth

28.623.8

12.9

36.1

28.4

22.419.4

23.9

05

10152025303540

Always Sometimes Rarely Never

%

Boys Girls

The proportions of sexually active boys and girls who reported never taking steps to prevent STIs, that is, just over one third of boys and one quarter of girls, were very similar to the proportions reporting that they never used contraception (Figure 8.10.5). Figure 8.10.5 Use of measures to protect against sexually transmitted infections by out-of-school youth

30.6

20.4

8.8

36.135.8

16.4 16.4

28.4

0

10

20

30

40

Always Sometimes Rarely Never

%

Boys Girls

98

Section 9. Comparison of health and lifestyle behaviours between young people in-school and out-of-school Comparison of the health and lifestyle indicators between the in-school and out-of-school youth provides an additional way of examining the relative needs of these groups of young people. It is important to note, however, that there were demographic differences between the in-school and out-of-school samples which could contribute to differences between them in the health and lifestyle variables. Figures 9.01 and 9.02 depict the differences between the samples in age structure, gender and location of parent’s residence. Given these demographic differences, two steps were taken in order to improve the comparability of these two samples. Firstly, only in-school and out-of-school youth between the ages of 14 and 18 years were included in this comparative analysis because both samples had a reasonable representation of young people in these age groups. Because of this age selectivity the prevalences of each variable for in-school and out-of-school youth in this Chapter differ from those shown in the earlier Chapters presenting the results for each of these groups (Chapters 6 and 8). Secondly, a statistical method called logistic regression, which adjusts for gender, age and parental location differences, was used to compare the prevalences on each variable for in-school and out-of-school youth. The statistics calculated to show the relative likelihood of each behaviour between in-school and out-of-school youth were adjusted odds ratios (OR)20. A selected set of comparisons is shown in this Chapter between the samples, to profile the different needs of these two populations of young people. Figure 9.0.1. Age distribution of the in-school and out-of-school samples

20 Odds ratios indicate the relative likelihood that the results on each indicator are significantly different between the groups after allowing for their different demographic characteristics. An adjusted odds ratio of 2.00, for instance, indicates that one group is two times more likely than the other to show the result of interest. If the 95 percent confidence interval does not cross over 1.00 for this result, for example being a range of 1.5-2.5, the odds ratio is statistically significant. The P value for each confidence interval indicates the strength of this statistical significance, with a lower P value (for example P<0.001) indicating greater significance.

Age in years

2019181716151413121110

P

erce

nt o

f sam

ple

30

25

20

15

10

5

0

Sample

out of school

in school

99

Figure 9.0.2. Gender breakdown and location of parent’s residence of the in-school and out-of-school youth

50.1 49.9

4.2

25.5

70.362.7

37.3

4.2

40.9

54.5

0

10

20

30

40

50

60

70

80

male female overseas rural outerislands

Gender Residence of parents

%

in-school out-of-school

9.1 Substance use The prevalence of ever having tried tobacco, alcohol and other drugs are shown for in-school and out-of-school youth in Figure 9.1.1, with adjusted odds ratios included to show the differences between the samples on each indicator. After adjustment for age, gender and parental residence, the out-of-school youth were 70% more likely to have tried smoking, 50% more likely to have tried alcohol and at least twice as likely to have tried most other substances. The out-of-school youth were two and a half times as likely to have been drunk compared to the student sample. Figure 9.1.1 Comparison of the use of substances between in-school and out-of school

youth (showing OR and 95% CI)

28.4 28.9

1.5

14.9

5.21.6

5

45.246.7 44.4

3.9

26.7

12.9

3.47

69.7

0

10

20

30

40

50

60

70

80

Tobacco Alcohol Mushroom Kava Methylatedspirits

Marijuana Solvents Been drunk

%

in-school out-of-school

** P <0.01; **P<0.01; ***P<0.001; OR – odds ratio; CI – 95% confidence interval

1.7*** (1.35-2.19)

1.5** (1.16-1.88)

2.5*** (1.3-4.8)

2.2*** (1.7-2.8)

2.1*** (1.5-3.0) 2.2***

(1.2-3.9)

1.4 (0.9-2.2)

2.5*** (2.0-3.3)

100

9.2 Nutrition Table 9.2.1 shows that in-school youth were significantly more likely than those out-of-school to drink water more than once per day, but less likely to consume coconut juice or soft drinks. The in-school youth were also more likely to report eating vegetables or tinned fish more than once per day, but showed significantly lower proportions eating taro or fresh mutton. Table 9.2.1 Comparisons of the prevalence of regular consumption of various foods

and drinks between in-school and out-of-school youth (showing OR and 95% CI)

In-school (%) Out-of-school (%) P OR(CI)

Tea 79.7 75.7 * 1.3 (1.0-1.7)

Coffee 24.9 28.8 0.9 (0.7-1.1)

Coconut juice 30.0 38.2 ** 0.7 (0.5-0.8)

Fruits 47.7 44.9 1.0 (0.8-1.3)

Soft drinks 13.1 23.2 *** 0.5 (0.4-0.7)

Sweets 100.0 24.2 N/A

Vegetables 69.0 52.5 *** 1.9 (1.5-2.4)

Bread 63.3 56.7 ** 1.5 (1.2-1.9)

Taro 33.5 43.6 ** 0.7 (0.5-0.8)

Tinned fish 37.8 28.7 1.2 (0.9-1.5)

Tinned mutton/corned beef 18.1 16.0 1.2 (0.8-1.6)

Fresh mutton 4.0 9.2 *** 0.3 (0.2-0.5)

Chicken 21.9 25.8 0.8 (0.6-1.1)

Water 94.3 81.9 *** 4.1 (2.9-5.8)

*P<0.05; **P<0.01; ***P<0.001; OR – odds ratio; CI – 95% confidence interval 9.3 Physical activity Comparison between the two samples showed that the out-of-school youth were more physically active than those in-school (Table 9.3.1). The in-school sample were significantly less likely to be exercising at least 4 times per week, but there were no differences in total exercise hours/week, nor in hours of television watching between the samples. Table 9.3.1 Comparisons of levels of physical activity and television watching among

in-school and out-of school youth (showing OR and 95% CI)

In-school (%) Out-of-school (%) P OR(CI)

Exercise 4-6 times/week or more 23.3 44.4 *** 0.4 (0.3-0.5)

Exercise 2-3 hours/week or more 30.0 35.8 0.8 (0.6-1.1)

Watch TV/videos 4 or more hrs/day 11.7 13.1 0.8 (0.5-1.1)

***P<0.001; OR – odds ratio; CI – 95% confidence interval

101

9.4 Personal well-being and development It was notable that in-school youth were significantly more likely than the out-of-school youth to indicate that it was easy for them to speak to their fathers or mothers about things that were bothering them (Table 9.4.1). They were also more likely to feel that it was easy for them to speak with their brothers in such situations. On the other hand, those outside of the family like youth workers, friends, other adults or other people altogether, were more likely to be identified by out-of-school youth as individuals that they could easily approach to discuss problems. Table 9.4.1 Comparisons of the proportions of in-school and out-of-school youth who

found it easy to discuss their difficulties with various others (showing OR and 95% CI)

In-school (%) Out-of-school (%) P OR(CI)

Father 58.4 45.3 *** 1.6 (1.3-2.0)

Mother 78.5 65.5 *** 1.9 (1.5-2.5)

Other adult(s) 35.6 41.3 * 0.7 (0.6-0.9)

Brother(s) 65.4 61.3 * 1.3 (1.1-1.7)

Sister(s) 74.3 68.0 1.3 (1.0-1.6)

Friend(s) 64.5 70.4 * 0.8 (0.6-1.0)

Youth worker(s) 26.4 34.8 ** 0.7 (0.6-0.9)

Clergy 19.2 21.8 1.0 (0.7-1.3)

Other person(s) 17.0 25.5 ** 0.6 (0.4-0.8)

*P<0.05; **P<0.01; ***P<0.001; OR – odds ratio; CI – 95% confidence interval The proportion of in-school youth who reported that they did not feel happy or had suffered severe sadness or depression in the past six months was significantly higher than that of the out-of-school youth sample (Figure 9.4.1). On the other hand students were significantly less likely to report often feeling lonely. Figure 9.4.1 Comparison of levels of mental distress between in-school and out-of-

school youth (showing OR and 95% CI)

29.8

13.3

18.715

24.521.9

16.8

11.3

0

10

20

30

40

Don't feel happy Often feel lonely Rarely/never feelconfident

Severe sadness, depression

%

in-school out-of-school

** P <0.01; ***P<0.001; OR – odds ratio; CI – 95% confidence interval

1.5*** (1.2-1.9)

0.7** (05-0.9) 1.1

(0.8-1.5) 1.6* (1.0-2.3)

102

9.5 Community participation In-school youth were twice as likely as those out-of-school to report that they felt encouraged by their parents to express their views (Table 9.5.1). They were also more likely to indicate that the community was important to them. There was, however, little difference in the proportion of in-school and out-of-school youth who felt strongly involved in the community. Table 9.5.1 Comparison of proportions of in-school and out-of-school youth who felt

encouraged to express their views in various contexts (showing OR and 95% CI)

In-school (%) Out-of-school

(%) P OR(CI)

Parents 69.7 55.2 *** 2.1 (1.7-2.7)

Friends 59.2 56.0 1.2 (0.9-1.5)

The community 35.0 38.5 0.8 (0.6-1.1)

Church group 55.3 57.6 0.8 (0.6-1.0)

Consider the community to be very important to them

57.7 39.7 *** 1.9 (1.6-2.5)

Feel strongly involved in local community 29.2 33.8 0.8 (0.6-1.0)

** P <0.01; ***P<0.001; OR – odds ratio; CI – 95% confidence interval 9.6 Trust in adults and social institutions The ratings of credibility of various authority figures in the social environments of the in-school and out-of-school youth showed that the latter were more likely to place trust in figures in the public sphere (Table 9.6.1). In-school youth were significantly more likely to identify fathers, mothers or the church as credible sources of authority, but less likely to see those who govern the land or the mayor of the town or city in this way. It was notable that the in-school youth were one fifth as likely as the out-of-school youth to rate those who govern the land as credible. On the other hand, the Prime Minister had very high levels of credibility in both groups. Table 9.6.1 Comparison of proportions of in-school and out-of-school youth who

rated adults and social institutions as credible (showing OR and 95% CI)

In-school (%)

Out-of-school (%)

P OR(CI)

Adults/elders 65.3 62.8 1.0 (0.8-1.3)

Father 70.5 59.5 *** 1.7 (1.3-2.1)

Mother 60.4 51.6 ** 1.5 (1.2-1.8)

Teacher 56.8 53.5 ** 1.3 (1.0-1.7)

Church 82.5 73.8 ** 1.7 (1.3-2.3)

The Mayor of the town/city 48.2 63.8 *** 0.5 (0.4-0.7)

Those who govern the land 38.1 79.4 *** 0.2 (0.1-0.3)

The President/Prime Minister 77.8 78.6 0.9 (0.7-1.3)

**P<0.01; ***P<0.001; OR – odds ratio; CI – 95% confidence interval

9.7 Physical injury, bullying and violence

103

The results from each sample concerning injuries in the last twelve months showed that in-school youth were half as likely as those out-of-school to report that they had been deliberately injured by another person in this period (Figure 9.7.1). As might be expected, the young people not going to school were slightly less likely to report that they had been bullied, or had been a bully towards others in the previous three months, but these differences were not significant after adjustment for demographic differences between the samples. Figure 9.7.1 Comparisons of levels of physical injury and bullying between in-school

and out-of-school youth (showing OR and 95% CI)

74.7

28.7

59.7 61.2

77.7

43.753.8 53.5

0102030405060708090

100

Had a physical injury Suffered a deliberateinjury

Ever been bullied Ever bullied others

%

in-school out-of-school

***P<0.001; OR – odds ratio; CI – 95% confidence interval 9.8 Personal hygiene Personal hygiene habits were markedly worse among the out-of-school sample. The in-school youth were more likely to brush their teeth at least twice a day and to always wash their hands before eating or after going to the toilet than the out-of-school sample. Figure 9.8.1 Comparisons of frequency of personal hygiene habits between in-school

and out-of-school youth (showing OR and 95% CI)

64.3 6979.2

39.3

54.967.8

0102030405060708090

Brush teeth two or moretimes/day

Always wash hands beforeeating

Always wash hands after usingthe toilet

%

in-school out-of-school

***P<0.001; OR – odds ratio; CI – 95% confidence interval

0.9 (0.7-1.2)

0.5*** (0.4-0.6)

1.2 (0.9-1.5)

1.2 (0.9-1.5)

2.9*** (2.3-3.6)

1.7*** (1.4-2.2)

2.0*** (1.6-2.6)

104

Section 10 Exploration of interrelationships between behavioural and lifestyle factors and demographic characteristics This section examines associations between key indicators in this survey and demographic variables. In addition, correlations between the behavioural and mental health variables are also examined. The approach taken in this section is to use the magnitude of the correlation to define whether there is a substantial association between the variables under study. Given the large sample size, using statistical significance may not be the appropriate method, as even very small correlations will achieve statistical significance with a large sample. For this reason, correlations are included in the tables below on the basis of whether their magnitude is above a level of 0.2. When the data were examined looking for correlations among behavioural factors, correlations of 0.2 were considered moderate while 0.4 or greater were considered substantial. These associations do not imply a causal relationship but merely indicate characteristics that are consistently associated with phenomena of interest. Table 10.1 shows the associations between different variables in the in-school youth sample and a range of demographic characteristics. The demographic characteristics were gender, age, province, strength of adherence to religious faith, and father’s occupation (as a proxy variable for socioeconomic status). The levels of association are described as moderately weak if the correlation is between 0.1 and 0.19, and these are shown by a plus sign (+) in the table. Stronger associations are shown by a double plus sign (++), where the correlation is greater than 0.2 or greater. Table 10.1 shows that there were clear gender and age associations with most of the behavioural variables. Boys were more likely than girls to smoke or use alcohol or kava, and these behaviours also increased in prevalence with age. There were some associations between the behaviour and lifestyle variables and province, but these were generally weak. On the other hand there were no associations between any of the variables and religious commitment or father’s occupation. The only exception was that those with stronger adherence to a religious faith felt that their local community was more important to them. There were few associations between mental health and psychosocial variables and these demographic variables. This is important, as the lack of substantial gender differences here make these Vanuatu data different to other adolescent health surveys in developed countries, where gender differences are large, and age gradients are also significant. There were some gender differences in tooth brushing or hand washing behaviours, as these were more likely among girls than boys.

105

Table 10.1 Associations between health and lifestyle variables and demographic

characteristics in the in-school sample Gender Age Province Religion

(faith) Father’s

job Behavioural variables Ever smoked ++ ++ + Ever tasted alcohol + ++ + Ever tried kava ++ + Been drunk + ++ + Frequency of exercise ++ + TV watching + Mental health/psychosocial variables Easy to talk to father + + Easy to talk to mother Feel happy about life + Feeling lonely Ever been bullied Other variables Local community important to you + Feel involved in local community + Injury past 12 months Deliberate injury sustained + + Brush teeth + + Wash hands before eating + Wash hands after toilet + +Correlation 0.1-0.19 ++Correlation >0.2 Table 10.2 shows the associations between selected behavioural and lifestyle factors in the in-school youth sample. Those who had ever smoked were much more likely to have ever tried kava or been drunk. Those who brushed their teeth were much more likely to wash their hands before meals or after using the toilet. There were no other substantial patterns of association among these behavioural and lifestyle variables. There were few strong correlations between the mental health variables either, shown in Table 10.3. Those who found it easy to talk to their fathers also reported it easy to talk to their mothers. There was some association between feeling happy about life and being bullied, and also between being bullied and reporting a deliberate injury in the previous 12 months. There were small associations between feeling lonely and lacking self confidence, and between feeling happy about life and reporting it easy to talk to either fathers or mothers in times of difficulty.

106

Table 10.2 Associations between selected behavioural factors among in-school

youth 1 2 3 4 5 6 7 8 9 1. Ever smoked

+++

+++

+

2. Ever tried kava

++

3. Ever been drunk

4. Frequency of exercise

+

5. TV watched

6. Injury past 12 months

7. Teeth brushed

++

++

8. Hand washing meals

+++

9. Hand washing toilet

+ Correlation 0.1-0.19 ++ Correlation 0.2-0.39 +++ Correlation >0.4 Table 10.3 Associations between selected mental health and psychosocial variables

among in-school youth 1 2 3 4 5 6 7 8 1. Easy to talk to father

+++

+

2. Easy to talk to mother

+

3. Feel happy about life

+

4. Feeling lonely

+

5. Severe sadness or depression

6. Confident

7. Bullied +

8. Deliberate injury

+ Correlation 0.1-0.19 ++ Correlation 0.2-0.39 +++ Correlation >0.4 Table 10.4 shows the same correlational analysess applied to the smaller sample of out-of-school youth. Only the demographic variables of gender and age are included here, with age categorized into three groups. The same pattern of gender and age relationships with substance use was apparent for the out-of-school youth as was evident for the in-school sample. Among out-of-school youth there were stronger relationships between age and the perception that the local community is important or that one is strongly involved in the local community,

107

while perceived involvement in the local community was also related to gender. In this out-of-school youth sample there was also a relationship between gender and physical activity and television/video watching, with boys more likely than girls to engage in each of these past times. Out-of-school girls showed the same pattern of higher levels of brushing their teeth or washing their hands after using the toilet, compared to boys, as the in-school girls did. Table 10.4 Associations between health and lifestyle variables and demographic

characteristics in the out-of-school sample Gender Age Behavioural variables Ever smoked ++ ++ Ever tasted alcohol ++ ++ Ever tried kava ++ ++ Been drunk ++ ++ Frequency of exercise ++ TV watching + Mental health/psychosocial variables Easy to talk to father + Easy to talk to mother Feel happy about life Feeling lonely Ever been bullied Other variables Local community important to you ++ Feel involved in local community ++ ++ Injury past 12 months Deliberate injury sustained + Brush teeth + Wash hands before eating Wash hands after toilet + +Correlation 0.1-0.19 ++Correlation >0.2 These preliminary correlations show some of the patterns of association in the Vanuatu HPLPY sample. Further multivariable analyses are required to disentangle these associations further, but there are some consistent observations here, particularly by gender and age. Some of these are quite different to the results found in correlational analyses conducted on the European HBSC surveys and are therefore informative about some of the differences between that survey and this population of Vanuatu youth.

108

Section 11 Summary and conclusions

11.1 Summary of main findings This survey of health and lifestyle behaviours of young people in Vanuatu is the first in a series of surveys planned to examine needs and issues among young people in Pacific nations. It is part of an endeavor by UNICEF Pacific to obtain evidence to assist the effective delivery of life skills programs for young people in this region. The survey is linked to WHO initiatives, both in this region, and in the HBSC survey in Europe. These data collected in Vanuatu represent a major step forward in conducting adolescent health surveys in developing countries, and provides a unique insight into the health and lifestyle issues among young people in this nation. In general the prevalence of tobacco and other drug use among young people in Vanuatu was lower than that observed in other nations. Alcohol and tobacco, followed by the traditional kava drink, were the main types of drugs that young people reported using, but the proportions who used these on a weekly or more regular basis were small. The rate of regular smoking and the proportion who had consumed alcohol or been drunk 2 or times were below the prevalence rates found in the HBSC surveys in Europe. As would be expected, the use of most types of substances increased among students between the ages 12 and 17 years. In addition, boys were consistently higher substance users than girls. The province of Shefa had the highest proportions of in-school youth who had tried tobacco or alcohol, and this province together with Sanma had the highest proportions who reported ever being drunk. Comparison of the in-school and out-of-school samples showed that the latter had a significantly higher likelihood of ever being drunk or of trying most substances. The data about dietary patterns indicated that nutrition is an important health issue among young people in Vanuatu. More than half of students and over two thirds of out-of-school youth did not eat important foods such as fruit and vegetables more than once per day. Yams, the primary root crop, may have been consumed regularly by young people instead of the food items surveyed, but this food type was not examined in the survey. There were also some marked differences between provinces in the prevalence of the consumption of fibres like fruits, vegetables, bread and taro. Shefa, for instance, had the lowest proportions of students who reported eating fruits, vegetables or taro on a daily basis, but the highest prevalence of daily bread consumption. Some of these findings could relate to the level of urbanization, or to different access to foodstuffs in different regions. Another apparent trend was that in-school youth were more likely than those out-of-school to eat vegetables more than once per day but significantly less likely to eat taro this frequently. A striking finding in regard to dietary behaviours was that all students reported that they ate sweets at least once per day. This far exceeded the rates found in the HBSC surveys in Europe and was also significantly higher than the levels of sweet consumption in the out-of-school sample from Vanuatu. This unusual finding warrants further investigation in order to determine its validity and possible causes. Physical activity levels were low among both in-school and out-of-school youth. The proportions of 13 and 15 year olds who reported participating in regular physical activity were below the range observed in the European HBSC survey. Girls were less likely to be active than boys, and those at younger ages were less likely than older youth. The provinces of Malampa and Tafea had the lowest proportions of students reporting regular physical activity. In addition, young people at school were less active than those not in school. While the measures of mental health and social support showed that some young people in Vanuatu were experiencing difficulties, these rates were not especially high and were within the range of what is usually observed in such surveys in other countries. Comparison of students with out-of-school youth showed that the latter were significantly more likely to report that they often felt lonely. The social support patterns among these two population groups were also different, with those out-of-school significantly less likely to consider it easy to

109

discuss problems with parents, but more likely to identify youth workers, friends or other adults as approachable. It was notable that while most of the out-of-school sample were not working, and almost half had left school involuntarily, there was general optimism among this group about their future work and training prospects. Generally, students were positive about their teachers and peers at school, but had more divided views about the school environment overall. This was most apparent in regard to their perceptions about whether students were treated too strictly and the levels of safety and cleanliness at schools. The proportion of students who felt that students were treated too strictly at school was higher than the range observed in the European HBSC surveys. The home, peer and church contexts were identified by in-school and out-of-school youth as the settings in which they were most likely to be encouraged to express their views. Most did not feet such encouragement in the community context, and girls were even less likely to feel comfortable to express themselves in this context than boys. The province of Penama showed the highest proportions of young people indicating that they were encouraged to express their views by friends, parents, the community or their church, while Tafea had among the lowest proportions of students who indicated that they received encouragement in these contexts. Out-of-school youth were about half as likely as those in-school to indicate that they were encouraged to express their views by their parents. Even though most young people did not feel encouraged to express themselves in their community, a substantial proportion rated their community as important to them. This was more likely among young people in-school than young people who were out-of-school. The perceived importance of the community, however, was not matched by a sense of involvement within it. Just under one third of students and out-of-school youth felt strongly involved in their community. In regard to their social environment students placed greatest trust and credibility in the church and their national leaders, and these were followed in importance by parents and adults generally. It was interesting that there were markedly lower proportions of students in Tafea compared to the other provinces who regarded parents, the church or civic and governmental leaders as credible. Out-of-school youth were more likely than those in-school to consider figures in the public sphere, such as those with governmental or civic leadership, as credible. Students, on the other hand placed greater trust in parents and the church. Injuries deliberately inflicted by others were a serious health concern in Vanuatu. Almost one third of young people reported that they had received a deliberate injury from another person in the past 12 months, with levels higher among boys than girls and generally higher in younger age groups. Deliberate injury was reportedly caused by peers, but also by teachers, parents, the police and other adults. The highest proportion of students who reported that they had been deliberately injured was in Malampa, while the lowest was in Shefa. Bullying at school was also associated with higher rates of reported deliberate injury. Out-of-school youth represented a particularly high risk group in regard to deliberate injury with rates almost twice as high as those at school. Levels of bullying at school appeared to be within the range of what has been observed in other countries. Malampa showed the highest proportion of students who said that they had been bullied in the last school term at school. The majority of students reported brushing their teeth 2 or more times per day and washing their hands before eating or after using the toilet. There was still, however, about one third who did not brush their teeth this regularly and about one quarter who could improve their frequency of hand washing. Poorer hygiene practices were evident among the out-of-school youth, with significantly lower rates of regular tooth brushing and hand washing than those at school. The information collected about the sexual health behaviours was only from the out-of-school youth sample. These data indicated that boys represented a greater risk group than girls. Around 2 in 5 boys who had ever had sex reported having sex with 4 or more people in the past, and a similar proportion said that they had had unwanted sex when drunk in the past. About one quarter of girls reported having unwanted sex when drunk in

110

the past. There was inconsistent use of contraception or safe-sex measures by the young people who were sexually active, with between one quarter and one third stating that they never took action in these areas. 11.2 Conclusions The experience of conducting this survey in Vanuatu has demonstrated the potential to obtain population measures of health and lifestyle needs and risks among youth in the Pacific nations. The survey was carried out in a manner comparable with the methods used in the HBSC surveys conducted in Europe. The sample size of young people collected in Vanuatu was consistent with protocols for the HBSC surveys, and indeed, the high response rate that was obtained indicates the potential to collect high quality representative youth health data in the context of developing nations. The process of developing the survey before applying it in the field also showed that the language and cultural factors that may affect the validity of the data can be addressed. Initial pilot testing of the survey instrument helped to ensure that it addressed the health needs and concerns of young people in Vanuatu, and feedback from field workers after this pilot indicated that young people felt comfortable to answer the questions honestly. Careful attention to translation and back-translation of the final survey instrument helped to ensure that the meaning of the questions was accurately portrayed in Bislama. There were several unique features of this health behaviour survey in Vanuatu compared to those that have been carried out in other parts of this world, and many of these represent particular strengths of this study. An important feature of the survey was the high level of involvement of local young people in its design and implementation. The willingness of local youth to participate in focus groups and interviews helped in the identification of health and lifestyle issues that needed to be addressed in the survey. A number of youth also undertook training and were involved in implementing the survey in schools and other locations, then later participated in training for data entry and basic data analysis techniques. This participatory research approach was intended to increase the relevance to, and ownership of, the whole survey process for young people. It also aimed to provide an opportunity for local youth to enhance their research capacity and general life skills. Anecdotal evidence indicates that the latter has already been improved, with a number of local young people who participated as survey field staff going on to find paid jobs and showing signs of increased self-esteem. Apart from such immediate benefits, the development of local capacity in this manner will increase the potential for such surveys to be successfully implemented in future. Aside from local youth, the organizations who collaborated in the planning and implementation of the study was critical to its success. These included the national government of Vanuatu and its relevant Ministries, Peace Corps Vanuatu, UNICEF Pacific and the Australian Centre for Health Promotion. This collaboration was not only desirable for improving the quality and relevance of the survey, but necessary for addressing the cultural and geographical challenges of undertaking the study in Vanuatu. The latter challenges related to the rugged topography and the wide dispersion of the population in Vanuatu. Another distinctive feature of this study was that, unlike comparable surveys conducted in Europe (HBSC) which are administered to students in years 6 (aged 11-12), 8 (aged 13 -14) and 10 (aged 15-16), this study in Vanuatu was usually carried out with whole school populations. This was necessary to ensure that there would be adequate samples of students from the key age groups given the variation in the ages of students in each year at school in Vanuatu. This survey samples almost three quarters of all secondary school students in the country, approximating a universe of students rather than a sample. The result was a large sample size of in-school youth surveyed in Vanuatu. It is intended that subsequent Pacific nation comparisons be drawn especially with those aged 13 and 15 years old, in order to facilitate comparison with recent surveys in developed countries. Apart from the value of this survey in fostering collaboration to address the needs of young people in Vanuatu, it has collected a wealth of data that may be used to assist the planning of youth programs. These data are valuable in identifying important health needs and risks among in-school youth and those out-of-school, in discerning

111

variations in health and lifestyle issues among in-school youth across provinces and in recognizing the relative significance of particular issues among the in-school and out-of-school populations. An important role that periodic implementation of such surveys can play is in monitoring the extent to which health and lifestyle gains are being made among youth in Vanuatu and provide a source of surveillance of emerging issues among youth. While these data highlight some key health and lifestyle issues among young people, the methodological limitations which may have some impact upon their validity should be acknowledged. The first of these concerns the reliance upon self-report to obtain information about respondents. This has the potential for bias as a result of young people not accurately recalling their recent behaviours or even deliberately misrepresenting their behaviours in order to present themselves in a more socially desirable way. However, steps were taken in the study to minimize such possible influences. An important one of these was careful piloting of the instrument, including interviewing young people after they had competed the pilot surveys to examine the accuracy of their responses. Others were thorough training of field staff in survey implementation and ensuring that there were adequate numbers of staff to answer any questions that young people had about the survey as they completed it. In addition to this, when introducing the survey to young people these field staff highlighted the confidentiality of the information that would be provided to put respondents at ease about giving honest answers. While the possible effect of bias cannot be ruled out, even when such steps are taken, the use of self-report measures offered some important strengths for this study. These included its usefulness in efficiently gaining information at the population level, and its value in measuring factors that are very difficult or impossible to study using clinical or observational techniques. Another methodological limitation of the study was the use of a convenience sample in only one province for the out-of-school youth survey. Consequently, these findings can only be treated as indicative, rather than representative, of health and lifestyle needs among this population group. They do, however, provide pointers towards issues that might be addressed in specific needs assessments by those working with this segment of the youth population in various provinces in Vanuatu. This study has demonstrated that it is feasible to collect high quality information about health and lifestyle needs among youth in developing countries and report on it at low cost, without the need for substantial funding. Fundamental to the success of this initiative was the endorsement of the relevant government Ministries in Vanuatu. UNICEF Pacific has been critical in facilitating local youth agencies and providing technical support at the various stages of this survey, such as on the ground coordination and the training and supervision of field staff. Academic groupings, such as the Australian Centre for Health Promotion Research Unit can play a role in processes like these in fostering the development of local research capacity and helping to analyze and interpret the data which are collected. It is essential that youth health and development programs in developing countries are based on local country data, rather than extrapolations from the regular health behaviour surveys that are carried out with young people in developed nations. In this case data that are unique to Vanuatu have been collected and can be applied in policies and programme planning to address the needs of young people. There is scope for the collection of such data in other nations in the Pacific. Such initiatives should be encouraged and supported, and in the longer term will enable the collection of comparative data for the Pacific nations to help identify youth health and development priorities at the regional level.

112

Appendix 1. Data tables – results of student survey stratified by age and gender Table A1.1 Parent occupation and living arrangements of students by gender and age ______________________________________________________________________________________________________________________________________ -------------------------------------------------------------------------------------------------------------------------------------- Gender Age Total ----------------------- ----------------------------------------------------------------------- ----------- Boy Girl 12yrs 13yrs 14yrs 15yrs 16yrs 17yrs n % ----------- ----------- ----------- ----------- ----------- ----------- ----------- ----------- n % n % n % n % n % n % n % n % -------------------------------------------------------------------------------------------------------------------------------------- Dad's job Doesn't work 308 13.6 318 14.1 53 13.2 124 12.9 138 13.3 132 15.0 101 14.2 69 15.4 617 13.9 Office worker 587 25.9 668 29.6 105 26.2 267 27.8 287 27.7 253 28.8 202 28.4 113 25.2 1227 27.7 Manual labourer/worker 671 29.7 635 28.1 136 33.9 309 32.1 275 26.6 238 27.1 185 26.0 125 27.9 1268 28.6 Works at home to earn money 697 30.8 638 28.2 107 26.7 262 27.2 335 32.4 255 29.0 223 31.4 141 31.5 1323 29.8 Mum's job Doesn't work 744 32.7 691 30.5 101 25.1 309 31.9 297 28.6 295 33.4 241 33.8 170 38.0 1413 31.7 Office worker 479 21.1 547 24.1 94 23.4 210 21.6 237 22.8 191 21.6 175 24.5 93 20.8 1000 22.4 Manual labourer/worker 253 11.1 226 10.0 60 14.9 122 12.6 104 10.0 93 10.5 53 7.4 26 5.8 458 10.3 Works at home to earn money 799 35.1 804 35.4 147 36.6 329 33.9 401 38.6 305 34.5 244 34.2 158 35.3 1584 35.6 Living with parents for most of the time Yes 1582 70.8 1681 75.3 286 73.0 678 71.8 772 76.1 656 75.1 516 72.8 289 64.4 3197 73.0 No 651 29.2 552 24.7 106 27.0 266 28.2 242 23.9 217 24.9 193 27.2 160 35.6 1184 27.0 Parents live: Overseas 25 4.6 17 3.8 4 4.7 15 6.5 6 3.0 6 3.6 8 5.6 2 1.4 41 4.2 In a rural area (outside Port Vila) 143 26.3 107 24.1 28 32.6 70 30.2 57 28.4 39 23.5 28 19.4 20 14.5 242 25.0 In outer islands 375 69.1 320 72.1 54 62.8 147 63.4 138 68.7 121 72.9 108 75.0 116 84.1 684 70.7 The number of people you are living with 1-2 83 3.7 67 3.0 19 4.9 31 3.3 36 3.5 22 2.5 15 2.2 20 4.6 143 3.3 3-10 1852 83.6 1899 86.2 316 81.4 800 85.6 848 83.3 741 85.9 601 86.5 370 85.3 3676 84.8 >10 279 12.6 238 10.8 53 13.7 104 11.1 134 13.2 100 11.6 79 11.4 44 10.1 514 11.9

113

Table A1.2 Religious denomination and commitment to faith of students by gender and age ___________________________________________________________________________________________________________________________________ -------------------------------------------------------------------------------------------------------------------------------------- Gender Age Total ----------------------- ----------------------------------------------------------------------- ----------- Boy Girl 12yrs 13yrs 14yrs 15yrs 16yrs 17yrs n % ----------- ----------- ----------- ----------- ----------- ----------- ----------- ----------- n % n % n % n % n % n % n % n % -------------------------------------------------------------------------------------------------------------------------------------- Religion Catholic 410 18.1 412 18.2 84 21.2 175 18.1 187 18.0 134 15.2 118 16.5 99 22.1 797 17.9 Presbyterian 798 35.2 794 35.0 120 30.2 347 35.8 368 35.4 332 37.6 264 37.0 138 30.8 1569 35.3 Seventh Day Adventist 351 15.5 303 13.4 47 11.8 149 15.4 134 12.9 155 17.6 103 14.4 54 12.1 642 14.4 Pentecostal 175 7.7 181 8.0 28 7.1 67 6.9 95 9.1 67 7.6 54 7.6 41 9.2 352 7.9 Other 503 22.2 551 24.3 110 27.7 216 22.3 236 22.7 189 21.4 167 23.4 112 25.0 1030 23.1 Methodist/Hindu/Muslim/Bud dhist/Latter Day Saints 33 1.5 27 1.2 8 2.0 14 1.4 20 1.9 6 .7 8 1.1 4 .9 60 1.3 Commitment to faith Not at all 30 1.3 30 1.3 5 1.3 19 2.0 8 .8 13 1.5 6 .8 7 1.6 58 1.3 Weak 195 8.7 219 9.8 37 9.3 87 9.1 99 9.7 71 8.1 66 9.3 39 8.7 399 9.1 Strong 1035 46.0 1133 50.6 167 42.1 431 45.2 493 48.2 460 52.8 362 51.2 218 48.9 2131 48.4 Stronger 383 17.0 329 14.7 70 17.6 148 15.5 156 15.2 145 16.6 107 15.1 70 15.7 696 15.8 A bit stronger 220 9.8 242 10.8 47 11.8 102 10.7 104 10.2 79 9.1 72 10.2 55 12.3 459 10.4 Very strong 387 17.2 284 12.7 71 17.9 167 17.5 163 15.9 104 11.9 94 13.3 57 12.8 656 14.9

114

Table A1.3 Past use of substances (ever) among students by gender and age ______________________________________________________________________________________________________________________________________ -------------------------------------------------------------------------------------------------------------------------------------- Gender Age Total ----------------------- ----------------------------------------------------------------------- ----------- Boy Girl 12yrs 13yrs 14yrs 15yrs 16yrs 17yrs n % ----------- ----------- ----------- ----------- ----------- ----------- ----------- ----------- n % n % n % n % n % n % n % n % -------------------------------------------------------------------------------------------------------------------------------------- Ever smoked Yes 741 32.9 302 13.5 39 9.8 109 11.5 182 17.6 222 25.3 233 32.9 215 47.7 1000 22.7 No 1514 67.1 1938 86.5 357 90.2 838 88.5 850 82.4 654 74.7 476 67.1 236 52.3 3411 77.3 Ever tasted alcohol Yes 664 29.5 368 16.5 28 7.0 104 11.0 162 15.7 222 25.3 221 31.4 254 56.4 991 22.5 No 1470 65.2 1776 79.5 336 84.4 781 82.5 812 78.9 628 71.7 460 65.3 190 42.2 3207 72.8 Don't know 119 5.3 91 4.1 34 8.5 62 6.5 55 5.3 26 3.0 23 3.3 6 1.3 206 4.7 Ever tried marijuana Yes 50 2.3 12 0.5 5 1.3 12 1.3 10 1.0 14 1.6 12 1.7 10 2.2 63 1.4 No 2130 97.7 2174 99.5 393 98.7 941 98.7 1021 99.0 857 98.4 693 98.3 438 97.8 4343 98.6 Ever had magic mushrooms Yes 52 2.3 28 1.3 12 3.0 20 2.1 11 1.1 14 1.6 16 2.3 6 1.3 79 1.8 No 2032 89.8 2087 93.5 360 90.5 861 90.8 956 92.5 807 92.1 637 90.5 421 93.6 4042 91.7 Don't know 178 7.9 117 5.2 26 6.5 67 7.1 67 6.5 55 6.3 51 7.2 23 5.1 289 6.6 Ever tried Kava Yes 438 19.4 135 6.0 21 5.3 84 8.8 116 11.3 114 13.0 110 15.6 105 23.4 550 12.5 No 1822 80.6 2105 94.0 379 94.8 870 91.2 914 88.7 762 87.0 596 84.4 344 76.6 3865 87.5 Ever drunk methylated spirit(with or without water) Yes 138 6.1 47 2.1 7 1.8 17 1.8 22 2.1 31 3.6 43 6.1 48 10.7 168 3.8 No 2109 93.9 2190 97.9 392 98.2 933 98.2 1007 97.9 842 96.4 658 93.9 400 89.3 4232 96.2 Ever sniffed glue or petrol Yes 150 6.7 72 3.2 19 4.8 46 4.8 54 5.2 44 5.1 30 4.3 24 5.4 217 4.9 No 2105 93.3 2161 96.8 380 95.2 908 95.2 975 94.8 826 94.9 674 95.7 424 94.6 4187 95.1

115

Table A1.4.1 Dietary habits of students by gender and age ______________________________________________________________________________________________________________________________________ -------------------------------------------------------------------------------------------------------------------------------------- Gender Age Total ----------------------- ----------------------------------------------------------------------- ----------- Boy Girl 12yrs 13yrs 14yrs 15yrs 16yrs 17yrs n % ----------- ----------- ----------- ----------- ----------- ----------- ----------- ----------- n % n % n % n % n % n % n % n % -------------------------------------------------------------------------------------------------------------------------------------- Frequency of drinking tea Less than once a day 434 19.9 456 20.7 87 23.6 178 19.5 192 19.0 190 21.9 137 19.7 90 20.5 874 20.4 Once a day or more 1742 80.1 1745 79.3 282 76.4 735 80.5 816 81.0 676 78.1 559 80.3 349 79.5 3417 79.6 Frequency of drinking coffee Less than once a day 1591 73.7 1583 73.2 253 69.1 637 70.8 731 73.7 631 74.2 532 77.7 337 76.4 3121 73.7 Once a day or more 568 26.3 579 26.8 113 30.9 263 29.2 261 26.3 219 25.8 153 22.3 104 23.6 1113 26.3 Frequency of drinking coconut juice Less than once a day 1401 64.7 1559 71.8 237 64.2 592 65.4 667 67.4 600 70.1 482 69.4 328 75.8 2906 68.4 Once a day or more 763 35.3 611 28.2 132 35.8 313 34.6 323 32.6 256 29.9 213 30.6 105 24.2 1342 31.6 Frequency of eating fruits Less than once a day 1139 52.7 1095 50.6 169 45.7 463 51.7 492 49.8 429 49.8 371 53.5 258 59.6 2182 51.4 Once a day or more 1023 47.3 1070 49.4 201 54.3 432 48.3 496 50.2 433 50.2 323 46.5 175 40.4 2060 48.6 Frequency of drinking soft drinks Less than once a day 1842 86.3 1832 85.8 305 84.0 748 84.8 842 87.0 714 84.2 609 89.0 389 88.6 3607 86.2 Once a day or more 292 13.7 303 14.2 58 16.0 134 15.2 126 13.0 134 15.8 75 11.0 50 11.4 577 13.8 Frequency of eating sweets Once a day or more 2140 100 2139 100 364 100 893 100 979 100 841 100 681 100 434 100 4192 100 Frequency of eating vegetables Less than once a day 666 31.1 707 32.6 136 37.2 299 33.4 323 32.7 261 30.5 199 29.2 134 30.7 1352 32.0 Once a day or more 1475 68.9 1462 67.4 230 62.8 596 66.6 665 67.3 594 69.5 483 70.8 303 69.3 2871 68.0 Frequency of eating bread Less than once a day 807 38.1 813 38.2 158 43.6 360 40.9 400 41.2 315 37.4 239 35.3 126 29.2 1598 38.4 Once a day or more 1311 61.9 1315 61.8 204 56.4 520 59.1 570 58.8 528 62.6 438 64.7 305 70.8 2565 61.6

116

Table A1.4.2 Dietary habits of students by gender and age ______________________________________________________________________________________________________________________________________ -------------------------------------------------------------------------------------------------------------------------------------- Gender Age Total ----------------------- ----------------------------------------------------------------------- ----------- Boy Girl 12yrs 13yrs 14yrs 15yrs 16yrs 17yrs n % ----------- ----------- ----------- ----------- ----------- ----------- ----------- ----------- n % n % n % n % n % n % n % n % -------------------------------------------------------------------------------------------------------------------------------------- Frequency of eating bread Less than once a day 1382 63.3 1412 64.9 215 58.3 535 59.1 638 63.7 595 68.9 452 65.3 306 69.2 2741 64.2 Once a day or more 800 36.7 762 35.1 154 41.7 370 40.9 363 36.3 268 31.1 240 34.7 136 30.8 1531 35.8 Frequency of eating tinned fish Less than once a day 1321 60.9 1364 62.7 229 62.2 556 61.1 595 60.2 507 59.4 425 61.3 315 71.6 2627 61.8 Once a day or more 847 39.1 810 37.3 139 37.8 354 38.9 393 39.8 347 40.6 268 38.7 125 28.4 1626 38.2 Frequency of eating tinned mutton/corned beef Less than once a day 1756 81.8 1772 82.8 300 82.6 745 84.4 828 84.1 681 79.8 549 80.6 366 83.4 3469 82.5 Once a day or more 391 18.2 368 17.2 63 17.4 138 15.6 157 15.9 172 20.2 132 19.4 73 16.6 735 17.5 Frequency of eating fresh mutton Less than once a day 1983 95.2 1999 95.6 329 94.0 819 95.1 912 95.4 792 96.1 633 95.2 420 97.9 3905 95.6 Once a day or more 99 4.8 91 4.4 21 6.0 42 4.9 44 4.6 32 3.9 32 4.8 9 2.1 180 4.4 Frequency of eating chicken Less than once a day 1678 78.7 1609 74.7 260 72.0 669 75.3 747 75.9 666 78.4 557 82.4 341 77.9 3240 77.2 Once a day or more 454 21.3 544 25.3 101 28.0 220 24.7 237 24.1 183 21.6 119 17.6 97 22.1 957 22.8 Frequency of drinking water Less than once a day 150 6.8 157 7.1 44 11.8 82 8.9 70 6.9 49 5.6 38 5.4 17 3.8 300 6.9 Once a day or more 2050 93.2 2064 92.9 330 88.2 840 91.1 947 93.1 822 94.4 666 94.6 428 96.2 4033 93.1

117

Table A1.5 Physical activity habits of students by gender and age _________________________________________________________________________________________________________________________________________ -------------------------------------------------------------------------------------------------------------------------------------- Gender Age Total ----------------------- ----------------------------------------------------------------------- ----------- Boy Girl 12yrs 13yrs 14yrs 15yrs 16yrs 17yrs n % ----------- ----------- ----------- ----------- ----------- ----------- ----------- ----------- n % n % n % n % n % n % n % n % -------------------------------------------------------------------------------------------------------------------------------------- Frequency of doing exercise Less than 4-6 times a week 1561 69.6 1961 87.1 332 84.3 773 81.3 820 79.5 660 75.4 525 73.9 339 75.8 3449 78.2 4-6 times a week or more 681 30.4 291 12.9 62 15.7 178 18.7 211 20.5 215 24.6 185 26.1 108 24.2 959 21.8 Number of hours of doing exercise Less than 4-6 hours a week 2012 89.3 2161 96.1 373 94.4 905 95.0 979 94.7 800 91.2 631 89.0 403 90.4 4091 92.7 4-6 hours a week or more 241 10.7 88 3.9 22 5.6 48 5.0 55 5.3 77 8.8 78 11.0 43 9.6 323 7.3 Number of hours of watching TV/videos in a day Less than 4 hours 1961 86.9 1975 87.4 322 81.3 821 85.7 909 87.7 761 86.4 636 89.3 408 91.3 3857 87.0 4 hours or more a day 295 13.1 286 12.6 74 18.7 137 14.3 128 12.3 120 13.6 76 10.7 39 8.7 574 13.0

118

Table A1.6.1 Social support and mental well-being of students by gender and age ______________________________________________________________________________________________________________________________________ -------------------------------------------------------------------------------------------------------------------------------------- Gender Age Total ----------------------- ----------------------------------------------------------------------- ----------- Boy Girl 12yrs 13yrs 14yrs 15yrs 16yrs 17yrs n % ----------- ----------- ----------- ----------- ----------- ----------- ----------- ----------- n % n % n % n % n % n % n % n % -------------------------------------------------------------------------------------------------------------------------------------- Easy to talk to father about things bothering you Very easy/Easy 1454 65.2 1290 58.1 274 70.3 637 68.1 661 65.5 517 59.2 371 52.5 235 52.3 2695 61.8 Other 775 34.8 932 41.9 116 29.7 298 31.9 348 34.5 356 40.8 335 47.5 214 47.7 1667 38.2 Easy to talk to mother about things bothering you Very easy/Easy 1753 79.4 1783 80.4 326 84.5 764 81.8 823 81.9 672 77.0 546 78.0 332 75.1 3463 79.8 Other 456 20.6 434 19.6 60 15.5 170 18.2 182 18.1 201 23.0 154 22.0 110 24.9 877 20.2 Easy to talk to other adults about things bothering you Very easy/Easy 902 41.6 678 31.5 159 42.0 348 38.5 374 38.2 306 36.0 242 35.1 134 30.9 1563 36.9 Other 1268 58.4 1472 68.5 220 58.0 555 61.5 604 61.8 544 64.0 448 64.9 300 69.1 2671 63.1 Easy to talk to brother/s about things bothering you Very easy/Easy 1690 77.5 1232 56.9 283 74.7 643 70.7 700 70.6 553 64.7 439 64.1 258 58.4 2876 67.5 Other 491 22.5 932 43.1 96 25.3 267 29.3 291 29.4 302 35.3 246 35.9 184 41.6 1386 32.5 Easy to talk to sister/s about things bothering you Very easy/Easy 1495 69.1 1787 82.9 304 81.1 720 80.0 758 77.1 658 77.0 495 72.4 292 67.1 3227 76.3 Other 668 30.9 368 17.1 71 18.9 180 20.0 225 22.9 197 23.0 189 27.6 143 32.9 1005 23.7

119

Table A1.6.2 Social support and mental well-being of students by gender and age ______________________________________________________________________________________________________________________________________ -------------------------------------------------------------------------------------------------------------------------------------- Gender Age Total ----------------------- ----------------------------------------------------------------------- ----------- Boy Girl 12yrs 13yrs 14yrs 15yrs 16yrs 17yrs n % ----------- ----------- ----------- ----------- ----------- ----------- ----------- ----------- n % n % n % n % n % n % n % n % -------------------------------------------------------------------------------------------------------------------------------------- Easy to talk to friends about things bothering you Very easy/Easy 1384 63.9 1345 61.8 226 60.8 535 58.9 620 63.0 559 64.9 453 65.5 281 64.0 2674 62.8 Other 783 36.1 830 38.2 146 39.2 373 41.1 364 37.0 302 35.1 239 34.5 158 36.0 1582 37.2 Easy to talk to youth workers about things bothering you Very easy/Easy 654 30.2 460 21.4 91 24.5 221 24.6 250 25.5 227 26.5 171 24.8 134 30.7 1094 25.8 Other 1513 69.8 1689 78.6 280 75.5 679 75.4 729 74.5 629 73.5 519 75.2 303 69.3 3139 74.2 Easy to talk to Pastor/Minister/Priest about things bothering you Very easy/Easy 491 22.8 342 15.9 75 19.9 182 20.2 178 18.1 158 18.7 118 17.4 108 25.1 819 19.4 Other 1662 77.2 1807 84.1 302 80.1 720 79.8 805 81.9 686 81.3 561 82.6 323 74.9 3397 80.6 Easy to talk to other persons about things bothering you Very easy/Easy 419 20.0 287 14.2 61 16.9 159 18.3 173 18.5 129 15.9 104 16.0 71 17.4 697 17.3 Other 1675 80.0 1733 85.8 300 83.1 712 81.7 764 81.5 681 84.1 546 84.0 336 82.6 3339 82.7 Feeling about life at present Feel OK or very happy 1672 73.9 1629 72.2 323 81.2 754 78.4 784 75.8 631 71.8 474 66.7 276 61.6 3242 73.1 Not happy 590 26.1 627 27.8 75 18.8 208 21.6 250 24.2 248 28.2 237 33.3 172 38.4 1190 26.9 Ever feel lonely Yes, very often 316 14.0 301 13.3 53 13.4 148 15.3 140 13.6 107 12.1 93 13.0 66 14.7 607 13.7 (continued)

120

Table A1.6.3 Social support and mental well-being of students by gender and age ______________________________________________________________________________________________________________________________________ -------------------------------------------------------------------------------------------------------------------------------------- Gender Age Total ----------------------- ----------------------------------------------------------------------- ----------- Boy Girl 12yrs 13yrs 14yrs 15yrs 16yrs 17yrs n % ----------- ----------- ----------- ----------- ----------- ----------- ----------- ----------- n % n % n % n % n % n % n % n % -------------------------------------------------------------------------------------------------------------------------------------- Other 1943 86.0 1961 86.7 344 86.6 818 84.7 891 86.4 774 87.9 620 87.0 382 85.3 3829 86.3 Ever feel confident Rarely/Never 427 18.9 530 23.5 93 23.4 272 28.3 224 21.7 157 17.9 122 17.1 74 16.6 942 21.3 Other 1829 81.1 1728 76.5 304 76.6 690 71.7 807 78.3 722 82.1 591 82.9 373 83.4 3487 78.7 Felt unhappy, sad or depressed during past six months No 579 25.8 585 26.1 136 34.3 289 30.3 290 28.5 211 24.2 149 21.0 69 15.5 1144 26.0 Yes, at home and at school 604 26.9 633 28.3 83 20.9 236 24.7 242 23.7 258 29.6 230 32.5 154 34.6 1203 27.4 Yes, but only at home 456 20.3 463 20.7 82 20.7 201 21.0 219 21.5 155 17.8 139 19.6 103 23.1 899 20.5 Yes, but only at school 603 26.9 558 24.9 96 24.2 229 24.0 268 26.3 247 28.4 190 26.8 119 26.7 1149 26.1 When feeling unhappy/sad/depressed, how bad was it Almost more than I can take 261 11.7 243 10.9 41 10.4 104 11.0 106 10.5 98 11.3 83 11.8 60 13.5 507 11.3 Other 1971 88.3 1980 89.1 352 89.6 840 89.0 907 89.5 771 88.7 623 88.2 384 86.5 3984 88.7 Frequency of snubbed by other students at school About once a week or more 269 11.9 282 12.4 61 15.2 133 13.8 145 14.0 92 10.4 81 11.4 36 8.0 548 12.3 Other 2001 88.1 1986 87.6 341 84.8 833 86.2 894 86.0 790 89.6 632 88.6 413 92.0 3903 87.7 Likelihood of getting a job after leaving school Very likely/Likely 1730 76.3 1710 75.4 303 75.6 710 73.7 775 74.5 700 79.4 529 74.2 343 76.2 3360 75.5 Unlikely/impossible 538 23.7 559 24.6 98 24.4 254 26.3 265 25.5 182 20.6 184 25.8 107 23.8 1090 24.5

121

Table A1.7.1 Encouragement to express views and perceived credibility of adults and social institutions among students by gender and age ______________________________________________________________________________________________________________________________________ ------------------------------------------------------------------------------------------------------------------------------------- Gender Age Total ----------------------- ----------------------------------------------------------------------- ---------- Boy Girl 12yrs 13yrs 14yrs 15yrs 16yrs 17yrs n % ----------- ----------- ----------- ----------- ----------- ----------- ----------- ----------- n % n % n % n % n % n % n % n % ------------------------------------------------------------------------------------------------------------------------------------- I am encouraged to express my own views by my parents Strongly agree/Agree 1507 67.9 1496 67.1 248 63.1 588 62.7 671 66.4 607 69.5 478 68.0 353 79.9 2945 67.6 Other 712 32.1 732 32.9 145 36.9 350 37.3 339 33.6 266 30.5 225 32.0 89 20.1 1414 32.4 I am encouraged to express my own views by my friends Strongly agree/Agree 1187 54.6 1236 56.6 185 48.4 434 47.9 520 52.5 513 59.7 417 60.3 306 69.4 2375 55.6 Other 988 45.4 946 43.4 197 51.6 472 52.1 470 47.5 347 40.3 275 39.7 135 30.6 1896 44.4 I am encouraged to express my own views in the community Strongly agree/Agree 810 37.6 663 30.7 124 33.1 282 31.2 306 31.2 285 33.6 251 36.9 189 43.2 1437 34.0 Other 1342 62.4 1499 69.3 251 66.9 621 68.8 676 68.8 564 66.4 429 63.1 249 56.8 2790 66.0 I am encouraged to express my own views in my church group Strongly agree/Agree 1207 56.0 1118 51.4 196 52.0 449 49.4 517 52.4 476 56.1 380 55.2 265 60.2 2283 53.7 Other 949 44.0 1059 48.6 181 48.0 460 50.6 470 47.6 373 43.9 308 44.8 175 39.8 1967 46.3 Adults/elders in general are believable or credible Yes 1470 67.7 1271 58.0 210 56.1 531 58.0 635 63.6 549 63.8 455 65.8 312 71.1 2692 62.9 Other 702 32.3 922 42.0 164 43.9 385 42.0 363 36.4 311 36.2 236 34.2 127 28.9 1586 37.1 Father is believable or credible Yes 1516 69.4 1474 66.5 227 60.1 587 63.6 671 67.0 611 70.6 504 72.2 331 74.4 2931 68.0

122

Table A1.7.2 Encouragement to express views and perceived credibility of adults and social institutions among students by gender and age ______________________________________________________________________________________________________________________________________ ------------------------------------------------------------------------------------------------------------------------------------- Gender Age Total ----------------------- ----------------------------------------------------------------------- ---------- Boy Girl 12yrs 13yrs 14yrs 15yrs 16yrs 17yrs n % ----------- ----------- ----------- ----------- ----------- ----------- ----------- ----------- n % n % n % n % n % n % n % n % ------------------------------------------------------------------------------------------------------------------------------------- Other 669 30.6 741 33.5 151 39.9 336 36.4 330 33.0 255 29.4 194 27.8 114 25.6 1380 32.0 Mother is believable or credible Yes 1308 60.6 1229 56.1 193 51.6 491 54.6 563 57.0 525 60.8 425 61.6 283 63.9 2480 58.2 Other 849 39.4 961 43.9 181 48.4 409 45.4 425 43.0 339 39.2 265 38.4 160 36.1 1779 41.8 Teacher is believable or credible Yes 1193 55.5 1201 55.1 197 52.5 464 51.6 539 54.8 480 55.8 383 55.7 273 62.5 2336 55.1 Other 956 44.5 978 44.9 178 47.5 435 48.4 444 45.2 380 44.2 304 44.3 164 37.5 1905 44.9 Church is believable or credible Yes 1753 81.5 1741 79.9 267 73.0 698 77.4 808 81.5 706 82.2 569 82.8 376 84.9 3424 80.6 Other 399 18.5 437 20.1 99 27.0 204 22.6 183 18.5 153 17.8 118 17.2 67 15.1 824 19.4 The mayor of the town/city is believable or credible Yes 1094 50.9 1004 46.5 190 51.5 437 48.9 504 51.4 401 46.7 312 45.6 203 46.7 2047 48.5 Other 1054 49.1 1156 53.5 179 48.5 457 51.1 477 48.6 458 53.3 372 54.4 232 53.3 2175 51.5 Those who govern the land are believable or credible Yes 878 41.0 811 37.3 156 42.5 367 40.9 394 40.1 325 37.9 239 34.9 172 38.9 1653 39.1 Other 1265 59.0 1363 62.7 211 57.5 530 59.1 589 59.9 532 62.1 446 65.1 270 61.1 2578 60.9 The President/Prime Minister is believable or credible Yes 1658 76.2 1751 79.4 288 76.2 715 78.0 792 79.7 665 76.5 545 78.4 336 76.2 3341 77.8 Other 517 23.8 455 20.6 90 23.8 202 22.0 202 20.3 204 23.5 150 21.6 105 23.8 953 22.2

123

Table A1.8 The importance of, and involvement in, community among students by gender and age ______________________________________________________________________________________ -------------------------------------------------------------------------------------- Is your local community important Do you feel involved in your local to you? community? ----------------------------------- --------------------------------- Other Very important Other Strongly ----------------- ----------------- ----------------- --------------- n % n % n % n % -------------------------------------------------------------------------------------- Gender Boy 923 40.8 1340 59.2 1527 67.5 735 32.5 Girl 1051 46.5 1207 53.5 1753 77.5 510 22.5 Age 12yrs 200 49.8 202 50.2 299 74.6 102 25.4 13yrs 440 45.6 524 54.4 742 77.2 219 22.8 14yrs 471 45.7 559 54.3 764 73.9 270 26.1 15yrs 376 42.7 504 57.3 618 70.0 265 30.0 16yrs 285 40.2 424 59.8 511 71.9 200 28.1 17yrs 170 37.9 278 62.1 286 63.8 162 36.2 Total 1942 43.8 2491 56.2 3220 72.6 1218 27.4 --------------------------------------------------------------------------------------

124

Table A1.9 Physical injury and bullying experienced by students by gender and age ______________________________________________________________________________________________________________________________________ ------------------------------------------------------------------------------------------------------------------------------------- Gender Age Total ----------------------- ----------------------------------------------------------------------- ---------- Boy Girl 12yrs 13yrs 14yrs 15yrs 16yrs 17yrs n % ----------- ----------- ----------- ----------- ----------- ----------- ----------- ----------- n % n % n % n % n % n % n % n % ------------------------------------------------------------------------------------------------------------------------------------- Times had a physical injury that needed treatment in last 12 months Never 575 25.5 633 28.0 132 33.1 273 28.4 256 24.8 231 26.2 189 26.7 97 21.7 1178 26.6 Once/2-5 times 1336 59.3 1337 59.1 226 56.6 547 57.0 630 60.9 520 59.0 423 59.7 285 63.6 2631 59.4 More than 5 times 343 15.2 293 12.9 41 10.3 140 14.6 148 14.3 130 14.8 96 13.6 66 14.7 621 14.0 Suffering from any deliberate Inflicted injury No 1469 64.3 1657 72.8 235 58.3 624 64.2 697 66.8 625 70.5 538 74.9 349 77.4 3068 68.6 Yes 815 35.7 620 27.2 168 41.7 348 35.8 347 33.2 261 29.5 180 25.1 102 22.6 1406 31.4 Ever been bullied in school this term Other 965 42.9 746 33.0 129 32.5 322 33.8 393 38.1 367 41.6 294 41.6 186 41.5 1691 38.3 I have not been bullied in school this term 1282 57.1 1512 67.0 268 67.5 631 66.2 638 61.9 516 58.4 412 58.4 262 58.5 2727 61.7 Frequency of taking part in bullying other students in school this term Other 928 41.1 738 32.9 121 30.3 324 34.0 371 35.9 352 40.3 277 39.2 183 40.8 1628 36.9 I have not bullied others in school this term 1328 58.9 1505 67.1 278 69.7 629 66.0 661 64.1 522 59.7 430 60.8 265 59.2 2785 63.1

125

Table A1.10 The personal hygiene habits of students by gender and age ______________________________________________________________________________________ -------------------------------------------------------------------------------------- Frequency of tooth Frequency of washing hands Frequency of washing brushing before eating hands after using toilet ----------------------- ----------------------- ----------------------- Other More than Sometimes/ Always Sometimes/ Always once a day Never Never ----------- ----------- ----------- ----------- ----------- ----------- n % n % n % n % n % n % -------------------------------------------------------------------------------------- Gender Boy 1017 44.9 1248 55.1 810 35.8 1453 64.2 570 25.2 1695 74.8 Girl 682 30.2 1577 69.8 566 25.1 1689 74.9 370 16.3 1893 83.7 Age 12yrs 172 43.0 228 57.0 98 24.6 301 75.4 83 20.8 316 79.2 13yrs 395 41.2 564 58.8 298 31.2 658 68.8 198 20.6 762 79.4 14yrs 409 39.4 629 60.6 324 31.2 713 68.8 257 24.7 783 75.3 15yrs 305 34.8 572 65.2 262 29.8 616 70.2 156 17.7 723 82.3 16yrs 253 35.6 458 64.4 214 30.1 496 69.9 153 21.5 558 78.5 17yrs 133 29.6 317 70.4 153 34.0 297 66.0 76 16.9 374 83.1 Total 1667 37.6 2768 62.4 1349 30.5 3081 69.5 923 20.8 3516 79.2 --------------------------------------------------------------------------------------

126

Appendix 2. Data tables – results of out-of-school youth survey stratified by age and gender Table A2.1 Parental occupation and living arrangements of out-of-school youth by gender and age ______________________________________________________________________________________ -------------------------------------------------------------------------------------- Gender Age groups Total ------------------- ----------------------------- --------- Boy Girl 11-14 yrs 15-16 yrs 17-20 yrs n % --------- --------- --------- --------- --------- n % n % n % n % n % -------------------------------------------------------------------------------------- Dad's job Doesn't work 45 18 21 14 9 20 12 10 45 18 66 16 Office worker 51 20 33 22 10 22 25 22 51 21 86 21 Manual labourer/worker 53 21 29 19 12 27 33 28 37 15 82 20 Works at home to earn money 104 41 66 44 14 31 46 40 114 46 174 43 Mum's job Doesn't work 81 32 43 28 14 32 35 30 77 31 126 31 Office worker 28 11 14 9.3 7 16 13 11 22 8.8 42 10 Manual labourer/worker 16 6.3 6 4.0 1 2.3 9 7.8 12 4.8 22 5.4 Works at home to earn money 127 50 88 58 22 50 59 51 138 55 219 54 Living with parents for most of the time Yes 211 82 130 87 37 84 104 90 203 80 344 83 No 47 18 20 13 7 16 12 10 50 20 69 17 The place of parent’s residence Overseas 3 1.9 1 0.8 2 0.8 3 0.7 In a rural area (outside Port Vila) 15 5.7 9 5.8 5 11.1 7 5.8 15 5.8 27 6.4 In outer islands 27 10.3 8 5.2 1 2.2 6 5.0 28 10.9 35 8.3 Did not respond 219 83.9 135 87.1 39 86.7 106 88.3 212 82.5 357 84.6 The number of people you living with 1-2 11 4.4 4 2.6 6 5.1 9 3.6 15 3.7 3-10 205 82 133 86 39 87 98 83 207 84 344 84 >10 34 14 17 11 6 13 14 12 31 13 51 12

127

Table A2.2 Religious denomination and commitment to faith of out-of-school youth by gender and age ______________________________________________________________________________________ -------------------------------------------------------------------------------------- Gender Age groups Total ------------------- ----------------------------- --------- Boy Girl 11-14 yrs 15-16 yrs 17-20 yrs n % --------- --------- --------- --------- --------- n % n % n % n % n % -------------------------------------------------------------------------------------- Religion Catholic 12 4.6 7 4.6 3 6.8 6 5.1 10 3.9 19 4.6 Presbyterian 157 61 93 61 27 61 69 58 158 62 254 61 Seventh Day Adventist 17 6.6 9 5.9 3 6.8 9 7.6 14 5.5 26 6.2 Pentecostal 28 11 17 11 4 9.1 15 13 26 10 45 11 Other 37 14 22 14 6 14 16 14 38 15 60 14 Methodist/Hindu/Muslim/Bud Dhist/Latter Day Saints 8 3.1 5 3.3 1 2.3 3 2.5 9 3.5 13 3.1 Commitment to faith Not at all 8 3.1 2 1.3 3 6.8 5 4.3 3 1.2 11 2.7 Weak 37 15 26 17 11 25 21 18 33 13 65 16 Strong 89 35 56 37 15 34 39 33 93 37 147 36 Stronger 58 23 34 22 7 16 27 23 59 24 93 23 A bit stronger 28 11 15 9.9 3 6.8 14 12 25 10 42 10 Very strong 34 13 19 13 5 11 11 9.4 38 15 54 13 --------------------------------------------------------------------------------------

128

Table A2.3 Past use of substances (ever) among out-of-school youth by gender and age ________________________________________________________________________________________________________________________ ------------------------------------------------------------------------------------------------------------------------ Gender Age groups Total --------------------------- ----------------------------------------- ------------- Boy Girl 11-14 yrs 15-16 yrs 17-20 yrs n % ------------- ------------- ------------- ------------- ------------- n % n % n % n % n % ------------------------------------------------------------------------------------------------------------------------ Ever smoked Yes 158 62.2 53 34.9 15 33.3 54 45.4 145 58.5 214 51.9 No 96 37.8 99 65.1 30 66.7 65 54.6 103 41.5 198 48.1 Ever tasted alcohol Yes 165 64.2 51 33.8 12 27.3 43 36.1 163 64.9 218 52.7 No 81 31.5 86 57.0 29 65.9 64 53.8 77 30.7 170 41.1 Don't know 11 4.3 14 9.3 3 6.8 12 10.1 11 4.4 26 6.3 Ever had a drink with magic mushroom Yes 14 5.4 2 1.3 2 4.4 5 4.2 10 4.0 17 4.1 No 201 78.2 126 82.4 40 88.9 90 75.6 201 80.1 331 79.8 Don't know 42 16.3 25 16.3 3 6.7 24 20.2 40 15.9 67 16.1 Ever tried Kava Yes 113 45.0 33 21.9 6 13.3 23 19.8 118 47.8 147 36.0 No 138 55.0 118 78.1 39 86.7 93 80.2 129 52.2 261 64.0 Ever drunk methylated spirit(with or without water) Yes 58 23.5 12 8.1 3 6.7 13 11.4 54 22.3 70 17.5 No 189 76.5 136 91.9 42 93.3 101 88.6 188 77.7 331 82.5 Ever tried marijuana Yes 16 6.3 4 2.7 2 4.4 7 5.9 10 4.1 19 4.7 No 237 93.7 144 97.3 43 95.6 111 94.1 234 95.6 388 95.3 Ever sniffed glue or petrol Yes 27 10.7 6 4.0 11 9.2 21 8.5 32 7.8 No 226 89.3 145 96.0 44 100 109 90.8 225 91.5 378 92.2

129

Table A2.4.1 Dietary habits of out-of-school youth by gender and age ______________________________________________________________________________________________________________ -------------------------------------------------------------------------------------------------------------- Gender Age groups Total --------------------------- ----------------------------------------- ------------- Boy Girl 11-14 yrs 15-16 yrs 17-20 yrs n % ------------- ------------- ------------- ------------- ------------- n % n % n % n % n % -------------------------------------------------------------------------------------------------------------- Frequency of drinking tea Less than once a day 57 23.3 41 28.5 15 35.7 24 22.0 62 25.5 101 25.6 Once a day or more 188 76.7 103 71.5 27 64.3 85 78.0 181 74.5 293 74.4 Frequency of drinking coffee Less than once a day 184 78.6 95 65.1 30 69.8 72 68.6 180 75.9 282 73.2 Once a day or more 50 21.4 51 34.9 13 30.2 33 31.4 57 24.1 103 26.8 Frequency of drinking coconut juice Less than once a day 159 66.8 84 59.6 27 67.5 60 55.0 158 67.2 245 63.8 Once a day or more 79 33.2 57 40.4 13 32.5 49 45.0 77 32.8 139 36.2 Frequency of eating fruits Less than once a day 144 61.8 65 47.1 24 60.0 55 52.4 132 57.4 211 56.3 Once a day or more 89 38.2 73 52.9 16 40.0 50 47.6 98 42.6 164 43.7 Frequency of drinking soft drinks Less than once a day 191 81.6 103 74.1 28 71.8 81 77.9 188 80.0 297 78.6 Once a day or more 43 18.4 36 25.9 11 28.2 23 22.1 47 20.0 81 21.4 Frequency of eating sweets Less than once a day 178 78.1 105 76.1 29 74.4 77 74.8 179 78.9 285 77.2 Once a day or more 50 21.9 33 23.9 10 25.6 26 25.2 48 21.1 84 22.8 Frequency of eating vegetables Less than once a day 112 49.1 56 38.9 16 39.0 54 51.9 101 43.7 171 45.5 Once a day or more 116 50.9 88 61.1 25 61.0 50 48.1 130 56.3 205 54.5 Frequency of eating bread Less than once a day 92 39.7 68 48.2 18 43.9 44 41.5 102 44.3 164 43.5 --------------------------------------------------------------------------------------------------------------

(continued)

130

Table A2.4.2 Dietary habits of out-of-school youth by gender and age ______________________________________________________________________________________________________________ -------------------------------------------------------------------------------------------------------------- Gender Age groups Total --------------------------- ----------------------------------------- ------------- Boy Girl 11-14 yrs 15-16 yrs 17-20 yrs n % ------------- ------------- ------------- ------------- ------------- n % n % n % n % n % -------------------------------------------------------------------------------------------------------------- Once a day or more 140 60.3 73 51.8 23 56.1 62 58.5 128 55.7 213 56.5 Frequency of eating bread Less than once a day 140 59.8 72 51.1 25 64.1 63 57.8 128 55.2 216 56.8 Once a day or more 94 40.2 69 48.9 14 35.9 46 42.2 104 44.8 164 43.2 Frequency of eating tinned fish Less than once a day 176 73.9 85 62.5 27 75.0 76 69.1 160 69.0 263 69.6 Once a day or more 62 26.1 51 37.5 9 25.0 34 30.9 72 31.0 115 30.4 Frequency of eating tinned mutton/corned beef Less than once a day 197 86.4 110 82.1 32 84.2 82 80.4 196 86.7 310 84.7 Once a day or more 31 13.6 24 17.9 6 15.8 20 19.6 30 13.3 56 15.3 Frequency of eating fresh mutton Less than once a day 197 90.4 120 90.2 30 83.3 89 90.8 201 91.0 320 90.1 Once a day or more 21 9.6 13 9.8 6 16.7 9 9.2 20 9.0 35 9.9 Frequency of eating chicken Less than once a day 178 77.4 95 69.3 31 73.8 80 76.9 166 73.5 277 74.5 Once a day or more 52 22.6 42 30.7 11 26.2 24 23.1 60 26.5 95 25.5 Frequency of drinking water Less than once a day 47 19.3 26 17.9 10 22.7 20 19.0 44 18.0 74 18.8 Once a day or more 196 80.7 119 82.1 34 77.3 85 81.0 200 82.0 319 81.2 --------------------------------------------------------------------------------------------------------------

131

Table A2.5 Physical activity habits of out-of-school youth by gender and age ______________________________________________________________________________________________________________ -------------------------------------------------------------------------------------------------------------- Gender Age groups Total --------------------------- ----------------------------------------- ------------- Boy Girl 11-14 yrs 15-16 yrs 17-20 yrs n % ------------- ------------- ------------- ------------- ------------- n % n % n % n % n % -------------------------------------------------------------------------------------------------------------- Frequency of doing exercise Less than 4-6 times a week 115 45.3 117 75.5 30 66.7 63 53.4 142 56.6 235 56.8 4-6 times a week or more 139 54.7 38 24.5 15 33.3 55 46.6 109 43.4 179 43.2 Number of hours doing exercise Less than 4-6 hours a week 214 82.9 140 92.1 42 93.3 101 85.6 215 85.3 358 86.3 4-6 hours a week or more 44 17.1 12 7.9 3 6.7 17 14.4 37 14.7 57 13.7 Number of hours of watching TV/Videos in a day Less than 4 hours or more 225 87.5 133 85.8 35 77.8 100 84.7 228 89.8 363 87.1 4 hours or more a day 32 12.5 22 14.2 10 22.2 18 15.3 26 10.2 54 12.9

132

Table A2.6.1 Social support and mental well-being of out-of-school youth by gender and age __________________________________________________________________________________________________________________________ -------------------------------------------------------------------------------------------------------------------------- Gender Age groups Total ------------------------------- ----------------------------------------------- --------------- Boy Girl 11-14 yrs 15-16 yrs 17-20 yrs n % --------------- --------------- --------------- --------------- --------------- n % n % n % n % n % -------------------------------------------------------------------------------------------------------------------------- Easy to talk to father about things bothering you Other 120 50.2 89 62.7 23 53.5 56 50.5 134 57.5 213 55.0 Very easy/Easy 119 49.8 53 37.3 20 46.5 55 49.5 99 42.5 174 45.0 Easy to talk to mother about things bothering you Other 92 39.0 44 30.3 16 38.1 42 37.8 81 34.8 139 36.0 Very easy/Easy 144 61.0 101 69.7 26 61.9 69 62.2 152 65.2 247 64.0 Easy to talk to other adults about things bothering you Other 133 57.6 83 58.9 25 61.0 66 61.1 129 56.8 220 58.5 Very easy/Easy 98 42.4 58 41.1 16 39.0 42 38.9 98 43.2 156 41.5 Easy to talk to brother/s about things bothering you Other 91 39.1 71 50.0 22 53.7 39 36.1 102 44.2 163 42.9 Very easy/Easy 142 60.9 71 50.0 19 46.3 69 63.9 129 55.8 217 57.1 Easy to talk to sister/s about things bothering you Other 104 44.8 28 19.6 13 30.2 37 34.6 81 35.2 131 34.5 Very easy/Easy 128 55.2 115 80.4 30 69.8 70 65.4 149 64.8 249 65.5 Easy to talk to friends about things bothering you -------------------------------------------------------------------------------------------------------------------------- (continued)

133

Table A2.6.2 Social support and mental well-being of out-of-school youth by gender and age __________________________________________________________________________________________________________________________ -------------------------------------------------------------------------------------------------------------------------- Gender Age groups Total ------------------------------- ----------------------------------------------- --------------- Boy Girl 11-14 yrs 15-16 yrs 17-20 yrs n % --------------- --------------- --------------- --------------- --------------- n % n % n % n % n % -------------------------------------------------------------------------------------------------------------------------- Other 63 27.3 44 30.8 16 40.0 35 32.1 59 25.7 110 29.0 Very easy/Easy 168 72.7 99 69.2 24 60.0 74 67.9 171 74.3 269 71.0 Easy to talk to youth workers about things bothering you Other 135 60.8 94 67.6 27 73.0 73 69.5 134 59.8 234 63.9 Very easy/Easy 87 39.2 45 32.4 10 27.0 32 30.5 90 40.2 132 36.1 Easy to talk to Pastor/Minister/Priest about things bothering you Other 163 74.8 110 81.5 33 84.6 78 80.4 165 74.3 276 77.1 Very easy/Easy 55 25.2 25 18.5 6 15.4 19 19.6 57 25.7 82 22.9 Easy to talk to other persons about things bothering you Other 144 72.0 94 75.2 28 80.0 76 75.2 136 70.5 240 72.9 Very easy/Easy 56 28.0 31 24.8 7 20.0 25 24.8 57 29.5 89 27.1 Feeling about life at present Feel OK or very happy 198 78.3 107 70.4 32 72.7 98 83.1 179 71.9 309 75.2 Not happy 55 21.7 45 29.6 12 27.3 20 16.9 70 28.1 102 24.8 Ever feel lonely Other 201 79.8 122 81.3 37 84.1 89 75.4 199 80.9 325 79.7 Yes, very often 51 20.2 28 18.7 7 15.9 29 24.6 47 19.1 83 20.3 Ever feel confident Other 227 89.4 117 77.0 31 68.9 101 86.3 218 87.2 350 85.0 -------------------------------------------------------------------------------------------------------------------------- (continued)

134

Table A2.6.3 Social support and mental well-being of out-of-school youth by gender and age __________________________________________________________________________________________________________________________ -------------------------------------------------------------------------------------------------------------------------- Gender Age groups Total ------------------------------- ----------------------------------------------- --------------- Boy Girl 11-14 yrs 15-16 yrs 17-20 yrs n % --------------- --------------- --------------- --------------- --------------- n % n % n % n % n % -------------------------------------------------------------------------------------------------------------------------- Rarely/Never 27 10.6 35 23.0 14 31.1 16 13.7 32 12.8 62 15.0 Felt unhappy, sad or depressed during past six months No 68 27.9 35 23.3 10 22.2 36 31.0 61 25.5 107 26.8 Yes, at home and at school 35 14.3 22 14.7 8 17.8 15 12.9 36 15.1 59 14.8 Yes, but only at home 129 52.9 90 60.0 22 48.9 59 50.9 138 57.7 219 54.8 Yes, but only at school 12 4.9 3 2.0 5 11.1 6 5.2 4 1.7 15 3.8 When feeling unhappy/sad/depressed, how bad was it? Other 231 91.7 139 92.7 38 88.4 110 92.4 229 93.1 377 92.4 Almost more than I can take 21 8.3 11 7.3 5 11.6 9 7.6 17 6.9 31 7.6

135

Table A2.7 Reason for leaving school, job prospects and the likelihood of future training among out-of-school youth by gender and age ______________________________________________________________________________________ -------------------------------------------------------------------------------------- Gender Age groups ----------------------- ----------------------------------- Boy Girl 11-14 yrs 15-16 yrs 17-20 yrs ----------- ----------- ----------- ----------- ----------- n % n % n % n % n % -------------------------------------------------------------------------------------- Likelihood of being working in a year's time Very likely/Likely 219 84.9 119 76.8 33 73.3 91 75.8 214 84.3 Unlikely/impossible 39 15.1 36 23.2 12 26.7 29 24.2 40 15.7 The reason for leaving school I wanted to leave, even though I could continue 61 24.7 32 21.2 9 20.9 29 25.2 56 22.8 I had to leave, even though I wanted to continue 118 47.8 66 43.7 21 48.8 54 47.0 112 45.5 I finished all compulsory schooling, and had no reasons to c 68 27.5 53 35.1 13 30.2 32 27.8 78 31.7 Likelihood of receiving further training Very likely/Likely 188 74.0 96 62.3 31 68.9 80 68.4 179 71.0 Unlikely/Impossible 66 26.0 58 37.7 14 31.1 37 31.6 73 29.0 --------------------------------------------------------------------------------------

136

Table A2.8.1 Encouragement to express views and perceived credibility of adults and social institutions among out-of-school youth by gender and age __________________________________________________________________________________________________________________________ -------------------------------------------------------------------------------------------------------------------------- Gender Age groups Total ------------------------------- ----------------------------------------------- --------------- Boy Girl 11-14 yrs 15-16 yrs 17-20 yrs n % --------------- --------------- --------------- --------------- --------------- n % n % n % n % n % -------------------------------------------------------------------------------------------------------------------------- I am encouraged to express my own views by my parents Strongly agree/Agree 154 62.1 74 49.3 22 48.9 60 51.7 151 62.1 233 57.7 Other 94 37.9 76 50.7 23 51.1 56 48.3 92 37.9 171 42.3 I am encouraged to express my own views by my friends Strongly agree/Agree 152 63.9 78 54.2 22 53.7 61 55.5 148 63.0 231 59.8 Other 86 36.1 66 45.8 19 46.3 49 44.5 87 37.0 155 40.2 I am encouraged to express my own views in the community Strongly agree/Agree 113 49.3 52 36.6 14 35.0 42 39.3 110 48.0 166 44.1 Other 116 50.7 90 63.4 26 65.0 65 60.7 119 52.0 210 55.9 I am encouraged to express my own views in my church group Strongly agree/Agree 150 64.1 80 57.1 23 57.5 64 59.8 144 62.1 231 60.9 Other 84 35.9 60 42.9 17 42.5 43 40.2 88 37.9 148 39.1 Adults/elders in general are believable or credible Yes 179 73.1 91 62.8 18 43.9 61 53.0 194 81.2 273 69.1 Other 66 26.9 54 37.2 23 56.1 54 47.0 45 18.8 122 30.9 Father is believable or Credible Yes 169 71.9 70 49.0 16 42.1 58 51.3 168 72.4 242 63.2 Other 66 28.1 73 51.0 22 57.9 55 48.7 64 27.6 141 36.8 -------------------------------------------------------------------------------------------------------------------------- (continued)

137

Table A2.8.2 Encouragement to express views and perceived credibility of adults and social institutions among out-of-school youth by gender and age __________________________________________________________________________________________________________________________ -------------------------------------------------------------------------------------------------------------------------- Gender Age groups Total ------------------------------- ----------------------------------------------- --------------- Boy Girl 11-14 yrs 15-16 yrs 17-20 yrs n % --------------- --------------- --------------- --------------- --------------- n % n % n % n % n % -------------------------------------------------------------------------------------------------------------------------- Mother is believable or credible Yes 150 64.7 56 39.2 14 36.8 53 47.3 141 61.6 208 54.9 Other 82 35.3 87 60.8 24 63.2 59 52.7 88 38.4 171 45.1 Teacher is believable or credible Yes 125 55.1 72 52.9 14 36.8 50 46.7 136 61.0 200 54.3 Other 102 44.9 64 47.1 24 63.2 57 53.3 87 39.0 168 45.7 Church is believable or credible Yes 169 76.1 104 75.9 23 60.5 65 62.5 187 84.2 275 75.5 Other 53 23.9 33 24.1 15 39.5 39 37.5 35 15.8 89 24.5 The mayor of the town/city is believable or credible Yes 125 57.6 103 74.1 22 62.9 57 54.3 152 68.8 231 64.0 Other 92 42.4 36 25.9 13 37.1 48 45.7 69 31.2 130 36.0 Those who govern the land are believable or credible Yes 185 80.8 119 82.1 28 71.8 79 73.8 199 85.8 306 81.0 Other 44 19.2 26 17.9 11 28.2 28 26.2 33 14.2 72 19.0 The President/Prime Minister is believable or credible Yes 170 74.6 121 84.0 29 80.6 71 65.1 192 83.1 292 77.7 Other 58 25.4 23 16.0 7 19.4 38 34.9 39 16.9 84 22.3 --------------------------------------------------------------------------------------------------------------------------

138

Table A2.9 The importance of, and involvement in, community among out-of-school youth by gender and age ________________________________________________________________________________________ ---------------------------------------------------------------------------------------- Is your local community important Do you feel involved in your local to you? community? ----------------------------------- ---------------------------------- Other Very important Other Strongly ----------------- ----------------- ----------------- ---------------- n % n % n % n % --------------------------------------------------------------------------------------- Gender Boy 140 54.7 116 45.3 136 52.9 121 47.1 Girl 85 55.2 69 44.8 114 74.5 39 25.5 Age groups 11-14 yrs 33 75.0 11 25.0 38 86.4 6 13.6 15-16 yrs 74 62.7 44 37.3 79 67.5 38 32.5 17-20 yrs 121 47.8 132 52.2 137 53.9 117 46.1 Total 228 54.9 187 45.1 254 61.2 161 38.8 ---------------------------------------------------------------------------------------

139

Table A2.10 Physical injury and bullying experienced by out-of-school youth by gender and age __________________________________________________________________________________________________________________________ -------------------------------------------------------------------------------------------------------------------------- Gender Age groups Total ------------------------------- ----------------------------------------------- --------------- Boy Girl 11-14 yrs 15-16 yrs 17-20 yrs n % --------------- --------------- --------------- --------------- --------------- n % n % n % n % n % -------------------------------------------------------------------------------------------------------------------------- Times had a physical injury that needed treatment in last 12 months Never 60 23.6 27 17.8 12 27.3 26 22.4 51 20.3 89 21.7 Once/2-5 times 163 64.2 94 61.8 26 59.1 75 64.7 159 63.3 260 63.3 More than 5 times 31 12.2 31 20.4 6 13.6 15 12.9 41 16.3 62 15.1 Suffered any deliberately inflicted injury Other 150 57.5 90 58.1 23 51.1 62 51.7 159 61.9 244 57.8 Yes 111 42.5 65 41.9 22 48.9 58 48.3 98 38.1 178 42.2 Ever been bullied in school this term Other 120 47.1 67 44.4 16 36.4 53 44.9 120 48.0 189 45.9 I have not been bullied in school this term 135 52.9 84 55.6 28 63.6 65 55.1 130 52.0 223 54.1 Frequency of taking part in bullying other students in school this term Other 119 46.3 67 43.8 13 29.5 53 44.5 122 48.2 188 45.2 I have not bullied others in school this term 138 53.7 86 56.2 31 70.5 66 55.5 131 51.8 228 54.8 --------------------------------------------------------------------------------------------------------------------------

140

Table A2.11 The personal hygiene habits of out-of-school youth by gender and age ________________________________________________________________________________________ ---------------------------------------------------------------------------------------- Gender Age groups Total ----------------------- ----------------------------------- ----------- Boy Girl 11-14 yrs 15-16 yrs 17-20 yrs n % ----------- ----------- ----------- ----------- ----------- n % n % n % n % n % ---------------------------------------------------------------------------------------- Frequency of tooth brushing Other 174 67.7 75 48.7 26 57.8 71 59.2 156 61.9 253 60.7 More than once a day 83 32.3 79 51.3 19 42.2 49 40.8 96 38.1 164 39.3 Frequency of washing hands before eating? Sometimes/Never 126 49.0 60 39.2 24 54.5 58 48.7 107 42.3 189 45.4 Always 131 51.0 93 60.8 20 45.5 61 51.3 146 57.7 227 54.6 Frequency of washing hands after using the toilet? Sometimes/Never 99 38.5 36 23.4 15 33.3 41 34.2 82 32.5 138 33.1 Always 158 61.5 118 76.6 30 66.7 79 65.8 170 67.5 279 66.9 ----------------------------------------------------------------------------------------