This survey of health and lifestyle behaviors of young people in Vanuatu is the first in a series of surveys planned to examine the 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 Behavior 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).
Purpose / Objective
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 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 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
- contribute to a better understanding of the factors associated with positive and negative youth health states and behaviors
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 Behavior 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.
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.
Key Findings and Conclusions
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 regularly. About 10% of students said that they had been drunk at least once, and a little over 3% said 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 in 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.
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 very likely to undertake future training.
The majority of students considered school a nice place to be in 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.
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 in-school youth 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 in-school youth 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 reported 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.
Sexual behavior among out-of-school youth:
The information collected about the sexual health behavior 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 one-quarter to one-third stating that they rarely or never took action in these areas.
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.
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WHO/WPF, Australia Centre for Health Promotion, Government of Vanuatu