7.1 General context
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Portuguese data from the HBSC survey (Inchley, J et al. (2020), Spotlight on adolescent health and well-being. Findings from the 2017/2018 Health Behaviour in School-aged Children (HBSC) survey in Europe and Canada. International report. Volume 2. Key data. Copenhagen: WHO Regional Office for Europe) revealed that in 2018 only 19% (girls) and 26% (boys) of 11-year old’s reported to engage in at least one hour of moderate-to-vigorous exercise daily. In what concerns 13 and 15- year old´s, the numbers are even lower (i.e: 13y-21% boys,13% girls); 15y- 18%boys, 10%girls). Physical Activity levels also fall when comparing with the 2006, 2010 and 2014 HBSC surveys (for both genders and all age groups).
According to the National Health Survey (2014), 20% of respondents with more than 15 years said that they "practice physical activity through sporting and leisure activities" 3 or more times per week (15% for females and 25% for males). However, in their free time, most Portuguese people don't have the habit of practicing sport (60% men; 70% of women). This tendency is less noticeable among young people between 15-24 years, who report to be more active. This trend is also confirmed by the second Nutritional and Physical Activity National Survey (IAN-AF), where it is patent that the age group from 15 to 21 is the most active, with around 20% of girls and 50% of boys being physically active.
Besides age, level of education is also a differentiator: higher levels of education tend to have greater likelihood of practicing a sporting activity. The same applies for gender (men display higher levels than women).
Regarding eating and nutritional habits, the 2nd National Food and Physical Activity Survey (IAN-AF), with data collected between 2015 and 2016, allowed to identify those at nutritional risk, in order to develop intervention strategies and prevent/reverse public health risks.
The data reveals that young people and children are the ones that consume the most milk, yogurt and fermented milk and cereal, however, they also are the ones that eat the least fruit and vegetables. In all age groups, the daily intake of meat is superior to fish. These tendencies contradict, in both cases, the recommendations of the Portuguese Food Wheel. The consumption of cakes, sweets, biscuits, savoury snacks, pizzas, sodas, nectars is equally high. The World Health Organisation recommends a daily intake of 400 grams of fruit and vegetables per person, however, 69% of children and 66% of teenagers don't meet those recommendations. About 42% of adolescents had a daily consumption of sugar-sweetened beverages (National Programme for Promoting Healthy Eating, 2017).
The reduced practice of phisical activities, coupled with inadequate heating habits with high sugar, salt and fat content and the reduced intake of vegetables and fruit, places Portuguese teenagers and young people in a situation of risk and disease prevalence resulting from unhealthy lifestyle habits.
According to the report The citizens' health from a global perspective (2016), in a whole decade (between 2005 and 2014/2015), the age group above 65 years and the age group between 18-24 years registered a greater increase in the levels of pre-obesity and obesity, considering the ratio of overweight population.
Prevalence of addictive behaviours in youth
According with the Study on the Consumption of Alcohol, Tobacco, Drugs and others Additive Behaviours and Dependencies (ECATD-CAD 2019, SICAD) the vast majority (68%) of the adolescents, between 13 and 18 years old, drank an alcoholic drink throughout their lives, being slightly lower (59%) the percentage of those who drank alcohol in the last year Still the current alcohol consumers, that is, those who have had an alcoholic drink in the last 30 days prior to the survey, constitute a very considerable group (38%). Alcohol intake on a daily or almost daily basis is not very prevalent, either among respondents (2%) or among consumers (5% of current consumers).
With regard to other patterns of increased risk consumption, 40% of respondents have already drank alcohol to the point of feeling mild drunkenness, while in the last month they totalled 17%. The prevalence of severe drunkenness is considerably lower: 25%, 20% and 9%, over time in life, the last 12 months and the last 30 days, respectively. On the other hand, in the last month, 20% ingested alcoholic beverages (five or more drinks at the same time).
Tobacco is the second most consumed psychoactive substance: 38% of respondents smoked tobacco at one time, while 29% did it in the last year and 18% in the last month. Few respondents consume tobacco on a daily or almost daily basis (4%)
Cannabis is by far the most widely used illicit substance (13%, 12% and 6% in life-span, last 12 months and last 30 days, respectively). The use of illicit drugs other than cannabis has some expression at the level of experimentation (5%) and recent consumption (3%), with the percentage that consumed this type of drugs in the last month (<1%).
With regard to taking medications, 17% of the respondents used tranquilizers at some time in their lives, being naturally lower the percentage of those that did in the last month (4%,). The use of tranquilizers without medical prescription was (5%) in this age group
In all the periods considered, the use of tobacco and illicit drugs are more masculine than feminine practices. The same does not happen with the use of alcoholic beverages, since the prevalence of alcohol intake is quite approximate between the elements of both sexes, such as drunkenness.
Virtually all students (96%) accessed social networks in the 7 days prior to the survey, while a large majority (72%) played electronic games in the last month. Gambling is much less prevalent: 13% played cash for the past year, with a focus on sports betting and lotteries.
Gambling is more a male than female activity; the difference between the two sexes is particularly pronounced. In this case too, the prevalence of gambling in the last 12 months increases in direct proportion to the age of the students.
With regard to the daily time spent on the Internet, in the week prior to the survey, 55% accessed social networks for 4 or more hours on a day without school, while the percentage of those who did so even on a school day is 32%.
The percentage of those who that spent 4 or more hours a day playing electronic games in the last month is 29%, in days without school, and 11%, in school days. In the week before the survey, about 1/3 played this type of games on a daily or almost daily basis.
Abuse in Children and Young People
Child and young people abuse refers to any non-accidental act or omission perpetrated by parents, caregivers or others, which threatens the victim's safety, dignity, and biopsychosocial and affective development. (Health Action for Children and Young People at Risk 2008).
Group of situations that constitute abuse:
Negligence: inability to provide the child or the young man/woman with basic hygiene, affection, educational and health needs, which are essential for the normal growth and development.
Physical Abuse: any non-accidental, isolated or repeated action, inflicted by parents, caregivers or others responsible for the child or young person, which causes (or may cause) physical damage;
Psychological/Emotional Abuse: deprivation of an environment of tranquillity and affective well-being which is essential for the growth, development and balanced behaviour of the child/young person;
Sexual Abuse: Concept: involvement of a child or teenager in activities whose purpose is the sexual gratification of an adult or other person;
Munchausen syndrome by proxy: giving the child various signs and symptoms, by an element of the family or caregiver, in order to convince the clinical team of the existence of an illness, sometimes generating exhaustive diagnostic procedures, including the use of invasive techniques and frequent hospitalisations.
Addictive Behaviours and Dependency
Addiction is a complex condition, a brain disease that is manifested by compulsive substance use despite harmful consequence. People with addiction (severe substance use disorder) have an intense focus on using a certain substance(s), such as alcohol or drugs, to the point that it takes over their life. (APA).
Behavioural Addictions or non-substances addictions are behaviours, besides psychoactive substance use, that produce short-term reward/pleasure experience that may engender persistent behaviour/addiction with diminished control over it and with prejudice in the one’s responsibilities (i.e pathological gambling/gaming, sex addiction, internet problematic use, etc.)
An addictive behaviour is a behaviour, that is both rewarding and reinforcing, and is associated with the development of an addiction. This type of behaviours my evolve or not the use of psychoactive substance use.