Background
Health-related behaviors developed in adolescence influence health later in life. Youth dietary behaviors, physical activities, mental wellbeing, and parent-child relationships are correlated with physical health, mental health and behavioral risk in their adulthood. In order to understand the prevalence of adolescent health behavior, relating factors, and to develop effective prevention strategies, the Taiwan Youth Health Survey (TYHS) was initiated in 2006. The survey was designed by referring to the Youth Risk Behavior Survey (YRBS), which was conducted every two years since 1990 by the US Centers for Disease Control and Prevention (US CDC) in the U.S., and Global School – Based Student Health Survey (GSHS), which was developed by the World Health Organization (WHO) in collaboration with United Nations’ UNICEF, UNESCO, and UNAIDS; and with technical assistance from CDC.
The GSHS is a school-based cross-sectional survey and targets junior or senior high school student populations in Taiwan. The Health Promotion Administration collaborated with US CDC and launched Taiwan GSHS in 2013.This survey collects data on health behaviors and protective factors among students, such as family status, body weight, dietary behaviors, physical activity, hygiene, violence and unintentional injury, deviance behavior, mental health, health-risk behaviors, and sexual behaviors. The survey can establish trends in the prevalence of health behaviors and protective factors for use in evaluation of school health and youth health promotion.
Since 2013, the survey was conducted annually on a national representative sample of students selected from the 22 counties/ cities in Taiwan.The survey is conducted every year for the biennium, for one year in junior high schools students and the other year for the senior high schools students.
The survey results applied to policy prioritizing, program evaluation, and as the reference of the advocate. To better reflect the change in health behavior prevalence, the annual survey was changed to once in two years since 2019. In 2021, the survey was conducted with country representative samples of junior and senior high school students. However, the completion rate was lower than previous years in 2021 due to the COVID-19 pandemic, the completion rate be taken into consideration for data comparison limitation. In keeping with the WHO’s NCD Global monitoring framework aims international trends in public health surveillance, the GYTS and GSHS were integrated as the Adolescent Smoking and Health Behavior Survey in 2023. This integration aims to provide a better understanding of the current status and changing trends of youth smoking and health behaviors, thereby providing valuable insights for relevant agencies in formulating and advancing school-based tobacco control and youth health promotion policies.
Aim of the Survey
●To understand the prevalence of health risk behavior of the youth population.
●To understand the relation between background characteristics and health risk behaviors among the youth population.
●To investigate the co-occurrence of health risk behaviors among the youth population.
●To monitor trends in prevalence of health risk behavior of the youth.
Sampling Design
The sampling was designed by the CDC of the United States, following the protocol of the GSHS. In order to draw a national representative sample, the schools was categorized into 4 levels by the population density of its located township before sampling. The sampling method was a 2-step “probability proportional to size (PPS)”method, the sample schools was drawn first, and then sample classes in that school was drawn next. All students in the sample classes were invited to join the survey.
Contents of the Survey
The contents of the questionnaire are:
● Demographic information
● Health behaviors: Tobacco use, Alcohol use, Dietary behaviors, Hygiene, the time spent sitting
● Knowledge of the cervical cancer vaccine
● Unintentional injury
● Mental health: Bullying, Feelings and friendships
● Sexual behaviors, exposure to pornographic material
● Experiences at school and at home
Survey Methods
The GSHS survey uses a self-administered, anonymous questionnaire to collect data. All staffs that administrate the GSHS survey has to attend a one-day training provided by the HPA. Three to six trained staff members from the local health bureaus are responsible to coordinate with the sample schools and decide the date and time of the survey in sample school. If local health bureaus are short of human resources, HPA would support and designate its staff. To avoid sample students from discussing with each other about the questionnaire, which might contaminate the data collected, all sample students in each sample school shall complete the survey one the same day at same school hour. The survey is conducted in the classroom of the sample classes. Informed consents are provided to parents of the sample students. The contents of the informed consent will make it clear the aim and the importance of the GSHS survey. The participation in the survey is voluntary, and the information is completely confidential. Both parents and the students have the right of refusal.
Survey Result
The survey results are published in the format of survey reports, press releases, and conferences, or journal papers. Some of the statistical indicators are collected and can be accessed from the Statistical Yearbook of Health Promotion.