Our study provides evidence that negative subjective wellbeing is associated with increased odds of drinking alcohol and engagement with sexual activity. While cause and effect cannot be extrapolated from cross-sectional surveys, the association between wellbeing and risk behaviours was incremental suggesting–as a minimum–that children with poor wellbeing are more likely to also encounter behavioural health risks. Generation of internationally recognised key indicators of poor child wellbeing, such as income and poverty, was precluded from this school-based study since children could not accurately record these data. Nevertheless, youth resilience, self-esteem, social- and school-connectedness are critical determinants of successful transition from childhood into adulthood,[17–19] and the general and school wellbeing indicators we chose represent these themes. Data were generated from the baseline of a sex and relationship education project. Schools were chosen by the Government Office North West, rather than random selection from a broader schools list. The sample was not intended to be representative but opportunistic for both students and classroom participation. Survey participants may thus not be fully representative of all children in North West England. However, schools would have included those agreeing to participate in the SRE pilot, characterizing 'progressive' teaching attitudes, as well as others representing schools in need of educational change. While children across the wellbeing spectrum were represented in our study, and analyses achieved statistical significance, generalising results directly to wider populations should be undertaken with caution. Our main analyses thus focuses on relationships between variables recorded by individual participants and do not seek to establish population prevalence. Despite these caveats we believe this study contributes further evidence to the hypothesis that school wellbeing influences children's risk behaviours,[11, 12, 20] and supports current efforts to enhance wellbeing at school.
Dislike of school has been identified as a potential contributor to teenage pregnancy risk,[11, 12] and to substance abuse, poor mental health, and low academic achievements[13, 17, 19]. Strengthening school-connectedness and development of resiliency programmes has thus been recommended to reduce teen pregnancies and substance misuse in the UK[13, 20]. However, a UK-based multi-component youth development programme did not secure a reduction in teen pregnancy, substance abuse and other harms, suggesting further understanding is needed to clarify factors that are associated with risky behaviours in teenagers. Our study found children stating a dislike of school had 2.5-fold higher odds of having any sexual relationship and 86% higher odds of having sex, although the latter was not statistically significant. Dislike of school also strongly predicted alcohol use. We also explored other school wellbeing indicators, noting teacher-related markers were more strongly associated with alcohol use and frequency of drinking. Clearly, children involved with risky health behaviours are most in need of guidance and support through school programmes, but they appear to be the very children who poorly engage and are thus less receptive to learning new skills. Programmes supporting targeted activities to bring about healthier behaviours, such as the Healthy Schools enhancement model, thus need to pay particular attention to fostering the engagement of disenfranchised children.
We report evidence of an incremental association between the frequency of alcohol use and the prevalence of sexual activity, including having sex, among young teenagers. To our knowledge, this is the first study to show such a strong and consistent association between alcohol use and sexual activity in children the UK, although the contributions of alcohol to pregnancy has been explored. In the largest UK-based study of sexual activity in teenagers, being drunk or stoned elevated the risk of regretted sex, but student self-recording of being drunk was not found to be a strong predictor of sexual activity. However, a survey among 15-16 year olds in north west England in 2007 found an association between binge drinking and sexual regret, but data on children's sexual activity were not available to explore this association further. International studies have noted associations between alcohol and early onset of sexual activity,[24, 25] having multiple sexual partners,[26, 27] and becoming pregnant. An American study of young people aged 12 to 20 years, showed a correlation between pregnancy and rates of binge drinking. They documented a 30-fold higher odds of making/becoming pregnant in persons bingeing up to 10 times in the past 30 days, 10-fold in those bingeing twice, and 4-fold in non-bingers, compared with non-drinkers. In our study we also noted that the odds of having sexual activity (and sex) were higher among children who reported drinking rarely, compared with non-drinkers. This corroborates studies showing that even low level drinking increases the potential risk of harm[14, 29].