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Diet and lifestyle

Major survey maps the health and well-being of Denmark’s vocational education and training students

A survey of more than 6000 students attending Denmark’s vocational education and training schools found differences in students’ health and well-being depending on their choice of educational programme and the administrative region in which their school is located. However, too many adolescents and young adults in all the educational programmes at these schools smoke, are overweight, get too little exercise and eat too little fruit and vegetables.

In a major questionnaire survey, researchers from Steno Diabetes Center Copenhagen, the Danish Cancer Society and the Danish Heart Foundation have mapped the health and well-being of students attending Denmark’s vocational education and training schools.

The cross-sectional survey, the results of which have been published as a report (in Danish), shows that these students have good well-being in some areas but that there is room for improvement in other areas.

Overall, the students are doing well: 91% are pleased to attend their school; 83% think that their lives are well organized; and 73% say that they are very satisfied with their lives.

However, 19% said they are considering dropping out of school; 10% feel lonely; and 12% are unhappy, nervous or irritable on a daily basis.

The figures from the report also show that there is room for improving the health of Denmark’s vocational education and training students, with 39% being overweight or obese with these numbers increasing to 57% among students older than 25 years. Two out of three do not eat fruit and vegetables daily, and many exercise too little.

Among students 19–25 years old, 45% smoke cigarettes, e-cigarettes, hookahs and/or use snuff daily.

“In this report, we wanted to elucidate the current state of health and well-being of vocational education and training students. We focus on initiatives to curb social inequality in health, and focusing on these schools is therefore important, since many students at these schools end up with a short education, and we know that people with shorter education have an increased risk of adopting unhealthy lifestyles and later developing lifestyle-related diseases,” explains Charlotte Demant Klinker, Researcher, Steno Diabetes Center Copenhagen.

In addition to the major report, some of the survey results were published in the International Journal of Environmental Research and Public Health.

The Capital Region has the most stressed vocational education and training students

In the survey, 6119 students attending 58 vocational education and training schools completed a questionnaire on their health and well-being.

The survey is the first of its kind since it collected representative data, enabling the differences between Denmark’s administrative regions and the various educational programmes to be investigated.

The survey showed that vocational education and training students in the Capital Region of Denmark are more stressed than vocational education and training students in other regions.

• 41% of these students in the Capital Region report being stressed on a daily or weekly basis.

• 32% in the Capital Region sleep less than 7 hours a day.

• 35% smoke daily, which is the highest percentage across Denmark’s regions, and 70% of the smokers began to smoke at age 15 years or earlier.

• 74% of those who smoke want to stop smoking.

• 16% smoked hashish within the past 30 days.

Regional differences in health

The other regions also have notable characteristics.

• Region Zealand and the North Denmark Region have the highest percentage of overweight or obese vocational education and training students (45%).

• Central Denmark Region has the lowest percentage of overweight or obese students (33%).

• The Central Denmark Region and the North Denmark Region have the most students (77%) who sleep at least 7 hours per night.

• Region Zealand has the highest share of students who eat vegetables every day (33%).

• Region Zealand also has the highest percentage of heavy smokers (32% of the daily smokers).

• In the North Denmark Region, 39% of students do not meet the WHO minimum recommendations for physical activity, and the region also has the lowest percentage of students eating vegetables daily: only one fifth.

• The North Denmark Region has positive indicators: the lowest percentage of stressed students (28%), the lowest percentage of students who smoke together with school employees (18%) and the lowest percentage of students who smoked hashish recently (4%).

“We thought that the regions would differ, and they do. However, we are a little surprised at how systematic this is, and this emphasizes that potential interventions must be very specific to the individual school in a specific region,” says Charlotte Demant Klinker.

Health status differs between educational programmes

The report also shows major differences between the educational programmes at the vocational education and training schools.

• Food, agriculture and hospitality students are often heavy smokers (27% of daily smokers). But only 24% of the men are stressed daily or weekly.

• Office administration, commerce and business service students have the lowest level of well-being among educational programmes: 15% are not too pleased to attend their school; 29% are thinking of dropping out; and 45% feel stressed daily or weekly.

• Care, health and pedagogy students seem to have the greatest focus on their health: 92% drink less than the Danish Health Authority’s high-risk threshold for alcohol intake; 34% eat fruit and 39% vegetables daily; and 56% exercise as part of their studies. However, the students in these programmes have the highest prevalence of overweight and obesity (49%).

• Technology, construction and transport students have the greatest consumption of tobacco and psychoactive drugs: 61% of the smokers are addicted to tobacco and 30% are heavy smokers; 13% smoked hashish within the past month; and 23% have taken cocaine at some point. These educational programmes have the lowest percentage of students who are stressed on a daily or weekly basis.

“We emphasize that interventions involving adolescents and young adults attending vocational education and training schools must relate to the individual students, because they differ greatly in their challenges. Among technology, construction and transport students, focusing on smoking cessation and smoking culture in the schools may be beneficial, whereas interventions for care, health and pedagogy students should also focus on overweight,” says Charlotte Demant Klinker.

Health and well-being differ between vocational students in the normal-level and higher-level programmes

The survey also focused on the differences between the vocational students in the normal-level and the higher-level programmes.

The normal level (EUD) qualifies the student to work within a specific trade, and the higher level (EUX) also qualifies for higher education because the students also obtain an upper-secondary degree.

The higher-level students appear to have worse well-being than normal-level students: 26% consider dropping out of school, and one third feel that they seldom or never get support from their teachers or other staff members.

However, only 19% of the students attending a higher-level programme smoke daily, and a smaller percentage are overweight than normal-level students.

“The higher vocational level is somewhere between an upper-secondary educational programme and a normal-level vocational programme on several parameters. More of the general upper-secondary students are stressed and have worse well-being than normal-level vocational students, and the normal-level students are in between. Conversely, general upper-secondary students are better at taking care of their health, and higher-level students are between normal-level vocational education and training students and general upper-secondary students,” explains Charlotte Demant Klinker.

Collaboration requires interventions from several actors

Charlotte Demant Klinker emphasizes that the new survey is intended as a tool for the actors aiming to influence the well-being and health of people attending short vocational educational programmes.

These actors include the vocational education and training schools, the municipalities and nongovernmental organizations such as the Danish Cancer Society and the Danish Heart Association.

“It is important to focus not only on the negative but also on the positive in this report. Many students are motivated to adopt healthier lifestyles and therefore need access to the structures and support that can enable them to do this. We believe that the best way to achieve this is in collaboration between the various actors who are interested in promoting health at vocational education and training schools. This may be one way to break the link between lower educational levels and poorer health,” says Charlotte Demant Klinker.

Health literacy is associated with health behaviors in students from vocational education and training schools: a Danish population-based survey” has been published in Environmental Research and Public Health. Several of the article’s authors are from Steno Diabetes Center Copenhagen, which has received funding from the Novo Nordisk Foundation.

Charlotte Demant Klinker
Researcher, PhD and MSc
1. Intervention research: Development, design and evaluation of complex health promotion interventions in real life setting, e.g. in vulnerable neighborhoods or at vocational schools 2. Children, youth and physical activity: Research investigating how to improve physical activity among diverse target groups using novel approaches and techniques 3. Social Network Analyses: Research investigating development of networks between health professionals and residents 4. Partnerships and Health Promotion: Combination of qualitative and quantitative research investigating the significance of partnerships on the development of and work with health promotion activities