societies

Article
Family Structure through the Adolescent Eyes: A Comparative
Study of Current Status and Time Trends over Three Decades of
HBSC Study
Apolinaras Zaborskis 1, * , Aistė Kavaliauskienė 2 , Charli Eriksson 3 , Elitsa Dimitrova 4 and Joana Makari 5

1 Faculty of Public Health, Medical Academy, Lithuanian University of Health Sciences,

LT-44307 Kaunas, Lithuania
2 Department of Orthodontics, Faculty of Odontology, Medical Academy, Lithuanian University of Health
Sciences, LT-44307 Kaunas, Lithuania; [email protected]
3 Department of Public Health, Stockholm University, SE-10691 Stockholm, Sweden; [email protected]
4 Institute for Population and Human Studies, Bulgarian Academy of Sciences & Plovdiv University Paisii
Hilendarski, 1000 Sofia, Bulgaria; [email protected]
5 Department of Pediatrics, Skåne University Hospital, Lund University, SE-22185 Lund, Sweden;
[email protected]
* Correspondence: [email protected]

Abstract: This study aimed to investigate how family structure varies and identify its time trends in
European and North American countries using data from seven surveys conducted between 1994
and 2018 according to the Health Behaviour in School-aged Children (HBSC) study. The current
family structure in 44 countries was described and time trend analysis of 28 countries was performed.
Adolescents were asked whom they lived with in their home to describe family structures. Family
structures showed distinct patterns and dynamics between countries. In 2018, in all countries, 73%
Citation: Zaborskis, A.;
of adolescents lived with both their mother and father; 14% and 5% of adolescents lived in a single-
Kavaliauskienė, A.; Eriksson, C.; parent family and stepfamily, respectively; and around 9% of adolescents lived in another family
Dimitrova, E.; Makari, J. Family type. In the period 1994–2018, the proportion of young people living in intact families decreased
Structure through the Adolescent from 79.6% to 70.0%, on average about 10 percentage points. There were no significant changes in
Eyes: A Comparative Study of the prevalence of single-parent families and stepfamilies, but a significant increase in the number
Current Status and Time Trends over of adolescents living without either parent was revealed. The findings have implications for cross-
Three Decades of HBSC Study. national adjustment of adolescent health, well-being, and behaviours, and for critical analysis of
Societies 2022, 12, 88. https://
socioeconomic family resources.
doi.org/10.3390/soc12030088

Academic Editor: Gregor Wolbring Keywords: adolescents; family structure; intact family; time trends; HBSC

Received: 23 April 2022

Accepted: 28 May 2022
Published: 31 May 2022
1. Introduction
Publisher’s Note: MDPI stays neutral
The family is the primary place for the development and socialization of adolescents.
with regard to jurisdictional claims in
In the family, they learn the norms of behaviour and the values of life. Many factors
published maps and institutional affil-
determine the functioning of the family and its significance for young people’s development,
iations.
but the structure of the family is undoubtedly of great importance [1].
Different family structures include nuclear families, single-parent families, stepfam-
ilies, families headed by two unmarried partners (either of the opposite sex or the same
Copyright: © 2022 by the authors.
sex), adoptive families, extended families, and grandparent families [2]. Nuclear families
Licensee MDPI, Basel, Switzerland. are usually married couples who have any number of children. Although there are differ-
This article is an open access article ences in the definitions among observers, in this study, we use the intact family structure
distributed under the terms and equivalent to the nuclear family structure as a concept to refer to those children who are
conditions of the Creative Commons living in families in which both biological parents are present in the household [3]. This
Attribution (CC BY) license (https:// type of family structure contrasts with the non-intact family. This term is also known as
creativecommons.org/licenses/by/ the reconstructed, reconstituted, or blended family in which one of the partners is not a
4.0/). biological parent [2]. From the child’s perspective, the non-intact family type includes

Societies 2022, 12, 88. https://doi.org/10.3390/soc12030088 https://www.mdpi.com/journal/societies

Societies 2022, 12, 88 2 of 16

children living in a single-parent family, stepfamily, or living with someone or somewhere

else. Parental separation or divorce is the most common cause of family composition
disintegration [1,4–6].
The literature on the impact of family structure on child development and well-being
is huge. It covers several disciplines, including economics, demography, sociology, and
psychology. A recent scoping review evaluated 283 studies focused on the associations
between family structure and well-being [7]. Nearly three decades of research on the
impact of changing family structures shows that the highest levels of physical, emotional,
and academic well-being are achieved among children living in nuclear or intact families,
controlling for other family circumstances [4,8–13].
Research shows that living with both parents constitutes a protective factor for nor-
mative development while living with a single parent or in stepfamilies has previously
been associated with a higher risk of poor psychological adjustment (depression, anxiety,
poor perception of well-being, and social isolation) [14–17]. Young people who are living
in non-intact families are also more likely to engage in risky behaviour, such as sexual
initiation [18]. The most disturbing finding that researchers have found is the relationship
between impaired family structure and suicide [19,20]. Changes in family structure can
also predict poorer behavioural outcomes such as cigarette smoking and/or use of alco-
hol in adolescence [21–23]. Living in a single-parent family or in a reconstituted family
was unfavourably associated with physical activity, sport participation, and screen-based
behaviours among youth [24]. Adolescents from non-intact families had a less healthy
diet [25,26] and higher risk of being overweight [27,28].
Research on the impact of changing family structures on general life satisfaction found
that children living with both biological parents reported higher life satisfaction than
children living with a single parent or in stepfamilies [29,30]. However, the effect size of
such a parenthood/family structure on child well-being varied between countries, with no
systematic link to differences in policies [10,31,32]. Evidence has shown that in adolescence,
the quality of family relationships might be more important for health outcomes than
family structure per se [33–35]. Shared physical custody after divorce is an increasing
pattern in some countries such as Sweden [36]. In a study of 37 countries [37], it was found
that adolescents’ life satisfaction in such an arrangement is higher than in asymmetric
arrangements, although this is related to the children and family characteristics. Moreover,
a large body of research has shown that families can function well and children can thrive
in a variety of family structures if families are stable, have good parent–child relationships,
and are financially secure [38,39].
Despite the examples of the strong implications of family structure on child devel-
opment, data on the prevalence of different types of families can only be found mostly in
official statistics. For many countries, official statistics contain only data on the frequency
of parental divorces, families by number of children, births to unmarried women, and other
data that are successfully recorded during the census [40–43].
It should be noted that family structure can be measured in two different ways:
from a family-centred perspective and from a child-centred perspective [32]. From the
first perspective, generally for national databases, information is gathered in population
surveys assessing the proportion of some types of family structure in all families with
children. The sampling frame for the surveys is most typically a household address-based
one. The person responding to questions regarding the family situation is an adult, rather
than a dependent child. From the second child-centred perspective, the proportion of all
children who are living in some type of family structure is estimated. Researchers record
the child’s response and use the school rather the household address as a sampling frame.
In this way, the questions on family structure are measured by the responses of the children,
not the adults. Adult and child perceptions of family structure, of course, may differ. The
perceptions of the children are certainly more important when examining the effects of
family structure on children’s health. However, very few cross-national studies collect
information on family structure from the child’s perspective [44].
Societies 2022, 12, 88 3 of 16

The Health Behaviour in School-aged Children (HBSC) study is a World Health

Organization (EURO) collaborative cross-national project that aims to investigate the
health and well-being of adolescents in Europe and North America (see: www.hbsc.org
(accessed on 22 April 2022)). Cross-sectional surveys with school-aged children of 11, 13,
and 15 years of age have been conducted regularly since 1983/84 across an increasing
number of countries [45,46]. As HBSC focuses on the social context of young people’s
health, health behaviour, well-being, and education, family measures are undoubtedly of
great importance. The determination of family structure is one of the key measurements
used since the first HBSC survey. The family structure is assessed based on the child’s
own responses, and the methodology for collecting this information has not changed
since 1994. The impact of family structure on adolescent health, well-being, and health
behaviour has already been highlighted in a number of papers from the HBSC survey
data. The concept of family has been used in more than 100 HBSC scientific papers (see:
www.hbsc.org/publications/ (accessed on 1 April 2022)). Comparative studies of family
structure have been conducted by Chapple in 2009 [32] and Låftman in 2010 [10], but these
studies, despite their age, were limited to single-mother families. Tables and/or graphs
showing family structure by HBSC countries have been presented in the international
reports for each HBSC survey [47–53]; however, no detailed analysis of family structure
time trends using data of the HBSC study has been performed to date.
Consequently, using the large datasets from HBSC surveys, the present study aimed to
answer the following two questions: (1) how does family structure vary between countries
participating in the HBSC, and (2) what time trends in family structure are shown over the
three decades of HBSC study?

2. Materials and Methods

2.1. Study Population
In this study, we used data from the HBSC surveys that were conducted in the period
of 1993/1994 (coded as 1994) to 2017/2018 (coded as 2018), which spanned almost three
decades. During this period, seven surveys were conducted every four years. The number
of countries or regions participating in the study increased from 24 (in 1994 [47]) to 45
(in 2018 [53]) (hereinafter, the Flemish- and French-speaking regions of Belgium, and the
England, Scotland, and Wales regions of the United Kingdom were considered individually
as countries). In all surveys, data collection followed the standard methodology outlined in
the HBSC protocols and included country-representative samples of 11-, 13-, and 15-year-
old students. The data were gathered through a self-filled questionnaire administered in
schools. A detailed description of the aims, theoretical framework, and survey methodology
of the HBSC study can be found in the study website (www.hbsc.org) (accessed on 22 April
2022), international protocols [54], and international reports, which summarized the results
of each of the seven surveys [47–53]. The data were obtained from the International HBSC
Data Bank (Bergen University, Bergen, Norway).
The status of the family structure was described, using data from the 45 countries that
participated in the HBSC survey in 2018. Since no data on family structure was received
from Azerbaijan, the final list of countries in the present analysis included 44 countries,
with a total of 215,875 surveyed students with non-missing responses on family structure.
Time trend analysis was performed using the data of 28 countries in which the survey
was conducted in 1994 (or at least in 1998) and in 2018 (or at least in 2014). Overall,
906,235 students of both sexes aged 11, 13, and 15 years were included in this analysis:
94,618 students in 1994; 116,173 students in 1998; 128,756 students in 2002; 141,630 students
in 2006; 136,573 students in 2010; 148,466 students in 2014; and 140,019 students in the 2018
study waves.

2.2. Ethics
This study conformed with the principles outlined in the World Medical Associa-
tion Declaration of Helsinki. National teams obtained ethical consent from the institu-
Societies 2022, 12, 88 4 of 16

tional ethics committee(s), when required. Parental consent was passive in most coun-
tries. Students were informed orally and in writing that participation in HBSC was vol-
untary. Students did not provide any personal information (such as name, classroom,
teacher) to guarantee the students’ anonymity and to ensure the confidentiality of the
personal responses.

2.3. Measurements
Family structure. The measure of family structure aimed to gain a full picture of the
(sometimes complex) type of families in which children lived [54]. It remained unchanged
and mandatory over the study period (1994 to 2018), except for editing the preamble of
the question. The measure examined the family composition in the main home where the
child lived all the time or most of the time. Following the suggestion of some countries, in
the 2002, 2006, and 2010 surveys, the measurement of family structure was supplemented
by an analogous examination of the family composition in the second home, if any (for
instance, among children whose parents were divorced), but such data were not included
in the analysis of the present study. The validity of the question was confirmed in all
HBSC surveys, with a strong influence of family structure on adolescent lifestyle and
health [47–53].
To define the type of family structure, the students were asked to answer a question
of whom they lived with. When choosing the answer “yes” or “no”, they had to indicate
whether they lived with their “mother”, “father”, “stepmother (or father’s girlfriend)”,
“stepfather (or mother’s boyfriend)”, “grandmother”, “grandfather”, “I live in a foster
home or children’s home”, or “I live with someone or somewhere else: please write it
down”. The students who responded that they lived with their “mother” and “father”
were defined as living with two biological parents or living in an intact family. Those who
responded that they lived with their “mother” but not their “father” or “stepfather” were
defined as living with their mother only (single-mother family). In addition to these types
of family structure, four more types were formed, as shown in Figure 1, with a total of
six types. The group of adolescents living in an “other type” of family structure included
those who reported living in a foster home or children’s home, living with someone or
somewhere else, living with grandparents, or living in a homosexual family.
Reasons for not living with both parents. This measure was developed with the aim of
identifying why the teen did not live with both parents. This optional measure has been
tested by several countries participating in HBSC. At first, students were asked if they
lived with both parents. If the answer was no, then they were asked why. The answer
options were: 1—parents are divorced; 2—mother/father is dead; 3—mother/father is
living/working far away; 4—never seen father/mother/parents; 5—other reasons.

2.4. Statistical Analysis

The proportions of family structure types were estimated from the HBSC data of each
country by the wave of the survey. The aggregated data of all countries was estimated by
weighting data by the country’s sample size to ensure that the sample was representative of
the general population. In the time trend analysis, a z-test with Bonferroni correction was
conducted to estimate the significance of the proportion changes. Associations between
variables were assessed using the non-parametric Spearman correlation. A significance
level was set at p < 0.05. Descriptive analyses were performed with SPSS (version 21.0;
SPSS Inc., Chicago, IL, USA, 2012).
 Societies2022,
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Figure1.1. Flow
Figure Flow diagram
diagram of of the
theclassification
classification of
of families
families by
by the
the type
type ofofstructure.
structure. Sample
Sample size
size of
of the
the
HBSC survey
HBSC survey inin 2018
2018isispresented.
presented. Codes
Codes ofofitems:
items: 11 == yes;
yes; 22 == no;
no; 99== missing;
missing; Foster—living
Foster—living inin
foster home or children’s home; Else—living with someone or
foster home or children’s home; Else—living with someone or somewhere else. somewhere else.

3.
3. Results
Results
3.1.
3.1. Family
Family Structure
Structure in
in HBSC
HBSC Countries
Countries in
in 2018
2018
Based
Basedon on data
data that
that was
was aggregated
aggregated and
and weighted
weighted byby country
country sample,
sample, the
the percentages
percentages
of adolescents who reported living in a certain type of family were estimated
of adolescents who reported living in a certain type of family were estimated (Figure 2). 2).
(Figure In
contrast to crude data (69.7%, see Figure 1), the weighted data showed that 72.7% of young
In contrast to crude data (69.7%, see Figure 1), the weighted data showed that 72.7% of
people reported living in an intact family, i.e., in a family with both parents. Fourteen
young people reported living in an intact family, i.e., in a family with both parents. Four-
percent of respondents reported that they lived with only one parent, but most of them lived
teen percent of respondents reported that they lived with only one parent, but most of
with their mother. About five percent of the respondents indicated living in stepfamilies,
them lived with their mother. About five percent of the respondents indicated living in
mostly in families with the biological mother and stepfather. Eight percent of adolescents
Societies 2022, 12, x FOR PEER REVIEW 6 of 18
Societies 2022, 12, 88 6 of 16

stepfamilies, mostly in families with the biological mother and stepfather. Eight percent
lived in the other
of adolescents type
lived in of
thehousehold,
other typesuch as being cared
of household, such for by grandparents
as being cared for byorgrandpar-
the state
(in
entsfoster homes
or the or children’s
state (in homes,
foster homes for instance).
or children’s homes, for instance).

Father &
Mother & stepmother
stepfather 1%
4% Other
8%
Single-father
2%
Single-
mother
12%
Intact family
73%

Figure 2.
Figure 2. Average family structure,
Average family according to
structure, according to the
the HBSC
HBSC survey
survey conducted
conducted in
in 44
44 countries
countries in
in 2018.
2018.
Data were
Data were weighted
weighted by
by the
the country’s
country’s sample
sample size.
size.

There was much variability between countries in the proportion of adolescents who
reported living
reported livingwith
withboth
bothparents
parents(Figure
(Figure
3).3).
InIn 8 44
8 of of 44 countries,
countries, over over
80%80% of adolescents
of the the adoles-
cents lived
lived with parents
with both both parents (Switzerland
(Switzerland (80.1%),
(80.1%), Greece
Greece (81.4%),
(81.4%), Slovenia
Slovenia (81.7%),
(81.7%), Cro-
Croatia
atia (84.2%),
(84.2%), GeorgiaGeorgia (85.1%),
(85.1%), North North Macedonia
Macedonia (89.1%),(89.1%),
ArmeniaArmenia
(89.8%), (89.8%), Albania
Albania (90.5%))
(90.5%)) compared
compared to adolescents
to adolescents from Greenland,
from Greenland, of whom lessofthan whom halfless thanreported
(48.4%) half (48.4%)
livingre-
in
an intact
ported family.
living in an intact family.
There was also high high variability
variability between countries regarding other family structure
types. For instance, Romania, Kazakhstan, and Scotland excelled as countries where more
than 20% of adolescents indicated that they lived in a single-mother family. In contrast,
the lowest proportions of children living in single-mother families were registered in the
Netherlands (4.7%) and Albania (5.1%) where the corresponding figures were about five
times
times lower
lower than
than in
in Romania
Romania (24.9%)
(24.9%) (Figure
(Figure 4). 4). The
The percentage
percentage of of adolescents
adolescents living
living in
in
families
families with
with their
their mother
mother andand stepfather ranged from
stepfather ranged from under
under 0.2%
0.2% inin Albania, Armenia,
Albania, Armenia,
and
and Georgia
Georgiato toover
over8%8%ininWales
WalesandandHungary.
Hungary.InIn North
North Macedonia,
Macedonia, Armenia,
Armenia, and
andGeorgia,
Geor-
very few (less than 2%) of the young people responded that they lived
gia, very few (less than 2%) of the young people responded that they lived with someone with someone other
than at least one parent. However, in Greenland, England, Norway,
other than at least one parent. However, in Greenland, England, Norway, and Estonia, and Estonia, this
proportion reached 20% (data for the last two indices are not presented).
this proportion reached 20% (data for the last two indices are not presented).
3.2. Reasons for a Non-Intact Family Structure
3.2. Reasons for a Non-Intact Family Structure
Information on the reasons for the change in the family composition was collected
Information on the reasons for the change in the family composition was collected
through an optional question in the HBSC survey questionnaire. In 2014, the question was
through an optional question in the HBSC survey questionnaire. In 2014, the question was
tested in Lithuania, and in 2018, it was adopted in Armenia, Moldova, and Ukraine. Table 1
tested in Lithuania, and in 2018, it was adopted in Armenia, Moldova, and Ukraine. Table
shows the distribution of the reasons mentioned by the children for not living with both
1 shows the distribution of the reasons mentioned by the children for not living with both
parents. The most common cause was parental divorce, the frequency of which ranged
parents. The most common cause was parental divorce, the frequency of which ranged
from 27.4% in Armenia to 63.4% in Ukraine. The proportions of families with a deceased
from 27.4% in Armenia to 63.4% in Ukraine. The proportions of families with a deceased
parent in the selected countries were almost equal (about 15%) while in Lithuania, Armenia,
parent
and in the selected
Moldova, countries
the proportion ofwere almost
families whereequal
the(about 15%) while
mother/father wasinliving
Lithuania, Arme-
or working
nia,away
far and Moldova, the proportion
was noticeable (13.4% to of families where the mother/father was living or work-
22.9%).
ing far away was noticeable (13.4% to 22.9%).
Societies
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Albania 90.5
Armenia 89.8
North Macedonia 89.1
Georgia 85.1
Croatia 84.2
Slovenia 81.7
Greece 81.4
Switzerland 80.1
Italy 79.2
Spain 78.8
Netherlands 78.6
Finland 78.1
Poland 78.0
Denmark 76.7
Bulgaria 76.4
Serbia 75.7
Germany 73.9
Malta 72.5
Ireland 72.3
Belgium (Flemish) 72.3
Ukraine 71.9
Austria 71.7
Sweden 71.6
Slovakia 71.4
Czech Republic 71.3
Canada 71.3
Iceland 71.1
Hungary 70.9
Portugal 70.6
Russia 69.9
Moldova 69.6
Lithuania 68.2
Kazakhstan 67.1
Estonia 67.0
Wales 66.7
France 66.0
Belgium (French) 65.3
Scotland 65.0
Luxembourg 64.8
Latvia 62.3
Norway 61.2
Romania 61.1
England 58.8
Greenland 48.4

0 20 40 60 80 100
%

Figure3.3.Proportion
Figure Proportionof of intact
intact families
families by HBSC
by HBSC countries
countries in 2018.
in 2018.
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18

Romania 24.9
Kazakhstan 22.2
Scotland 20.2
Wales 18.7
Greenland 17.6
Luxembourg 15.2
Belgium (Flemish) 15.1
Latvia 14.8
Canada 14.6
England 14.1
Ireland 14.0
Bulgaria 14.0
Belgium (French) 14.0
France 13.5
Austria 13.5
Germany 13.1
Serbia 13.0
Ukraine 12.6
Sweden 12.5
Hungary 12.5
Moldova 12.4
Slovakia 12.2
Spain 11.8
Georgia 11.5
Norway 11.4
Lithuania 11.1
Italy 11.1
Portugal 10.4
Greece 10.3
Slovenia 9.8
Iceland 9.6
Czech Republic 9.6
Malta 9.4
Poland 8.8
Finland 8.8
Russia 8.3
Croatia 8.2
Estonia 8.1
Armenia 7.5
North Macedonia 7.4
Switzerland 7.1
Denmark 6.3
Albania 5.1
Netherlands 4.7

0 5 10 15 20 25 30
%

Figure 4.
Figure 4. Proportion
Proportion of
of single-mother
single-mother families
families by
by HBSC
HBSCcountries
countriesin
in2018.
2018.

Table 1. Reasons given for not living with both parents in several countries.
Table 1. Reasons given for not living with both parents in several countries.
Parents Are Mother/Father Is Mother/Father Is Liv- Never Seen Fa- Other Rea-
Country Parents Are Mother/Father Mother/Father Is Never Seen Other
Country Year
Year N N
Divorced
Divorced Dead
Is Dead ing/Working Far
Living/Working Away
Far Away ther/Mother
Father/Mother sons
Reasons
Lithuania
Lithuania 2014
2014 18751875 58.658.6 14.9
14.9 13.4
13.4 3.9
3.9 9.2
9.2
Armenia 2018 647 27.4 16.8 22.9 8.0 24.9
Armenia 2018 647 27.4 16.8 22.9 8.0 24.9
Moldova 2018 1078 50.0 12.1 18.6 3.6 15.7
Moldova
Ukraine 2018
2018 10781762 50.063.4 12.1
16.6 18.6
3.1 3.6
4.7 15.7
12.2
Ukraine 2018 1762 63.4 16.6 3.1 4.7 12.2
Societies 2022, 12, 88 9 of 16

3.3. Time Trend of Family Structures over 1994–2018

Time trend analysis of family structures was performed using data from 28 countries
in which the HBSC surveys were conducted in 1994 (or 1998) and 2018 (or 2014). The data
presented in Table 2 allow a comparison of the proportions of all types of family structures
between the selected survey waves by countries. In all countries, except Denmark and
Finland, the proportion of intact families significantly decreased. There was a small
change in the rank of countries that were sorted by the proportion of intact families, as
the proportions of intact families that were estimated in 1994 (or 1998) and 2018 (or 2014)
within selected countries were highly correlated (r = 0.79). In 17 of 28 countries, the
proportion of adolescents living in a single-mother significantly increased (the highest
increase was in Belgium (Flemish) and more than doubled to 15.1%) while in the rest of the
countries, the percentage of children living in single-mother families decreased or did not
change significantly.

Table 2. Comparison of the family structure between surveys in 1994 (or 1998) and 2018 (or 2014)
across 28 HBSC countries.

Survey in 1994 (or 1998) Survey in 2018 (or 2014)

Country or
Region Both Single Mother and Both Single Mother and
Year N Other Year N Other
Parents Mother Stepfather Parents Mother Stepfather
Austria 1994 5349 85.2 8.0 3.0 1.8 2018 4032 71.7 * 13.5 * 2.7 10.2 *
Belgium
1994 4476 86.0 6.8 4.0 0.6 2018 4034 72.3 * 15.1 * 4.0 4.8 *
(Flemish)
Belgium
1994 5196 75.5 10.3 6.3 4.8 2018 4020 65.3 * 14.0 * 5.3 11.9 *
(French)
Canada 1994 6699 77.1 11.8 6.3 0.8 2018 12707 71.3 * 14.6 * 5.0 * 5.2 *
Czech
1994 3584 83.8 8.1 5.7 0.7 2018 11070 71.3 * 9.6 * 4.7 * 12.7 *
Republic
Denmark 1994 3867 74.8 12.6 8.2 1.1 2018 3073 76.7 6.3 * 1.2 * 14.0 *
England 1998 6373 68.2 14.4 11.0 2.9 2018 3397 58.8 * 14.1 3.8 * 21.2 *
Estonia 1994 3516 76.2 15.1 6.1 1.1 2018 4725 67.0 * 8.1 * 3.9 * 19.4 *
Finland 1994 4181 76.6 12.4 5.8 1.9 2018 3100 78.1 8.8 * 5.8 4.5 *
France 1994 3971 81.6 10.0 4.9 1.0 2018 9170 66.0 * 13.5 * 5.8 * 11.4 *
Germany 1998 4770 81.1 9.7 5.3 1.4 2018 4061 73.9 * 13.1 * 5.1 5.8 *
Greece 1998 4285 91.1 5.6 1.0 1.4 2018 3863 81.4 * 10.3 * 1.4 4.9 *
Greenland 1994 1238 57.7 17.9 7.3 11.6 2018 1168 48.4 * 17.6 6.2 21.6 *
Hungary 1994 5775 78.5 10.8 5.7 2.9 2018 3748 70.9 * 12.5 * 8.2 * 5.5 *
Ireland 1998 4352 86.1 8.1 0.9 3.2 2018 3833 72.3 * 14.0 * 4.1 * 7.9 *
Israel 1994 4103 91.5 5.5 1.4 1.0 2014 6104 86.1 * 9.8 * 1.8 0.9
Latvia 1994 3774 74.1 15.6 6.7 2.1 2018 4412 62.3 * 14.8 4.3 * 15.7 *
Lithuania 1994 5425 82.7 10.9 4.4 1.0 2018 3797 68.2 * 11.1 5.6 * 13.6 *
Norway 1994 4920 78.3 10.8 6.6 0.9 2018 3127 61.2 * 11.4 4.5 * 19.3 *
Poland 1994 4519 88.4 7.1 2.2 1.1 2018 5164 78.0 * 8.8 * 1.7 10.2 *
Portugal 1998 3720 85.4 7.9 2.6 2.5 2018 5655 70.6 * 10.4 * 3.3 13.8 *
Russian
1994 4001 75.7 16.6 5.2 1.6 2018 4260 69.9 * 8.3 * 5.0 15.9 *
Federation
Scotland 1994 4770 75.8 14.6 4.9 1.7 2018 4773 65.0 * 20.2 * 5.2 7.3 *
Slovakia 1994 3402 88.5 7.6 1.9 0.6 2018 3911 71.4 * 12.2 * 4.3 * 9.9 *
Spain 1994 4431 90.8 6.2 1.3 0.7 2018 4320 78.8 * 11.8 * 2.2 * 5.6 *
Sweden 1994 3570 76.0 11.3 6.5 2.4 2018 4185 71.6 * 12.5 5.1 * 6.5 *
Switzerland 1998 3997 83.3 10.4 3.6 1.1 2018 7375 80.1 * 7.1 * 3.6 7.9 *
Wales 1994 3851 77.2 12.3 6.3 1.3 2018 13039 66.7 * 18.7 * 8.2 * 3.3 *
Notes: Proportions of adolescents who were living with a single father and living with a father and stepmother
are not presented because they have only a small proportion in the family structure; * p < 0.05 compared with the
data of the survey conducted in 1994 (or 1998).

In all countries, the proportion of the other type of family structure (adolescents living
with someone other than at least one parent) significantly increased. On average, the share
of such families reached 9.3% while in several countries, such as Greenland and England,
that figure was over 20%. Compared with the data of the 1994 HBSC survey, the highest
increases were observed in Norway (18.4%), Estonia (18.3%), Russia (14.3%), Latvia (13.6%),
and Lithuania (12.6%).
 countries, the percentage of children living in single-mother families decreased or did not
change significantly.
In all countries, the proportion of the other type of family structure (adolescents liv-
ing with someone other than at least one parent) significantly increased. On average, the
share of such families reached 9.3% while in several countries, such as Greenland and
Societies 2022, 12, 88 England, that figure was over 20%. Compared with the data of the 1994 HBSC survey, 10 ofthe
16

highest increases were observed in Norway (18.4%), Estonia (18.3%), Russia (14.3%), Lat-
via (13.6%), and Lithuania (12.6%).
Figure 5A shows the
Figure the time
timetrend
trendof ofthe
theproportion
proportionofofintact
intactfamilies
familiesover
over1994–2018
1994–2018 in
in
thethe
28 28 countries.
countries. In this
In this period,
period, the the proportion
proportion of families
of families wherewhere the adolescent
the adolescent livedlived
with
with
both both parents
parents decreased
decreased from 79.6%
from 79.6% to 70.0%;
to 70.0%; thus,
thus, the the overall
overall decreasedecrease was almost
was almost 10 per-
10 percentage
centage points.
points. Similarly,
Similarly, Figure
Figure 5B shows
5B shows thethe time
time trendofofthe
trend theproportion
proportion of
of families
families
where
where the
the adolescent
adolescent lived
lived with
with aa single
single mother.
mother. Here, it is difficult
difficult to
to notice
notice any
any regular
regular
change trend.
change trend. The mean percentage
percentage of of this type of family structure
structure during the observation
observation
period
period was
was about
about 12%.
12%.

Figure 5.
Figure 5. Time
Time trend
trend of
of the
the proportion
proportion of
of families
families where
where the adolescent lived with both parents (A)
and with
and with aa single
single mother
mother (B)(B) over
over 1994–2018
1994–2018 in
in 28
28 HBSC
HBSC countries
countries (see
(see Table
Table 2),
2), except
except England,
England,
Germany,Greece,
Germany, Greece,Ireland,
Ireland,Portugal,
Portugal, and
and Wales
Wales in 1994;
in 1994; Belgium
Belgium (French)
(French) and and Spain
Spain in 1998;
in 1998; Slo-
Slovakia
vakia in 2002; Israel and Russia in 2010; and Israel in 2018. Vertical bars indicate a standard error.
in 2002; Israel and Russia in 2010; and Israel in 2018. Vertical bars indicate a standard error.

4. Discussion
The present study aimed to answer to the following two questions: (1) how do family
structures vary between countries, and (2) what are the time trends shown in family
structures over the three decades of the HBSC study? Extensive data from the HBSC study
conducted between 1994 and 2018 was used to answer these questions. Over this period,
in seven waves of the HBSC survey, adolescents from many countries reported on the
composition of their family by responding to a question regarding whom they lived with.
In contrast with the data from the official statistics, the results of this study are visible
“through the eyes of adolescents”, so they reflect the child’s perspective in regard to family
structure. Thus, the present study was conducted in accordance with the UN Convention
on the Rights of the Child, which states that “Children have the right to give their opinions
freely on issues that affect them. Adults should listen and take children seriously” [55].
Overall, the results of the present study revealed a wide variety of family structures in
the European region and North American countries. The results from the analysis outlined
significant shifts in the composition of families over the last three decades. These results
confirmed the basic idea that the family is not a closed and static unit but a complex and
dynamic system, both affecting and being affected by social, cultural, and historical devel-
Societies 2022, 12, 88 11 of 16

opment [1,5,56] and by individual cycles and life course transitions [57,58]. Adolescence is
one of the life course periods that is most sensitive to family structure change.
Using aggregated data from all countries, we found that in 2018, around 73% of
adolescents lived with both their mother and father, i.e., in an intact family; 14% and 5% of
young people lived in a single-parent family or a stepfamily, respectively; and around 9%
lived in the other types of family. According to the data from the countries that completed
the HBSC surveys, in almost all waves, the proportion of adolescents who reported living in
intact families decreased by about 10 percentage points compared to the initial wave of the
survey conducted in 1994. Although there were no significant changes in the prevalence of
single-parent families and stepfamilies during the follow-up period, a significant increase
was revealed in the number of adolescents living elsewhere or with someone other than
their biological parents. However, variation between countries was markedly contrastive.
Two-parent families constitute the majority of families with children around the globe,
but every region of the world has distinct patterns regarding family structures [41]. Our
findings are in line with the literature [41] showing that intact families are more common in
Eastern European countries while Western countries have higher rates of adolescents living
in non-intact families (and subsequently lower rates of adolescents living with two parents),
though there is strong variation among countries. Different cultural and societal norms
and political and economic factors can account for many of these differences [6,41,59].
In particular, the countries with the highest rate of intact families or the fewest rates of
single-parent families or stepfamilies often have strong religious traditions and strong
familistic cultures [42].
In the present study, the time trends of the family structure types were also studied
from the child’s perspective. The HBSC data from 28 countries showed that during the
period 1994–2018, the proportion of adolescents who reported living in intact families
decreased from 79.6% to 70.0% on average, although there were no significant changes
in the prevalence of single-parent families and stepfamilies during the follow-up period.
Although there may be differences in the definitions of the types of family structures, it can
be observed that this finding correlates with data reported by the OECD Family Database,
which states that on average across the OECD countries, the proportion of children living
with two married parents decreased between 2005 and 2018—from 73% to 66%—while
the share of children living in households with a single-parent remained stable [43]. This
phenomenon is related to increasing trends of divorce or separation [1]. The optional
question regarding the reasons adolescents did not live with both parents, which was
utilized in the surveys of several HBSC countries, confirmed that parental divorce was
the main reason for over half of the cases of children living in a non-intact family in
Lithuania, Moldova, and Ukraine. Demographers are increasingly interested in another
family phenomenon—the growing prevalence of cohabitation—which can significantly
reduce the percentage of intact families. According to the OECD Family Database [43],
living with two cohabiting parents is becoming increasingly common in Belgium, the
Czech Republic, and Poland, where in each case, the proportion of children living with
two cohabiting parents increased by over 10 percentage points between 2007 and 2018.
The HBSC study did not investigate this phenomenon, but it may partly explain the
low proportion of intact families in several countries, which is a result of the diffusion
of cohabitations.
The results from the present study confirmed the painful social fact that a large
proportion of adolescents live in single-parent families, most of which are headed by single
mothers. In 2018, it was recorded that 12% of children only lived with their mother and 2%
only lived with their father. This figure is in line with official statistics; according to the
Eurostat data, in 2020, approximately 14% were single-parent households with dependent
children [60]. According to the 2020 U.S. Census Bureau [61], out of about 11 million single-
parent families with children under the age of 18, 80% were headed by single mothers;
nearly one-third of them live in poverty. The percentage of children living in single-mother
families is considered an indicator of child poverty [40]. There are several reasons for
Societies 2022, 12, 88 12 of 16

this. Recent demographic data show that, for example, in the USA, around half (49.5%) of
single mothers have never married, almost one-third (29.9%) are divorced, and 20.5% are
either separated or widowed [61]. The share of single-mother families varied considerably
from one country to another. To compare the observed variation with data from other
sources, we sorted the countries by the values of the proportion of single-mother families
and compared their rank with analogous ranks found in official statistics. There was a
significant correlation ($ = 0.449, p = 0.010) with the ranking of a subset of 32 countries
from the Luxembourg Income Study (LIS) [40], but there was no significant correlation
($ = 0.114, p = 0.571) with the ranking of a subset of 27 countries from the European Union
regarding single-parent families but not single-mother families [60].
Studies have focused on the rise of single motherhood in the EU [62] and the USA [61].
Over the study period, we observed an increase in single-mother families in 17 of 28 HBSC
countries. However, regarding the data from all countries, the change between the surveys
waves in 1994 and 2018 was not significant. Instead of this change, across all countries
we observed a significant rise in the proportion of adolescents living in a family of the
other structure type. In several countries, such as Greenland and England, this figure was
over 20%. Although the World Family Map (2017) shows that the share of children living
without parents is more common in African countries, there is also data on countries in the
European region in previous years: for example, 5% in Italy (2014), 5% in Hungary (2001),
and 4% in Romania (2004) [41]. So, it is clear that recently, the situation may have changed
a lot. This phenomenon is related to the growing incidence of parental divorce and the
subsequent establishment of new family types and living arrangements for young people.
For instance, a child may be part of two families, when both biological parents establish
new households after separation. A child may live part of the time with one biological
parent and the remaining time with the other biological parent [1,49]. It is also the case
that children are often raised by other relatives, either for their own good (e.g., fostered to
an aunt who lives near a good school) or for the benefit of their host family (e.g., fostered
in need of domestic labour) [42]. The increasing frequency of births outside of marriage,
especially among young women, may also be one of the reasons why there has been an
increase in the share of children who do not live with both biological parents. This may
also be the case when the child is cared for by grandparents in order to help the parents to
continue their studies and careers [41].
A specific reason for adolescents living without any of their parents could be that their
parents go to work abroad due to difficult living conditions in their country. At the time of
the survey (in 2014 and 2018), this phenomenon was more common in countries in Eastern
Europe [63]. It corresponds to our findings, which showed that the number of adolescents
living in families without parents has recently increased in Estonia, Latvia, Lithuania, and
Russia. An optional question regarding the reasons why adolescents did not live with both
parents also confirmed that a high proportion of adolescents declared that their parents
work far away (it is unfortunate that this question was included in the HBSC survey in
only four countries from Eastern Europe—Lithuania, Armenia, Moldova, and Ukraine).
Communication is a key modality by which the family functions as a protective health
asset for adolescent development [64]. Difficult communication or a complete lack of
communication due to the absence of the mother and father increases the probability of
emotional and behavioural problems [65]. For many children whose parents work abroad,
“home” means the absence of parents, emotional and psychological distress, and often
physical and mental health problems [63,66]. Therefore, it deserves further and more
detailed study.

Strengths and Limitations

One the strengths of the present analysis is that this study provided detailed analysis of
the HBSC data on the composition of families in the year 2018 in 44 European countries and
Canada and a trends analysis of the changes in family structures in 28 countries over the
past three decades. Another strength is that the data was collected from the adolescent’s life
Societies 2022, 12, 88 13 of 16

perspective, making it more suitable for an assessment of adolescent health, well-being, and
behaviour compared to official statistics. This study presents the adolescents’ perspectives
and views on the types of families in which they live, and this has a strong added value to
official statistics on family compositions and dynamics.
We also hereby acknowledge several limitations of the present study. First, the present
study relied only on the adolescents’ self-reported data and these reports may have been
subject to a potential response bias. The question on the composition of the family may have
been sensitive for children who lived with one parent or with other relatives. For example,
using sensitive questions, such as the question regarding with whom the adolescent lived
with, can be affected by the possibility of a social fear bias in young people’s responses.
The sensitivity was minimized by an effort to ensure the strict anonymity of respondents.
Second, the classification of family structure types may have been a limitation, which
was based on the adolescents’ responses. For example, some respondents indicated that
they lived with their mother, father, and stepfather. According to our methodology, these
responses were classified as an intact family, but it is also likely that the family couple was
already in the process of separation. Third, the question regarding the reasons why the
adolescent did not live with both parents was only asked in four countries participating in
the HBSC study. After all, there was no clarification of the “other family structure”.

5. Conclusions
Over the last three decades, family structures in the European and North American
regions have shown distinct patterns and changed considerably. The model of the intact
family has been challenged by the recent trends of increasing family union instability and
physical separation of families due to the emigration of parents or living apart.
The present study demonstrates how the adolescent’s perspective can contribute
to better understanding the demographic trends and provide deeper knowledge on the
changing sphere of family and parenthood. Its findings may have implications for cross-
national adjustment of adolescent health, well-being, and behaviour by family structure,
and for a critical analysis of socioeconomic family resources.

Author Contributions: Conceptualization, A.Z.; methodology, A.Z., C.E. and E.D.; software, A.Z.;
validation, A.Z. and C.E.; formal analysis, A.K.; investigation, A.Z., C.E., E.D. and J.M.; writing—
original draft prep-aration, A.K.; writing—review and editing, C.E. and E.D.; visualization, A.Z.
and J.M.; supervi-sion, A.Z.; project administration, A.Z. All authors have read and agreed to the
published version of the manuscript.
Funding: This research received no external funding. The data collection for the HBSC data was
funded at the national level in each country.
Institutional Review Board Statement: The study was conducted in accordance with the Declaration
of Helsinki. Each country obtained approval to conduct the survey from the ethics review board or
equivalent regulatory body asso-ciated with their institution. Surveys at school were authorized by
national, regional, and school authorities.
Informed Consent Statement: Informed consent was obtained from all participants, their parents,
and the school administrators included in the study. Participation was voluntary and confidential.
The article does not present neither individual- nor school-level data.
Data Availability Statement: The data presented in this study are available on reasonable request
from the HBSC Data Man-agement Centre, University of Bergen, Norway ([email protected]).
Acknowledgments: This study used survey data collected in the Health Behaviour in School-aged
Children (HBSC) study during period of 1994–2018. The HBSC study is an internationally com-
parative study carried out in collaboration with WHO/EURO. The international coordinator of the
2017/18 study was A complete list of participating countries and researchers is available on the HBSC
website (http://www.hbsc.org accessed on 22 April 2022).
Conflicts of Interest: The authors declare no conflict of interest.
Societies 2022, 12, 88 14 of 16

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