Inequalities in adolescent self-rated health and smoking in Europe: comparing different indicators of socioeconomic status

• Published in: Journal of epidemiology and community health (1979) 2019-10, Vol.73 (10), p.963-970
• Main Authors: Moor, Irene, Kuipers, Mirte A G, Lorant, Vincent, Pförtner, Timo-Kolja, Kinnunen, Jaana M, Rathmann, Katharina, Perelman, Julian, Alves, Joana, Robert, Pierre-Olivier, Rimpelä, Arja, Kunst, Anton E, Richter, Matthias
• Format: Article
• Language: English
• Subjects: Academic achievement; Adolescent; Adolescent Health - statistics & numerical data; Adolescents; Affluence; Child development; Cognition & reasoning; Education; Europe - epidemiology; Female; Health behavior; Health disparities; Health Status Disparities; Humans; Learning; Low income groups; Male; Medical research; Parents & parenting; Public health; Regression analysis; Research report; Schools; Self Report; Smoking; Smoking - epidemiology; Social Class; Social classes; Social interactions; Socioeconomic factors; Socioeconomic status; Socioeconomics; Teenagers
• ISSN: 0143-005X; 1470-2738
• DOI: 10.1136/jech-2018-211794

BackgroundAlthough there is evidence for socioeconomic inequalities in health and health behaviour in adolescents, different indicators of socioeconomic status (SES) have rarely been compared within one data sample. We examined associations of five SES indicators with self-rated health (SRH) and smoking (ie, a leading cause of health inequalities) in Europe.MethodsData of adolescents aged 14–17 years old were obtained from the 2013 SILNE survey (smoking inequalities: learning from natural experiments), carried out in 50 schools in 6 European cities (N=10 900). Capturing subjective perceptions of relative SES and objective measures of education and wealth, we measured adolescents’ own SES (academic performance, pocket money), parental SES (parental educational level) and family SES (Family Affluence Scale, subjective social status (SSS)). Logistic regression models with SRH and smoking as dependent variables included all SES indicators, age and gender.ResultsCorrelations between SES indicators were weak to moderate. Low academic performance (OR=1.96, 95% CI 1.53 to 2.51) and low SSS (OR=2.75, 95% CI 2.12 to 3.55) were the strongest indicators of poor SRH after adjusting for other SES-indicators. Results for SSS were consistent across countries, while associations with academic performance varied. Low academic performance (OR=5.71, 95% CI 4.63 to 7.06) and more pocket money (OR=0.21, 95% CI 0.18 to 0.26) were most strongly associated with smoking in all countries.ConclusionsSocioeconomic inequalities in adolescent health were largest according to SES indicators more closely related to the adolescent’s education as well as the adolescent’s perception of relative family SES, rather than objective indicators of parental education and material family affluence. For future studies on adolescent health inequalities, consideration of adolescent-related SES indicators was recommended.