Inequalities in adolescent self-rated health and smoking in Europe: comparing different indicators of socioeconomic status
Inequalities in adolescent self-rated health and smoking in Europe: comparing different indicators of socioeconomic status
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DOI：
10.1136/jech-2018-211794
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发表时间：
2019-10-01
影响因子：
6.3
通讯作者：
Richter, Matthias
中科院分区：
文献类型：
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作者：
Moor, Irene;Kuipers, Mirte A. G.;Richter, Matthias
背景虽然有证据表明青少年的健康和健康行为存在社会经济不平等，但在一个数据样本中很少对不同的社会经济状况(SES)指标进行比较。我们研究了五个SES指标与欧洲自评健康(SRH)和吸烟(即，健康不平等的主要原因)之间的关系。方法从2013年SILNE(吸烟不平等：从自然实验中学习)调查中获得14-17岁青少年的数据，该调查在6个欧洲城市(N=10900)的50所学校进行。通过对亲人的主观感受和教育和财富的客观测量，我们测量了青少年自身的自尊(学业成绩、零用钱)、父母自尊(父母教育水平)和家庭自尊(家庭富裕程度、主观社会地位)。以SRH和吸烟为因变量的Logistic回归模型包括所有SES指标、年龄和性别。结果各SES指标间呈弱至中度相关。低学业成绩(OR=1.96，95%CI 1.53~2.51)和低SSS(OR=2.75，95%CI 2.12~3.55)是调整其他SES指标后SRH较差的最强指标。SSS的结果在不同的国家是一致的，而与学习成绩的联系则不同。在所有国家，低学习成绩(OR=5.71，95%CI为4.63~7.06)和较多零花钱(OR=0.21，95%CI为0.18~0.26)与吸烟的关系最为密切。结论青少年健康的社会经济不平等程度最大的是与青少年的教育程度以及青少年对亲人家庭的感知程度密切相关的社会经济不平等，而不是父母教育程度和物质家庭富裕程度的客观指标。对于未来关于青少年健康不平等的研究，建议考虑与青少年相关的SES指标。
Background Although 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. Methods Data 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. Results Correlations 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. Conclusions Socioeconomic 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.