Health inequality in adolescence. Does stratification occur by familial social background, family affluence, or personal social position?

BACKGROUND: Two new sets of stratification indicators--family's material affluence and adolescent's personal social position- were compared with traditional indicators of familial social position based on parental occupation and education for their ability to detect health inequality among adolescents. METHODS: Survey data were collected in the Adolescent Health and Lifestyle Survey in 2003 from nationally representative samples of 12-, 14- and 16-year-old Finns (number of respondents 5394, response rate 71%). Indicators of the familial social position were father's socio-economic status, parents' education, parents' labour market position. Indicators of material affluence were number of cars, vacation travels, and computers in the family, own room and amount of weekly spending money. Adolescent's personal social position was measured as school performance. Measures of health were long-standing illness, overweight, use of mental health services, poor self-rated health and number of weekly health complaints. Ordinal logistic regression analysis was applied to study the associations between stratification indicators and health variables. RESULTS: All three groups of indicators of social stratification showed inequality in health, but the strongest associations were observed with the adolescent's personal social position. Health inequality was only partly identifiable by the traditional indicators of familial social position. The direction of the inequality was as expected when using the traditional indicators or personal social position: adolescents from higher social positions were healthier than those from lower positions. The indicators of family's material affluence showed mainly weak or no association with health and some of the indicators were inversely associated, although weakly. CONCLUSION: In addition to traditional indicators describing the socio-structural influences on the distribution of health among adolescents, indicators of family's material affluence should be further developed. Adolescents' personal social position should be included in the studies of health inequalities.

Health behavior-based selection into educational tracks starts in early adolescence.

Health behaviors and educational tracks of an individual are here presumed to have a strengthening influence on each other during the developmental process, through which individuals gradually reach their adult health and social position. This longitudinal study of a Finnish nationally representative sample of 12 year olds born in 1970 (N = 1009) examined the associations of health behaviors at ages 12 and 14 with educational track at age 16. The dependent variable, educational track, classified the respondents into five successive categories, thought to predict their adult social position. Selection into different educational tracks according to health behaviors was obvious already at age 12, when frequency of tooth brushing, consumption of sweets, coffee drinking and level of participation in physical exercise predicted educational track independently of sociodemographic background. At age 14, the independent predictors were smoking, frequency of tooth brushing and coffee drinking. At both ages, sociodemographic factors had independent associations with educational track. It seems that certain health-related behaviors in early adolescence are indicators of a person's possibilities to benefit from a country's educational supply. Both sociodemographic background and health-related behaviors influence the process of selection into educational tracks leading to social position and health in adulthood.

Health-related lifestyle in adolescence--origin of social class differences in health?

Survey data collected by mail, representing Finnish 16 year olds (N = 2977; response rate 83%), were used to identify which particular aspects of lifestyle are typical of adolescents who select various educational tracks and, thus, have different probabilities of ending up in low or high social positions. The dependent variable, educational track, was formed by classifying the respondents into five successive categories predicting their social position in adulthood. Lifestyle is measured by health behaviours, leisure-time activities and social relations. The probability of belonging to educational tracks with good social prospects in adulthood was high among adolescents who placed much emphasis on health-enhancing behaviours (not smoking, physical exercise, low milk-fat diet, dental hygiene, use of seatbelts, etc.), who did not spend much time watching TV or listening to music and who attended church or other religious meetings weekly. Health-related lifestyle, at the age of 16, is oriented towards the social group the individual is likely to belong to as an adult. The study provides evidence for a strong association between health-related lifestyle and educational track in adolescence.