Welfare state regimes, health and health inequalities in adolescence: a multilevel study in 32 countries.

Comparative research on health and health inequalities has recently started to establish a welfare regime perspective. The objective of this study was to determine whether different welfare regimes are associated with health and health inequalities among adolescents. Data were collected from the 'Health Behaviour in School-aged Children' study in 2006, including 11- to 15-year-old students from 32 countries (N = 141,091). Prevalence rates and multilevel logistic regression models were calculated for self-rated health (SRH) and health complaints. The results show that between 4 per cent and 7 per cent of the variation in both health outcomes is attributable to differences between countries. Compared to the Scandinavian regime, the Southern regime had lower odds ratios for SRH, while for health complaints the Southern and Eastern regime showed high odds ratios. The association between subjective health and welfare regime was largely unaffected by adjusting for individual socioeconomic position. After adjustment for the welfare regime typology, the country-level variations were reduced to 4.6 per cent for SRH and to 2.9 per cent for health complaints. Regarding cross-level interaction effects between welfare regimes and socioeconomic position, no clear regime-specific pattern was found. Consistent with research on adults this study shows that welfare regimes are important in explaining variations in adolescent health across countries.

The role of behavioural factors in explaining socio-economic differences in adolescent health: a multilevel study in 33 countries.

Attempts to describe and explain socio-economic differences in health have mainly focused on adults. Little is known about the mechanisms of the relationship between socio-economic status (SES) and health in adolescence including inconsistent findings between SES and health among young people. Data were derived from representative samples of 13 and 15-year-old students in 33 European and North American countries (n=97,721) as part of the Health Behaviour in School-aged Children (HBSC) study 2001/2002. Multilevel logistic regression models were used to investigate socio-economic differences in self-rated health among adolescents and the contribution of health-related behaviours to the explanation of such differences. Odds ratios of self-rated health by family affluence were calculated before and after adjustment for behavioural factors (tobacco smoking, physical activity, television use, breakfast intake, consumption of fruits and vegetables). On average, adolescents from low affluent families had an odds ratio for low self-rated health of 1.84 for boys and 1.80 for girls, compared to those from high affluent families. The majority of behavioural factors were significantly associated with family affluence in all countries and explained part of the relationship between self-rated health and family affluence. Smoking, physical activity and breakfast consumption showed the largest independent effect on health. The present study suggests that behavioural factors in early adolescence partly account for the association between self-rated health and socio-economic status. Prevention programmes should target unhealthy behaviours of adolescents from lower socio-economic groups to help prevent future life-course disadvantages in terms of health and social inequalities.

Socioeconomic effects on meeting physical activity guidelines: comparisons among 32 countries.

PURPOSE: This study examined the relationship between age and gender with physical activity (PA) and how meeting of PA guidelines (PAGL) is related to socioeconomic status (SES) and sedentary behaviors (SB). METHODS: Data were collected from 11-, 13-, and 15-yr-old students in 32 countries participating in the Health Behaviour in School-aged Children (HBSC) survey 2001/2002. A self-completed questionnaire assessed weekly moderate-to-vigorous physical activity (MVPA) and SB for the past 7 d and MVPA for a typical week. SES was assessed using the Family Affluence Scale (FAS). RESULTS: None of the countries averaged enough MVPA to meet PAGL. The pattern of MVPA across age and gender was consistent among all countries. In all countries, older children were less active when compared with the youngest children; girls were significantly less active than boys were (mean hours per week of MVPA 3.52 +/- 1.88 vs 4.13 +/- 1.95) and were more likely to not meet the PAGL. SES was significantly associated with the amount of reported MVPA. SES and PAGL were not significantly related in seven countries, and a significant decrease in the influence of age was observed in these countries compared with other countries. CONCLUSIONS: Levels of MVPA during adolescence showed consistent patterns across countries in relation to age, gender, and social class. The limited effect of age on PA in countries where the influence of social class was less strong suggests the possibility of a moderating effect of context in the development of habits acquired during childhood.

School-based prevention for illicit drugs use: a systematic review.

OBJECTIVE: To evaluate the effectiveness of school-based interventions in preventing or reducing drug use. METHODS: The search strategy was conducted according to the Cochrane Collaboration method, and applied to MEDLINE, EMBASE, ERIC, PSYCHINFO, Cochrane Library, ACP Journal Club, Cochrane Drugs and Alcohol Group Register. RCTs and CCTs evaluating school-based interventions designed to prevent substance use were reviewed. Data were extracted independently by two reviewers. Quality was assessed. Interventions were classified as skills, affective, and knowledge focused. RESULTS: 29 RCTs were included; 28 were conducted in the USA; most were focused on 6th-7th grade students. Compared with usual curricula, skills-based interventions significantly reduce marijuana use (RR=0.82; 95% CI: 0.73, 0.92) and hard drug use (RR=0.45; 95% CI: 0.24, 0.85), and improve decision-making skills, self-esteem, peer pressure resistance (RR=2.05; 95% CI: 1.24, 3.42) and drug knowledge. Compared with usual curricula, affective interventions improve decision-making skills and drug knowledge, and knowledge-focused programs improve drug knowledge. Skills-based interventions are better than affective ones in improved self-efficacy. No differences are evident for skills vs. knowledge-focused programs on drug knowledge. Affective interventions improve decision-making skills and drug knowledge to a higher degree than knowledge-focused programs. CONCLUSION: Skills-based programs help to deter drug use. Well designed, long-term randomised trials, and evaluation of intervention components are required.

Girls growing through adolescence have a higher risk of poor health.

INTRODUCTION: Self rated health, in adult population, is strongly associated with mortality and life expectancy. In younger people this association is less evident, but it may anticipate a similar risk in adult life. Our research, based on the HBSC (Health Behaviour in School-Aged Children) International collaboration, contributes to deepen the knowledge in this field by monitoring adolescents' health through a multi-national survey involving 29 European countries, plus North America (Canada and USA) and Israel. METHODS: Following an established methodology, the HBSC survey has elaborated a questionnaire on health and health behaviour, filled in by a representative national sample of 11-, 13- and 15-year-old boys and girls. The sample is constituted of more than 160,000 subjects interviewed during the 2001/2002 survey. Reported symptoms and self-rated health have been analysed by sex and age and through the different countries. RESULTS: Girls resulted to have a poorer perception of their health, with respect to males, at all ages and in all countries (Overall OR = 1.70, 95% CI: 1.66-1.76). Age increases this risk both for males and females, with an average increase of 32% (95% CI: 29-34%) per year in the age-range 11-15. The situation is similar for reported symptoms, with an overall OR of 1.81 (95% CI: 1.77-1.85) for females of reporting three or more symptoms at least once a week; also this risk increases of 26% (95% CI: 24-27%) per year during the pre-adolescence phase. In both cases it could be shown a significant interaction effect between age and gender: OR = 1.19 (CI: 1.15-1.23) for perceived health and OR = 1.26 (CI: 1.23-1.29) for reported symptoms in females with respect to males. CONCLUSIONS: Even if adolescence is described as the healthiest period of life, a consistent minority of young people perceive and report a poor health and a high number of symptoms. Females are constantly in a worse position than males and older age groups are worse than younger ones.

Do welfare regimes mediate the effect of socioeconomic position on health in adolescence? A Cross-national comparison in Europe, North America, and Israel.

This article examines whether different types of welfare states mediate the effect of socioeconomic position on adolescents' health. The authors' main hypothesis is that countries with stronger redistributive policies will be more effective in weakening the association between socioeconomic position and health, thus reducing health inequalities. Analyses were carried out for Israel and 32 countries of Europe and North America. Data in the 2001-2002 Health Behavior in School-aged Children survey were collected through self-administered questionnaires distributed in schools to boys and girls 11, 13, and 15 years old. Socioeconomic position was measured with the Family Affluence Scale, based on reported consumption in the family. Health indicators were perceived health, general well-being, symptom load, and health behaviors. Social welfare regimes were classified using an expanded Esping-Andersen classification. The analysis supports the authors' hypothesis, at least partially. Social democratic and conservative welfare regimes rank lowest in the strength of association between low socioeconomic position and poor health, followed by liberal and other regime types, but it is more difficult to interpret data from Mediterranean and post-communist countries.

Socio-economic position and adolescents' health in Italy: the role of the quality of social relations.

BACKGROUND: The quality of social relations in adolescence is possibly one of the major determinants of habits that can influence the health of young people, and it may also be one of the mediators of the effect of social position on health. In this paper we propose to test these hypotheses for Italian adolescents, in order to suggest interventions aimed at improving their health. METHODS: The Italian data of the HBSC (Health Behaviour in School-Aged Children) survey 2001-02 have been analysed, and the distribution of the perceived quality of social relations has been described, stratified by age, gender, and economic well-being. Logistic models have been fitted using health behaviours as dependent variables and economic well-being and social relations as determinants. RESULTS: The quality of relations with adults seems to decrease consistently from age 11 through age 15, while the relation with peers improves. The relation with the father seems positively correlated with economic well-being. Difficult relations with adults are associated with higher probability of smoking, drinking alcohol and using cannabis; difficult relations with peers are associated with lower physical activity and lower probability of having used cannabis. CONCLUSIONS: Even if the relations with adults become less important in adolescence, they are still associated with health behaviours. Our results fit the framework of socialization theories and can be used for planning adequate health education interventions.