Socioeconomic health inequalities among a nationally representative sample of Danish adolescents: the role of different types of social relations

Does socio-economic status moderate the associations between psychosocial predictors and fruit intake in schoolchildren? The Pro Children study

This study tested whether socio-economic status (SES) moderated the association between the psychosocial constructs included in the attitude-social influence-self-efficacy (ASE) model and fruit intake in Norwegian schoolchildren. The sample consisted of 962 Norwegian sixth graders, mean age 11.3 years. They were split into three SES groups, and multi-group structural equation modeling (MSEM) was used. Children in the highest SES group reported eating fruit more frequently and reported more positive ASE variables than children in the lower SES groups. This was particularly true for social environmental factors, home availability of fruit and intention to eat fruit. MSEM showed that the relationships specified in the adapted ASE model were moderated by SES, as we did not find support for equal model structure across the three samples. Model modification for each SES group separately showed that the relation between home availability and fruit intake was not significant for the medium and low SES groups, and the relation between self-efficacy and intention to eat fruit was not significant for the medium SES group. Future interventions aiming at increasing fruit intake in children need to be sensitive to such SES-related differences and should in particular affect factors that may impede fruit intake in the lower SES groups.

Sense of coherence and medicine use for headache among adolescents

OBJECTIVE

To examine the association between headache, sense of coherence (SOC), and medicine use for headaches in a community-based sample of adolescents.

METHODS

Epidemiological cross-sectional study, encompassing 20 out of 23 schools in the network of health-promoting schools in the county of South Jutland, Denmark. The study population consisted of students from seventh and ninth grade, participation rate 93%, n=1393. The students answered questions on demographic variables, health behavior including medicine use, psychosocial health aspects, and sense of coherence, in an anonymous standardized questionnaire. The outcome measure was self-reported medicine use for headaches. The determinants were headache frequency and SOC measured by Wold and Torsheim's version for children of Antonovsky's 13-item SOC scale.

RESULTS

Analyses adjusted for age group, family social class, exposure to bullying, and headache frequency showed increasing odds for medicine use for headaches (hereafter: medicine use) by decreasing SOC. There was no association between SOC and medicine use among students with a rare experience of headaches but a significant and graded association among students with at least weekly experience of headaches, that is, frequency of headaches modified the association between SOC and medicine use.

CONCLUSIONS

We found that adolescents with low SOC used medicine to cope with headaches to a greater extent than adolescents with high SOC.

Socioeconomic inequality in exposure to bullying during adolescence: a comparative, cross-sectional, multilevel study in 35 countries

OBJECTIVES

We examined the socioeconomic distribution of adolescent exposure to bullying internationally and documented the contribution of the macroeconomic environment.

METHODS

We used an international survey of 162,305 students aged 11, 13, and 15 years from nationally representative samples of 5998 schools in 35 countries in Europe and North America for the 2001-2002 school year. The survey used standardized measures of exposure to bullying and socioeconomic affluence.

RESULTS

Adolescents from families of low affluence reported higher prevalence of being victims of bullying (odds ratio [OR] = 1.13; 95% confidence interval [CI] = 1.10, 1.16). International differences in prevalence of exposure to bullying were not associated with the economic level of the country (as measured by gross national income) or the school, but wide disparities in affluence at a school and large economic inequality (as measured by the Gini coefficient) at the national level were associated with an increased prevalence of exposure to bullying.

CONCLUSIONS

There is socioeconomic inequality in exposure to bullying among adolescents, leaving children of greater socioeconomic disadvantage at higher risk of victimization. Adolescents who attend schools and live in countries where socioeconomic differences are larger are at higher risk of being bullied.

Socioeconomic position and mental health problems in pre- and early-adolescents: the TRAILS study

BACKGROUND

Family socioeconomic position (SEP) is known to be associated with adolescent mental health. Whether the relationship is different for different mental health dimensions is unknown.

METHODS

Using a cross-sectional design, we investigated the differential effects of family SEP on multiple mental health dimensions in preadolescents (N = 2230, baseline age 10-12, 49% boys) using reports from multiple informants (parent, self, and teachers). A score equal to or higher than the 85th percentile (averaged across informants) defined mental health problems.

RESULTS

SEP was inversely associated with all dimensions. Compared to high SEP, the odds ratios (OR) for externalizing problems were 3.88 (95% confidence interval (CI): 2.56, 5.90) and 2.05 (CI: 1.34, 3.14) for low and intermediate SEP, respectively. For internalizing problems, they were 1.86 (CI: 1.28, 2.70) and 1.37 (CI: 0.94, 2.00), respectively. When adjusted for externalizing problems, SEP effects on internalizing problems materially attenuated (OR: 1.47, CI: 0.78, 1.68 and OR: 1.34, CI: 0.91, 1.96) while the converse was less pronounced (OR: 3.39, CI: 2.24, 5.15) and (OR: 1.91, CI: 1.25, 2.94).

CONCLUSION

In early adolescence, the risk of mental health problems increases with decreasing SEP, particularly for externalizing problems. Further, the SEP-internalizing problems relationship is partly explained by shared aspects with externalizing problems.

Knowledge and sources of information about medicines among adolescents in Malta

Objective

To investigate knowledge of medicines and sources of information about medicines among adolescents in Malta.

Methods

A self-administered questionnaire was used to survey knowledge of medicines and information sources among adolescents attending secondary schools in Malta. A random stratified sample design generated a sample size of 514 students. Knowledge of medicines was investigated by questions that included topics about the efficacy of medicines, proper communication during a medical consultation, the safety of medicines, antibiotic use and pictograms.

Results

The analytical sample, of which 53.8% were girls, was made up of 474 students, aged 1416 years. The students obtained a mean score of 22.92 points (SD = 4.31) out of a maximum of 32 points for medicine knowledge. More than 30.0% of the respondents did not mark the correct answer for 40.6% of the questions that investigated knowledge of medicines. The family physician, community pharmacist and parents were the sources of information that were mostly cited. A proportion of 4.4% had obtained information from the teacher. A quarter of the respondents (24.7%) had obtained information from friends/schoolmates, young relatives or the media, generally television (17.3%).

Conclusion

Although the level of knowledge about medicines among this study sample of Maltese students was good, there appeared to be particular misconceptions with regard to important aspects associated with the proper use of medicines. These findings highlight the need to educate adolescents about the proper use of medicines. The most important information providers about medicines appeared to be the physician, pharmacist and parents. It is being suggested that education campaigns should be organized in order to help parents guide adolescents on how to use medicines appropriately. In addition, adolescents would benefit if more information about the proper use of medicines would be disseminated by means of television programs and school-based health education curricula.

Low birth weight, prematurity, and paternal social status: impact on the basic competence test in Taiwanese adolescents

OBJECTIVE

To investigate whether birth weight and paternal education may have independent and interactive effects on the learning achievement of adolescents.

STUDY DESIGN

We linked birth weights, gestational ages (term or preterm) and paternal education of a 4-year birth cohort to the Basic Competence Test (BCT) scores in Mandarin, mathematics and science for junior high school students age 15 to 16 years. The study groups comprised infants with term low birth weight (TLBW; n = 33 507), preterm normal birth weight (PNBW; n =19 905), and preterm low birth weight (PLBW; n = 25 840), as well as randomly selected term infants with normal birth weight (TNBW; n = 83 756). Paternal education levels were categorized.

RESULTS

Compared with the TNBW adolescents, the TLBW adolescents consistently showed larger deficits in mean scores for Mandarin (beta = -2.36), mathematics (beta = -2.89), and science (beta = -2.11). The corresponding significant deficit scores for the PLBW adolescents were -1.93, -2.80, and -1.92. The deficit scores were very small for the PNBW adolescents. Paternal education was inversely associated with scores of all 3 groups. Lower paternal education level tended to worsen the negative impact of low birth weight on BCT scores.

CONCLUSIONS

Both lower birth weight and lower paternal education exert an independent and interactive effect on adolescent learning achievement.

Psychosomatic complaints and sense of coherence among adolescents in a county in Sweden: a cross-sectional school survey

Background

Over the last five to ten years there has been an increase in psychosomatic complaints (PSC) in Swedish children. The objective of the study was to examine the relation between PSC and sense of coherence (SOC).

Methods

A cross-sectional school survey in the county of Västmanland, Sweden. All 16- and 19-year old adolescents present at school on the day of the survey were asked to complete a questionnaire in their classrooms during a one-lesson hour session under the supervision of their teachers. Totally 3,998 students in both private and public schools, studying in ninth grade elementary school or third grade secondary school participated.

Results

The results from our study show that there is a statistically significant relation between PSC and SOC among adolescents. It also shows that adolescents with a weak SOC score have more symptoms of PSC.

Conclusion

Our study indicates that SOC can help the adolescents to choose a coping strategy that is appropriate for the situation and thereby may prevent them from developing PSC. However, additional studies are needed to confirm our findings.

Bullying and attention-deficit- hyperactivity disorder in 10-year-olds in a Swedish community

The association of attention-deficit-hyperactivity disorder (ADHD) with bullying in the peer group in school was studied in an entire population of 577 fourth graders (10-year-olds) in one municipality in Stockholm, Sweden. The schoolchildren were screened for ADHD in a two-step procedure that included Conners'ratings of behavioural problems: teacher and parent interviews in a first step; and a clinical assessment in the second. Information about bullying was collected from the children themselves in a classroom questionnaire. Five-hundred and sixteen children (89.4%; 252 females, 264 males), for whom there was information from all data sources, were included in the study population. Conners'ratings that were collected from parents early in first grade were available for 382 of these children. Hypotheses were tested by multivariate analyses with adjustment for sex and parental education. Pervasive ADHD was diagnosed in 9.5% (95% confidence interval [CI] 5.6-12.8) of the males and 1.6% (CI 0.1-3.1) of the females. ADHD was associated with bullying other students (adjusted odds ratios (OR) 3.8 [CI 2.0-7.2]) as well as being bullied (often, OR 10.8 [CI 4.0-29.0]; sometimes, OR 2.9 [CI 1.5-5.7]). Bullying other students in fourth grade was associated with high scores in parental reports of behavioural problems at entry into first grade, suggesting a causal link to the ADHD syndrome. Being bullied, on the other hand, was not linked to behavioural problems at school entry. This study demonstrates a connection between ADHD and bullying in the peer group at school. Evaluation and treatment strategies for ADHD need to include assessment and effective interventions for bullying. Evaluation of ADHD should be considered in children involved in bullying.

Evaluation of a school-based health promotion programme for adolescents aged 12–15 years with focus on well-being related to stress

OBJECTIVE

The aim of this study was to evaluate a school-based adolescent health promotion programme with focus on well-being related to stress.

STUDY DESIGN

Interventional and evaluative with tests before and after the intervention. The study was performed in two secondary schools in a town on the west coast of Sweden.

METHODS

A health promotion programme comprising massage and mental training was implemented for a single academic year in one school (intervention school, 153 participants) in order to strengthen and maintain well-being. No intervention was implemented in the other school (non-intervention school, 287 participants). A questionnaire was developed and tested, resulting in 23 items distributed across the following six areas: self-reliance; leisure time; being an outsider; general and home satisfaction; school satisfaction; and school environment.

RESULTS

A pre- and postintervention comparison of the six areas was made within each school. In the intervention school, the boys maintained a very good or good sense of well-being related to stress in all six areas, while the girls' sense of well-being was maintained in five areas and deteriorated in one area. In the non-intervention school, the boys maintained a very good or good sense of well-being related to stress in four areas and deteriorated in two areas, while the girls' sense of well-being was maintained in two areas and deteriorated in four areas.

CONCLUSION

Massage and mental training helped to maintain adolescents' very good or good sense of well-being related to stress. A questionnaire with acceptable validity and reliability was developed and tested in order to evaluate the health promotional approach. However, there is a need for further study to develop both the intervention and the questionnaire for young people.

Living conditions and psychosomatic complaints in Swedish schoolchildren

BACKGROUND

The proportion of Swedish schoolchildren that reports psychosomatic complaints has increased during recent decades, parallel to major structural changes in Swedish society.

AIM

To investigate the association of psychosomatic complaints in relation to household socio-economic conditions.

METHODS

Cross-sectional study based on data from child supplements linked to nationally representative household surveys in Sweden during 2000-2003, covering a sample of 5390 children aged 10-18 y. Symptom variables were based on child interviews, while data from parental interviews were used to create socio-economic variables.

RESULTS

Girls more often reported headache and recurrent abdominal pain (RAP) than boys, and these differences became more pronounced with age. Economic stress in the household was associated with headache (OR 1.21, p<0.05), RAP (OR 1.46, p<0.001) as well as difficulties falling asleep (OR 1.35, p<0.01), while there were no consistent associations between symptoms and social class or unemployed parents. Children in single-parent families consistently reported somewhat more symptoms than children in two-parent families (OR 1.26 for at least two of the three symptoms, p<0.05).

CONCLUSION

Economic stress, but not social class, was a significant but moderate risk factor for all three psychosomatic symptoms. It is possible that a growing proportion of families in economic stress has contributed to the parallel increase in reported psychosomatic complaints among Swedish schoolchildren. Further studies are needed to clarify the relation between lack of money, relational strain/support and psychosomatic complaints.

School-related risk factors for drunkenness among adolescents: risk factors differ between socio-economic groups

PURPOSE

To examine, separately for boys and girls, whether socio-economic differences in drunkenness exist in adolescence, whether the level of exposure to school-related risk factors differ between socio-economic groups, and whether the relative contribution of school-related risk factors to drunkenness differ between socio-economic groups.

METHODS

The study population was a random sample of 1453 Danish 15-year-old students. The outcome measure was drunkenness 10 times or more, as a lifetime measure. Predictor variables comprised five aspects of well-being at school. Socio-economic position (SEP) was measured by parental occupation.

RESULTS

Among girls, exposures to school-related risk factors were more prevalent in lower socio-economic groups. Poor school satisfaction was associated with drunkenness among girls from high SEP, odds ratio (OR) = 2.98 (0.73-12.16). Among boys from high SEP autonomy in decision-making was associated with drunkenness, OR = 2.74 (1.06-7.08), whereas poor school satisfaction was associated with drunkenness among boys from intermediate SEP, OR = 2.26 (0.98-5.22). Weak Parental Support in school-related matters, OR = 3.92 (1.16-13.24), and disliking school, OR = 9.12 (1.77-47.09), were associated with drunkenness among boys from low SEP. These associations were also seen among girls although not significant.

CONCLUSION

We found that well-being at school had socially differential impact on drunkenness in adolescence.

Country material distribution and adolescents' perceived health: multilevel study of adolescents in 27 countries

OBJECTIVE

To assess the impact of country material distribution on adolescents' perceptions of health.

DESIGN

Cross sectional multilevel study.

SETTING

Data were collected from the school based health behaviour in school aged children: WHO cross national study 1997/98, which includes students from 27 European and North American countries.

PARTICIPANTS

12 0381 students in year 6, 8, and 10 who were attending school classes on the day of data collection.

MAIN RESULT

Adolescents in countries with a high dispersion of family affluence were more likely to have self rated poor health even after controlling for individual family level of affluence and family social resources.

CONCLUSION

There are substantial inequalities in subjective health across European and North American countries related to the distribution of family material resources in these 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.

The pros and cons of social relations: an analysis of adolescents' health complaints

This paper examines the association between social relations and psychological and psychosomatic health complaints, among adolescents in Sweden. We focused on relationships with parents, as well as relationships with peers in school and in leisure time. Both the structure and the content of relations were analysed. For the latter, we looked at supportive as well as strained relations. The data was the pooled child supplements of the Swedish welfare surveys conducted in 2000-2003. This constitutes a nationally representative, cross-sectional sample of 10-18-year-olds (n = 5137), where information was collected from both adolescents and their parents. Results showed that young people's social relations with parents and peers clearly covaried with their health complaints. With regard to family relations and psychological complaints, the association was more pronounced for relational content than for relational structure. For instance, whether relations with parents were strained or not seemed more relevant than family structure and parental working hours. Moreover, strained relations were more strongly associated with health complaints, especially psychosomatic complaints, than were supportive relations. This applied to relationships with parents as well as with peers in school.

Social equalization in youth: evidence from a cross-sectional British survey

BACKGROUND

A number of studies have suggested that social inequalities in health disappear or are attenuated in early adolescence possibly due to changing risk exposures. The present study examines social equalization in youth in a representative sample of British households with children aged 0-18 years.

METHODS

Secondary analysis of a cross-sectional survey of a representative sample of British households with children and youth with parent-reported less than good health, long-standing illness, and chest problems as outcomes.

RESULTS

Data were available on 15 756 children aged 0-18 years in 8541 households in the third sweep (2001) of the British government's Families and Children Study. Parent-rated health status, long-standing illness, and chest problems all showed social patterning among children who were 0-11 years of age. Among 12- to 14-year-olds, the social gradients in these outcomes noted in childhood associated with income, social class, and education were lost but inequalities in parent-rated health status and long-standing illness but not chest problems persisted associated with measures of household work status and wealth. Among 15- to 18-year-olds, income inequalities appeared to reassert themselves, particularly among girls, but gradients by maternal education noted among 0- to 11-year-olds were absent in both sexes. Inequalities persisted with measures of household worklessness and wealth.

CONCLUSIONS

In this cross-sectional study, the social equalization in youth was noted for some health outcomes and by some measures of socioeconomic status but not for others. Inequalities in parent-rated health status and long-standing illness persist among young people in workless households and those experiencing severe material hardship.

The influence of birth weight and socioeconomic position on cognitive development: Does the early home and learning environment modify their effects?

OBJECTIVE

To establish whether effects of birth weight and socioeconomic position on cognition are explained or modified by home or learning environments.

STUDY DESIGN

Prospective birth cohort (n = 13,980) with math tests at 7, 11, and 16 years of age and qualifications by 33 years of age.

RESULTS

For 1 kg increase in birth weight, 7-year math Z score increased 0.23 (0.19 adjusted for parental interest in child's progress) and adult qualifications increased 0.22 (on a 5-point scale). Maternal reading benefited math less among lower than higher birth weights (p < .05). The birth weight effect remained unchanged 7 to 16 years of age. For each increment in social class (4 categories; IV&V to I&II), 7-year math increased 0.19 (0.12 adjusted for parental interest). Benefits of mother's reading and father's interest were greatest in classes IV&V (interaction p < .05). The difference in Z scores between classes I&II to IV&V was 0.57 at 7 years; 1.12 at 16 years of age. Estimates were little affected by home and school factors. Adult qualifications increased 0.40 per unit social class (0.33 adjusted for parental interest). Maternal interest reduced the chances of those from unskilled manual origins gaining few qualifications (p < .05). Similarly, interactions were seen for maternal reading and paternal interest.

CONCLUSION

Influences in the home partly underlie associations between social background and cognition, but they do little to explain a birth weight/cognition association.

Social class variations in schoolchildren's self-reported outcome of the health dialogue with the school health nurse

INTRODUCTION AND PURPOSE

School health services is an important element in many countries' health promotion activities but little is known about the pupils' acceptance and perception of these services and their effects. The objective of this paper was to examine the pupils' self-reported outcome of the health dialogue and to examine the effect of social class on this response controlled for the effect of other relevant social factors.

MATERIAL AND METHODS

The study is a survey. The population were all pupils in the fifth, seventh and ninth grade (11, 13 and 15 years old) in a random sample of schools in Denmark, response rate 87%, n = 5205. Data were collected by questionnaires.

RESULTS

The majority of the pupils had reflected about the content of the last health dialogue with the school health nurse (54%), had discussed the content with their mother (62%) and with friends (54%); 62% had followed the nurse's advice, 77% had made their own autonomous decisions based on the health dialogue, and 11% had returned to the nurse for further advice. Pupils from the lower social classes had more often followed the nurse's advice (OR = 1.16, 95% CI: 0.99-1.37) and returned to the nurse (OR = 1.46, 95% CI: 1.12-1.90). Pupils from the middle and lower social classes had more often made their own autonomous decisions (middle social classes: OR =1.23, 95% CI: 1.08-1.39, lower social classes: OR = 1.13, 95% CI: 0.95-1.34).

CONCLUSION

Most pupils reported an outcome of the health dialogue with the school health nurse. Pupils from lower social classes seemed to benefit more than pupils from higher social classes.

Evidence on equalisation in health in youth from the West of Scotland

Many studies report few socioeconomic (SES) differences in health in youth, a pattern contrasting with that of health inequalities in childhood and adulthood. This paper focuses on the child-youth transition to examine the hypothesis of equalisation in health over this period. Specifically, we test two hypotheses: (a) that equalisation is more likely for health state measures (physical and malaise symptoms and accidents) than health status ([limiting] longstanding illness and self-rated health) or health potential (height), and (b) that the patterning of health over this period is similar between occupational (social class) and non-occupational (deprivation, housing tenure and family affluence) SES measures. Data are derived from the West of Scotland 11 to 16 cohort, followed from late childhood (aged 11) through early (13) to mid (15) adolescence. The results showed very little evidence of SES differences in (limiting) longstanding illness at any age for both sexes, while self-rated health exhibited some differentiation, and height (as expected) consistent gradients throughout. By contrast, among males evidence of equalisation was found for both physical and malaise symptoms and pedestrian road traffic accidents (RTAs). Among females, equalisation was confined to specific physical symptoms, pedestrian RTAs, sports injuries and burns/scalds, while for malaise symptoms a reverse gradient at age 11 strengthened with age. These patterns were generally unaffected by the SES measure used. We conclude that while some of the evidence is consistent with the equalisation hypothesis, it needs extending to accommodate patterns of no SES differences, and particularly reverse gradients, in childhood. These patterns may reflect the increasingly pervasive influence of youth culture, suggesting that in the UK the boundary between childhood and youth should be set at an earlier age. This in turn suggests that international comparisons have considerable analytic potential for identifying the conditions under which equalisation does and does not occur.