Assessing socioeconomic status in adolescents: the validity of a home affluence scale

STUDY OBJECTIVE: To examine the completion rate, internal reliability, and external validity of a home affluence scale based on adolescents' reports of material circumstances in the home as a measure of family socioeconomic status. DESIGN: Cross sectional survey. SETTING: Data were collected from a school based study in seven schools in the north of England Cheshire over a five month period from September 1999 to January 2000. PARTICIPANTS: 1824 students (1248 girls, 567 boys) aged 13-15 years who were attending normal classes in Years 9 and 10 in 7 schools on the days of data collection. Main results: Comparatively poor completion rates were found for questions on parental education and occupation while material deprivation items had much higher completion rates. There was evidence that students with poorer material circumstances were less able to report parental education and occupation whereas material based questions showed less bias. A home affluence scale composed of material items was found to have adequate internal reliability and good external validity. CONCLUSIONS: A home affluence scale based on material markers provides a useful alternative in assessing family affluence in adolescents. Additionally, it prevents exclusion of those less materially well off adolescents who fail to complete conventional socioeconomic status items.     

Country-Level Meritocratic Beliefs Moderate the Social Gradient in Adolescent Mental Health: A Multilevel Study in 30 European Countries

PurposeAdolescents with higher socioeconomic status (SES) report better mental health. The strength of the association—the “social gradient in adolescent mental health”—varies across countries, with stronger associations in countries with greater income inequality. Country-level meritocratic beliefs (beliefs that people get what they deserve) may also strengthen the social gradient in adolescent mental health; higher SES may be more strongly linked to adolescent's perceptions of capability and respectful treatment.MethodsUsing data from 11–15 year olds across 30 European countries participating in the 2013/2014 Health Behaviour in School-aged Children study (n = 131,101), multilevel regression models with cross-level interactions examined whether country-level meritocratic beliefs moderated the association between two individual-level indicators of SES, family affluence and perceived family wealth, and three indicators of adolescent mental health (life satisfaction, psychosomatic complaints, and aggressive behavior).ResultsFor family affluence, in some countries, there was a social gradient in adolescent mental health, but in others the social gradient was absent or reversed. For perceived family wealth, there was a social gradient in adolescent life satisfaction and psychosomatic complaints in all countries. Country-level meritocratic beliefs moderated associations between SES and both life satisfaction and psychosomatic complaints: in countries with stronger meritocratic beliefs associations with family affluence strengthened, while associations with perceived family wealth weakened.ConclusionsCountry-level meritocratic beliefs moderate the associations between SES and adolescent mental health, with contrasting results for two different SES measures. Further understanding of the mechanisms connecting meritocratic beliefs, SES, and adolescent mental health is warranted.     

Socioeconomic inequalities and mental health problems in children and adolescents: A systematic review

Socioeconomic inequalities in health are an important topic in social sciences and public health research. However, little is known about socioeconomic disparities and mental health problems in childhood and adolescence. This study systematically reviews publications on the relationships between various commonly used indicators of socioeconomic status (SES) and mental health outcomes for children and adolescents aged four to 18 years. Studies published in English or German between 1990 and 2011 were included if they reported at least one marker of socioeconomic status (an index or indicators, e.g., household income, poverty, parental education, parental occupation status, or family affluence) and identified mental health problems using validated instruments. In total, 55 published studies met the inclusion criteria, and 52 studies indicated an inverse relationship between socioeconomic status and mental health problems in children and adolescents. Socioeconomically disadvantaged children and adolescents were two to three times more likely to develop mental health problems. Low socioeconomic status that persisted over time was strongly related to higher rates of mental health problems. A decrease in socioeconomic status was associated with increasing mental health problems. The strength of the correlation varied with age and with different indicators of socioeconomic status, whereas heterogeneous findings were reported for gender and types of mental health problems. The included studies indicated that the theoretical approaches of social causation and classical selection are not mutually exclusive across generations and specific mental health problems; these processes create a cycle of deprivation and mental health problems. The review draws attention to the diversity of measures used to evaluate socioeconomic status, which might have influenced the comparability of international epidemiological studies. Furthermore, the review highlights the need for individual-level early childhood interventions as well as a reduction in socioeconomic inequalities at a societal level to improve mental health in childhood and adolescence.     

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 status and adolescent injuries

Injuries are the major cause of morbidity among children and adolescents in developed countries, but there is a lack of consensus on the relationship between socioeconomic status and risk of injuries. A self-complete questionnaire survey, to gather information on non-fatal injuries and sociodemographic details, was administered in schools during April–June 1994 to a national sample of 4710 Scottish adolescents aged 11, 13 and 15 years. Although there was no evidence of a socioeconomic gradient in the total incidence of medically attended injuries among adolescents, based on the Registrar General's classifications of paternal occupation and a composite measure of family affluence, marked socioeconomic variation in the circumstances in which injuries occurred was observed. There were also socioeconomic differences in the extent and type of risk behaviours reported by adolescents, indicating differential rates of risk exposure. The finding that socioeconomic status affects the kinds of injury events adolescents experience and levels of risk behaviour has implications for the design of injury prevention strategies.     

Indicators of socioeconomic status for adolescents: the WHO Health Behaviour in School-aged Children Survey

Many indicators of socioeconomic status used for adults are inappropriate for use in research on adolescents. In a school-based survey of 4079 Scottish schoolchildren using a self-completion questionnaire, over 20% of 11-15 year olds were unable to provide a substantive response on father's occupation. In contrast, indicators derived to construct a family affluence scale, which included car ownership, telephone ownership and the child having their own unshared bedroom, resulted in a 98% response rate; and 92% of children responded to a question on their weekly spending money. The intercorrelations between the conventional indicator of father's occupation and each family affluence and spending money were examined, and their associations with a range of health indicators and health behaviour measures compared. Father's occupational status and family affluence were moderately correlated and showed broadly similar patterns of association with the selected health measures although there were also some distinct differences. Child's spending money was only weakly correlated with father's occupation and showed rather different patterns of association with health measures. A case is made for the use of multiple indicators of socioeconomic status in adolescent health surveys, and it is argued that that the family affluence scale provides a useful and easily applied additional indicator to father's occupation or an alternative measure of socioeconomic background where occupational data are unavailable.     

Health Status in Immigrants and Native Early Adolescents in Italy

The aim of the study was to compare health status between native and immigrant early adolescents in Italy and to analyze related psychosocial factors. Data were taken from “Health Behavior in School Aged Children”, a cross-sectional survey investigating health behaviors among early adolescents in selected European countries. A representative sample of 6,744 (50.4% males) Italian students (11, 13 and 15-years-old) completed a questionnaire. Students were assessed for demographics characteristics, socio-economic conditions, social support and bullying victimization, and, as dependent variables, for health complaints, self-reported health, life satisfaction and happiness. It turned out that immigrant adolescents, as compared to natives, are more often affected by psychosomatic symptoms, less satisfied about their health and about life, and less happy. A multiple regression model showed that migration itself is related to life satisfaction and happiness. Socio-economic inequalities, lack of social integration and victimization determine the differences between immigrants and natives in terms of health symptoms and self-reported health. Immigrant adolescents demonstrated worse health status then their native classmates. However, the differences in terms of subjective well-being are not explained by socio-economic differences, lack of social integration and discrimination.     

Early puberty is associated with mental health problems in middle adolescence

This study set out to assess the relationship between pubertal timing and emotional and behavioural problems in middle adolescence. The study involved a school based survey of health, health behaviour and behaviour in school as well as questions about emotional and behavioural problems (the School Health Promotion Study). Secondary schools in four regions and 13 towns in Finland participated in the study in 1998. The respondents were 36,549 adolescents aged 14-16. The study included questions on depression, bulimia nervosa, psychosomatic symptoms, anxiety, drinking, substance use, smoking, bullying and truancy. Among girls, both internalising and externalising symptoms were more common the earlier puberty occurred. Among boys, externalising symptoms only were associated with early puberty. It is concluded that early pubertal timing is associated with increased mental health problems. Professionals working with adolescents should consider the mental health needs of early maturing adolescents.     

National mortality rates: the impact of inequality?

Although health is closely associated with income differences within each country there is, at best, only a weak link between national mortality rates and average income among the developed countries. On the other hand, there is evidence of a strong relationship between national mortality rates and the scale of income differences within each society. These three elements are coherent if health is affected less by changes in absolute material standards across affluent populations than it is by relative income or the scale of income differences and the resulting sense of disadvantage within each society. Rather than socioeconomic mortality differentials representing a distribution around given national average mortality rates, it is likely that the degree of income inequality indicates the burden of relative deprivation on national mortality rates.     

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

STUDY OBJECTIVE: To investigate the role of different types of social relations in adolescent health inequalities. DESIGN: Cross sectional study. Measures included family social class, indices of social relations to parents, friends, teachers, and school. SETTING: Random sample of 55 schools in Denmark. PARTICIPANTS: Nationally representative sample of 5205 students from grades 5, 7, and 9. MAIN OUTCOME MEASURES: Self reported physical and psychological symptoms. RESULTS: Adolescents from families of lower socioeconomic position reported more physical and psychological symptoms. This ranged from 40% increased odds for multiple physical symptoms among less advantaged girls, to 90% increased odds of multiple psychological symptoms for less advantaged boys. Relationships with friends or teachers showed small social class differences, while strong and consistent social class differences were found in the ways adolescents reported their own and their parents relations to school. For example, girls from families of lower socioeconomic position were more than four times as likely to report their parents unwilling to attend school meetings (odds ratio=4.54, 95% confidence intervals: 2.68 to 7.69). Poorer relations with parents, peers, teachers, and school were all associated with worse health. Patterns of parent-child relations with the school were the greatest contributors to socioeconomic differences in physical and psychological symptoms. CONCLUSIONS: The school is one of the first important social institutions directly experienced by children and socioeconomic differences in how adolescents and their parents relate to the school may be part of the cascade of early life influences that can lead to later social and health disadvantage.     

Material versus social deprivation and health: a case study of an urban area

Socioeconomic factors are one of the main determinants of health inequalities. However, which component of socioeconomic status affects health most and how that relationship should be measured remains an open question. The aim of this study was to compare material and social deprivation indexes in order to determine which better explains health inequalities within an urban area. Following a review of the literature on small area deprivation indexes, a case study of the Italian city Genoa is presented. The city of Genoa is split into 71 small areas [urbanistic units (UU)], each of which has about 9,500 inhabitants. For each small area, socioeconomic indicators were extracted from the 2001 Census, whereas health indicators were computed from the death registry for 2001–2003. Factorial analyses was used to choose the deprivation variables, which were utilised to create two distinct deprivation indexes referring to material and social deprivation, respectively. Both deprivation indexes are positively correlated with health status proxied by standardised mortality ratios (SMRs) under 65. The material index, however, correlates more highly with SMRs than the social index, and thus the material index is the more suitable measure to explain variations in premature mortality within an urban area. Moreover, the two indexes must be kept distinct.      

Income, relative income, and self-reported health in Britain 1979-2000

We test the relative income hypothesis that an individual's health depends on the distribution of income in a reference group, as well as on the income of the individual. We use data on 231 208 individuals in Great Britain from 19 rounds of the General Household Survey between 1979 and 2000. Results are insensitive to the measure of self-assessed health used but the sign and significance of the effect of relative income depend on the reference group (national or regional) and the measure of relative income (Gini coefficient, absolute or proportional difference from the reference group mean, Yitzhaki absolute and proportional relative deprivation and affluence). Only one model (relative deprivation measured as income proportional to regional mean income) performs better than the model without relative income and has a positive estimated effect of absolute income on health. In this model the increase in the probability of good health from a ceteris paribus reduction in relative deprivation from the upper quartile to zero is 0.010, whereas an increase in income from the lower to the upper quartile increases the probability by 0.056. While our results provide only very weak support for the relative deprivation hypothesis, the inevitable correlation of measures of individual income and relative deprivation measured by comparing income and incomes in a reference group makes identification of the separate effects of income and relative deprivation problematic.     

Does social support mediate or moderate socioeconomic differences in self-rated health among adolescents?

Objective

Social support is assumed to be a protective social determinant of health. The aim of this cross-sectional study was to explore whether social support from the father, mother and friends mediates or moderates the association between socioeconomic position and self-rated health among adolescents.

Methods

The sample consisted of 1,863 secondary school students from the Kosice region in Slovakia (mean age 16.85; 53.3% females, response rate 98.9%). We assessed the mediation and moderation effects of social support from the mother, father and friends on the relation between socioeconomic position and self-rated health, performing binary logistic regression models. Socioeconomic position was measured by parents?? education, the family affluence scale and financial strain.

Results

Social support from the father mediated the association between family affluence and self-rated health among both males and females and the association between financial strain and self-rated health among males only. No moderating effect of social support on socioeconomic differences in self-rated health was found.

Conclusion

Father involvement seems to have the potential to mediate socioeconomic differences in health during adolescence.     

Psychosomatic symptom formation as a health status indicator in early adolescence: behavioral epidemiologic analysis

INTRODUCTION AND AIMS: In adolescence, due to the ongoing biological-hormonal and psychosocial changes, the formation of psychosomatic symptoms becomes more frequent. The psychosomatic symptom formation has an influence on adolescents' self-perceived health as well as on their later health and illness related attitudes and behaviors. The main goal of the present study has been to detect the occurrence of psychosomatic symptoms among early adolescents, and to see the impact of psychosocial and psychological variables on the symptom formation. METHODS: In the frame of the South Plain Youth Study, the survey was going on among middle school aged students (N = 548, classes 5-8, mean age of 12.2 years). Data were collected by means of self-completed questionnaires which contained items on sociodemographics (age, gender, parental schooling, socioeconomic status of the family), mapping psychosomatic symptoms, and certain psychosocial and psychological variables affecting psychosomatic symptom formation (such as academic achievement, health-compromising behaviors, the lack of aggression control and social comparison). Statistical analyses included chi2 test, student's t-test, ANOVA, and multiple linear regression analyses. RESULTS: Fatigue proved to be the most frequent psychosomatic symptoms in both sexes which was followed by headache and lower back pain. These latter symptoms were more common among girls (p < 0.001). Good academic achievement was a protective factor (p < 0.05), while the lack of aggression control increased the psychosomatic symptom formation (boys: beta = 0.37, p < 0.001, girls: beta = 0.21, p < 0.01). Smoking (beta = 0.24, p < 0.01) and social comparison (beta = 0.16, p < 0.05) were predictors only among girls. CONCLUSION: The results draw the attention to the importance of psychosomatic symptom formation in clinical practice. Beyond the difficulties in differential diagnosis, all efforts should be made to start a causal therapy of the latent psychosocial problems so as to prevent the onset of more serious ill health states.     

Socioeconomic disparities in cancer-risk behaviors in adolescence: baseline results from the Health and Behaviour in Teenagers Study (HABITS)

BACKGROUND: This study explores the association between socioeconomic deprivation and five factors associated with long-term risk of cancer, in adolescents. METHODS: BMI, fat intake, fruit and vegetable intake, smoking, and exercise were assessed in 4320 students ages 11 to 12, from 36 schools, in the first year of a 5-year longitudinal study of the development of health behaviors (HABITS study). Neighborhood socioeconomic deprivation for each student's area of residence was matched to their postcode (zip code). We used multiple logistic regression analyses to investigate the relationship between risky behaviors and socioeconomic circumstances. RESULTS: Univariate analyses showed boys and girls from more deprived neighborhoods were more likely to have tried smoking, to eat a high fat diet, and to be overweight. Girls living in more deprived areas were also less likely to eat five servings of fruit and vegetables or to exercise at the weekend. Most differences persisted after controlling for ethnicity. A clear deprivation gradient emerged for each risk factor, indicating the linear nature of the relationship. CONCLUSIONS: This study demonstrates the influence of deprivation on engaging in cancer-risk health behaviors. These patterns may set young people from more socioeconomically deprived social environments on a trajectory leading to increased cancer mortality in adult life.     

Social capital and social inequality in adolescents' health in 601 Flemish communities: a multilevel analysis

Although it is widely acknowledged that community social capital plays an important role in young people’s health, there is limited evidence on the effect of community social capital on the social gradient in child and adolescent health. Using data from the 2005–2006 Flemish (Belgium) Health Behavior among School-aged Children survey (601 communities, n = 10,915), this study investigated whether community social capital is an independent determinant of adolescents’ perceived health and well-being after taking account of individual compositional characteristics (e.g. the gender composition within a certain community). Multilevel statistical procedures were used to estimate neighborhood effects while controlling for individual level effects. Results show that individual level factors (such as family affluence and individual social capital) are positively related to perceived health and well-being and that community level social capital predicted health better than individual social capital. A significant complex interaction effect was found, such that the social gradient in perceived health and well-being (i.e. the slope of family affluence on health) was flattened in communities with a high level of community social capital. Furthermore it seems that socioeconomic status differences in perceived health and well-being substantially narrow in communities where a certain (average) level of community social capital is present. This should mean that individuals living in communities with a low level of community social capital especially benefit from an increase in community social capital. The paper substantiates the need to connect individual health to their meso socioeconomic context and this being intrinsically within a multilevel framework.     

The contribution of material,psychosocial, and behavioral factors in explaining educational and occupational mortality inequalities in a nationally representative sample of South Koreans: Relative and absolute perspectives

The contributions of material, psychosocial, and behavioral factors in explaining socioeconomic inequalities in health have been explored in many Western studies. Most prior investigations have looked at relative abilities to explain such inequalities. In addition, little research focuses on Asian countries, despite the fact that the prevalence and socioeconomic distribution of risk factors for mortality are different there. This study examined relative and absolute abilities of material, psychosocial, and behavioral pathways to explain educational and occupational inequalities in mortality in a nationally representative sample from South Korea. The 1998 and 2001 National Health and Nutrition Examination Survey data were pooled and linked to national mortality data. Of 8366 men and women over 30 years of age, 310 died between 1999 and 2005. Nine pathway variables were examined: three material factors (income, health insurance, and car ownership status), three psychosocial factors (depression, stress, and marital status), and three behavioral factors (smoking, alcohol consumption, and physical exercise). The relative risk and relative index of inequality were used as measures of relative inequality, and risk differences and the slope index of inequality were used as measures of absolute inequality. Material factors explained a total of 29.0% of the excess in relative risk for education and 50.0% of the excess in relative risk for occupational class. Material factors explained 78.6% of the excess in absolute mortality difference for education and 41.1% for occupational class. Psychosocial factors for both education and occupational class had a relative and absolute explanatory power of less than 15%. Behavioral factors showed a relative explanatory power of about 15%, but absolute explanatory power reached 84.0% for education and 105.4% for occupational class. However, the number of deaths used to calculate the absolute explanatory power was small. Results of this study suggest that absolute socioeconomic mortality inequalities could be substantially reduced if behavioral risk factors were reduced in the whole population.     

Household item ownership and self-rated health: material and psychosocial explanations

Background  

There has been an ongoing debate whether the effects of socioeconomic factors on health are due to absolute poverty and material factors or to relative deprivation and psychosocial factors. In the present analyses, we examined the importance for health of material factors, which may have a direct effect on health, and of those that may affect health indirectly, through psychosocial mechanisms.     

The relative importance of family socioeconomic status and school-based peer hierarchies for morning cortisol in youth: An exporatory study

This paper examines the relative importance of family socioeconomic status (SES) and school-based peer hierarchies for young people's psychoneuroendocrine response, represented by cortisol level. Data are drawn from a study of 2824, 15-year-olds in 22 Scottish secondary schools in 2006 who provided information on family SES (parental occupation, material deprivation and family affluence) and social position in school hierarchies, together with two morning salivary cortisol samples. School social position was assessed by participants placing themselves on seven ‘ladders’, from which three factors were derived, termed scholastic, peer and sports hierarchies. Controlling for confounds, there was little or no variation in cortisol by any SES measure. By contrast, each school hierarchy was independently associated with cortisol, but in different ways. For the scholastic hierarchy, an inverse linear relationship was found for females, cortisol increasing with lower position. For peer hierarchy, an opposite (direct) linear relationship occurred for males, while for females elevated cortisol was associated only with ‘top’ position. For sports, elevated cortisol among males was associated with ‘bottom’ position, among females with all except the ‘top’. These results are interpreted in the context of Sapolsky's (Sapolsky, 2005) predictions for stress responses to hierarchical position in stable and unstable social systems, the former represented by the scholastic hierarchy involving elevated cortisol in lower positions, the latter by peer hierarchy with elevated cortisol in higher positions. Overall, the results highlight the greater importance of school-based peer groups than family SES for young people's psychoneuroendocrine response.