The relative influence of individual and contextual socio-economic status on consumption of fruit and soft drinks among adolescents in Europe

BACKGROUND: The number of studies among children and adolescents that focus on socio-economic differences in food habits is limited. Moreover, most are done in only one country and often include a non-representative sample. The present study examines whether socio-economic differences in the consumption of fruit and soft drinks can be found among young adolescents in a wide range of European countries. METHODS: Multilevel statistical analysis of 114 558 school-pupils aged 11, 13 and 15 from 28 countries participating in the WHO collaborative cross-national study of Health Behaviours among School-aged Children 2001-2002. The individual outcomes were daily fruit and soft drink consumption and the socio-economic predictors at the individual level were occupation of the head of household and family material wealth. Family material wealth was aggregated at the country level to operationalize country-level socio-economic status. RESULTS: In general, girls and younger pupils consumed fruit more often and soft drinks less often. Significant between-school, between-country and between-region differences were found. Fruit consumption increased with family material wealth and higher parental occupational status. Soft drink consumption was lower among pupils of higher parental occupational status in Northern, Southern and Western European countries, but not in Central and Eastern European countries. Only in Central and Eastern European countries was a significant increase in soft drink consumption with increasing family affluence found. The country level of family affluence did not seem to have an effect on either outcome variable. CONCLUSION: The findings underscore the importance of socio-economic factors in relation to the food habits of young adolescents.     

Income inequality and mortality in Italy

BACKGROUND: The relationship between income inequality and health remains controversial in terms of whether or not it exists and, if so, its extent and the mechanisms involved. This study examines the relationship between income inequality, as indicated by the Gini coefficient, and mortality in Italy. METHODS: Cross-sectional ecological study on the 57,138,489 inhabitants living in the 95 provinces existing in Italy in 1994. Multivariate weighted regression analysis of total and age-specific mortality, income inequality, gender, and interaction between income inequality and median income or geographical area. RESULTS: A positive association between income inequality and total mortality was observed for both genders in provinces with a low per capita income and in Southern and Central Italy. The effect was present for infants and for persons over 24 years of age; it was marked for the elderly, particularly women. A negative association with mortality was observed for males living in the North-west. Interactions between income inequality and median income, and between income inequality and geographical area were found. CONCLUSION: In Italy, the relationship between income inequality and health is mixed and not universal, in so far as a positive association was observed only in provinces with lower absolute income. Elderly persons living in Southern Italy represent the population subgroup most vulnerable to unequal income distribution. Income inequality can, in part, explain the historically higher mortality among women in Southern Italy compared to women in the North. These results indicate that income inequality affects the health of population subgroups differentially.     

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.     

Individual, group and community risk and protective factors for alcohol and drug use among Swedish adolescents

BACKGROUND: A number of factors have been identified that protect adolescents or, alternatively, put them at risk for drug use and other high-risk behaviours. These factors concern different personal and environmental factors, e.g. the community, the school setting, family, peer group and individual characteristics.The aim of the present study was to examine the associations between risk and protective factors and adolescents' use of alcohol and drugs. METHODS: In both May 2003 and 2004, random samples of 4800 adolescents (a total of 9600) in Sweden were contacted and asked to fill out a questionnaire.It concerned use of alcohol and illicit drugs and a large number of adolescent risk and protective factors. A total of 5445 (57%) adolescents agreed to participate. RESULTS: About 44% of the adolescents in grade 9 (15-16 years of age) had been drunk on at least one occasion and nearly 80% of those in grade 11 (17-18 years of age). Almost 15% in grade 9 and 40% in grade 11 had been drinking heavily during the previous month, and 4% in grade 9 and 12% in grade 11 had used cannabis. Strong associations were found between elevated individual, family, school and community risk factors and use of alcohol and drugs. Conversely, protective factors were negatively related to the use of alcohol and drugs. CONCLUSIONS: This study confirms the importance of risk and protective factors within different domains in explaining alcohol and drug use among adolescents. The results support efforts targeting multiple risk and protective factors in alcohol and drug preventive interventions for adolescents.     

Absolute and relative family affluence and psychosomatic symptoms in adolescents

Previous research on the links between income inequality and health and socioeconomic differences in health suggests that relative differences in affluence impact health and well-being more than absolute affluence. This study explored whether self-reported psychosomatic symptoms in adolescents relate more closely to relative affluence (i.e., relative deprivation or rank affluence within regions or schools) than to absolute affluence. Data on family material assets and psychosomatic symptoms were collected from 48,523 adolescents in eight countries (Austria, Belgium, Canada, Norway, Scotland, Poland, Turkey, and Ukraine) as part of the 2009/10 Health Behaviour in School-aged Children study. Multilevel regression analyses of the data showed that relative deprivation (Yitzhaki Index, calculated in regions and in schools) and rank affluence (in regions) (1) related more closely to symptoms than absolute affluence, and (2) related to symptoms after differences in absolute affluence were held constant. However, differences in family material assets, whether they are measured in absolute or relative terms, account for a significant variation in adolescent psychosomatic symptoms. Conceptual and empirical issues relating to the use of material affluence indices to estimate socioeconomic position are discussed.     

The impact parenting behaviors have on recent alcohol use and binge drinking among adolescents based on age

Adolescent alcohol use is a persistent problem in the United States. Despite numerous prevention efforts, alcohol still remains the most commonly used substance among youth. The primary aim of this study was to determine the impact parenting behaviors have on adolescent recent alcohol use and binge drinking among youth aged 12–13 years, 14–15 years, and 16–17 years. For the study purpose, recent alcohol use was defined as drinking alcohol in the past 30 days and binge drinking was defined as consuming five or more alcoholic beverages in a row on the same occasion in the past 30 days of taking the survey. A secondary data analysis of the 2012 National Survey on Drug Use and Health was conducted and included a national sample of 17,399 adolescents. To determine the impact parenting behaviors have on adolescent alcohol use at the varying age ranges, logistic regression analyses were performed. All statistically significant results were retained and subsequent logistic regression analyses were completed to examine the effect parenting behaviors have on past month alcohol use and past month binge drinking for each age group. Results revealed that 13.3% of youth drank alcohol in the past month, and 7.5% of youth binge drank alcohol in the past month. Results indicated a lack of positive parenting behaviors increased the odds of youth reporting recent alcohol use and binge drinking across all ages. Of all age groups, the youngest youth (12–13 years old) had the highest risk of alcohol use and binge drinking after assessing the lack of positive parenting behaviors followed by 14–15-year olds and 16–17-year olds. Three specific parenting practices were found to influence youths’ alcohol use, especially among younger youth. Recommendations for future studies are included.     

Income inequality and health in Ontario: a multilevel analysis

OBJECTIVE: To examine the association of income inequality at the public health unit level with individual health status in Ontario. METHODS: Cross-sectional multilevel study carried out among subjects aged 25 years or older residing in 42 public health units in Ontario. Individual-level data drawn from 30,939 respondents in 1996-97 Ontario Health Survey. Median area income and income inequality (Gini coefficient) calculated from 1996 census. Self-rated health status (SRH) and Health Utilities Index (HUI-3) scores were used as main outcomes. RESULTS: Controlling for individual-level factors including income, respondents living in public health units in the highest tercile of income inequality had odds ratios of 1.20 (95% CI 1.04 - 1.38) for fair/poor self-rated health, and 1.11 (95% CI 1.01 - 1.22) for HUI score below the median, compared with people living in public health units in the lowest tercile. Controlling further for median area income had little effect on the association. CONCLUSION: Income inequality was significantly associated with individual self-reported health status at public health unit level in Ontario, independent of individual income.     

Seat belt use and social inequality in Belgium

BACKGROUND: To search for and quantify the importance of socio-economic inequality in seat belt use in young Belgians (15-24 years old). METHODS: Using the data of the National Health Survey of Belgium (1997), socio-economic indicators were constructed combining characteristics of the individual and the household to which s/he 'belongs' (equivalent household income, employment, poverty, subjective poverty, and socio-economic insecurity) and the corresponding concentration curves and indices were calculated. RESULTS: Significant differences were found in seat belt use related to young people's socio-economic status. The failure to buckle up was concentrated most heavily in the least favoured socio-economic groups. Such inequality was a constant finding, although its magnitude varied according to the socio-economic indicator used, going from -0.142 for the variable 'occupational category of the household' to -0.028 for the variable 'poverty'. CONCLUSIONS: This finding of true socio-economic inequality in the use of seat belts by 15-24 year olds should prompt special vigilance in health promotion approaches aimed at changing behaviour. It also underlines the importance of being attentive to the socio-economic indicators that are chosen to quantify such inequality in intra- and inter-country comparisons.     

Income inequality and limitations in activities of daily living: a multilevel analysis of the 2003 American Community Survey

OBJECTIVES: This study examined whether state income inequality was associated with an individual's limitations in activities of daily living (ADL) when controlling for the individual's demographic and socio-economic characteristics. STUDY DESIGN AND METHODS: The study was based on secondary analyses of data collected in the 2003 American Community Survey (ACS). The ACS is a national survey of Americans with a 96.7% response rate. The sample used for this research included 645,835 participants aged 25 years and older. A multilevel model with a non-linear logit link function was used. RESULTS: A 0.05 increase in the Gini coefficient (a measure of state level income inequality) was associated with an increase of 11% in the odds of ADL limitations [odds ratio (OR) 1.11, 95% confidence intervals 1.01-1.22] even after controlling for the individual's demographic and socio-economic characteristics. These elevated odds are comparable with those associated with women in comparison with men (OR 1.12). A separate analysis indicated that individuals in the three least equitable states had consistently higher probabilities of ADL limitations across the whole economic spectrum when compared with individuals in the three most equitable states. CONCLUSIONS: State-level income inequality and individual income levels were significant independent predictors of ADL limitations. The impact of any future changes in state-level income inequality or shifts in individual income levels in the USA could be used to further investigate if this relationship is causal.     

Prevalence of tobacco and alcohol use disorders in Polish primary care settings

BACKGROUND: Primary care settings are an ideal system in which to identify and treat tobacco and alcohol use disorders. This project surveyed patients from the offices of 20 Polish primary care clinicians to ascertain the prevalence of tobacco and alcohol use by gender and age. METHODS: A total of 4373 adults aged 18-80 years seeking routine care completed a nurse-administered Health Screening Survey as part of a clinical trial designed to assess the efficacy of brief physician advice on heavy alcohol use. RESULTS: Of the 4373 subjects screened, 44.4% reported cigarette use within the past three months. Most perceived smoking as a problem and had considered reducing their tobacco use. A stepwise model to examine factors that predict smoking status found that alcohol consumption was the best predictor of current cigarette use. Alcohol consumption was common, with 64% of the subjects reporting some use within the previous three months. Of these, 55% were classified as low risk drinkers, 14% as at-risk drinkers, 12% as problem drinkers, and 19% as dependent drinkers. CONCLUSION: This is the first report on the combined prevalence of tobacco and alcohol use disorders in a sample of persons attending community-based primary care clinics in Poland. This report confirms the high prevalence of these problems and suggests that patients will accurately complete a screening test such as the Health Screening Survey. The methods employed for this study provide the Polish health care system with a procedure to effectively screen patients for tobacco and alcohol use disorders.     

The prevalence of the use of androgenic anabolic steroids by adolescents in a county of Sweden

Background: The prevalence of the use of androgenic anabolicsteroids has been poorly studied in Europe. This study was undertakento examine the prevalence of the misuse - the non-medical use- of androgenic anabolic steroids among adolescents in a countyof Sweden. Methods: The total population of 16 and 17 year oldmale and female adolescents in a county on the south-west coastof Sweden was studied. The investigation was done by an anonymousmultiple-choice questionnaire. The questionnaire was completedby 5,827 pupils and statistically analysed. The participationrate was 95%. Results: Among male adolescents 16 and 17 yearsold, 3.6% and 2.8% had misused androgenic anabolic steroids,respectively. These male adolescents had also misused alcohol,growth hormones and narcotic drugs more than the steroid hormonenon-users. Among female adolescents there was no recorded misuseof these drugs (0.0%). Conclusions: The misuse of androgenicanabolic steroids Is a reality in both small and large municipalitiesin Sweden. The prevalence figures are higher among 16 year oldcompared to 17 year old male adolescents. There is an associationbetween this drug misuse and other substance misuse such asnarcotic drugs. Female adolescents do not misuse steroid hormones.The findings indicate the need for preventive work among maleadolescents in order to induce adolescents not to start misusingandrogenic anabolic steroids.     

An exploratory multilevel analysis of income,income inequality and self-rated health of the elderly in China

In the last three decades, China has experienced rapid economic development and growing economic inequality, such that economic disparities between rural and urban areas, as well as coastal and interior areas have deepened. Since the late 1990s China has also experienced an ageing population which has attracted attention to the wellbeing of the rapidly growing number of elderly. This research aims to characterise province differences in health and to explore the effects of individual income and economic disparity in the form of income inequality on health outcomes of the elderly. The study is based on the Chinese Longitudinal Healthy Longevity Survey data collected in 2008 for 23 provinces. Multilevel logistic models are employed to investigate the relationship between income, income inequality and self-rated health for the elderly using both individual and province-level variables. Results are presented as relative odds ratios, and for province differentials as Median Odds Ratios. The analysis is deliberately exploratory so as to find evidence of income effects if they exist and particular attention is placed on how province-level inequality (contemporaneous and lagged) may moderate individual relationships. The results show that the health of the elderly is not only affected by individual income (the odds of poor health are 3 times greater for the elderly with the lowest income compared to those at the upper quartile) but also by a small main effect for province-level income inequality (odds ratio of 1.019). There are significant cross-level interactions such that where inequality is high there are greater differences between those with and without formal education, and between men and women with the latter experiencing poorer health.     

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.     

Mortality in childhood, youth and early adulthood: Social inequality in a Swedish city

In 1971–1985 statistically significant social differencesin mortality in youth and early adulthood were found in thecity of Göteborg, when divided into 3 socio-economic areagroups according to income. This applied to total mortality,to major biological causes of death and external causes of death,i.e. intentional injuries (mainly suicide) as well as accidents.The differences increased from 1971–1975 to 1981–1985.A similar pattern, which was not statistically significant,was found in childhood mortality. A comparison of the socialdifferences in mortality in childhood, youth and early adulthoodshowed an increasing level of difference by age group. A politicaland administrative decentralization was implemented in Swedenin the 1980s. Local area research thus has relevance for policy,planning and provision of services. The results can be usedin targeting for health and as a basis for planning of healthand social services based on local needs. It gives an indicationof the possible gains in public health if the socio-economicdifferences can be reduced. Further studies should focus uponthe uneven distribution of possibly preventable risk factorsbehind the obseived inequality in mortality. Although furtherstudies are needed as a basis for prevention, the social inequalityin mortality rates and causes of death can be used in targetingfor health and as a basis for the allocation of resources inhealth services.     

Adolescent drinking, academic achievement and leisure time use by secondary education students in a rural area of Crete

This study investigated the alcohol consumption of secondary education students and their relationship to school life and leisure time use with peers. A cross-sectional survey was conducted in March 2007, and the study population consisted of 14- to 19-year-old students living in an agricultural area of Crete. The final sample consisted of 117 individuals (response rate 90.0%). A short previously validated self-completion questionnaire was used collecting information on: personal and family characteristics; school progress; leisure time activities and relations with other adolescents; and alcohol consumption. Alcohol consumption differed significantly between male (75.5%) and female (25.8%) students (P < 0.001). Almost half of the participants (48.3%) reported alcohol consumption during nights out with friends. The mean grade for the previous year for students consuming alcohol was lower compared with those who did not, but the difference was not statistically significant (P = 0.066). Statistical evidence supported the hypothesis that students who consumed alcohol had more absences and this association was stronger for male students. The frequency of alcohol consumption was found to relate to the number of absences for both sexes. Male students who had been suspended from school were more likely to drink alcohol than those who had not been suspended. Statistical evidence also supported the hypotheses that students who spent their free time in cafeterias, bars or billiard halls were more likely to drink alcohol and also consume alcohol at higher frequencies than those that did not spend their free time this way (P = 0.002 and P < 0.001, respectively). More health education programmes and actions are needed at the national and local level to help students, families, schools, communities and the state better understand the real dimensions of the problem.     

The social pattern of heavy drinking in Russia during transition: Evidence from Taganrog 1993

Background: we examined the pattern of Russian alcohol consumption,in particular its link with the social and economic situationin Russia after the first year of ‘shock therapy’and super-inflation in a middle-sized Russian city, Taganrog.Methods: face-to-face Interviews were conducted, with a samplingframe consisting of dwellings selected from an official registerand stratified by type and size. Results: In 1993–1994heavy alcohol drinking (>0.5 I of 40% alcohol/week) was verycommon among men in Taganrog (34%), while it was uncommon amongwomen (3%). Male heavy drinking was closely related to social,economic and family characteristics. The lowest educationalgroups and those In manual occupations reported heavy drinkingmore frequently than others, independently of household income.Among men, quarrels and conflicts in the family were associatedwith a sixfold higher frequency of heavy drinking compared tofamilies reporting good relations. The social transformationtaking place at present is being accompanied by increased socialand economic pressures on families. Conclusions: we suggestthat heavy alcohol consumption Is particularly common amongmen who are likely to have lost out during this transition.Russia's mortality crisis seems to be closely linked to itssocial transformation, but in different ways for men and women.     

Alcohol drinking, consumption patterns and breast cancer among Danish nurses: a cohort study

BACKGROUND: The aim of this study was to analyse the impact of alcohol intake and drinking pattern on the risk of breast cancer. METHODS: A total of 17 647 nurses were followed from 1993 until the end of 2001. At baseline participants completed a questionnaire on alcohol intake and other lifestyle-related factors. Data were analysed using Cox's proportional hazard model. RESULTS: During follow-up 457 women were diagnosed with breast cancer. The relative risk of breast cancer was 2.30 [Confidence interval (CI): 1.56-3.39] for alcohol intake of 22-27 drinks per week, compared to 1-3 drinks per week. Among alcohol consumers, weekly alcohol intake increased the risk of breast cancer with 2% for each additional drink consumed. Weekend consumption increased the risk with 4% for each additional drink consumed friday through sunday. Binge drinking of 4-5 drinks the latest weekday increased risk with 55%, compared with consumption of one drink. A possible threshold in risk estimates was found for consumption above 27 drinks per week. CONCLUSIONS: For alcohol consumption above the intake most frequently reported, the risk of breast cancer is increased. The risk is minor for moderate levels but increases for each additional drink consumed during the week. Weekend consumption and binge drinking imply an additional increase in breast cancer risk.     

Correlates of depression in a representative nationwide sample of adolescents (15-19 years) and young adults (20-24 years)

BACKGROUND: The authors investigated correlates of depression in a general population sample of adolescents (15-19 years) and young adults (20-24 years). METHODS: As part of the Finnish Health Care Survey a random sample of 509 adolescents (281 females, 228 males) and 433 young adults (224 females, 209 males) was interviewed in 1996. DSM-IIR major depressive episode (MDE) was assessed by the University of Michigan Composite International Diagnostic Interview Short Form (UM-CIDI SF). RESULTS: In multivariable regression analysis, current smoking (odds ratio (OR) 5.54; 95% confidence interval (CI) 1.44, 21.3) and chronic illness (OR 3.77; 95% CI: 1.04, 13.7) associated with MDE among adolescents. Among young adults, drunkenness at least twice a month (OR 4.48; 95% CI: 1.44, 14.0) or once a month (OR 2.79; 95% CI: 1.14, 6.83), not being married nor cohabiting (OR 3.50; 95% CI: 1.35, 9.08) and infrequent physical exercise (OR 4.01; 95% CI: 1.18, 14.0) were related to MDE. Female MDE associated with not being married nor cohabiting (OR 3.56; 95% CI: 1.23, 10.1) and living in southern Finland (OR 2.30; 95% CI: 1.06, 5.02). Drunkenness at least twice a month was related to MDE among males (OR 4.54; 95% CI: 1.27, 16.3). CONCLUSIONS: Attention should be paid to compromised health and health-related behaviour associating with MDE in youth. Specifically, the association between smoking and major depression in early adolescence should be borne in mind, and drinking habits or frequency of drunkenness should be carefully noted.     

Between harm and dangers. Oral snuff use, cigarette smoking and problem behaviours in a survey of Swedish male adolescents

BACKGROUND: The prevalence of smokeless tobacco use (moist snuff) in Sweden is among the highest world-wide, and snuff is gaining popularity as a less harmful alternative to cigarettes. METHODS: Patterns of current tobacco use and indicators of behavioural problems were analysed in a sample of 6287 boys participating in a census survey among 9th graders in Stockholm County, Sweden. RESULTS: Among participants reporting current use of oral snuff (OS) the majority (71%) also smoked cigarettes. The prevalence of daily smoking was significantly higher in this group than among exclusive smokers. Conditionally on smoking behaviour, the likelihood of being a current user of OS was several times higher among boys who had ever been drunk (adjusted odds ratio = 9.64, 95% confidence interval: 7.32-12.94) or experimented with illicit drugs (adjusted odds ratio = 2.39, 95% confidence interval: 1.99-2.87), compared with those who did not. OS use was also significantly associated to other problem behaviours such as drinking and driving, unsafe sex, and school truancy. The same pattern of associations was present when the analyses were restricted to tobacco users. CONCLUSIONS: Smokeless tobacco use in adolescence does not substitute cigarette smoking and can be an indicator of a drug- and risk-seeking lifestyle. The availability of smokeless tobacco might thus increase the potential for nicotine addiction in some vulnerable subgroups of young males.