K Rathmann

The association between family affluence and smoking among 15‐year‐old adolescents in 33 European countries, Israel and Canada: the role of national wealth

AIMSnTo examine the role of national wealth in the association between family affluence and adolescent weekly smoking, early smoking behaviour and weekly smoking among former experimenters.nnnDESIGN AND PARTICIPANTSnData were used from the Health Behaviour in School-aged Children (HBSC) study conducted in 2005/2006 in 35 countries from Europe and North America that comprises 60u2009490 students aged 15 years. Multi-level logistic regression was conducted using Markov chain Monte Carlo methods (MCMC) to explore whether associations between family affluence and smoking outcomes were dependent upon national wealth.nnnMEASUREMENTnFamily Affluence Scale (FAS) as an indicator for the socio-economic position of students. Current weekly smoking behaviour is defined as at least weekly smoking (dichotomous). Early smoking behaviour is measured by smoking more than a first puff before age 13u2009years (dichotomous). Weekly smoking among former experimenters is restricted to those who had tried a first puff in the past.nnnFINDINGSnThe logistic multi-level models indicated an association of family affluence with current weekly smoking [odds ratio (OR)u2009=u20091.088; 95% credible interval (CrI)u2009=u20091.055-1.121, Pu2009<u20090.001], early smoking behaviour (ORu2009=u20091.066; CrIu2009=u20091.028-1.104, Pu2009<u20090.001) and smoking among former experimenters (ORu2009=u20091.100; CrIu2009=u20091.071-1.130; Pu2009<u20090.001). Gross domestic product (GDP) per capita was associated positively and significantly with the relationship between family affluence and current weekly smoking (ORu2009=u20091.005; CrIu2009=u20091.003-1.007; Pu2009<u20090.001), early smoking behaviour (ORu2009=u20091.003; CrIu2009=u20091.000-1.005; Pu2009=u20090.012) and smoking among former experimenters (ORu2009=u20091.004; CrIu2009=u20091.002-1.006; Pu2009<u20090.001). The association of family affluence and smoking outcomes was significantly stronger for girls.nnnCONCLUSIONSnThe difference in smoking prevalence between rich and poor is greater in more affluent countries.

Zeitliche Entwicklung von Bildungsunterschieden im Rauchverhalten von Jugendlichen in Deutschland

ZusammenfassungHintergrundSeit Beginn der 2000er-Jahre ist der Anteil der Jugendlichen, die rauchen, in Deutschland deutlich zurückgegangen. Vorliegende Daten weisen jedoch auf erhebliche Unterschiede im Rauchverhalten von Schülern unterschiedlicher Schulformen hin. Der Beitrag untersucht, wie sich Bildungsunterschiede im Rauchverhalten von Jugendlichen im Zeitverlauf entwickelt haben.MethodikAls Datengrundlage werden 4 bevölkerungsweite Studien herangezogen, die von 2001 bis 2015 wiederholt Querschnittdaten erhoben haben: die Repräsentativerhebungen der Bundeszentrale für gesundheitliche Aufklärung, die Studie zur Gesundheit von Kindern und Jugendlichen in Deutschland, die Studie Health Behaviour in School-aged Children sowie die Europäische Schülerstudie zu Alkohol und anderen Drogen. Je nach Studie werden unterschiedliche Altersgruppen (innerhalb der Altersspanne 11–17xa0Jahre) und Indikatoren des Rauchverhaltens betrachtet. Die Jugendlichen werden gemäß ihrer besuchten Schulform zu Bildungsgruppen zusammengefasst. Absolute und relative Bildungsunterschiede werden in Form von Prävalenzdifferenzen bzw. Prävalenzverhältnissen berichtet.ErgebnisseTrotz methodisch unterschiedlicher Zugänge zeigen alle 4xa0Studien, dass der Raucheranteil unter den Jugendlichen in allen Bildungsgruppen signifikant zurückgegangen ist. Jugendliche, die ein Gymnasium besuchen, rauchen deutlich seltener als Gleichaltrige an anderen Schulformen. Während die absoluten Bildungsunterschiede im Rauchverhalten von Jugendlichen zumeist abgenommen haben, sind die relativen Bildungsunterschiede in der Regel konstant geblieben oder haben sogar zugenommen.DiskussionRückläufige Prävalenzen sprechen dafür, dass das Rauchen bei Jugendlichen an Attraktivität verloren hat. Zudem könnten die Befunde ein Indiz für die Wirksamkeit tabakkontrollpolitischer Maßnahmen wie Steuererhöhungen, Rauchverbote und die Anhebung der Altersgrenze für den Erwerb von Tabakprodukten sein. Da die relativen Bildungsunterschiede im Rauchverhalten von Jugendlichen bislang jedoch nicht verringert werden konnten, sollten zielgruppen- und settingspezifische Interventionen zukünftig noch stärker Schüler an Haupt‑, Real‑, Gesamt- und Förderschulen in den Blick nehmen.AbstractBackgroundIn Germany, smoking prevalence among adolescents has significantly declined since the early 2000s. However, data show that adolescent smoking rates considerably differ between different types of secondary schools. The aim of our study was to examine how educational inequalities in adolescent smoking behaviour have developed over time.MethodsData were used from four population-based studies (each consisting of repeated cross-sectional surveys from 2001–2015): the representative surveys of the Federal Centre for Health Education, the German Health Interview and Examination Survey for Children and Adolescents, the Health Behaviour in School-aged Children Study, and the European School Survey Project on Alcohol and Other Drugs. Each study comprised different age groups (within the age range of 11–17 years) and used different smoking measures. Adolescents’ educational status was based on the attended type of secondary school. Absolute and relative educational inequalities were presented as prevalence differences and prevalence ratios, respectively.ResultsDespite methodical differences, all four studies similarly reveal that adolescent smoking rates have significantly declined in all educational groups. However, lower smoking rates among secondary school students attending higher educational tracks could be observed. While absolute educational inequalities tended to decrease over time, relative inequalities between educational groups remained rather stable or even increased.DiscussionDeclining adolescent smoking rates suggest that smoking may have lost some of its attractiveness for young people. Our findings further emphasize the importance of tobacco control measures such as raising cigarette taxes, smoking bans, and increasing minimum legal age for tobacco purchase. As relative educational inequalities in adolescent smoking rates did not diminish over time, setting- and target group-specific interventions should focus more on students in middle and lower secondary school tracks.BACKGROUNDnIn Germany, smoking prevalence among adolescents has significantly declined since the early 2000s. However, data show that adolescent smoking rates considerably differ between different types of secondary schools. The aim of our study was to examine how educational inequalities in adolescent smoking behaviour have developed over time.nnnMETHODSnData were used from four population-based studies (each consisting of repeated cross-sectional surveys from 2001-2015): the representative surveys of the Federal Centre for Health Education, the German Health Interview and Examination Survey for Children and Adolescents, the Health Behaviour in School-aged Children Study, and the European School Survey Project on Alcohol and Other Drugs. Each study comprised different age groups (within the age range of 11-17 years) and used different smoking measures. Adolescents educational status was based on the attended type of secondary school. Absolute and relative educational inequalities were presented as prevalence differences and prevalence ratios, respectively.nnnRESULTSnDespite methodical differences, all four studies similarly reveal that adolescent smoking rates have significantly declined in all educational groups. However, lower smoking rates among secondary school students attending higher educational tracks could be observed. While absolute educational inequalities tended to decrease over time, relative inequalities between educational groups remained rather stable or even increased.nnnDISCUSSIONnDeclining adolescent smoking rates suggest that smoking may have lost some of its attractiveness for young people. Our findings further emphasize the importance of tobacco control measures such as raising cigarette taxes, smoking bans, and increasing minimum legal age for tobacco purchase. As relative educational inequalities in adolescent smoking rates did not diminish over time, setting- and target group-specific interventions should focus more on students in middle and lower secondary school tracks.

Psychosoziale Gesundheit bei Kindern und Jugendlichen in Nordrhein-Westfalen: Die Bedeutung von Alter, Geschlecht und Schultyp

OBJECTIVESnChildren and adolescents in Germany are generally considered to be healthy if health is measured with classic indicators of health. However, health impairments increasingly emerge in terms of psychosocial health. The present study addresses the question whether and what aspects of psychosocial health are associated with age, gender and socioeconomic status.nnnMETHODSnData were obtained from the North Rhine-Westphalian sample of the Health Behaviour in School-aged Children (HBSC) study in 2006. Overall, 4 324 students aged 11-15 years were interviewed with a standardised questionnaire. Descriptive methods were used to analyse the association between age, gender and socioeconomic status and the four measures of psychosocial health. The socioeconomic status of the adolescents was measured by type of school.nnnRESULTSnAbout 20% of the adolescents suffer from impairments in their psychosocial health. In general, girls report worse psychosocial health than boys. Students perceived rating of psychosocial health decreases with increasing age. Independently of gender, pupils from general school rate their health worse than pupils from grammar school.nnnCONCLUSIONSnThe results underline that there are manifold health problems in adolescence, which can lead to severe diseases in later life such as chronic diseases. The findings suggest that preventive strategies should be directed toward girls and pupils from general schools.

Welche Wohlfahrtspolitik fördert die Gesundheit? Der ungeklärte Zusammenhang von ökonomischer und gesundheitlicher Ungleichheit

In all highly developed countries, the overall health status of the population has significantly improved within the past 30 years. The most important reason for this is the increase in economic prosperity. Economic wealth, however, today is much more unequally distributed than it was 3 decades ago. Countries with relatively small disparities in the availability of material resources between socioeconomic groups, such as the Scandinavian countries, have better health outcomes on the population level. Health inequalities, however, have also reached a higher level than 30 years ago. As of today, we do not have convincing explanations for the interrelation of economic and health inequality. This paper gives an overview of existing research on a comparative basis. The research results are ambivalent. They show the puzzling result that the Scandinavian countries with their highly distributive welfare policy manage to achieve the comparatively highest level of economic, but not health, equity. Based on these results, we develop proposals for future research approaches. A central assumption is that in rich societies no longer only material, but more and more immaterial determinants are crucial for the formation of health inequality. The promotion of salutogenic self-management capabilities in socially disadvantaged groups is considered to be the central element in effective intervention strategies.

How Does Social Behavior Relate to Both Grades and Achievement Scores

Prosocial behavior and peer problems are an important correlate of academic development; however, these effects vary by achievement measures and social behaviors. In this paper, we examined data from the German National Education Panel Study (NEPS), and we use structural equation modeling (SEM) to model the effects of prosocial behavior and peer problems on grades and competencies for both math (n = 3,310) and reading (n = 3,308) in grades 5 and 7. Our models account for the moderating effect of both gender and socioeconomic status (SES) as determined by parental education. We conclude that social behaviors relate to grades more strongly than competencies, that peer problems relate more strongly to achievement than prosocial behavior, and that the relationship is weaker in later grades. We discuss the implication that grades and achievement tests are not interchangeable measures for educators and researchers.

[Social inequalities in adolescent smoking: A cross-national perspective of the role of individual and macro-structural factors].

ZusammenfassungHintergrundIm Rahmen eines von der EU geförderten Projektes wurde auf Basis internationaler Vergleichsstudien untersucht, welche Faktoren sozioökonomische Unterschiede im Rauchverhalten von Jugendlichen begleiten und erklären können. Der vorliegende Beitrag stellt die gewonnenen Ergebnisse vor und diskutiert ihre Implikationen für Politik und Forschung.MethodeDie Ergebnisse basierten auf der „Health Behaviour in School-aged Children (HBSC)“-Studie aus dem Jahr 2006 und umfassten mehr als 50.000 Jugendliche in 37 Ländern. Im Mittelpunkt stand der Zusammenhang zwischen familiärem Wohlstand und wöchentlichem Rauchen (regelmäßiges, mindestens einmal wöchentliches Rauchen) bei Jugendlichen. Als Erklärungsdeterminanten wurden auf der Individualebene Faktoren zu den psychosozialen Ressourcen und Belastungen der Schule, Familie und Peers hinzugezogen. Auf der Länderebene wurden das nationale Einkommen, verschiedene Tabakkontrollpolitiken und die externe Differenzierung im Bildungssystem berücksichtigt.ErgebnisseDie psychosozialen Faktoren der Schule und Familie erklärten einen Großteil der Ungleichheiten im Rauchverhalten von Jugendlichen. Im internationalen Vergleich zeigten sich größere Ungleichheiten im Tabakkonsum in reicheren Ländern. Länder mit höheren Tabakpreisen zeigten hingegen eine geringere Ungleichheit und bei Jungen eine allgemein geringere Prävalenz von Rauchen. Differenziertere Bildungssysteme wiesen hingegen zwar geringere Ungleichheiten im Rauchverhalten von Mädchen auf, aber auch eine vergleichsweise hohe Rauchprävalenz. Größere soziale Ungleichheiten im Rauchverhalten zeigten sich zudem in Ländern, die einen größeren Umfang an Präventionsmaßnahmen gegen das Rauchen besaßen (bei Jungen) und mehr Geld in die Tabakkontrollpolitik investierten (bei Mädchen).FazitDie Erfahrungen in reicheren Ländern zeigen, dass die Tabakprävention mit Blick auf sozial benachteiligte Personen weiter verstärkt werden muss. Anknüpfungspunkte zur Reduktion der allgemeinen Rauchprävalenz und der sozioökonomischen Ungleichheiten im Rauchverhalten liefern einerseits die Stärkung der psychosozialen Ressourcen in Familie und Schule, aber auch eine Erhöhung der Tabakpreise.AbstractBackgroundIn an EU-funded project, we examined on the basis of international comparative analyses which factors were associated with and contributed to socioeconomic inequalities in adolescent smoking. This paper presents the results obtained and discusses their implications for policy and research.MethodsAnalyses were based on the “Health Behaviour in School-aged Children (HBSC)” study in 2006 and included more than 50,000 adolescents from 37 countries. The focus was on the association between family affluence and weekly smoking (regularly, at least once a week) among adolescents. Explanatory variables at the individual level refer to psychosocial resources and burdens of school, family, and peers. At the country level, national income, various tobacco control policies, and an index of external differentiation of the educational system were used.ResultsThe psychosocial factors of school and family explained many of the inequalities in the smoking behavior of adolescents. In an international comparison, socioeconomic inequalities in smoking were stronger in richer countries. Absolute smoking rates were lower and inequalities in smoking smaller for boys in countries with higher tobacco prices. On the other hand, educational systems with higher degrees of external differentiation showed lower inequalities in smoking beahviour by girls, and relatively higher rates of smoking (for boys and girls). Stronger inequalities in smoking behaviour were demonstrated in countries with a greater range of preventative measures for tobacco dependence (for boys) and with higher levels of government spending on tobacco control (for girls).ConclusionExperiences in richer countries revealed that tobacco control needs to be strengthened for socially disadvantaged adolescents. The reduction of smoking prevalence and socioeconomic inequalities in smoking behavior should be based not only on a strengthening of psychosocial resources in the family and at school, but also on an increase in tobacco prices.BACKGROUNDnIn an EU-funded project, we examined on the basis of international comparative analyses which factors were associated with and contributed to socioeconomic inequalities in adolescent smoking. This paper presents the results obtained and discusses their implications for policy and research.nnnMETHODSnAnalyses were based on the Health Behaviour in School-aged Children (HBSC) study in 2006 and included more than 50,000 adolescents from 37 countries. The focus was on the association between family affluence and weekly smoking (regularly, at least once a week) among adolescents. Explanatory variables at the individual level refer to psychosocial resources and burdens of school, family, and peers. At the country level, national income, various tobacco control policies, and an index of external differentiation of the educational system were used.nnnRESULTSnThe psychosocial factors of school and family explained many of the inequalities in the smoking behavior of adolescents. In an international comparison, socioeconomic inequalities in smoking were stronger in richer countries. Absolute smoking rates were lower and inequalities in smoking smaller for boys in countries with higher tobacco prices. On the other hand, educational systems with higher degrees of external differentiation showed lower inequalities in smoking beahviour by girls, and relatively higher rates of smoking (for boys and girls). Stronger inequalities in smoking behaviour were demonstrated in countries with a greater range of preventative measures for tobacco dependence (for boys) and with higher levels of government spending on tobacco control (for girls).nnnCONCLUSIONnExperiences in richer countries revealed that tobacco control needs to be strengthened for socially disadvantaged adolescents. The reduction of smoking prevalence and socioeconomic inequalities in smoking behavior should be based not only on a strengthening of psychosocial resources in the family and at school, but also on an increase in tobacco prices.

Integrierte Bildungssysteme: Gute Bildungserfolge – schlechte Gesundheit?

Einleitung/Hintergrund: Seit den PISA-Studien ist hinreichend bekannt, dass integrierte Bildungssysteme mit einer geringen Anzahl an Bildungsgangen und einer langen Zeit gemeinsamen Lernens positiv mit dem Lernerfolg von Heranwachsenden assoziiert sind. Der individuelle Lernerfolg steht wiederum mit der Gesundheit in Zusammenhang. Welchen Einfluss unterschiedliche Bildungssysteme und deren Ausgestaltung auf die Gesundheit von Jugendlichen in einer international vergleichenden Perspektive ausuben, wurde bislang selten untersucht. Daher wird im Rahmen dieses Beitrags untersucht, wie unterschiedliche Bildungssysteme mit der Gesundheit der Heranwachsenden assoziiert sind. Material und Methoden: Datenbasis ist die internationale „Health Behaviour in School-aged Children„ (HBSC)-Studie 2005/06. Insgesamt 25 europaische und nordamerikanische Lander (n=111.339) wurden anhand von bildungssystemspezifischen Merkmalen, wie Jahre gemeinsamen Lernens und der Anzahl der Bildungsgange, charakterisiert. Um die Relevanz der bildungssystembezogenen Determinanten fur die Selbsteinschatzung der Gesundheit und Beschwerdelast von 11–15-jahrigen Jugendlichen abzuschatzen, wurden logistische hierarchische Regressionsmodelle berechnet. Ergebnisse: Heranwachsende in Landern mit einer hoheren Anzahl an Jahren gemeinsamen Lernens weisen ein hoheres Risiko fur Beschwerden auf, wahrend sich fur die subjektive Gesundheit keine signifikanten Unterschiede feststellen lassen. Die Anzahl der Bildungsgange steht dagegen weder mit der Selbsteinschatzung der Gesundheit noch der Beschwerdelast in einem signifikanten Zusammenhang. Diskussion/Schlussfolgerungen: Das Ergebnis der hoheren Beschwerdelast in Bildungssystemen mit einer hoheren Anzahl der Jahre gemeinsamen Lernens ist zunachst verwunderlich. Es kann davon ausgegangen werden, dass sich die heterogene Zusammensetzung der Heranwachsenden in Bildungssystemen mit einer langen Zeit gemeinsamen Lernens aufgrund von Wettbewerb zwischen den Schulerinnen und Schulern, anders als beim Bildungserfolg, nicht zu Gunsten der Beschwerdelast im Jugendalter auswirkt.