Educational inequalities in life satisfaction among teens – what do we know? A closer look at the role of health behaviour and gender differences

This post, written by HBSC's Irene Moor and Joseph Hancock, discusses a newly released study on life satisfaction among German adolescents. It also presents the health behaviour inequalities among German girls and boys following different education tracks. The blog is a part of Wikichild's series on Health.

       Research has identified a clear link between people’s social position and their health. Mackenbach (2006) found health inequalities among people with higher and lower socio-economic status in all European countries and, furthermore, a widening of some of these inequalities during the last decades. In some countries, differences in life expectancy amount to 10 years or more due to these inequalities in educational level, occupational class and income inequalities. In addition to social status, we know that gender also substantially affects an individual's health. In general, the social gradient in health is more pronounced among men than women. However, these gender differences vary by age, health outcome, and also social status. In a birth cohort from 1958, for instance, Matthews et al. (1999) found greater social inequalities among men in their 30’s for long-standing illness but greater inequalities among women for psychological distress at the same age.

      Previously, studies focusing on gender differences in health inequalities have looked almost exclusively at adults. There is now a growing body of work suggesting that inequalities in health and health behaviours are already well-established by the time of transition from adolescent to adult, resulting from the social experiences and living conditions that young people experience during this formative period. For example, behavioural factors such as smoking, physical activity, fruit and vegetable consumption, or illegal drug use have been shown to be socially patterned behaviours, ingrained during the teenage years. Understanding the mechanisms which link the social position and health of adolescents is essential if we want develop effective strategies that help place socially disadvantaged teens on healthier, happier trajectories into adult life.

      Previous international research from the Health Behaviour in School-aged Children study (HBSC) revealed that life satisfaction, a multi-factorial psychological concept of well-being, is unequally distributed among different social groups. Adolescents from families with high social positions were found to have higher levels of life satisfaction than adolescents from families with lower social positions. These socially determined inequalities appear in nearly all countries across Europe and North America, in both boys and girls, and are stronger for life satisfaction than other subjective health indicators among teens.

      Using data from over 5,000 school children, members of the German HBSC national team investigated the role of health behaviour in explaining educational inequalities in adolescent life satisfaction nationally.

In particular they looked at:

1. The significance of differences in life satisfaction by educational track, in boys and girls. 
2. The presence of gender differences in terms of how behavioural factors impact life satisfaction. 
3. The different patterns of health behaviours among adolescents on different educational tracks.  
4. The extent to which educational inequalities in life satisfaction can be explained by behavioural factors.

The main results can be summarised as follows:

1. Significant inequalities in life satisfaction by educational track were found for both genders. The higher the educational track, the more likely it is that an adolescent would report high levels of life satisfaction. This effect was found to be stronger among boys than girls.

2. Several behavioural factors were found to be associated with low life satisfaction in both boys and girls. Such as not eating breakfast every day and drinking soft drinks daily. However, gender differences in the effect of behavioural factors on life satisfaction were also found. For example, the association between low life satisfaction and not having breakfast every school day was much stronger for girls than boys. Other behaviours such as smoking regularly, drinking alcohol, having been drunk, both watching TV and eating fruits daily were associated with lower life satisfaction in girls but not in boys. Whereas lower levels of physical activity were more strongly related to lower life satisfaction in boys than girls.

3. Regular smoking, having been drunk, watching TV, drinking soft drinks and eating breakfast less than daily were more prevalent among boys and girls from lower education tracks. Whereas frequent alcohol drinking, fruit consumption (less than daily) and daily sweet consumption were associated with lower education tracks only in girls, and physical activity only in boys.

4. In boys, three indicators were significantly linked to life satisfaction as well as to their educational track, including physical activity levels, eating breakfast and the consumption of soft drinks. Whereas a total of seven indicators, including smoking, drinking alcohol, having been drunk, watching TV, eating breakfast, fruits, and the consumption of soft drinks, were significantly linked to life satisfaction in girls. Altogether, up to 40% of educational inequalities in life satisfaction among girls were explained by behavioural determinants, which is nearly twice the figure for boys.

German adolescent health behaviors from Wikiprogress_slides

      The study's findings confirm that educational inequalities in life satisfaction are already established by adolescence. These findings also indicate that behavioural factors are an important mediating force, acting upon educational inequalities in adolescent life satisfaction for both boys and girls, but to a much greater extent among girls. In order to tackle inequalities in adolescent health, targeting health behaviours among teens from lower educational tracks, with a gender specific perspective, looks like a promising approach. 

More information on the analysis
 

Moor I, Lampert T, Rathmann K, Kuntz B, Kolip P, Spallek J, Richter M (2013): Explaining educational inequalities in adolescent life satisfaction: do health behaviour and gender matter? International Journal of Public Health. DOI 10.1007/s00038-013-0531-9

About the HBSC Study

      The HBSC research network is an alliance of researchers who collaborate to collect data on the health, well-being, health behaviours, social environments and economic contexts of adolescents. The HBSC study is currently conducted in 44 countries across Europe and North America, and the network includes over 450 experts from a wide range of disciplines. Members of the HBSC network collaborate to develop a standardized questionnaire, which is used to survey nationally representative samples of school-aged children in each participating country.

      HBSC's research themes currently include: chronic conditions, eating and dieting, electronic media, family culture, gender, medicine-use, peer culture, physical activity, positive health, puberty, risk behaviours, school, sexual health, social inequality, and violence and injuries.

For more information visit www.hbsc.org

See also:

The HBSC 30th Anniversary Summary Report

The HBSC Ireland Trends Report 1998-2010

The synthesis report for the online discussion "How should child well-being be measured?"

FGM: the Dynamics of Change

This blog, by Wikichild Co-ordinator Melinda Deleuze, is part of the Wikiprogress Series on the Wikiprogress Africa Network. This post provides a summary of the UNICEF report entitled “Female genital mutilation/cutting: a statistical overview and exploration of the dynamics of change.” 

When I first heard of female genital mutilation/cutting (FGM/C), I was mortified. Upon reading this UNICEF report, I realized that my previous impressions - that this practice it only occurs in small African villages and affects very few women -  were misconceptions. Only now is reliable data on FGM/C available, giving us a clearer picture about the practice, at least for all 29 countries where the practice is concentrated. The report addresses key questions: How many girls and women have undergone FGM/C? Where is the practice most prevalent? How does this concentration vary within countries and across population groups? 

This WHO report defines FGM/C as “all procedures involving partial or total removal of the female external genitalia or other injury to the female genital organs for non-medical reasons,” and the Organization categorizes the procedure into 4 types. In 2012, the UN General Assembly unanimously passed a resolution that banned FGM/C. Twenty-six countries in Africa and the Middle East have prohibited FGM/C by law; however, the legislation has proven ineffective. The practice remains widespread in 24 countries where FGM/C is illegal. 

There is a social obligation to perform the procedure and the belief that if one does not, then the consequences could include exclusion, criticism, ridicule, stigma or inability to find suitable marriage partners. Relatively few women reported concern over marriage prospects as justification for FGM/C, except in Eritrea and Sierra Leone. The primary benefit cited among men and women was social acceptance and preserving virginity.

In the 29 countries assessed, more than 125 million girls and women alive today have undergone FGM/C, and in the next decade, another 30 million are at risk. There is a large variation in percentages of cut females across the countries. The countries are divided into 5 categories based on their prevalence levels of FGM/C. One in five cut girls live in one country: Egypt.

 

Variation among regions within a country can be striking, as seen in this map of Senegal (right).

The age at which the procedure is carried out varies across countries. In Somalia, Egypt, Chad and the Central African Republic, at least 80% of cut girls were between 5 and 14 years old. In Nigeria, Mali, Eritrea, Ghana and Mauritania, at least 80% of cut girls were younger than 5. Half of cut girls in Kenya were older than 9 when they had the procedure performed.

Initially, opposition towards the practice focused on health risks, which may have unintentionally encouraged medical professionals to carry out the practice. Traditional practitioners and, more specifically, traditional circumcisers usually perform FGM/C. Though, in countries such as Egypt, Sudan and Kenya, many medical personnel now complete the procedure. In Egypt, for example, 77% of procedures were carried out mostly by doctors, and around half of those procedures were performed at the girl’s home.

Ethnicity still plays a strong role in some countries, as it may be a proxy for shared norms and values. Also, the practice remains to be a physical marker of insider/outsider status. This graph below shows the degree of variability in FGM/C prevalence among ethnic lines by contrasting ethnic groups with the highest and lowest prevalence in countries.

Regarding religion, the practice is most prevalent among Muslim girls and women; however, it is also found among Catholic and other Christian communities. In Niger, for example, 55% of Christian girls and women have undergone FGM/C, compared to 2% of Muslim girls and women.

There is also a rural-urban divide, an income divide, and an education divide. In Kenya, for example, the percentage of girls in rural areas was four times that of those in urban areas. In most instances, daughters of wealthier families were less likely to be cut. In terms of education, the prevalence of FGM/C was highest among daughters of women with no education, and tends to diminish considerably as the mother’s educational level rises. The reason given for these trends is due to the fact that those in urban areas, in wealthier households, or with a higher educational level are more likely to interact with individuals and groups that do not practice FGM/C, shifting normative expectations around FGM/C as a result.

Support for the continuation of FGM/C varies across countries. In most countries (19 out of 29), a majority of girls and women think the practice should end (see graph below). Nevertheless, more than half the female population in Mali, Guinea, Sierra Leone, Somalia, Gambia and Egypt think FGM/C should continue. More men than women favored stopping the practice, especially in Guinea, Sierra Leone and Chad. When fathers were included in the decision-making, their daughters were less likely to be cut. 

FGM/C remains a complicated issue, and this report does not give the whole picture; FGM/C is being performed outside these 29 countries, including  in Europe and North America. The fight against FGM/C has just begun. Stronger efforts will be essential in order to transform the cultural traditions and expectations ingrained in these societies. 

Fortunately, this report gives us a better understanding of FGM/C and, more importantly, an evidence base to begin measuring progress in this area. We know there have already been steps forward in terms of awareness, decreased health risks and legislative bans, but now we can track progress inside countries regarding specific population groups, procedures and attitudes. Hopefully, this evidence base will help us be more effective in promptly eliminating the practice.

- Melinda Deleuze

*This week's Wikiprogress spotlight is on the e-Frame Net (European Network on Measuring Progress).  

Abstinence doesn’t do the trick

This blog, written by Wikichild co-ordinator Melinda Deleuze, discusses the negative impact that adolescent pregnancies can have on the child, the mother and all of society. It is a contribution to the last day of the Wikiprogress spotlight on the Wikigender Network.

When I was 16 years old, I had one week of sex education required by my American high school. However, my state’s curriculum revolved around abstinence as the preferred means of birth control, along with fear as the method to encourage restraint until marriage. In my class, at least one girl, aged 15, already had an abortion before taking the course, and one boy, also aged 15, was a father. The course provided too little, too late. YES, abstinence has a 100% success rate. YES, it is the best way to avoid catching a sexually transmitted infection. NO, I’m not surprised that the US ranks second to last among the rich countries for number of teen births: 36 per 1,000 births among 15-19 year old girls (read more in this blog). 

Rich countries vs. the US in teen births (per 1,000 15-19 years old)

*Legend: In the lefthand graph, the UNICEF 

colors  represent the first, second and third 

Data from UNICEF's 11th Report Card and KIDS COUNT Data Book. 

tiers of countries' ranking. In the graph on the right, the colors match states with the country tiers. In this case,  the darkest blue indicates the 21 states which have a higher rate of teen births than the lowest ranking country (i.e. Bulgaria).

This year’s UN World Population Day focused on adolescent pregnancies, a persistent occurrence in both developing and developed countries. Around 16 million adolescent girls aged 15 to 19 give birth each year, according to the WHO. While there may be varying opinions on this issue, the fact is that adolescent pregnancies gravely affect the teen mother, the child and the rest of society (i.e. you and me). Despite misleading perceptions, these consequences can occur among married and unmarried adolescents in developed and developing countries for both intended and unintended pregnancies.

 How does it affect the well-being of the child?

The immediate health of children born to adolescent mothers is at risk, and the younger the mother, the higher the risk. This WHO Report states that “in low- and middle-income countries, stillbirths and death in the first week and first month of life are 50% higher among babies born to mothers younger than 20 years than those born to mothers aged 20–29 years.” Also, babies born to adolescent mothers are more likely to be pre-term, have a lower birth weight and have asphyxia, which all increase the baby’s chance of death or future health problems. Substance abuse during pregnancy is higher among adolescent girls, which contributes to a higher percentage of low birth-weight babies and infant mortality, along with other health issues.

How does it affect the well-being of the young mother?

First of all, the health of young mothers is severely compromised, as pregnant teenagers face double the risk of dying from pregnancy-related complications relative to women in their 20s.* This UNFA report summary states that “across developing countries, complications from pregnancy and unsafe abortion are the leading cause of death for girls aged 15-19.” The younger the mother, the more she is at risk of maternal complications, death and disability, including obstetric fistula. Up to 65% of women with obstetric fistula developed this during adolescence, says this WHO Report. Additionally, adolescent pregnancies are at higher risk for sexually transmitted diseases. Younger girls are less likely to practice safe sex and make up 64% of all new infections among young people worldwide, states this UNFPA factsheet.

Additionally, adolescent pregnancy contends with secondary education. In developed countries, motherhood during adolescent years increases girls’ chances of dropping out of school. In the United States, teen mothers are 10% less likely to obtain a high school diploma, as shown in this UNFPA report summary. Whereas in developing countries, the longer girls remain in school, the less likely they are to become pregnant in their teens. In Timor-Leste, for example, total fertility rates vary from 6 to1 ratio births per woman with no education to only 2 to 9 ratio births for women with secondary schooling or above, as indicated in this Women Deliver background paper. Delaying childbearing also increases chances of obtaining a higher income and better careers, among with other aspects of well-being, such as mental and psychological.

How does it affect the overall well-being of society?

Adolescent pregnancies concern us all as they negatively impact the development of a society. This UNFPA report summary states that “investing in family planning helps reduce poverty, improve health, promote gender equality, enable adolescents to finish their schooling and increase labour force participation.” In the UN Secretary-General Ban Ki-moon’s message for this year’s World Population Day, he stated that “when we devote attention and resources to the education, health and well-being of adolescent girls, they will become an even greater force for positive change in society that will have an impact for generations to come.”

I’m grateful that the World Population Day addressed adolescent pregrancy. While we often talk about maternal and infant mortality rates, as well as low birth-weight babies, we overlook at times this major proponent. I hope that there can be more open conversations with teens in order to overcome some of the obstacles to preventing teen pregnancies. And believe me, teaching abstinence just doesn't do the trick.

Melinda Deleuze

* Gennari, Pamela, J. 2013. “Adolescent Pregnancy in Developing Countries.” International Journal of Childbirth Education 28:57

"Yes, Malala, we're listening" - youth participation

This blog, written by Wikichild co-ordinator Melinda George, is part of the Wikiprogress Series on child well-being. It focuses on three necessary steps to increase youth participation: listening, involvement in decision-making and involvement in the implementation.

Have you ever witnessed a child tugging on his or her parent’s clothes, soliciting a moment of attention? How long does it take for this primary caregiver to acknowledge the child’s presence? And then how much longer until this person, responsible for the child’s well-being, responds “yes, dear, I’m listening”, if ever? 

If our objective is to improve the lives and well-being of children, then we need to acknowledge their presence and take the necessary steps to include them in our efforts.

Listening to the youth is the first step in increasing youth participation.

Hear part of Malala Yousafzai's speech to the General Assembly:

All children have a voice, and we should do more to seek it out. Last week’s youth takeover at the UN General Assembly on “Malala Day” represents more than just a girl’s stand for education. Young people have been advocating for more rights and better treatment for centuries. The difference is that now we hear them. We are listening to what they have to say and are praising their efforts at an international level, at least those who speak loudly enough. We need to expand our audible range to go farther and deeper.

(See the Special Focus on Malala and her fight for education on Wikigender.)

Youth involvement in the policy-making process is the second step.

We have been saying for years that youth involvement is an important factor in generating sustainable progress. Agenda 21, a comprehensive plan of action on sustainable development for the 21st century [i], states that “youth comprise nearly 30 per cent of the world's population. The involvement of today's youth in environment and development decision-making and in the implementation of programmes is critical to the long-term success of Agenda 21”[ii]. It also states that beyond their intellectual contribution and their ability to mobilise support, children and young people bring unique perspectives which need to be taken into account. This report was written over 20 years ago.

This month, Wikichild hosted an online discussion entitled How should child well-being be measured in view of future development frameworks? Several participants mentioned the need to involve young people when deciding how to measure well-being and to include "having a voice" as an indicator. 

The discussion was launched at the HBSC 30th Anniversary Event, which discussed and executed youth participation. First, the Scottish Commissioner for Children and Young People presented the “7 Golden Rules for Participation” (see slides below).

(7 Golden Rules for Participation from Wikiprogress_slides)

Also at the event, HBSC welcomed a panel of youth from Canada, Scotland, Wales, Ireland and England, who presented a video on how they have been participatory in the decision-making process 
(see video below).

.

The audience, full of child well-being experts, had countless questions about how young people could be better supported by schools, parents, relevant agencies and the community during this transitional adolescent period. The exchange was enriching, with the main message of support us, trust us and ask us.

Here's a quote from the Wikichild online discussion: 

“We need to ask young people in a more systematic and constructive way. They need to be involved in the development and the implementation of well-being measures.” 

- HBSC Event Participant

The third step is to involve youth in the implementation process.

Empowering youth so that they may be involved in the implementation procedure is the final stage of youth participation. A report by the Youth Visioning for Island Living (YVIL) states that young people, while dynamic and innovative, “often lack the concrete skills and tools necessary to implement their ideas[iii].”  We should find out what skills and tools the youth are lacking and then do what we can to make them readily available. Reaching this level of involvement requires time, training and investment, but it’s worth it.

These three steps should loop around, as we listen to feedback from young people in order to continuously improve the means by which youth can participate in the decision-making and implementation of  programs.

But first thing’s first ... Go ahead, youth, we’re listening. 

Melinda Deleuze
Wikichild co-ordinator

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 [i] Agenda 21 was drawn up after the United Nations Conference on Environment and Development (UNCED) held in Rio de Janeiro, Brazil, in 1992

[ii] Chapter 25 of Section III of Agenda 21, entitled “Children & Youth in Sustainable Development”

[iii] Supporting Youth in the Implementation of Sustainable Development Activities (following the review of the SIDS programme of action, Mauritius 2005), initiative of the United Nations Educational, Scientific and Cultural Organization (UNESCO)