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?"

Cannabis Use among Adolescents in Europe, 2002-2010: Overall Decrease, but Increasing Inequalities

This blog, written ­by Dr. Margaretha de Looze (researcher and lecturer at Utrecht University, the Netherlands), discusses HBSC's study on cannabis use among adolescents in Europe. The post is part of the Wikichild series on Adolescent health, examining cross-national changes in frequent adolescent cannabis use (40+ times consumed over life-time at age 15) over time and relating these trends to societal wealth, family affluence and gender.

Cannabis use among adolescents in wealthy European countries is decreasing, while in poorer European countries it is on the rise. In particular, Russia, Latvia, Lithuania, and FYR Macedonia experienced increased cannabis consumption amongst adolescents between 2002 and 2010. These findings come from a recent publication by members of the Health Behaviour in School-aged Children (HBSC) study and research network.

Decrease in wealthy countries

 

This analysis, from 14 members of the international WHO collaborative study, looked at trends over time in frequent adolescent cannabis use (40+ times consumed over lifetime at age 15) in 2002, 2006 and 2010. We found that frequent cannabis use has decreased among adolescents in the more affluent western and southern European and North American countries. In some of these countries, the decreases were dramatic. For example, in 2010, frequent cannabis use among German boys decreased from 6.6% in 2002 to 1.2%, and  among Dutch girls it decreased from 4.1% in 2002 to 1.5%.  

This decline in frequent cannabis use in the wealthier countries of Europe is consistent with a general decrease in a range of other risk behaviours among these young people. In many of these countries, adolescent tobacco use, alcohol consumption, sexual risk behaviors and fighting have also declined.

How can this decline in adolescent risk behaviours be explained? One possible answer lies in substance use policies. Legislations to limit underage access and to restrict illicit substance use in general are enforced in all Western countries, with stricter substance use prevention policies coming into action in recent years. Additionally, a stronger focus on educating young people on the harmful effects of substance use has changed social norms leading to lower tolerance and acceptance of substance use among teenagers. 

Increase in Russia, Latvia, Lithuania, and FYR Macedonia

 

In contrast to Western European countries, frequent cannabis use stabilized or increased between 2002 and 2010 in the poorer Eastern European countries. For example, frequent cannabis use among boys in Latvia increased from 1.1% to 3.3%, with Russian girls showing an increase from 0.2% to 0.8%. 

Although the rates in these countries are still lower than those in Western Europe, the increasing trends over time are steady - and thus alarming. Adolescents from less affluent countries seem to be adopting consumption patterns consistent with their peers in richer countries. 

The growing wealth of Eastern European countries appears to have fostered adolescent substance use due to the increased availability of substances and the emergence of a flourishing youth culture. However, this apparent effect of national wealth seems to have leveled off in Western European countries, potentially due to the implementation of stricter cannabis use policies.

Importantly, adolescent cannabis use appears not only to have ‘trickled down’ from richer to developing countries, but also from more affluent to less affluent youth within countries. While cannabis consumption emerged as a central component of the ‘Bohemian’ ideals of the 1960’s and 1970’s and was first popularized by middle class youth, it now appears to have spread to the youth population of a lower socioeconomic status.

Girls do not catch up with boys

While one might have expected that gender differences would narrow between 2002 and 2010, as a result of girls’ and women’s continuing liberation, cannabis use has actually become (even) more characteristic of males during this period. This rather surprising finding might be explained by the de-normalization of cannabis use over the past decade. While cannabis use was widespread and quite ‘normalized’ among well-adjusted, non-risk-taking young people at the end of the 20th century, the recent declining rates may have changed young people’s perception of cannabis use as de-normalized and highly risky behaviour. As risk-taking increases social status among boys but less so for girls, it may be easier for boys to remain part of a cannabis-using scene.

Although it is reassuring that, overall, cannabis use has decreased for both genders, male adolescents have always been, and remain, at higher risk for excessive use, dependence and associated health problems.

What next?

Future studies should closely monitor tendencies for ‘trickle down’ and ‘de-normalization’ effects in frequent cannabis use as fundamental indicators of substance use and health in adolescent populations. Currently, data for the new HBSC cycle are being collected in more than 40 countries in Europe and North America. Within a year, we will be able to conclude whether the observed trends have continued into 2014

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. 

- Dr. Margaretha de Looze
Researcher and lecturer at Utrecht University, the Netherlands 

For more information visit www.hbsc.org 

See also:
- Injury Among Young Canadians: A national study of contextual determinants
- Health Behaviour in School-Aged Children
- Adolescence

Youth Unemployment and the OECD's Action Plan

This blog, by Wikichild Co-ordinator Melinda Deleuze, is part of the Wikiprogress Series on the European Network on Measuring Progress and Child Well-being. Today wraps up the spotlight on the European Network with this post on youth unemployment in Europe and the OECD Action Plan for Youth, which proposes how to tackle the issue.

  
It’s far too often that we hear the word “youth” immediately followed by “unemployment”. Hardship of the global economic crises are not spread equally among all individuals and households. According to the OECD’s Employment Outlook 2013, unemployment rates will remain high for the next 18 months across the board, but youth are hit the hardest (see the table below). While not all youth in Europe face difficulties when searching for a meaningful and practical job, there is without question a core group in each country that face either unemployment, inadequate jobs or social exclusion. The most disadvantaged youth are those with low skills or from migrant backgrounds.

Youth participation within the labor market is not only about their material benefits, but also about entering into adulthood, leaving home, building relationships and improving their overall well-being. Society also benefits, thanks to the boost in economic growth and greater social cohesion. The international community recognizes the advantages of higher youth employment rates and has create numerous initiatives to help policymakers tackle this issue (e.g. the ILO resolution on “The youth employment crisis: a call for action”; the G20 commitments on youth employment; the EU Council’s agreement on the Youth Guarantee).

Analyzing education, skills and youth-related employment policies, the OECD is among the organizations assessing the situation in order to find a solution. The OECD’s Secretary-General Angel Gurría has called for more youth-oriented policies, because “they advance the cause of building a stronger, fairer and cleaner post-crisis world.” In May 2013, the OECD endorsed “The OECD Action Plan for Youth: giving youth a better start in the labour market”, and is now working with countries to implement the plan in their national context.

The Action Plan identifies the urgency in finding short-term solutions to immediately tackle the current unemployment problem, but acknowledges that deeper structural changes will have to be dealt for the situation to improve in the long-term.

The Plan’s first objective is to confront current high levels of youth unemployment by:

• Creating jobs, along with providing income support, employment services or conditional cash-transfer programs
• Expanding apprenticeship and internship programs, which might include financial incentives for employers
• Maintaining a reasonably low minimum wage (perhaps a separate, lower minimum wage for teens), not to discourage employers from hiring low-skilled workers
• Strengthening employers’ incentives by lowering social security contribution or providing wage subsidies

The Plan’s second objective is to produce relevant skills and remove barriers by:

Strengthening the education system in order to prepare the young for work 

• Effective investment in education and training to obtain relevant skills
• Quality information about the necessary education and skills for certain careers 
• Tackle education failure at the system and school level 
• Provide second-chance opportunities for those who dropped out 
• Reinforce the role and effectiveness of vocational education and training, promoting both workplace and classroom learning

Assisting with the transition from school to work 

• Better link education to work world to help employers find people with the skills they need 
• Help the educated youth find a job without crowding out lower-skilled youth 
• Expand unemployment benefits to include school leavers, who are hard to contact and engage 
• Create re-employment programs, perhaps making participation in programs compulsory after a certain period of job searching (e.g. 6 months)

Reshaping labor market policy to facilitate employment access and tackle social exclusion 

• Encourage trial periods rather than unstable, fixed contracts 
• Provide training, remedial education and adult mentoring to the youth with multiple disadvantages 
• Expand access to unemployment and social assistance systems

The number of short-term options provided are few; however, there are still actions for governments to take if they want to incite immediate improvements. While there are many changes that could be made to produce long-term results, making decisions on which actions to implement may prove to be difficult. Fortunately, the OECD is prepared to help implement these action steps. Several experts across of the OECD are engaged and have offered to assist developing national and local action plans, tailoring national skills strategies, advising on specific youth policies, organizing workships on good practise and caring you comprehensive country reviews. The Organisation also provides a space where countries can discuss what works and what does not, and an update of the progress will be reported to the Ministerial Council Meeting 2014.

Melinda Deleuze

See Also:
The OECD Youth Portal 

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).