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

The impact of discriminatory social norms on adolescent girls

Wikigender and Wikichild and partners would like to hear your views, lessons learned and best practices or policies on empowering adolescent girls. From 2-11 April 2013, we invite you to participate in an online discussion on “The impact of discriminatory social norms on adolescent girls” and to be heard at a seminar on “Empowering adolescent girls by tackling social norms” that takes place on 26 April in London!

The event will be co-organised by the OECD Development Centre, the Overseas Development Institute (ODI), the Department for International Development (DFID UK) and The Girl Hub. The inputs from the Wikigender and Wikichild communities in this discussion will be presented via a summary report at the event. 

This online discussion is organised in partnership with the Health Behaviour in School-aged Children Research Network (HBSC), the Department for International Development (DFID UK), ASCD – The Whole Child, the Girl Hub, the Overseas Development Institute (ODI) and Plan (UK).

There is compelling evidence that adolescent girls are an under-invested segment of the society that could significantly help us reach the development goals. Numerous reports and campaigns highlight the link between discriminatory social norms affecting adolescent girls to development outcomes, such as ODI’s background note on “Adolescent girls, capabilities and gender justice: review of theliterature for East Africa, South Asia and South-East Asia”. Many reports point out to the challenges experienced by adolescent girls along with solutions, such as: Plan’s Because I am a Girl 2012 report; "Grow: A Vital Force In Rural Economies - A Girls Count Report On Adolescent Girls” by the Chicago Council on Global Affairs; Plan’s “Adolescent Girls’ Views on Safety in Cities” report; Plan’s “Adolescent voices: experiences in implementing youth sexual and reproductive health and rightsprogrammes” report; resources by ‘The Girl hub’, a partnership between DFID and the Nike Foundation; and many more. Despite some progress, for example on gender parity in primary education, girls throughout the developing world continue to be constrained by the intergenerational transmission of poverty and gender inequality. The OECD Development Centre’s 2012 Social Institutions and Gender Index (SIGI) also finds that discriminatory social norms have significant and enduring consequences for adolescent girls in terms of their health, access to economic resources and opportunities both in and outside the household.

This online discussion will be a unique opportunity to gather your views on:

1. How discriminatory social norms shape the lives of adolescent girls by influencing their access to opportunities, resources and power 
2. Which interventions are the most effective in transforming such discriminatory social norms and practices
   

Participants will be invited to share their examples of successful approaches, recommendations and actions needed with the gender and development community. 

We count on your participation in this important discussion and look forward to reading your comments.

You can post a comment in a few clicks by going to the “Contribute!” section of the online discussion page. The hashtag for Twitter is #adolescentgirls