Adolescence and health inequalities: Extensions to macintyre and west

doi:10.1016/0277-9536(92)90006-C

Social Science & Medicine

Volume 35, Issue 5, September 1992, Pages 679-687

https://doi.org/10.1016/0277-9536(92)90006-C Get rights and content

Abstract

The paper investigates class based health inequalities in mid to late adolescence. Health status is assessed by means of three subjective self-report measures; evaluation of general health, psychological well-being and disability/long-standing illness. Using six measures of social class (three occupationally and three non-occupationally based) which derive from parental characteristics, no evidence for consistent class based differentials in health amongst adolescents is found. However, it is not concluded that class based health inequalities are absent at this stage of the life cycle. Instead, it is argued that the above measures of social class differentiate between young people on the basis of the socio-economic status of their parents. As such they fail to allow for the possibility that variations in the current social position of young people themselves may have important consequences for their health. Current social position is assessed in terms of economic activity status, occupation and educational attainment. Using these measures, class based health inequalities are indeed found. Extending the analysis further, the relationship between social class of origin, current social circumstances and self-assessed health status is investigated by considering inter-generational occupational mobility. Again, evidence for class based health inequalities is found.

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Among youth, there was little or no impact of income inequalities on their SPMH in the present study. This is in line with previous studies which showed that no or weak socioeconomic status differences for self-rated health among adolescents/youth compared to adults (Glendinning et al., 1992; Siahpush and Singh, 2000). The limited association among youth could be explained by the socioeconomic equalization theory.
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Data analyzed was from the Montreal Southwest Social and Psychiatric Epidemiology Catchment Area study (ZEPSOM), a longitudinal community-based cohort. The baseline survey was conducted in 2007/8 with follow-up every two years. We traced a total of 3464 participants over a period of 8 years. To examine the associations between income and SPMH at both between-person or within-person levels, cross-lagged panel models (CLPMs) and random intercept cross-lagged panel models (RI-CLPMs) were used. Gender and age effects were examined using multiple group analyses. Complete case analyses evaluated the findings’ robustness.
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Loss to follow-up may affect the generalizability of the research findings.
This study suggests that higher household income predicts higher SPMH at between-person levels. Policy and programs aiming at promoting mental health should focus on low-income individuals, especially men and older adults.
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Some studies of adolescents report similar findings (Goodman et al., 2007, 2005; Koivusilta et al., 2006; Richter et al., 2012). However, others have found little or no evidence of consistent differentials in (self-report) health/well-being measures according to various indicators of parent or household SES or area-based deprivation (Fagg et al., 2013; Glendinning et al., 1992; Spencer, 2006). Subjective social status (SSS) has been defined as a person's sense of place within a hierarchy, which may or may not reflect objective status (Adler and Stewart, 2007).
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Moving beyond the residential neighborhood to explore social inequalities in exposure to area-level disadvantage: Results from the Interdisciplinary Study on Inequalities in Smoking
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Commonly used indicators such as parental education or occupation may also provide only imperfect measure of young adults' own socio-economic status since, as hypothesized by West (1997) during youth and young adulthood, people may be developing their own identity and moving away from parental influences including that of their socio-economic background (West, 1997). For these reasons, and since education has previously been used in studies on health inequalities in young adults (Casswell et al., 2003; Glendinning et al., 1992; Kestila et al., 2006; Rahkonen et al., 1995), it was deemed the most appropriate proxy for their current social position, knowledge and access to economic and cultural resources, as well as future social attainment (Galobardes et al., 2006). In the event of misclassification of participants' highest educational attainment, with less educated participants potentially moving on to higher education, the findings reported here would underestimate inequalities across educational categories.
The focus, in place and health research, on a single, residential, context overlooks the fact that individuals are mobile and experience other settings in the course of their daily activities. Socio-economic characteristics are associated with activity patterns, as well as with the quality of places where certain groups conduct activities, i.e. their non-residential activity space. Examining how measures of exposure to resources, and inequalities thereof, compare between residential and non-residential contexts is required. Baseline data from 1890 young adults (18–25 years-old) participating in the Interdisciplinary Study of Inequalities in Smoking, Montreal, Canada (2011–2012), were analyzed. Socio-demographic and activity location data were collected using a validated, self-administered questionnaire. Area-level material deprivation was measured within 500-m road-network buffer zones around participants' residential and activity locations. Deprivation scores in the residential area and non-residential activity space were compared between social groups. Multivariate linear regression was used to estimate associations between individual- and area-level characteristics and non-residential activity space deprivation, and to explore whether these characteristics attenuated the education–deprivation association. Participants in low educational categories lived and conducted activities in more disadvantaged areas than university students/graduates. Educational inequalities in exposure to area-level deprivation were larger in the non-residential activity space than in the residential area for the least educated, but smaller for the intermediate group. Adjusting for selected covariates such as transportation resources and residential deprivation did not significantly attenuate the education–deprivation associations. Results support the existence of social isolation in residential areas and activity locations, whereby less educated individuals tend to be confined to more disadvantaged areas than their more educated counterparts. They also highlight the relevance of investigating both residential and non-residential contexts when studying inequalities in health-relevant exposures.
Adolescent precocious development and young adult health outcomes
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The objective of this study was to investigate the health implications of adolescent precocious transitions into young adulthood while addressing several limitations of previous studies. Data came from four waves of the National Longitudinal Study of Adolescent Health (n = 13,500). The analysis included the identification of seven adolescent life events, including early sexual activities, early pregnancy, early cohabitation, early marriage, dropping out of high school, leaving home at an early age, and early full-time working. These precocious events were then compared in terms of health problems in young adulthood, including smoking, obesity, physical inactivity, diabetes, hypertension, sexually transmitted diseases, and depression. Adolescents who experienced any of the precocious events showed significantly higher risks for health problems in young adulthood, even after controlling for family socioeconomic characteristics and race/ethnicity. However, differing precocious events were associated with different health problems, suggesting non-specific but unique etiological processes.
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The findings underline previous studies which observed social inequalities in SRH in adolescence (Call & Nonnemaker, 1999; Goodman, 1999; Koivusilta, Rimpela, & Kautiainen, 2006; van der Lucht & Groothoff, 1995; Piko & Fitzpatrick, 2001; Spencer, 2006; Starfield et al., 2002; West, 1997). It needs to be acknowledged, though, that there are other studies that could not confirm a socio-economic patterning of health in adolescents (Glendinning et al., 1992; Rahkonen et al., 1995; Siahpush & Singh, 2000; Tuinstra, 1998; West, 1988). Further, our results confirm studies which identified weaker relationships between socio-economic status and adolescent tobacco use, indicating that socio-economic differences in adolescent smoking are not as pronounced as for adult smoking.
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The social gradient in adolescent health has largely been explored using objective indicators of the socioeconomic components of parents' social class, such as income, education, or occupation, which serve as proxy measures of access to goods and services. Several recent studies have also investigated adolescents' perceptions of their relative subjective social status (SSS)—using scales modeled after those used in adults—and found the ladders to be valuable in explaining adolescents' health status even after taking into account objective indicators of parental social class (Glendinning, Love, Hendry, & Shucksmith, 1992; Goodman et al., 2001; Goodman et al., 2000). Similar to the measurements for SSS in adults, the youth-specific indicators involve two “ladders:” one representing broader society, and the other representing one's immediate community; adolescents are asked to rank themselves on these ladders.
This study examines the shape of social class gradients for substance use among Mexican adolescents. Substance use and objective and subjective indicators of social class were assessed in house-to-house surveys conducted with 7614 Mexican adolescents in 2004. The sample was designed to be representative of the poorest urban communities in seven Mexican states. The prevalence of current smoking was 16.8%, alcohol consumption was 30.2%, and drug use was 4.6%. Multiple logistic regressions are used to estimate the associations of objective indicators of socioeconomic status (SES) and subjective social status (SSS)—at both community and societal levels–and smoking, alcohol and drug use. Adolescents who perceived themselves as higher in social status in reference to their local community reported more smoking and drinking. Our findings were similar when we used objective measures of SES, such as maternal education and total monthly household expenditures per person. In contrast, adolescents who perceived that they had high social standing in reference to Mexican society as a whole were less likely to report being current smokers and drinkers. We found no significant association between social status and drug use. Research into how adolescents perceive themselves in reference to their peer communities may help strengthen programs and policies aimed at promoting health in vulnerable adolescent populations.

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Adolescence and health inequalities: Extensions to macintyre and west

Abstract

Soc. Sci. Med.

Soc. Sci. Med.

Soc. Sci. Med.

Soc. Sci. Med.

Inequalities in Health

The inequalities health debate: a critical review of the issues

J. soc. Pol.

Longitudinal studies in Britain relevant to inequalities in health

Young People's Leisure and Lifestyles: Report on Phase I, 1985–1989