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Dieser Beitrag untersucht die Relevanz makro-struktureller Merkmale für die Gesundheit und sozioökonomische Ungleichheit in der Gesundheit von Jugendlichen in hochentwickelten Wohlfahrtsstaaten. Datenbasis ist die internationale "Health Behaviour in School-aged Child-ren (HBSC)"-Studie 2005/06. Sie umfasst 11- bis 15-jährige Jugendliche in 27 europäischen und nordamerikanischen Länder (n=134.632), die in fünf Wohlfahrtsstaatsregimes (sozialde-mokratisch, konservativ, liberal, süd- und osteuropäisch) zusammengefasst wurden. In hierar-chischen Regressionsmodellen wurden für die psychosomatische Beschwerdelast als gesund-heitliche Zielgrößee individuelle (familiärer Wohlstand) und makro-strukturelle Determinanten (Einkommensungleichheit, Ausgaben für das Gesundheitssystem, Regime-Dummies) unter Kontrolle des nationalen Wohlstands analysiert. Im liberalen Regime und damit in Ländern mit hoher Einkommensungleichheit fallen die Beschwerderate und sozioökonomische Un-gleichheiten in der Beschwerdelast am höchsten aus. Der gesellschaftliche Wohlstand und die Ausgaben für das Gesundheitssystem sind dagegen nicht mit den Beschwerden assoziiert
This study aims to determine whether educational differentiation (i.e. early and long tracking to different school types) relate to socioeconomic inequalities in adolescent smoking. Data were collected from the WHO-Collaborative 'Health Behaviour in School-aged Children (HBSC)' study 2005/2006, which included 48,025 15-year-old students (Nboys = 23,008, Ngirls = 25,017) from 27 European and North American countries. Socioeconomic position was measured using the HBSC family affluence scale. Educational differentiation was determined by the number of different school types, age of selection, and length of differentiated curriculum at the country-level. We used multilevel logistic regression to assess the association of daily smoking and early smoking initiation predicted by family affluence, educational differentiation, and their interactions. Socioeconomic inequalities in both smoking outcomes were larger in countries that are characterised by a lower degree of educational differentiation (e.g. Canada, Scandinavia and the United Kingdom) than in countries with higher levels of educational differentiation (e.g. Austria, Belgium, Hungary and The Netherlands). This study found that high educational differentiation does not relate to greater relative inequalities in smoking. Features of educational systems are important to consider as they are related to overall prevalence in smoking and smoking inequalities in adolescence.
Objectives
Cross-national studies have rarely focused on young people. The aim of this study is to investigate whether macro-level determinants are associated with health and socioeconomic inequalities in young people's health.
Study design
Data were collected from the Health Behaviour in School-aged Children (HBSC) study in 2006, which included 11- to 15-year old adolescents from 27 European and North American countries (n = 134,632). This study includes national income, health expenditure, income inequality, and welfare regime dummy-variables as macro-level determinants, using hierarchical regression modelling.
Main outcome measure
Psychosomatic health complaints and socioeconomic inequalities in psychosomatic health complaints.
Results
Adolescents in countries with higher income inequality and with liberal welfare tradition were associated with more health complaints and a stronger relationship between socioeconomic status and macro-level determinants compared to adolescents from countries with lower income inequality or the Social Democratic regime. National income and health expenditure were not related to health complaints. Countries with higher national income, public health expenditure and income inequality showed stronger associations between socioeconomic status and psychosomatic health complaints.
Conclusion
Results showed that macro-level characteristics are relevant determinants of health and health inequalities in adolescence.