Institute of Social and Preventive Medicine, University of Bern, Niesenweg 6, 3012 Bern, Switzerland.
J Epidemiol Community Health. 2012 Aug;66(8):691-7. doi: 10.1136/jech.2010.125500. Epub 2011 May 4.
Efforts to explain social inequalities in health have mainly focused on adults. Few studies have systematically analysed different explanatory pathways in adolescence. This study is among the first to examine the contribution of material, psychosocial and behavioural factors in the explanation of inequalities in adolescent health.
Data were obtained from the German part of the cross-sectional 'Health Behaviour in School-aged Children' Survey in 2006, with a total of 6997 respondents aged 11-15 years (response rate 86%). Socioeconomic position was measured using the Family Affluence Scale. Multistage logistic regression models were used to assess the relative importance of explanatory factors.
Compared with adolescents from high affluent backgrounds, the ORs of fair/poor self-rated health increased to 1.53 (95% CI 1.11 to 2.12) in low affluent boys and to 2.08 (95% CI 1.62 to 2.67) in low affluent girls. In the separate analyses, material, psychosocial and behavioural factors attenuated the OR by 30-50%. Together, the three explanatory factors reduced the OR by about 80% in low affluent boys and girls. The combined analyses illustrated that material factors contributed most to the differences in self-rated health because of their direct and indirect effect (through psychosocial and behavioural factors).
The findings show that the main explanatory approaches for adults also apply to adolescents. The direct and indirect contribution of material factors for inequalities in self-rated health was stronger than that of behavioural and psychosocial factors. Strategies for reducing health inequalities should primarily focus on improving material circumstances in lower affluent groups.
解释健康方面的社会不平等问题主要集中在成年人身上。很少有研究系统地分析了青少年时期的不同解释途径。本研究是首次检验物质、心理社会和行为因素对青少年健康不平等的贡献的研究之一。
本研究的数据来自于 2006 年德国横断面“儿童健康行为调查”的一部分，共有 6997 名 11-15 岁的受访者（应答率为 86%）。社会经济地位使用家庭富足量表进行衡量。多阶段逻辑回归模型用于评估解释因素的相对重要性。
与来自高富足背景的青少年相比，低富足男孩的自评为一般/差健康状况的比值比（OR）增加到 1.53（95%置信区间 1.11 至 2.12），低富足女孩的 OR 增加到 2.08（95%置信区间 1.62 至 2.67）。在单独的分析中，物质、心理社会和行为因素使 OR 降低了 30-50%。这三个解释因素共同将低富足男孩和女孩的 OR 降低了约 80%。综合分析表明，物质因素由于其直接和间接效应（通过心理社会和行为因素）对自评健康差异的贡献最大。
研究结果表明，适用于成年人的主要解释方法也适用于青少年。物质因素对自评健康不平等的直接和间接贡献大于行为和心理社会因素。减少健康不平等的策略应主要侧重于改善较低富裕群体的物质条件。
