Youth Health Care and Drug Addiction Prevention Department, Croatian National Institute of Public Health, Rockefellerova 7, 10000 Zagreb, Croatia.
Department of Medical Statistics, Epidemiology and Medical Informatics, University of Zagreb, School of Medicine, Andrija Stampar School of Public Health, Rockefellerova 4, 10000 Zagreb, Croatia.
Soc Sci Med. 2013 Dec;98:154-61. doi: 10.1016/j.socscimed.2013.09.021. Epub 2013 Oct 3.
The socioeconomic inequality in pupils' risk behaviors has been the topic of many studies with quite contradictory findings. Furthermore, the role of socioeconomic environment has been analyzed much less often than the role of individual socioeconomic status (SES). This study examined the association between school/area-level socioeconomic environment and Croatian pupils' risk behaviors (tobacco use, drunkenness, cannabis use, early sexual initiation and fighting). Data from the WHO-Collaborative 'Health Behavior in School-aged Children' study conducted in Croatia in 2006 (1601 secondary schools' pupils, aged 15) and census data were used. Multilevel logistic regression analyses, adjusted by gender, were performed. The individual level of SES explained the majority of differences in all risk behaviors among adolescents. Differences in tobacco use, early sexual initiation and fighting were more closely attributed to school level than area level, which was more closely associated with differences in adolescent drunkenness and cannabis use. At the individual level, high individual SES was associated with higher probability for tobacco use and drunkenness compared to low individual SES. Furthermore, school heterogeneity (compared to school homogeneity) and medium school-level SES (compared to low school-level SES) were associated with higher probability for cannabis use. Compared to the most advanced schools (gymnasiums), attending the least advanced schools (industrial and crafts schools) was associated with higher probability for fighting. Compared to low area-level SES, medium area-level SES was associated with higher probability for cannabis use and fighting. Conclusively, it was found that low SES at individual, school and area levels, school homogeneity and advanced school attendance play a protective role against risk behaviors. To reduce inequalities in pupils' risk behaviors, there is a need for community and school-based programs that take into consideration not only individual SES but also school- and area-level socioeconomic circumstances.
学生风险行为的社会经济不平等一直是许多研究的主题，但研究结果却存在很大的差异。此外，与个体社会经济地位（SES）相比，社会经济环境的作用分析得较少。本研究调查了学校/地区社会经济环境与克罗地亚学生风险行为（吸烟、酗酒、使用大麻、早期性行为和打架）之间的关系。使用了 2006 年在克罗地亚进行的世界卫生组织合作“儿童期行为研究”（1601 所中学，年龄 15 岁）和人口普查数据。进行了调整性别后多水平逻辑回归分析。SES 的个体水平解释了青少年所有风险行为中大多数差异的原因。与地区水平相比，吸烟、早期性行为和打架等方面的差异更接近学校水平，而地区水平则与青少年酗酒和使用大麻的差异更密切相关。在个体水平上，与低 SES 相比，高 SES 与吸烟和酗酒的可能性更高有关。此外，与学校同质性（与学校同质性相比）相比，学校异质性（与学校同质性相比）和中等 SES（与低 SES 相比）与使用大麻的可能性更高相关。与最先进的学校（高中）相比，就读于最不发达的学校（工业和手工艺学校）与打架的可能性更高相关。与低 SES 相比，中 SES 与使用大麻和打架的可能性更高相关。总之，发现个体、学校和地区层面的 SES 较低、学校同质性和先进学校入学率对风险行为具有保护作用。为了减少学生风险行为的不平等，需要开展以社区和学校为基础的项目，不仅要考虑到个体 SES，还要考虑到学校和地区层面的社会经济环境。
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