Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany.
PLoS One. 2018 Mar 7;13(3):e0192968. doi: 10.1371/journal.pone.0192968. eCollection 2018.
This study's aim was to investigate the association between family structure and different health-related outcomes in adolescence (self-rated health, emotional and behavioural problems, health-related quality of life, regular smoking, and heavy episodic drinking). Furthermore, we analysed the extent to which socio-economic status, family cohesion and the pre-transition health status explain family structure-related health disparities.
We used longitudinal data from the first two waves of the German KiGGS cohort study carried out by the Robert Koch Institute (baseline: 2003-2006, follow-up: 2009-2012). The sample comprised 4,692 respondents aged 11 to 17 years. Using data from both waves, effects of family structure on health status at follow-up were calculated applying linear and logistic regression models.
We found that adolescents continuously living with both birth parents were in good health. Adolescents whose parents separated after the baseline survey, reported poorer health and were more likely to smoke. The transition from stepfamily to single parent family was also associated with a higher risk of regular smoking. Lower health-related quality of life as well as higher scores for emotional and behavioural problems occurred in almost all non-nuclear family structures, although not all effects were statistically significant. No significant effects of family structure on heavy episodic drinking were found. While family cohesion mediated the effects of family structure on adolescents' health, the mediating effect of socio-economic status was small. After controlling for pre-transition health, the effects were even lower.
Because the direct effects of family structure on adolescents' health were small and family cohesion was found to be an important mediator in the association between family structure and adolescents' health, prevention programmes and interventions should be directed towards the parent-adolescent relationship rather than just the family structure, in order to minimize the psychosocial stress of adolescents during the period of family transition.
本研究旨在探讨家庭结构与青少年不同健康相关结果之间的关系（自我评估健康、情绪和行为问题、健康相关生活质量、定期吸烟和重度间歇性饮酒）。此外，我们分析了社会经济地位、家庭凝聚力和过渡前健康状况在多大程度上解释了与家庭结构相关的健康差异。
我们使用了罗伯特·科赫研究所（Robert Koch Institute）进行的德国 KiGGS 队列研究的前两个波次的纵向数据（基线：2003-2006 年，随访：2009-2012 年）。样本包括 4692 名年龄在 11 至 17 岁的受访者。使用两个波次的数据，通过线性和逻辑回归模型计算家庭结构对随访时健康状况的影响。
我们发现，持续与亲生父母生活在一起的青少年身体健康。与基线调查后父母离异的青少年相比，他们报告的健康状况较差，更有可能吸烟。从继父家庭过渡到单亲家庭也与定期吸烟的风险增加有关。几乎所有非核心家庭结构都出现了健康相关生活质量较低以及情绪和行为问题得分较高的情况，尽管并非所有影响都具有统计学意义。家庭结构对重度间歇性饮酒没有显著影响。尽管家庭凝聚力在家庭结构对青少年健康的影响中起到了中介作用，但社会经济地位的中介作用较小。在控制过渡前健康状况后，这些影响甚至更低。
由于家庭结构对青少年健康的直接影响较小，并且家庭凝聚力被发现是家庭结构与青少年健康之间关联的一个重要中介因素，因此预防计划和干预措施应该针对父母与青少年的关系，而不仅仅是家庭结构，以最大限度地减少家庭过渡期间青少年的心理社会压力。
