Socioeconomic position and self-rated health among female and male adolescents: The role of familial determinants in explaining health inequalities. Results of the German KiGGS study

Abstract

Objective Although health inequalities in adolescence are well documented, the underlying mechanisms remain unclear. Few studies have examined the role of the family in explaining the association between the family’s socioeconomic position and adolescents’ self-rated health. The current study aimed to explore whether the association between socioeconomic position and self-rated health was mediated by familial determinants. Methods Using data from wave 2 of the”German Health Interview and Examination Survey for Children and Adolescents” (KiGGS) (1,838 female and 1,718 male 11- to 17-year-olds), linear regression analyses were conducted to decompose the total effects of income, education, occupational status, socioeconomic position index and adolescents’ subjective social status on self-rated health into direct effects and indirect effects through familial determinants (family cohesion, parental well-being, parental stress, parenting styles, parental obesity, smoking and sporting activity). Results A significant total effect of all socioeconomic position indicators on self-rated health was found, except for income in male adolescents. In female adolescents, more than 70% of the total effects of each socioeconomic position indicator were explained by familial mediators, whereas no significant direct effects remained. The most important mediator was parental well-being, followed by family cohesion, parental smoking and sporting activity. In male adolescents, the associations between income, parental education, the socioeconomic position index and subjective social status were also mediated by familial determinants (family cohesion, parental smoking, obesity and living in a single-mother family). However, a significant direct effect of subjective social status remained. Conclusion The analysis revealed how a family’s position of socioeconomic disadvantage can lead to poorer health in adolescents through different family practices. The family appears to play an important role in explaining health inequalities, particularly in female adolescents. Reducing health inequalities in adolescence requires policy interventions (macro-level), community-based strategies (meso-level) and programs to improve parenting and family functioning (micro-level).

Parental resources and heritability as factors shaping children's health. An analysis of twins' self-rated health using TwinLife

“…Results show a social gradient in self-rated health with children with lower SES experience worse health (Kuntz et al, 2018 ). This finding is confirmed by Rattay et al ( 2022 ) who analyze the same dataset focusing on adolescents and their parents ( N = 3,556; adolescents aged 11–17). Not only do they find a relationship of income (only for girls), education and occupational status separately with self-rated health but also of an SES index and health.…”

Self-rated health of university students in Germany–The importance of material, psychosocial, and behavioral factors and the parental socio-economic status

“…Although the expansion of education in the last decades had improved the access to higher education across all social classes, there was still a bias toward children from a higher socio-economic background being more likely to be enrolled at universities. We found that the importance of the socio-economic status of parents for the health of their offspring was still persistent among university students, a connection that was already known for adolescents (41) and young children (42). This showed that the "social class" of origin had more persistence than the aspired social class as suggested by Hagquist (14).…”

Socio-economic inequalities in body mass index among preschool children: do sports programs in early childhood education and care centers make a difference?

“…However, we found evidence for the relevance of ECEC center sports focus for BMI for boys only. Therefore, it might be speculated that for boys' factors outside the family might be relevant concerning BMI, whereas for girls, the family SEP seems to play a more important role ( 44 ). Our finding is all the more surprising considering that girls are known to have more sedentary lifestyles and lower levels of physical activity than boys ( 45 ).…”