Abstract
Background: Adolescence is the period in which smoking onset usually occurs and the course for future socioeconomic status (SES) is set. However, because of the transitional nature of adolescence, it is questionable whether health inequalities are best measured by indicators of parental SES or rather by indicators of the adolescents’ own developing SES. We examine the independent effects of parental and adolescent education and intergenerational educational mobility on adolescent smoking behaviour while controlling for differences in parental and close friends’ smoking behaviour. Methods: The study is based on data from a subsample (12–17 years, n = 5,053) of the nationally representative German Health Interview and Examination Survey for Children and Adolescents (KiGGS). Participants reported their education level as well as their personal and close friends’ smoking behaviour. Information on parental education and smoking behaviour was obtained via parent interviews. Adolescent and parental education data were dichotomized (low/high), leading to four categories of intergenerational educational mobility: stable high, potentially upwardly mobile, potentially downwardly mobile, and stable low. Results: After adjustment for parental and close friends’ smoking behaviour, adolescent smoking habits were strongly related to their personal education level, but not that of their parents. Among boys, both stable low and downwardly mobile adolescents had a 2.7-fold increased risk of being a smoker compared with peers with a stable high education. Among girls, only those with a stable low education had a 2.2-fold increased risk of smoking. Among both genders, educational upward mobility was associated with significantly lower smoking rates compared with peers with a stable low education (boys: OR 0.32; 95% CI 0.20–0.53; girls: OR 0.52; 95% CI 0.37–0.73). Conclusions: Our results show that the risk of an adolescent smoking is influenced by their own education level rather than that of their parents. Educational upward mobility seems to be protective against becoming a smoker in youth. Boys who experience downward mobility tend to have a significantly higher inclination to smoke than their peers with a stable high education. These findings illustrate the potential public health benefits of investments in education and help identify high-risk groups for smoking onset.
Highlights
Tobacco smoking has been identified as the most important source of preventable morbidity and premature death and the primary cause of health inequalities between socioeconomic groups in most high-income countries [1,2]
It seems evident that a lower socioeconomic status (SES) in adulthood relates to a higher smoking prevalence [8,9], the relationship between SES and smoking in adolescence is less clear
What our study has shown is that adolescent smoking behaviour is strongly linked to their own educational level, while the effect of parental education disappears after controlling for personal education and educational differences in parental and close friends’ smoking behaviour
Summary
Tobacco smoking has been identified as the most important source of preventable morbidity and premature death and the primary cause of health inequalities between socioeconomic groups in most high-income countries [1,2]. Methods: The study is based on data from a subsample (12–17 years, n = 5,053) of the nationally representative German Health Interview and Examination Survey for Children and Adolescents (KiGGS) Participants reported their education level as well as their personal and close friends’ smoking behaviour. Results: After adjustment for parental and close friends’ smoking behaviour, adolescent smoking habits were strongly related to their personal education level, but not that of their parents. Among boys, both stable low and downwardly mobile adolescents had a 2.7-fold increased risk of being a smoker compared with peers with a stable high education.
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