Individual and local socioeconomic status: associations in adolescents’ health (Barcelona province)

Abstract

Abstract Individual-level and local socioeconomic status (SES) are both significant social determinants of adolescents' health, but usually their distinct effects are not properly disentangled. A validated health survey of 76 items was conducted among last compulsory education course students (15/16 years old) in 59 municipalities from Barcelona province, Spain (N = 7351). Individual SES was defined by the Family Affluence Scale and municipal SES by its Gross Disposable Household Income. Both were dichotomized and crossed. Bivariate analyses were performed for all variables, comparing Low (L) and High (H) Individual (i) SES, L and H Municipal (m) SES and then the 4 groups: LiLm, LiHm, HiLm, HiHm. Chi square tests were performed with SAS. The significance level was set to 0.05. Most of the items (self-perceived health, general mood, night leisure, excessive use of internet, and unsafe sex, among others) were only related to individual SES (in the direction usually described in literature) without municipal influence. Only for sexual harassment was found a significant association with the municipal SES (more on Lm) but no differences between individual SES groups. Different patterns emerged when individual and municipal significant associations were detected. In a LiLm-LiHm-HiLm-HiHm order, a healthy gradient was observed in frequency of sport and physical activity, neighbourhood assessment and adherence to Mediterranean Diet. On the contrary, a risk gradient appeared on tobacco, cannabis and alcohol consumption. An opposite SES effect was found on gender violence and on sexual health information demands: Individual SES was positively associated with demand while Municipal SES was negatively associated. No association with neither individual nor municipal SES was found on information interest on bullying. The different effect of individual and municipal SES and their interactions on various aspects of adolescents' health should be taken into account in health promotion. Key messages Individual SES have stronger association with most of adolescents’ health items than Municipal SES. The latter reinforces, except on gender and sexual health information demands where link is opposed. Different effects and interactions between individual and municipal socioeconomic status in adolescents’ health should be incorporated in health promotion priorization.