Abstract
Health risk behaviours such as tobacco smoking, excessive alcohol consumption, drug use, unhealthy diet and unprotected sexual intercourse contribute to the global burden of non‐communicable diseases and are often initiated in adolescence. An individualistic focus on ‘health risk behaviours’ has resulted in behaviour change strategies that are potentially ineffective and increase inequalities. We conducted a grounded theory study of 25 young adults to increase the limited qualitative evidence base surrounding young people, health risk behaviours and socioeconomic inequalities. We found that health risk behaviours were perceived as class markers, manifesting as class stigma, leading some participants from lower socioeconomic backgrounds to employ strategies to avoid such behaviours. Peers and family were core constructs for understanding the relationship between health risk behaviours and socioeconomic life trajectories. However, individualism and choice were consistently expressed as the overriding narrative for understanding health risk behaviour and socioeconomic position during the transition to adulthood. The use of ‘personal responsibility’ discourse by young adults, we argue, highlights the need for a public health focus on achieving structural changes as opposed to individualised approaches to avoid reinforcing neoliberal ideologies that serve to marginalise and maintain social inequalities.
Highlights
Health risk behaviours such as tobacco smoking, excessive alcohol consumption, drug use, unhealthy diet and unprotected sexual intercourse are global health issues, contributing to a range of non-communicable diseases (James et al, 2018)
The use of the Avon Longitudinal Study of Parents and Children (ALSPAC) cohort reflected our desire to interview young adults as they would be mature enough to reflect on their adolescent health risk behaviours and the impact on their recent transition into adulthood, while still being able to remember the experiences of their youth
We identified three interrelated categories that served as mechanisms for participants’ understanding of the relationship between adolescent health risk behaviour and socioeconomic position (SEP)
Summary
Health risk behaviours such as tobacco smoking, excessive alcohol consumption, drug use, unhealthy diet and unprotected sexual intercourse are global health issues, contributing to a range of non-communicable diseases (James et al, 2018). Sociological critique highlights how the public health emphasis on ‘individual behaviours’ supports neoliberal ideology, whereby, individuals think of themselves as morally responsible for the prevention of personal illness through avoiding risks and making ‘healthy’ choices (Cohn, 2014; Morris, 2017). This attention on health risk behaviours is reflected in the dominance of individual ‘behaviour change’ interventions, which are increasingly challenged over concerns about ineffectiveness (Frohlich & Abel, 2014) and the potential for increasing inequalities through marginalising those who are unable to change their behaviour (Lupton, 1993). We used the more neutral term ‘health behaviours’ in interviews to avoid judgement of participants, we adopt the term ‘health risk behaviours’ in this paper to reflect our specific interest with behaviours that are harmful to health, not just behaviours broadly related to health
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