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Inequalities in adolescent self-rated health and smoking in Europe: comparing different indicators of socioeconomic status
  1. Irene Moor1,
  2. Mirte A G Kuipers2,
  3. Vincent Lorant3,
  4. Timo-Kolja Pförtner4,
  5. Jaana M Kinnunen5,
  6. Katharina Rathmann6,
  7. Julian Perelman7,
  8. Joana Alves7,
  9. Pierre-Olivier Robert3,
  10. Arja Rimpelä5,8,
  11. Anton E Kunst2,
  12. Matthias Richter1
  1. 1 Institute of Medical Sociology, Medical Faculty, Martin-Luther-University Halle-Wittenberg, Halle, Germany
  2. 2 Department of Public Health, Amsterdam Public Health research institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
  3. 3 Institute of Health and Society, Université catholique de Louvain, Louvain-la-Neuve, Belgium
  4. 4 Institute of Medical Sociology, Health Services Research, and Rehabilitation Science, Faculty of Human Sciences, Faculty of Medicine, University of Cologne, Koln, Germany
  5. 5 Faculty of Social Sciences, Unit of Health Sciences, Tampere University, Tampere, Finland
  6. 6 Department of Nursing and Health Sciences, Fulda University of Applied Sciences, Fulda, Germany
  7. 7 Centro de Investigação em Saúde Pública, Escola Nacional de Saúde Pública, Universidade Nova de Lisboa, Lisboa, Portugal
  8. 8 Department of Adolescent Psychiatry, Tampere University Hospital, Tampere, Finland
  1. Correspondence to Irene Moor, Institute of Medical Sociology, Medical Faculty, Martin-Luther-University Halle-Wittenberg, Halle 06108, Germany; irene.moor{at}


Background Although there is evidence for socioeconomic inequalities in health and health behaviour in adolescents, different indicators of socioeconomic status (SES) have rarely been compared within one data sample. We examined associations of five SES indicators with self-rated health (SRH) and smoking (ie, a leading cause of health inequalities) in Europe.

Methods Data of adolescents aged 14–17 years old were obtained from the 2013 SILNE survey (smoking inequalities: learning from natural experiments), carried out in 50 schools in 6 European cities (N=10 900). Capturing subjective perceptions of relative SES and objective measures of education and wealth, we measured adolescents’ own SES (academic performance, pocket money), parental SES (parental educational level) and family SES (Family Affluence Scale, subjective social status (SSS)). Logistic regression models with SRH and smoking as dependent variables included all SES indicators, age and gender.

Results Correlations between SES indicators were weak to moderate. Low academic performance (OR=1.96, 95% CI 1.53 to 2.51) and low SSS (OR=2.75, 95% CI 2.12 to 3.55) were the strongest indicators of poor SRH after adjusting for other SES-indicators. Results for SSS were consistent across countries, while associations with academic performance varied. Low academic performance (OR=5.71, 95% CI 4.63 to 7.06) and more pocket money (OR=0.21, 95% CI 0.18 to 0.26) were most strongly associated with smoking in all countries.

Conclusions Socioeconomic inequalities in adolescent health were largest according to SES indicators more closely related to the adolescent’s education as well as the adolescent’s perception of relative family SES, rather than objective indicators of parental education and material family affluence. For future studies on adolescent health inequalities, consideration of adolescent-related SES indicators was recommended.

  • health behaviour
  • health inequalities
  • public health
  • adolescents cg

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  • IM and MAGK are joint first authors.

  • Correction notice This article has been corrected since it first published online. The affiliations have been corrected.

  • Contributors IM and MR conceived and designed the draft of this manuscript. IM and MAGK conducted the statistical analyses, interpreted the data and drafted the manuscript. Both agreed to share first authorship. AEK, AR, IM, JA, JP, JMK, MAGK, MR, P-OR and VL carried out the study in each European city. All authors contributed to the interpretation of the data and assisted in revising the manuscript. VL initiated and conceptualised the survey. AEK is the PI of the SILNE project and provided critical feedback on the conceptualisation of the study and in revising the manuscript. All authors have read and approved the final manuscript.

  • Funding This study was part of the project 'Tackling socio-economic inequalities in smoking: learning from natural experiments by time trend analyses and cross-national comparisons' - SILNE, which was funded by the European Commission, Directorate General for Research and Innovation, under the FP7 Health 2011 programme, with grant agreement number no 278273. The study was also part of the SILNE-R project, which received funding from the European Commission (EC), Horizon2020 programme, Call PHC 6 - 2014, under grant agreement no 635056.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval Ethical approval was obtained from institutional and/or national ethics committees in each country.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement No data are available.