Background Health risk behaviours such as tobacco smoking, alcohol consumption, drug misuse, unhealthy diet and unprotected sexual intercourse are global health issues, often initiated in adolescence. There is contrasting evidence on the association between health risk behaviours and socioeconomic position in adolescence and young adulthood, with little qualitative evidence to illuminate the relationship. The aim of the study was to examine to what extent young people perceive health risk behaviours to shape socioeconomic inequalities while transitioning into adulthood.
Methods We undertook a nested qualitative study within The Avon Longitudinal Study of Parents and Children (ALSPAC) birth cohort using semi-structured interviews of 25 young adults aged 26–28 years. A grounded theory approach was adopted. Theoretical sampling was conducted based on participants’ early life socioeconomic background and engagement in health risk behaviours when they were adolescents. Data collection and analysis were undertaken iteratively to aid constant comparison.
Results Categories of peer influence, family influence, ‘drive to succeed’ and personal responsibility were identified. These data underline the importance of family and peers in relation to both health risk behaviours and socioeconomic life chances as young people transition into adulthood. Engaging in some level of health risk behaviour allowed young people to gain experiences and bond with peers but avoiding certain behaviours helped construct their identity and self-security. Some participants adopted a moralistic or neoliberal perspective in labelling peers who engaged in certain risk behaviours, such as drug use, as irresponsible or immature. Adolescent alcohol use was seen as normative during adolescence and therefore less tied to socioeconomic position. Many participants saw the individualised concept of ‘drive to succeed’ as pivotal for the transition to adulthood, claiming the possessing this quality made it possible to achieve in education or employment regardless of upbringing or structural factors. The study highlighted class stigma, with some young people from low socioeconomic backgrounds avoiding health risk behaviours such as tobacco smoking or hazardous alcohol consumption as a strategy to evade further stigmatisation.
Conclusion While individual agency was highlighted by many participants, family support was recognised as essential for navigating adolescence in relation to health behaviours and socioeconomic life trajectories. Class stigma related to health risk behaviours was either experienced or witnessed by young people throughout their adolescence. Therefore, while quantitative data suggest that youth from low SES backgrounds engage in more health risk behaviours, public health interventions should adopt measures to avoid further stigmatising these young people.
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