The international Family Affluence Scale (FAS): Charting 25 years of indicator development, evidence produced, and policy impact on adolescent health inequalities

In the absence of suitable indicators of adolescent socioeconomic status, the Family Affluence Scale (FAS) was first developed in Scotland 25 years ago. Since then, it has been adapted for use in the Health Behaviour in School-Aged Children (HBSC) Study to research inequalities in adolescent health in Europe and North America. FAS has also been used as an indicator of adolescent socioeconomic status in research studies outside of HBSC, worldwide. There has been a need for FAS to evolve and change its component items over time in order to take into account social and technological changes influencing the families of adolescents. This paper uniquely charts the development of FAS describing the methodological work carried out to validate the measure internationally and over time. It also presents an overview of the body of evidence on adolescent health inequalities produced over years from the HBSC Study and other research studies. Interviews conducted with policy stakeholders reveal that the evidence from FAS-related HBSC work has influenced their strategic work to raise awareness of inequalities and make the case for action to address these. Finally, the future of FAS is discussed with respect to its continual evolution in the context of technological, environmental and social change.

Health beliefs associated with preventive behaviors against noncommunicable diseases

OBJECTIVE

To investigate the relationship between health beliefs and preventive behaviors against noncommunicable diseases (NCDs).

METHODS

A survey was conducted in Health Management Center of the First Affiliated Hospital of Fujian Medical University from August 2019 to December 2019. An structured questionnaire was designed to collect the data on sociodemographic characteristics, health belief model (HBM) constructs and NCD-related behaviors. Structural equation model was used to describe the relationship between health beliefs and the behaviors.

RESULTS

Among 4453 participants, the most common unhealthy behaviors were sedentary living and working, mood disorders and staying up late. Female, aging, living in urban areas, good physical health were associated with healthy behaviors. HBM constructs including perceived barriers, self-efficacy, cues to action, perceived benefits, perceived severity, and perceived susceptibility were directly or indirectly related to NCD-related behaviors. Perceived barriers (effect coefficient=0.495) and self-efficacy (effect coefficient=0.435) were found to have the greatest impact on the behaviors.

CONCLUSION

Health beliefs are verified to be associated with preventive behaviors against NCDs.

PRACTICE IMPLICATIONS

Changing sedentary living and working, mood disorders and staying up late are the top priority of health education. Health education based on HBM, especially focusing on helping overcome difficulties and building confidence of behavior change, may be more effective for the prevention of NCDs.

Factors Associated with Smartphone Addiction Tendency in Korean Adolescents

This study aims to identify the factors associated with smartphone addiction tendency in Korean adolescents. A convenience sample of 502 students from four middle schools participated in the survey for the assessment of demographic, personal factors (resilience and academic stress), environmental factors (parental support, teacher support, friend support, and bullying victimization), as well as smartphone addiction tendency. Smartphone addiction tendency was determined based on the Smartphone Addiction Proneness Scale for Youth (SAPS) criteria developed by Kim et al. The collected data were analyzed using descriptive statistics, chi-squared test, t-test, Pearson’s correlation coefficients, and hierarchical logistic regression. Among the adolescents, 17.9% were in the smartphone addiction tendency group. The factors associated with smartphone addiction tendency were subjective economic level, academic stress, parental support, and bullying victimization. Based on the findings of this study, it is considered necessary to approach smartphone addiction management considering personal factors as well as environmental factors.

Perceived social status and unhealthy habits in Korea

BACKGROUND

The association between socioeconomic status and unhealthy behaviors is well-documented in the literature. Less is known, however, about the role of subjective social status, but recent evidence shows that perceived standing in the social hierarchy has important roles in health.

METHODS

This paper studies the association between perceived social status and the consumption of alcohol and tobacco among the South Korean elderly. Using data from a large longitudinal survey in Korea, we empirically estimate these correlations while controlling for a large set of confounders that include measures of objective social status.

RESULTS

Respondents who view themselves as lower in the social hierarchy are more likely to be active smokers but equally likely to be drinkers as respondents who view themselves better off socially. We also find that among smokers and drinkers, the actual amounts of tobacco and alcohol consumed correlate well with perceived social status. In terms of drinking, the higher the subjective social status, the lower the amount of alcohol consumed. In terms of smoking, people at the two extremes of the social hierarchy smoke more than people in the middle.

CONCLUSIONS

South Korea is facing unique problems regarding aging, economic and social inequality, and high rates of tobacco and alcohol consumption. Understanding the role of perceived social status on these unhealthy habits is therefore extremely important for designing policies that address these health issues from multiple perspectives.

Socioeconomic inequalities in health among Swedish adolescents - adding the subjective perspective

Background

Socioeconomic inequalities in adolescent health predict future inequalities in adult health. Subjective measures of socioeconomic status (SES) may contribute with an increased understanding of these inequalities. The aim of this study was to investigate socioeconomic health inequalities using both a subjective and an objective measure of SES among Swedish adolescents.

Method

Cross-sectional HBSC-data from 2002 to 2014 was used with a total sample of 23,088 adolescents aged 11–15 years. Three measures of self-rated health (dependent variables) were assessed: multiple health complaints, life satisfaction and health perception. SES was measured objectively by the Family Affluence Scale (FAS) and subjectively by “perceived family wealth” (independent variables). The trend for health inequalities was investigated descriptively with independent t-tests and the relationship between independent and dependent variables was investigated with multiple logistic regression analysis. Gender, age and survey year was considered as possible confounders.

Results

Subjective SES was more strongly related to health outcomes than the objective measure (FAS). Also, the relation between FAS and health was weakened and even reversed (for multiple health complaints) when subjective SES was tested simultaneously in regression models (FAS OR: 1.03, CI: 1.00;1.06 and subjective SES OR: 0.66, CI: 0.63;0.68).

Conclusions

The level of socioeconomic inequalities in adolescent health varied depending on which measure that was used to define SES. When focusing on adolescents, the subjective appraisals of SES is important to consider because they seem to provide a stronger tool for identifying inequalities in health for this group. This finding is important for policy makers to consider given the persistence of health inequalities in Sweden and other high-income countries.

Gender-Specific Analyses of the Prevalence and Factors Associated with Substance Use and Misuse among Bosniak Adolescents

Ethnicity and religion are known to be important factors associated with substance use and misuse (SUM). Ethnic Bosniaks, Muslims by religion, are the third largest ethnic group in the territory of the former Yugoslavia, but no study has examined SUM patterns among them. The aim of this study was to explore the prevalence of SUM and to examine scholastic-, familial- and sport-factors associated with SUM in adolescent Bosniaks from Bosnia-and-Herzegovina. The sample comprised 970 17-to-18-year-old adolescents (48% boys). Testing was performed using an previously validated questionnaire investigating socio-demographic-factors, scholastic-variables, and sport-factors, cigarette smoking, alcohol drinking, simultaneous smoking and drinking (multiple SUM), and the consumption of other drugs. The 30% of boys and 32% of girls smoke (OR = 1.13; 95% CI = 0.86–1.49), 41% of boys and 27% of girls are defined as harmful alcohol drinkers (OR = 1.94; 95% CI = 1.48–2.54), multiple SUM is prevalent in 17% of boys and 15% of girls (OR = 1.11; 95% CI = 0.79–1.56), while the consumption of other drugs, including sedatives, is higher in girls (6% and 15% for boys and girls, respectively; OR = 2.98; 95% CI = 1.89–4.70). Scholastic achievement is negatively associated with SUM. SUM is more prevalent in those girls who report higher income, and boys who report a worse familial financial situation. The study revealed more negative than positive associations between sport participation and SUM, especially among girls. Results can help public health authorities to develop more effective prevention campaign against SUM in adolescence.