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Sozioökonomische Unterschiede im Rauchverhalten bei Jugendlichen

Eine ländervergleichende Perspektive zum Stellenwert individueller und makrostruktureller Faktoren

Social inequalities in adolescent smoking

A cross-national perspective of the role of individual and macro-structural factors

  • Leitthema
  • Published:
Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz Aims and scope

Zusammenfassung

Hintergrund

Im Rahmen eines von der EU geförderten Projektes wurde auf Basis internationaler Vergleichsstudien untersucht, welche Faktoren sozioökonomische Unterschiede im Rauchverhalten von Jugendlichen begleiten und erklären können. Der vorliegende Beitrag stellt die gewonnenen Ergebnisse vor und diskutiert ihre Implikationen für Politik und Forschung.

Methode

Die Ergebnisse basierten auf der „Health Behaviour in School-aged Children (HBSC)“-Studie aus dem Jahr 2006 und umfassten mehr als 50.000 Jugendliche in 37 Ländern. Im Mittelpunkt stand der Zusammenhang zwischen familiärem Wohlstand und wöchentlichem Rauchen (regelmäßiges, mindestens einmal wöchentliches Rauchen) bei Jugendlichen. Als Erklärungsdeterminanten wurden auf der Individualebene Faktoren zu den psychosozialen Ressourcen und Belastungen der Schule, Familie und Peers hinzugezogen. Auf der Länderebene wurden das nationale Einkommen, verschiedene Tabakkontrollpolitiken und die externe Differenzierung im Bildungssystem berücksichtigt.

Ergebnisse

Die psychosozialen Faktoren der Schule und Familie erklärten einen Großteil der Ungleichheiten im Rauchverhalten von Jugendlichen. Im internationalen Vergleich zeigten sich größere Ungleichheiten im Tabakkonsum in reicheren Ländern. Länder mit höheren Tabakpreisen zeigten hingegen eine geringere Ungleichheit und bei Jungen eine allgemein geringere Prävalenz von Rauchen. Differenziertere Bildungssysteme wiesen hingegen zwar geringere Ungleichheiten im Rauchverhalten von Mädchen auf, aber auch eine vergleichsweise hohe Rauchprävalenz. Größere soziale Ungleichheiten im Rauchverhalten zeigten sich zudem in Ländern, die einen größeren Umfang an Präventionsmaßnahmen gegen das Rauchen besaßen (bei Jungen) und mehr Geld in die Tabakkontrollpolitik investierten (bei Mädchen).

Fazit

Die Erfahrungen in reicheren Ländern zeigen, dass die Tabakprävention mit Blick auf sozial benachteiligte Personen weiter verstärkt werden muss. Anknüpfungspunkte zur Reduktion der allgemeinen Rauchprävalenz und der sozioökonomischen Ungleichheiten im Rauchverhalten liefern einerseits die Stärkung der psychosozialen Ressourcen in Familie und Schule, aber auch eine Erhöhung der Tabakpreise.

Abstract

Background

In an EU-funded project, we examined on the basis of international comparative analyses which factors were associated with and contributed to socioeconomic inequalities in adolescent smoking. This paper presents the results obtained and discusses their implications for policy and research.

Methods

Analyses were based on the “Health Behaviour in School-aged Children (HBSC)” study in 2006 and included more than 50,000 adolescents from 37 countries. The focus was on the association between family affluence and weekly smoking (regularly, at least once a week) among adolescents. Explanatory variables at the individual level refer to psychosocial resources and burdens of school, family, and peers. At the country level, national income, various tobacco control policies, and an index of external differentiation of the educational system were used.

Results

The psychosocial factors of school and family explained many of the inequalities in the smoking behavior of adolescents. In an international comparison, socioeconomic inequalities in smoking were stronger in richer countries. Absolute smoking rates were lower and inequalities in smoking smaller for boys in countries with higher tobacco prices. On the other hand, educational systems with higher degrees of external differentiation showed lower inequalities in smoking beahviour by girls, and relatively higher rates of smoking (for boys and girls). Stronger inequalities in smoking behaviour were demonstrated in countries with a greater range of preventative measures for tobacco dependence (for boys) and with higher levels of government spending on tobacco control (for girls).

Conclusion

Experiences in richer countries revealed that tobacco control needs to be strengthened for socially disadvantaged adolescents. The reduction of smoking prevalence and socioeconomic inequalities in smoking behavior should be based not only on a strengthening of psychosocial resources in the family and at school, but also on an increase in tobacco prices.

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Authors and Affiliations

  1. Institut für Medizinsoziologie, Versorgungsforschung und Rehabilitationswissenschaft, Universität zu Köln, Eupener Straße 129, 50933, Köln, Deutschland

    Timo-Kolja Pförtner

  2. Institut für Medizinische Soziologie, Martin-Luther-Universität Halle-Wittenberg, Halle (Saale), Deutschland

    Timo-Kolja Pförtner, Katharina Rathmann, Irene Moor & Matthias Richter

  3. Department of Public Health, AMC, University of Amsterdam, Amsterdam, Niederlande

    Anton E. Kunst

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  1. Timo-Kolja Pförtner
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Correspondence to Timo-Kolja Pförtner.

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T.-K. Pförtner, K. Rathmann, I. Moor, A.E. Kunst und M. Richter geben an, dass kein Interessenkonflikt besteht.

Die ethischen und datenschutzrechtlichen Voraussetzungen für die Erhebung wurden auf Basis der Bestimmungen und Richtlinien der jeweiligen Länder zum Zeitpunkt der Erhebung überprüft.

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Pförtner, TK., Rathmann, K., Moor, I. et al. Sozioökonomische Unterschiede im Rauchverhalten bei Jugendlichen. Bundesgesundheitsbl. 59, 206–216 (2016). https://doi.org/10.1007/s00103-015-2280-9

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