1. Health Inequalities among Adolescents - impacts of different measures of social position Curt Hagquist, PhD Centre for Research on Child and Adolescent Mental Health Karlstad University, Sweden Presentation at the 2nd International Conference of the International Society for Child Indicators, 4 – 5 November 2009 at the University of Western Sydney, Australia [curt.hagquist@kau.se]

2. Measurement of Health Inequalities among Adolescents – distinctive features l Inconsistent patterns and results reported in previous studies. l Socio-economic position primarily measured based on parents’ occupation, education or income. l Incomplete and bad measurement when based on children’s reports on their parents.

3. Conceptual and pragmatic reasons for shifting the focus FROM socio-economic position of origin TO socio-economic position of destination

4. Academic orientation - Rough indicator of future social position

5. The empirical example

6. Adolescent survey data on health and health-related behaviours l Data set 1: Students in year 9 (15-16 years old) in a Swedish county. Data collections in 1988, 1991, 1995, 1998, 2002, 2005. About 15 000 participants. l Data set 2: Students in year 2 of upper secondary school (about 18 years old) in a city in Sweden. Data collections in 1999 and 2003. About 1 800 participants

7. Academic orientation - operationalisation l Students in Year 9: First choice of program in application for upper secondary school. l Students in Year 2 of upper secondary school: Current program affiliation. l Dichotomisation: Theoretical and non theoretical (vocational) programs.

8. The PsychoSomatic Problems (PSP) - scale The PsychoSomatic Problems (PSP) - scale During this school year, have you... "Had difficulty in concentrating?" "Had difficulty in sleeping?" "Suffered from headaches?" "Suffered from stomach aches?" "Felt tense?" "Had little appetite?" "Felt sad?" "Felt giddy?” Composite measure: Person parameter estimates (”Rasch-scores”)

9. Year 9 (i.e. last year in the compulsory school)

10. Psychosomatic problems by academic orientation 1995-2005, Year 9 - Boys

11. Psychosomatic problems by academic orientation 1995-2005, Year 9 - Girls

12. Binge drinking once a month or more Year 9, 1995 – 2005

13. Ever used narcotics Year 9, 1995 – 2005

14. Year 2 in upper secondary school

15. Selection to program by parental education in upper secondary school

16. Program affiliation distributed by parent’s educational level

17. The role of Academic orientation Controlling for Parental education

18. Health and health-related behaviours Year 2 of upper secondary school, 1999 & 2003 Odds Ratios

19. In conclusion 1 l Strong link between academic orientation and health/health-related behaviours. l No direct link between parents’ education and health/health-related behaviours, but mediating effects.

20. In conclusion 2 l Academic orientation is a useful concept to detect health inequalities among adolescents. l Academic orientation is a powerful way of identifying adolescents at higher risk. l Social class of origin and social class of destination are not mutually exclusive but complementary concepts.

21. References l Hagquist C Socioeconomic differences in smoking behaviours among adolescents. The role of academic orientation. Childhood, 2000;7:467-478. l Hagquist C Health inequalities among adolescents – the impact of academic orientation and parents’ education. European Journal of Public Health 2007; 17: 21-26 l Hagquist C Psychometric properties of the PsychoSomatic Problems scale – a Rasch analysis on adolescent data. Social Indicators Research 2008; 86: 511- 523

22. Contact: curt.hagquist@kau.se