title: Socioeconomic position, macroeconomic environment and overweight among adolescents in 35 countries.
abstract: OBJECTIVE
  It is important to understand levels and social inequalities in childhood overweight within and between countries. This study examined prevalence and social inequality in adolescent overweight in 35 countries, and associations with macroeconomic factors.
  
  
  METHODS
  International cross-sectional survey in national samples of schools.
  
  
  METHODS
  A total of 11-, 13- and 15-year-olds from 35 countries in Europe and North America in 2001-2002 (N=162 305).
  
  
  METHODS
  The main outcome measure was overweight based on self-reported height and weight (body mass index cut-points corresponding to body mass index of 25 kg/m(2) at the age of 18 years). Measures included family and school affluence (within countries), and average country income and economic inequality (between countries).
  
  
  RESULTS
  There were large variations in adolescent overweight, from 3.5% in Lithuanian girls to 31.7% in boys from Malta. Prevalence of overweight was higher among children from less affluent families in 21 of 24 Western and 5 of 10 Central European countries. However, children from more affluent families were at higher risk of overweight in Croatia, Estonia and Latvia. In Poland, Lithuania, Macedonia and Finland, girls from less affluent families were more overweight whereas the opposite was found for boys. Average country income was associated with prevalence and inequality in overweight when considering all countries together. However, economic inequality as measured by the Gini coefficient was differentially associated with prevalence and socioeconomic inequality in overweight among the 23-high income and 10-middle income countries, with a positive relationship among the high income countries and a negative association among the middle income countries.
  
  
  CONCLUSIONS
  The direction and magnitude of social inequality in adolescent overweight shows large international variation, with negative social gradients in most countries, but positive social gradients, especially for boys, in some Central European countries. Macroeconomic factors are associated with the heterogeneity in prevalence and social inequality of adolescent overweight.
authors.affiliation: National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark. pdu@niph.dk
authors.forename: P
authors.initials: P
authors.lastname: Due
authors.forename: M T
authors.initials: MT
authors.lastname: Damsgaard
authors.forename: M
authors.initials: M
authors.lastname: Rasmussen
authors.forename: B E
authors.initials: BE
authors.lastname: Holstein
authors.forename: J
authors.initials: J
authors.lastname: Wardle
authors.forename: J
authors.initials: J
authors.lastname: Merlo
authors.forename: C
authors.initials: C
authors.lastname: Currie
authors.forename: N
authors.initials: N
authors.lastname: Ahluwalia
authors.forename: T I A
authors.initials: TI
authors.lastname: Sørensen
authors.forename: J
authors.initials: J
authors.lastname: Lynch
authors.forename: A
authors.initials: A
authors.lastname: Borraccino
authors.forename: I
authors.initials: I
authors.lastname: Borup
authors.forename: W
authors.initials: W
authors.lastname: Boyce
authors.forename: F
authors.initials: F
authors.lastname: Elgar
authors.forename: S N
authors.initials: SN
authors.lastname: Gabhainn
authors.forename: R
authors.initials: R
authors.lastname: Krølner
authors.forename: C
authors.initials: C
authors.lastname: Svastisalee
authors.forename: M C
authors.initials: MC
authors.lastname: Matos
authors.forename: T
authors.initials: T
authors.lastname: Nansel
authors.forename: H
authors.initials: H
authors.lastname: Al Sabbah
authors.forename: C
authors.initials: C
authors.lastname: Vereecken
authors.forename: R
authors.initials: R
authors.lastname: Valimaa
mesh_terms: D000293:Adolescent; D015992:Body Mass Index; D003430:Cross-Sectional Studies; D005060:Europe / Q000453:epidemiology; D005260:Female; D054624:Health Status Disparities; D006801:Humans; D008297:Male; D009656:North America / Q000453:epidemiology; D016017:Odds Ratio; D050177:Overweight / Q000453:epidemiology* / Q000517:prevention & control; D015995:Prevalence; D012737:Sex Factors; D012959:Socioeconomic Factors