Inequalities in Croatian pupils' unhealthy behaviours and health outcomes: role of school, peers and family affluence.
BACKGROUND
To examine the influence of family affluence (measure of socioeconomic status), school environment (liking school, school pressure, academic achievement and classmates support) and peer group (size of the peer group and frequency of peer contact) on unhealthy behaviours (smoking, drunkenness, physical inactivity, irregular breakfast and soft drink consumption) and health outcomes (self-rated health, multiple health complaints and life satisfaction) in Croatian pupils.


METHODS
The Croatian data from Health Behaviour in School-aged Children 2005/06 (HBSC) were used (1666 11-year-olds, and 1630 15-year-olds). Binary logistic regression analysis was conducted (95% confidence intervals, P < 0.05 and P < 0.01).


RESULTS
School environment and peer group were connected to more unhealthy behaviours along with greater differences in those behaviours than family affluence. The only exception was physical inactivity at age 11 (compared to high family affluence, low family affluence increased 80% odds for physical inactivity, whereas, compared to favourable school environment, poor school environment increased 50% odds). Compared to favourable school environment, poor school environment was the most consistent and strongest predictor of poor health outcomes (all three measures). No influence of peer group to health outcomes was found. Compared to high-affluent families, low-affluent families were associated to higher odds for poor self-rated health and life dissatisfaction, and, for 11-year-olds, medium-affluent families to lower odds for multiple health complaints. Gender differences in unhealthy behaviours and health outcomes were also found.


CONCLUSIONS
Compared to socioeconomic inequalities, greater inequalities in unhealthy behaviours were connected to school environment and peer group, and in health outcomes to school environment.
Youth Health and Drug Prevention Service, Croatian National Institute of Public Health, Zagreb, Croatia. ivana.pavic@hzjz.hr
Ivana Pavic
IP
Simetin
Marina
M
Kuzman
Iva Pejnovic
IP
Franelic
Ivan
I
Pristas
Tomislav
T
Benjak
Jagoda Dabo
JD
Dezeljin
D000293:Adolescent; D002648:Child; D017523:Croatia / Q000453:epidemiology; D004777:Environment; D005260:Female; D015438:Health Behavior; D006304:Health Status; D054624:Health Status Disparities; D006801:Humans; D007182:Income / Q000706:statistics & numerical data*; D007398:Interpersonal Relations; D008297:Male; D010379:Peer Group; D010549:Personal Satisfaction; D012574:Schools / Q000706:statistics & numerical data*