title: Educational differences in smoking among adolescents in Germany: what is the role of parental and adolescent education levels and intergenerational educational mobility?
abstract: BACKGROUND
  Adolescence is the period in which smoking onset usually occurs and the course for future socioeconomic status (SES) is set. However, because of the transitional nature of adolescence, it is questionable whether health inequalities are best measured by indicators of parental SES or rather by indicators of the adolescents' own developing SES. We examine the independent effects of parental and adolescent education and intergenerational educational mobility on adolescent smoking behaviour while controlling for differences in parental and close friends' smoking behaviour.
  
  
  METHODS
  The study is based on data from a subsample (12-17 years, n = 5,053) of the nationally representative German Health Interview and Examination Survey for Children and Adolescents (KiGGS). Participants reported their education level as well as their personal and close friends' smoking behaviour. Information on parental education and smoking behaviour was obtained via parent interviews. Adolescent and parental education data were dichotomized (low/high), leading to four categories of intergenerational educational mobility: stable high, potentially upwardly mobile, potentially downwardly mobile, and stable low.
  
  
  RESULTS
  After adjustment for parental and close friends' smoking behaviour, adolescent smoking habits were strongly related to their personal education level, but not that of their parents. Among boys, both stable low and downwardly mobile adolescents had a 2.7-fold increased risk of being a smoker compared with peers with a stable high education. Among girls, only those with a stable low education had a 2.2-fold increased risk of smoking. Among both genders, educational upward mobility was associated with significantly lower smoking rates compared with peers with a stable low education (boys: OR 0.32; 95% CI 0.20-0.53; girls: OR 0.52; 95% CI 0.37-0.73).
  
  
  CONCLUSIONS
  Our results show that the risk of an adolescent smoking is influenced by their own education level rather than that of their parents. Educational upward mobility seems to be protective against becoming a smoker in youth. Boys who experience downward mobility tend to have a significantly higher inclination to smoke than their peers with a stable high education. These findings illustrate the potential public health benefits of investments in education and help identify high-risk groups for smoking onset.
authors.affiliation: Department of Epidemiology and Health Monitoring, Robert Koch Institute, General-Pape-Strasse 62-66, Berlin 12101, Germany. b.kuntz@rki.de
authors.forename: Benjamin
authors.initials: B
authors.lastname: Kuntz
authors.forename: Thomas
authors.initials: T
authors.lastname: Lampert
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior; D002648:Child; D004522:Educational Status; D005260:Female; D033062:Friends; D005858:Germany; D006801:Humans; D008297:Male; D016017:Odds Ratio; D010290:Parents; D012907:Smoking / Q000453:epidemiology*