title: From childhood socio-economic position to adult educational level - do health behaviours in adolescence matter? A longitudinal study.
abstract: BACKGROUND
  Our interest was in how health behaviours in early and late adolescence are related to educational level in adulthood. The main focus was in the interplay between school career and health behaviours in adolescence. Our conceptual model included school career and health-compromising (HCB) and health-enhancing (HEB) behaviours as well as family background. Two hypotheses were tested: 1) the primary role of school career in shaping educational level in adulthood (an unsuccessful school career in adolescence leads to HCB and not adopting HEB and to low educational level in adulthood); 2) the primary role of health behaviours (HCB and not adopting HEB in adolescence leads to a school career with low education in adulthood).
  
  
  METHODS
  Mailed surveys to 12 to18 year-old Finns in 1981-1991 (N=15,167, response rate 82%) were individually linked with the Register of Completed Education and Degrees (28 to 32-year-olds). We applied structural equation modeling to study relations of latent variables (family SEP, family structure, school career, HCB, HEB) in adolescence, to the educational level in adulthood.
  
  
  RESULTS
  Standardized regression coefficients between school career and health behaviours were equally strong whether the direction was from school career to HEB (0.21-0.28 for 12-14 years; 0.38-0.40 for 16-18 years) or from HEB to school career (0.21-0.22; 0.28-0.29); and correspondingly from school career to HCB (0.23-0.31; 0.31-0.32) or from HCB to school career (0.20-0.24; 0.22-0.22). The effect of family background on adult level of education operated mainly through school career. Only a weak pathway which did not go through school career was observed from behaviours to adult education.
  
  
  CONCLUSIONS
  Both hypotheses fitted the data showing a strong mutual interaction of school achievement and adoption of HCB and HEB in early and late adolescence. Both hypotheses acknowledged the crucial role of family background. The pathway from health behaviours in adolescence to adult education runs through school career. The interplay between behaviours and educational pathways in adolescence is suggested as one of the mechanisms leading to health inequalities in adulthood.
authors.affiliation: University Consortium of Seinäjoki, Seinäjoki Technology and Innovation Centre,, University of Tampere, School of Health Sciences, Kampusranta 9C, Seinäjoki FIN-60320, Finland. leena.koivusilta@uta.fi
authors.forename: Leena Kristiina
authors.initials: LK
authors.lastname: Koivusilta
authors.forename: Patrick
authors.initials: P
authors.lastname: West
authors.forename: Vesa Markus Antero
authors.initials: VM
authors.lastname: Saaristo
authors.forename: Tapio
authors.initials: T
authors.lastname: Nummi
authors.forename: Arja Hannele
authors.initials: AH
authors.lastname: Rimpelä
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior; D000328:Adult; D002648:Child; D004522:Educational Status; D015444:Exercise; D005190:Family; D005260:Female; D015438:Health Behavior; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D012574:Schools; D012923:Social Class; D012959:Socioeconomic Factors
references.citation: J Health Econ. 2010 Jan;29(1):1-28
references.pmid: 19963292
references.citation: J Fam Psychol. 2001 Sep;15(3):355-70
references.pmid: 11584788
references.citation: Prev Sci. 2006 Jun;7(2):127-49
references.pmid: 16596470
references.citation: J Adolesc Health. 2002 Nov;31(5):394-400
references.pmid: 12401425
references.citation: Am J Epidemiol. 1995 Mar 15;141(6):575-80
references.pmid: 7900725
references.citation: Health Aff (Millwood). 2008 Mar-Apr;27(2):350-60
references.pmid: 18332489
references.citation: Eur J Public Health. 2012 Apr;22(2):203-9
references.pmid: 21474547
references.citation: Proc Natl Acad Sci U S A. 2005 Jul 5;102(27):9730-3
references.pmid: 15976024
references.citation: J Adolesc Health. 2010 Nov;47(5):479-87
references.pmid: 20970083
references.citation: Scand J Soc Med. 1995 Jun;23(2):129-36
references.pmid: 7676219
references.citation: Prev Med. 2009 Apr;48(4):378-82
references.pmid: 19463486
references.citation: Eur J Oral Sci. 2012 Feb;120(1):54-60
references.pmid: 22288921
references.citation: J Health Soc Behav. 2005 Mar;46(1):51-67
references.pmid: 15869120
references.citation: N Engl J Med. 2008 Jun 5;358(23):2468-81
references.pmid: 18525043
references.citation: Am J Epidemiol. 2011 Jan 1;173(1):55-63
references.pmid: 21051448
references.citation: Subst Use Misuse. 2011;46(5):569-79
references.pmid: 20874007
references.citation: Soc Sci Med. 2011 Feb;72(4):591-9
references.pmid: 21227556
references.citation: J Dent Res. 2003 May;82(5):361-6
references.pmid: 12709502
references.citation: Soz Praventivmed. 2000;45(1):35-45
references.pmid: 10743028