title: Socioeconomic inequities patterns of multi-morbidity in early adolescence.
abstract: BACKGROUND
  Multi-morbidity such as cumulating mental health, behavioral, and school difficulties (consumptions of alcohol, tobacco, cannabis, and hard drugs, obesity, depressive symptoms, suicide attempts, involvement in violence, and low school performance) is common in early adolescence and can be favored by a number of socioeconomic factors (gender, age, nationality, family structure, parents' education, father' occupation, and income). This study assessed the concurrent roles of various socioeconomic factors in multi-morbidity defined as cumulated number of difficulties (CD) which has been partially documented.
  
  
  METHODS
  Adolescents from middle schools in north-eastern France (N = 1,559) completed a questionnaire measuring socioeconomic characteristics and mental health, behavioral, and school difficulties. Data were analyzed using logistic regression models.
  
  
  RESULTS
  Alcohol use affected 35.2% of subjects, tobacco use 11.2%, cannabis use 5.6%, hard drugs use 2.8%, obesity 10.6%, depressive symptoms 13.3%, suicide attempts 9.9%, involvement in violence 10.3%, and low school performance 8.2%. Insufficient income and non-intact families impacted most mental health, behavioral, and school difficulties with adjusted odds ratios (ORa) between 1.51 and 3.72. Being immigrant impacted illicit drugs use and low school performance (ORa 2.31-4.14); low parents' education depressive symptoms (1.42) and school performance (3.32); and manual-worker/inactive offspring low school performance (2.56-3.05). Multi-morbidity was very common: CD0 44.1%, CD1 30.8%, CD2-3 18.4%, and CD ≥ 4 6.7%. Insufficient income, divorced/separated parents, reconstructed families, and single parents played impressive roles with strong ORa gradients (reaching 4.86) from CD1 to CD ≥ 4. Being European immigrant, low parents' education, and low fathers' occupations had significant gender-age-adjusted odds ratios for CD2-3 and CD ≥ 4, but these became non-significant when adjusted for all socioeconomic factors. Older adolescents had higher risks for multi-morbidity which did not change when adjusting for all socioeconomic factors.
  
  
  CONCLUSIONS
  Multi-morbidity including a wide range of mental health, behavioral, and school difficulties was common in early adolescence. Insufficient income and non-intact families played impressive roles. Being immigrant, low parents' education, and low fathers' occupations also played strong roles but these were explained by insufficient income and non-intact families. Prevention against multi-morbidity should be designed to help adolescents to solve their difficulties, especially among adolescents with socioeconomic difficulties.
authors: Kénora
authors: K
authors: Chau
authors: Michèle
authors: M
authors: Baumann
authors: Nearkasen
authors: N
authors: Chau
mesh_terms: D000293:Adolescent; D015897:Comorbidity; D004522:Educational Status; D005260:Female; D005602:France / Q000453:epidemiology; D054624:Health Status Disparities; D006801:Humans; D016015:Logistic Models; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology / Q000209:etiology*; D016017:Odds Ratio; D012920:Social Behavior Disorders / Q000453:epidemiology / Q000209:etiology*; D012959:Socioeconomic Factors; D019966:Substance-Related Disorders / Q000209:etiology; D011795:Surveys and Questionnaires; D014754:Violence / Q000706:statistics & numerical data
references: Lancet. 2012 Jul 7;380(9836):37-43
references: 22579043
references: J Clin Epidemiol. 1998 May;51(5):367-75
references: 9619963
references: BMC Public Health. 2012 Mar 19;12:201
references: 22429338
references: Neuroimage. 2005 Jul 1;26(3):860-9
references: 15955496
references: Br J Psychiatry. 2010 Jun;196(6):440-6
references: 20513853
references: J Occup Rehabil. 2010 Sep;20(3):275-92
references: 20091105
references: Addict Behav. 2012 Feb;37(2):160-6
references: 21983294
references: J Adolesc Health. 2011 Jun;48(6):591-6
references: 21575819
references: J Adolesc Health. 2011 Jun;48(6):585-90
references: 21575818
references: Health Rep. 2012 Sep;23(3):37-41
references: 23061263
references: BMC Public Health. 2012 Jun 19;12(1):453
references: 22712754
references: Eur J Gen Pract. 2008;14 Suppl 1:28-32
references: 18949641
references: Eur J Epidemiol. 2000 Jan;16(1):33-42
references: 10780340
references: Int J Public Health. 2012 Feb;57(1):95-105
references: 21523616
references: Arch Gen Psychiatry. 1982 Oct;39(10):1205-12
references: 7125850
references: Child Maltreat. 2007 Aug;12(3):208-19
references: 17631621
references: Br J Gen Pract. 2011 Jan;61(582):e12-21
references: 21401985
references: Addict Behav. 2011 Nov;36(11):1101-5
references: 21794987
references: J Occup Environ Med. 2011 Dec;53(12):1452-9
references: 22076039
references: Psychiatr Serv. 2008 Apr;59(4):429-32
references: 18378843
references: Am J Epidemiol. 2002 Nov 15;156(10):936-44
references: 12419766
references: JAMA. 2009 Dec 23;302(24):2695-6
references: 20040558
references: Child Maltreat. 2007 Aug;12(3):220-32
references: 17631622
references: J Adolesc Health. 2011 Sep;49(3):278-86
references: 21856520
references: J Adolesc Health. 2008 Aug;43(2):180-7
references: 18639792
references: J Affect Disord. 2012 Feb;136(3):267-75
references: 22197508
references: J Adolesc Health. 2012 Apr;50(4):395-402
references: 22443845
references: Arch Gen Psychiatry. 2012 Mar;69(3):256-64
references: 22393218
references: JAMA. 2001 Dec 26;286(24):3089-96
references: 11754674
references: Alcohol Alcohol. 2008 Jan-Feb;43(1):73-80
references: 17932077
references: Eur J Clin Nutr. 1991 Jan;45(1):13-21
references: 1855495
references: Pediatrics. 2010 Apr;125(4):e778-86
references: 20231180
references: Soc Psychiatry Psychiatr Epidemiol. 2012 Feb;47(2):175-84
references: 21184214
references: J Psychiatr Pract. 2005 May;11(3):161-76
references: 15920390
references: Soc Sci Med. 2011 May;72(9):1447-53
references: 21492977
references: Addiction. 2011 Aug;106(8):1520-31
references: 21631617
references: Psychiatr Serv. 2010 Mar;61(3):250-7
references: 20194401
references: BMC Public Health. 2011 Dec 22;11:949
references: 22192716
references: J Am Coll Nutr. 2007 Dec;26(6):650-4
references: 18187429
references: JAMA. 1994 Dec 21;272(23):1825-31
references: 7990216
references: Dev Psychopathol. 1998 Spring;10(2):235-57
references: 9635223
references: J Am Acad Nurse Pract. 2010 Jul;22(7):369-75
references: 20590959
references: PLoS One. 2012;7(2):e32190
references: 22393389