title: Macro-level determinants of young people's subjective health and health inequalities: a multilevel analysis in 27 welfare states.
abstract: OBJECTIVE
  Cross-national studies have rarely focused on young people. The aim of this study is to investigate whether macro-level determinants are associated with health and socioeconomic inequalities in young people's health.
  
  
  METHODS
  Data were collected from the Health Behaviour in School-aged Children (HBSC) study in 2006, which included 11- to 15-year old adolescents from 27 European and North American countries (n=134,632). This study includes national income, health expenditure, income inequality, and welfare regime dummy-variables as macro-level determinants, using hierarchical regression modelling.
  
  
  METHODS
  Psychosomatic health complaints and socioeconomic inequalities in psychosomatic health complaints.
  
  
  RESULTS
  Adolescents in countries with higher income inequality and with liberal welfare tradition were associated with more health complaints and a stronger relationship between socioeconomic status and macro-level determinants compared to adolescents from countries with lower income inequality or the Social Democratic regime. National income and health expenditure were not related to health complaints. Countries with higher national income, public health expenditure and income inequality showed stronger associations between socioeconomic status and psychosomatic health complaints.
  
  
  CONCLUSIONS
  Results showed that macro-level characteristics are relevant determinants of health and health inequalities in adolescence.
authors.affiliation: Institute of Medical Sociology, Medical Faculty, Martin Luther University Halle-Wittenberg, Germany; Berlin Graduate School of Social Sciences (BGSS), Socioeconomic and Statistical Studies (SESS), Humboldt University Berlin, Germany. Electronic address: katharina.rathmann@medizin.uni-halle.de.
authors.forename: Katharina
authors.initials: K
authors.lastname: Rathmann
authors.affiliation: University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Veronika
authors.initials: V
authors.lastname: Ottova
authors.affiliation: Hertie School of Governance, Berlin, Germany.
authors.forename: Klaus
authors.initials: K
authors.lastname: Hurrelmann
authors.affiliation: Faculty of Social and Behavioral Sciences, University of Utrecht, The Netherlands.
authors.forename: Margarethe
authors.initials: M
authors.lastname: de Looze
authors.affiliation: NHS Greater Glasgow & Clyde, Glasgow, Scotland, United Kingdom.
authors.forename: Kate
authors.initials: K
authors.lastname: Levin
authors.affiliation: Department of Health Promotion, National University of Ireland, Galway, Ireland.
authors.forename: Michal
authors.initials: M
authors.lastname: Molcho
authors.affiliation: Institute for Health and Social Policy and Douglas Institute, McGill University, Montreal, Quebec, Canada.
authors.forename: Frank
authors.initials: F
authors.lastname: Elgar
authors.affiliation: Department of Health Promotion, National University of Ireland, Galway, Ireland.
authors.forename: Saoirse Nic
authors.initials: SN
authors.lastname: Gabhainn
authors.affiliation: Graduate School Kosice Institute for Society and Health, PJ Safarik University, Kosice, Slovak Republic; Department of Community & Occupational Health, University Medical Center Groningen, University of Groningen, The Netherlands.
authors.forename: Jitse P
authors.initials: JP
authors.lastname: van Dijk
authors.affiliation: Institute of Medical Sociology, Medical Faculty, Martin Luther University Halle-Wittenberg, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Richter
mesh_terms: D000293:Adolescent; D002648:Child; D005060:Europe; D005260:Female; D005102:Health Expenditures; D006304:Health Status; D054624:Health Status Disparities; D006306:Health Surveys; D006801:Humans; D008297:Male; D055361:Multilevel Analysis; D009656:North America; D011602:Psychophysiologic Disorders / Q000209:etiology; D012923:Social Class; D012959:Socioeconomic Factors
keywords: Adolescents; HBSC; Health inequality; Macro-level determinants; Subjective health