title: [Social inequalities in adolescent smoking: A cross-national perspective of the role of individual and macro-structural factors].
abstract: BACKGROUND
  In an EU-funded project, we examined on the basis of international comparative analyses which factors were associated with and contributed to socioeconomic inequalities in adolescent smoking. This paper presents the results obtained and discusses their implications for policy and research.
  
  
  METHODS
  Analyses were based on the "Health Behaviour in School-aged Children (HBSC)" study in 2006 and included more than 50,000 adolescents from 37 countries. The focus was on the association between family affluence and weekly smoking (regularly, at least once a week) among adolescents. Explanatory variables at the individual level refer to psychosocial resources and burdens of school, family, and peers. At the country level, national income, various tobacco control policies, and an index of external differentiation of the educational system were used.
  
  
  RESULTS
  The psychosocial factors of school and family explained many of the inequalities in the smoking behavior of adolescents. In an international comparison, socioeconomic inequalities in smoking were stronger in richer countries. Absolute smoking rates were lower and inequalities in smoking smaller for boys in countries with higher tobacco prices. On the other hand, educational systems with higher degrees of external differentiation showed lower inequalities in smoking beahviour by girls, and relatively higher rates of smoking (for boys and girls). Stronger inequalities in smoking behaviour were demonstrated in countries with a greater range of preventative measures for tobacco dependence (for boys) and with higher levels of government spending on tobacco control (for girls).
  
  
  CONCLUSIONS
  Experiences in richer countries revealed that tobacco control needs to be strengthened for socially disadvantaged adolescents. The reduction of smoking prevalence and socioeconomic inequalities in smoking behavior should be based not only on a strengthening of psychosocial resources in the family and at school, but also on an increase in tobacco prices.
authors.affiliation: Institut für Medizinsoziologie, Versorgungsforschung und Rehabilitationswissenschaft, Universität zu Köln, Eupener Straße 129, 50933, Köln, Deutschland. timo-kolja.pfoertner@uk-koeln.de.|Institut für Medizinische Soziologie, Martin-Luther-Universität Halle-Wittenberg, Halle (Saale), Deutschland. timo-kolja.pfoertner@uk-koeln.de.
authors.forename: Timo-Kolja
authors.initials: TK
authors.lastname: Pförtner
authors.affiliation: Institut für Medizinische Soziologie, Martin-Luther-Universität Halle-Wittenberg, Halle (Saale), Deutschland.
authors.forename: Katharina
authors.initials: K
authors.lastname: Rathmann
authors.affiliation: Institut für Medizinische Soziologie, Martin-Luther-Universität Halle-Wittenberg, Halle (Saale), Deutschland.
authors.forename: Irene
authors.initials: I
authors.lastname: Moor
authors.affiliation: Department of Public Health, AMC, University of Amsterdam, Amsterdam, Niederlande.
authors.forename: Anton E
authors.initials: AE
authors.lastname: Kunst
authors.affiliation: Institut für Medizinische Soziologie, Martin-Luther-Universität Halle-Wittenberg, Halle (Saale), Deutschland.
authors.forename: Matthias
authors.initials: M
authors.lastname: Richter
mesh_terms: D000293:Adolescent; D000067697:Adolescent Health / Q000191:economics* / Q000706:statistics & numerical data; D005260:Female; D005858:Germany / Q000453:epidemiology; D006293:Health Promotion / Q000191:economics* / Q000706:statistics & numerical data; D054624:Health Status Disparities; D006801:Humans; D038622:Internationality; D008297:Male; D012907:Smoking / Q000191:economics* / Q000453:epidemiology; D016540:Smoking Cessation / Q000191:economics / Q000706:statistics & numerical data; D000074606:Smoking Prevention; D064890:Social Determinants of Health / Q000191:economics* / Q000706:statistics & numerical data; D012959:Socioeconomic Factors
keywords: Adolescents; Determinants; HBSC; Smoking; Socioeconomic factors