title: Is educational differentiation associated with smoking and smoking inequalities in adolescence? A multilevel analysis across 27 European and North American countries.
abstract: This study aims to determine whether educational differentiation (i.e. early and long tracking to different school types) relate to socioeconomic inequalities in adolescent smoking. Data were collected from the WHO-Collaborative 'Health Behaviour in School-aged Children (HBSC)' study 2005/2006, which included 48,025 15-year-old students (Nboys = 23,008, Ngirls = 25,017) from 27 European and North American countries. Socioeconomic position was measured using the HBSC family affluence scale. Educational differentiation was determined by the number of different school types, age of selection, and length of differentiated curriculum at the country-level. We used multilevel logistic regression to assess the association of daily smoking and early smoking initiation predicted by family affluence, educational differentiation, and their interactions. Socioeconomic inequalities in both smoking outcomes were larger in countries that are characterised by a lower degree of educational differentiation (e.g. Canada, Scandinavia and the United Kingdom) than in countries with higher levels of educational differentiation (e.g. Austria, Belgium, Hungary and The Netherlands). This study found that high educational differentiation does not relate to greater relative inequalities in smoking. Features of educational systems are important to consider as they are related to overall prevalence in smoking and smoking inequalities in adolescence.
authors.affiliation: Institute of Medical Sociology, Medical Faculty, Martin Luther University Halle-Wittenberg, Germany.
authors.forename: Katharina
authors.initials: K
authors.lastname: Rathmann
authors.affiliation: Institute of Medical Sociology, Medical Faculty, Martin Luther University Halle-Wittenberg, Germany.
authors.forename: Irene
authors.initials: I
authors.lastname: Moor
authors.affiliation: Department of Public Health, AMC, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Anton E
authors.initials: AE
authors.lastname: Kunst
authors.affiliation: Institute of Medical Sociology, Medical Faculty, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany.
authors.forename: Nico
authors.initials: N
authors.lastname: Dragano
authors.affiliation: Institute of Medical Sociology, Health Services Research, and Rehabilitation Science, Faculty of Human Sciences and the Faculty of Medicine, University of Cologne, Cologne, Germany.
authors.forename: Timo-Kolja
authors.initials: TK
authors.lastname: Pförtner
authors.affiliation: Institute for Health and Social Policy, McGill University, Montreal, Quebec, Canada.
authors.forename: Frank J
authors.initials: FJ
authors.lastname: Elgar
authors.affiliation: Hertie School of Governance Berlin, Berlin, Germany.
authors.forename: Klaus
authors.initials: K
authors.lastname: Hurrelmann
authors.affiliation: Faculty of Sport and Health Sciences, Department of Health Sciences, University of Jyväskylä, Finland.
authors.forename: Lasse
authors.initials: L
authors.lastname: Kannas
authors.affiliation: Department of Public Health, Jessenius Faculty of Medicine, Comenius University, Martin, Slovak Republic.
authors.forename: Tibor
authors.initials: T
authors.lastname: Baška
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; D000294:Adolescent Behavior / Q000523:psychology*; D004522:Educational Status; D005060:Europe / Q000453:epidemiology; D005260:Female; D006306:Health Surveys; D006801:Humans; D008297:Male; D009656:North America / Q000453:epidemiology; D015995:Prevalence; D012907:Smoking / Q000453:epidemiology*; D012959:Socioeconomic Factors
keywords: HBSC; adolescence; educational differentiation; multilevel analysis; socioeconomic inequality; socioeconomic status; tobacco smoking