Desigualdades socioeconómicas
A continuación se recogen los artículos de investigación publicados por el equipo HBSC. Para hacer más sencilla la búsqueda, los artículos se dividen por áreas temáticas. Pulse aquella que le interese y será redirigido a las publicaciones científicas publicadas en esta temática.
Desigualdades socioeconómicas
Las desigualdades socioeconómicas tienen una importante influencia en la salud y su reducción sigue siendo una de las principales preocupaciones de los gobiernos actuales. Además, de forma paradójica y a pesar del desarrollo alcanzado por los estados modernos, en la actualidad las desigualdades socioeconómicas se mantienen e incluso continúan en aumento. Añadido a ello, el impacto de la crisis económica que comenzó en 2008 ha afectado de forma especialmente severa a países como Grecia, Italia, Portugal, Irlanda y, entre ellos, España. Desde su inicio, se constata un severo aumento de las tasas de desempleo, un incremento de las desigualdades existentes así como un ascenso en el número de las familias en riesgo de pobreza o sufriendo inseguridad financiera.
Algunas dimensiones socioeconómicas, como el nivel educativo y el estatus ocupacional de los padres y de las madres, la capacidad adquisitiva familiar y la riqueza familiar percibida resultan de especial relevancia para los hábitos de vida saludables adoptados por los chicos y chicas adolescentes, así como para su salud. Entre las dimensiones clave, el nivel educativo de las madres revela ser el indicador más predictivo del bienestar adolescente, especialmente relevante en el caso de los estilos de vida. Por lo tanto, las madres desarrollan un papel protagonista en los comportamientos relacionados con la salud de sus hijos e hijas. Se constata, así, la necesidad, por un lado, de no escatimar recursos que mejoren el nivel educativo de la población; por otro, de seguir insistiendo en la paridad de la participación de los padres y las madres en la crianza de sus hijos e hijas. Además, los chicos y chicas adolescentes reflejan ser vulnerables al desempleo de sus madres, y especialmente el de sus padres, sobretodo si estos tienen un alto nivel educativo, y por tanto, más expectativas de alcanzar una mejor posición socioeocnómica. Sin embargo, la satisfacción con la familia y los iguales, así como el gusto por la escuela y el apoyo del profesorado y de los compañeros y compañeras de los centros educativos tienen una capacidad protectora ante los efectos adversos de las desventajas socioeconómicas. Concretamente, la familia desempeña un rol fundamental, especialmente para aquellos chicos y chicas en situaciones de mayor desventaja.
A continuación se recogen los artículos de investigación publicados por el equipo HBSC en esta temática.
Association of alcohol control policies with adolescent alcohol consumption and with social inequality in adolescent alcohol consumption: A multilevel study in 33 countries and regions.
       Leal-López, E., Moreno-Maldonado, C., Inchley, J., Deforche, D., Van Havere, T., Van Dammeg, J., Buijs, T., Sánchez-Queija, I., Currie, D., Vieno, A., De Clercq, B. (2020)
International Journal of Drug Policy.
JCR (2019): SUBSTANCE USE (3 OF 36): Q1
FI: 4.444
Enlace
Abstract: Background Previous research found inconsistent associations between alcohol control policies and socioeconomic inequality with adolescent drinking outcomes. This study expands the focus beyond individual associations to examine whether a combination of policies is related to socioeconomic inequality in adolescent drinking outcomes and whether this relationship varies across survey years. Methods Multilevel modelling of 4 waves of repeat cross-sectional survey data (2001/02, 2005/06, 2009/10, and 2013/14) from the Health Behaviour in School-aged Children (HBSC) study was carried out. The sample was composed of 671,084 adolescents (51% girls) aged 11, 13, and 15 (mean age=13.58; SD=1.65) from 33 European and North American countries/regions. The dependent variables were lifetime alcohol consumption, weekly alcohol consumption, and lifetime drunkenness. Independent variables were of three types: individual-level variables (age, sex, Family Affluence Scale, and the Perceived Family Wealth), time-level variable (survey year), and context-level variables (minimum legal drinking age, physical availability, advertising restrictions, a total alcohol policy index, and affordability of alcohol). Results The total alcohol policy index showed a negative relationship with both lifetime and weekly consumption. Higher affordability of alcohol was related to higher lifetime and weekly consumption and higher lifetime drunkenness. Family Affluence Scale was positively related to all three alcohol measures and Perceived Family Wealth was negatively related to lifetime drunkenness, with these associations increasing across survey years. The total alcohol policy index buffered the associations of Family Affluence Scale and Perceived Family Wealth with adolescent drinking outcomes. Conclusion A combination of alcohol control policies is more effective in reducing adolescent drinking outcomes than single policy measures. Reducing the affordability of alcohol stood out as the most successful single measure. Socioeconomic inequalities (i.e. higher alcohol consumption and drunkenness in adolescents with higher family affluence and higher drunkenness in adolescents perceiving their families to be poor) have persisted and even increased across survey years. A combined alcohol control policy can help in tackling them.
Intersectionality and Adolescent Mental Well-being: A Cross-Nationally Comparative Analysis of the Interplay Between Immigration Background, Socioeconomic Status and Gender.
       Kern, M. R., Duinhof, E. L., Walsh, S. D., Cosma, A., Moreno-Maldonado, C., Molcho, M., Currie, C., Stevens, G.W.J.M. (2020)
Journal of Adolescent Health.
JCR (2019): PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH (30 OF 193): Q1 / PEDIATRICS (9 OF 128): Q1
FI: 3.900
Enlace
Abstract: Purpose: Intersectionality theory highlights the importance of the interplay of multiple social group memberships in shaping individual mental well-being. This article investigates elements of adolescent mental well-being (life dissatisfaction and psychosomatic complaints) from an intersectional perspective. It tests mental well-being consequences of membership in combinations of multiple social groups and examines to what extent such intersectional effects depend on the national context (immigration and integration policies, national-level income, and gender equality). Methods: Using Multilevel Analysis of Individual Heterogeneity and Discriminatory Accuracy, we assessed the role of the national context in shaping the interplay between immigration background, socioeconomic status, and gender, using data from 33 countries from the 2017/2018 Health Behaviour in School-aged Children survey. Results: We found no uniform intersectionality effects across all countries. However, when allowing the interplay to vary by national context, results did point toward some intersectional effects. Some aggravated negative effects were found for members of multiple disadvantaged social groups in countries with low levels of income equality and restrictive migration policies, whereas enhanced positive effects were found for members of multiple advantaged groups in these countries. Similarly, mitigated negative effects of membership in multiple disadvantaged groups were shown in countries with higher levels of income equality and more inclusive migration policies, whereas mitigated positive effects were found for multiply advantaged individuals. Although for national-level gender equality results pointed in a similar direction, girls' scores were counterintuitive. High national-level gender equality disproportionately benefitted groups of disadvantaged boys, whereas advantaged girls were doing worse than expected, and reversed effects were found for countries with low gender equality. Conclusions: To fully understand social inequalities in adolescent mental well-being, the interplay between individual-level and national-level indicators must be explored.
Factors associated with life satisfaction of adolescents living with employed and unemployed parents in Spain and Portugal: A person focused approach.
    Moreno-Maldonado, C., Jiménez-Iglesias, A., Camacho, I., Rivera, F., Moreno, C., & Matos, M. G. (2020).
Children and Youth Services Review.
JCR (2019): FAMILY STUDIES (18 de 46). Q2 / SOCIAL WORK (7 de 43). Q1
FI: 1.684
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Abstract: Family and friend relationships may have a protective effect against the negative consequences of parental unemployment. However, whereas some studies have shown positive effects of family and peer relationships for all adolescents, others suggest that vulnerable groups have more difficulty benefiting from the positive effects of these relationships. The aim of this work was: (1) to analyze the association of different factors (satisfaction with family and friends, age, sex, and country) with life satisfaction in four groups of adolescents created according to their parents’ employment status (both parents unemployed, unemployed mothers and employed fathers, unemployed fathers and employed mothers, and both parents unemployed); and (2) to examine differences between countries in the constellations of factors related to adolescents life satisfaction in each group. The sample was composed of 21,081 adolescents from Portugal and Spain (11–16 years old) who participated in the 2014 edition of the HBSC study in both countries. Classification tree Analyses for the first objective, and general linear model and mean comparisons for the second, were performed. Results showed that some factors were associated with high life satisfaction in the majority of the adolescents: high family and friend satisfaction, being male, being younger, and being Spanish. However, for adolescents with both parents unemployed, life satisfaction was associated only with family satisfaction and age. Sex- and country-based differences were significant in all adolescents with at least one employed parent, but were not significant in adolescents with both parents unemployed. Findings highlight that family satisfaction plays a fundamental role in adolescent life satisfaction —especially for those with both parents unemployed— and that cultural and sex differences disappear in vulnerable situations.
The Role of Body Image in Internalizing Mental Health Problems in Spanish Adolescents: An Analysis According to Sex, Age, and Socioeconomic Status.
    Ramos, P., Moreno-Maldonado, C., Moreno, C., & Rivera, F. (2019).
Frontiers in Psychology, 10:1952.
JCR (2018): PSYCHOLOGY, MULTIDISCIPLINARY (40 OF 137): Q2
FI: 2,129
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Abstract: During adolescence there is a relatively high prevalence of weight problems and eating disorders. Furthermore, body image plays an important role in weight control and eating behaviors as well as in mental health. This study analyses the influence of body mass index, perception of being overweight, and body image satisfaction (BIS) on internalizing symptoms related to mental health in adolescents. In addition, sex, age, socioeconomic status (SES), dieting, and physical activity are taken into consideration. This research is based on the international study Health Behaviour in School-aged Children (HBSC). The sample consists of 4531 Spanish adolescents from 13 to 18 years old. Participants were selected through random multi-stage sampling stratified by conglomerates. Two instruments were employed: the HBSC questionnaire and the Youth Self-Report (Achenbach System of Empirically Based Assessment, ASEBA). Results demonstrated that BIS –the emotional component related to body image– was the main predictor of adolescent internalizing symptoms. In addition, results show double-inequalities according to the interaction effects of sex, age, and SES. Likewise, interesting results are shown regarding how dieting behaviors to lose or gain weight/volume and physical activity relate to body image perception and satisfaction, as well as with internalizing symptoms. This study highlights important body image aspects relevant to intervention and prevention of internalized mental health problems in adolescence.
Direct and Indirect Influences of Objective Socioeconomic Position on Adolescent Health: The Mediating Roles of Subjective Socioeconomic Status and Lifestyles.
    Moreno-Maldonado, C., Ramos, P., Moreno, C., & Rivera, F. (2019).
International Journal of Environmental Research and Public Health, 16(9), 1637.
JCR (2018): ENVIRONMENTAL SCIENCES (112 OF 250): Q2, PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH (67 OF 185): Q2
FI: 2,468
Enlace
Abstract: The use of composite indices and subjective measures to evaluate socioeconomic position, taking into account the effect of inequalities on adolescent health-related behaviors, can contribute to understanding the effect of inequalities on health during adolescence. The aim of this study was to examine the direct and indirect contribution of objective and subjective socioeconomic factors in a broad range of health and lifestyles outcomes. The data come from a representative sample of adolescents (N = 15,340; M age = 13.69) of the Health Behavior in School-aged Children study in Spain. Structural equation modeling was used for data analysis. A global index for evaluating objective socioeconomic position predicted both health and healthy lifestyles. Subjective socioeconomic status mediated the relationship between objective socioeconomic position and health but did not have a significant effect on healthy lifestyles when objective indicators were considered. Lastly, fit indices of the multiple-mediator model—including the direct effect of objective socioeconomic position on health and its indirect effects through the subjective perception of wealth and lifestyles—explained 28.7% of global health variance. Interventions aimed at reducing the impact of health inequalities should address, in addition to material deprivation, the psychological and behavioral consequences of feeling poor.
Characterization of Resilient Adolescents in the Context of Parental Unemployment.
    Moreno-Maldonado, C., Jiménez-Iglesias, A., Rivera, F., & Moreno, C. (2019).
Child Indicators Research.
JCR (2018) SOCIAL SCIENCE, INTERDISCIPLINARY (39 OF 104): Q2
FI: 1,656
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Abstract: This research analyzes a group of Spanish adolescents at high risk of adversity –conceptualized as living in households with no employed parent– in one of the countries where unemployment rates have risen significantly due to the recent economic recession. The objective was to identify sociodemographic and contextual factors that promote resilience in this context. Using the Extreme Group Approach and the theoretical framework of resilience, two groups of adolescents living in households with no employed parent were selected from the HBSC-2014 edition in Spain depending on their adaptive response to the risk, measured by a global health score. Therefore, from a total sample of 1336 adolescents at high risk (living in households with no employed parent), 290 resilient adolescents (those who presented the highest scores in their global health score) and 618 maladaptive adolescents (those presenting lower scores in their global health score) were selected, resulting in a final sample composed of 908 adolescents aged 11–18 years old (M = 15.2; DT = 2.18), with a balanced representation of boys and girls. Results showed that support from, and satisfaction with, family and friend relationships, as well as support from classmates and teachers, and satisfaction with the school environment, are protective factors that can foster resilience when facing adversity provoked by parental unemployment and its negative consequences for adolescent health. Intervention programs aimed at reducing the negative impact of parental unemployment on adolescent health should consider these contextual factors, as well as individual factors such as age or sex.
Social inequality in adolescent life satisfaction: Comparison of measure approaches and correlation with macro-level indices in 41 countries.
Zaborskis, A. Grincaite, M., Lenzi, M., Tesler, R., Moreno-Maldonado, C., & Mazur, J. (2019).
Social Indicators Research, 141 (3), 1055–1079.
JCR (2018) SOCIAL SCIENCE, INTERDISCIPLINARY (35 OF 104): Q2, SOCIOLOGY (50 OF 148): Q2.
FI: 1,703
Enlace
Abstract: Family affluence plays a crucial role in adolescent well-being and is potential
source of health inequalities. There are scarce research findings in this area from a cross-
national perspective. This study introduces several methods for measuring family affluence
inequality in adolescent life satisfaction (LS) and assesses its relationship with macro-level
indices. The data  (N =192,718)  were collected in 2013/2014 in 39 European countries,
Canada,  and  Israel,  according  to the  methodology  of  the  cross-national Health  Behavior in
School-aged Children study. The 11-, 13- and 15-year olds were surveyed by means of
self-report  anonymous  questionnaires.  Fifteen  methods  controlling  for  confounders  were
tested to measure social  inequality in adolescent  LS. In each country,  all measures indi-
cated that adolescent from more affluent families showed higher satisfaction with their life
than did those from less affluent families. According to the Poisson regression estimations,
for instance, the lowest inequality in LS was found among adolescents in Malta, while the
highest inequality in LS was found among adolescents in Hungary. The ratio between the
mean values of LS score at the extreme highest and lowest family affluence levels (Relative
Index of Inequality) derived from the regression-based models distinguished for its posi-
tive correlation with the Gini index, and negative correlation with Gross National Income,
Human  Development  Index  and  the  mean  Overall  Life  Satisfaction  score.  The  measure
allows in-depth exploration of the interplay between individual and macro-socioeconomic
factors affecting adolescent well-being from a cross-national perspective.
Multidimensional poverty among adolescents in 38 countries: Evidence from the Health Behaviour in School-aged Children (HBSC) 2013/14 Study. 
Chzhen, Y., Bruckauf, Z., Toczydlowska, E., Elgar, F. J., Moreno-Maldonado, C., Stevens, G. W., ... & Gariépy, G. (2018).
Child Indicators Research, 11(3), 729–753.
JCR (2017) SOCIAL SCIENCES, INTERDISCIPLINARY (21 OF 98). Q1
FI: 1,858
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Abstract: This study applied UNICEF’s Multiple Overlapping Deprivation Analysis (MODA) framework to adolescents (aged 11, 13 and 15) in 37 European countries and Canada using data from the 2013/14 Health Behaviour in School-aged Children survey. It is one of the first applications of MODA based entirely on data collected from adolescents themselves rather than from household reference persons on their behalf. Unlike most other multidimensional child poverty studies, the present analysis focuses on non-material, relational aspects of child poverty. Substantial cross-country variation was found in the prevalence of adolescent deprivations in nutrition, perceived health, school environment, protection from peer violence, family environment and information access. These single dimensions of poverty did not closely relate to national wealth and income inequality. However, when we looked at deprivation in three or more dimensions (i.e., multidimensional poverty), we found association with income inequality. In most countries, girls were at a higher risk of multidimensional poverty than boys. In addition, adolescents who lived with both parents in the household or reported higher family wealth were consistently less poor than other adolescents, in both single and multiple dimensions. The results of this study show the interconnectedness of social (family, school support) and psychological (health and violence) dimensions of poverty for adolescents in higher income countries. Children poor in the domains of family and school environment are also likely to be poor in terms of perceived health and protection from peer violence. 
Measuring the socioeconomic position of adolescents: A proposal for a composite index.
Moreno-Maldonado, C., Rivera, F., Ramos, P., & Moreno, C. (2018).
Social Indicators Research, 136(2), 517-538.
JCR (2017) SOCIAL SCIENCE, INTERDISCIPLINARY (27 OF 98) Q2, SOCIOLOGY (42 OF 147) Q2.
FI: 1,648
Enlace
Abstract: Despite evidence that socioeconomic inequalities impact health, studies on adolescents are limited and often show contradictory results depending on the measures employed to evaluate socioeconomic position. Little research has focused on the differential impact of each indicator on adolescent health, and few measures have been developed that provide a global evaluation. In this research, the relationship between classic socioeconomic indicators (education and occupation) and others that have been proposed more recently (family affluence scale and subjective family wealth) is analysed. A composite global score of socioeconomic position is also presented, based on the principal objective dimensions: parental education, parental occupation and family material wealth. Data were collected in Spain, in 2014, within the framework of the Health Behaviour in School-aged Children study, from a representative national sample of 8739 adolescents aged between 11 and 16 (mean = 13.72, SD = 1.71). The results contribute to resolving methodological difficulties associated with the evaluation of adolescent socioeconomic position, showing the unidimensionality of a global measure of objective wealth and demonstrating it to be a useful instrument for assessing the socioeconomic position in health inequalities research. The subjective perception of wealth presented a similar, and even higher, association with health than the objective measures. However, low correlations between perceived family wealth and the objective socioeconomic indicators (oscillating between .110 and .299) proved to measure a different construct, and thus was not included in the composite measure for assessing the adolescents’ objective socioeconomic position. Results highlighted the importance of including different indicators for measuring socioeconomic inequalities in adolescent health.
How family socioeconomic status, peer behaviors, and school-based intervention on healthy habits influence adolescent eating behaviors.
Moreno-Maldonado, C., Ramos, P., Rivera, F., & Moreno, C. (2018).
School Psychology International, 39(1), 92-118.
JCR (2017) PSYCHOLOGY, EDUCATIONAL (44 OF 59). Q3
FI: 1,103
Enlace
Abstract: Psychologists in schools can play an important role in developing policies and programs to promote healthy eating habits. This study analyses the contributions of family socioeconomic status, peer influence (schoolmates’ food consumption), and school-based nutrition interventions to explain adolescent eating behaviors. Data were obtained from the 2014 Health behaviour in school-aged children survey in Spain, with a sample of 6,851 adolescents (11- to 16-years-old). The results suggest that school-based healthy-eating programs could improve by considering parental education level and by implementing interventions focused on the peer social network. Policies that limit access to unhealthy products in schools – rather than simply offering healthy foods alongside unhealthy products – could be more effective.
Indicadores para detectar y evaluar el impacto de las desigualdades socioeconómicas en los estilos de vida y la salud de los adolescentes españoles.
Moreno-Maldonado, C., Moreno, C. y Rivera, F. (2016).
Apuntes de Psicología, 34(2-3),177-188.
JSM (2015) PSYCOLOGY (923 OF 1027). Q4.

 
Enlace
Abstract: En este estudio se comparan distintos indicadores socioeconómicos en cuanto a su capacidad para predecir desigualdades en la salud y los estilos de vida de la población adolescente. Los resultados muestran que la relación entre los diferentes indicadores socioeconómicos, a pesar de ser significativa, es débil, sugiriendo que cada uno evalúa en cierto grado aspectos distintos del constructo socioeconómico. Además, mientras que el nivel educativo de los progenitores, y especialmente el nivel educativo de las madres, es la variable que muestra mayor capacidad para detectar desigualdades en los estilos de vida adolescentes, la percepción subjetiva de riqueza se revela como el predictor más importante de las desigualdades en salud. Adicionalmente, los resultados de este estudio muestran que no todas las conductas relacionadas con los estilos de vida adolescente y su bienestar están igualmente influenciadas por determinantes socioeconómicos. De esta forma, mientras que las conductas relacionadas con los hábitos de alimentación o la salud adolescente se ven fuertemente influidas por factores socioeconómicos, el efecto de las desigualdades es menos claro en conductas tales como el consumo de tabaco y alcohol. Esta investigación subraya la importancia de la elección de un determinado indicador en estudios que evalúan los efectos de las desigualdades socioeconómicas en los estilos de vida y la salud adolescente.
Analysis of social inequalities in health through an integrated measure of perceived and experienced health in Spanish and Portuguese adolescents.
Ramos, P., Moreno, C., Rivera, F., Gaspar, M., & Morgan, A. (2012). 
Journal of Health Psychology, 17(1), 57-67. 
JCR: CLINICAL PSYCHOLOGY (44 OF 114). Q2
FI: 1,882
Enlace
Abstract: This article compares the self reported health of a sample of 9854 Spanish and Portuguese adolescents aged 11-15 years using an integratedmeasure of health, which takes account of positive and negative factors that affect overall feelings of health and wellbeing. This improved measuresupports the emergence of health agendas that aim to make wellbeing improvements in populations through a combination of both the promotion of positive protective factors and the need to deal with those risk factors that inhibit individuals, communities and populations to attain good health. 
Integrated analysis of the health and social inequalities of Spanish adolescents.
Ramos, P., Moreno, C., Rivera, F., & Pérez, P.J. (2010). 
Child Indicators Research. Online first.
International Journal of Clinical and Health Psychology, 10 (3), 477- 498
JCR: CLINICAL PSYCHOLOGY (38 of 104). Q2
FI: 1,842
Enlace
Abstract: This survey descriptive study presents the process leading up to the creation of a global health score for adolescents. In recent years, the concept of health, which is the bases for this study, has undergone changes to include both dysfunctional elements as well as the individual resources that protect health. The sample was made up of 18,955 adolescents between 11 to 18 years of age, in Spain and with participants in each of the regions making up the kingdom of Spain. Using exploratory and confirmatory factorial analysis techniques, the results showed a global dimension of the health, starting from self-report indicators of life satisfaction, health-related quality of life, perception of the general state of health and psychosomatic complaints. This health score decreased as age increased and more notably among girls, as well as in adolescents from low-income families. The comparative analyses between regions showed differences which were, in principle, not attributable to the economic well-being of the geographic area. Finally, these results and their implications were discussed, as well as the importance of the calculation used in the analysis of the social inequalities in health. 
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