Socially structured health behaviors : Studies of social inequality in adolescent and young adult physical activity, alcohol consumption, and smoking in Sweden

Health behaviors contribute to the Swedish national disease burden and to social inequalities in health. This thesis aims to increase our knowledge of whether, when, and how health behaviors become socially structured during early life in Sweden. The thesis contains four empirical studies that together examine how dimensions of childhood socioeconomic position associate with adolescent and young adult health behaviors using Swedish Level-of-Living survey data. Study I examined how different dimensions of social stratification (i.e., parental education, social class, income, immigration background) associate with adolescent and young adult physical inactivity. Analyses showed that physical inactivity in adolescence tracked to young adulthood; however, prior inactivity did not fully explain social differences in young adult physical inactivity. Physical inactivity was socially patterned, but different dimensions of social stratification should not be considered interchangeable as they may operate independently, through intersection with gender, and at different time points in youth in increasing the risk of physical inactivity. Study II examined how parental education associates with two often-conflated drinking patterns in young adulthood. It also examined whether this association could be explained by parental drinking patterns or young adult educational attainment. The results show that parental education constitutes an early-life structural position that confers differential risk for young adult drinking patterns: Young adults with lower educated parents were less likely to drink frequently but were more likely to drink heavily per occasion, a drinking pattern that may place more disadvantaged young adults at a greater health risk. Study III assessed how different measures of education in early life associate with smoking behavior in young adulthood. Analyses showed that young adults with lower educated parents were more likely to have started smoking and were less likely to have quit smoking. School performance in adolescence was associated with smoking initiation and cessation, and school performance explained differences in initiation by parental education. Results suggest that adolescent school performance (which in part connects adolescents’ socioeconomic position of origin with their destination) may play an important role in how educational disparities in smoking are formed. Study IV examined whether young adults’ sense of coherence explains educational differences in their health lifestyles. Education (parental and young adult) was positively associated with sense of coherence and with having a health-promoting lifestyle. Sense of coherence was also positively associated with having a health-promoting lifestyle. However, young adults’ sense of coherence did not explain educational differences in their health lifestyles. This thesis shows that health behaviors are socially patterned in adolescence and young adulthood in Sweden. However, for the most part, examined inter- and intra-generational pathways did not explain associations between childhood socioeconomic position and young adult health behaviors. Instead, the studies point to multiple relevant early life structural and behavioral factors. This highlights the importance of reducing childhood social inequalities, as early life social inequalities may affect early life behavioral inequalities, which have consequences for health and health equity in a life course perspective