Socioeconomic Disparities in Health Risk Behavior Clusterings Among Korean Adolescents
This study aims to investigate the socioeconomic disparities in health risk behavior clusterings among Korean adolescents and to assess the mediating role of stress on this association.
We analyzed the 2015 Korean Youth Risk Behavior Survey, a nationally representative sample of Korean middle and high school students aged 12–18 years (N = 68,043). The co-occurrence of multiple health risk behaviors (i.e., cigarette smoking, drinking, and unprotected sex) was used to operationalize health risk behavior clusterings that ranged from zero to three. Ordinal and multinomial logistic regressions were conducted to examine socioeconomic disparities in health risk behavior clusterings and mediating effect of perceived stress between socioeconomic status (SES) and health risk behaviors.
When SES was grouped into five groups, adolescents in the lowest SES [adjusted odds ratio (AOR) = 2.15, 95% confidence interval (CI) = 1.90–2.44] and the highest SES (AOR = 1.29, 95% CI = 1.18–1.40) showed a higher likelihood of risk behavior clusterings than any other SES groups. Stress partially mediated the relationship between SES and co-occurrence of multiple health risk behaviors while accounting for their demographic characteristics. Adolescents in the lowest and highest SES reported higher stress than other SES groups, which, in turn, was associated with the co-occurrence of multiple health risk behaviors.
The results suggest that perceived stress level partly explains why affluent as well as low-SES adolescents engage in multiple risk behaviors. The findings also discourage use of a linear approach in socioeconomic disparity investigation in relation to adolescent health behaviors.
KeywordsAdolescent health Risk behaviors Co-occurrence Socioeconomic status Health disparities
Compliance with Ethical Standards
Conflict of Interest
The authors declare that they have no conflicts of interest.
This study was exempted from the review of the Institutional Review Board at the authors’ institution because of the public availability of the data.
Because this was a secondary data analysis of a publicly available dataset, there was no need for informed consent.
- 1.Danaei G, Ding EL, Mozaffarian D, Taylor B, Rehm J, Murray CJ, et al. The preventable causes of death in the United States: comparative risk assessment of dietary, lifestyle, and metabolic risk factors. PLoS Med. 2009;6(4):e1000058. https://doi.org/10.1371/journal.pmed.1000058.CrossRefPubMedPubMedCentralGoogle Scholar
- 3.U.S. Department of Health and Human Services. Preventing tobacco use among youth and young adults: a report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health; 2012. Available athttp://www.surgeongeneral.gov/library/reports/preventing-youth-tobacco-use/full-report.pdf
- 5.U.S. Department of Health and Human Services. The surgeon general’s call to action to prevent and reduce underage drinking. U.S. Department of Health and Human Service, Office of the Surgeon General; 2007. Available athttps://www.ncbi.nlm.nih.gov/books/NBK44360/pdf/Bookshelf_NBK44360.pdf
- 8.DiClemente RJ, Crittenden CP, Rose E, Sales JM, Wingood GM, Crosby RA, et al. Psychosocial predictors of HIV-associated sexual behaviors and the efficacy of prevention interventions in adolescents at-risk for HIV infection: what works and what doesn’t work? Psychosom Med. 2008;70(5):598–605. https://doi.org/10.1097/PSY.0b013e3181775edb.CrossRefPubMedGoogle Scholar
- 14.Schofield HL, Bierman KL, Heinrichs B, Nix RL, Conduct Problems Prevention Research G. Predicting early sexual activity with behavior problems exhibited at school entry and in early adolescence. J Abnorm Child Psychol. 2008;36(8):1175–88. https://doi.org/10.1007/s10802-008-9252-6. CrossRefPubMedPubMedCentralGoogle Scholar
- 19.Adler NE, Ostrove JM. Socioeconomic status and health: what we know and what we don’t. Ann N Y Acad Sci. 1999;896:3–15. https://doi.org/10.1111/j.1749-6632.1999.tb08101.x.CrossRefPubMedGoogle Scholar
- 26.Moor I, Rathmann K, Lenzi M, Pförtner TK, Nagelhout GE, de Looze M, et al. Socioeconomic inequalities in adolescent smoking across 35 countries: a multilevel analysis of the role of family, school and peers. Eur J Pub Health. 2015;25(3):457–63. https://doi.org/10.1093/eurpub/cku244.CrossRefGoogle Scholar
- 41.Ministry of Education, Ministry of Health and Welfare, Korea Centers for Disease Control and Prevention. The 2015 Korea Youth Risk Behavior Web-based Survey. Korea: Sejong; 2015. Available at http://www.yhs.go.kr.
- 43.Adler NE, Epel ES, Castellazzo G, Ickovics JR. Relationship of subjective and objective social status with psychological and physiological functioning: preliminary data in healthy white women. Health Psychol. 2000;19(6):586–92. https://doi.org/10.1037//0278-6188.8.131.526.CrossRefPubMedGoogle Scholar
- 49.Senn TE, Walsh JL, Carey MP. The mediating roles of perceived stress and health behaviors in the relation between objective, subjective, and neighborhood socioeconomic status and perceived health. Ann Behav Med. 2014;48(2):215–24. https://doi.org/10.1007/s12160-014-9591-1.CrossRefPubMedPubMedCentralGoogle Scholar
- 55.Kwon JA, Wickrama KA. Linking family economic pressure and supportive parenting to adolescent health behaviors: two developmental pathways leading to health promoting and health risk behaviors. J Youth Adolesc. 2014;43(7):1176–90. https://doi.org/10.1007/s10964-013-0060-0.CrossRefPubMedGoogle Scholar