Trends in health inequalities in Canadian adolescents from 2002 to 2018

Trends in health inequalities in Canadian adolescents from 2002 to 2018

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Organization: Public Health Agency of Canada

Type: Publication

Date published: 2022-01-04

Findings from the 2018 Health Behaviour of School-aged Children (HBSC) Study.

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Introduction

Social patterns in health track strongly from childhood and adolescence into adulthood (Patton et al., 2016). Therefore, trends in adolescent health inequalities between genders and socioeconomic groups may foreshadow future health inequalities in the adult population.

Despite rising wealth and greater scientific evidence of systemic differences in population health, little progress has been made globally towards the goal of reducing health inequality (Mackenbach, 2012). Data from the Health Behaviour in School-aged Children (HBSC) study show that inequalities in some domains of adolescent health have widened between socioeconomic groups in international populations (Elgar et al., 2015) and gender groups in Canadian populations (Gariépy and Elgar 2016), resembling similar trends found in adult populations (Hu et al., 2016; Mackenbach et al., 2015; Shahidi et al., 2018).

The Canadian HBSC study provides a long view of these trends on nationally representative samples of adolescents in multiple health domains. This report describes trends in socioeconomic and gender inequalities in six domains of adolescent health measured in five consecutive survey cycles (2002 to 2018):

  • physical activity
  • excess body weight
  • frequent physical symptoms
  • frequent psychological symptoms
  • low life satisfaction
  • fair or poor self-rated health

Characteristics of the study sample

There was a decline in two-parent households from 2002 (84.9%) to 2014 (78.0%). Although still lower than 2002, there was an increase in two-parent households noted from 2014 to 2018 (81.3%).

The prevalence of excess body weight increased from 2002 (19.7%) to 2014 (25.1%). Although still higher than 2002, there was a decrease in excess body weight noted from 2014 to 2018 (23.0%).

Across the survey years, adolescents in 2002 had the lowest prevalence of psychological symptoms, low life satisfaction, and fair or poor health with increases reported in the following survey years.

Table 1: Characteristics of the study sample (weighted percentages and 95% confidence intervals) by survey cycle (n = 94,887)
N/A 2002 2006 2010 2014 2018
Girls

53.41
(50.58, 56.23)

52.92
(51.72, 54.15)

50.83
(49.29, 52.41)

50.63
(49.53, 52.21)

51.33
(51.12, 53.81)

Boys

46.59
(43.79, 49.43)

47.06
(45.86, 48.24)

49.14
(47.60, 50.71)

48.87
(47.76, 50.41)

46.52
(46.20, 48.88)

Family structure:
Two-parent family

84.94
(83.68, 86.16)

78.93
(77.80, 80.02)

77.68
(76.74, 78.51)

77.98
(76.96, 78.92)

81.33
(80.34, 82.21)

Family structure:
One-parent family

13.84
(12.76, 14.91)

18.25
(17.25, 19.21)

18.67
(17.86, 19.54)

17.64
(16.79, 18.55)

16.35
(15.47, 17.23)

Family structure: Other

1.23
(0.93, 1.62)

2.82
(2.47, 3.21)

3.65
(3.30, 4.03)

4.38
(3.96, 4.83)

2.32
(2.00, 2.70)

Physically activeTable 1 Footnote a

22.27
(20.68, 23.91)

23.18
(22.00, 24.42)

22.80
(21.90, 23.73)

24.00
(23.03, 24.97)

24.98
(23.73, 26.25)

Excess body weightTable 1 Footnote b

19.67
(18.17, 21.21)

21.39
(20.27, 22.51)

21.43
(20.51, 22.34)

25.05
(23.97, 26.15)

23.01
(21.85, 24.22)

Two or more physical symptomsTable 1 Footnote c

24.35
(22.90, 25.87)

27.50
(26.42, 28.62)

26.85
(25.96, 27.77)

25.98
(25.13, 26.88)

25.42
(24.33, 26.56)

Two or more psychological symptomsTable 1 Footnote d

38.12
(36.33, 39.93)

42.21
(41.04, 43.34)

41.33
(40.37, 42.21)

40.95
(39.90, 42.12)

42.73
(41.50, 43.97)

Low life satisfactionTable 1 Footnote e

14.32
(13.10, 15.63)

14.91
(13.99, 15.81)

16.93
(16.20, 17.68)

17.09
(16.37, 17.85)

17.86
(16.86, 18.84)

Fair or poor healthTable 1 Footnote f

12.95
(11.85, 14.20)

15.87
(15.04, 16.71)

16.17
(15.44, 16.94)

17.05
(16.30, 17.84)

17.10
(15.99, 18.23)

Socioeconomic differences in six health domains

Socioeconomic differences were found in five health domains, with adolescents at the lowest level of material deprivation (i.e., highest socioeconomic status) experiencing more physical activity, less excess body weight, fewer psychological symptoms, less low life satisfaction, and less fair or poor health as compared to adolescents at the highest level of material deprivation. The prevalence of physical symptoms did not differ between socioeconomic groups.

From 2002 to 2018, differences in health between socioeconomic groups increased in four domains - in excess body weight, physical symptoms, low life satisfaction and fair or poor health. In each case, the absolute difference in prevalence between the highest and lowest socioeconomic groups increased. However, relative differences (i.e., rate ratio for the lowest socioeconomic group compared to the highest) were found only in excess body weight. The significance of these trends is summarized in Table 2. Measures of socioeconomic status and health inequality are described in the Methods.

Figure 1: Prevalence estimates in six health domains by levels of socioeconomic status (lowest, mean and highest; n=94,887)
Figure 1: Prevalence estimates in six health domains by levels of socioeconomic status (lowest, mean and highest; n=94,887)
Figure 1: Text equivalent
Physically active
Deprivation Survey cycle Prevalence (%) 95% confidence interval
(lower limit)
95% confidence interval
(upper limit)
Lowest deprivation 2002 25.56% 23.17% 27.95%
2006 28.51% 26.74% 30.28%
2010 26.97% 25.51% 28.43%
2014 28.21% 26.67% 29.74%
2018 30.44% 28.61% 32.27%
Mean deprivation 2002 21.89% 20.72% 23.07%
2006 23.25% 22.39% 24.11%
2010 22.75% 22.02% 23.47%
2014 23.64% 22.88% 24.40%
2018 24.35% 23.46% 25.23%
Highest deprivation 2002 18.23% 16.02% 20.44%
2006 17.99% 16.42% 19.56%
2010 18.52% 17.16% 19.88%
2014 19.07% 17.62% 20.53%
2018 18.25% 16.64% 19.87%
Excess body weight
Deprivation Survey cycle Prevalence (%) 95% confidence interval
(lower limit)
95% confidence interval
(upper limit)
Lowest deprivation 2002 16.24% 13.66% 18.82%
2006 18.64% 16.74% 20.54%
2010 17.24% 15.66% 18.83%
2014 17.99% 16.30% 19.68%
2018 16.54% 14.53% 18.55%
Mean deprivation 2002 19.69% 18.33% 21.06%
2006 21.40% 20.43% 22.38%
2010 21.21% 20.37% 22.06%
2014 24.98% 24.04% 25.91%
2018 23.33% 22.22% 24.43%
Highest deprivation 2002 23.15% 20.35% 25.94%
2006 24.17% 22.12% 26.21%
2010 25.19% 23.40% 26.98%
2014 31.96% 29.93% 33.99%
2018 30.12% 27.70% 32.53%
Two or more physical symptoms
Deprivation Survey cycle Prevalence (%) 95% confidence interval
(lower limit)
95% confidence interval
(upper limit)
Lowest deprivation 2002 26.81% 24.41% 29.22%
2006 26.81% 25.03% 28.60%
2010 25.61% 24.19% 27.02%
2014 25.10% 23.60% 26.59%
2018 24.15% 22.41% 25.89%
Mean deprivation 2002 25.97% 24.77% 27.18%
2006 26.91% 26.02% 27.80%
2010 26.85% 26.11% 27.59%
2014 25.99% 25.22% 26.75%
2018 25.94% 25.05% 26.83%
Highest deprivation 2002 25.13% 22.80% 27.46%
2006 27.01% 25.23% 28.78%
2010 28.09% 26.59% 29.60%
2014 26.88% 25.33% 28.42%
2018 27.74% 25.97% 29.50%
Low life satisfaction
Deprivation Survey cycle Prevalence (%) 95% confidence interval
(lower limit)
95% confidence interval
(upper limit)
Lowest deprivation 2002 9.14% 7.49% 10.78%
2006 9.83% 8.62% 11.04%
2010 9.94% 8.91% 10.96%
2014 9.04% 8.02% 10.06%
2018 9.70% 8.43% 10.97%
Mean deprivation 2002 14.87% 13.87% 15.88%
2006 14.90% 14.19% 15.61%
2010 16.74% 16.11% 17.38%
2014 16.73% 16.05% 17.40%
2018 17.02% 16.24% 17.79%
Highest deprivation 2002 20.61% 18.49% 22.72%
2006 19.97% 18.45% 21.48%
2010 23.55% 22.19% 24.92%
2014 24.42% 22.96% 25.87%
2018 24.33% 22.70% 25.96%
Fair or poor health
Deprivation Survey cycle Prevalence (%) 95% confidence interval
(lower limit)
95% confidence interval
(upper limit)
Lowest deprivation 2002 10.97% 9.29% 12.64%
2006 10.30% 9.03% 11.58%
2010 10.92% 9.84% 12.00%
2014 10.74% 9.67% 11.80%
2018 11.30% 9.96% 12.65%
Mean deprivation 2002 14.10% 13.15% 15.04%
2006 15.39% 14.65% 16.12%
2010 15.64% 15.02% 16.26%
2014 16.57% 15.91% 17.23%
2018 16.76% 15.99% 17.52%
Highest deprivation 2002 17.22% 15.29% 19.16%
2006 20.47% 18.91% 22.02%
2010 20.37% 19.04% 21.69%
2014 22.41% 21.00% 23.81%
2018 22.21% 20.61% 23.81%
Two or more psychological symptoms
Deprivation Survey cycle Prevalence (%) 95% confidence interval
(lower limit)
95% confidence interval
(upper limit)
Lowest deprivation 2002 37.61% 34.82% 40.40%
2006 38.57% 36.56% 40.58%
2010 38.39% 36.75% 40.03%
2014 36.66% 34.94% 38.38%
2018 40.72% 38.64% 42.81%
Mean deprivation 2002 39.59% 38.20% 40.98%
2006 41.76% 40.76% 42.77%
2010 41.65% 40.81% 42.49%
2014 41.19% 40.31% 42.08%
2018 44.16% 43.11% 45.21%
Highest deprivation 2002 41.58% 38.80% 44.35%
2006 44.96% 42.93% 46.99%
2010 44.91% 43.18% 46.63%
2014 45.73% 43.90% 47.55%
2018 47.60% 45.51% 49.69%

Prevalence estimates were weighted and adjusted for gender, age, and family structure. Shaded area represents 95% confidence interval. Socioeconomic status is a regression-based indicator based on a proportional rank in material deprivation. Change in health inequalities over time was tested by regressing each health measure on interactions of deprivation and survey cycle (see Methods).

Source: Health Behaviour in School-aged Children (HBSC), Canada, 2002-2018.

Gender differences in six health domains

In all five survey cycles, girls reported experiencing worse health than boys in all domains, except for excess body weight which was more prevalent in boys.

From 2002 to 2018, health differences between gender groups widened in terms of physical symptoms, psychological symptoms, and low life satisfaction. Health differences between gender groups remained stable in physical activity and fair or poor health.

Figure 2: Prevalence estimates in six health domains by gender (n=94,887)
Figure 2: Prevalence estimates in six health domains by gender (n=94,887)
Figure 2: Text equivalent
Physically active
Gender Year Prevalence (%) 95% confidence interval
(lower limit)
95% confidence interval
(upper limit)
Male 2002 26.92% 25.03% 28.81%
2006 30.64% 29.25% 32.04%
2010 28.45% 27.32% 29.59%
2014 30.76% 29.54% 31.99%
2018 31.17% 29.72% 32.61%
Female 2002 17.04% 15.54% 18.55%
2006 16.89% 15.84% 17.93%
2010 17.49% 16.57% 18.42%
2014 17.48% 16.54% 18.43%
2018 18.23% 17.12% 19.34%
Excess body weight
Gender Year Prevalence (%) 95% confidence interval
(lower limit)
95% confidence interval
(upper limit)
Male 2002 23.11% 21.02% 25.20%
2006 25.73% 24.23% 27.23%
2010 24.72% 23.48% 25.96%
2014 28.38% 27.00% 29.76%
2018 25.62% 23.96% 27.27%
Female 2002 16.30% 14.52% 18.07%
2006 17.43% 16.17% 18.68%
2010 17.66% 16.53% 18.78%
2014 21.13% 19.87% 22.38%
2018 20.24% 18.77% 21.71%
Two or more physical symptoms
Gender Year Prevalence (%) 95% confidence interval
(lower limit)
95% confidence interval
(upper limit)
Male 2002 20.64% 18.97% 22.30%
2006 20.27% 19.08% 21.46%
2010 20.07% 19.10% 21.03%
2014 18.59% 17.62% 19.56%
2018 17.91% 16.80% 19.03%
Female 2002 30.09% 28.27% 31.92%
2006 32.80% 31.46% 34.14%
2010 32.87% 31.72% 34.01%
2014 32.94% 31.75% 34.12%
2018 33.69% 32.32% 35.06%
Low life satisfaction
Gender Year Prevalence (%) 95% confidence interval
(lower limit)
95% confidence interval
(upper limit)
Male 2002 12.23% 10.96% 13.51%
2006 12.34% 11.45% 13.24%
2010 14.02% 13.22% 14.82%
2014 12.57% 11.77% 13.38%
2018 12.20% 11.28% 13.11%
Female 2002 17.17% 15.71% 18.63%
2006 17.42% 16.37% 18.47%
2010 18.61% 17.65% 19.57%
2014 20.34% 19.33% 21.36%
2018 21.67% 20.50% 22.84%
Fair or poor health
Gender Year Prevalence (%) 95% confidence interval
(lower limit)
95% confidence interval
(upper limit)
Male 2002 12.78% 11.56% 14.00%
2006 13.02% 12.07% 13.97%
2010 14.16% 13.34% 14.98%
2014 14.86% 14.00% 15.72%
2018 14.84% 13.81% 15.87%
Female 2002 15.73% 14.40% 17.06%
2006 17.57% 16.50% 18.63%
2010 16.86% 15.96% 17.76%
2014 17.74% 16.79% 18.69%
2018 18.33% 17.23% 19.44%
Two or more psychological symptoms
Gender Year Prevalence (%) 95% confidence interval
(lower limit)
95% confidence interval
(upper limit)
Male 2002 36.27% 34.25% 38.30%
2006 35.73% 34.29% 37.17%
2010 34.81% 33.65% 35.98%
2014 31.74% 30.55% 32.93%
2018 34.73% 33.28% 36.18%
Female 2002 42.17% 40.21% 44.14%
2006 47.09% 45.67% 48.51%
2010 47.74% 46.53% 48.96%
2014 50.07% 48.80% 51.33%
2018 52.80% 51.34% 54.27%

Prevalence estimates are weighted and adjusted for socioeconomic status, age and family structure. Shaded area represents 95% confidence interval. Change in health inequalities over time was tested by regressing each health measure on interactions of gender and survey cycle (see Methods).

Source: Health Behaviour in School-aged Children (HBSC), Canada, 2002-2018.

Trends in prevalence and inequalities in adolescent health

From 2002 to 2018, the prevalence of ill health increased in four domains. However, the prevalence of daily physical activity rose from 22 to 25 percent. Physical activity is the only health measure that showed no change in inequality between socioeconomic and gender groups over the five survey cycles.

Differences in the prevalence of ill health between socioeconomic groups increased in four domains - excess body weight, physical symptoms, low life satisfaction, and fair or poor health. The largest change was found in excess body weight, where the difference between the highest and lowest socioeconomic groups increased from a 7-point difference in 2002 to a 14-point difference in 2018.

Gender differences in health were stable with respect to daily physical activity and fair or poor health and increased in three domains in both absolute and relative terms: physical symptoms, psychological symptoms, and low life satisfaction. In each case, girls reported poorer health than boys and those gender gaps increased over time.

A decrease in health inequality was found in excess body weight, which decreased in relative terms between gender groups. In 2002, the prevalence of excess body weight in girls was 71% the rate found in boys. In 2018, that figure decreased slightly to 69%.

Table 2. Trends in the prevalence and inequalities in adolescent health, 2002 to 2018
N/A Prevalence Socioeconomic inequality Gender inequality
AbsoluteTable 2 Footnote a RelativeTable 2 Footnote b AbsoluteTable 2 Footnote a RelativeTable 2 Footnote b
Physically active (22 to 25%)Table 2 Footnote 1 (-7 to -12)Table 2 Footnote 3 (71 to 60%)Table 2 Footnote 3 (-10 to -13)Table 2 Footnote 3 (63 to 58%)Table 2 Footnote 3
Excess body weight (20 to 23%)Table 2 Footnote 1 (7 to 14)Table 2 Footnote 1 (142 to 182%)Table 2 Footnote 1 (-7 to -8)Table 2 Footnote 3 (71 to 69%)Table 2 Footnote 2
Two or more physical symptoms (24 to 25%)Table 2 Footnote 3 (-2 to 4)Table 2 Footnote 1 (94 to 114%)Table 2 Footnote 3 (6 to 16)Table 2 Footnote 1 (146 to 188%)Table 2 Footnote 1
Two or more psychological symptoms (38 to 43%)Table 2 Footnote 1 (4 to 7)Table 2 Footnote 3 (111 to 117%)Table 2 Footnote 3 (6 to 18)Table 2 Footnote 1 (116 to 152%)Table 2 Footnote 1
Low life satisfaction (14 to 18%)Table 2 Footnote 1 (11 to 15)Table 2 Footnote 1 (225 to 251%)Table 2 Footnote 3 (5 to 10)Table 2 Footnote 1 (140 to 178%)Table 2 Footnote 1
Fair or poor health (13 to 17%)Table 2 Footnote 1 (6 to 11)Table 2 Footnote 1 (156 to 196%)Table 2 Footnote 3 (3 to 4)Table 2 Footnote 3 (123 to 124%)Table 2 Footnote 3

Limitations

All research studies have limitations and it is important to interpret results in light of their limitations.

  1. All data in the HBSC were collected using self-report, which is prone to reporting biases (Choi & Pak, 2005).
  2. Socioeconomic status is estimated using an index of material assets that provide or symbolize affluence in the family (e.g., car ownership, vacations). The HBSC Family Affluence Scale is a valid, age-appropriate tool for adolescents, however these data do not correlate closely to household income or parent occupational rank (Elgar et al., 2017). Therefore, the health inequalities reported here may differ from other estimates based on other socioeconomic assessments. Additionally, two items were added to the scale in 2014 and 2018 cycles that were not included in previous cycles. Our use of a proportional rank index (ridit score) to estimate socioeconomic status adjusts for this and harmonizes the variable accordingly.
  3. Binary measures of gender (male/female) were used from 2002 to 2014, which excluded and/or misrepresented adolescents who did not identify as either. The 2018 survey allowed for a non-binary response option ("neither term describes me"), as will future cycles.

Conclusions

Five survey cycles of the Canadian HBSC study revealed increased health inequalities between socioeconomic and gender groups from 2002 to 2018.

The burden of ill health shifted towards disadvantaged adolescents in terms of excess body weight, physical symptoms, low life satisfaction, and fair or poor health.

Gender inequalities increased in frequent physical and psychological symptoms and low life satisfaction.

Similar trends were reported in the Canadian adult population (Shahidi et al., 2018) and in adolescents in several European countries (Inchley, 2020).

Monitoring health inequalities in adolescents informs policy approaches to reducing these gaps early in the life course.

Methods

Data source

The data were collected from the 4th to 8th cycles of the Canadian Health Behaviour in School-aged Children (HBSC) study, a World Health Organization cross-national research study that focuses on the health of 11-15 year-old students and was conducted every 4 years.

The main purposes of the HBSC are to understand youth health and well-being and to inform education, health policy and health promotion programs in Canada and abroad (Public Health Agency of Canada, 2020).

Eligible school classrooms across Canada were selected at random and invited to participate in the study. Data were collected in school settings from a nationally representative random two-stage cluster sample of adolescents in grades 6 to 10 from all provinces and territories in Canada.

Measures

Questionnaires included a 6-item measure of material assets in the home (HBSC Family Affluence Scale), which measures number of cars, having one's own bedroom, number of computers in the home, number of bathrooms, family holidays in the past year, and having a dishwasher. The responses were compiled into proportional rank index of material deprivation in the family, ranging from a score of 0 (lowest deprivation) to a score 1 (highest deprivation) with an average of 0.5 (Elgar et al., 2017). Questionnaires also included measures of physical activity (days of 60+ minutes of moderate-to-vigorous physical activity in the previous week), self-reported height and weight, eight psychological and physical symptoms (Gariepy et al., 2016), life satisfaction (Cantril, 1965), and general health (fair, poor, good or excellent).

Statistical analyses

We evaluated differences in health between socioeconomic and gender groups in six health domains. The measure of socioeconomic status (SES) allowed for the computation of regression-based indicators of socioeconomic inequality (Mackenbach & Kunst, 1997). SES was used as an interaction term with the survey cycle to assess for significant trends in socioeconomic inequality over time, while controlling for age, gender, and family structure in multilevel regression models. The gender inequality analysis used gender as an interaction term with the survey cycle to assess for significant trends in gender inequality over time, while controlling for age, SES, and family structure in multilevel regression models. Survey weights were applied to ensure the results were representative of the Canadian population and to equalize the importance of each survey cycle to the analysis. All analyses used standardized weights to account for variations in sampling and a level of significance set at p<0.05, and were conducted in Stata 16.0 (Stata Press, 2019).

References

Bor, W., Dean, A. J., Najman, J., & Hayatbakhsh, R. (2014). Are child and adolescent mental health problems increasing in the 21st century? A systematic review. The Australian and New Zealand Journal of Psychiatry, 48(7), 606-616. https://doi.org/10.1177/0004867414533834

Cantril, H. (1965). The pattern of human concerns. Rutgers University Press, New Brunswick.

Choi, B. C. K., & Pak, A. W. P. (2005). A catalog of biases in questionnaires. Preventing Chronic Disease, 2, A13.

Eikemo, T. A., Skalická, V., & Avendano, M. (2009). Variations in relative health inequalities: are they a mathematical artefact? International Journal for Equity in Health, 8, 32. https://doi.org/10.1186/1475-9276-8-32

Elgar, F. J., Pförtner, T. K., Moor, I., De Clercq, B., Stevens, G. W. J. M., & Currie, C. (2015). Socioeconomic inequalities in adolescent health 2002-2010: A time-series analysis of 34 countries participating in the Health Behaviour in School-aged Children study. The Lancet, 385(9982), 2088-2095. https://doi.org/10.1016/s0140-6736(14)61460-4

Elgar, F. J., Xie, A., Pfortner, T.-K., White, J., & Pickett, K. E. (2017). Assessing the view from bottom: How to measure socioeconomic position and relative deprivation in adolescents. In SAGE Research Methods Cases (Vol. Part 2). SAGE.

Gariépy, G., & Elgar, F. J. (2016). Trends in psychological symptoms among Canadian adolescents from 2002 to 2014: Gender and socioeconomic differences. Canadian Journal of Psychiatry, 61(12), 797-802. https://dx.doi.org/10.1177%2F0706743716670130

Gariepy, G., McKinnon, B., Sentenac, M., & Elgar, F. J. (2016). Validity and reliability of a brief symptom checklist to measure psychological health in school-aged children. Child Indicators Research, 9(2), 471-484.

Hu, Y., van Lenthe, F. J., Borsboom, G. J., Looman, C. W., Bopp, M., Burström, B., Dzúrová, D., Ekholm, O., Klumbiene, J., Lahelma, E., Leinsalu, M., Regidor, E., Santana, P., de Gelder, R., & Mackenbach, J. P. (2016). Trends in socioeconomic inequalities in self-assessed health in 17 European countries between 1990 and 2010. Journal of Epidemiology and Community Health, 70(7), 644-652.

Inchley, J., Currie, D., Budisavljevic, S., Torsheim, T., Jåstad, A., Cosma, A. et al. (2020). Spotlight on adolescent health and well-being. Findings from the 2017/2018 Health Behaviour in School-aged Children (HBSC) survey in Europe and Canada. International report. Volume 1. Key findings. Copenhagen: WHO Regional Office for Europe.

Keeley, B. (2015). Income inequality: The gap between rich and poor. OECD Insights, Paris: OECD Publishing.

Mackenbach, J. P., Kulhánová, I., Menvielle, G., Bopp, M., Borrell, C., Costa, G., Deboosere, P., Esnaola, S., Kalediene, R., Kovacs, K., Leinsalu, M., Martikainen, P., Regidor, E., Rodriguez-Sanz, M., Strand, B. H., Hoffmann, R., Eikemo, T. A., Östergren, O., Lundberg, O., & Eurothine and EURO-GBD-SE consortiums (2015). Trends in inequalities in premature mortality: a study of 3.2 million deaths in 13 European countries. Journal of Epidemiology and Community Health, 69(3), 207-206.

McCartney, G., Collins, C., & Mackenzie, M. (2013). What (or who) causes health inequalities: theories, evidence and implications? Health Policy, 113(3), 221-227. https://doi.org/10.1016/j.healthpol.2013.05.021

Patton, G. C., Sawyer, S. M., Santelli, J. S., Ross, D. A., Afifi, R., Allen, N. B., Arora, M., Azzopardi, P., Baldwin, W., Bonell, C., Kakuma, R., Kennedy, E., Mahon, J., McGovern, T., Mokdad, A. H., Patel, V., Petroni, S., Reavley, N., Taiwo, K., Waldfogel, J., Wickremarathne, D., Barroso, C., Bhutta, Z., Fatusi, A. O., Mattoo, A., Diers, J., Fang, J., Ferguson, J., Ssewamala, F., & Viner, R. M. (2016). Our future: A Lancet commission on adolescent health and wellbeing. The Lancet, 387(10036), 2423-2478. https://doi.org/10.1016/s0140-6736(16)00579-1

Pillas, D., Marmot, M., Naicker, K., Goldblatt, P., Morrison, J., & Pikhart, H. (2014). Social inequalities in early childhood health and development: A European-wide systematic review. Pediatric Research, 76(5), 418-424.

Public Health Agency of Canada [PHAC]. (2020). The health of Canadian youth: Findings from the health behaviour in school-aged children study. Retrieved from https://www.canada.ca/en/public-health/services/publications/science-research-data/youth-findings-health-behaviour-school-agedchildren-study.html

Shahidi, Vahid, F., Muntaner, C., Shankardass, K., Quiñonez, C., & Siddiqi, A. (2018). Widening health inequalities between the employed and the unemployed: A decomposition of trends in Canada (2000-2014). PloS one, 13(11), e0208444. https://dx.doi.org/10.1371%2Fjournal.pone.0208444

Acknowledgements

  • Health Behaviour in School-aged Children (HBSC) is an international study carried out in collaboration with the World Health Organization, European Region (WHO/EURO). The International HBSC Coordinator was Dr. Joanna Inchley (University of Glasgow, Scotland) for the 2017/18 survey and the Data Bank Manager was Dr. Oddrun Samdal (University of Bergen, Norway). The Canadian 2017/18 HBSC survey was funded by the Public Health Agency of Canada, the principal investigators were Drs. John Freeman, William Pickett and Wendy Craig (Queen's University), and the national coordinator was Matthew King (Social Program Evaluation Group, Queen's University).
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