Skip to main content
Log in

Indirect health-related selection or social causation? Interpreting the educational differences in adolescent health behaviours

  • Special Section Article
  • Published:
Social Theory & Health Aims and scope Submit manuscript

Abstract

Adolescents’ health behaviours vary with educational achievement. This has been interpreted as indirect health-related selection contributing to later socioeconomic health inequalities. This article discusses whether this pattern rather should be considered within a social causation framework. As adolescents usually are labelled with respect to school performance before engaging in typical unhealthy practices, it may be questioned whether behaviours are important selective factors for being sorted into different educational tracks. In addition, a social causation perspective that emphasises influences from immediate social environments such as social class background and peer milieus seems insufficient to account for the association between health behaviours and school achievement. Educational differences in health behaviours could be due to how education imposes a sorting of adolescents into hierarchies of learning performance and social prospects, with corresponding inequalities in moral recognition. These experiences are likely to impact on adolescents’ identities and behavioural inclinations. Motivations such as communicating feelings of stress, adaptation to future socioeconomic milieus and opposition to the social authorities that have denied them social value may contribute to the higher frequency of unhealthy behaviours among low-achieving adolescents. It is concluded that a social causation perspective may be fruitful for analysing the association between adolescents’ educational careers and their health-related practices.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  • Aaro, L.E., Wold, B., Kannas, L. and Rimpela, M. (1986) Health behaviour in schoolchildren. A WHO cross-national survey. Health Promotion 1 (1): 17–33.

    Article  Google Scholar 

  • Andersen, A., Holstein, B.E. and Due, P. (2008) Large-scale alcohol use and socioeconomic position of origin: Longitudinal study from ages 15 to 19 years. Scandinavian Journal of Public Health 36 (3): 326–329.

    Article  Google Scholar 

  • Bartley, M., Head, J. and Stansfeld, S. (2007) Is attachment style a source of resilience against health inequalities at work? Social Science & Medicine 64 (4): 765–775.

    Article  Google Scholar 

  • Berle, J.O., Mykletun, A., Daltveit, A.K., Rasmussen, S. and Dahl, A.A. (2006) Outcomes in adulthood for children with foetal growth retardation. A linkage study from the Nord-Trondelag Health Study (HUNT) and the Medical Birth Registry of Norway. Acta Psychiatrica Scandinavica 113 (6): 501–509.

    Article  Google Scholar 

  • Beyers, W. and Cok, F. (2008) Adolescent self and identity development in context. Journal of Adolescence 31 (2): 147–150.

    Article  Google Scholar 

  • Black, D. and Whitehead, M. (1992) Inequalities in Health. Harmondsworth, UK: Penguin Books.

    Google Scholar 

  • Blane, D., Smith, G.D. and Bartley, M. (1993) Social selection – What does it contribute to social-class differences in health. Sociology of Health & Illness 15 (1): 2–15.

    Article  Google Scholar 

  • Blane, D., Smith, G.D. and Hart, C. (1999) Some social and physical correlates of intergenerational social mobility: Evidence from the West of Scotland collaborative study. Sociology – The Journal of the British Sociological Association 33 (1): 169–183.

    Google Scholar 

  • Chandola, T., Clarke, P., Morris, J.N. and Blane, D. (2006) Pathways between education and health: A causal modelling approach. Journal of the Royal Statistical Society Series A – Statistics in Society 169: 337–359.

    Article  Google Scholar 

  • Currie, C., et al (eds.) (2008) Inequalities in Young People's Health. Copenhagen, Denmark: WHO Regional office for Europe. HBSC International Report from the 2005/2006 Survey.

  • Denscombe, M. (2000) Social conditions for stress: Young people's experience of doing GCSEs. British Educational Research Journal 26 (3): 359–374.

    Article  Google Scholar 

  • Denscombe, M. (2001) Uncertain identities and health-risking behaviour: The case of young people and smoking in late modernity. British Journal of Sociology 52 (1): 157–177.

    Article  Google Scholar 

  • Finkelstein, D.M., Kubzansky, L.D. and Goodman, E. (2006) Social status, stress, and adolescent smoking. Journal of Adolescent Health 39 (5): 678–685.

    Article  Google Scholar 

  • Friestad, C. and Klepp, K.I. (2006) Socioeconomic status and health behaviour patterns through adolescence: Results from a prospective cohort study in Norway. European Journal of Public Health 16 (1): 41–47.

    Article  Google Scholar 

  • Gadin, K.G. and Hammarstrom, A. (2000) School-related health – A cross-sectional study among young boys and girls. International Journal of Health Services 30 (4): 797–820.

    Article  Google Scholar 

  • Glendinning, A., Hendry, L. and Shucksmith, J. (1995) Life-style, health and social-class in adolescence. Social Science & Medicine 41 (2): 235–248.

    Article  Google Scholar 

  • Glendinning, A., Shucksmith, J. and Hendry, L. (1994) Social-class and adolescent smoking-behavior. Social Science & Medicine 38 (10): 1449–1460.

    Article  Google Scholar 

  • Goldthorpe, J.H. (1996) Class analysis and the reorientation of class theory: The case of persisting differentials in educational attainment. British Journal of Sociology 47 (3): 481–505.

    Article  Google Scholar 

  • Hagquist, C.E.I. (2007) Health inequalities among adolescents – The impact of academic orientation and parents’ education. European Journal of Public Health 17 (1): 21–26.

    Article  Google Scholar 

  • Hammarstrom, A. and Janlert, U. (2005) Health selection in a 14-year follow-up study – A question of gendered discrimination? Social Science & Medicine 61 (10): 2221–2232.

    Article  Google Scholar 

  • Hansen, K.T., Heckman, J.J. and Mullen, K.J. (2004) The effect of schooling and ability on achievement test scores. Journal of Econometrics 121 (1–2): 39–98.

    Article  Google Scholar 

  • Hanson, M.D. and Chen, E. (2007) Socioeconomic status and health behaviors in adolescence: A review of the literature. Journal of Behavioral Medicine 30 (3): 263–285.

    Article  Google Scholar 

  • Hart, C.L., et al (2005) Childhood IQ and all-cause mortality before and after age 65: Prospective observational study linking the Scottish Mental Survey 1932 and the Midspan studies. British Journal of Health Psychology 10: 153–165.

    Article  Google Scholar 

  • Jessor, R. (1987) Problem-behavior theory, psychosocial development, and adolescent problem drinking. British Journal of Addiction 82 (4): 331–342.

    Article  Google Scholar 

  • Johansen, A., Rasmussen, S. and Madsen, M. (2006) Health behaviour among adolescents in Denmark: Influence of school class and individual risk factors. Scandinavian Journal of Public Health 34 (1): 32–40.

    Article  Google Scholar 

  • Kestila, L., et al (2006) Influence of parental education, childhood adversities, and current living conditions on daily smoking in early adulthood. European Journal of Public Health 16 (6): 617–626.

    Article  Google Scholar 

  • Kobus, K. (2003) Peers and adolescent smoking. Addiction 98: 37–55.

    Article  Google Scholar 

  • Koivusilta, L., Arja, R. and Andres, V. (2003) Health behaviours and health in adolescence as predictors of educational level in adulthood: A follow-up study from Finland. Social Science & Medicine 57 (4): 577–593.

    Article  Google Scholar 

  • Koivusilta, L.K., Rimpela, A.H. and Rimpela, M.K. (1999) Health-related lifestyle in adolescence – Origin of social class differences in health? Health Education Research 14 (3): 339–355.

    Article  Google Scholar 

  • Koivusilta, L.K., Rimpela, A.H., Rimpela, M. and Vikat, A. (2001) Health behavior-based selection into educational tracks starts in early adolescence. Health Education Research 16 (2): 201–214.

    Article  Google Scholar 

  • Lucey, H. and Reay, D. (2002) Carrying the beacon of excellence: Social class differentiation and anxiety at a time of transition. Journal of Education Policy 17 (3): 321–336.

    Article  Google Scholar 

  • Lundberg, O. (1991) Childhood living conditions, health status, and social mobility: A contribution to the health selection debate. European Sociological Review 7 (2): 149–162.

    Google Scholar 

  • Mackenbach, J.P. (2005) Genetics and health inequalities: Hypotheses and controversies. Journal of Epidemiology and Community Health 59 (4): 268–273.

    Article  Google Scholar 

  • Major, B. and O'Brien, L.T. (2005) The social psychology of stigma. Annual Review of Psychology 56: 393–421.

    Article  Google Scholar 

  • Mercken, L., Candel, M., Willems, P. and de Vries, H. (2007) Disentangling social selection and social influence effects on adolescent smoking: The importance of reciprocity in friendships. Addiction 102 (9): 1483–1492.

    Article  Google Scholar 

  • Michell, L. and West, P. (1996) Peer pressure to smoke: The meaning depends on the method. Health Education Research 11 (1): 39–49.

    Article  Google Scholar 

  • Mielewczyk, F. and Willig, C. (2007) Old clothes and an older look – The case for a radical makeover in health behaviour research. Theory & Psychology 17 (6): 811–837.

    Article  Google Scholar 

  • Nabi, H., et al (2008) Does personality explain social inequalities in mortality? The French GAZEL cohort study. International Journal of Epidemiology 37 (3): 591–602.

    Article  Google Scholar 

  • Nutbeam, D., Smith, C., Moore, L. and Bauman, A. (1993) Warning – Schools can damage your health – Alienation from school and its impact on health behavior. Journal of Paediatrics and Child Health 29: S25–S30.

    Article  Google Scholar 

  • Pensola, T.H. and Valkonen, T. (2002) Effect of parental social class, own education and social class on mortality among young men. European Journal of Public Health 12 (1): 29–36.

    Article  Google Scholar 

  • Piko, B.F., Luszczynska, A., Gibbons, F.X. and Tekozel, M. (2005) A culture-based study of personal and social influences of adolescent smoking. European Journal of Public Health 15 (4): 393–398.

    Article  Google Scholar 

  • Rasmussen, M., Damsgaard, M.T., Holstein, B.E., Poulsen, L.H. and Due, P. (2005) School connectedness and daily smoking among boys and girls: The influence of parental smoking norms. European Journal of Public Health 15 (6): 607–612.

    Article  Google Scholar 

  • Reay, D. (2005) Beyond consciousness? The psychic landscape of social class. Sociology – The Journal of the British Sociological Association 39 (5): 911–928.

    Google Scholar 

  • Reay, D. and William, D. (1999) ‘I’ll be a nothing’: Structure, agency and the construction of identity through assessment. British Educational Research Journal 25 (3): 343–354.

    Article  Google Scholar 

  • Richter, M. and Lampert, T. (2008) Embodied inequalities: The role of multiple measures of socioeconomic position for adolescent health behaviour. Zeitschrift Fur Soziologie Der Erziehung Und Sozialisation 28 (2): 174–190.

    Google Scholar 

  • Richter, M., Leppin, A. and Gabhainn, S.N. (2006) The relationship between parental socio-economic status and episodes of drunkenness among adolescents: Findings from a cross-national survey. BMC Public Health 6: 289, http://www.biomedcentral.com/1471-2458/6/289, accessed 6 December 2009.

    Article  Google Scholar 

  • Salonna, F., van Dijk, J.P., Geckova, A.M., Sleskova, M., Groothoff, J.W. and Rejneveld, S.A. (2008) Social inequalities in changes in health-related behaviour among Slovak adolescents aged between 15 and 19: A longitudinal study. BMC Public Health 8: 57, http://www.biomedcentral.com/1471-2458/8/57, accessed 6 December 2009.

    Article  Google Scholar 

  • Savage, M. (2000) Class Analysis and Social Transformation. Buckingham, UK: Open University.

    Google Scholar 

  • Savage, M., Bagnall, G. and Longhurst, B. (2001) Ordinary, ambivalent and defensive: Class identities in the Northwest of England. Sociology – The Journal of the British Sociological Association 35 (4): 875–892.

    Google Scholar 

  • Sayer, A. (2003) What are you worth? Recognition, valuation and moral economy. On-Line Papers, published by the Department of Sociology, Lancaster University, http://www.comp.lancs.ac.uk/sociology/papers/Sayer-What-Are-You-Worth.pdf.

  • Sayer, A. (2005a) Class, moral worth and recognition. Sociology – The Journal of the British Sociological Association 39 (5): 947–963.

    Google Scholar 

  • Sayer, A. (2005b) The Moral Significance of Class. Cambridge: Cambridge University Press.

    Book  Google Scholar 

  • Scheffels, J. (2008) A difference that makes a difference: Young adult smokers’ accounts of cigarette brands and package design. Tobacco Control 17 (2): 118–122.

    Article  Google Scholar 

  • Silventoinen, K. (2003) Determinants of variation in adult body height. Journal of Biosocial Science 35 (2): 263–285.

    Article  Google Scholar 

  • Singh-Manoux, A. and Marmot, M. (2005) Role of socialization in explaining social inequalities in health. Social Science & Medicine 60 (9): 2129–2133.

    Article  Google Scholar 

  • Torsheim, T., Aaroe, L.E. and Wold, B. (2003) School-related stress, social support, and distress: Prospective analysis of reciprocal and multilevel relationships. Scandinavian Journal of Psychology 44 (2): 153–159.

    Article  Google Scholar 

  • Tuinstra, J., Groothoff, J.W., Van den Heuvel, W.J.A. and Post, D. (1998) Socio-economic differences in health risk behavior in adolescence: Do they exist? Social Science & Medicine 47 (1): 67–74.

    Article  Google Scholar 

  • Turkheimer, E., Haley, A., Waldron, M., D'Onofrio, B. and Gottesman, I.I. (2003) Socioeconomic status modifies heritability of IQ in young children. Psychological Science 14 (6): 623–628.

    Article  Google Scholar 

  • Tyas, S.L. and Pederson, L.L. (1998) Psychosocial factors related to adolescent smoking: A critical review of the literature. Tobacco Control 7 (4): 409–420.

    Article  Google Scholar 

  • Undheim, A.M. and Sund, A.M. (2005) School factors and the emergence of depressive symptoms among young Norwegian adolescents. European Child & Adolescent Psychiatry 14 (8): 446–453.

    Article  Google Scholar 

  • Vereecken, C.A., Maes, L. and De Bacquer, D. (2004) The influence of parental occupation and the pupils’ educational level on lifestyle behaviors among adolescents in Belgium. Journal of Adolescent Health 34 (4): 330–338.

    Article  Google Scholar 

  • West, P. (1991) Rethinking the Health Selection Explanation for Health Inequalities. Social Science & Medicine 32 (4): 373–384.

    Article  Google Scholar 

  • West, P. (1997) Health inequalities in the early years: Is there equalisation in youth? Social Science & Medicine 44 (6): 833–858.

    Article  Google Scholar 

  • Wilkinson, R.G. (1986) Socio-economic differences in mortality: Interpreting the data on their size and trends. In: R.G. Wilkinson (ed.) Class and Health: Research and Longitudinal Data. London: Tavistock, pp. 1–20.

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Jon Ivar Elstad.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Elstad, J. Indirect health-related selection or social causation? Interpreting the educational differences in adolescent health behaviours. Soc Theory Health 8, 134–150 (2010). https://doi.org/10.1057/sth.2009.26

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1057/sth.2009.26

Keywords

Navigation