Smoking contributes to health inequalities, but how social inequalities in smoking develop in early life remains unclear. This study examines how measures of education attained over the early life course (representing so-cioeconomic position of origin, socioeconomic position of destination, and in-between) contribute to smoking behavior in a Swedish longitudinal sample. We used data obtained from the Swedish Level-of-Living Surveys in addition to national register data. Young adults (aged 20–28, n =749) self-reported their educational attainment and smoking behavior (initiation and cessation) in 2010. Ten years earlier, their parents self-reported their own education and smoking behavior. We used linked register data on school performance in adolescence (in grade 9). Logistic regression models showed that lower parental education, lower adolescent school performance, and low young adult educational attainment were respectively associated with young adult smoking initiation. The association between parental education and young adult smoking initiation was explained by adolescent school performance and not parental smoking. Young adult smoking cessation was associated with high parental ed-ucation and high adolescent school performance (marks in the top quartile), but only school performance remained significant in the final model, which included all measures of education and parental smoking. Results suggest that school performance in adolescence (which connects adolescents’ socioeconomic position of origin with their destination) may play an important role in how educational disparities in smoking form over the life course.   

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.

Background

Alcohol consumption contributes to health inequalities, but few studies have examined how socially differentiated alcohol use develops across the life course. In this study, we examine how one aspect of childhood socioeconomic position (parental education) relates to two often-conflated young adult drinking patterns: drinking frequency and quantity per occasion. Using a life course perspective, we also explore whether parental drinking patterns or young adults’ own educational attainment might account for such associations.

Methods

This study used longitudinal data from the nationally representative Swedish Level of Living Surveys (LNU). Young adults’ (aged 20–28, n = 803) drinking patterns and educational attainment were determined through the LNU 2010 and official registers. A decade earlier, parents self-reported their education and drinking patterns in the LNU 2000 and Partner-LNU 2000.

Results

Logistic regression models showed that high parental education predicted young adult frequent drinking, while low parental education predicted young adult high quantity drinking. Drinking patterns were associated inter-generationally, but parental alcohol use did not account for differences in young adult drinking patterns by parental education. Young adults’ own education similarly predicted their drinking patterns but did not account for differences in drinking frequency by parental education. Differences in drinking quantity by parental education were no longer significant when young adults’ own education was included in the final model.

Conclusions

Findings suggest that parental education constitutes an early-life structural position that confers differential risk for young adult drinking patterns. Young adults whose parents had low education 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.

Background

Alcohol-related mortality is more prevalent in disadvantaged socioeconomic groups. Yet the relationship between socioeconomic position and alcohol use in young adulthood, when alcohol is often consumed in high quantities, is not well understood and findings are inconclusive. In this study, our aim was to examine whether two often-conflated dimensions of alcohol use (i.e., frequency and quantity) in young adulthood associate with parental educational attainment. We also explored whether parental alcohol use (same two dimensions) or young adult educational attainment may help explain this association.

Methods

Data was collected from two waves (2000 & 2010) of the Swedish Level of Living Survey, with parents surveyed ten years before the young adults. Young adults’ (N = 803) risk of daily/weekly and monthly drinking, relative to less frequent drinking, was analysed by multinomial logistic regression and estimated as relative risk ratios (RR); episodic heavy drinking was assessed through binary logistic regression and estimated as odds ratios (OR).

Results

Young adults whose parents held a compulsory (versus tertiary) degree were less likely to drink daily/weekly (RR = 0.18, 95% CI [0.07, 0.47]) but more likely to drink heavily (OR = 2.67, 95% CI [1.17, 6.06]). The same dimensions of alcohol use were associated across generations but did not explain inequalities by parental educational attainment. Accounting for young adult educational attainment left an independent effect of parental compulsory education (RR = 0.27, 95% CI [0.10, 0.73]) on young adult daily/weekly drinking.

Conclusions

Parental educational attainment can be viewed as an early-life structural factor that confers differential risk for young adult alcohol use, depending on the dimension of use: high educational attainment is a risk factor for frequent drinking while low educational attainment is a risk factor for episodic heavy drinking.

As physical inactivity may track from adolescence to adulthood, it is important to identify social determinants of physical inactivity in early life. However, most studies have measured socioeconomic position as one dimension. We examine whether multiple dimensions of socioeconomic position, in addition to other dimensions of inequality (i.e., gender, immigrant background), associate with physical inactivity at two time points in youth. Longitudinal data were drawn from the Swedish Level of Living Survey (N = 765) and analysed by gender-stratified logistic regression. Among girls, low parental social class (odds ratio [OR] = 2.63, 95% confidence interval [CI; 1.28, 5.42]) and income (OR = 2.28, 95% [CI 1.12, 4.65]) were associated with physical inactivity, while immigrant background (OR = 2.33, 95% CI [1.03, 5.23]) and a low level of parental education (OR = 3.38, 95% CI [1.15, 9.95]) predicted physical inactivity among women. Among boys, low parental income (OR = 3.27, 95% CI [1.39, 7.69]) was associated with physical inactivity, whereas immigrant background (OR = 2.29, 95% CI [1.04, 5.03]) predicted physical inactivity among men. Our results suggest that physical inactivity is 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.

Educational differences in health are in part attributed to educational differences in health behaviors. However, it remains largely unclear why individuals with higher education are more likely to engage in health-promoting behaviors (like frequent physical activity) and to avoid health damaging behaviors (like smoking and high quantity drinking). Drawing from the human capital theory of learned effectiveness, this study examines whether sense of coherence (an individual-level global orientation towards life) explains educational differences in young adults’ health lifestyles. Information from young adults (aged 20-28, n = 1,518) was drawn from the Swedish Level-of-Living Survey in 2010. Young adults reported their own educational attainment and their parents’ education. Young adults’ sense of coherence was measured using a validated instrument with three components (meaningfulness, manageability, and comprehensibility). Young adults were defined as having a health-promoting lifestyle if they engaged in frequent physical activity, did not drink in high quantities per drinking occasion, and did not smoke cigarettes. Logistic regression models showed that young adults with higher educated parents were more likely to have an intermediate or strong sense of coherence (compared to a weak sense of coherence) and were more likely to have a health-promoting lifestyle. Similarly, young adults with higher educational attainment themselves were more likely to have an intermediate or strong sense of coherence and to have a health-promoting lifestyle. Sense of coherence was positively associated with having a health-promoting lifestyle. However, sense of coherence did not explain educational differences in young adults’ health lifestyles. Findings suggest that sense of coherence is linked to educational attainment and to engagement in health behaviors in young adulthood, but that other mechanisms may explain how health behaviors become socially differentiated in early life.