Expressions of context : Studies of schools, families, and health risk behaviours

Abstract: This thesis explores the health behaviours of young people. The main focus is on risk behaviours, i.e. those which may have adverse consequences for health. Two fields of interest are looked at. On the one hand, the thesis explores social determinants of such behaviours, with particular focus on the influence of schools’ structural and social environment on health risk behaviours among youth. On the other hand, the thesis addresses the role of such behaviours in the relationship between childhood social inequalities and adult health. In terms of theory, the study sets out from Coleman's view of the association between structure and agency and the assumption that macro level structures and patterns can be understood on the basis of individual actors’ actions. The thesis consists of four studies addressing different, but related, aspects of the above areas of interest. The overall conclusion of studies I-III is that the school context has direct and indirect effects on young people's risk behaviours. The results of multilevel analyses indicate, more specifically, that students who attend more advantaged schools report more risk behaviours such as smoking, alcohol- and drug use than students at more disadvantaged schools. Self-reported crime is however higher in the more disadvantaged school settings. Further analyses show that a school's social and normative climate also is important for the extent to which youth consume alcohol, smoke, or have used drugs. These risk behaviours are most prevalent in schools where a large proportion of the parents have a more permissive attitude towards alcohol and smoking, and where teacher-rated levels of trust and informal social control (collective efficacy) are high. The results show, further, that school contexts also act indirectly on youth risk behaviours. Young people who reports weak bonds with their parents tend generally to be more involved in risk behaviours than those who report strong bonds. This tendency is reinforced in more advantaged school settings. Finally, Study IV demonstrates that youth risk behaviours act accumulatively and indirectly on later health, rather than directly. Moreover, the importance of risk behaviours for later health varies between the birth cohorts. Health behaviours explain a larger part of the relationship between socioeconomic conditions in childhood and health as an adult in the younger cohort.