Breaking the cycle of poverty:routes to counteract intergenerational transmission of socioeconomic health differences

Many people are still trapped in the cycle of poverty in Europe, from generation to next generation. This is reflected in the large health inequalities, which are a persisting major public health concern that persists despite numerous efforts to reduce it. This thesis is focused on socioeconomic differences in health, with education and employability as major means to combat the intergenerational transmission of poverty. It contributes to the understanding of this the cycle of poverty, but also explores ways to break it. Using the data from Slovakia, it demonstrates how health inequalities are manifest, what their major determinants are, what their impact is, and how we could tackle them. This thesis supports the evidence that poor socioeconomic conditions pose health risks. It points that education is a key mechanism. And it shows that school satisfaction has an important role to make an educational trajectory successful, with some groups at risk. In particular boys, children from low affluence families, children with learning difficulties and with a disrupted social context, deserve extra attention. This thesis also adds evidence on ways to break the cycle of poverty. It shows room for strengthening of social policies focused on deprived families and communities in general, based on a participatory approach. And it shows the importance of improving the employability of disadvantaged workers and of developing public-private partnerships to provide work for them and to support deprived communities. This thesis can greatly add to public health and to public prosperity in Central Europe and other parts of the world

The international Family Affluence Scale (FAS): charting 25 years of indicator development, evidence produced, and policy impact on adolescent health inequalities

In the absence of suitable indicators of adolescent socioeconomic status, the Family Affluence Scale (FAS) was first developed in Scotland 25 years ago. Since then, it has been adapted for use in the Health Behaviour in School-Aged Children (HBSC) Study to research inequalities in adolescent health in Europe and North America. FAS has also been used as an indicator of adolescent socioeconomic status in research studies outside of HBSC, worldwide. There has been a need for FAS to evolve and change its component items over time in order to take into account social and technological changes influencing the families of adolescents. This paper uniquely charts the development of FAS describing the methodological work carried out to validate the measure internationally and over time. It also presents an overview of the body of evidence on adolescent health inequalities produced over years from the HBSC Study and other research studies. Interviews conducted with policy stakeholders reveal that the evidence from FAS-related HBSC work has influenced their strategic work to raise awareness of inequalities and make the case for action to address these. Finally, the future of FAS is discussed with respect to its continual evolution in the context of technological, environmental and social change

The Implications of the COVID-19 Pandemic for the Construction of the Family Affluence Scale: Findings from 16 Countries

The Family Affluence Scale (FAS) is a widely used and validated instrument to measure adolescents’ socioeconomic status (SES). It is plausible that the COVID-19 pandemic and resulting social and economic changes have affected the capacity of the six-item FAS-III to measure adolescent SES, particularly the holiday and computer items. Using data from 247,503 adolescents from 16 European countries participating in the Health Behaviour in School-aged Children (HBSC) study before (2013/14 and 2017/18) and during (2021/22) the pandemic, the present study aims to fill this gap. Findings showed that although the internal consistency of the scale decreased during the pandemic, related to the functioning of the computer and especially the holiday item, it was still acceptable in all countries. Furthermore, measurement invariance analysis showed that during the pandemic the item thresholds of the computer and particularly the holiday item deviated from the thresholds of these items before the pandemic. However, all item factor loadings were comparable to the factor loadings before the pandemic. In addition, during the pandemic the computer and holiday item and their correlations with health-related outcomes were mostly still in the expected direction. Removing these items from the scale yielded comparable or decreased scale criterion validity as compared to the original FAS-III scale in most countries. These findings inform future research that although mean differences in family affluence levels before and during the pandemic should be interpreted with caution, it is a suitable tool to study (changes in) socioeconomic health inequalities among adolescents during the pandemic

The implications of the COVID-19 pandemic for the construction of the family affluence scale: findings from 16 countries

The Family Affluence Scale (FAS) is a widely used and validated instrument to measure adolescents’ socioeconomic status (SES). It is plausible that the COVID-19 pandemic and resulting social and economic changes have affected the capacity of the six-item FAS-III to measure adolescent SES, particularly the holiday and computer items. Using data from 247,503 adolescents from 16 European countries participating in the Health Behaviour in School-aged Children (HBSC) study before (2013/14 and 2017/18) and during (2021/22) the pandemic, the present study aims to fill this gap. Findings showed that although the internal consistency of the scale decreased during the pandemic, related to the functioning of the computer and especially the holiday item, it was still acceptable in all countries. Furthermore, measurement invariance analysis showed that during the pandemic the item thresholds of the computer and particularly the holiday item deviated from the thresholds of these items before the pandemic. However, all item factor loadings were comparable to the factor loadings before the pandemic. In addition, during the pandemic the computer and holiday item and their correlations with health-related outcomes were mostly still in the expected direction. Removing these items from the scale yielded comparable or decreased scale criterion validity as compared to the original FAS-III scale in most countries. These findings inform future research that although mean differences in family affluence levels before and during the pandemic should be interpreted with caution, it is a suitable tool to study (changes in) socioeconomic health inequalities among adolescents during the pandemic

The International Family Affluence Scale (FAS): charting 25 years of indicator development, evidence produced, and policy impact on adolescent health inequalities

In the absence of suitable indicators of adolescent socioeconomic status, the Family Affluence Scale (FAS) was first developed in Scotland 25 years ago. Since then, it has been adapted for use in the Health Behaviour in School-Aged Children (HBSC) Study to research inequalities in adolescent health in Europe and North America. FAS has also been used as an indicator of adolescent socioeconomic status in research studies outside of HBSC, worldwide. There has been a need for FAS to evolve and change its component items over time in order to take into account social and technological changes influencing the families of adolescents. This paper uniquely charts the development of FAS describing the methodological work carried out to validate the measure internationally and over time. It also presents an overview of the body of evidence on adolescent health inequalities produced over years from the HBSC Study and other research studies. Interviews conducted with policy stakeholders reveal that the evidence from FAS-related HBSC work has influenced their strategic work to raise awareness of inequalities and make the case for action to address these. Finally, the future of FAS is discussed with respect to its continual evolution in the context of technological, environmental and social change

Social and economic policies matter for health equity : Conclusions of the SOPHIE project

SOPHIE is a collaborative research project, coordinated by Agència de Salut Pública de Barcelona, that has received funding from the European Community’s Seventh Framework Programme (Grant Agreement 278173) from November 2011 to October 2015. More information: www.sophie-project.eu</p