Family life and health in adolescence: a role for culture in the health inequalities debate?

Until recently, the role of the family in the 'health inequalities' debate has been largely ignored. Using data from the youngest cohort in the West of Scotland Twenty-07 Study, three dimensions of family life (family structure, culture and conflict) are examined in respect of their association both with health when respondents were aged 15 and 18, and with labour market position at 18. Despite a strong association between family structure and material deprivation, those from intact, reconstituted and single parent families were largely undifferentiated in terms of health. By contrast, aspects of family functioning, particularly a poorer relationship and conflict with parent(s), were independently associated with lower self-esteem, poorer psychological well-being and (among females) more physical symptoms at both ages. In addition, both family culture and conflict were associated with labour market position over and above the effects of material deprivation, with those from family centred and lower conflict homes having a greater likelihood of being in tertiary education. While the relationships between the family and psychological well-being and, to a lesser extent, physical symptoms appeared to be mediated by self-esteem, those between the family and labour market position did not. These findings suggest that in adolescence family life may have more direct effects on health than material factors and, through social mobility, may be indirectly linked to health inequalities in adulthood. These family processes, we argue, are expressions of cultural influences, the scope of which to date has been too narrowly focused on health behaviours.