Türk Çocuklarında Çok Boyutlu Yoksulluk Göstergeleri ile Sağlık Davranışları Arasındaki İlişki

Bu çalışmanın amacı, Türk çocuklarında çok boyutlu yoksulluk göstergeleri ile sağlık davranışları arasındaki ilişkiyi araştırmaktır. Araştırmanın örneklemi, Türkiye’nin Ankara ilindeki sosyo-ekonomik duruma göre dört grupta sınıflandırılan ilçelerinden her gruptan en az bir okul olacak şekilde belirlenip, veriler 10-14 yaş aralığındaki 2145 erkek 2136 kız çocuğu olmak üzere toplam 4.276 çocuğa anket formları uygulanarak toplanmıştır. Veriler, PASW İstatistiklerinde tanımlayıcı istatistikler, ki-kare testi ve ikili lojistik regresyon ile analiz edilmiştir. Analizlerin en etkileyici sonuçları, kız çocuklarının; 5, 6 ve 7. sınıf öğrencilerinin; sağlıklarını iyi olarak değerlendirenlerin; yüksek ve orta düzeyde aile zenginliği olanların; çocuk yoksunluğu endeksine göre yoksun olmayanların; aile gelir düzeyini yüksek ve orta olarak değerlendirenlerin ve hiç açlık çekmemiş olanların sağlıklı davranışlar sergileyen grupta olma olasılıkları daha yüksektir. Sonuç olarak, özellikle yoksulluk içinde yaşayan çocukların sağlıklı davranışlarını geliştirmek için aile hekimliği sisteminde uygulanacak okul temelli bazı müdahaleler ve politikalar önerilmiştir.

Anahtar Kelimeler:

Yoksulluk, sağlık davranışı, ergenlik, yaşam tarzı, okul tabanlı sağlık

Relationship between Multidimensional Poverty Indicators and Health Behaviors among Turkish Children

The aim of the study is to investigate the relationship between multidimensional poverty indicators and health behaviors among Turkish children. The sample of the study was determined to include at least one school from each socioeconomic status group in the districts of Ankara, which are classified into four socioeconomic groups, and the data were collected by applying face-to-face questionnaires to a total of 4,276 children, 2145 boys and 2136 girls, between the ages of 10 and 14. The data were analyzed using descriptive statistics, chi-squared test and binary logistic regression in the PASW Statistics program. The most striking results of the analysis showed that the female children, 5th, 6th, and 7th grade students, those who rated their health as good, those with a high or medium family affluence levels, those who were not deprived according to the Child Deprivation Index, those who rated their family income level as high or medium, and those who never suffered from hunger were more likely to be in the group with healthy behaviors (p<0.05). Accordingly, some school-based interventions and policies to be implemented in the family medicine system are recommended to promote the healthy behaviors of children, especially those living in poverty.

Keywords:

Poverty, health behaviors, adolescence, lifestyle, school-based health,

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Asaka, Y., Sekine, M., Yamada, M., & Tatsuse, T. (2020). Associations of socioeconomic status and lifestyle factors with dental neglect of elementary school children: the MEXT Super Shokuiku School Project. Environmental Health and Preventive Medicine, 25(73), 1-7. doi:10.1186/s12199-020-00916-y.
Aue, K., Roosen, J., & Jensen, H.H. (2016). Poverty dynamics in Germany: Evidence on the relationship between persistent poverty and health behavior. Social Science and Medicine, 153, 62–70. doi:10.1016/j.socscimed.2016.01.040.
Basha, S., Mohammad, R.N., Swamy, H. S., & Sexena, W. (2015). Association between traumatic dental injury, obesity, and socioeconomic status in 6- and 13-year-old schoolchildren. Social Work and Public Health, 30(4), 1-9. doi:10.1080/19371918.2014.1002598.
Belvin, C., Britton, J., Holmes, J., & Langley, T. (2015). Parental smoking and child poverty in the UK: an analysis of national survey data. BMC Public Health, 15(1), 507. doi:10.1186/s12889-015-1797-z.
Borodulin, K., Zimmer, C., Sippola, R., Mäkinen, T.E., Laatikainen T., & Prättälä, R. (2012). Health behaviours as mediating pathways between socioeconomic position and body mass index. Int J Behav Med, 19, 14-22. doi:10.1007/s12529-010-9138-1.
Buonomo, E., Moramarco, S., Tappa, A., Palmieri, S., Michele S., Biondi, G., Agosti, G., Alessandroni C., Caredda, E., & Palombi, L. (2020). Access to health care, nutrition and dietary habits among school- age children living in socio-economic inequality contexts: results from the “For Good: Sport is Well-Being” program. International Journal of Food Sciences and Nutrition, 71(3), 352-361. doi:10.1080/09637486.2019.1655714.
Caburnay, C.A., Kreuter, M.W., Luke, D.A., Logan, R.A., Jacobsen, H.A., Reddy V.C., Vempaty, A.R., & Zayed, H.R. (2003). The news on health behaviors: Coverage of diet, activity, and tobacco in local newspapers. Health Education and Behavior, 30(6), 709-722.
Cole, H.P. (1997). Stories to live by: A narrative approach to health behavior research and injury prevention. In D. S. Gochman (Ed.), Handbook of health behavior research IV: Relevance for professionals and issues for the future (pp. 325-349). New York: Plenum.
Conner, M., & Norman, P. (2017). Health behavior: current issues and challenges. Psychology and Health, 32(8), 895-906. doi:10.1080/08870446.2017.1336240.
Contoyannis, P., & Jones, A. (2004). Socio-economic status, health and lifestyle. Journal of Health Economics, 23(5): 965-995. doi:10.1016/j.jhealeco.2004.02.001.
Cottrell, L., Zatezalo, J., Bonasso, A., Lattin, J., Shawley, S., Murphy, E., Lilly, C., & Neal, W.A. (2015). The relationship between children’s physical activity and family income in rural settings: A cross- sectional study. Preventive Medicine Reports, 2, 99-114. doi:10.1016/j.pmedr.2015.01.008.
Dinsa, G.D., Goryakin, Y., Fumagalli, E., & Suhrcke, M. (2012). Obesity and socioeconomic status in developing countries: A systematic review. Obesity Reviews, 13(11), 1067-1079. doi:10.1111/j.1467- 789X.2012.01017.x.
Dorri, M., Sheiham, R.H., & Watt, R. (2010). The relationship between sense of coherence and toothbrushing behaviours in Iranian adolescents in Mashhad. J Clin Periodontol, 37, 46-52. doi:10.1111/j.1600- 051X.2009.01497.x.
Drewnowski, A., & Specter, S.E. (2004). Poverty and obesity: The role of energy density and energy costs. Am J Clin Nutr, 79, 6-16. doi:10.1093/ajcn/79.1.6.
Dye, B.A., & Thornton-Evans, G. (2010). Trends in oral health by poverty status as measured by Healthy People 2010 objectives. Public Health Rep, 125(6), 817-30. doi:10.1177/003335491012500609.
Elgar, F.J., Pförtner, T.K., Moore, I., de Clercq B., Stevens., G.W.J.M., & Currie, C. (2015). Socioeconomic inequalities in adolescent health 2002-2010: a time-series analysis of 34 countries participating in the health behaviour in school-aged children study. Lancet, 385(9982):2088-2095.
Finkelstein, D.M., Petersen, D.M., & Schottenfeld, L.S. (2017). Promoting children’s physical activity in Low-income communities in Colorado: What are the barriers and opportunities? Prev Chronic Dis, 14(14), E134. doi:10.5888/pcd14.170111.
Fonseca, M. (2012). The effects of poverty on children’s development and oral health. Podiatry Dent, 34(1), 32-38.
Hoare, E., Crooks, N., Hayward, J., Allender S., & Strugnell, C. (2019). Associations between combined overweight and quality of life among Australian regional school children: baseline findings of the Gulburn Valley health behaviours monitoring study. Health and Quality of Life Outcomes, 17(1),16. doi:10.1186/s12955-019-1086-0.
Inchley, J.C., Stevens, G.W., Samdal, O., & Currie, D.B. (2020). Enhancing understanding of adolescent health and well-being: The health behavior in school-aged children study. Journal of Adolescent Health, 66(6), S3-S5. doi:10.1016/j.jadohealth.2020.03.014.
Jarvis, M.J., & Wardle, J. (2006). Social patterning of individual health behaviours: the case of cigarette smoking. In Marmot M, Wilkinson RG, (Eds). Social determinants of health (pp. 224-37). New York: Oxford University Press.
Kahraman, F., & Gül, S.S. (2015). Child Poverty in Turkey: A Research on Gaziantep. Hitit University Journal of Social Sciences Institute, 8, 339–366 [in Turkish].
Keddell, E. (2017). The vulnerable child in neoliberal contexts: the construction of children in the Aotearoa New Zealand child protection reforms. Childhood, 25(1):93-108.
Kovács, K.E., & Nagy, B.E. (2017). Adolescents’ health behaviour according to sport and family structure. Különleges Bánásmód, III. évf. 2017/1. szám, 27-37. doi:10.18458/KB.2017.1.27.
Köktaş, A.M., Gölçek, G.A., & Selçuk, I.Ş. (2019). Socioeconomic characteristics of obese individuals in Turkey: 2016 Example. Artvin International Congress on Social Sciences (AICOSS 19) 17-19 April 2019. [in Turkish]
Lampert, T., & Kuntz, B. (2019). Effects of poverty for health and health behavior of children and adolescents: Results from KiGGS Wave 2. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz, 62(10), 1263-1274. doi:10.1007/s00103-019-03009-6.
Lawlor, D.A., Ronalds, G., Macintyre, S., Clark, H., & Leon, D.A. (2006). Family socioeconomic position at birth and future car- diovascular disease risk: Findings from the Aberdeen Children of the 1950s cohort study. American Journal of Public Health, 96, 1271–1277. doi:10.2105/AJPH.2005.066290.
Lee, A., Lo, A., Li, Q., Keung, W., & Kwong, A. (2020). Health promoting schools: An update. Appl Health Econ and Health Policy, 18, 605-623. doi:10.1007/s40258-020-00575-8.
Levin, K.A., & Currie, C. (2010). Adolescent tootbrushing and the home environment: Sociodemographic factors, family relationships and mealtime routines and disorganisation. Community Dent Oral Epidmiol, 38, 10-18. doi:10.1111/j.1600-0528.2009.00509.x.
Levine, J.A. (2011). Poverty and obesity in the U.S. Diabetes, 60(11), 2667-68. doi:10.2337%2Fdb11-1118.
Liu T., Yang, X., Guo, K., Wang, W., Li, J., & Liu, L. (2020). Evaluation of healh behaviours and self- rated health among Chinese healthcare students. Journal of Community Health, 45 (5), 1006-1016. doi:10.1007/s10900-020-00820-0.
Lynch, J., Krause, N., Kaplan, G.A., Tuomilehto, J., & Salonen, J.T. (1997). Workplace conditions, socioeconomic status, and the risk of mortality and acute myocardial infarction: the Kuopio Ischemic Heart Disease Risk Factor Study. Am J Public Health, 87(4), 617-22. doi:10.2105/ajph.87.4.617.
Marttila-Tornio, K., Männikkö, N., Ruotsalainen, H., Miettunen, J., & Kääriäinen, M. (2020). Lower parental socioeconomic status in childhood and adolescence predicts unhealthy health behaviour patterns in adolescence in Northern Finland. Scand J. Caring Sci, 34(2), 1-11. doi:10.1111/scs.12888.
Min, J., Xue, H., & Wang, Y. (2018). Association between household poverty dynamics and childhood overweight risk and health behaviors in the United States: a 8-year nationally representative longitudinal study of 16 800 children. Podiatry Obes, 13(10), 590-597. doi:10.1111/ijpo.12292.
Moore, G.F., & Littlecott, H.J. (2015). School-and family-level socioeconomic status and health behaviors: Multilevel analysis of a national survey in Wales, United Kingdom. Journal of School Health, 85, 267-275. doi:10.1111/josh.12242.
Northridge, M.E., Kumar, A., & Kaur, R. (2020). Disparities in access to oral health care. Annual Review of Public Health, 41, 513-535. doi:10.1146/annurev-publhealth-040119-094318.
Okuyan, C.B., & Alkaya, S.A. (2018). The role of school-based programs in protection and development of school health. J Comm Pub Health Nurs, 4(2), 214. doi:10.4172/2471-9846.1000214.
Omotowo, B., Anne, N., Olanike, A.U., Ezeoke, U., & Arthur, I. (2017). Assessment of Health Risk Behaviours among Secondary School Students in Enugu: South-East, Nigeria. Global Journal of Health Science, 9(7), 57-66. doi:10.5539/gjhs.v9n7p57.
Ortiz, I., Daniels, L., & Engilbertsdóttir, S. (Eds.). (2012). Child poverty and inequality: New perspectives. New York: United Nations Children’s Fund (UNICEF), Division of Policy and Practice.
Pampel, F.C., Patrick K.M., & Denney, J.T. (2010). Socioeconomic disparities in health behaviors. Annu Rev Sociol, 36, 349-370. doi:10.1146/annurev.soc.012809.102529.
Pastor, R., & Tur, J.A. (2020). Effectiveness of interventions to promote healthy eating habits in children and adolescents at risk of poverty: systematic review and meta-analysis. Nutrients, 12(6), 1891. doi:10.3390%2Fnu12061891.
Peltzer, K., & Pengpid, S. (2014). Oral health behavior and social and health factors in university students from 26 low, middle and high income countries. Int J Environ Res Public Health, 11(12), 12247-60. doi:10.3390/ijerph111212247.
Pender, N.J., Murdaugh, C.L., & Parsons, M.A. (2002). Health Promotion in Nursing Practice (4th ed.). Upper Saddle River, NJ: Prentice Hall.
Petersen, P.E., Jiang, H., Peng, B., Tai, B.J., & Bian, Z. (2008). Oral and general health behaviours among Chinese urban adolescents. Community Dentistry Oral Epidemiology, 36(1), 76-84. doi:10.1111/j.1600-0528.2007.00375.x.
Powell, T.M., & Davis J.P. (2018). Addressing the social emotional needs of children in chronic poverty: A pilot of the Journey of Hope. Children and Youth Services Review, 98, 319-327. doi:10.1016/j.childyouth.2018.11.010.
Proper, K.I., Cerin, E., Brown, W.J., & Owen, N. (2007). Sitting time and socio-economic differences in overweight and obesity. International Journal of Obesity, 31(1), 169.
Ridder, D., & Wit, J. (2006). Self-regulation in health behavior: Concepts, theories, and central issues. In D. de Ridder, & J. de Wit, (Eds.), Self-regulation in health behavior (pp. 1-23). Chichester: John Wiley & Sons Ltd.
Rhodes, R.E., Janssen, I., Bredin, S.S.D., Warburton, E.R.D., & Bauman, A. (2017). Physical activity: Health impact, prevalence, correlates and interventions. Psychology & Health, 32(8), 942-975. doi:10.1080/08870446.2017.1325486.
Sanchez, A., Norman, G.J., Sallis, J.S., Calfas, K.J., Cella, J., & Patrick, K. (2007). Patterns and correlates of physical activity and nutrition behaviours in adolescents. American Journal of Preventive Medicine, 32(2), 124-130. doi:10.1016%2Fj.amepre.2006.10.012.
Seker, M., Bakış, Ç., & Dizeci, B. (2018). Transition from consumer to human. Human Development Foundation [Original work published in Turkish].
Setia, S.M. (2016). Methodology series module 3: cross-sectional studies. Indian J Dermatol, 61(3):261-264.
Simpson, D, Lumsden, E., & Clark, R. M. (2014). Neoliberalism, global poverty policy and early childhood education and care: a critique of local uptake in England. Early Years An International Journal of Research and Development, 35(1):96-109.
Sgan-Cohen, H.D., & Mann, J. (2007). Health, oral health and poverty. J Am Dent Assoc, 138(11), 1437-42. doi:10.14219/jada.archive.2007.0077.
Sprigg S.M., Wolgin, F. Chubinski, J., Keller, K. (2017). School-based health centers: a funder’s view of effective grant making. Health Affairs, 36(4), 768-772. doi:10.1377/hlthaff.2016.1234.
Squassi, A., Mauro, S., Mauro M.J., Sanchez, G., & Noemi, B. (2008). Relationship between oral health in children and poverty related factors. Acta Odontol Latinoam, 21(1), 49-56.
Stalsberg, R., & Pedersen, A.V. (2010). Effects of socioeconomic status on the physical activity in adolescents: a systematic review of the evidence. Scand J Med Sci Sports, 20, 368–383. doi:10.1111/j.1600-0838.2009.01047.x.
Steptoe, A., Wardle, J., Pollard, T.M., Canaan, L., & Davies, G.J. (1996). Stress, social support and health-related behavior: a study of smoking, alcohol consumption and physical exercise. Journal of Psychosomatic Research, 41, 171–180.
Sutherland, R., Campbell, E., Lubans, D.R., Morgan, P.J., Okely, A.D., Nathan, N., Gillham, K., Lecathelinais, C., & Wiggers, J. (2016). Physical education in secondary schools located in low-income communities: Physical activity levels, lesson context and teacher interaction. J Sci Med Sport, 19(2), 135-141. doi:10.1016/j.jsams.2014.12.003.
Tıpırdamaz Sipahi, H. (2008). Factors affecting and accompanying peer bullying in 6th and 7th grade students in a school in the Bornova District of İzmir Province [Unpublished doctoral dissertation]. Ege University. [in Turkish]
TURKSTAT (2019). Child statics-poverty. Retrieved September 06, 2020 from https://biruni.tuik.gov.tr/medas/?kn=203&locale=tr. [in Turkish]
UNICEF (2005). The state of the world’s children 2005. Retrieved August 02, 2022 from https://www.unicef.org/turkey/pdf/_dcd05.pdf
UNICEF, (2011). Report of case of children in Turkey: The poor children, Retrived September 10, 2020 from https://abdigm.meb.gov.tr/projeler/ois/egitim/032.pdf [in Turkish].
UNICEF Innocenti Research Centre. (2012). Measuring Child Poverty: New league tables of child poverty in the world’s rich countries’, Innocenti Report Card 10, UNICEF Innocenti Research Centre, Florence. Retrieved February 12, 2020 from https://www.unicefirc.org/publications/pdf/rc10eng.pdf.
UNICEF (2020). Children in monetary poor households and COVID-19: Technical Note. Retrieved September 05, 2020 from https://www.unicef.org/media/69656/file/TechnicalNote-Children-living-in- monetary-poor-households-and-COVID-19.pdf.
United Nations Economic and Social Council, Committee on Economic, Social and Cultural Rights. (2001, May 13). Substantive issues arising in the implementation of the international covenant on economic, social and cultural rights. Poverty and the international covenant on economic, social and cultural rights. Geneva, United Nations Third United Nations Conference on the Least Developed Countries, Belgium.
Weri, D., Brigell, R., Khadka, A., Perales, N., & Fink, G. (2019). Comprehensive school-based health programs to improve child and adolescent health: Evidence from Zambia. PLoS One,31, 1-15. doi:10.1371/journal.pone.0217893.
West, R. (2017). Tobacco smoking: Health impact, prevalence, correlates and interventions. Psychology and Health, 32(8), 1-19. doi:10.1080/08870446.2017.1325890.
WHO (2012). Social determinants of health and well-being among young people. Health Behaviour in School-aged Children (HBSC) study: International report from the 2009/2010 survey. Retrieved September 29, 2020 from https://www.euro.who.int/__data/assets/pdf_file /0003/163857/Social-determinants-of-health-and-well-being-among-young-people.pdf.
Williamson, D.L., & Fast, J.E. (1998). Poverty status, health behaviors, and health: Implications for social assistance and health care policy. Canadian Public Policy, 24(1), 1-25. doi:10.2307/3551727.