Despite a commitment by the Canadian government to eliminate child poverty, the rate of poverty among children and adolescents remains at nearly 20% (Centre for International Statistics, 1994, 1995). The individual and societal implications of this situation are of growing concern. The Canadian Council on Social Development, for instance, has noted that poverty often is accompanied by a higher rate of infant mortality, childhood health problems, psychosocial disorders, and school dropout rates.
Although the association between low socioeconomic status and health is well established (Frank & Mustard, 1994), the mechanisms by which income influences health are less clear. Evans and Stoddart (1994) suggest that health and disease are determined by interactions between influences in the social environment, physical environment, access to health care, and individual behavioral and biological responses. Their model expresses the interrelationship between the determinants of health and measures of health, as well as among the determinants themselves. This study uses the Evans-Stoddart model as a framework to explore data from the 1994 National Population Health Survey regarding the pathways by which income adequacy might influence the health and well-being of young Canadians.
The 1994 National Population Health Survey (NPHS) collected information from households across Canada, excluding populations residing on Indian reserves, Canadian military bases, and in remote regions of Quebec and Ontario (Statistics Canada, 1995). Limited information was gathered on all household members, followed by a more detailed interview with a randomly selected household member, aged 12 years or above, which examined health status, health service utilization, behavioral risk factors, psychosocial factors, demographics, and socio-economic status.
A stratified two-stage sampling design, including mechanisms to ensure equal representation of members of larger households, was employed. The overall household response rate was 88.7%; the selected person response rate was 92.5%. A total of 637 youths aged 12 to 14 and 1,210 aged 15 to 19 across Canada were directly interviewed. Partial nonresponse occurred for several individual variables. Information on household income was unavailable for 88 respondents, reducing the sample size for this analysis to 1,759.
Wherever possible, several variables were chosen to represent the determinant category within the model. In some cases, however, the nature of the data collected was such that certain categories contain few measures. As a consequence, the indicators used cannot be considered exhaustive, but rather represent certain components of the determinants.
Income adequacy. Household income was recoded and grouped into one of five fixed income categories adjusted for family size. This measure is based on all sources of income, including government transfers. It does not define or classify poverty per se, but acts as a crude relative measure of income adequacy based on predetermined cutoff points.
Social and physical environment. Social environment was represented by living arrangement (children living with a single parent compared with all other family types), urban or rural dwelling, and social support index (a five-point scale ranging from low to high support). The presence of a smoker in the house was the only available indicator of physical environment.
Individual response. Behavioral responses included the subject's smoking, alcohol use, and physical activity. Self-esteem, mastery, and distress scales were used to measure psychological responses.
Health and function. Health and function were conceptualized as the individual's perception of his or her own as well as its impact on day-to-day functioning. These concepts were measured via self-assessed health (ranging across five categories from poor to excellent), number of disability days in the last two weeks, and whether the individual had experienced an activity-limiting injury in the last 12 months. …