Low socioeconomic status and the resulting health behaviors are persistently found in every corner of the world, causing serious health and developmental consequences in individuals, particularly children and adolescents [96, 97]. Therefore, this review examines the association between socioeconomic status and six different categories of health behaviors: smoking, drinking alcohol, consumption of fruits and vegetables, diet, physical exercise, cannabis use, involvement in gambling and substance abuse in children and adolescents. The findings of this review study reveal that coming from a low SES family posed a greater risk to health behaviors in children and adolescents (i.e., children and adolescents from low SES families have a higher risk of developing unhealthy behaviors). It is well known that the differences in level of education, income and occupation create fewer opportunities to experience regular medical services, participation in physical activity, and the job market. As a result, children and adolescents may have a poor level of general knowledge, low confidence, low self-esteem, and poor health and health-seeking behaviors. Certainly, some current studies are investigating the link between SES and health behaviors and have found that socioeconomic disparities significantly impact on the health and health behaviors of children and adolescents .
In relation to SES and smoking behavior, the majority of results have been reported in this literature review demonstrating that low parental socioeconomic status is found to have a negative association with early exposure to smoke in children and early initiation of smoking in adolescents. These findings were consistently found in previous studies and reported that children and adolescents living with low parental education, unemployment, and low material well-being were found to be at a greater risk of smoking compared to those living with high parental education, high social class occupation and high material well-being . In addition, due to economic hardship, parents struggled to manage materials (e.g., money and resources) for their children, which in turn led to a discordant relationship between parents, children, and adolescents . This poor relationship between parents and children was also found to lead to higher odds of smoking in children and adolescents . Therefore, low education, poor income, high unemployment, and low self-esteem implied a significant risk of smoking in children and adolescents .
Moreover, although drinking alcohol was found to have been significantly higher among adolescents from high SES, they were not drinking to excess. The possible explanation is due to the social and cultural activity (e.g., business meeting, party celebration), regular availability of alcohol at home, and pocket money to buy alcohol. So, drinking alcohol is more common among the adolescents from high parental SES. Similar findings were mentioned in other studies and it was reported that those adolescents who were from high SES were found to have a higher chance of drinking alcohol under parental guidelines . On the other hand, adolescents with low SES were found to be at risk of drunkenness or intention to become drunk. Thus, it may be reasonably assumed that the poor parental education, occupation, income, and lower parental attachment were significant. The adolescents who were from most deprived parental SES were negatively influenced by family, low education, work stress, and poor support from parents, all of which caused drunkenness in adolescents [104–108].
Furthermore, our literature review found that SES was significantly associated with physical activity in children and adolescents. Children and adolescents who were involved in physical activity were found to have higher levels of parental education, occupation, and income. If parents had a good family income, then there would be a higher chance of availability of goods and materials resources at home . This availability of materials would make it possible to be more engaged in doing physical activity rather than spending more time watching television or doing nothing . These findings were consistent with those found in previous studies and led to the conclusion that parental education, income, and occupation were strongly associated with participation in indoor and outdoor physical activities by the children and adolescents [111, 112]. However, children and adolescents from lower parental SES were found to participate less often in physical activity, but to be more often involved in sedentary behaviors. Previous literature suggested that poor parental SES was significantly associated with poor physical activity, high sedentary activity, and high screen time in children and adolescents [113–115]. Moreover, ample evidence suggested that more children and adolescents from deprived SESs were more likely to live inside the home due to the lack of a secure neighborhood, lack of green areas for sports and recreational activities, and the cost associated with physical activity. Thus, the majority of children and adolescents from poor SES backgrounds were found to be less active in sports and other indoor and outdoor physical activities and more involved in media in their bedroom or living room [115–119] .
In relation to SES and diet (e.g., dairy products, fruits, vegetables, breakfast, soft drink, high fat diet), we found that higher SES was positively associated with consumption of breakfast, dairy products, fruits, vegetables, and a balanced diet, but negatively associated with consumption of sugar, sugary items, high fat diet and soft drink. The findings of this literature review are consistent with other studies that indicate that children’s diet is strongly influenced by the parental SES . Moreover, Yanagi et al. (2018), Spence et al. (2018), and Leyva et al. (2020), reported that that parental SES has the potential ability to secure a healthy and nutritious diet, including fruits and vegetables. Therefore, children and adolescents from high SES consume a good proportion of calories rather than high-energy food . In addition, high parental SES provides active guidance with promoting healthy food and making it available at home . These practices help to encourage the children and adolescents to consume healthy and nutritious food . At the same time, other studies found that high parental education and income were found to be positive amplifiers to adopting healthy diet practices while discouraging sweets and sweet beverages [122, 124, 125]. On the other hand, children and adolescents from poor parental SES may face food insecurity and even food unavailability at home . Consequently, poor parental income and poor parental education put pressure on food security for their children and led to failure to meet the nutritious guidelines. Hence, low SES parents, with low income, and low education may provide low price food, high-fat diet, high salt food, energy-dense food, and low intake of regular breakfast, dairy products, fruits, and vegetables for their children [126–129].
Moreover, in the context of SES and cannabis and other substances that could be abused, this study revealed that they were more likely to be consumed by adolescents from high parental SES. It is reasonably due to the recreational and experimentational purposes. Additionally, it is linked with cost, so adolescents from high parental SES are more likely to have more purchasing capacity. Thus, there is a higher chance of consuming cannabis and other substances. This clear pattern of using cannabis and other illicit drugs is well documented in other studies, which found that those adolescents from a high SES had more likelihood of consuming these drugs [15, 130, 131]. In contrast, our study also revealed the negative association between SES and cannabis consumption in adolescents, indicating that a lower level of parental SES and low parental education is found to lead to a more frequent consumption of cannabis than adolescents from a high SES. This finding has also been found in previous studies indicating that adolescents from low parental SES have a greater risk of consuming cannabis [132–134]. Furthermore, our study reported a negative association between SES and gambling. This is possibly due to the entertainment and coping mechanism. It is possibly argued that those adolescents from low parental SES were struggling to manage their materials from their early stages of life. The poor availability of goods and services could undermine their goal or objectives. Thus, more adolescents from a low SES may be involved in any form of gambling, as a way to get relief from stress. This finding is consistently mentioned in other studies, reporting that children and adolescents from poor SES were more vulnerable to involvement in gambling due to the economic and poor family structure [89, 135]. According to Yücel et al. (2018), there is a link between neuro-social behavior and gambling and this behavior provides a better coping mechanism for reducing stress. Thus, adolescents from poor SES families were found to be at higher risk of gambling [136, 137]. Therefore, the findings of our review are consistent across the studies and provide robust information on socioeconomic status and health behaviors in children and adolescents from both developed and developing countries [102, 103, 108, 119, 126, 135]. In addition, this review study found that risky health behaviors are major concerns in children and adolescents from low socioeconomic status. However, due to the limited number of studies in developing countries. It is difficult to conclude that the SES is associated with health behaviors problem in children and adolescents. Therefore, more studies are recommended on socioeconomic status and health behaviors on children and adolescents in low- and middle-income countries.