# Country-level income inequality and risky health behaviors of “golden youth” in the post-Communist countries of Europe: A cluster analysis

## TL;DR

The paper finds that high-income adolescents in post-Communist European countries with high income inequality are more likely to engage in risky health behaviors.

## Contribution

This study introduces a cluster analysis approach to examine how income inequality affects risky behaviors among high-socioeconomic status adolescents in post-Communist Europe.

## Key findings

- High-SEP adolescents in countries with higher income inequality are more likely to engage in risky behaviors like alcohol consumption and bullying.
- The odds of risky behaviors among high-SEP adolescents increase significantly in countries with high Gini index values.
- Policies promoting income redistribution could reduce risky behaviors among affluent adolescents in post-Communist countries.

## Abstract

•High-SEP adolescents might be at an increased risk for unhealthy behavior in post-Communist countries of Europe.•Wide income inequality might contribute to risky behaviors among high-SEP adolescents.•Policies promoting a fairer distribution of income may be necessary in several post-Communist countries of Europe.

High-SEP adolescents might be at an increased risk for unhealthy behavior in post-Communist countries of Europe.

Wide income inequality might contribute to risky behaviors among high-SEP adolescents.

Policies promoting a fairer distribution of income may be necessary in several post-Communist countries of Europe.

We aim to study the “golden youth” hypothesis, which suggests that risky behaviors might be prevalent among affluent adolescents in post-Communist countries of Europe (PCCE) with high income inequality.

We included 71,119 adolescents aged 11–15 from 14 PCCE participating in the Health Behavior in School-aged Children survey 2017/18. A K-means cluster analysis was conducted to group adolescents based on risky behavior. Generalized linear mixed models were fitted.

The proportion of high-SEP adolescents in Cluster 2, characterized by frequent alcohol consumption but moderate frequency of drunkenness, was greater than that of low-SEP adolescents (14.3 % vs. 10.7 %). The prevalence of risky behaviors was similar for high and low-SEP adolescents in Cluster 3 (high smoking, frequent alcohol use, drunkenness, and moderate bullying) (8.0 % vs. 8.2 %) and Cluster 4 (high bullying perpetration) (6.7 % vs. 7.2 %). Countries with higher Gini index were at greater risk of reporting risky behaviors. High-SEP adolescents were more likely to engage in risky behaviors in countries with high income inequality. The odds ratios comparing high- vs. low-SEP adolescents ranged from 0.89 in the least unequal to 1.67 in the most unequal countries for multiple risky behaviors (Cluster 3: P-interaction = 0.042) and from 0.61 to 1.19 for bullying perpetration (Cluster 4: P-interaction = 0.030).

High-SEP adolescents in PCCE might be at increased risk for unhealthy and vicious behaviors, especially in countries with high income inequality. Redistributive policies decreasing the gap between rich and poor are needed to ensure the health and well-being of adolescents in PCCE.