Date Published: March 7, 2018
Publisher: Public Library of Science
Author(s): Petra Rattay, Elena von der Lippe, Elvira Mauz, Felicitas Richter, Heike Hölling, Cornelia Lange, Thomas Lampert, Karen Lidzba.
This study’s aim was to investigate the association between family structure and different health-related outcomes in adolescence (self-rated health, emotional and behavioural problems, health-related quality of life, regular smoking, and heavy episodic drinking). Furthermore, we analysed the extent to which socio-economic status, family cohesion and the pre-transition health status explain family structure-related health disparities.
We used longitudinal data from the first two waves of the German KiGGS cohort study carried out by the Robert Koch Institute (baseline: 2003–2006, follow-up: 2009–2012). The sample comprised 4,692 respondents aged 11 to 17 years. Using data from both waves, effects of family structure on health status at follow-up were calculated applying linear and logistic regression models.
We found that adolescents continuously living with both birth parents were in good health. Adolescents whose parents separated after the baseline survey, reported poorer health and were more likely to smoke. The transition from stepfamily to single parent family was also associated with a higher risk of regular smoking. Lower health-related quality of life as well as higher scores for emotional and behavioural problems occurred in almost all non-nuclear family structures, although not all effects were statistically significant. No significant effects of family structure on heavy episodic drinking were found. While family cohesion mediated the effects of family structure on adolescents’ health, the mediating effect of socio-economic status was small. After controlling for pre-transition health, the effects were even lower.
Because the direct effects of family structure on adolescents’ health were small and family cohesion was found to be an important mediator in the association between family structure and adolescents’ health, prevention programmes and interventions should be directed towards the parent–adolescent relationship rather than just the family structure, in order to minimize the psychosocial stress of adolescents during the period of family transition.
The diversity of family arrangements is rising in developed countries. In Germany in 2013, 18% of the 13 million children younger than age 18 were living in single parent families . Nine out of ten single parents were mothers. Single fathers lived more often with adolescents than with children of younger age . Official data on the number of children and adolescents living in stepfamilies were not available for Germany. Estimates from scientific studies on the proportion of children and adolescents living in stepfamilies varied between 6.0%  and 10.9% .
Adolescents who still lived in nuclear families at follow-up, showed the best scores on self-rated health (Table 2). In general, adolescents from families that did not experience any change between baseline and follow-up had better self-rated health than youngsters from families that experienced a transition in this period. Young people who at baseline were living in nuclear families and at follow-up reported living in stepfamilies had the worst self-rated health.
The aim of this analysis was to investigate the association between family structure and different health-related outcomes in adolescence. Consistent with the current state of research, we found adolescents who continuously lived with both birth parents to be in good health. However, not all non-nuclear families were associated with adverse health outcomes. There were diverse patterns according to the outcome studied. When the parents’ separation took place after the baseline survey, young people reported poorer health and were more likely to smoke. The transition from stepfamily to single parent family was also associated with a higher risk of regular smoking. Lower HRQoL as well as higher scores for emotional and behavioural problems were found in almost all non-nuclear family structures, although not all effects reached statistical significance—this may be due to the small sample size in some family subgroups. Although many international studies confirmed the association between family structure and higher alcohol consumption [24, 28, 30, 31], we found no higher rates of heavy episodic drinking in adolescents living in non-nuclear families. We assume that according to family-related factors, parental drinking behaviour (e.g. exposure to drunkenness within the family ) as well as parent–child relations  may play a greater role than family structure per se.
Although family structure has been shown to have only a moderate direct effect on adolescents’ health when adjusting for family cohesion, SES, and pre-transition health status, the family structure helps to identify adolescents who are at risk . Because family cohesion was found to be an important mediator in the association between family structure and adolescents’ health, prevention programmes as well as interventions, however, should be directed toward the parent–adolescent relationship rather than just the family structure . To minimize the psychosocial stress of young people during periods of the family transition, counselling and mediation programmes may help to sensitize mothers and fathers to the child’s needs and to enable adolescents to process the transition and thus allow parents and their children to remain in good contact.