Canadian adolescent perceptions and knowledge about the social determinants of health: an observational study of Kingston, Ontario youth

BACKGROUND Upstream social determinants of health (SDH) have become widely acknowledged as lying at the root of poor health outcomes in Canada and globally. The Commission on the Social Determinants of Health maintains that educating the public about the SDH is a key step towards population health equity. Little is known about adolescent perceptions of the determinants of health. Curriculum in Ontario is lacking in SDH content, placing a much greater emphasis on individual, lifestyle behaviors, such as diet, physical activity, and safe sex practices. Identifying a gap in SDH knowledge within the adolescent population is required to advocate for health curriculum revision to include SDH material. METHODS Student sociodemographic information was obtained through a self-administered questionnaire. Concept mapping exercises were used to determine students' knowledge of the determinants of health and the SDH. Knowledge was approximated by the relative number of SDH concepts present in student maps. Poisson regression analysis was used to determine correlations between sociodemographic characteristics and SDH knowledge. RESULTS Concept maps indicated that students attributed their health primarily to physical determinants versus social determinants; 44% of maps contained no SDH content. Statistical analyses indicated that students' SDH knowledge varied by their relative socioeconomic status (SES). CONCLUSIONS Findings suggest that 1) there is an SDH knowledge gap in the adolescent population, and 2) an inequity in adolescent SDH knowledge exists across socio-economic factors. Current Ontario health curriculum requires revision to include SDH material, which will require greater communication and collaboration from both educational institutions and health agencies in Canada.