Reproducing inequalities: luck, wallets, and the enduring effects of childhood health

Do work and family care histories predict health in older women?

Background

Social and policy changes in the last several decades have increased women’s options for combining paid work with family care. We explored whether specific combinations of work and family care over the lifecourse are associated with variations in women’s later life health.

Methods

We used sequence analysis to group women in the English Longitudinal Study of Ageing according to their work histories and fertility. Using logistic regression, we tested for group differences in later life disability, depressive symptomology and mortality, while controlling for childhood health and socioeconomic position and a range of adult socio-economic circumstances and health behaviours.

Results

Women who transitioned from family care to either part-time work after a short break from the labour force, or to full-time work, reported lower odds of having a disability compared with the reference group of women with children who were mostly employed full-time throughout. Women who shifted from family care to part-time work after a long career break had lower odds of mortality than the reference group. Depressive symptoms were not associated with women’s work and family care histories.

Conclusion

Women’s work histories are predictive of their later life disability and mortality. This relationship may be useful in targeting interventions aimed at improving later life health. Further research is necessary to explore the mechanisms linking certain work histories to poorer later life health and to design interventions for those affected.

Early-life Medicaid Coverage and Intergenerational Economic Mobility

New data reveal significant variation in economic mobility outcomes across U.S. localities. This suggests that social structures, institutions, and public policies-particularly those that influence critical early-life environments-play an important role in shaping mobility processes. Using new county-level estimates of intergenerational economic mobility for children born between 1980 and 1986, we exploit the uneven expansions of Medicaid eligibility across states to isolate the causal effect of this specific policy change on mobility outcomes. Instrumental-variable regression models reveal that increasing the proportion of low-income pregnant women eligible for Medicaid improved the mobility outcomes of their children in adulthood. We find no evidence that Medicaid coverage in later childhood years influences mobility outcomes. This study has implications for the normative evaluation of this policy intervention as well as our understanding of mobility processes in an era of rising inequality.

The Population Impact of Childhood Health Conditions on Dropout from Upper-Secondary Education

OBJECTIVES

To quantify how large a part of educational dropout is due to adverse childhood health conditions and to estimate the risk of dropout across various physical and mental health conditions.

STUDY DESIGN

A registry-based cohort study was conducted on a 20% random sample of Finns born in 1988-1995 (n = 101 284) followed for school dropout at ages 17 and 21. Four broad groups of health conditions (any, somatic, mental, and injury) and 25 specific health conditions were assessed from inpatient and outpatient care records at ages 10-16 years. We estimated the immediate and more persistent risks of dropout due to health conditions and calculated population-attributable fractions to quantify the population impact of childhood health on educational dropout, while accounting for a wide array of sociodemographic confounders and comorbidity.

RESULTS

Children with any health condition requiring inpatient or outpatient care at ages 10-16 years were more likely to be dropouts at ages 17 years (risk ratio 1.71, 95% CI 1.61-1.81) and 21 years (1.46, 1.37-1.54) following adjustment for individual and family sociodemographic factors. A total of 30% of school dropout was attributable to health conditions at age 17 years and 21% at age 21 years. Mental disorders alone had an attributable fraction of 11% at age 21 years, compared with 5% for both somatic conditions and injuries. Adjusting for the presence of mental disorders reduced the effects of somatic conditions.

CONCLUSIONS

More than one fifth of educational dropout is attributable to childhood health conditions. Early-onset mental disorders emerge as key targets in reducing dropout.

Intergenerational pathways linking maternal early life adversity to offspring birthweight

Adverse birth outcomes can lead to problematic long-term outcomes for children, and are also known to transmit socioeconomic disadvantage across generations, thereby amplifying the importance of identifying their social determinants. However, the full set of factors causing adverse birth outcomes remains unknown. Drawing together theory describing intragenerational (life course) processes linking early life adversity to adult health, and intergenerational transmissions of inequality via birthweight, this study tests a chain of risk that originates within early adolescence, impacts young women's risky health behaviors in late adolescence/early adulthood and risky health behaviors during pregnancy, and ultimately decreases offspring's birthweight. We do so using structural equation models and prospective, population-level data on a racially and socioeconomically diverse cohort of young adults (National Longitudinal Study of Adolescent to Adult Health). Results (a) reveal four pathways that fully mediate the association between a young woman's family-of-origin socioeconomic status in adolescence and her offspring's birthweight, and (b) identify a trigger effect-a place in the chain of risk where prevention efforts could be targeted, thereby breaking the chain of risk leading to poor offspring health at birth for vulnerable individuals.

Birth Weight and Early Cognitive Skills: Can Parenting Offset the Link?

Objectives There is an enduring negative association between low birth weight (<2500 g) and early childhood cognitive skills. This study examines if parenting practices meaningfully contribute to or offset birth weight disparities in cognitive development prior to formal schooling. Methods This study uses the ECLS-B, a nationally representative sample of live births in the United States in 2001. Unlike studies focused on one or two measures of parenting and investment, this study considers a wide array parenting measures collected at multiple time points, tracked from before birth across 5 years of development. Results Regression results show that nearly 50 % of the low-birth-weight gap in early math and reading ability is associated with family socioeconomic status. Between-family OLS regressions show that parenting practices, including "parental interaction," "cognitive stimulation," and "parent quality", are negatively associated with low birth weight and positively associated with improved cognitive skill among all children. After adjustment for family socioeconomic status, parenting practices did little to offset (by mediation or moderation) remaining birth weight disparities in early cognitive development. Conclusions Effective parenting is positively associated with cognitive development, but parenting is not a panacea-the developmental disadvantages associated with poor child health are not linked to parenting practices. We argue that birth weight disparities are rooted in biology and cannot easily be offset by parenting practices.

Unintended Childbearing and Child Growth in Northern Malawi

Objective The study aims to assess whether unintended children experience slower growth than intended children. Methods We analysed longitudinal data linked to the Karonga Health and Demographic Surveillance Site collected over three rounds between 2008 and 2011 on women’s fertility intentions and anthropometric data of children. Using the prospective information on fertility intention we assessed whether unintended children are more likely to be stunted than intended children. We applied Propensity Score Matching technique to control for endogenous factors affecting both the probability that a family has an unwanted birth and a child with poor health outcomes. Results We found that 24 % of children from unwanted pregnancies were stunted compared with 18 % of mistimed pregnancies and 17 % of those from wanted pregnancies. However, these differences in probability of children being stunted, though in the expected direction, were not significant either for large or small families, after controlling for age. The number of children in the household was associated with stunting and boys were substantially more likely to be stunted than girls. Conclusion We found no significance difference in probability of being stunted by mother’s fertility intention.

The Biosocial Approach to Human Development, Behavior, and Health Across the Life Course

Social and biological phenomena are widely recognized as determinants of human development, health, and socioeconomic attainments across the life course, but our understanding of the underlying pathways and processes remains limited. To address this gap, we define the "biosocial approach" as one that conceptualizes the biological and social as mutually constituting, and that draws on models and methods from the biomedical and social/behavioral sciences. By bringing biology into the social sciences, we can illuminate mechanisms through which socioeconomic, psychosocial, and other contextual factors shape human development and health. Human biology is a social biology, and biological measures can therefore identify aspects of social contexts that are harmful, as well as beneficial, with respect to well-being. By bringing social science concepts and study designs to biology and biomedicine, we encourage an epistemological shift that foregrounds social/contextual factors as important determinants of human biology and health. The biosocial approach also underscores the importance of the life course, as assessments of both biological and social features throughout human development over time, and across generations, are needed to achieve a full understanding of social and physical well-being. We conclude with a brief review of the papers in the volume, which showcase the value of a biosocial approach to understanding the pathways linking social stratification, biology, and health across the life course.

Pathways of Health and Human Capital from Adolescence into Young Adulthood

Social inequalities in health and human capital are core concerns of sociologists, but little research examines the developmental stage when such inequalities are likely to emerge-the transition to adulthood. With new data and innovative statistical methods we conceptually develop, and empirically operationalize, pathways of physical health and human capital accumulation from adolescence into young adulthood, using an autoregressive cross-lagged structural equation model. Results reveal that pathways of health and human capital accumulate at differential rates across the transition to adulthood; evidence of cross-lagged effects lend support for both social causation and health selection hypotheses. We then apply this model to assess the presence of social inequality in metabolic syndrome-the leading risk factor of cardiovascular disease in the U.S. Findings document social stratification of cardiovascular health that is robust to both observed and unobserved social and health selection mechanisms. We speculate that this social stratification will only increase as this cohort ages.

Mental Well-Being Differences in Cohabitation and Marriage: The Role of Childhood Selection

Prior studies have found that marriage benefits well-being, but cohabitation may provide similar benefits. An analysis of the British Cohort Study 1970, a prospective survey following respondents to age 42, examines whether partnerships in general, and marriage in particular, influence mental well-being in midlife. Propensity score matching indicates whether childhood characteristics are a sufficient source of selection to eliminate differences in well-being between those living with and without a partner and those cohabitating and married. The results indicate that matching on childhood characteristics does not eliminate advantages to living with a partner; however, matching eliminates differences between marriage and cohabitation for men and women more likely to marry. On the other hand, marriage may provide benefits to women less likely to marry unless they have shared children and are in long-lasting partnerships. Hence, childhood selection attenuates differences between cohabitation and marriage, except for women less likely to marry.

Today's decisions, Tomorrow's outcomes: Does self-control explain the educational smoking gradient?

People with more education tend to have relatively healthy lifestyles. Among other things, they smoke less than those with less education. This link between education and smoking (known as the "educational gradient") is frequently interpreted as causal: many researchers argue that education develops skills, habits, and preferences that discourage smoking and other unhealthy behaviors. However, an alternative possibility is that these skills, habits, and preferences develop early in life and determine the likelihood of both attaining a high level of education and avoiding smoking. I test the latter possibility using data from the Longitudinal Study of Adolescent to Adult Health (Add Health). In particular, I assess the degree to which indicators of self-control in adolescence explain the association between educational attainment and smoking in adulthood. Results from a series of regression-based tests indicate that self-control is a significant predictor of both outcomes, even when controlling for a host of other risk factors. However, it does not appear to explain the educational gradient.

Health Endowment at Birth and Variation in Intergenerational Economic Mobility: Evidence From U.S. County Birth Cohorts

New estimates of intergenerational economic mobility reveal substantial variation in the spatial distribution of opportunity in the United States. Efforts to explain this variation in economic mobility have conspicuously omitted health despite it being a key pathway for the transmission of economic position across generations. We begin to fill this gap in the literature by examining the relationship between health endowment at birth and intergenerational economic mobility across county birth cohorts in the United States, drawing on estimates from two population-level data sets. Exploiting variation across counties and over time, we find a negative relationship between the incidence of low-weight births and the level of economic mobility as measured in adulthood for the county birth cohorts in our sample. Our results build on a large and growing literature detailing the role of early childhood health in the transmission of economic status across generations and suggest that the incidence of low-weight births is negatively associated with intergenerational economic mobility.

The Influence of Social Conditions Across the Life Course on the Human Gut Microbiota: A Pilot Project With the Wisconsin Longitudinal Study

Objective

To test the feasibility of collecting and integrating data on the gut microbiome into one of the most comprehensive longitudinal studies of aging and health, the Wisconsin Longitudinal Study (WLS). The long-term goal of this integration is to clarify the contribution of social conditions in shaping the composition of the gut microbiota late in life. Research on the microbiome, which is considered to be of parallel importance to human health as the human genome, has been hindered by human studies with nonrandomly selected samples and with limited data on social conditions over the life course.

Methods

No existing population-based longitudinal study had collected fecal specimens. Consequently, we created an in-person protocol to collect stool specimens from a subgroup of WLS participants.

Results

We collected 429 stool specimens, yielding a 74% response rate and one of the largest human samples to date.

Discussion

The addition of data on the gut microbiome to the WLS-and to other population based longitudinal studies of aging-is feasible, under the right conditions, and can generate innovative research on the relationship between social conditions and the gut microbiome.

Maternal Education, Changing Family Circumstances, and Children's Skill Development in the United States and UK

Among the core dimensions of socioeconomic status, maternal education is the most strongly associated with children's cognitive development, and is a key predictor of other resources within the family that strongly predict children's well-being: economic insecurity, family structure, and maternal depression. Most studies examine these circumstances in isolation of one another and/or at particular points in time, precluding a comprehensive understanding of how the family environment evolves over time and contributes to educational disparities in children's skill development and learning. In addition, very little research examines whether findings observed among children in the United States can be generalized to children of a similar age in other countries. We use latent class analysis and data from two nationally representative birth cohort studies that follow children from birth to age five to examine two questions: 1) how do children's family circumstances evolve throughout early childhood, and 2) to what extent do these trajectories account for the educational gradient in child skill development? Cross-national analysis reveals a good deal of similarity between the U.S. and U.K. in patterns of family life during early childhood, and in the degree to which those patterns contribute to educational inequality in children's skill development.

Young Children's Developmental Ecologies and Kindergarten Readiness

Children enter the crucial transition to school with sociodemographic disparities firmly established. Domain-specific research (e.g., on poverty and family structure) has shed light on these disparities, but we need broader operationalizations of children's environments to explain them. Building on existing theory, this study articulates the concept of developmental ecology-those interrelated features of a child's proximal environment that shape development and health. Developmental ecology links structural and demographic factors with interactional, psychological, and genetic factors. Using the Early Childhood Longitudinal Study, Birth Cohort (ECLS-B), this study conducts latent class analyses to identify how 41 factors from three domains-namely, household resources, health risks, and ecological changes-cluster within children as four overarching developmental ecologies. Because it documents how numerous factors co-occur within children, this method allows an approximation of their lived environments. Findings illuminate powerful relationships between race/ethnicity, parental age, socioeconomic background, and nativity and a child's developmental ecology, as well as associations between developmental ecology and kindergarten cognition, behavior, and health. Developmental ecology represents a major pathway through which demographic characteristics shape school readiness. Because specific factors have different implications depending on the ecologies in which they are embedded, findings support the usefulness of a broad ecological approach.

Why does college education matter? Unveiling the contributions of selection factors

This study investigates the contributions of pre-college selection factors that may partially lead to the college degree - health link by using longitudinal data from the National Longitudinal Survey of Youth (1979) cohort. Propensity score matching method finds that the effects of college degree on various health outcomes (self-rated health, physical component summary index, health limitations, CESD scale) are reduced by 51% on average (range: 37%-70%) in the matched sample. Among these observed factors, cognitive skill is the biggest confounder, followed by pre-college health and socioeconomic characteristics (marital aspiration, years of schooling, marriage, fertility, poverty status) and non-cognitive skills (e.g., self-esteem). Rotter Internal-External Locus of Control scale is not significantly associated with all four health measures. The effects of most indicators of family background (parental education, family stability, family size, religious background) on the health of adult children are not direct but through offspring's early adulthood health and socioeconomic status.

The Simultaneous Effects of Socioeconomic Disadvantage and Child Health on Children's Cognitive Development

Family socioeconomic status (SES) and child health are so strongly related that scholars have speculated child health to be an important pathway through which a cycle of poverty is reproduced across generations. Despite increasing recognition that SES and health work reciprocally and dynamically over the life course to produce inequality, research has yet to address how these two pathways simultaneously shape children's development. Using longitudinal data from the Fragile Families and Child Wellbeing Study and marginal structural models, we ask three questions: (1) how does the reciprocal relationship between socioeconomic disadvantage and child health affect estimates of each circumstance on children's cognitive development?; (2) how do their respective effects vary with age?; and (3) do family SES and child health have differential effects on cognitive development across population subgroups? The results show that the negative effects of socioeconomic disadvantage and poor health are insensitive to their reciprocal relationships over time. We find divergent effects of socioeconomic disadvantage and poor health on children's cognitive trajectories, with a widening pattern for family SES effects and a leveling-off pattern for child health effects. Finally, the effects of socioeconomic disadvantage are similar across all racial/ethnic groups, while the effects of child health are largely driven by white children. We discuss theoretical and policy implications of these findings for future research.

Grandparents' Education and Infant Health: Pathways across Generations

Using data from the Fragile Families and Child Wellbeing survey linked to respondents' medical records (N=2,870), this study examines the association between grandparents' education and birth outcomes and explores potential pathways underlying this relationship. Results show that having a grandfather with less than a high school education was associated with a 93 gram reduction in birthweight, a 59% increase in the odds of low birthweight, and a 136% increase in the odds of a neonatal health condition, compared to having a grandfather with a high school education or more. These associations were partially accounted for by mother's educational attainment and marital status, as well as by prenatal history of depression, hypertension, and prenatal health behaviors, depending on the specific outcome. The findings from this study call for heightened attention to the multigenerational influences of educational attainment for infant health.

Children with disabilities and trajectories of parents' unsecured debt across the life course

Prior research shows that having a child with a disability is economically burdensome for parents but we know little about whether this burden extends to unsecured debt. In this study, we examine the link between having a child with a disability that manifests between birth and age 4 and subsequent trajectories in unsecured household debt. We have three key findings. First, we find that having a child with an early-life disabling health condition is associated with a substantial increase in indebtedness in the years immediately following the child's birth, and that this association persists net of a range of potential confounders. Second, we find that parents do not quickly repay this debt, such that parents of a child with a disabling health condition have different trajectories of unsecured debt across the life course than do parents of children without a disabling health condition. Third, we find that the association between early-life child disability and debt is stronger for more severe conditions, such as those that require ongoing medical treatment. The results of this study are informative for understanding an important aspect of economic functioning-indebtedness-for parents of children with disabilities, as well as the causes and correlates of rising unsecured debt in the U.S.

Education and patient preferences for treating type 2 diabetes: a stratified discrete-choice experiment

PURPOSE

Diabetes is a chronic condition that is more prevalent among people with lower educational attainment. This study assessed the treatment preferences of patients with type 2 diabetes by educational attainment.

METHODS

Patients with type 2 diabetes were recruited from a national online panel in the US. Treatment preferences were assessed using a discrete-choice experiment. Participants completed 16 choice tasks in which they compared pairs of treatment profiles composed of six attributes: A1c decrease, stable blood glucose, low blood glucose, nausea, treatment burden, and out-of-pocket cost. Choice models and willingness-to-pay (WTP) estimates were estimated using a conditional logit model and were stratified by educational status.

RESULTS

A total of 231 participants with a high school diploma or less education, 156 participants with some college education, and 165 participants with a college degree or more completed the survey. Participants with a college degree or more education were willing to pay more for A1c decreases ($58.84, standard error [SE]: 10.6) than participants who had completed some college ($28.47, SE: 5.53) or high school or less ($17.56, SE: 3.55) (p≤0.01). People with a college education were willing to pay more than people with high school or less to avoid nausea, low blood glucose events during the day/night, or two pills per day.

CONCLUSION

WTP for aspects of diabetes medication differed for people with a college education or more and a high school education or less. Advanced statistical methods might overcome limitations of stratification and advance understanding of preference heterogeneity for use in patient-centered benefit-risk assessments and personalized care approaches.

Migration, Family Arrangement, and Children's Health in China

With unprecedented migration taking place in China, millions of children are profoundly affected. Using a sample of 916 children (aged 5-18) of migrants and the life course perspective, this article examines the impact of parental migration on children's health. Results show that migration has a complex impact on children's health. Although migrating to cities itself does not benefit children, poor housing conditions in cities have a negative impact on their health. The timing of parental migration is important, as preschoolers migrating with parents and teenagers left behind by parents have significantly worse health than others. Migration also has a gendered effect, as teenage boys benefit from migrating to cities but suffer from being left behind when compared to teenage girls.

Disparities in self-rated health across generations and through the life course

Extensive evidence leads us to expect that health disparities by race and socioeconomic status found in one generation might be reproduced in the next. To the extent that this occurs it is important to assess life course processes responsible for the reproduction. Prospective evidence concerning such life course processes is hard to come by as it requires long-term follow-up of individuals from childhood through adult life. We present data from the Child Health and Development Disparities study that provides evidence relevant to this issue with respect to self-rated health. Mothers and offspring recruited in California's Bay Area between 1959 and 1967 were assessed during pregnancy with follow-up exams of offspring along with in-person interviews with mothers (at offspring ages 5, 9-11, 15-17) and offspring (at ages 15-17, ∼50). Available data allow us to assess the importance of three potential life course pathways in the reproduction of inequalities in self-rated health - socioeconomic pathways, cognitive pathways and pathways involving emerging health itself. As expected we found that race and SES disparities in SRH are reproduced across generations. They are evident in mothers, not strong or significant in offspring at 15-17, but present once again in offspring at age ∼50. Concerning potential pathways, we found that indicators of child health were related to adult SRH and played some role in accounting for race but not SES disparities in adult SRH. Cognitive abilities were unrelated to adult SRH with childhood SES controlled. Childhood SES was associated with adult SRH independent of other childhood factors and is reduced to non-significance only when offspring college attainment is controlled. Race and SES disparities in self-reported health in one generation are re-expressed in the next with strongest support for SES pathways in this transmission.

Individualized Education Program Development Among Racially/Ethnically Diverse Children and Adolescents with Health Conditions

Background Black, Hispanic, and low income children bear a greater burden of chronic health conditions compared to wealthier white counterparts. Under federal law, schools provide services to children when their health conditions impair learning. These school services, called individualized education programs (IEPs) can reduce disparities in school outcomes. This paper examines the extent to which children with health conditions have an IEP plan, an important first step in understanding service utilization. Method Andersen's Behavioral Model was used to examine IEP plan presence by using the 2012 National Survey of Children's Health. School aged children (6-17), with at least one health condition (N = 16,496) were examined using multivariable logistic regression analysis to understand predisposing (age, sex, race/ethnicity), enabling (family and neighborhood), and need (health related) factors as predictors of having an IEP plan. Race/ethnicity interaction terms tested for moderating effects of race/ethnicity on the relationship between predisposing, enabling and need factors and having an IEP plan. Results Hispanic children were 93.4 % (OR = .066) less likely and Black children were 87.9 % (OR = .121) less likely to have an IEP plan compared to White children. Black, Hispanic, and Multiracial children were more likely to have an IEP plan if they had more family and neighborhood resources (OR range 1.37-1.62) and greater health needs and health care needs (OR range 1.29-2.57). Conclusion The Behavioral Model was useful in predicting the presence of IEP plans among racially/ethnically diverse children with health conditions as an important step in understanding disparities in healthcare access in schools.

Prevention of Age-Related Cognitive Decline: Which Strategies, When, and for Whom?

Brain aging is characterized by the progressive and gradual accumulation of detrimental changes in structure and function, which increase risk of age-related cognitive decline and dementia. This devastating chronic condition generates a huge social and economic burden and accounts for 11.2% of years of disability. The increase in lifespan has contributed to the increase in dementia prevalence; however, there is currently no curative treatment for most causes of dementias. This paper reviews evidence-based strategies to build, enhance, and preserve cognition over the lifespan by examining approaches that work best, proposing when in the life course they should be implemented, and in which population group(s). Recent work shows a tendency to decreased age-specific prevalence and incidence of cognitive problems and dementia among people born later in the first half of the 20th century, citing higher educational levels, improvements in lifestyle, and better handling of vascular risk factors. This implies that we can target modifiable environmental, lifestyle, and health risk factors to modify the trajectory of cognitive decline before the onset of irreversible dementia. Because building cognitive reserve and prevention of cognitive decline are of critical importance, interventions are needed at every stage of the life course to foster cognitive stimulation, and enable healthy eating habits and physical activity throughout the lifespan. Preventive interventions to decrease and delay cognitive decline and its consequences in old age will also require collaboration and action on the part of policy-makers at the political and social level.

Parental and adolescent health behaviors and pathways to adulthood

This paper examines associations among parental and adolescent health behaviors and pathways to adulthood. Using data from the National Longitudinal Study of Adolescent to Adult Health, we identify a set of latent classes describing pathways into adulthood and examine health-related predictors of these pathways. The identified pathways are consistent with prior research using other sources of data. Results also show that both adolescent and parental health behaviors differentiate pathways. Parental and adolescent smoking are associated with lowered probability of the higher education pathway and higher likelihood of the work and the work & family pathways (entry into the workforce soon after high school completion). Adolescent drinking is positively associated with the work pathway and the higher education pathway, but decreases the likelihood of the work & family pathway. Neither parental nor adolescent obesity are associated with any of the pathways to adulthood. When combined, parental/adolescent smoking and adolescent drinking are associated with displacement from the basic institutions of school, work, and family.

Nutrition activation and dietary intake disparities among US adults

OBJECTIVE

To introduce the concept 'nutrition activation' (the use of health and nutrition information when making food and diet decisions) and to assess the extent to which nutrition activation varies across racial/ethnic groups and explains dietary disparities.

DESIGN

Cross-sectional sample representative of adults in the USA. Primary outcome measures include daily energy intake and consumption of sugar-sweetened beverages (SSB), fast foods and sit-down restaurant foods as determined by two 24 h dietary recalls. We use bivariate statistics and multiple logistic and linear regression analyses to assess racial/ethnic disparities in nutrition activation and food behaviour outcomes.

SETTING

USA.

SUBJECTS

Adult participants (n 7825) in the 2007-2010 National Health and Nutrition Examination Survey.

RESULTS

Nutrition activation varies across racial/ethnic groups and is a statistically significant predictor of SSB, fast-food and restaurant-food consumption and daily energy intake. Based on the sample distribution, an increase from the 25th to 75th percentile in nutrition activation is associated with a decline of about 377 kJ (90 kcal)/d. Increased nutrition activation is associated with a larger decline in SSB consumption among whites than among blacks and foreign-born Latinos. Fast-food consumption is associated with a larger 'spike' in daily energy intake among blacks (+1582 kJ (+378 kcal)/d) than among whites (+678 kJ (+162 kcal)/d).

CONCLUSIONS

Nutrition activation is an important but understudied determinant of energy intake and should be explicitly incorporated into obesity prevention interventions, particularly among racial/ethnic minorities.

An education gradient in health, a health gradient in education, or a confounded gradient in both?

There is a positive gradient associating educational attainment with health, yet the explanation for this gradient is not clear. Does higher education improve health (causation)? Do the healthy become highly educated (selection)? Or do good health and high educational attainment both result from advantages established early in the life course (confounding)? This study evaluates these competing explanations by tracking changes in educational attainment and Self-rated Health (SRH) from age 15 to age 31 in the National Longitudinal Study of Youth, 1997 cohort. Ordinal logistic regression confirms that high-SRH adolescents are more likely to become highly educated. This is partly because adolescent SRH is associated with early advantages including adolescents' academic performance, college plans, and family background (confounding); however, net of these confounders adolescent SRH still predicts adult educational attainment (selection). Fixed-effects longitudinal regression shows that educational attainment has little causal effect on SRH at age 31. Completion of a high school diploma or associate's degree has no effect on SRH, while completion of a bachelor's or graduate degree have effects that, though significant, are quite small (less than 0.1 points on a 5-point scale). While it is possible that educational attainment would have greater effect on health at older ages, at age 31 what we see is a health gradient in education, shaped primarily by selection and confounding rather than by a causal effect of education on health.

Maternal Education and Investments in Children's Health

Maternal education differences in children's academic skills have been strongly linked to parental investment behaviors. This study extended this line of research to investigate whether these same maternal education patterns in parenting are observed among a set of parenting behaviors that are linked to young children's health. Drawing on data from the Early Childhood Longitudinal Study, Birth Cohort (n = 5,000) and longitudinal models incorporating random effects, the authors found that higher levels of maternal education were associated with more advantageous health investment behaviors at each phase of early development (9 months, 2 years, 4 years, 5 years). Moreover, these disparities were typically largest at the developmental stage when it was potentially most sensitive for children's long-term health and development. These findings provide further evidence of a developmental gradient associated with mothers' education and new insight into the salience of mothers' education for the short- and long-term health and well-being of their children.

The humanistic and economic burden of juvenile idiopathic arthritis in the era of biologic medication

Juvenile idiopathic arthritis (JIA) is a poorly understood, heterogeneous, incurable, inflammatory syndrome. Long-term outcomes are uncertain, and this painful condition can result in lifelong disability. JIA is associated with considerable financial and humanistic burden for those affected and the healthcare system. Early diagnosis and effective treatment are indicated to optimise outcomes. Modern treatment aims to achieve remission and preserve joint function by using disease-modifying antirheumatic drugs (DMARDs) early. DMARDs can be classified as conventional/traditional or biologic. Biologic medications may be more effective but cost approximately ten times more than traditional DMARDs. Decision-makers in healthcare are increasingly comparing the cost and consequences of alternative treatment strategies to guide resource allocation decisions. There have been few economic evaluations to date to guide medicines optimisation in JIA. This systematic review highlights the lack of existing evidence relating to the humanistic and economic burden of JIA in the era of biologic medication.

Does Growing Childhood Socioeconomic Inequality Mean Future Inequality in Adult Health?

Over the past half century, American children have experienced increasingly unequal childhoods. The goal of this article is to begin to understand the implications of recent trends in social and economic inequalities among children for the future of inequalities in health among adults. The relative importance of many of the causal pathways linking childhood social and economic circumstances to adult health remains underexplored, and we know even less about how these causal pathways have changed over time. I combine a series of original analyses with reviews of relevant literature in a number of fields to inform a discussion of what growing childhood inequalities might mean for future inequalities in adult health. In the end, I argue that there is good reason to suppose that growing inequalities in children's social and economic circumstances will lead to greater heterogeneity in adults' morbidity and mortality.

Childhood Adversity and Men's Relationships in Adulthood: Life Course Processes and Racial Disadvantage

OBJECTIVES

Prior U.S. population studies have found that childhood adversity influences the quality of relationships in adulthood, with emerging research suggesting that this association might be especially strong for black men. We theorize psychosocial and behavioral coping responses to early life adversity and how these responses may link early life adversity to strain in men's relationships with their indeterminate partners and children across the life course, with attention to possible racial variation in these experiences and implications for later life well-being.

METHOD

We analyze in-depth interviews with 15 black men and 15 white men. We use qualitative analysis techniques to connect childhood experiences to psychosocial processes in childhood and behavioral coping strategies associated with relationship experiences throughout adulthood.

RESULTS

Black men describe much stronger and more persistent childhood adversity than do white men. Findings further suggest that childhood adversity contributes to psychosocial processes (e.g., diminished sense of mastery) that may lead to ways of coping with adversity (e.g., self-medication) that are likely to contribute to relationship difficulties throughout the life span.

DISCUSSION

A life course perspective directs attention to the early life origins of cumulative patterns of social disadvantage, patterns that extend to later life. Our findings suggest psychosocial and behavioral pathways through which early life adversity may constrain and strain men's relationships, possibly contributing to racial inequality in family relationships across the life span.

The relationship between lifetime health trajectories and socioeconomic attainment in middle age

A large literature demonstrates the direct and indirect influence of health on socioeconomic attainment, and reveals the ways in which health and socioeconomic background simultaneously and dynamically affect opportunities for attainment and mobility. Despite an increasing understanding of the effects of health on social processes, research to date remains limited in its conceptualization and measurement of the temporal dimensions of health, especially in the presence of socioeconomic circumstances that covary with health over time. Guided by life course theory, we use data from the British National Child Development Study, an ongoing panel study of a cohort born in 1958, to examine the association between lifetime health trajectories and socioeconomic attainment in middle age. We apply finite mixture modeling to identify distinct trajectories of health that simultaneously account for timing, duration and stability. Moreover, we employ propensity score weighting models to account for the presence of time-varying socioeconomic factors in estimating the impact of health trajectories. We find that, when poor health is limited to the childhood years, the disadvantage in socioeconomic attainment relative to being continuously healthy is either insignificant or largely explained by time-varying socioeconomic confounders. The socioeconomic impact of continuously deteriorating health over the life course is more persistent, however. Our results suggest that accounting for the timing, duration and stability of poor health throughout both childhood and adulthood is important for understanding how health works to produce social stratification. In addition, the findings highlight the importance of distinguishing between confounding and mediating effects of time-varying socioeconomic circumstances.

Children's Elicitation of Changes in Parenting during the Early Childhood Years

Using a subsample of the Early Childhood Longitudinal Study-Birth Cohort (ECLS-B; n = 1,550), this study identified parents who engaged in more developmentally problematic parenting-in the form of low investment, above average television watching, and use of spanking-when their children were very young (M = 24.41 months, SD = 1.23) but changed their parenting in more positive directions over time. Latent profile analysis and other techniques revealed that parents who demonstrated less optimal parenting behaviors when their children were 2 years old were more likely to be African American, from lower socioeconomic backgrounds, and experiencing greater depressive symptoms. Approximately half of such parents, however, made positive changes in their parenting practices, with 5% in the profile characterized by high investment and low use of spanking by the time that their children were in elementary school. These positive changes in parenting behavior were more likely to occur among parents whose children were already demonstrating early reading skills and less problem behavior. These potential "child effects", suggesting that children elicited improvements in parenting, were more pronounced among higher income families but did not vary according to parents' educational attainment. Findings from this study have important implications for intervention programs, suggesting that children's academic and behavioral skills can be leveraged as one means of facilitating positive parenting.

Cumulative inequality in child health and academic achievement

Our understanding of health and social stratification can be enriched by testing tenets of cumulative inequality theory that emphasize how the accumulation of inequality is dependent on the developmental stage being considered, the duration and stability of poor health, and the family resources available to children. I analyze longitudinal data from the British National Child Development Study (N = 9,252) to ask: (1) if child health is a source of cumulative inequality in academic achievement, (2) whether this relationship depends on the timing and duration of poor health, and (3) whether trajectories are sensitive to levels of family capital. The results suggest that the relationship between health and academic achievement emerges very early in life and persists and that whether we observe shrinking or widening inequality as children age depends on when we measure their health and whether children have access to compensatory resources.

Why do older people change their ratings of childhood health?

A growing number of studies in life course epidemiology and biodemography make use of a retrospective question tapping self-rated childhood health to assess overall physical health status. Analyzing repeated measures of self-rated childhood health from the Health and Retirement Study (HRS), this study examines several possible explanations for why respondents might change their ratings of childhood health. Results reveal that nearly one-half of the sample revised their rating of childhood health during the 10-year observation period. Whites and relatively advantaged older adults-those with more socioeconomic resources and better memory-were less likely to revise their rating of childhood health, while those who experienced multiple childhood health problems were more likely to revise their childhood health rating, either positively or negatively. Changes in current self-rated health and several incident physical health problems were also related to the revision of one's rating of childhood health, while the development of psychological disorders was associated with more negative revised ratings. We then illustrate the impact that these changes may have on an adult outcomes: namely, depressive symptoms. Whereas adult ratings of childhood health are likely to change over time, we recommend their use only if adjusting for factors associated with these changes, such as memory, psychological disorder, adult self-rated health, and socioeconomic resources.

The relationship between student health and academic performance: Implications for school psychologists

Children who are unhealthy are at higher risk for school problems than students who are free from medical problems. Students with poor health have a higher probability of school failure, grade retention, and dropout. The relationship between student health and academic success is complex. Common manageable factors of student health are nutrition, maintaining healthy weight, and physical fitness. Through a comprehensive literature review the relationships among school achievement and nutrition, maintaining healthy weight, and physical fitness are examined. Furthermore, the efficacy of educational programs to improve nutrition, maintain healthy weight, and increase physical fitness is evaluated. The complexity of the relationship among variables is presented and areas for future research and practice for school psychologists are described.

Incorporating Health into Studies of Political Behavior: Evidence for Turnout and Partisanship

We argue that research on political behavior, including political participation, public opinion, policy responsiveness, and political inequality will be strengthened by studying the role of health. We then provide evidence that health matters for voter turnout and partisanship. Using the General Social Survey (GSS) and The National Longitudinal Study of Adolescent Health (Add Health), we find that people who report poor health are less likely to vote and identify with the Republican Party. Moreover, the effects of health on voter turnout and partisanship appear to have both developmental and contemporaneous components. Taken together, our findings suggest that health inequalities may have significant political consequences.

Prenatal exposure to violence and birth weight in Mexico: Selectivity, exposure, and behavioral responses

This article examines the effect of maternal exposure to local homicides on birth weight. We create a monthly panel by merging all births in Mexico from 2008 to 2010 with homicide data at the municipality level. Findings from fixed-effects models indicate that exposure to homicides in the first trimester of gestation increases infant birth weight and reduces the proportion of low birth weight. The effect is not driven by fertility or migration responses to environmental violence. The mechanism driving this surprising positive effect appears to be an increase in mothers’ health-enhancing behaviors (particularly the use of prenatal care) as a result of exposure to violence. The positive effect of homicide exposure is heterogeneous across socioeconomic status (SES). It is strong among low-SES women—but only those living in urban areas—and null among the most advantaged women. This variation suggests that behavioral responses to an increase in local homicides depend on a combination of increased vulnerability and access to basic resources that allow women to obtain prenatal care.

Stress proliferation across generations? Examining the relationship between parental incarceration and childhood health

Stress proliferation theory suggests that parental incarceration may have deleterious intergenerational health consequences. In this study, I use data from the 2011-2012 National Survey of Children's Health (NSCH) to estimate the relationship between parental incarceration and children's fair or poor overall health, a range of physical and mental health conditions, activity limitations, and chronic school absence. Descriptive statistics show that children of incarcerated parents are a vulnerable population who experience disadvantages across an array of health outcomes. After adjusting for demographic, socioeconomic, and familial characteristics, I find that parental incarceration is independently associated with learning disabilities, attention deficit disorder and attention deficit hyperactivity disorder, behavioral or conduct problems, developmental delays, and speech or language problems. Taken together, results suggest that children's health disadvantages are an overlooked and unintended consequence of mass incarceration and that incarceration, given its unequal distribution across the population, may have implications for population-level racial-ethnic and social class inequalities in children's health.

Mortality deceleration and mortality selection: three unexpected implications of a simple model

Unobserved heterogeneity in mortality risk is pervasive and consequential. Mortality deceleration-the slowing of mortality's rise with age-has been considered an important window into heterogeneity that otherwise might be impossible to explore. In this article, I argue that deceleration patterns may reveal surprisingly little about the heterogeneity that putatively produces them. I show that even in a very simple model-one that is composed of just two subpopulations with Gompertz mortality-(1) aggregate mortality can decelerate even while a majority of the cohort is frail; (2) multiple decelerations are possible; and (3) mortality selection can produce acceleration as well as deceleration. Simulations show that these patterns are plausible in model cohorts that in the aggregate resemble cohorts in the Human Mortality Database. I argue that these results challenge some conventional heuristics for understanding the relationship between selection and deceleration; undermine certain inferences from deceleration timing to patterns of social inequality; and imply that standard parametric models, assumed to plateau at most once, may sometimes badly misestimate deceleration timing-even by decades.

Modeling old-age wealth with endogenous early-life outcomes: The case of Mexico

This paper contributes to the literature on the life course and aging by examining the association between early-life outcomes and late-life well being, using data from the Mexican Health and Aging Study. Empirical research in this area has been challenged by the potential endogeneity of the early-life outcomes of interest, an issue which most studies ignore or downplay. Our contribution takes two forms: (1) we examine in detail the potential importance of two key life-cycle outcomes, age at marriage (a measure of family formation) and years of educational attainment (a measure of human capital investment) for old-age wealth, and (2) we illustrate the empirical value of past context variables that could help model the association between early-life outcomes and late-life well being. Our illustrative approach, matching macro-level historical policy and census variables to individual records to use as instruments in modeling the endogeneity of early-life behaviors, yields a statistically identified two-stage model of old-age wealth with minimum bias. We use simulations to show that the results for the model of wealth in old age are meaningfully different when comparing the approach that accounts for endogeneity with an approach that assumes exogeneity of early-life outcomes. Furthermore, our results suggest that in the Mexican case, models which ignore the potential endogeneity of early-life outcomes are likely to under-estimate the effects of such variables on old-age wealth.

Race, gender, and chains of disadvantage: childhood adversity, social relationships, and health

We use a life course approach to guide an investigation of relationships and health at the nexus of race and gender. We consider childhood as a sensitive period in the life course, during which significant adversity may launch chains of disadvantage in relationships throughout the life course that then have cumulative effects on health over time. Data from a nationally representative panel study (Americans' Changing Lives, N = 3,477) reveal substantial disparities between black and white adults, especially pronounced among men, in the quality of close relationships and in the consequences of these relationships for health. Greater childhood adversity helps to explain why black men have worse health than white men, and some of this effect appears to operate through childhood adversity's enduring influence on relationship strain in adulthood. Stress that occurs in adulthood plays a greater role than childhood adversity in explaining racial disparities in health among women.

The interplay between child and maternal health: reciprocal relationships and cumulative disadvantage during childhood and adolescence

While many studies use parental socioeconomic status and health to predict children's health, this study examines the interplay over time between child and maternal health across childhood and adolescence. Using data from women in the National Longitudinal Study of Youth 1979 cohort and their children (N = 2,225), autoregressive cross-lagged models demonstrate a reciprocal relationship between child activity limitations and maternal health limitations in direct effects of child activity limitations on maternal health limitations two years later and vice versa-net of a range of health-relevant time-varying and time-invariant covariates. Furthermore, there are indirect effects of child activity limitations on subsequent maternal health limitations and indirect effects of maternal health limitations on subsequent child activity limitations via intervening health statuses. This study examines how the interplay between child and maternal health unfolds over time and describes how these interdependent statuses jointly experience health disadvantages.

Early life conditions, partnership histories, and mortality risk for Swedish men and women born 1915-1929

This paper investigates the relationship between early life biological and social factors, partnership history, and mortality risk. Mortality risks for Swedish men and women over age 50 in the Uppsala Birth Cohort born 1915-1929 were estimated using survival analysis. Relative mortality risk was evaluated through nested multiplicative Gompertz models for 4348 men and 3331 women, followed from age 50 to the end of 2010. Being born to an unmarried mother was associated with higher mortality risk in later life for men and women, and relative to married individuals, being unmarried after age 50 was associated with elevated mortality risk. Single women and divorced men were the highest risk groups, and women were negatively impacted by a previous divorce or widowhood, while men were not. Both genders showed direct effects of early life variables on later life mortality and were vulnerable if unmarried in later life. However, in this study, previous marital disruptions appeared to have more (negative) meaning in the long-term for women.