Early-life social origins of later-life body weight: the role of socioeconomic status and health behaviors over the life course

Socio-economic accounting of inequalities in excess weight: a population-based analysis

BACKGROUND

The prevalence of excess weight has been increasing globally in the last decades, affecting disproportionally adults from low socio-economic backgrounds and putting undue pressure on health systems and societal resources. In England, tackling unfair and unjust health inequalities is at the heart of national public health policy, and a prerequisite for enabling these decision makers to set policy priorities is an understanding of the prevalence and determinants of excess weight inequalities in their local population.

METHODS

We conducted both pooled (England) and regional-level (nine regions: North-East, North-West, Yorkshire and Humber, East Midlands, West Midlands, East of England, London, South East and South West) analyses of individual level data from a nationally representative sample of adults (N = 6,387). We used the Corrected Concentration Index (CCI) to measure absolute inequalities in excess weight across three dimensions of socio-economic deprivation: neighbourhood-level deprivation, occupational status and educational qualification. We used a Shapley decomposition method to evaluate their relative contribution to inequality.

RESULTS

At a national level, all three dimensions of socio-economic deprivation were found to be positively associated with excess weight across the adult population, as measured by the CCI, with educational qualification ranking first [CCI: -0.090, p < 0.01], closely followed by neighbourhood-level deprivation [CCI: -0.050, p < 0.01]. Large variation was found between regions and genders, with inequality being either considerably higher or exclusively patterned among women. The strongest independent factor contributing to excess weight inequalities was having a long-lasting limiting illness, especially among women and towards the right tail of the excess weight spectrum. Heterogeneous patterns of contribution across the excess weight spectrum were found, however age played a dominant role toward the left tail of the distribution.

CONCLUSIONS

While socio-economic inequalities in excess weight exist in the English adult population, our findings underscore the importance of considering multiple dimensions of deprivation and the unique needs of different populations when developing policies to address overweight and obesity. Targeted interventions for adults with overweight and obesity with long-lasting illnesses and women can generate both short-term and long-term economic benefits, by reducing healthcare costs and increasing workforce productivity.

Associations between socioeconomic status and risk of obesity and overweight among Chinese children and adolescents

BACKGROUND

In China, the threat of obesity and overweight in children and adolescents is developing quickly. It may be possible to lower the risk of obesity and overweight in children and adolescents by understanding the factors that drive these conditions. Therefore, this study aimed to investigate the association between SES and risk of obesity and overweight among children and adolesecnts in China's provinces of Jiangsu, Anhui, Zhejiang, and Shanghai.

METHODS

Chinese children and adolescents (n = 2,746; 46.3% boys) were recruited using multistage sampling. SES was measured using self-reported questionnaires, the specific indicators were parental education, perceived family wealth, and Family Affluence Scale II. Height and weight were measured and used to calculate body mass index (BMI, categorized into obesity or overweight). The definition of obesity or overweight was based on the Chinese standard "Screening for obesity and overweight among school-age children and adolescents". Descriptive statistics, independent sample t-tests, and a Chi-square test were used to report the sample characteristics and analyse BMI differences across different sociodemographic groups. A binary logistic regression was then applied to analyse the association of SES indicators with BMI in children and adolescents.

RESULTS

Overall, 22.5% of children and adolescents were obese or overweight. Participants with medium and high maternal education levels were 1.48 [95% CI 1.15-1.91] and 1.47 [95% CI 1.03-2.11] times more likely to be obese/overweight. Girls with medium maternal education levels were 1.70[95% CI 1.21-2.40] times more likely to be obese/overweight. For boys, no association was observed. Junior middle school students with medium maternal education levels were 1.51[95% CI 1.10-2.07] times more likely to be obese/overweight. Participants with medium or high FAS, perceived family wealth, or paternal education levels were not associated with obesity/overweight.

CONCLUSIONS

The findings of this study indicated a positive association between SES and risk of overweight/obesity in girls, suggesting that maternal education level may have a substantial impact on future prevention efforts for these conditions in girls. To increase the effectiveness of interventions, longitudinal studies are necessary to better understand the causal association between SES and obesity/overweight.

Multiple pathways linking early socioeconomic circumstances and depressive symptoms in late Middle age in the U.S

Objectives: A growing number of life course studies are examining the influence of earlier life experiences on morbidity, disability, and mortality in mid-old age.Method: Drawing from the social pathway model, this study expands the life course literature by utilizing data collected over 35 years from the National Longitudinal Survey of Youth, 1979 Cohort, spanning four life course phases (childhood, young adulthood, middle adulthood, and late-middle adulthood). Through structural equation analyses with a phantom model, we estimated depressive symptoms in late middle age as a result of pathway effects starting with childhood socio-economic status (SES) which effect young adulthood and middle adulthood. The multi-pathway life course model includes three potential mediators of middle adulthood: health risk behaviors, social activity, and negative life events.Results: We found limited support for a direct effect of childhood SES disadvantage on depressive symptoms in middle age. Instead, much of the effects of childhood SES on later-year depressive symptoms appear to be mediated by SES in young adulthood. Further, the long-term pathway is mediated through the influence of health risk behaviors and negative life events in middle adulthood.Conclusion: Our findings do not propose this chain is permanent and irreversible; rather, this study highlights the possibility that interventions focused on promoting health behaviors and improving living conditions for people from socioeconomically disadvantaged backgrounds could help reduce the instance of depression in middle age and health outcomes along the life course could be improved.

Increased adult child schooling and older parents' health behaviors in Europe: A quasi-experimental study

There is growing evidence that adult child educational attainment is associated with older parents' physical health and longevity. Scholars have hypothesized that these associations may be driven by health-behavior pathways, whereby adult children with more education may share information about healthy lifestyles, role-model healthier behaviors, and/or have more economic resources to support leisure-based physical activity or the purchase of healthy foods for older parents. However, this relationship has not been comprehensively evaluated with methods capable of addressing the confounding bias expected for observational studies on this topic. We estimated the association between increased adult child schooling and older parents' health behaviors using data from the Survey for Health, Aging and Retirement in Europe (SHARE) (n = 8195). We leveraged changes to compulsory schooling laws that would have impacted respondents' adult children as quasi-experiments and estimated the association between increased schooling among oldest adult children and respondents' (parents') body mass index, obesity, physical inactivity, excessive drinking, and current smoking using two-stage least squares regression. Each year of increased schooling among oldest adult children was associated with a lower risk of current smoking (β: −0.029, 95% CI: −0.056, −0.003), physical inactivity (β: −0.034, 95% confidence interval [CI]: −0.077, 0.009), obesity (β: −0.038, 95% CI: −0.065, −0.011) and lower body mass index (β: −0.37, 95% CI: −0.73, −0.02). The direction of associations with excessive drinking varied by parent gender (β: −0.027, 95% CI: −0.046, −0.007 for mothers; β: 0.068, 95% CI: −0.011, 0.148 for fathers). Increases in adult child schooling may have upward influences on parents' late-life health behaviors, although there may be some differences by parent gender. Findings should be replicated across other global settings and studies should directly evaluate parent health behaviors as mediators of the relationship between increased adult child schooling and older parents’ longevity.

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Growing research suggests adult child education influences parents' mortality.

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This association may be due to health behavior pathways, but evidence is scarce.

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We conducted a quasi-experimental study of this topic using European data.

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Increased child schooling was associated with improved health behaviors for older parents.

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Associations with older parents' risk of excessive drinking varied by parent gender.

Early-Life Socioeconomic Disadvantage and Health in Late Middle-Age: Importance of Heterogeneous Income Trajectories

This paper aims to investigate heterogeneous income changes and whether the income trajectories moderate effects of early socioeconomic disadvantage on health in late middle age. The sample was restricted to 9,056 middle-aged adults from the Health and Retirement Study (1998-2010). Through a latent class growth analysis, six patterns of income changes were identified: constantly low, constantly moderate, constantly high & increasing, high to low, moderate to high, and high to moderate. The Constantly low group more frequently displayed depressive symptoms if exposed to early socioeconomic disadvantage and Constantly low income mobility. Individuals who experienced early socioeconomic disadvantage and a downward income mobility in middle age tended to have multiple chronic conditions while there was no moderating effect of income changes for mobility functional limitations. These findings suggest that not all health outcomes are programmed in early life: Disadvantage can be somewhat alleviated through stable and better later-life economic status.

Socioeconomic status and immune aging in older US adults in the health and retirement study

Socioeconomic and demographic factors including educational attainment, race and ethnicity, and childhood socioeconomic status (SES) are powerful predictors of inequalities in aging, morbidity, and mortality. Immune aging, including accumulation of late-differentiated, senescent-like lymphocytes and lower levels of naïve lymphocytes, may play a role in the development of the age-related health inequalities. This study used nationally representative data from more than 9,000 US adults from the Health and Retirement Study to investigate associations between educational attainment, race and ethnicity, and childhood SES and lymphocyte percentages. Respondents with lower educational attainment, Hispanic adults, and those who had a parent with less than a high school education had lymphocyte percentages consistent with more immune aging compared to those with greater educational attainment, non-Hispanic White adults, and respondents who had parents with a high school education, respectively. Associations between education, Hispanic ethnicity, and parents' education and late differentiated senescent-like T lymphocytes (TemRA) and B cells were largely driven by cytomegalovirus (CMV), suggesting it is a factor in observed SES inequalities in immunosenescence. Naïve T lymphocytes may be particularly affected by socioeconomic position and may therefore be of particular interest to research interested in inequalities in health and aging.

Using sibling models to unpack the relationship between education and cognitive functioning in later life

As the population ages and the prevalence of dementia increases, unpacking robust and persistent associations between educational attainment and later life cognitive functioning is increasingly important. We do know, from studies with robust causal designs, that policies that increase years of schooling improve later life cognitive functioning. Yet these studies don't illuminate why older adults with greater educational attainment have relatively preserved cognitive functioning. Studies focused on why, however, have been hampered by methodological limitations and inattention to some key explanations for this relationship. Consequently, we test explanations encompassing antecedent factors, specifically family environments, adolescent IQ, and genetic factors, as well as adult mediating mechanisms, specifically health behaviors and health. We employ the Wisconsin Longitudinal Study, which includes 80 years of prospectively collected data on a sample of 1 in every 3 high school graduates, and a selected sibling, from the class of 1957. Sibling models, and the inclusion of prospectively collected early and midlife covariates, allows us to address the explanatory and methodological limitations of the prior literature to better unpack the relationship between education and later life cognitive functioning. We find little evidence that early life genetic endowments and environments, or midlife health and health behaviors, explain the relationship. Adolescent cognition, however, does matter; higher educational attainment, linked to antecedent adolescent cognitive functioning, helps protect against lower levels of cognitive functioning in later life. Both adolescent cognition and education, however, independently associate with later life cognitive functioning at relatively similar magnitudes. Educational attainment's relationship to later life cognitive functioning is not simply a function of adolescent cognitive functioning.

Early Origins of Body Mass in Later Life: Examining Childhood Risks and Adult Pathways

Prior research reveals that negative early-life experiences play a major role in the development of obesity in later life, but few studies identify mechanisms that alter the lifetime risk of obesity. This study examines the influence of negative childhood experiences on body mass index (BMI) and obesity (BMI ≥30) during older adulthood and the psychosocial and behavioral pathways involved. Using a nationally representative sample, we examine the influence of cumulative misfortune as well as five separate domains of misfortune on BMI and obesity. Results show that four of the five domains are associated with BMI and obesity either directly, indirectly, or both. The influence of cumulative misfortune on the outcomes is mediated by three adult factors: socioeconomic status, depressive symptoms, and physical activity. The mediators identified here provide targets for intervention among older adults to help offset the health risks of excess BMI attributable of early-life exposure to misfortune.

Examining Cumulative Inequality in the Association Between Childhood Socioeconomic Status and Body Mass Index From Midlife to Old Age

OBJECTIVES

Socioeconomic status (SES) is among the strongest determinants of body mass index (BMI), particularly for women. For older populations, selection bias due to attrition is a large barrier to assessing the accumulation of inequality. Under multiple missing data mechanisms, we investigated the extent to which childhood and midlife SES affects BMI from midlife to old age and gender differences in the association.

METHOD

Data come from a longitudinal national study of 2,345 U.S. adults aged 40-54 at baseline. We used latent growth models to estimate BMI trajectory over a period of 20 years. We examined results under different missing data patterns and applied methods that account for nonrandom-selection bias.

RESULTS

Compared with individuals who had higher childhood SES, individuals who had lower childhood SES have higher BMI in midlife and experience a faster increase in BMI between midlife and old age. The observed associations remain significant even after controlling for midlife SES. After addressing nonrandom selection, the gap in BMI between high and low childhood SES widens from midlife to old age for women.

DISCUSSION

The findings provide new evidence of cumulative inequality among older adults, documenting increasing BMI inequality from midlife to old age, particularly for women from low-SES families.

From childhood financial hardship to late-life depression: socioeconomic pathways

OBJECTIVE

Childhood financial hardship is associated with depression throughout the life course, including older adulthood. However, it is still unclear the extent to which occupation, education level and household income are mediators of this association. We aimed to examine the association between childhood financial hardship and late-life depression, and potential socioeconomic mediators using community-based data.

METHODS

A nationally representative sample of 3623 non-institutionalized older Spanish adults aged 50+ was used. The associations between childhood financial hardship and depression, socioeconomic mediator variables and confounding variables such as chronic physical conditions, number of close people, and loneliness, were assessed through logistic regression models. Mediation analyses of socioeconomic variables were carried out.

RESULTS

Older Spanish adults who experienced a poor childhood financial situation were nine times more likely to obtain a lower level of education than those with a good childhood financial situation, and about three times more likely to suffer from depression. Participants' education level mediated about 35-40% of the association between childhood financial hardship and late-life depression whereas we found no significant mediation effect of household income and occupation skill.

CONCLUSION

Improving access to the educational system during the life course might result in a reduction in the prevalence of depression in the general population of older adults and particularly among individuals with low socioeconomic status.

Early life socioeconomic position and mortality from cardiovascular diseases: an application of causal mediation analysis in the Stockholm Public Health Cohort

OBJECTIVE

We aimed to quantify the mediating impact of adult social and behavioural mechanisms in the association between childhood socioeconomic position (SEP) and cardiovascular disease (CVD) mortality by employing a weighting approach to mediation analysis.

DESIGN

Prospective cohort study.

SETTING

Stockholm County, Sweden.

PARTICIPANTS

19 720 individuals who participated in the Stockholm Public Health Cohort survey in 2002 and were older than 40 years.

PRIMARY AND SECONDARY OUTCOME MEASURES

The primary outcome was CVD mortality. Non-CVD mortality was additionally analysed for comparison.

METHODS

Study subjects were followed in routine registers from 2002 to 2011 for mortality. Data on father's SEP and adult social and behavioural factors came from questionnaire survey. The inverse odds weighting method was used to estimate the total effect, the natural direct effect and the natural indirect effect (NIE) in Poisson regression models. All results were adjusted for gender, age, country of birth and marital status. Multiple imputation was used to handle missing data.

RESULTS

The total effect of manual versus non-manual father's SEP on CVD mortality was estimated as an incidence rate ratio (IRR) of 1.24 (95% CI 1.09 to 1.41). When the social and behavioural factors were accounted for, the IRR for the NIE was 1.09 (95% CI 1.04 to 1.14), suggesting a mediation of 44% of the total effect. As for non-CVD mortality, father's manual SEP was associated with 1.15 fold excess risk (IRR: 1.15; 95% CI 1.04 to 1.27) of which the effect represented by the whole set of mediators was 1.06 (95% CI 1.01 to 1.10).

CONCLUSION

Adult social and behavioural factors had a considerable mediating effect on the early life social origin of mortality from CVDs and other causes. Future research employing causal mediation analysis may nevertheless have to consider additional factors for a fuller understanding of the mechanisms.

Association between life-course socio-economic status and prevalence of cardio-metabolic risk ractors in five middle-income countries

BACKGROUND

The burden of non-communicable diseases has increased rapidly in low- and middle-income countries. Past studies have reported an association between socioeconomic status (SES) and cardio-metabolic risk factors, but most have focused on upper income countries. The purpose of this study is to examine the association between SES over the life-course and the burden of cardio-metabolic risk factors in middle-income countries.

METHODS

A total of 38 297 adults from China, Mexico, India, South Africa and Russia were included in this cross-sectional study. Life-course SES was defined based on maternal and participant education, and data on blood pressure, body mass index (BMI), self-reported diabetes and hypertension were obtained by trained interviewers. Descriptive, age standardized and multivariable adjusted analyses were conducted using survey weighted statistical procedures in SAS 9.4 (SAS Institute, Cary, NC, USA).

RESULTS

Although 14% of men and 12% of women had current hypertension based on blood pressure measurements, only 2% of men and 4% of women were aware of their hypertensive status. Men with stable high life-course SES had higher odds of being overweight/obese (odds ratio OR = 2.01, 95% confidence interval (CI) = 1.30-3.10), diabetic (OR = 4.82, 95% CI = 2.07-11.2) and hypertensive based on self-report (OR = 3.42, 95% CI = 1.85-6.32) compared to men of low life-course SES. Among women, the odds of being overweight/obese were significantly higher among women with high life-course SES (OR = 1.50, 95% CI = 1.08-2.08).

CONCLUSIONS

Higher life-course SES for both men and women was associated with increased odds of overweight/ obesity, and additionally diabetes and hypertension for men in middle income countries.

Childhood poverty dynamics and adulthood overweight/obesity: Unpacking the black box of childhood

Integrating several life course models, this study examines how childhood poverty dynamics shape the risk of adulthood overweight/obesity. Growth mixture models of yearly poverty data from age 0-16 from the U.S. Panel Study of Income Dynamics identify four childhood poverty trajectories: chronic poverty, early childhood poverty, downward mobility, and poverty-free. Chronic poverty and early childhood poverty groups have higher risk of adulthood overweight/obesity than the poverty-free group. Overweight/obesity risk is not significantly different between the chronic poverty group and the early childhood poverty group, suggesting that the effects of early childhood exposure persist despite subsequent upward mobility. Downward mobility in the absence of early childhood poverty does not significantly increase adulthood obesity risk, providing further evidence that early childhood is a critical period for developing risk of overweight and obesity. These findings shed new light on the timing model, social mobility model, cumulative model, and cumulative inequality theory.

Association Between Sustained Poverty and Changes in Body Mass Index, 1990-2015: The Coronary Artery Risk Development in Young Adults Study

We sought to determine whether sustained poverty is associated with change in body mass index (BMI, calculated as weight (kg)/height (m)2) among 4,762 black and white adults from the Coronary Artery Risk Development in Young Adults study. Household income in the prior year and current BMI were measured at 7 visits between 1990 and 2015. Sustained poverty was the proportion of visits during which household income was below 200% of the federal poverty level (range, 0%-100%). Sustained poverty and BMI were time-updated. Mean age in 1990 was 30 years. In adjusted linear mixed-effects models, every 10% increase in sustained poverty was significantly associated with faster BMI growth among white men (0.004/year, 95% CI: 0.001, 0.008) and white women (0.003/year, 95% CI: 0.000, 0.006), and slower BMI growth among black men (-0.008/year, 95% CI: -0.010, -0.005) and black women (-0.003/year, 95% CI: -0.006, 0.000). In other words, being always versus never in poverty from 1990 to 2015 was predicted to result in greater BMI gain by 1.00 unit and 0.75 units among white men and women and less BMI gain by 2.0 units and 0.75 units among black men and women, respectively. Sustained poverty was a predictor of changes in BMI with differential associations according to race.

Body size reference norms and subjective weight status: A gender and life course approach

This paper uses data from The National Longitudinal Study of Adolescent to Adult Health (Add Health) to describe county-level variation in norms regarding physical weight among adolescents in the United States. We demonstrate that regardless of one's physical size, those residing in counties with a heavier weight norm are significantly less likely to see themselves as overweight than those residing in counties with a light weight norm. We further show that the local weight norm during adolescence (Wave 1) is associated with individuals' weight perceptions through adolescence and into young adulthood (Wave 4), though these associations attenuate in strength as respondents age. Our results suggest that weight norms have a stronger influence on weight perceptions among women compared to men and that the role of gender is particularly important during adolescence. We encourage life course researchers to consider the normative health environment during adolescence as an important context for understanding disparities in health and health lifestyles as people age.

Socioeconomic status in childhood and obesity in adults: a population-based study

OBJECTIVE To test whether there is an association between socioeconomic status in childhood and measures of body mass index, waist circumference and the presence of overall and abdominal obesity in adult life. METHODS A cross-sectional analysis of a population-based cohort study, including a sample of adults (22-63 years old) living in Florianópolis, Southern Brazil. The socioeconomic status in childhood was analyzed through the education level of the participant's parents. Height, weight and waist circumference were measured by previously trained interviewers. Linear and logistic regressions with adjustment for confounding factors and stratification of data according to gender were used. RESULTS Of the 1,222 adults evaluated, 20.4% (95%CI 18.1-22.8) presented overall obesity and 24.8% (95%CI 22.4-27.4), abdominal obesity. The body mass index and waist circumference averages among women were, respectively, 1.2 kg/m2 (95%CI -2.3- -0.04) and 2.8 cm (95%CI -5.3- -0.2) lower among those with higher socioeconomic status in childhood. Among men, waist circumference was 3.9 cm (95%CI 1.0-6.8) higher in individuals with higher socioeconomic status in childhood. Regarding obesity, women of higher socioeconomic status in childhood had lower odds of abdominal obesity (OR = 0.56, 95%CI 0.34-0.90), and no such association was observed among men. CONCLUSIONS The socioeconomic status in childhood influences body mass index, waist circumference and obesity in adults, with a difference in the direction of association according to gender. The higher socioeconomic status among men and the lower socioeconomic status among women were associated with higher adiposity indicators.

Adolescent socioeconomic status and depressive symptoms in later life: Evidence from structural equation models

BACKGROUND

The complex association between socioeconomic status (SES) and depressive symptoms is not entirely understood and the existing literature does not address the relationship between early-life SES and later-life depression from a life-course perspective, incorporating mediating events.

METHODS

Using data from the Wisconsin Longitudinal Study, we employed structural equation modeling to examine how SES measured at age 18 affects depressive symptoms at age 54 directly and through mediating variables college graduation, marriage, and household income level at age 36.

RESULTS

The total effect of adolescent SES on later-life depressive symptoms is largely mediated through college graduation. Our final model was driven by the effects of women. The variables contributing most to depressive symptoms in women were the direct effect of being raised in a home with a low SES and the indirect effect of low adolescent SES mediated through non-completion of college.

LIMITATIONS

Cohort was exclusively comprised of white, high school graduates born in 1939 (± 2 years). In our analysis we assume that missing values are missing at random (MAR); however, attrition both from death (excluded from our population) and from non-response could be associated with depression, i.e. missing not at random (MNAR).

CONCLUSIONS

This study demonstrates the impact of completion of college, particularly among women, and supports the social mobility hypothesis to explain the relationship between adolescent socioeconomic circumstances and late-life health.

Motherhood, Fatherhood and Midlife Weight Gain in a US Cohort: Associations differ by race/ethnicity and socioeconomic position

While there is an association of greater short-term weight gain with childbearing among women, less is known about longer-term weight gain, whether men have similar gains, and how this varies by race/ethnicity and socioeconomic position. Our cohort consisted of a nationally representative sample of 7356 Americans with oversampling of Black and Hispanic populations. We estimated the associations between number of biological children and parental weight, measured as both change in self-reported body mass index (BMI) from age 18 and overweight/obese status (BMI ≥ 25) at age 40. We performed multivariate linear and logistic regression analysis and tested for effect modification by gender. For change in BMI, men gained on average 0.28 BMI (95% CI: (0.01, 0.55)) units per child, while women gained 0.13 units per child (95% CI: (-0.22, 0.48)). The adjusted odds ratios for overweight/obesity associated with each child were 1.32 (95% CI: (1.11, 1.58)) for men and 1.15 (95% CI: (1.01, 1.31)) for women. Stratified analyses by race/ethnicity and socioeconomic position suggested that the observed full-cohort differences were driven primarily by gendered differences in low-income Hispanics and Whites – with the greatest associations among Hispanic men. For example, among low-income Hispanic men we observed a positive relationship between the number of children and weight change by age 40, with average weight change of 0.47 units per child (95%CI: (-0.65, 1.59 For low-income Hispanic women, however, the average weight change was -0.59 units per child (95%CI: (-1.70, 0.47), and the P-value for the test of interaction between gender and number of children was P < 0.001. Our findings suggest that the shared social and economic aspects of raising children play an important role in determining parental weight at mid-life.

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Researchers have seen associations between having a child and short term weight gain.

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We examined the relationship of having children with long term weight gain by gender.

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We did not observe any evidence that women tended to gain more weight than men.

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In some subcohorts, we observed stronger associations among men than women.

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Hispanics of lower socioeconomic position had the strongest gendered difference.

Why Do College Graduates Behave More Healthfully than Those Who Are Less Educated?

College graduates live much healthier lives than those with less education, but research has yet to document with certainty the sources of this disparity. This study examines why U.S. young adults who earn college degrees exhibit healthier behavior than those with less education. I use data from the National Longitudinal Study of Adolescent to Adult Health (Add Health), which offers information on education and health behaviors across adolescence and young adulthood (N=14,265). Accounting for selection into college degree attainment substantially reduces the associations between college degree attainment and health behavior, but college degree attainment demonstrates a strong causal effect on young adult health. Financial, occupational, social, cognitive, and psychological resources explain less than half of the association between college degree attainment and health behavior. The healthier behaviors of college graduates are the result of sorting into educational attainment, embedding of human capital, and mechanisms other than socioeconomic and psychosocial resources.

Does psychosocial stress explain socioeconomic inequities in 9-year weight gain among young women?

OBJECTIVE

This study investigated the contribution of psychosocial stress to mediating inequities in weight gain by educational status in a large cohort of young Australian women over a 9-year follow-up.

METHODS

This observational cohort study used survey data drawn from 4,806 women, aged 22 to 27 years at baseline (2000), participating in the Australian Longitudinal Study on Women's Health, who reported their education level (2000), perceived stress (2003), and weight (2003 and 2012). Using a causal inference framework based on counterfactuals for mediation analysis, we fitted linear or logistic regression models to examine the total effect, decomposed into natural direct and indirect effects via perceived stress, of education level (highest qualification completed: up to year 12/trade or diploma vs. university) on weight change.

RESULTS

Women with lower education gained more weight over 9 years (6.1 kg, standard deviation [SD] 9.5) than women with higher education (3.8 kg, SD 7.7; P < 0.0001) and were more likely to be very or extremely stressed. The higher weight gain associated with low education was not mediated through perceived stress (per SD increase, percent mediated: 1.0%).

CONCLUSIONS

Education-based inequities in weight gain over time were not attributable to greater psychosocial stress among women with lower education levels.

Socio-economic life course and obesity among adults in Florianopolis, southern Brazil

OBJECTIVE

To estimate the association between socio-economic life course and body mass index (BMI), waist circumference (WC) and general and abdominal obesity in adults.

METHODS

A cross-sectional analysis of a population-based cohort study of 1,222 adults (aged 22-63) from Florianopolis, southern Brazil. The socio-economic life course was analysed using the educational level of participants and their parents. Height, weight and WC were measured by specially trained staff. Linear and logistic regressions were used with adjustment for confounding factors, and data were stratified according to sex.

RESULTS

Mean BMI and WC were about 2kg/m² (95% CI: -3.3 to -0.7) and 6cm (95% CI: -9.7 to -2.9) lower in women with a high socio-economic position, while the association was reversed in men with a high socio-economic position, with WC being about 4cm higher (95% CI: 0.1 to 7.5). In addition, women who had always been in a high socio-economic position were less likely to have abdominal obesity (OR: 0.38; 95% CI: 0.20 to 0.76) while no such association was found in men.

CONCLUSION

Socio-economic life course influences BMI, WC and obesity, with differences between males and females, thereby indicating that public policies that contemplate a socio-economic life course approach can be effective for controlling obesity.

Life-course socio-economic status and adult BMI in Ghana; analysis of the WHO study on global ageing and adult health (SAGE)

Background

Obesity rates have continued to increase over time globally, resulting in an increase in the burden of obesity-associated chronic diseases. There is a paucity of research on the association between obesity and generational changes in socio-economic status (SES) in developing countries like Ghana, and therefore a critical need to better understand within-country differences in obesity and its association with SES over the life-course.

Methods

Data from a nationally representative sample of adult women in Ghana was used to examine the association between life-course SES and adult body mass index (BMI). Life-course SES was defined based on changes in the employment and education status of both parents and the study participant. Survey weighted multivariable linear regression models were used to examine the association between individual and life-course SES in relation to BMI.

Results

Participants with higher SES over their life course, that is, both the participant and her father had at least a primary education (both > = primary vs. both < primary: BMI 27.2 vs. 24.1), and both were employed (both employed vs. both unemployed: BMI 26.5 vs. 24.4) had higher BMI compared with participants with lower SES over their life course.

Conclusion

Higher individual and life-course SES is associated with higher BMI among women in Ghana, although maternal employment was associated with lower BMI.

Intersystem Implications of the Developmental Origins of Health and Disease: Advancing Health Promotion in the 21st Century

The developmental origins of health and disease (DOHaD) theory and life course theory (LCT) are emerging fields of research that have significant implications for the public health and health promotion professions. Using a DOHaD/LCT perspective, social determinants of health (SDH) take on new critical meaning by which health promotion professionals can implement DOHaD/LCT guided interventions, including recommended policies. Through these interventions, public health could further address the sources of worldwide chronic disease epidemics and reduce such disease rates substantially if related policy, programs, and interdisciplinary and multi-sector collaboration are emphasized. Additional characteristics of the most effective interventions involve context-specific adaptation and societal structures that impact upstream, early life environments on a broad scale, influencing multiple locations and/or diseases.

Neighborhood disadvantage and obesity across childhood and adolescence: Evidence from the NLSY children and young adults cohort (1986-2010)

Previous research suggests that youth who grow up in socioeconomically disadvantaged neighborhoods face higher odds of becoming obese. Neighborhood effects scholars, meanwhile, have suggested that contextual influences may increase in strength as children age. This is the first study to examine whether developmental epochs moderate the effect of neighborhood disadvantage on obesity over time. I use thirteen waves of new restricted and geo-coded data on children ages 2-18 from the National Longitudinal Survey of Youth, Children and Young Adults. Bivariate and pooled logistic regression results suggest that neighborhood disadvantage has a stronger impact on adolescents' likelihood of becoming obese. Fixed effects models reveal that after adjusting for observed and unobserved confounders, adolescents continue to face higher odds of becoming obese due to the conditions associated with living in disadvantaged neighborhoods. Moreover, as research on adults suggests, girls experience larger impacts of neighborhood disadvantage than boys.

Hair cortisol levels, perceived stress and body mass index in women and children living in socioeconomically disadvantaged neighborhoods: the READI study

Disadvantaged communities provide adverse psychosocial exposures that have been linked to high levels of stress, and this may provide one explanatory pathway linking socioeconomic disadvantage to obesity. This study used hair cortisol analysis to quantify associations between stress and body mass index (BMI), and between hair cortisol and perceived psychological stress levels, in women and children living in socioeconomically disadvantaged neighborhoods. Participants were a volunteer sample of 70 women from the Resilience for Eating and Activity Despite Inequality study, including 30 maternal-child pairs. Women self-reported body weight, height and perceived psychological stress using the Perceived Stress Scale (PSS), and provided hair samples for themselves and their child. Children's body weight and height were measured. Following extraction, hair cortisol levels were measured using enzyme-linked immunosorbent assay. Multiple linear regression models examined associations between stress and BMI, and between hair cortisol and perceived stress levels in women and children. Women's hair cortisol levels were not associated with their BMI or PSS scores. Women's PSS scores were positively associated with their BMI (p = 0.015). Within maternal-child pairs, mothers and children's hair cortisol levels were strongly positively associated (p = 0.006). Maternal hair cortisol levels and PSS scores were unrelated to their child's zBMI. Children's hair cortisol levels were not associated with their zBMI or with their mother's PSS score. Findings suggest that cortisol-based and perceived psychological measures of stress may be distinct among women and children living in disadvantaged neighborhoods. Perceived psychological measures may be more important predictors of weight-related risk.

Social determinants of disparities in weight among US children and adolescents

PURPOSE

To explore whether contextual variables attenuate disparities in weight among 18,639 US children and adolescents aged 2 to 18 years participating in the National Health and Nutrition Examination Survey, 2001 to 2010.

METHODS

Disparities were assessed using the Symmetrized Rényi Index, a new measure that summarizes disparities in the severity of a disease, as well as the prevalence, across multiple population groups. Propensity score subclassification was used to ensure covariate balance between racial and ethnic subgroups and account for individual-level and contextual covariates.

RESULTS

Before propensity score subclassification, significant disparities were evident in the prevalence of overweight and/or obesity and the degree of excess weight among overweight/obese children and adolescents. After propensity score subclassification, racial/ethnic disparities in the prevalence and severity of excess weight were completely attenuated within matched groups, indicating that racial and ethnic differences were explained by social determinants such as neighborhood socioeconomic and demographic factors.

CONCLUSIONS

The limited overlap in covariate distributions between various racial/ethnic subgroups warrants further attention in disparities research. The attenuation of disparities within matched groups suggests that social determinants such as neighborhood socioeconomic factors may engender disparities in weight among US children and adolescents.