Health selection and the process of social stratification: the effect of childhood health on socioeconomic attainment

Nonparticipation in Work and Education in Emerging Adulthood and Depressive Symptoms through Early Midlife

More than one-in-eight young adults in the US between the ages of 16 to 24 were not in employment, education, or training (NEET) in 2020 - a level not seen since the Great Recession. This study examines the long-term association between NEET status in emerging adulthood and later depressive symptoms using the National Longitudinal Study of Adolescent to Adult Health (1995-2018). Growth curve models chart the association between NEET status and depressive symptoms over time in the US. The analytic sample includes 9,349 individuals and 28,047 person-wave observations for respondents between ages 18 to 43. In a fully specified model, respondents who reported NEET status in emerging adulthood (ages 18-26), exhibited greater depressive symptoms across emerging adulthood through early midlife (ages 33-43) (b=0.44, 95% CI 0.33, 0.54) compared to those participating in employment, education, or training. Associations persisted even after accounting for early life disadvantage and using propensity score matching to further diminish possible sources of bias. Results indicate that disconnection from school and work during emerging adulthood may constitute a risk factor for depressive symptoms through early midlife.

Assessing the built environment through photographs and its association with obesity in 21 countries: the PURE Study

BACKGROUND

The built environment can influence human health, but the available evidence is modest and almost entirely from urban communities in high-income countries. Here we aimed to analyse built environment characteristics and their associations with obesity in urban and rural communities in 21 countries at different development levels participating in the Prospective Urban and Rural Epidemiology (PURE) Study.

METHODS

Photographs were acquired with a standardised approach. We used the previously validated Environmental Profile of a Community's Health photo instrument to evaluate photos for safety, walkability, neighbourhood beautification, and community disorder. An integrated built environment score (ie, a minimum of 0 and a maximum of 20) was used to summarise this evaluation across built environment domains. Associations between built environment characteristics, separately and combined in the integrated built environment score, and obesity (ie, a BMI >30kg/m2) were assessed using multilevel regression models, adjusting for individual, household, and community confounding factors. Attenuation in the associations due to walking was examined.

FINDINGS

Analyses include 143 338 participants from 530 communities. The mean integrated built environment score was higher in high-income countries (13·3, SD 2·8) compared with other regions (10·1, 2·5) and urban communities (11·2, 3·0). More than 60% of high-income country communities had pedestrian safety features (eg, crosswalks, sidewalks, and traffic signals). Urban communities outside high-income countries had higher rates of sidewalks (176 [84%] of 209) than rural communities (59 [28%] of 209). 15 (5%) of 290 urban communities had bike lanes. Litter and graffiti were present in 372 (70%) of 530 communities, and poorly maintained buildings were present in 103 (19%) of 530. The integrated built environment score was significantly associated with reduced obesity overall (relative risk [RR] 0·58, 95% CI 0·35-0·93; p=0·025) for high compared with low scores and for increasing trend (0·85, 0·78-0·91; p<0·0001). The trends were statistically significant in urban (0·85, 0·77-0·93; p=0·0007) and rural (0·87, 0·78-0·97; p=0·015) communities. Some built environment features were associated with a lower prevalence of obesity: community beautification RR 0·75 (95% CI 0·61-0·92; p=0·0066); bike lanes RR 0·58 (0·45-0·73; p<0·0001); pedestrian safety RR 0·75 (0·62-0·90; p=0·0018); and traffic signals RR 0·68 (0·52-0·89; p=0·0055). Community disorder was associated with a higher prevalence of obesity (RR 1·48, 95% CI 1·17-1·86; p=0·0010).

INTERPRETATION

Community built environment features recorded in photographs, including bike lanes, pedestrian safety measures, beautification, traffic density, and disorder, were related to obesity after adjusting for confounders, and stronger associations were found in urban than rural communities. The method presents a novel way of assessing the built environment's potential effect on health.

FUNDING

Population Health Research Institute, Hamilton Health Sciences Research Institute, Heart and Stroke Foundation of Ontario, Canadian Institutes of Health Research's Strategy for Patient Oriented Research, Ontario Support Unit, Ontario Ministry of Health and Long-Term Care, AstraZeneca, Sanofi-Aventis, Boehringer Ingelheim, Servier, and GlaxoSmithKline.

For Whom Does Education Convey Health Benefits? A Two-Generation and Life Course Approach

Scholars of social determinants of health have long been interested in how parent's and own education influence health. However, the differing effects of parent's and own education on health-that is, for what socioeconomic group education conveys health benefits-are relatively less studied. Using multilevel marginal structural models, we estimate the heterogeneous effects of parent's and own education over the life course on two health measures. Our analysis considers both parent's and respondent's pre-education covariates, such as childhood health and socioeconomic conditions. We find that the protective effects of college completion against negative health outcomes are remarkably similar regardless of parent's (measured by father's or mother's) education. Meanwhile, parent's education has a larger effect when the average educational level is low in the population. Our results also reveal distinct life course patterns between health measures. We conclude by discussing the implications of our study for understanding the education-health relationship.

Beyond the mean: Distributional differences in earnings and mental health in young adulthood by childhood health histories

Research on the long-term effects of health in early life has predominantly relied on parametric methods to assess differences between groups of children. However, this approach leaves a wealth of distributional information untapped. The objective of this study was to assess distributional differences in earnings and mental health in young adulthood between individuals who suffered a chronic illness in childhood compared to those who did not using the non-parametric relative distributions framework. Using data from the Panel Study of Income Dynamics, we find that young adults who suffered a chronic illness in childhood fare worse in terms of earnings and mental health scores in adulthood, particularly for individuals reporting a childhood mental health/developmental disorder. Covariate decompositions suggest that chronic conditions in childhood may indirectly affect later outcomes through educational attainment: had the two groups had similar levels of educational attainment, the proportion of individuals with a report of a chronic condition in childhood in the lower decile of the relative earnings distribution would have been reduced by about 20 percentage points. Findings may inform policy aimed at mitigating longer run effects of health conditions in childhood and may generate hypotheses to be explored in parametric analyses.

Physical attractiveness and cardiometabolic risk

OBJECTIVES

There is only limited evidence suggesting that physical attractiveness and individuals' actual health are causally linked. Past studies demonstrate that characteristics related to physical attractiveness are more likely to be present in healthy individuals, including those with better cardiovascular and metabolic health, yet many of these studies do not account for individuals' initial health and socioeconomic characteristics, which are related to both physical attractiveness and later life health.

METHODS

We use panel survey data from the National Longitudinal Study of Adolescent to Adult Health in the United States to examine the relationship between interviewer-rated in-person physical attractiveness and actual cardiometabolic risk (CMR) based on a set of relevant biomarkers: LDL cholesterol, glucose mg/dL, C-reactive protein, systolic and diastolic blood pressure, and resting heart rate.

RESULTS

We identify a robust relationship between individuals' physical attractiveness and 10-year follow up actual health measured by the levels of CMR. Individuals of above-average attractiveness appear to be noticeably healthier than those who are described as having average attractiveness. We find that individuals' gender and race/ethnicity do not have a major effect on the described relationship. The link between physical attractiveness and health is affected by interviewers' main demographic characteristics. We carefully address the possibility of confounders affecting our results including sociodemographic and socioeconomic characteristics, cognitive and personality traits, initial health problems and BMI.

CONCLUSION

Our findings are largely in line with the evolutionary perspective which assumes that physical attractiveness is linked to individuals' biological health. Being perceived as physically attractive might also imply, among other aspects, high levels of satisfaction with life, self-confidence and ease of finding intimate partners, all of which can positively affect individuals' health.

The distribution of child physicians and early academic achievement

OBJECTIVE

To describe the distribution of pediatricians and family physicians (child physicians) across school districts and examine the association between physician supply and third-grade test scores.

DATA SOURCES AND STUDY SETTING

Data come from the January 2020 American Medical Association Physician Masterfile, the 2009-2013 and 2014-2018 waves of American Community Survey 5-Year Data, and the Stanford Education Data Archive (SEDA), which uses test scores from all U.S. public schools. We use covariate data provided by SEDA to describe student populations.

STUDY DESIGN

This descriptive analysis constructs a physician-to-child-population ratio for every school district in the country and describes the child population served by the current distribution of physicians. We fit a set of multivariable regression models to estimate the associations between district test score outcomes and district physician supply. Our model includes state fixed effects to control for unobservable state-level factors, as well as a covariate vector of sociodemographic characteristics.

DATA COLLECTION

Public data from three sources were matched by district ID.

PRINCIPAL FINDINGS

Physicians are highly unequally distributed across districts: nearly 3640 (29.6%) of 12,297 districts have no child physician, which includes 49% of rural districts. Rural children of color in particular have very little access to pediatric care, and this inequality is more extreme when looking exclusively at pediatricians. Districts that have higher child physician supplies tend to have higher academic test scores in early education, independent of community socioeconomic status and racial/ethnic composition. While the national data show this positive relationship (0.012 SD, 95% CI, 0.0103-0.0127), it is most pronounced for districts in the bottom tertile of physician supply (0.163 SD, 95% CI, 0.108-0.219).

CONCLUSIONS

Our study demonstrates a highly unequal distribution of child physicians in the U.S., and that children with less access to physicians have lower academic performance in early education.

The "Long-arm" of chronic conditions in childhood: Evidence from Canada using linked survey-administrative data

The objective of this study was to investigate the relationship between health conditions in childhood (ages 4-11), and health and socioeconomic outcomes in adulthood (ages 21-33). This study takes advantage of a new linkage between the National Longitudinal Survey of Children and Youth (NLSCY) and administrative tax data from the T1 Family File (T1FF) from Statistics Canada. The NLSCY includes rich longitudinal information on child development, while the T1FF includes administrative tax information on each child in adulthood (e.g., income, social assistance). The primary measures of child health relate to the diagnosis of a chronic condition, affecting the child's physical or mental/developmental health. The results suggest that mental/developmental health conditions in childhood more negatively influence adult health and socioeconomic conditions, compared to physical health conditions. Interaction models reveal modest heterogenous effects; for example, there is some evidence of a cushioning effect from higher household income in childhood, as well as an exacerbating negative effect from lower birth weight for mental/developmental health conditions. Using a covariate decomposition approach to explore underlying pathways, the results reveal that associations between health in early life and outcomes in adulthood are partially explained by differences in cognitive skills (i.e., mathematics test scores) in adolescence (ages 16-17). Results may encourage policy investments to mitigate the occurrence of health conditions in childhood and to ensure timely access to educational supports and health services for children with chronic conditions.

Childhood Family Environment and Osteoporosis in a Population-Based Cohort Study of Middle-to Older-Age Americans

Demographic and early-life socioeconomic and parental investment factors may influence later-life health and development of chronic and progressive diseases, including osteoporosis, a costly condition common among women. The "long arm of childhood" literature links negative early-life exposures to lower socioeconomic attainment and worse adult health. We build on a small literature linking childhood socioeconomic status (SES) and bone health, providing evidence of whether associations exist between lower childhood SES and maternal investment and higher risk of osteoporosis diagnosis. We further examine whether persons identifying with non-White racial/ethnic groups experience underdiagnosis. Data from the nationally representative, population-based cohort Health and Retirement Study (N = 5,490-11,819) were analyzed for participants ages 50-90 to assess these relationships. Using a machine learning algorithm, we estimated seven survey-weighted logit models. Greater maternal investment was linked to lower odds of osteoporosis diagnosis (odds ratio [OR] = 0.80, 95% confidence interval [CI] = 0.69, 0.92), but childhood SES was not (OR = 1.03, 95% CI = 0.94, 1.13). Identifying as Black/African American (OR = 0.56, 95% CI = 0.40, 0.80) was associated with lower odds, and identifying as female (OR = 7.22, 95% CI = 5.54, 9.40) produced higher odds of diagnosis. There were differences in diagnosis across intersectional racial/ethnic and sex identities, after accounting for having a bone density scan, and a model predicting bone density scan receipt demonstrated unequal screening across groups. Greater maternal investment was linked to lower odds of osteoporosis diagnosis, likely reflecting links to life-course accumulation of human capital and childhood nutrition. There is some evidence of underdiagnosis related to bone density scan access. Yet results demonstrated a limited role for the long arm of childhood in later-life osteoporosis diagnosis. Findings suggest that (1) clinicians should consider life-course context when assessing osteoporosis risk and (2) diversity, equity, and inclusivity training for clinicians could improve health equity. © 2023 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.

Amplified disparities: The association between spousal education and own health

Positive associations between own educational attainment and own health have been extensively documented. Studies have also shown spousal educational attainment to be associated with own health. This paper investigates the extent to which spousal education contributes to the social gradient in health, net of own education; and whether parts of a seeming spousal education effect are attributable to differences in early-life human capital, as measured by respondents' height and childhood living standard. Furthermore, we investigate the relative contribution of predictors in the regression analysis by use of Shapley value decomposition. We use data from a comprehensive health survey from Northern Norway (conducted in 2015/16, N = 21,083, aged 40 and above). We apply three alternative health outcome measures: the EQ-5D-5L index, a visual analogue scale (EQ-VAS) and self-rated health. In all models considered, spousal education is generally positively significant for both men and women. The results also suggest that spousal education is generally more important for men than women. In the sub-sample of individuals having a spouse, decomposition analyses showed that the relative contribution of spousal education to the goodness-of-fit in men's (women's) health was 13% (14%) with the EQ-5D-5L; 25% (20%) with the EQ-VAS and; 30% (21%) with self-rated health. Heterogeneity analyses showed stronger spousal education effects in younger age groups. In conclusion, we have provided empirical evidence that spousal education may contribute to explaining the amplified health gradient in an egalitarian country like Norway.

Physical health conditions of the Amish and intervening social mechanisms: an exhaustive narrative review

As an ethnic religion, the Amish are of interest to population health researchers due to a distinctive health profile arising from ethnic attributes, including a closed genetic pool and shared culture that shapes lifestyle practices. Amish-focused health research both furthers our knowledge of health conditions by comparing Amish with non-Amish and assists health practitioners in serving this rapidly growing population. Amish health research, now representing approximately a quarter of all Amish-focused publications, is in need of review, to the end of strengthening this knowledge body's coherence, clarifying research directions, and identifying knowledge gaps, lapses, and stagnations. Herein, we synthesize and discuss Amish physical health conditions research, both the population's distinctive health profile and mechanisms shaping this profile. Specifically, we summarize research addressing BMI, physical activity, and body image; diet and supplements; cancer; cardiovascular conditions; communicable diseases; immunity; sleep; genetic disorders; tobacco and alcohol use; periodontal conditions; traumatic injuries; natural treatments for burns; fertility; and sexually transmitted diseases. In reflection, we raise questions about the nature of intervening mechanisms shaping the Amish health profile, the strange omission of several common independent variables commonly used when studying other ethnic groups' health, several recurring methodological complications, and public health policy considerations.

The Life Course of Unemployment and Midlife Health

Objectives: We estimate associations between unemployment trajectories from ages 27-49 and physical and mental health at age 50. Methods: Data are from the U.S. National Longitudinal Survey of Youth, 1979 (N=6434). Group-based trajectory models are used to identify unemployment trajectories. Generalized linear models with a modified Bolck, Croon, and Hagenaars (BCH) correction are used to regress health on unemployment trajectory groups. Results: We identified "Consistently Low (70%)," "Decreasing Mid-Career (18%)," and "Persistently High (12%)" unemployment trajectories. Experiencing Decreasing Mid-Career or Persistently High trajectories was associated with worse physical and mental health at age 50 than Consistently Low trajectories. Experiencing a Persistently High trajectory was associated with worse physical and mental health than a Decreasing Mid-Career trajectory. Discussion: Timing and likelihood of unemployment are associated with midlife health. Mid-Career unemployment is associated with worse physical and mental health at age 50, but not to the same degree as Persistently High unemployment.

The COVID-19 pandemic, well-being, and transitions to post-secondary education

This study examines the immediate and intermediate effects of the COVID-19 pandemic on the well-being of two high school graduation cohorts (2020 and 2021) and how changes in well-being affect students' educational plans and outcomes. Our unique panel data on 3697 students from 214 schools in 8 German federal states contain prospective survey information on three dimensions of well-being: mental health problems, self-rated health, and life satisfaction. Data is collected several months before (fall 2019), shortly before and soon after (spring 2020) as well as several months after (fall/winter 2020/21) the beginning of the COVID-19 pandemic. Applying difference-in-differences designs, random effect growth curve models, and linear regression models, we find that school closures had a positive immediate effect on students' well-being. Over the course of the pandemic, however, well-being strongly declined, mainly among the 2021 graduation cohort. We show that a strong decline in mental health is associated with changes in educational and career plans and transition outcomes. As adverse life experiences in adolescence are likely to accumulate over the life course, this study is the first to exhibit potential long-lasting negative effects of the COVID-19 pandemic on education and careers of young individuals.

Social Mobility and Sense of Purpose From Midlife to Old Age: Examining the Role of Major Life Events

Purpose in life (PIL) has been linked with numerous health benefits and adaptive aging, yet it diminishes with age, possibly due to loss of social or familial roles through life transitions. Drawing from the longitudinal surveys of the Midlife in the US study (n = 3418), we use time-varying coefficient models to investigate how the trajectory of PIL differs across cumulatively (dis)advantaged, upwardly mobile, and downwardly mobile groups and the role of major life events in shaping these trajectories. We found the upwardly mobile group exhibits higher PIL than the cumulatively disadvantaged and downwardly mobile groups. The consistently disadvantaged group experiences more adverse events at non-normative times. Socioeconomic status disparities in PIL during old age decrease after controlling for life events. We discuss how and why well-being changes and the role of structural and social factors in facilitating or impeding the development or maintenance of PIL over the life course.

School-to-work and school-to-university transition and health inequalities among young adults: a scoping review

OBJECTIVES

The main objective was to systematically map evidence regarding the emergence of health inequalities in individuals aged 16-24 years during school-to-work and school-to-university transition (STWT). Second, we aimed to summarise the evidence on potential effects of contextual and compositional characteristics of specific institutional contexts entered during STWT on health and health behaviours.

DESIGN

Scoping review.

STUDY SELECTION

Relevant literature was systematically searched following the methodological framework proposed by Arksey and O'Malley. Ovid MEDLINE and Web of Science, and websites of the International Labour Organization and National Institute for Occupational Safety and Health were searched, using a predetermined search strategy. Articles in English or German published between 1 January 2000 and 3 February 2020 were considered.

DATA EXTRACTION

To collect the main information from the selected studies, a data extraction spreadsheet was created. Data were summarised and grouped into five health outcomes and five institutional contexts (school, vocational training, university, work, unemployment).

RESULTS

A total of 678 articles were screened for inclusion. To be able to draw a picture of the development of various health outcomes over time, we focused on longitudinal studies. Forty-six prospective studies mapping health-related outcomes during STWT were identified. Higher family socioeconomic position (SEP) was associated with higher levels of health behaviour and lower levels of health-damaging behaviour, but there was also some evidence pointing in the opposite direction. Disadvantaged family SEP negatively impacted on mental health and predicted an adverse weight development. There was limited evidence for the outcomes physical/somatic symptoms and self-rated health. Meso-level characteristics of the institutional contexts identified were not systematically assessed, only individual-level factors resulting from an exposure to these contexts, rendering an analysis of effects of contextual and compositional characteristics on health and health behaviours impossible.

CONCLUSIONS

This scoping review demonstrated a wide range of health inequalities during STWT for various health outcomes. However, knowledge on the role of the core institutional contexts regarding the development of health inequalities is limited.

Avoiding overadjustment bias in social epidemiology through appropriate covariate selection: a primer

Obtaining accurate estimates of the causal effects of socioeconomic position (SEP) on health is important for public health interventions. To do this, researchers must identify and adjust for all potential confounding variables while avoiding inappropriate adjustment for mediator variables on a causal pathway between the exposure and outcome. Unfortunately, 'overadjustment bias' remains a common and under-recognised problem in social epidemiology. This paper offers an introduction to selecting appropriate variables for adjustment when examining effects of SEP on health, with a focus on overadjustment bias. We discuss the challenges of estimating different causal effects including overadjustment bias, provide guidance on overcoming them, and consider specific issues including the timing of variables across the life-course, mutual adjustment for socioeconomic indicators, and conducting systematic reviews. We recommend three key steps to select the most appropriate variables for adjustment. First, researchers should be clear about their research question and causal effect of interest. Second, using expert knowledge and theory, researchers should draw causal diagrams representing their assumptions about the interrelationships between their variables of interest. Third, based on their causal diagram(s) and causal effect(s) of interest, researchers should select most appropriate set of variables, which maximises adjustment for confounding while minimising adjustment for mediators.

Associations of Parental Cancer With School Absenteeism, Medical Care Unaffordability, Health Care Use, and Mental Health Among Children

Importance

A cancer diagnosis can adversely affect other members of the family, including children. However, little is known about the extent to which history of parental cancer affects children's health.

Objective

To examine associations of parental cancer with children's school absenteeism, medical care unaffordability, health care use, and mental health.

Design, Setting, and Participants

This cross-sectional, nationally representative study used data from the 2010-2018 National Health Interview Survey. Statistical analyses were conducted from January to September 2021. Children aged 5 to 17 years living in families with and without a history of parental cancer were identified. Characteristics were grouped into child, parent, and family variables. Sequential multivariable regressions were conducted for unadjusted analyses and with the adjustment of child, parent, and family characteristics to assess associations between parental cancer and child outcomes.

Exposures

History of parental cancer.

Main Outcomes and Measures

School absenteeism, medical care unaffordability, health care use, and mental health.

Results

A total of 1232 children (mean [SD] age, 11.7 [0.13] years; 579 [48.6%] female; weighted N = 846 730; 3.4% of total sample) were living in families with a history of parental cancer. Compared with 33 870 children without a history of parental cancer (mean [SD] age, 10.8 [0.03]; 16 287 [48.8%] female; weighted N = 24 315 452; 96.6% of total sample), children of cancer survivors were more likely to be older, non-Hispanic White, and living in single parent families. Parents with a history of cancer were more likely to be older, to be female, to have more comorbid conditions, and to have public health insurance compared with parents without a history of cancer. History of parental cancer was adversely associated with school absenteeism, medical care unaffordability, health care use, and mental health among children. Sequential adjustment with child, parent, and family characteristics reduced the magnitude of the associations. For example, the odds ratios for school absenteeism of 1 day or more changed from 1.33 (95% CI, 1.11-1.59; P = .002) to 1.12 (95% CI, 0.93-1.34; P = .23) and for any child hospital emergency department visit from 1.56 (95% CI, 1.31-1.86; P < .001) to 1.36 (95 % CI, 1.13-1.64; P < .001). Similar results were found for medical care unaffordability, prescription medication use, and mental health.

Conclusions and Relevance

In this study, parental cancer was associated with school absenteeism, medical care unaffordability, increased health care use, and poor mental health among children. Health care professionals and policies should consider the unique needs of affected children and develop school-, parent-, and family-directed strategies to ameliorate the negative associations between parental cancer and children's health.

Health-related selection into employment among the unemployed

BACKGROUND

Successful transitions from unemployment to employment are an important concern, yet little is known about health-related selection into employment. We assessed the association of various physical and psychiatric conditions with finding employment, and employment stability.

METHODS

Using total population register data, we followed Finnish residents aged 30-60 with an unemployment spell during 2009-2018 (n = 814,085) for two years from the onset of unemployment. We predicted any, stable, and unstable employment by health status using Cox proportional hazards models. The data on specialized health care and prescription reimbursement were used to identify any alcohol-related conditions and poisonings, psychiatric conditions and self-harm, injuries, and physical conditions. We further separated physical conditions into cancer, diabetes, heart disease, and neurological conditions, and psychiatric conditions into depression, anxiety disorders and substance use disorders.

RESULTS

The likelihood of any employment was lower among those who had any of the assessed health conditions. It was lowest among those with alcohol-related or psychiatric conditions with an age-adjusted hazard ratio of 0.45 (95% confidence interval 0.44, 0.46) among men and 0.39 (0.38, 0.41) among women for alcohol-related and 0.64 (0.63, 0.65) and 0.66 (0.65, 0.67) for psychiatric conditions, respectively. These results were not driven by differences in socioeconomic characteristics or comorbidities. All the included conditions were detrimental to both stable and unstable employment, however alcohol-related and psychiatric conditions were more harmful for stable than for unstable employment.

CONCLUSIONS

The prospects of the unemployed finding employment are reduced by poor health, particularly alcohol-related and psychiatric conditions. These two conditions may also lead to unstable career trajectories. The selection process contributes to the health differentials between employed and unemployed people. Unemployed people with health problems may therefore need additional support to improve their chances of employment.

The Intergenerational Transmission of Mental and Physical Health in Australia: Evidence Using Data From the Household Income and Labor Dynamics of Australia Survey

Promoting good health across the life course is high on countries agenda. There is a growing evidence base that health is correlated across generations. We examine the persistence of physical and mental health status across generations and explore how different early life factors and adult outcomes impact on this association. In particular, we focus on childhood disadvantage and childhood health, educational attainment, and social mobility measured by household income compared to one's parents. We use data from 19 waves of the Household, Income and Labor Dynamics in Australia (HILDA) Survey. The analysis is restricted to young adults (aged 25-35 years old in 2019) and their parents. We find an intergenerational correlation in health which ranges from 0.19 for physical health to 0.20 for the QALY and 0.21 for mental health. After we include covariates related to childhood disadvantage, childhood health, educational attainment, and social mobility, the intergenerational correlations are reduced to 0.13 for physical health, 0.18 for mental health, and 0.14 for QALYs. We find that early life disadvantage is the only factor influencing the intergenerational correlation for all health measures. Policy focusing on reducing the negative impact of early life disadvantage is likely to have a larger impact on improving health across the life course and reducing intergenerational health inequalities.

Childhood Disadvantage and Adult Functional Status: Do Early-Life Exposures Jeopardize Healthy Aging?

OBJECTIVES

To examine whether childhood disadvantage is associated with later-life functional status and identify mediating factors.

METHODS

Unique and additive effects of five childhood domains on functional status were assessed at baseline (2006) and over time (2006-2016) in a sample of 13,894 adults from the Health and Retirement Study (>50 years). Adult health behaviors and socioeconomic status (SES) were tested as mediators.

RESULTS

Respondents exposed to multiple childhood disadvantages (OR = .694) as well as low childhood SES (OR = .615), chronic diseases (OR = .694), impairments (OR = .599), and risky adolescent behaviors (OR = .608) were less likely to be free of functional disability by baseline. Over time, these unique and additive effects of childhood disadvantage increased the hazard odds of eventually developing functional disability (e.g., additive effect: hOR = 1.261). Adult health behaviors and SES mediated some of these effects.

DISCUSSION

Given the enduring effects of childhood disadvantage, policies to promote healthy aging should reduce exposure to childhood disadvantage.

Health Outcomes, Income and Income Inequality: Revisiting the Empirical Relationship

In this paper we revisit the relationship between health outcomes, income, and income inequality by applying alternative panel methodologies to a dataset of high-income countries spanning the time period 1980-2017. In this direction, we adopt alternative methodological frameworks in order to provide a) meaningful results by taking into account standard errors that alleviate problems of cross-sectional (spatial) and temporal dependence, and b) insights into the underlying relationships at several points of the conditional distribution of the health outcomes dependent variables. The evidence strongly supports the significant role that income plays in determining health outcomes. The findings relating to income inequality and nonlinear terms are more fragmented in that their significance and sign-direction depend on the functional form and the respective quantiles of the distribution the relationships are evaluated.

Financial scarcity undermines health across the globe and the life course

The gradient between income and health is well established: the lower the income, the poorer the health. However, low income (having few economic resources) may not be enough to characterize economic vulnerability, and financial scarcity (perceiving having insufficient economic resources) may further reduce health. First, analysis of cross-national data (275,000+ participants from 200+ country-years) revealed that financial scarcity was associated with twice the odds of suffering from reduced self-rated health and feelings of unhappiness; this association was observed in ≈90% of the country-years and explained variance over and above income. Second, analysis of national longitudinal data (20,000+ participants over 20 years of assessment) revealed that facing financial scarcity in the course of one's life decreased self-rated and objective health and increased feelings of depression; again, these effects explained variance over and above income. Two subsidiary findings were obtained: (i) three adverse life events (illness, separation, family conflicts) predicted financial scarcity over the life course, and (ii) self-mastery (a component of sense of control) accounted for the detrimental longitudinal effects of financial scarcity on health. This research suggests that to understand socioeconomic inequality in health, one should consider not only an individual's quantity of monetary resources but also the perceived sufficiency of these resources.

Cumulative Childhood Adversity and Its Associations With Mental Health in Childhood, Adolescence, and Adulthood in Rural China

Capitalizing on a 15-year longitudinal dataset of 9-12 years old children in rural China, this study adopts a life course perspective and analyzes cumulative childhood adversity and its associations with mental health problems from childhood to adulthood. Four domains of childhood life are selected to construct cumulative childhood adversity: socioeconomic hardship, family disruption, physical issue, and academic setback. Overall, cumulative childhood adversity significantly associates with children's internalizing and externalizing problems as well as adults' depression and self-esteem. However, cumulative childhood adversity has no significant relationship with internalizing and externalizing problems in adolescence. Furthermore, different domains of childhood adversity matter differently for mental health problems in different life stages. Physical issue and academic setback have the strongest association with internalizing and externalizing problems in childhood, while only socioeconomic hardship has a significant relationship with depression and self-esteem in adulthood. The relationship between cumulative childhood adversity and adult mental health problems is fully mediated by educational attainment. Finally, there is no gender difference in either the occurrence of cumulative childhood adversity or the association between cumulative childhood adversity and mental health problems.

Modifiable Factors for the Trajectory of Health-Related Quality of Life among Youth Growing Up in Poverty: A Prospective Cohort Study

Poverty is a decisive risk factor for poor health and well-being, and its negative consequences could be more severe and substantial among children. Understanding the factors associated with improvement in well-being is vital to design interventions. This is a prospective cohort study of 546 youth growing up in families in poverty in Hong Kong. All participants were assessed twice, in 2016 and 2019, in regard to their physical and mental health, as well as for different economic, social, and psychological variables. The results show that approximately 41% experienced an improvement in their health-related quality of life (HRQoL). Findings from the logistic regression analyses suggest that the health and development of youth in poverty may be restored by promoting social support, a sense of hope, future orientation, job stability, and money management practices, such as savings, during childhood and adolescence. The findings shed light on future policy making and forms of service development that could help to end the vicious cycle of poverty and hampered health.

The Long Arm of Conflict: How Timing Shapes the Impact of Childhood Exposure to War

This paper examines how the timing of childhood exposure to armed conflict influences both the magnitude of the impact it has on later-life health and the pathways through which those impacts manifest. Utilizing the Survey of Health and Retirement in Europe, we examine cohorts of children during World War II. We find that cohorts born during the war show the largest negative effects of exposure on health in later life. The pathways also vary the timing of exposure. Consistent with a latent critical period process, children born during the war experienced increased risk of poor health and illness in childhood, as well as adult cardiometabolic conditions and poor functional health. Conversely, cohorts born before the war experienced more indirect pathways consistent with cumulative disadvantage processes and institutional breakdown. These pathways include stunted socioeconomic attainment, increased risk behaviors, and poorer mental health. Overall, this study emphasizes that the timing of exposure is critical to understanding the long-term health effects of war.

Structuring adolescent's oral health effects on labour market entry in a cohort study

AIM

To evaluate the influence of the oral conditions and oral health-related quality of life (OHRQoL) on the entry of adolescents on labour.

DESIGN

This cohort study was performed in southern Brazil, within a random sample of 12-year-old adolescents (n = 1134). Oral health (dental caries, malocclusion, and toothache), OHRQoL (Child Perceptions Questionnaire 11-14), demographic factors, and family's socioeconomic status (household income and mother's education) were collected at baseline (2012). Education level and employment outcomes, such as labour market entry and earnings from work, were collected at 6-year follow-up. Path analysis was used to estimate the overall fit measurement, standardized coefficients (SC), and its direct and indirect effects.

RESULTS

Among 1134 participants, 768 adolescents with mean of age 17.5 years old were reassessed (retention rate of 68%). There was direct effect from poor OHRQoL on labour market entry (SC 0.057; P = .02). Sex and age also had a direct effect on employment outcomes. Socioeconomic status impacts oral health conditions as well as OHRQoL scores (P < .01). Household income, malocclusion, and toothache had indirect effects on labour market entry.

CONCLUSION

Oral health indirectly affects employment outcomes, through its effects on OHRQoL. Moreover, OHRQoL directly affects labour market entry in adolescents.

Accumulation of economic hardship and health during the COVID-19 pandemic: Social causation or selection?

This study examines whether economic hardship during the COVID-19 pandemic is deleteriously associated with psychological distress and self-rated health. A social causation perspective suggests that exposure to economic hardship will harm well-being, but a social selection perspective suggests that the appearance of health effects of hardship during the pandemic are attributable to the increased risk of exposure to hardship associated with poor well-being at the start of the pandemic. We also propose a third perspective, economic selection, which suggests that economic hardship prior to the pandemic negatively affects health and increases risk of exposure to hardship during the pandemic; consequently, an association between health and economic hardship during the pandemic may be spurious, and entirely due to pre-existing levels of hardship. To test these competing perspectives, we use a longitudinal study based in Canada that began in late March of 2020 and followed respondents monthly in April, May, and June. Baseline psychological distress and self-rated health, as well as economic hardship prior to the pandemic, independently predict the accumulation of monthly periods of hardship from April to June. The accumulation of periods of hardship from April to June is deleteriously associated with psychological distress and self-rated health in June. Controls for prior economic hardship and baseline health weaken the association between accumulation of periods of hardship and psychological distress, while also eliminating the association between accumulation of hardship and self-rated health. These findings favor a social causation perspective for psychological distress and a social selection perspective for self-rated health, with less evidence found in support of economic selection. This study took place during the first months of the COVID-19 pandemic, though, and associations with self-rated health may have become more evident as hardship further wore on individual well-being over a longer period of time.

Early Social Origins of Biological Risks for Men and Women in Later Life

We investigate whether childhood exposures influence adult chronic inflammation and mortality risk via adult health characteristics and socioeconomic status (SES) and whether gender moderates these relationships. Analyzing a longitudinal national sample of 9,310 men and women over age 50, we found that childhood SES, parental behaviors, and adolescent behaviors were associated with adult chronic inflammation via health characteristics and SES in adulthood. The process of disadvantage initiated by low childhood SES (i.e., adult health risk factors, socioeconomic disadvantage, and chronic inflammation) subsequently raised mortality risk. In addition, gender moderated the mediating influence of childhood SES via unhealthy behaviors and parental behaviors via adult SES. Demonstrating how social forces shape biological health through multiple mechanisms informs health policies by identifying multiple points of intervention in an effort to reduce the lasting consequences of childhood disadvantage.

Working and disability expectancies at older ages: The role of childhood circumstances and education

The ability to work at older ages depends on health and education. Both accumulate starting very early in life. We assess how childhood disadvantages combine with education to affect working and health trajectories. Applying multistate period life tables to data from the Health and Retirement Study (HRS) for the period 2008-2014, we estimate how the residual life expectancy at age 50 is distributed in number of years of work and disability, by number of childhood disadvantages, gender, and race/ethnicity. Our findings indicate that number of childhood disadvantages is negatively associated with work and positively with disability, irrespective of gender and race/ethnicity. Childhood disadvantages intersect with low education resulting in shorter lives, and redistributing life years from work to disability. Among the highly educated, health and work differences between groups of childhood disadvantage are small. Combining multistate models and inverse probability weighting, we show that the return of high education is greater among the most disadvantaged.

Infants with big appetites: The role of a nonfood environment on infant appetitive traits linked to obesity

BACKGROUND

Individual differences in appetitive traits present in the first few weeks of life. Research has shown that infants with a greater food reinforcement ratio (FRR) have higher obesity risk. To date, limited work has examined the relation between FRR and appetitive traits of infants, and how FRR relates to appetitive traits and obesity development.

OBJECTIVES

To examine the relation between appetitive traits and food and nonfood reinforcement of infants aged 9-18 mo, and to examine whether food and nonfood reinforcement mediate the relation between appetitive traits and weight-for-length z-score (zWFL).

METHOD

This secondary data analysis was conducted by combining 4 different cohorts of infants (n = 143) who have complete data on the food/nonfood reinforcement task, Baby Eating Behavior Questionnaire, and anthropometrics and demographics assessments. Three different nonfood reinforcers were used: video (DVD; n = 27), playing with bubbles (Bubbles; n = 67), and music accompanied by instruments (Music; n = 49) for the nonfood portion of the task. For the food portion of the task, the infant's favorite food was used.

RESULTS

General appetite positively correlated with FRR and zWFL, but negatively correlated with nonfood reinforcement; satiety responsiveness negatively correlated with food reinforcement, FRR, and zWFL. Mediational analysis showed that effects of general appetite on zWFL were mediated by FRR (indirect effect = 0.100, 95% CI: 0.041, 0.187) and nonfood reinforcement (indirect effect = 0.076, 95% CI: 0.025, 0.156). We also observed the mediating effect of FRR on the relation of satiety responsiveness and zWFL (indirect effect = -0.097, 95% CI: -0.204, -0.026).

CONCLUSIONS

Our work contributes to the mechanistic understanding of the ontogeny of obesity development early in life among individuals who are born with appetitive drive for overconsumption. During early infancy, the nonfood environment may protect against this drive and prevent obesity development.

Adolescents With Chronic Medical Conditions and High School Completion: The Importance of Perceived School Belonging

Students with chronic medical conditions often experience barriers to academic progress, including impact of disease and treatment, increased school absence, and altered expectations of teachers and parents. School belonging is an important element of academic success and can be promoted by positive relationships, structure, and support in the school environment. One aim of this study was to explore group differences in perceived school belonging and rate of on-time high school completion for students with chronic medical conditions as compared to their healthy peers. The second goal was to analyze relations between belonging, health status, and on-time completion of high school. Restricted data from Add Health was used to answer the study questions. Results showed that students with chronic medical conditions reported lower levels of perceived school belonging than their healthy peers (t(1056) = 3.69, p < .001, d = 0.23). Students with chronic medical conditions also attained lower levels of on-time high school graduation than their healthy peers (t(1056) = 2.60, p = .005, d = 0.16). Perceived school belonging had a different impact for students with chronic medical conditions than for those who had no health concerns. Each unit increase in belonging for students with health impairment was related to a 63% increased likelihood of on-time high school graduation (OR = 1.629, p = .003). School belonging is especially important for students living with chronic medical conditions. Finding ways to facilitate a stronger sense of school belonging may be a way to support desired academic outcomes.

Gender disparities in the education gradient in self-reported health across birth cohorts in China

Background

Variation in the relationship between education and health has been studied intensely over the past few decades. Although there is research on gender disparity and cohort variations in educational effect on health using samples from the U.S. and Europe, research about China’s is limited. Given the specific social changes in China, our study is designed to analyze the gender and cohort patterns in the education-health gradient.

Method

The latent growth-curve modeling was used to analyze the gender and cohort variations in the education gradient in self-rated health among Chinese respondents. The study employed longitudinal and nationally representative data from the Chinese Family Panel Studies from the years 2010 to 2016. Each cohort is specified according to their distinct periods of social change in China. Following the analysis, we used latent growth-curve model to illustrate gender and cohort differences in the age-graded education and health trajectories.

Results

Although Chinese men have reported to have better health than women in general, women reported 1.6 percentage points higher in self-reported health for each additional year of schooling compared to that of men (P < 0.001). The latent growth curve model showed women’s extra education benefits were persistent overtime. Compared to the people born during the “Old China” (1908–1938), the education gradient in self-rated health did not change for cohorts born before 1955 and after 1977, but the education-health gap changed significantly in the 1956–1960 (O.R. = 1.038, P < 0.05), 1967–1976 (O.R. = 1.058, P < 0.001), and 1977–1983 (O.R. = 1.063, P < 0.001) cohorts. There was a gender difference for the cohort variations in the education-health gradient. For women, the education effect in the 1956–1960 (O.R. = 1.063, P < 0.05), 1967–1976 (O.R. = 1.088, P < 0.001) and 1977–1983 (O.R. = 1.102, P < 0.001) cohorts was significantly higher than that of the 1908–1938 cohort. On the contrary, the education-health gradient remained the same across all cohorts for men.

Conclusion

Our study suggests that the education-health gradient varies across cohorts for women, but the size of education effect remains consistent for men across cohorts. The findings support the resource-substitution hypothesis and not the rising-importance hypothesis in China. We discussed the potential influences of the unique, social transformation and educational expansion in China.

Finding Jobs, Forming Families, and Stressing Out? Work, Family, and Stress among Young Adult Women in the United States

The transition to adulthood is increasingly characterized by complex paths into the world of work and family, especially for young women. Yet how work and family combine to influence stress among young adult women is not well understood. Using data from the National Longitudinal Study of Adolescent to Adult Health, we leverage new extensions to latent class analysis (LCA) to identify common combinations of work and family circumstances among young adult women, their earlier life and contemporaneous correlates, and associations with two stress measures: a multi-item Perceived Stress Scale (PSS) and Epstein–Barr Viral (EBV) antibody titers, a well-validated biomarker of stress-related immunity impairments. We identify seven different common combinations of latent work–family combinations among young adult women ranging from well-compensated professional workers with and without children, mothers without paid employment, and delayed transitions to work and family. Completing a college degree was associated with a higher likelihood of membership in classes marked by professional work irrespective of motherhood, while being raised in a community with greater female labor opportunities was generally associated with membership in child-free classes. Mothers and child-free women in “pink-collar” work with low wages and decision-marking freedom reported higher stress compared to women in “white-collar” work with higher wages and decision-making freedom. These differences are mostly attenuated following adjustments for poverty-related stressors and work–family conflict. While prior work has emphasized the health benefits for women of combining work and family, our research suggests these benefits may be limited to women of higher socioeconomic status with flexible, well-compensated jobs.

Health and educational aspirations in adolescence: a longitudinal study in Finland

Background

The health selection hypothesis suggests that poor health leads to low educational attainment during the life course. Adolescence is an important period as poor health might prevent students from making the best educational choices. We test if health in adolescence is associated with educational aspirations and whether these associations persist over and above sociodemographic background and academic achievement.

Methods

Using classroom surveys, a cohort of students (n = 5.614) from the Helsinki Metropolitan Region was followed from the 7th (12–13 years,) up to the 9th grade (15–16 years) when the choice between the academic and the vocational track is made in Finland. Health factors (Strengths and Difficulties Questionnaire (SDQ), self-rated health, daily health complaints, and long-term illness and medicine prescribed) and sociodemographic background were self-reported by the students. Students’ educational aspirations (applying for academic versus vocational track, or both) and their academic achievement were obtained from the Joint Application Registry held by the Finnish National Agency for Education. We conducted multilevel multinomial logistic regression analyses, taking into account that students are clustered within schools.

Results

All studied health factors were associated with adolescents’ educational aspirations. For the SDQ, daily health complaints, and self-rated health these associations persisted over and above sociodemographic background and academic achievement. Students with better health in adolescence were more likely to apply for the academic track, and those who were less healthy were more likely to apply for the vocational track. The health in the group of those students who had applied for both educational tracks was in between. Inconsistent results were observed for long-term illness. We also found robust associations between educational aspirations and worsening health from grade 7 to grade 9.

Conclusions

Our findings show that selection by health factors to different educational trajectories takes place at early teenage much before adolescents choose their educational track, thus supporting the health selection hypothesis in the creation of socioeconomic health inequalities. Our findings also show the importance of adolescence in this process. More studies are needed to reveal which measures would be effective in helping students with poor health to achieve their full educational potential.

The childhood roots of adult psychological distress: Interdisciplinary perspectives toward a better understanding of exposure to cumulative childhood adversity

BACKGROUND

Although most children experience at least one adversity, it is the experience of multiple adversities that produces a context of disadvantage that increases the risk of various negative outcomes in adulthood. Previous measures of cumulative childhood adversity consider a limited number of adversities, overlook potential differences across experiences of adversity, and fail to measure the effects of multiple co-occurring childhood adversities. These limitations have led to inconsistent and incomplete conclusions regarding the impact of multiple adverse childhood experiences on adult mental health.

OBJECTIVE

This study assesses how the operationalization and modeling of exposure to cumulative childhood adversity (CCA) influences estimates of the association between CCA and adult psychological distress and develops an improved measure of CCA.

METHODS

We use data from the Panel Study of Income Dynamics, a nationally representative sample of households in the United States, and its supplement, the Childhood Retrospective Circumstances Study (N = 4219). We compare four measures of CCA that consider various distinct aspects of adverse experiences (additive, severity, type, and patterns of experience using latent class analysis).

RESULTS

All measures of CCA were associated with increases in adult psychological distress, but effects depend on the measurement of CCA. Results suggest the sum score overestimates the overall impact of CCA. Latent class analysis captures the co-occurrence of adversities across severity and type, providing an improved measure of CCA.

CONCLUSIONS

The heterogeneity across adversities impacts estimates of adult psychological distress. Measuring CCA as patterns of co-occurring adverse experiences is a promising approach.

An Enduring Health Risk of Childhood Adversity: Earlier, More Severe, and Longer Lasting Work Disability in Adult Life

Objectives

Childhood adversity has been linked with adult health problems. We hypothesized that childhood adversity would also be associated with work limitations due to physical or nervous health problems, known as work disability.

Method

With data from the Panel Study of Income Dynamics (PSID) (1968-2013; n = 6,045; 82,374 transitions; 129,107 person-years) and the 2014 PSID Childhood Retrospective Circumstances Study, we estimated work disability transition probabilities with multinomial logistic Markov models. Four or more adversities defined a high level. Microsimulations quantified adult work disability patterns for African American and non-Hispanic white women and men, accounting for age, education, race, sex, diabetes, heart disease, obesity, and sedentary behavior.

Results

Childhood adversity was significantly associated with work disability. Of African American women with high adversity, 10.2% had moderate work disability at age 30 versus 4.1% with no reported adversities; comparable results for severe work disability were 5.6% versus 1.9% (both p < .01). Comparable results for whites were 11.3% versus 4.7%, and 3.5% versus 1.1% (p < .01). The association of childhood adversity with work disability remained significant after adjusting for diabetes, heart disease, obesity, and sedentary behavior (p < .05).

Conclusions

Childhood adversity may increase work disability throughout adult life.

The Value of High School Graduation in the United States: Per-Person Shadow Price Estimates for Use in Cost–Benefit Analysis

One way for jurisdictions with limited analytic resources to increase their capability for doing cost–benefit analysis (CBA) is to use existing shadow prices, or “plug-ins”, for important social impacts. This article contributes to the further development of one important shadow price: the value of an additional high school graduation in the United States. Specifically, how valuable to a student, government, and the rest of society in aggregate is a high school graduation? The analysis builds on the method developed by the Washington State Institute for Public Policy and presents numerical updates and extensions to their analysis. For the U.S., the estimated net present value (the social value) using a 3 percent real discount rate of this shadow price is approximately $300,000 per each additional graduate. In appropriate circumstances, this value can be “plugged-in” to CBAs of policies that either directly or indirectly seeks to increase the number of students who graduate from high school.

Intergenerational educational mobility and health satisfaction across the life course: Does the long arm of childhood conditions only become visible later in life?

The contemporaneous association of socioeconomic status (SES) with health is well-established, whereas much less is known about the health-related effects of social mobility (i.e., movements across different SES). This study investigates the impact of SES in childhood and adulthood on health satisfaction across the life course. Using data from the German Socio-Economic Panel (SOEP) and education as a central marker of SES, we test whether parental education (i.e., childhood SES) affects adult health satisfaction, directly and/or indirectly through own educational attainment (i.e., adult SES) as a mediating variable. Moreover, we apply diagonal reference models to disentangle the independent effect of intergenerational educational mobility. Our findings show that parental education has both direct and indirect effects. Yet, the relative weight of parents' education as a predictor of health satisfaction is found to depend on when in the life course health satisfaction is measured: parental education shows an increasing relevance as a predictor of health satisfaction at higher ages. On top of (additive) effects of parental and own education, we find significant mobility effects in earlier adulthood: upward educational mobility is conducive to health satisfaction and the reverse for downward educational mobility.

Wealth in Middle and Later Life: Examining the Life Course Timing of Women's Health Limitations

BACKGROUND AND OBJECTIVES

Guided by cumulative inequality theory, this study poses two main questions: (a) Does women's poor health compromise household financial assets? (b) If yes, is wealth sensitive to the timing of women's health limitations? In addressing these questions, we consider the effect of health limitations on wealth at older ages, as well as examine how health limitations influence wealth over particular segments of the life course, giving attention to both the onset and duration of health limitations.

RESEARCH DESIGN AND METHODS

Using 36 years of data from the National Longitudinal Survey of Mature Women, piecewise growth curve and linear regression models were used to estimate the effects of life course timing and duration of health limitations on household wealth.

RESULTS

The findings reveal that women who experienced health limitations accumulated substantially less wealth over time, especially if the health limitations were manifest during childhood or early adulthood.

DISCUSSION AND IMPLICATIONS

This study identifies how early-life health problems lead to less wealth in later life.

Trajectories of Work Disability and Economic Insecurity Approaching Retirement

OBJECTIVES

In this article, we examine the connection between trajectories of work disability and economic precarity in late midlife. We conceptualize work disability as a possible mechanism linking early and later life economic disadvantage.

METHODS

We model trajectories of work disability characterized by timing and stability for a cohort of Baby Boomers (22-32 in 1981) using 32 years of data from the Panel Study of Income Dynamics and latent class analysis. Measures of childhood disadvantage are included as predictors of work disability trajectories, which are subsequently included in logistic regression models predicting four economic outcomes (poverty, asset poverty, home ownership, and pension ownership) at ages 54-64.

RESULTS

Childhood disadvantage selected individuals into five distinct classes of work disability that differed in timing and stability. All of the disability trajectories were associated with an increased risk of economic insecurity in late midlife compared to the never work disabled.

DISCUSSION

This study contributes to the aging literature through its incorporation of the early life origins of pathways of disability and their links to economic outcomes approaching retirement. Findings suggest work disability is anchored in early life disadvantage and is associated with economic insecurity later in life.

How Lifestyle Factors Affect Cognitive and Executive Function and the Ability to Learn in Children

In today's research environment, children's diet, physical activity, and other lifestyle factors are commonly studied in the context of health, independent of their effect on cognition and learning. Moreover, there is little overlap between the two literatures, although it is reasonable to expect that the lifestyle factors explored in the health-focused research are intertwined with cognition and learning processes. This thematic review provides an overview of knowledge connecting the selected lifestyle factors of diet, physical activity, and sleep hygiene to children's cognition and learning. Research from studies of diet and nutrition, physical activity and fitness, sleep, and broader influences of cultural and socioeconomic factors related to health and learning, were summarized to offer examples of research that integrate lifestyle factors and cognition with learning. The literature review demonstrates that the associations and causal relationships between these factors are vastly understudied. As a result, current knowledge on predictors of optimal cognition and learning is incomplete, and likely lacks understanding of many critical facts and relationships, their interactions, and the nature of their relationships, such as there being mediating or confounding factors that could provide important knowledge to increase the efficacy of learning-focused interventions. This review provides information focused on studies in children. Although basic research in cells or animal studies are available and indicate a number of possible physiological pathways, inclusion of those data would distract from the fact that there is a significant gap in knowledge on lifestyle factors and optimal learning in children. In a climate where childcare and school feeding policies are continuously discussed, this thematic review aims to provide an impulse for discussion and a call for more holistic approaches to support child development.

Health Status and Transitions in Cohabiting Relationships of American Young Adults

OBJECTIVE

This study examines whether individual health predicts cohabitors' union transitions to marriage in American young adults.

BACKGROUND

Associations between health and subsequent marital transitions are well documented, but less is known about how health influences transitions of cohabiting relationships. As cohabitation has become a common relationship experience, understanding how health may influence cohabitors' union transitions is an important component of how health shapes relationship exposures more broadly.

METHOD

Data were taken from Waves III and IV of the National Longitudinal Study of Adolescent to Adult Health (http://www.cpc.unc.edu/projects/addhealth), including the supplemental collection of relationship partners conducted during Wave III. Competing risk regressions for the transition of cohabiting unions to marriage were estimated in two samples: one of individuals and a smaller one of cohabiting couples with information from both partners.

RESULTS

Healthier cohabiters are more likely to marry than are their less healthy counterparts, but only women's health is significantly associated with the transition to marriage. In the dyadic sample with information from both partners, the significant association between the female partner's health and the transition to marriage is robust to male partner characteristics, including health.

CONCLUSION

Health is an important predictor of cohabitation transitions in early adulthood, but these transitions may only be sensitive to the female partner's health.

Social selection in historical time: The case of tuberculosis in South Korea after the East Asian financial crisis

The perspectives of social selection and causation have long been debated. Social selection theory is as "social" as social causation theory, since all diseases are social and no biological process occurs outside society. To identify the social selection pathway and historical juncture affected by socioeconomic and political changes, we investigated the reciprocal impact of suffering from tuberculosis (TB) on the current socioeconomic position (SEP), stratified by childhood SEP. We also examined the extent to which the social consequences of ill health changed since the East Asian economic downturn. Data were collected for 2007-2012 from the Korea National Health and Nutritional Examination Survey. To identify associations between TB history and current household income (HHI), we constructed an ordinal logistic regression model adjusted for covariates, including age, gender, educational attainment, and job status. We adopted a recursive regression model to examine trend changes in this association from 1980-2012 to 2003-2012. Of 28,136 participants, 936 had experienced TB. In the first ordinal logistic regression, the TB group was more likely to have lower HHI than the non-TB group. The odds ratios (ORs) increased from 1.30 (1980-2012) to 1.86 (2003-2012) for the TB group, increasing their probability of having low HHI. Among the low childhood SEP group, the TB group's probability of having low HHI was 1.35 (95% confidence interval [CI]: 1.16-1.57) during 1980-2012, which increased to 2.01 (95% CI: 1.37-2.95) during 2003-2012. For the high childhood SEP group, the TB group's OR range fluctuated, similar to that for the non-TB group. The results support the social selection pathway from TB history to adverse impact on current SEP. Our study identified downward social mobility due to TB history among the low childhood SEP group. Moreover, negative social consequences deteriorated since the East Asian economic crisis.

Intergenerational transmission of family adversity: Examining constellations of risk factors

This study adopts a socio-ecological approach to examine multiple factors and processes assumed to shape the intergenerational transmission of social disadvantage, including influences of social change, social causation and social selection. Moving beyond approaches focusing on cumulative risk indices, this study uses latent class analysis to examine how different socio-economic and psycho-social risk factors combine within families and to what extent and how constellations of risk are transmitted from one generation to the next. We draw on data collected for the longitudinal and national representative 1970 British Cohort Study, comprising information on more than 11,000 cohort members and their parents. We identified four distinct risk configurations among the parent generation (G1): low-risk families (57.6%), high-risk families (16.3%), high-risk single-parents (24%) and ethnic minority families (2.1%). Within their offspring (G2) we identified five distinct risk configurations: low-risk families (62%), low-risk no-children (15.1%), moderate-risk single parents (10.1%), moderate-risk large families (8.9%), high socio-economic and high psycho-social risk (4%). There is evidence of structural mobility, and the findings suggest that intergenerational transmission of disadvantage is not just a systemic tendency towards social reproduction, but also reflects processes of social change and social selection. We conclude that a socio-ecological model provides a useful framework for a more comprehensive understanding of the multiple processes involved in the transmission of inter-cohort inequality.

Educators' Perspectives of Collaboration With Pediatricians to Support Low-Income Children

BACKGROUND

Educational and healthcare systems operate in silos. Few studies explore educators' perspectives of collaboration with pediatricians or cross-system solutions for school-identified concerns. We sought to investigate educators' viewpoints of collaboration with pediatricians.

METHODS

We conducted semistructured, qualitative interviews with full-time teachers, vice-principals, and principals, who worked with low-income first- or second-grade students. Interviews explored which students were concerning to educators, educators' experiences with collaboration, and barriers and facilitators of collaboration. Interview transcripts were analyzed with modified grounded theory.

RESULTS

We interviewed 12 teachers and 3 principals/vice-principals. Students' socioemotional problems were a foremost concern. Effective collaboration with pediatricians was not typical. Participants described not knowing they could communicate with pediatricians or that collaboration was often limited or unidirectional. Respecting boundaries of parental privacy and maintaining parental trust emerged as potential barriers. Some participants described negative experiences with pediatricians and reflected on societal perceptions of doctors and teachers, which could affect the development of relationships. Participants recognized potential benefits to collaboration, including gaining a holistic understanding of a child's health and home life.

CONCLUSIONS

Educators perceived collaboration with pediatricians as inadequate. More developed and tested programs that foster collaboration between schools and pediatricians are needed to support low-income youth.

Men's Income Trajectories and Physical and Mental Health at Midlife

Using time-varying, prospectively measured income in a nationally representative sample of Baby-Boomer men (the National Longitudinal Survey of Youth - 1979 [NLSY79]), we identify eight group-based trajectories of income between ages 25-49 and use multinomial treatment models to describe the associations between group-based income trajectories and mental and physical health at midlife. We find remarkable rigidity in income trajectories: less than 25% of our sample experiences significant upward or downward mobility between the ages of 25 to 49 and most who move remain or move into poverty. Men's physical and mental health at age fifty is strongly associated with their income trajectories, and some upwardly mobile men achieve the same physical and mental health as the highest earning men after adjusting for selection. The worse physical and mental health of men on other income trajectories is largely attributable to their early life disadvantages, health behaviors, and cumulative work experiences.

The scars of the past? Childhood health and health differentials in later life

This study estimates multilevel mixed effects models of three retrospective measures of childhood health – self-rated childhood health, exposure to parental smoking growing up, and missing school for 30 or more consecutive days due to a health event – on levels and changes in physical functioning at age 50 and beyond. Using data from 15 waves of the Household, Income and Labour Dynamics in Australia survey, the results show that variation in the level of later-life physical functioning is associated with childhood health. Poor childhood health however is not associated with the rate of physical functioning decline. Respondents who reported poor childhood health and were migrants to Australia from a non-English speaking country reported better physical functioning in later life, compared with non-Indigenous Australian-born respondents who reported poor childhood health. In contrast, women who reported poor self-rated childhood health reported worse physical functioning compared with men who reported poor self-rated childhood health. These findings are robust to the inclusion of a range of measures of childhood and adult characteristics and circumstances. These results suggest that Australia, with arguably a strong and supportive health care system as compared with the U.S., may mitigate the accumulation of disadvantages to those who reported poor childhood health. We note that though functional health differences due to childhood health are not exacerbated in later life, neither are they eliminated.

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Poor childhood health is associated with worse physical functioning in later life.

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This association is stronger for women, as compared with men.

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Association weaker for migrants non-English speaking countries, vs. native-born.

Social stratification and allostatic load: shapes of health differences in the MIDUS study in the United States

Social stratification is an important mechanism of human organization that helps to explain health differences between demographic groups commonly associated with socioeconomic gradients. Individuals, or group of individuals, with similar health profiles may have had different stratification experiences. This is particularly true as social stratification is a significant non-measurable source of systematic unobservable differences in both SES indicators and health statuses of disadvantage. The goal of the present study was to expand the bulk of research that has traditionally treated socioeconomic and demographic characteristics as independent, additive influences on health by examining data from the United States. It is hypothesized that variation in an index of multi-system physiological dysregulation - allostatic load - is associated with social differentiation factors, sorting individuals with similar demographic and socioeconomic characteristics into mutually exclusive econo-demographic classes. The data were from the Longitudinal and Biomarker samples of the national Study of Midlife Development in the US (MIDUS) conducted in 1995 and 2004/2006. Latent class analyses and regression analyses revealed that physiological dysregulation linked to socioeconomic variation among black people, females and older adults are associated with forces of stratification that confound socioeconomic and demographic indicators. In the United States, racial stratification of health is intrinsically related to the degree to which black people in general, and black females in particular, as a group, share an isolated status in society. Findings present evidence that disparities in health emerge from group-differentiation processes to the degree that individuals are distinctly exposed to the ecological, political, social, economic and historical contexts in which social stratification is ingrained. Given that health policies and programmes emanate from said legal and political environments, interventions should target the structural conditions that expose different subgroups to different stress risks in the first place.

Association of Maternal Depressive Symptoms and Offspring Physical Health in Low-Income Families

Objectives The present study sought to examine the association between maternal depressive symptoms and characteristics of offspring physical health, including health status, health behaviors, and healthcare utilization, among low-income families. Maternal engagement was explored as a mediator of observed effects. Methods Cross-sectional survey data from a community sample of 4589 low-income women and their preschool-age children participating in the WIC program in Los Angeles County were analyzed using logistic, Poisson, and zero-inflated negative binomial regression. Mediation was tested via conditional process analyses. Results After controlling for the effects of demographic characteristics including maternal health insurance coverage, employment status, education, and preferred language, children of depressed women (N = 1025) were significantly more likely than children of non-depressed women (N = 3564) to receive a "poor" or "fair" maternal rating of general health (OR 2.34), eat fewer vegetables (IRR: 0.94) more sweets (IRR: 1.20) and sugary drinks daily (IRR: 1.32), and consume fast food more often (OR 1.21). These children were also less likely to have health insurance (OR 1.59) and more likely to receive medical care from a public medical clinic or hospital emergency room (OR 1.30). Reduced maternal engagement partially mediated associations between maternal depressive symptoms and several child health outcomes including poor diet, health insurance coverage, and use of public medical services. Conclusions for Practice Maternal depressive symptoms are associated with poor health among preschool-age children in low-income families. Prevention, screening, and treatment efforts aimed at reducing the prevalence of maternal depression may positively affect young children's health.