Health lifestyles in early childhood

Centre-based childcare in early childhood and child obesity: systematic review and meta-analysis protocol

OBJECTIVES

Centre-based childcare has been identified as a promising environment for obesity prevention in early childhood, but the longitudinal relationships between attending centre-based childcare and child obesity are not well understood. The objective of this systematic review is to evaluate the longitudinal associations between centre-based childcare attendance in early childhood and child body mass index compared with other childcare settings or parental care. Subgroup analyses will also be conducted to determine if socioeconomic factors and characteristics of the childcare setting modify the relationships.

METHODS

Databases that will be searched include MEDLINE, Embase, Cumulative Index to Nursing and Allied Health Literature, the Cochrane Database and Web of Science. Longitudinal prospective cohort studies, retrospective cohort studies, case-control studies and intervention trials conducted in middle-income and high-income countries will be included in the search strategy. Sensitivity and subgroup analyses will be conducted to explore factors that may modify the findings. Study selection, data extraction, risk of bias and quality of evidence assessments will be conducted independently and in duplicate by two reviewers. Risk of bias will be assessed using the Risk Of Bias In Non-randomized Studies - of Exposure tool. Meta-analysis will be conducted using random effects models to account for between-study variation. Heterogeneity across included studies will be estimated using the I2 statistic. If meta-analysis is not possible, a narrative summary will be provided. The quality of the evidence will be assessed using the Grading of Recommendations Assessment, Development and Evaluation tool.

ETHICS AND DISSEMINATION

Ethical approval is not required for this study since no data will be collected. Findings aim to inform interventions and guide efforts in childcare settings to support optimal child growth. Results will be published in a peer-reviewed journal. Results may be of relevance for childcare and public health policy, researchers, parents and healthcare practitioners.

PROSPERO REGISTRATION NUMBER

CRD42023436911.

Exploring the Influence of a Physical Activity and Healthy Eating Program on Childhood Well-Being: A Comparative Study in Primary School Students

Childhood is a crucial stage of human development in which the lifestyles children adopt can have a significant impact on their well-being throughout their lives. The aim of this study was to analyze and compare the healthy habits and Body Mass Index (BMI) of students from a primary school that participated in a program to promote physical activity and healthy eating one year earlier with other students from two schools that had not participated in this type of program. We analyzed a sample of 287 Spanish students, aged between 8 and 12 years. A survey of healthy habits was completed, and anthropometric data were taken to determine their Body Mass Index (BMI). The questionnaire data indicated that there are some significant differences (p = ≤ 0.05) in the consumption of some unhealthy foods between the evaluated groups. An amount of 11% of the sample was considered obese and 26% were overweight; no significant differences were found between the groups. This study suggests that the healthy habits strategy implemented by a school improves pupils' habits, especially in reducing the consumption of unhealthy foods. Despite the positive effects, the data indicate that these programs fall short of government recommendations, particularly in areas such as physical activity and certain dietary choices.

The formation of classed health lifestyles during youth: A two-generational, longitudinal approach

The topic of this article is the classed formation of health lifestyles in youth. Based on longitudinal interview data (41 youths, 17 of their parents) from two contrasting class contexts in Norway, we investigate how health lifestyles are reproduced across generations and during youth, focussing particularly on diet and physical activity. We find that young people's health lifestyles are powerfully shaped by social class and moulded over time in ways that may impact their further health trajectory. The health practices of upper-class young people are closely monitored; they are practically and emotionally scaffolded by their parents. Developing a rigorous health orientation, they come to view health as an investment for the future, intrinsically linked to achievement, discipline and identity. Working-class parents focus more on the child's autonomy in matters of diet and physical activity. Separating health practices from family life, their children's health orientation becomes more fragile and their children's health lifestyle trajectory more arbitrary and vulnerable to peer influence and marketised body cultures. Combining temporality, youth agency and relationality, it becomes evident that young people internalise their parents' health lifestyle, leaving room for different expressions of youth agency.

Health Lifestyle Theory in a Changing Society: The Rise of Infectious Diseases and Digitalization

Social change produces alterations in society that necessitate changes in sociological theories. Two significant changes affecting health lifestyle theory are the behaviors associated with the COVID-19 pandemic and the digitalization of society. The health-protective practices emerging from the ongoing pandemic and the recent parade of other newly emerging infectious diseases need to be included in the theory's framework. Moreover, the extensive digitalization of today's society leads to the addition of connectivities (electronic networks) as a structural variable. Connectivities serve as a computational authority influencing health lifestyle practices through health apps and other digital resources in contrast to collectivities (human social networks) as a normative authority. The recent literature supporting these features in an updated and expanded model of health lifestyle theory is discussed.

Narrative Review and Analysis of the Use of "Lifestyle" in Health Psychology

Lifestyle is a complex and often generic concept that has been used and defined in different ways in scientific research. Currently, there is no single definition of lifestyle, and various fields of knowledge have developed theories and research variables that are also distant from each other. This paper is a narrative review of the literature and an analysis of the concept of lifestyle and its relationship to health. This contribution aims to shed light on the lifestyle construct in health psychology. In particular, the first part of this manuscript reexamines the main definitions of lifestyle in the psychological and sociological fields through three perspectives: internal, external, and temporal. The main components that characterise lifestyle are highlighted. The second part of this paper explores the main concepts of lifestyle in health, underlining their strengths and weaknesses, and proposes an alternative definition of a healthy lifestyle, which integrates the individual dimensions with the social and cycle dimensions of life. In conclusion, a brief indication of a research agenda is presented.

Theoretical Approaches to Research on the Social Determinants of Obesity

This article reviews selected theoretical approaches explaining the social determinants of obesity. The significance of this topic for medicine, public health, and other areas of obesity-related research is the growing body of evidence showing that the social environment is often key to understanding the risk of obesity. A review of relevant literature and analysis of empirical evidence linking theory to data in studies of obesity was performed. Several studies show that differences in social behavior and living conditions associated with SES, lifestyles, inequality, and other social variables have important roles in weight gain. Because the social determinants of obesity often begin in childhood, life course theory and its concepts of cumulative advantage/disadvantage and cumulative inequality are initially reviewed, followed by a discussion of how fundamental cause theory, health lifestyle theory, and cultural capital theory can be applied to obesity research. The stress process model and the concepts of social networks and neighborhood disadvantage concerning obesity are also included.

Race, ethnicity and COVID-19 vaccine concerns: A latent class analysis of data during early phase of vaccination

Racial gaps in vaccine uptake in the United States have been widely reported. Existing studies, however, have not explored how individuals' concerns about COVID-19 vaccines are clustered. In this study, racial and ethnic background is linked to constellations of COVID-19 vaccine concerns during the early phase of vaccines in the United States, using the Household Pulse Survey (N = 60,492). Latent class analysis reveals five distinct classes of vaccine concerns: general skepticism, distrust of science and the government, safety, a desire to wait and see, and vague uncertainty. Compared to Whites, people of color more consistently report vaccine hesitancy due to safety and a desire to wait and see, rather than distrust of science and the government. Whites, however, more consistently report general skepticism and distrust of science and the government. Our findings suggest that distrust of science and government is not central to racial minorities' vaccine hesitancy, but it is so for Whites.

Peer Network Processes in Adolescents' Health Lifestyles

Combining theories of health lifestyles-interrelated health behaviors arising from group-based identities-with those of network and behavior change, we investigated network characteristics of health lifestyles and the role of influence and selection processes underlying these characteristics. We examined these questions in two high schools using longitudinal, complete friendship network data from the National Longitudinal Study of Adolescent to Adult Health. Latent class analyses characterized each school's predominant health lifestyles using several health behavior domains. School-specific stochastic actor-based models evaluated the bidirectional relationship between friendship networks and health lifestyles. Predominant lifestyles remained stable within schools over time, even as individuals transitioned between lifestyles. Friends displayed greater similarity in health lifestyles than nonfriend dyads. Similarities resulted primarily from teens' selection of friends with similar lifestyles but also from teens influencing their peers' lifestyles. This study demonstrates the salience of health lifestyles for adolescent development and friendship networks.

The relationship between postsecondary education and adult health behaviors

Nearly 80% of American adults between the ages of 33-44 have at least some postsecondary education, which ranges from vocational training to a doctorate or professional degree. However, in education-health studies, postsecondary credentials are often grouped into a limited number of categories. This is an important omission as it obscures differentiations between the various types of postsecondary credentials. This study provides the first comprehensive analysis of disparities in health behaviors across detailed levels of postsecondary education. Data comes from Wave 5 of the 2018 National Longitudinal Study of Adolescent to Adult Health (Add Health). A covariance-weighting technique is used to produce behavioral index scores that identify the full spectrum of health behaviors influenced by postsecondary educational attainment. Estimates are initially produced in aggregate for the total sample population, with interaction models subsequently being used to test differences across gender and race/ethnicity population subgroups. The aggregate results indicate that adults with at least a bachelor's degree exhibit healthier lifestyles; however, no difference is observed among adults with lower-level postsecondary credentials, compared to high school graduates. Women experience steeper gradients at higher levels of postsecondary education, compared to men. Both White and Hispanic American adults exhibit comparable health lifestyles across levels of postsecondary education; however, Black Americans were found to experience no returns except at the doctorate or professional degree level. These findings have important implications particularly as adults in their thirties and forties continue to exhibit troubling health and mortality trends.

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Adult health behaviors across detailed levels of postsecondary education.

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Estimates are provided both in aggregate and by the most influential population subgroups, including gender and race.

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Significant better health behaviors found among BA graduates and above.

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Lower or no returns found among sub-BA holders.

"Everything is Connected": Health Lifestyles and Teenagers' Social Distancing Behaviors in the COVID-19 Pandemic

Social distancing during the COVID-19 pandemic requires people to engage in new health behaviors that are public, monitored, and often contested. Parents are typically considered responsible for controlling their children's behavior and instilling norms. We investigated how parents and teens managed teenagers' social distancing behaviors. Analyzing 100 longitudinal (2015-2020), dyadic qualitative interviews with teenagers and their parents in 20 families from two middle-class communities in which social distancing was normative, we found that preexisting health lifestyles were used to link social distancing behaviors to specific identities, norms, and understandings of health. The pandemic presented challenges resulting from contradictory threats to health, differing preferences, and conflicting social judgments. Parents responded to challenges by adhering to community norms and enforcing teens' social distancing behaviors. They drew on preexisting, individualized health lifestyles as cultural tools to justify social distancing messages, emphasizing group distinctions, morality, and worth in ways that perpetuated inequalities.

Developing Health Lifestyle Pathways and Social Inequalities across Early Childhood

Lifestyles are a long-theorized aspect of social inequalities that root individual behaviors in social group differences. Although the health lifestyle construct is an important advance for understanding social inequalities and health behaviors, research has not theorized or investigated the longitudinal development of health lifestyles from infancy through the transition to school. This study documented children's longitudinal health lifestyle pathways, articulated and tested a theoretical framework of health lifestyle development in early life, and assessed associations with kindergarten cognition, socioemotional behavior, and health. Latent class analyses identified health lifestyle pathways using the US Early Childhood Longitudinal Study - Birth Cohort (ECLS-B; N≈6,550). Children's health lifestyle pathways were complex, combining healthier and unhealthier behaviors and changing with age. Social background prior to birth was associated with health lifestyle pathways, as were parents' resources, health behaviors, and non-health-focused parenting. Developing health lifestyle pathways were related to kindergarten cognition, behavior, and health net of social background and other parent influences. Thus, family context is important for the development of complex health lifestyle pathways across early childhood, which have implications for school preparedness and thus for social inequalities and well-being throughout life. Developing health lifestyles both reflect and reproduce social inequalities across generations.

Contributions and Challenges in Health Lifestyles Research

The concept of health lifestyles is moving scholarship beyond individual health behaviors to integrated bundles of behaviors undergirded by group-based identities and norms. Health lifestyles research merges structure with agency, individual-level processes with group-level processes, and multifaceted behaviors with norms and identities, shedding light on why health behaviors persist or change and on the reproduction of health disparities and other social inequalities. Recent contributions have applied new methods and life course perspectives, articulating health lifestyles's dynamic relationships to social contexts and demonstrating their implications for health and development. Culturally focused work has shown how health lifestyles function as signals for status and identity and perpetuate inequalities. We synthesize literature to articulate recent advances and challenges and demonstrate how health lifestyles research can strengthen health policies and inform scholarship on inequalities. Future work emphasizing health lifestyles's collective nature and attending to upstream social structures will further elucidate complex social processes.

COVID-19 Health Precautions: Identifying Demographic and Socio-Economic Disparities and Changes over Time

The recent coronavirus disease 2019 (COVID-19) pandemic has required the adoption of precautionary health behaviours to reduce the risk of infection. This study examines adherence, as well as changes in adherence, to four key precautionary behaviours among Canadian adults: wearing face masks, social distancing, hand washing, and avoiding large crowds. Data are drawn from Series 3 and 4 of the nationally representative Canadian Perspectives Survey Series, administered by Statistics Canada in June and July 2020. We calculate overall adherence levels as well as changes over time. Logistic regression models estimate each behaviour as a function of demographic and socio-economic characteristics to identify adherence disparities across population segments. We find a nearly universal increase in precautionary behaviours from June to July in mask wearing (67.3 percent to 83.6 percent), social distancing (82.4 percent to 89.2 percent), and avoiding crowds (84.1 percent to 88.9 percent); no significant change occurred in the frequency of hand washing. We observe significant disparities in adherence to precautionary behaviours, especially for mask wearing, in June; female, older, immigrant, urban, and highly educated adults were significantly more likely to adhere to precautionary behaviours than male, younger, Canadian-born, rural, and low-educated adults. By July 2020, these disparities persisted or were slightly attenuated; women, however, had consistently higher adherence to all behaviours at both time points. These findings have substantial implications for policy and potential public health interventions.

Sociodemographic Predictors of Adherence to National Diet and Physical Activity Guidelines at Age 5 Years: The Healthy Start Study

PURPOSE

To assess adherence to the 2015-2020 Dietary Guidelines for Americans and 2018 Physical Activity Guidelines, and identify sociodemographic predictors of adherence among children.

DESIGN

Cross sectional.

SETTING

Colorado, United States.

PARTICIPANTS

Children aged 5 (n = 482).

MEASURES

Sex, race/ethnicity, maternal education, maternal employment, maternal subjective social status and household income were assessed via questionnaires. Diet was assessed via 2 interviewer-administered 24-hour dietary recalls. Physical activity was objectively-measured with accelerometry for 7 days. Adherence was defined as a Healthy Eating Index-2015 score of ≥70 and/or ≥6 hours/day of light, moderate and vigorous activity.

ANALYSIS

For each predictor, logistic regression was used to estimate odds ratios for adherence to the diet guidelines only, the activity guidelines only or both guidelines.

RESULTS

In the full sample, 29% of children were non-adherent to both guidelines, 6% adhered to the dietary guidelines only, 50% adhered to the activity guidelines only and 14% adhered to both. Girls had a 41% lower odds of adhering to the physical activity guidelines than boys (p = 0.01), after adjustment for race/ethnicity, household income and maternal education level, perceived social status and employment status.

CONCLUSION

Efforts to improve the health of young children should promote adherence to the Dietary Guidelines for Americans among all children. Targeted interventions that increase physical activity among girls may help to mitigate health disparities.

Healthy living practices in families and child health: 5-year follow-up of Taiwan Birth Cohort Study

OBJECTIVES

We have previously developed the Child Healthy Living Practices in Family (CHLPF) Index and found that the CHLPF Index was concurrently associated with the health of children at age 3. In this follow-up study, we aimed to examine whether healthy living practices in family at age 3 predicted health of children at school age.

DESIGN AND SETTING

Data came from the Taiwan Birth Cohort Study designed to assess the development and health of 24 200 children born in 2005.

PARTICIPANTS

A total of 18 553 cohort members whose mothers or primary caregivers had completed 6-month, 3-year, 5-year and 8-year surveys were included for analysis, representing a response rate of 87.3%.

OUTCOME MEASURES

A multiple logistic regression model was used to test the relationship between mother-rated children's health at age 8 and the CHLPF Index level, after controlling for sex, birth outcomes, family structure, parental education, residential area, family income and mother-rated child's health at age 3.

RESULTS

The percentage of mother-rated good health at age 8 was 79.7%. Compared with the low CHLPF level, the adjusted OR of mother-rated good health was 1.38 (95% CI 1.19 to 1.60), 1.21 (95% CI 1.10 to 1.35) and 1.17 (95% CI 1.07 to 1.29), respectively, for high, high-low and mid-low CHLPF levels. Moreover, the prevalence of mother-rated good health at age 8 with high-level CHLPF Index in the low-income group was similar to that of the high-income group (83.72% vs 84.18%); the prevalence with low-level CHLPF Index in the low-income group was much lower than that of the high-income group (70.21% vs 78.98%).

CONCLUSIONS

Our study underscores that high level of healthy living practices in early childhood is positively associated with good health at school age, particularly for children from disadvantaged families.

Stability and Change in Health Behavior Profiles of U.S. Adults

OBJECTIVES

While understanding of complex within-person clustering of health behaviors into meaningful profiles of risk is growing, we still know little about whether and how U.S. adults transition from one profile to another as they age. This study assesses patterns of stability and change in profiles of tobacco and alcohol use and body mass index (BMI).

METHOD

A nationally representative cohort of U.S. adults 25 years and older was interviewed up to 5 times between 1986 and 2011. Latent transition analysis (LTA) models characterized the most common profiles, patterning of transitions across profiles over follow-up, and assessed whether some were associated with higher mortality risk.

RESULTS

We identified 5 profiles: "health promoting" with normal BMI and moderate alcohol consumption; "overweight"; "current smokers"; "obese"; and "nondrinkers". Profile membership was largely stable, with the most common transitions to death or weight gain. "Obese" was the most stable profile, while "smokers" were most likely to transition to another profile. Mortality was most frequent in the "obese" and "nondrinker" profiles.

DISCUSSION

Stability was more common than transition, suggesting that adults sort into health behavior profiles relatively early. Women and men were differently distributed across profiles at baseline, but showed broad similarity in transitions.

Health Lifestyles in Late Middle Age

A growing body of work identifies distinct health lifestyles among children, adolescents, and young adults and documents important social correlates. This study contributes to that line of research by identifying the health lifestyles of U.S. adults entering late middle age, assessing structural predictors of membership in different health lifestyles in this understudied age-group, and examining net associations between health lifestyles, chronic conditions, and physical health. The data come from the National Longitudinal Survey of Youth 1979 50+ Health Module. The analysis is based on respondents who answered the 50+ Health Module in 2008, 2010, 2012, or 2014 (N = 7,234). The results confirm similar relationships between health lifestyles and structural factors like class, gender, and race that prior studies observe and also reveal a unique pattern of associations between health lifestyle and health status because of diagnosed conditions that impact health behaviors in adulthood.

Promoting health equity to prevent crime

Traditionally, research activities aimed at diminishing health inequalities and preventing crime have been conducted in isolation, with relatively little cross-fertilization. We argue that moving forward, transdisciplinary collaborations that employ a life-course perspective constitute a productive approach to minimizing both health disparities and early delinquent involvement. Specifically, we propose a multidimensional framework that integrates findings on health disparities and crime across the early life-course and emphasizes the role of racial and socioeconomic disparities in health. Developing the empirical nexus between health disparities research and criminological research through this multidimensional framework could fruitfully direct and organize research that contributes to reductions in health inequalities and the prevention of crime during the early life course. We also propose that this unified approach can ultimately enhance public safety policies and attenuate the collateral consequences of incarceration.

Knowledge, attitudes and self-reported practices toward children oral health among mother's attending maternal and child's units, Salé, Morocco

Background

The occurrence of severe dental caries is particularly prevalent and harmful in children. A better understanding of parental factors that may be indicators of children’s risk of developing dental caries is important for the development of preventive measures.

This study was conducted to assess knowledge, attitudes, and practices (KAP) of mothers in Salé, Morocco regarding oral health and their predictors.

Methods

A cross-sectional KAP study was conducted of Mother and Child units in Salé, Morocco. Mothers attending the selected units from November 2014 to 29 January 2015 were recruited. Data were collected using a semi-structured questionnaire, administered by face-to-face interviews, to record socio-demographic factors and KAPs. The main outcome measures included knowledge about oral health diseases and preventive measures, and attitudes and practices related to oral health prevention measures and dental care. KAPs scores were then recoded based on responses and scores were determined for each KAP domain. Linear regression analysis was conducted to assess predictors of KAP scores.

Results

Among 502 mothers included, 140 (27.8%) were illiterate and 285 (60.9%) were aware that fluoride has a beneficial effect in caries prevention. Mothers’ own practices about dental care were statistically related to their children’s use of dental care services (p < 0.001). Multiple linear regression analysis revealed that the knowledge score was associated with mother’s age (β = 0.05; 95% CI; p < 0.001), education level, and median income (β = 0.38; p = 0.04). Significant predictors of oral health-related practices were mother’s education level and children’s health status.

Conclusions

Limited KAP scores were observed among the studied population. A great emphasis on oral health education and some risk factor modifications are recommended.

Electronic supplementary material

The online version of this article (10.1186/s12889-018-5542-2) contains supplementary material, which is available to authorized users.

Family, Peer, and School Influences on Children's Developing Health Lifestyles

Health lifestyles are important for health and social identity, yet little is known about their development in early life. We use data from the Early Childhood Longitudinal Study-Kindergarten Cohort of 1998-99 (ECLS-K; N = 8,786) to track children's health lifestyles and assess a theoretical model of health lifestyle development. Latent class analyses identify health lifestyles at four time points from first to eighth grade, and multivariate models investigate their interrelationships and social contextual influences. Health lifestyles are multidimensional and dynamic, and children demonstrate distinct combinations of risks and protections. Family factors, such as resources and parenting, shape earlier health lifestyles, which influence later lifestyles. Results show that development and contexts drive changes in health lifestyles, as family factors decrease in influence with age while some school and peer influences appear to emerge. Policy makers and researchers interested in shaping health behaviors should consider the multidimensional and dynamic nature of health lifestyles.

Health Lifestyles in Adolescence and Self-rated Health into Adulthood

Do health behaviors cluster together as health lifestyles in adolescence? Are these lifestyles socially patterned? Do these lifestyles impact physical health into adulthood? To answer these questions, we employed data from Waves 1 and 4 of the National Longitudinal Study of Adolescent to Adult Health ( n = 7,827). Our latent class analysis revealed four health lifestyles: (a) low risk, (b) moderate risk with substance use, (c) moderate risk with inactivity, and (d) high risk. As suggested by health lifestyle theory, membership in these classes varied according to gender, race-ethnicity, and family structure. Consistent with the life course perspective, regression analyses indicated that those in the high-risk lifestyle tend to exhibit worse health in adolescence and adulthood than those in the low-risk lifestyle. Our findings confirm that socially patterned lifestyles can be observed in adolescence, and these lifestyles are potentially important for understanding the distribution of physical health across the early life course.

Health Lifestyle Behaviors among U.S. Adults

Existing research that studies individual health behaviors and conceive of behaviors as simplistically reflecting narrow intentions toward health may obscure the social organization of health behaviors. Instead, we examine how eight health behaviors group together to form distinct health behavior niches. Using nationally-representative data from U.S. adults aged 18 and over from the 2004-2009 National Health Interview Survey (NHIS), we use Latent Class Analysis to identify classes of behavior based on smoking status, alcohol use, physical activity, physician visits, and flu vaccination. We identify 7 distinct health behavior classes including concordant health promoting (44%), concordant health compromising (26%), and discordant classes (30%). We find significant race/ethnic, sex, regional, and age differences in class membership. We show that health behavior classes are associated with prospective mortality, suggesting that they are valid representations of health lifestyles. We discuss the implications of our results for sociological theories of health behaviors, as well as for multiple behavior interventions seeking to improve population health.

Young Children's Developmental Ecologies and Kindergarten Readiness

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

Health lifestyles across the transition to adulthood: Implications for health

Research has long established the importance of individual health behaviors such as cigarette smoking for adult morbidity and mortality. However, we know little about how health behaviors cluster into health lifestyles among adolescents and young adults in the United States, or in turn, how such health lifestyles are associated with young adult health outcomes. This study establishes health lifestyles as distinct group phenomena at three developmental time points in a single cohort: late adolescence (ages 15-17), early adulthood (ages 20-24), and young adulthood (ages 26-31). We then identify the associations between these health lifestyles and young adult health outcomes. We use the National Longitudinal Study of Adolescent to Adult Health (Add Health), a nationally representative sample of U.S. adolescents followed into adulthood, and latent class analysis and regression models. We uncover diverse health lifestyles among adolescents, early adults, and young adults; however, few individuals engaged in a consistently salubrious lifestyle at any developmental stage. People with less healthy lifestyles also tended to exhibit poorer health in young adulthood. Our results showed that young adult health lifestyles were significantly associated with young adult cardiovascular risk. Moreover, health lifestyles in each of the three developmental stages were associated with young adult self-rated health, and accounting for lifestyles in later stages explained some of these associations. Overall, this study suggests a portrait of problematic health lifestyles among a nationally representative cohort of young Americans, with associated patterns of relatively poor physical health among those with poor health lifestyles.

Health-Related Parenting among U.S. Families and Young Children's Physical Health

Parenting is a constellation of behaviors, yet investigations of the link between parenting and children's health typically focus on singular behaviors. Thus, patterns of health-related parenting among U.S. families, associations between patterns and children's physical health, and the prevalence of such patterns among different sociodemographic groups remain unknown. Applying latent class analysis to the Early Childhood Longitudinal Study-Birth Cohort (2001; n=8,550) revealed six parenting patterns. The pattern characterized by high levels of television watching was associated with the worst overall health; the pattern characterized by the highest consumption of food and amount of outdoor play was linked to the highest odds of obesity. Children of less educated mothers and Black mothers were more likely to experience both of these patterns than the patterns associated with the best child health, but these patterns did not differ for Hispanics (versus Whites). Income differences only appeared for patterns associated with children's general health.

Chronic Disease at Midlife: Do Parent-child Bonds Modify the Effect of Childhood SES?

Childhood socioeconomic status (SES) often is associated with physical health even decades later. However, parent-child emotional bonds during childhood may modify the importance of childhood SES to emergent health inequalities across the life course. Drawing on national data on middle-aged adults (1995 and 2005 National Survey of Midlife Development in the United States; MIDUS; Ns = 2,746 and 1,632), I find that compromised parent-child bonds eliminate the association between childhood SES and midlife disease. Longitudinal models of incident disease across one decade show that childhood abuse in particular continues to undermine the health protection associated with childhood SES. When childhood SES is moderate to high, compromised parent-child bonds lead to no predicted health benefits from childhood SES. In total, these findings direct attention to parent-child bonds as social-psychological levers for the transmission of class-based health advantages.

Social Determinants and Health Behaviors: Conceptual Frames and Empirical Advances

Health behaviors shape health and well-being in individuals and populations. Drawing on recent research, we review applications of the widely applied "social determinants" approach to health behaviors. This approach shifts the lens from individual attribution and responsibility to societal organization and the myriad institutions, structures, inequalities, and ideologies undergirding health behaviors. Recent scholarship integrates a social determinants perspective with biosocial approaches to health behavior dynamics. Empirical advances model feedback among social, psychological and biological factors. Health behaviors are increasingly recognized as multidimensional and embedded in health lifestyles, varying over the life course and across place and reflecting dialectic between structure and agency that necessitates situating individuals in context. Advances in measuring and modeling health behaviors promise to enhance representations of this complexity.