Neighborhood Factors During Adolescence: Modest Effects On Cardiovascular Risk, Small Impact On Obesity And Depression

Peers' parental education and cardiovascular disease risk in adulthood: The mediating role of health-related behaviors

RATIONALE

Although there is a growing body of empirical evidence on the relationship between peers' parental education and adolescents' educational outcomes, little is known about whether exposure to highly educated peers' parents is associated with improved physical health in adulthood.

OBJECTIVE

This study investigated the relationship between the education level of peers' parents (Wave I) and the risk of developing cardiovascular disease (CVD) in adulthood (Wave IV). Moreover, we considered a set of health-related behaviors (Wave II) as the underlying mechanisms linking peers' parental education to later-life physical health such as substance use (smoking, binge drinking, and marijuana use) and other lifestyle behaviors (physical activity, sedentary behavior, and unhealthy dietary habits).

METHODS

Data from the National Longitudinal Study of Adolescent to Adult Health (Add Health), spanning respondents' adolescence to adulthood, were used. To address the endogenous school selection problem and account for the unobserved school-level confounders, this study exploited quasi-experimental within-school/across-cohort variation in peer composition. To formally test for mediation, Sobel tests were conducted.

RESULTS

The results of this study revealed that independent of own parents' education levels, exposure to higher levels of peers' parental education is associated with a lower CVD risk score in adulthood. For a one-standard-deviation increase in peers' parental education-that is, about a 0.98-year increase in grademates' parental educational attainment, a CVD risk in adulthood increased by about 6.2%. Our mediation analyses showed that part of this association is explained by a decrease in substance use (27% for smoking, 10% for binge drinking, and 11% for marijuana use). In contrast, none of the other lifestyle behaviors evaluated significantly mediated the association.

CONCLUSION

The study's findings suggest that the role of peers' parents should not be overlooked when developing health-promoting interventions for adolescents. Policymakers and practitioners may wish to increase opportunities for students to benefit from health-related social learning from their peers' highly educated parents.

Longitudinal pathways from adolescent depressive symptoms to cardiovascular disease risk in adulthood

RATIONALE

Despite existing literature on the impact of adolescent depressive symptoms on a variety of youth outcomes, little is known about whether and how adolescent depressive symptoms are associated with physical health in adulthood.

OBJECTIVE

This study aimed to investigate the longitudinal association between adolescent depressive symptoms and cardiovascular disease (CVD) risk in adulthood. An extensive list of potential mechanisms underlying this association, including health behaviors, substance use, academic effort and achievement, and school-based relationships, was also examined.

METHODS

Using the sibling sample from the National Longitudinal Study of Adolescent to Adult Health (N = 3011), this study employed sibling fixed-effects models to address unobservable family-level confounders, such as genetic factors, parental and familial characteristics, and school and neighborhood environments.

RESULTS

Adolescent depressive symptoms were associated with an increased risk of CVD in about 13 years later (b = 0.698). Sibling fixed-effects estimates revealed that, despite some attenuation (approximately 31%), this association is robust to adjustment for unobserved family-level heterogeneity. Substance use and academic effort/achievement explained about 35% and 16% of the association between adolescent depressive symptoms and adult CVD risk, respectively. In contrast, health behaviors and school-based relationships played little or no role in mediating the association.

CONCLUSION

The findings of this study suggest that policymakers and practitioners may wish to develop interventions to reduce adolescent depressive symptoms and to help adolescents with depressive symptoms avoid substance use and promote effort in school. Early interventions targeting adolescents with depressive symptoms may be a cost-effective strategy for preventing adult physical health problems.

Do intersecting identities structure social contexts to influence life course health? The case of school peer economic disadvantage and obesity

Scholarship linking social contextual measures to health outcomes has grown in recent decades, but the role of individuals' intersecting identities in structuring social contexts to influence health remains unclear. Building on an existing intersectionality framework, we conceptualize how this may occur through social relationships. Then, we apply this framework to analyze whether adolescent peer social contextual disadvantage influences life-course obesity heterogeneously by individual gender, race, and early-life income. We take a life course approach as adolescence is a sensitive period for both social development and adult obesity development. In our analysis, we use cohort data from the National Longitudinal Study of Adolescent to Adult Health and leverage quasi-experimental variation in adolescent peers to addresses common sources of bias in prior observational studies. We find that among Black men from lower-income households in adolescence, there is a strong negative relationship between adolescent peer economic disadvantage and adult obesity that strengthens over time. By contrast, among Black women across adolescent household income levels, we find a strong positive relationship between adolescent peer economic disadvantage and obesity that emerges as women leave high school and endures into mid-adulthood. Among non-Black women, a more modest positive relationship appears between peer disadvantage and obesity. Among non-Black men, we find no relationship. These diverging patterns suggest that the pathways through which adolescent peer economic disadvantage influences health may differ or produce differential effects based on intersecting race, gender, and socioeconomic identities. Such heterogenous effects offer new insights, and future directions, for better understanding social life-course determinants of adult health and addressing inequities.

Personality, health behaviours and physical health in young adulthood

OBJECTIVE

Personality traits and health are strongly correlated, but unobserved family-level characteristics may confound this relationship. This study investigates whether associations between personality traits and physical health are spurious owing to unobserved family background.

DESIGN

Participants were from the National Longitudinal Study of Adolescent to Adult Health. This study employed sibling fixed-effect approach to account for unobserved family characteristics.

MAIN OUTCOME MEASURES

Main dependent variables were Framingham Risk Scores for 30-year full cardiovascular disease (CVD) and metabolic syndrome.

RESULTS

Sibling fixed-effects models showed that conscientiousness is associated with reductions in CVD risk and metabolic syndrome, and that neuroticism is associated with an increase in both conditions. A higher extraversion score is positively associated with CVD risk. The adverse effect of extraversion on CVD risk is larger among females, and the protective effect of conscientiousness is larger among males. Moreover, while extraversion, neuroticism and conscientiousness are associated with health behaviours in somewhat distinct ways, the associations for agreeableness and openness are spurious owing to unobserved family background.

CONCLUSION

This study ruled out the concern that unobserved family background drives the personality-physical health link. Mechanisms linking personality to physical health may be gendered.

A life course perspective on BMI in rural America

Rural Americans are substantially more likely to be obese than their urban counterparts. A life course perspective offers insights into how growing up in rural areas may affect weight in young adulthood. Using data from the Panel Survey of Income Dynamics, this study follows the residential trajectories of 3157 respondents since birth. Living in a rural area during the critical period of early childhood (before age two) is predictive of higher BMI, while residence in later childhood and adolescence is not. Improving the health and wellbeing of rural mothers and infants could potentially help address the roots of rural obesity.

Estimating the influence of adolescent delinquent behavior on adult health using sibling fixed effects

Despite the well-established link between juvenile delinquency and socioeconomic attainment in adulthood, less is known about whether engagement in delinquent behavior during adolescence shapes adult health outcomes. This study examines the association between juvenile delinquency and adult physical and mental health, and whether this association is confounded by unobserved family heterogeneity. Moreover, this study explores the potential underlying mechanisms through which juvenile delinquency shapes adult physical and mental health. Using data from the National Longitudinal Study of Adolescent to Adult Health (Add Health) 1994-1995 (Wave 1) and 2007-2008 (Wave 4), we adopted a sibling fixed effect approach to account for genetic factors, family environment, and childhood social contexts such as school and neighborhood effects. The conventional OLS results show that engagement in delinquent behavior during adolescence strongly predicts higher levels of Framingham cardiovascular disease (CVD) risk score and depressive symptoms in adulthood. Once we account for family-specific heterogeneity, however, the point estimates of the associations of delinquency with CVD risk score and depressive symptoms are attenuated by 33% and 45%, respectively. Despite this attenuation, the association of juvenile delinquency with adult health is robust: a one standard-deviation increase in juvenile delinquency is associated with approximately 8 and 6 percent of one standard-deviation increases in CVD risk and depressive symptoms, respectively. Our mediation analyses suggest that a combination of several mediating pathways jointly explain the association between juvenile delinquency with adult health. The most consistent and significant mediating pathways connecting juvenile delinquency to both physical and mental health included disruption in student-teacher relationship, smoking, criminal justice contact, and educational attainment. Moreover, while binge drinking explained part of the association between delinquency and CVD risk score, student-friend relationship partially mediated the association with depression.

Assessing the Importance of Childhood Context in the Development of Hope and Optimism

This paper explores the importance of adolescent environments as a key determinant of hope and optimism. Data were taken from the prospective, nationally representative National Longitudinal Study of Adolescent to Adult Health to calculate correlations in hope and optimism among individuals who attended the same secondary school. These correlations generate upper-bound estimates of the influence of adolescent environments and suggest relatively modest contributions, accounting for 1-4% of population variation. In contrast, sibling correlations account for approximately 10% of the variation. Taken together, the results suggest that interventions that shape schools and neighborhoods during adolescence are likely to have relatively small benefits for hope and optimism development.

Revisiting the relationship between perceived discrimination and health: Evidence from sibling models with multiple health measures

Perceived discrimination (PD) is known to be significantly related to health outcomes. This link, however, warrants further scrutiny due to the possibility of unobserved family-level confounding. Using the Add Health and sibling fixed-effect approach, we examine whether the relationship between PD and health is confounded by family background characteristics such as genetics, family environment, and childhood social context (school and neighborhood effects). While the naive OLS models exhibit significant associations between PD and both physical and psychological health outcomes, our preferred sibling fixed-effect estimates reveal that the observed associations between PD and physical health outcomes are confounded by shared family background. In contrast, the observed associations for psychological health, self-reported health, and some of health behavior outcomes are robust to adjustment for sibling fixed-effects. Furthermore, we find similar overall patterns in the link between PD and health across races/ethnicities.

The indelible weight of place: Childhood neighborhood disadvantage, timing of exposure, and obesity across adulthood

I use 28 (1986-2014) years of restricted geocoded NLSY tract-level data and find positive associations between exposure to childhood neighborhood disadvantage and adult obesity and BMI among individuals growing up and entering adulthood during the rise of obesity in the United States. Sibling fixed effects and cousin fixed effects models partially address unobserved confounding nested in the nuclear as well as extended family. Furthermore, exposure to neighborhood disadvantage in adolescence is most salient, providing insight into when policy intervention may be most effective. Results are robust to alternative specifications for neighborhood disadvantage, ages of exposure, and to alternative sampling strategies.

Assessing cumulative neighborhood effects on adult health

A straightforward technique to explore the “total effects” of neighborhoods on health outcomes is to compare the degree of similarity of outcomes of neighbors with those of non-neighbors. Several issues arise in interpreting these estimates around spatial and temporal definitions of “neighbors” and life course mobility patterns. Indeed, much work uses “cross- sectional neighbors,” which makes the interpretation of the estimates unclear because they combine short-term effects (for movers) and long-term effects (for stayers). This paper contributes to the literature by assessing the importance of measuring neighbor mobility as well as neighborhood selection. Using the Panel Study of Income Dynamics, we examine the extent to which having longitudinal measures of “neighbors” shapes estimates of neighborhood effects, and also use a negative test of neighborhood effects to assess the importance of neighborhood selection. Specifically, we estimate similarity in self-rated health of adults over 30 years old who live in the same county over various periods of time and find that “cross-sectional” neighbor definitions may understate neighborhood effect estimates by as much as 35%. However, when we contrast these health estimates with contemporaneous neighborhood “effects” on completed education, we find that much of the “understated” effects on health are likely related to selection effects rather than causal effects of neighborhoods.