Abstract
Childhood poverty is associated with poorer adolescent health and health behaviours, but the importance of the timing of poverty remains unclear. There may be critical or sensitive periods in early life or early adolescence, or poverty may have cumulative effects throughout childhood. Understanding when poverty is most important can support efficient timing of interventions to raise family income or buffer against the effects of low income, but answers may vary across social contexts. The US and the UK are a useful comparison with similar liberal approaches to cash transfers, but very different approaches to healthcare provision. Utilising data from large population studies in the US (n = 9408; born 1979–1996) and UK (n = 1204; born 1991–1997), this study employs a structured life course approach to compare competing hypotheses about the importance of the timing or pattern of childhood exposure to poverty in predicting adolescent health limitations, symptoms of psychiatric distress, and smoking at age 16 (age 15/16 in US). Household income histories identified experience of poverty (measured as <60% of the national median equivalised income for a given year) in early life (ages 0–5), mid-childhood (ages 6–10) and early adolescence (ages 11–15). The Bayesian Information Criterion (BIC) compared fit across models with variables representing different life course patterns of exposure to poverty. Adolescent distress was not associated with poverty in either country. In both countries, however, variables representing cumulative or persistent experiences of poverty exhibited optimal fit of all poverty exposure variables in predicting adolescent smoking and health limitations. There was also evidence of an early life sensitive period for smoking in the US. Poverty was more persistent in the US, but associations between poverty and outcomes were consistent across countries. Although poverty can have cumulative effects on health and behaviour, early interventions may offer the best long-term protection.
Highlights
There is growing recognition of the importance of adolescence for shaping health over the life course (Due et al, 2011; Sawyer et al, 2012; Viner et al, 2015)
This study focuses on associations between childhood socioeconomic status (SES) and two adolescent health outcomes, and a health behaviour
Rates of smoking were similar across countries, but rates of health limitations and poor mental health were higher in the UK than in the US, this difference does not necessarily indicate worse health in the UK given that measurement differed
Summary
There is growing recognition of the importance of adolescence for shaping health over the life course (Due et al, 2011; Sawyer et al, 2012; Viner et al, 2015). Adolescence is a key stage in the development of health behaviours, such as smoking, and habits developed during this stage of life often persist into adulthood (Due et al, 2011; Sawyer et al, 2012; Viner et al, 2012). One potentially key determinant of adolescent health and behaviour is the socioeconomic status (SES) of the household in which the young person grew up. This study focuses on associations between childhood SES and two adolescent health outcomes (physical health limitations and mental distress), and a health behaviour (smoking)
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