Childhood Social Conditions Research Articles

Gender Differences in Avoiding Later-Life Disability: A Life Course Perspective

Identifying the early origins of adult health has underscored how experiences in the earliest stages of life can have lasting consequences. Whereas most research on the early origins of adult health has linked childhood conditions to worse health in adulthood, this study considered whether childhood conditions are associated with healthy aging. Guided by the World Health Organization’s emphasis on functional ability as a core component of healthy aging, the present study investigated the association between childhood social conditions and avoiding later-life limitations in basic and instrumental activities of daily living, referred to as disability-free status. This study also tested potential health-related and socioeconomic mediators and examined whether these life course antecedents of healthy aging vary by gender. Analyzing a sample of 9,376 adults over age 50 from the Health and Retirement Study over 10 years (2006-2016) revealed that childhood socioeconomic disadvantage reduced the odds of avoiding disability over time. For women, adult health lifestyles mediated this relationship whereas adult socioeconomic status (SES) mediated this relationship for men. Conditional indirect effects indicated that the mediational effects of body mass and education differed between men and women (i.e., moderated mediation). The direct effects of childhood and adult SES also varied by gender. These results demonstrate that the life course antecedents, especially SES, of healthy aging are distinct for men and women. Interventions should prioritize reducing early-life exposure to socioeconomic disadvantage, especially for women. Given the gendered differences in the mediating effects, midlife interventions can be tailored for men and women.

Spirituality as compensation for low-quality social environments in childhood among young Kenyan men

ABSTRACT This study explores the role of spirituality as a coping mechanism for poor social conditions in childhood, asking whether spirituality moderates poor childhood social conditions and suicide ideation, self-rated health and collective self-esteem among young Kenyan men. Measured outcomes were worse among men who recalled fewer memories of relational warmth and safety in childhood, and better among men who reported higher spirituality. Consistent with the “religion as attachment” framework, spirituality significantly moderated associations between suicide ideation, self-rated health and childhood relational warmth and safety. Contrary to expectations, the association between low childhood warmth and safety and collective self-esteem was exacerbated, rather than compensated for, by higher spirituality. We consider whether “a safe harbor” may exist for people higher in spirituality to accept and critique social arrangements, and whether such a situation might illuminate another way spirituality compensates for poor social environments.

Abstract P330: Childhood Material Deprivation and Self-reported, Physician-diagnosed Myocardial Infarction in a Southern Cohort of Middle-aged African American Men and Women

Introduction: The antecedents of cardiovascular disease occur early in life. However, most studies reporting associations between childhood social conditions and adult myocardial infarction (MI) have been conducted on European and US white populations. Hypothesis: We hypothesized that adverse childhood social conditions would be associated with increased risk for MI in a Southern cohort of middle-aged African American men and women. Methods: Multiple logistic regression models were used to investigate sex-specific associations between childhood material deprivation and 13 year incidence of self-reported-physician diagnosed MI among 413 Black men and 754 Black women in the Pitt County (NC) Study. Cohort members were aged 25 to 50 years in 1988, the baseline year, and were re-interviewed in 2001. For this study, childhood was defined as birth to age 13 years; and childhood material deprivation was measured by a composite index of receipt of public assistance, food insecurity, and the lack of household heat, electricity, or plumbing. Odds ratios (OR) of the association between childhood material deprivation and adult MI were estimated after adjusting for both childhood and adulthood socioeconomic position, demographics, lifestyle, co-morbidities and psychosocial factors. For women, menopausal status was also controlled. Results: Men exposed to 1-2 types of childhood material deprivation had 38% lower odds of MI than men unexposed to such deprivation during childhood, OR = 0.62; 95%CI: (0.41, 0.92). However, men exposed to 3+ types of material deprivation during childhood were 3 times more likely to report a physician-diagnosed heart attack than men who were unexposed, OR = 3.07; 95%CI: (1.79, 5.29). No difference in 13 year MI risk was observed between women exposed to 1-2 types of childhood material deprivation and women who were unexposed, OR = 1.23; 95%CI: (0.70, 2.16). However, women exposed to 3+ types of early-life material deprivation were 5 times more likely to report a physician-diagnosed MI compared to women who were unexposed, OR = 5.20; 95%CI: (2.58, 10.48). Conclusions: Our findings suggest that early childhood is a sensitive period wherein severe socioeconomic disadvantage may trigger, or exacerbate, biological processes that increase risk of MI, by middle age, in African American men and women.

Small-for-Gestational Age Portuguese Babies: The effect of Childhood Social Environment, Growth and Adult Socioeconomic Conditions.

Abstract Objective We aimed to estimate the extent to which differences in small-for-gestational age (SGA) according to maternal socioeconomic position (SEP) and anthropometrics are accounted for childhood background. Methods Adult mothers of singletons (n = 6893) recruited in 2005/2006 in Porto, Portugal self-reported data on socio-demographics. Grandparents' education and social class were used to characterise childhood social environment. Maternal education and marital status were used as adult SEP indicators. Height was categorised according to the 10th and 90th percentiles. The odds of SGA according to adult SEP and height were stratified by childhood conditions. Results SGA (14.5%) was less likely in taller [vs. 10th–90th percentiles: 0.62 (95% confidence interval (CI): 0.46–0.83)], more educated [vs. low: 0.77 (0.65–0.90)] and in married women [vs. single: 0.64 (0.47–0.86)]. No association was found between childhood social conditions and SGA. The protection provided by maternal education was found in women from deprived childhood backgrounds but not in those with more advantage conditions. Shorter women were more likely to deliver SGA babies but the effect was stronger (p interaction Conclusions Sufficient increase in education seems to overcome disadvantage earlier in life. Other pathological processes might impact physical development beyond social influence, having long lasting effects on SGA.

Small-for-gestational age Portuguese babies: The effect of childhood social environment, growth and adult socioeconomic conditions

ObjectiveWe aimed to estimate the extent to which differences in small-for-gestational age (SGA) according to maternal socioeconomic position (SEP) and anthropometrics are accounted for childhood background. MethodsAdult mothers of singletons (n=6893) recruited in 2005/2006 in Porto, Portugal self-reported data on socio-demographics. Grandparents' education and social class were used to characterise childhood social environment. Maternal education and marital status were used as adult SEP indicators. Height was categorised according to the 10th and 90th percentiles. The odds of SGA according to adult SEP and height were stratified by childhood conditions. ResultsSGA (14.5%) was less likely in taller [vs. 10th–90th percentiles: 0.62 (95% confidence interval (CI): 0.46–0.83)], more educated [vs. low: 0.77 (0.65–0.90)] and in married women [vs. single: 0.64 (0.47–0.86)]. No association was found between childhood social conditions and SGA. The protection provided by maternal education was found in women from deprived childhood backgrounds but not in those with more advantage conditions. Shorter women were more likely to deliver SGA babies but the effect was stronger (pinteraction<0.001) in those from least deprived childhood conditions. ConclusionsSufficient increase in education seems to overcome disadvantage earlier in life. Other pathological processes might impact physical development beyond social influence, having long lasting effects on SGA.

Using marginal structural models to estimate the direct effect of adverse childhood social conditions on onset of heart disease, diabetes, and stroke.

Early-life socioeconomic status (SES) is associated with adult chronic disease, but it is unclear whether this effect is mediated entirely via adult SES or whether there is a direct effect of adverse early-life SES on adult disease. Major challenges in evaluating these alternatives include imprecise measurement of early-life SES and bias in conventional regression methods to assess mediation. In particular, conventional regression approaches to direct effect estimation are biased when there is time-varying confounding of the association between adult SES and chronic disease by chronic disease risk factors. First-reported heart disease, diabetes, and stroke diagnoses were assessed in a national sample of 9760 Health and Retirement Study participants followed biennially from 1992 through 2006. Early-life and adult SES measures were derived using exploratory and confirmatory factor analysis. Early-life SES was measured by parental education, father's occupation, region of birth, and childhood rural residence. Adult SES was measured by respondent's education, occupation, labor force status, household income, and household wealth. Using marginal structural models, we estimated the direct effect of early-life SES on chronic disease onset that was not mediated by adult SES. Marginal structural models were estimated with stabilized inverse probability-weighted log-linear models to adjust for risk factors that may have confounded associations between adult SES and chronic disease. During follow-up, 24%, 18%, and 9% of participants experienced first onset of heart disease, diabetes, and stroke, respectively. Comparing those in the most disadvantaged with the least disadvantaged quartile, early-life SES was associated with coronary heart disease (risk ratio = 1.30 [95% confidence interval = 1.12-1.51]) and diabetes (1.23 [1.02-1.48]) and marginally associated with stroke via pathways not mediated by adult SES. Our results suggest that early-life socioeconomic experiences directly influence adult chronic disease outcomes.

Lifecourse Social Conditions and Racial Disparities in Incidence of First Stroke

Some previous studies found excess stroke rates among black subjects persisted after adjustment for socioeconomic status (SES), fueling speculation regarding racially patterned genetic predispositions to stroke. Previous research was hampered by incomplete SES assessments, without measures of childhood conditions or adult wealth. We assess the role of lifecourse SES in explaining stroke risk and stroke disparities. Health and Retirement Study participants age 50+ (n = 20,661) were followed on average 9.9 years for self- or proxy-reported first stroke (2175 events). Childhood social conditions (southern state of birth, parental SES, self-reported fair/poor childhood health, and attained height), adult SES (education, income, wealth, and occupational status) and traditional cardiovascular risk factors were used to predict first stroke onset using Cox proportional hazards models. Black subjects had a 48% greater risk of first stroke incidence than whites (95% confidence interval, 1.33-1.65). Childhood conditions predicted stroke risk in both blacks and whites, independently of adult SES. Adjustment for both childhood social conditions and adult SES measures attenuated racial differences to marginal significance (hazard ratio, 1.13; 95% CI, 1.00-1.28). Childhood social conditions predict stroke risk in black and White American adults. Additional adjustment for adult SES, in particular wealth, nearly eliminated the disparity in stroke risk between black and white subjects.

Commentary: Selected samples and nebulous measures: some methodological difficulties in life-course epidemiology

Introduction Ramsay et al.’s article contributes to a growing body of research on early life characteristics that predict health in adulthood. This research demonstrates that adults who lived in deprived socio-economic circumstances as children aremore likely to suffer from cardiovascular disease than adults who had privileged childhoods; an association that holds even among people with comparable indicators of adult socio-economic position (SEP). These articles provide a welcome impetus to consider how adult health is shaped by early life experiences, but they face a number of methodological problems that compromise causal inference regarding the effects of childhood social conditions on adult health. In this commentary, I wish to focus on just two of these problems: loss to follow-up and inadequate measurement. Throughout, I assume that the primary causal question of interest is how adult health would differ if we intervened to change childhood SEP, and a secondary causal question is how adult health would differ if we intervened to change not only childhood SEP but also adult SEP or adult behavioural risk factors. My goal in highlighting these difficulties is to prompt life-course researchers to present evidence addressing these possible biases, and improve our ability to interpret the now well-established association between early childhood circumstances and adult health.

Mensuration, Mendel, and a 19th century public health justification for US imperialism

Measurement is a key issue in epidemiology and rightly receives considerable attention in most textbooks. In this issue of the IJE many of the key issues regarding measurement get an outing. A first concern is with validity of measurement and this might be a particular issue with respect to somewhat fuzzy categories such as socioeconomic position. Laura Kauhanen et al. revisit the association of childhood social circumstances with mortality and morbidity in middle age in the Kuopio Ischemic Heart Disease (KIHD) study. Many studies have found that deprivation in childhood is related to increased cardiovascular disease (CVD) risk in later life but KIHD was an exception with one of Kauhanens current co-authors having shown that childhood social conditions as reported in adulthood were not independently associated with CVD risk. With longer follow-up they replicate the earlier null finding with adulthood recall of childhood social circumstances but show considerably more evidence of increased risk of CVD when childhood conditions were indexed by historical data from school health records. Adulthood recall of childhood social circumstances may simply be too inaccurate to demonstrate an effect in this context. (excerpt)

Birth order and mortality: a life-long follow-up of 14,200 boys and girls born in early 20th century Sweden

The present study examines the sex-specific patterns of mortality by birth order in four stages of the life-course, using Poisson and logistic regression analysis. The main question posed is whether there is any continuing social effect of birth order when (a) biological factors at birth, (b) other social factors at birth and (c) socio-economic circumstances in adulthood are adjusted for. The analyses are based on the Uppsala Birth Cohort Study consisting of all 14,192 boys and girls who were born alive at the Uppsala Academic Hospital in Sweden during the period 1915–29. The results showed that all-cause mortality differed according to birth order in all of the four studied age intervals when birth year, mother's age, birth weight, gestational age, diseases of mother, diseases of the infant, social class and mother's marital status at the time of childbirth were adjusted for. The general tendency was for laterborn siblings, particularly girls/women, to demonstrate a higher mortality risk than firstborn children. However, in the oldest age group (55–80 years) the previously significant association between birth order and male mortality became insignificant when adult socio-economic circumstances were controlled for. This indicates that the long-term influence of childhood birth order position on mortality is partly mediated by adult social class, education and income. The concluding section of the paper notes that laterborn children, and especially girls, were a disadvantaged group in early 20th century Sweden. Thus, for the subjects in the present study, the childhood social conditions linked to birth order position seem to have had consequences for these individuals’ health and survival that extend over the whole life-course.