Later-life Outcomes Research Articles

Perceived Ageism During the Covid-19-Crisis Is Longitudinally Related to Subjective Perceptions of Aging

Ageism in media and society has increased sharply during the Covid-19-crisis, with expected negative consequences for the health and well-being of older adults. The current study investigates whether perceived ageism during the crisis longitudinally affects how people perceive their own aging. In June 2020, N = 611 older adults from Luxembourg [aged 60–98 years, Mage(SD) = 69.92(6.97)] participated in a survey on their perception of the crisis. In October 2020, N = 523 participated in a second measurement occasion. Participants reported on perceived ageism during the crisis in different domains, their self-perceptions of aging and subjective age. In latent longitudinal regression models, we predicted views on aging at T2 with perceived ageism at T1, while controlling for baseline views on aging and covariates. Perceived ageism at T1 increased self-perceptions of aging as social loss and yielded a trend for physical decline, while there were no effects on subjective age and self-perceptions of aging as continued growth. Views on aging are powerful predictors of well-being and health outcomes in later life. Our data suggest that being the target of ageism during the crisis negatively affects older adults' self-perceptions of aging and this impact may be felt beyond the current crisis.

488 GRIP STRENGTH FROM MIDLIFE AS AN INDICATOR OF LATER-LIFE COGNITION AND BRAIN HEALTH: EVIDENCE FROM A BRITISH BIRTH COHORT

Abstract Introduction Grip strength is an objective measure of physical function with potential predictive value for health in ageing populations. We aimed to assess whether levels and changes in grip strength from midlife predicted later-life brain health and cognition. Methods 446 participants in an ongoing British birth cohort study, the MRC National Survey of Health and Development (NSHD), had their maximum grip strength measured at ages 53, 60–64, and 69, and underwent neuroimaging as part of its neuroscience sub-study, Insight 46, at 69–71. A group-based trajectory model identified latent groups of individuals in the whole NSHD cohort with below- and above-average grip strength over time, plus a reference group. Trajectory group membership, plus standardised grip strength levels and change from age 53, were each related to MRI-derived measures of whole-brain volume (WBV) and white-matter hyperintensity volume (WMHV), plus several cognitive tests. Models were adjusted for sex, body size, head size (where appropriate), sociodemographics, and behavioural and vascular risk factors. Results Consistently below-average grip strength from midlife was associated with lower WBV and non-verbal reasoning ability at age 69–71 (e.g. low group WBV vs. reference group β = −13.38 cm^3; 95% CI = (−24.12 cm^3, −2.64 cm^3); p = 0.015). There was some accompanying evidence that above-average maximum grip strength showed a positive association with WBV, which was more pronounced in female participants (high group female WBV vs. reference group β = 18.30 cm^3; 95% CI = (1.34 cm^3, 35.29 cm^3); p = 0.034). Steeper than average declines in grip strength between 53 and 69 were additionally weakly associated with an estimated 10% higher WMHV at age 69–71 (β = 1.10, 95% CI = (1.00, 1.22); p = 0.053). Conclusion This study provides preliminary evidence that tests of maximum grip strength may have value in predicting brain health. Future work should assess how these observed differences relate to later-life negative health outcomes, and whether changes in grip strength reflect concurrent changes in brain structure and connectivity.

Enhancing Social-Emotional Outcomes in Early Years (E-SEE): Randomized Pilot Study of Incredible Years Infant and Toddler Programs

Social emotional development in infancy is a predictor of outcomes in later life, yet there is little evidence of effectiveness for parenting interventions designed to enhance social emotional wellbeing in infancy. An 18-month two-arm randomized controlled pilot trial evaluated the feasibility of a definitive trial of Incredible Years (IY) Infant and Toddler parent programs delivered in a proportionate universal model, called Enhancing Social-Emotional Health and Wellbeing in the Early Years (E-SEE) Steps. Intervention families received an IY Babies book (universal dose), followed by the IY Infant and/or the Toddler group-based programs, based on parent depression (PHQ-9) and/or child social emotional development (ASQ:SE-2) scores. Control parents received services as usual. Parents from two English local authorities with a child eight-weeks-old or younger participated, and were block randomized using a web-based system. Primary endpoints for the study were feasibility parameters relating to recruitment, retention, intervention fidelity and appropriateness of measures. 205 participants were randomized (152:53, intervention:control). Our target was 288 parents. Trial retention rate was higher than expected, with a completion rate of 88% (n = 181, 137:44) at follow-up 3; equating to 94% of 192 expected participants. Intervention uptake was lower than expected. Fidelity of delivery was acceptable and measures were deemed appropriate. A definitive trial is feasible with design amendments to include: introduction of a child screener for intervention eligibility; enhanced intervention material; revised sample size and random allocation ratio. Our internal pilot became an external pilot due to these changes.

Association between hearing loss and frailty: a systematic review and meta-analysis

BackgroundFrailty is associated with poor health outcomes in later life. Recent studies suggested that hearing loss may be a potentially modifiable risk factor associated with frailty.MethodsThis systematic review and meta-analysis aimed to investigate the association between hearing loss and frailty in observational studies of adults aged 50 years or over. We included observational studies with participants ≥ 50 years old that have clear descriptions of hearing and frailty measurement methods. Meta-analyses were conducted using measurement of risk and 95 % confidence interval of each individual study. Quality assessment, risk of bias, heterogeneity and sensitivity analyses were also conducted. Our study followed PRISMA guidelines.ResultsOur search identified 4508 manuscripts published in English between 1 and 2000 and 9 February 2021. Sixteen articles reported acceptable measurements of both hearing loss and frailty. Two papers were not suitable for meta-analysis. Twelve sets of cross-sectional data involving 12,313 participants, and three sets of longitudinal data involving 3042 participants were used in the meta-analysis. Hearing loss was associated with an 87 % increase in the risk of frailty among cross-sectional studies (risk ratio [RR] 1.87; 95 %CI 1.63–2.13) and 56 % among longitudinal studies (RR 1.56; 95 %CI 1.29–1.88). There was considerable heterogeneity among studies, but their quality rating, sample size or approach used to assess hearing loss did not change the results substantially.ConclusionsThe findings of this systematic review and meta-analysis of observational studies suggest that hearing loss increases the risk of frailty in later life. Whether this relationship is causal remains to be determined.

Impact of Early Life Socioeconomic Status on Decision Making in Older Adults Without Dementia

ObjectivesA growing body of evidence points to the negative impact of early life socioeconomic status (SES) on health and cognitive outcomes in later life. However, the effect of early life SES on decision making in old age is not well understood. This study investigated the association of early life SES with decision making in a large community-based cohort of older adults without dementia from the Rush Memory and Aging Project. Materials and MethodsCross-sectional data from the Rush Alzheimer's Disease Center Memory and Aging Project was analyzed. Participants were 1044 community-dwelling older adults without dementia (M age = 81.15, SD = 7.49; 75.8% female; 5.4% non-White). Measures of financial and healthcare decision making and early life SES were collected, along with demographics, global cognition, and financial and health literacy. ResultsEarly life SES was positively associated with decision making (estimate = 0.218, p = 0.027), after adjustments for demographic covariates and global cognition, such that a one-unit increase in early life SES was equivalent to the effect of being four years younger in age as it pertains to decision making. A subsequent model demonstrated that the relationship was strongest in those with low literacy, and weakest for those with high literacy (estimate = -0.013, p = 0.029). ConclusionsFindings from this study suggest that early life SES is associated with late life decision making and that improving literacy, a modifiable target for intervention, may buffer the negative impact of low early life SES on decision making in older adulthood.

Trends in child marriage and new evidence on the selective impact of changes in age-at-marriage laws on early marriage.

This study adopts a cohort perspective to explore trends in child marriage – defined as the proportion of girls who entered first union before the age of 18 – and the effectiveness of policy changes aimed at curbing child marriage by increasing the minimum legal age of marriage. We adopt a cross-national perspective comparing six low- and middle-income countries (LMICs) that introduced changes in the minimum age at marriage over the past two decades. These countries belong to three broad regions: Sub-Saharan Africa (Benin, Mauritania), Central Asia (Tajikistan, Kazakhstan), and South Asia (Nepal, Bhutan). We combine individual-level data from Demographic and Health Surveys and Multiple Indicator Cluster Surveys with longitudinal information on policy changes from the PROSPERED (Policy-Relevant Observational Studies for Population Health Equity and Responsible Development) project. We adopt data visualization techniques and a regression discontinuity design to obtain estimates of the effect of changes in age-at-marriage laws on early marriage. Our results suggest that changes in minimum-age-at-marriage laws were not effective in curbing early marriage in Benin, Mauritania, Kazakhstan, and Bhutan, where child marriage showed little evidence of decline across cohorts. Significant reductions in early marriage following law implementations were observed in Tajikistan and Nepal, yet their effectiveness depended on the model specification and window adopted, thus making them hardly effective as policies to shape girls' later life trajectories. Our findings align with existing evidence from other countries suggesting that changes in age-at-marriage laws rarely achieve the desired outcome. In order for changes in laws to be effective, better laws must be accompanied by better enforcement and monitoring to delay marriage and protect the rights of women and girls. Alternative policies need to be devised to ensure that girls’ later-life outcomes, including their participation in higher education and society, are ensured, encouraged, and protected.

Adverse childhood experiences in New Zealand and subsequent victimization in adulthood: Findings from a population-based study

BackgroundAdverse childhood experiences (ACEs) are widespread and are associated with adverse outcomes in later life, yet few studies have explored their prevalence and consequences in New Zealand. ObjectivesTo provide prevalence estimates of ACEs in New Zealand using a large sample of adults, and to explore the associations between ACEs and experience of violence by intimate partners and non-partners in adulthood. Participants and setting2,887 participants (1464 female, 1423 male) from the 2019 New Zealand Family Violence Survey, a population based study conducted in New Zealand between March 2017–March 2019. MethodsDescriptive statistics for prevalence of each of the eight ACE types, and cumulative ACE scores were estimated across sociodemographic groups. Multivariate logistic regression models were developed to assess association between ACEs and five IPV and two non-partner violence variables. ResultsACEs were prevalent and co-occurring, with 55 % (95 % CI 53.2 %–56.8 %) of respondents reporting having experienced at least one ACE and 11.6 % (95 % CI 10.4 %–12.8 %) reporting at least four ACEs before the age of 18. Those who were younger, had lower socioeconomic status, and who identified as Māori reported higher prevalence of ACEs. Exposure to any ACE was significantly associated with later exposure to IPV and non-partner violence. ConclusionsThe findings provide the first comprehensive assessment of the prevalence of ACEs in the New Zealand population. They suggest that prevention of childhood trauma, maltreatment, and family dysfunction remain important and interconnected public health goals that need to be addressed to support the wellbeing of children and adults.

Multi-sample assessment of stress reactivity as a mediator between childhood adversity and mid- to late-life outcomes

Objectives We examined whether adult stress reactivity accounts for the relationship between early life adversity (ELA) and psychological, physical, and cognitive outcomes. Methods We examined the relationship between ELA, stress reactivity, psychological well-being, physical health, and cognitive function in two separate datasets - a cross-sectional community sample of older adults (N = 510) aged 60 and older, and waves I-III of the Midlife in the United States (MIDUS) dataset. Age, sex, and income served as covariates in all analyses. Bootstrapped mediation models were used to assess recent stress as a mediator between ELA and mid- to late-life outcomes. Results ELA was significantly associated with adult stress, anxiety, depression, health conditions, and object cognitive assessments. Adult stress partially accounted for the relationships between ELA and depression, anxiety, health conditions, and memory problems. Conclusion Our findings demonstrate that ELA may influence increased stress in older age, which confers additional risks for developing depression, anxiety, health problems, and cognitive decline. It is possible that intervening on adult stress may reduce risk for both psychological and physical pathology across the lifespan. Further research is needed to develop targeted interventions for mid and late-life stress to improve overall health as individuals age.

The Impact of Center-Based Childcare Attendance on Early Child Development: Evidence From the French Elfe Cohort.

Proponents of early childhood education and care programs cite evidence that high-quality center-based childcare has positive impacts on child development, particularly for disadvantaged children. However, much of this evidence stems from randomized evaluations of small-scale intensive programs based in the United States and other Anglo/English-speaking countries. Evidence is more mixed with respect to widespread or universal center-based childcare provision. In addition, most evidence is based on childcare experiences of 3- to 5-year-old children; less is known about the impact of center-based care in earlier childhood. The French context is particularly suited to such interrogation because the majority of French children who attend center-based care do so in high-quality, state-funded, state-regulated centers, known as crèches, and before age 3. We use data from a large, nationally representative French birth cohort, the Étude Longitudinale Français depuis l'Enfance (Elfe), and an instrumental variables strategy that leverages exogenous variation in both birth quarter and local crèche supply to estimate whether crèche attendance at age 1 has an impact on language, motor skills, and child behavior at age 2. Results indicate that crèche attendance has a positive impact on language skills, no impact on motor skills, and a negative impact on behavior. Moreover, the positive impact on language skills is particularly concentrated among disadvantaged children. This implies that facilitating increased crèche access among disadvantaged families may hold potential for decreasing early socioeconomic disparities in language development and, given the importance of early development for later-life outcomes, thereby have an impact on long-term population inequalities.

Common genetic variants with fetal effects on birth weight are enriched for proximity to genes implicated in rare developmental disorders.

Birth weight is an important factor in newborn survival; both low and high birth weights are associated with adverse later-life health outcomes. Genome-wide association studies (GWAS) have identified 190 loci associated with maternal or fetal effects on birth weight. Knowledge of the underlying causal genes is crucial to understand how these loci influence birth weight and the links between infant and adult morbidity. Numerous monogenic developmental syndromes are associated with birth weights at the extreme ends of the distribution. Genes implicated in those syndromes may provide valuable information to prioritize candidate genes at the GWAS loci. We examined the proximity of genes implicated in developmental disorders (DDs) to birth weight GWAS loci using simulations to test whether they fall disproportionately close to the GWAS loci. We found birth weight GWAS single nucleotide polymorphisms (SNPs) fall closer to such genes than expected both when the DD gene is the nearest gene to the birth weight SNP and also when examining all genes within 258 kb of the SNP. This enrichment was driven by genes causing monogenic DDs with dominant modes of inheritance. We found examples of SNPs in the intron of one gene marking plausible effects via different nearby genes, highlighting the closest gene to the SNP not necessarily being the functionally relevant gene. This is the first application of this approach to birth weight, which has helped identify GWAS loci likely to have direct fetal effects on birth weight, which could not previously be classified as fetal or maternal owing to insufficient statistical power.

Maternal iron status during early pregnancy and school‐age, lung function, asthma, and allergy: The Generation R Study

BackgroundIron deficiency during early life could affect the developing lung and immune system, and influence child's respiratory or allergy outcomes in later life.ObjectiveTo examine the associations of maternal iron status during early pregnancy with child's lung function, asthma, inhalant allergic sensitization, and physician‐diagnosed inhalant allergy at school‐age.MethodsIn a population‐based cohort study, among 3825 mother–child pairs, ferritin, transferrin concentrations, and transferrin saturation were measured from maternal venous blood samples during early pregnancy. In children at the age of 10 years, spirometry was used to determine child's lung function, current asthma and physician‐diagnosed inhalant allergy were assessed by questionnaires, and inhalant allergic sensitization was measured by skin prick tests. We used multivariable regression models to examine the associations.ResultsAfter adjustment for gestational age at maternal iron status measurement and sociodemographic or lifestyle‐related confounders, a higher maternal transferrin concentration was associated with a higher risk of physician‐diagnosed inhalant allergy (odds ratio [95% confidence interval]: 1.13 [1.01 to1.26]), but not with lung function, asthma, or inhalant allergic sensitization. This association did not attenuate after further adjustment for maternal hemoglobin levels or early growth factors. We observed no consistent association of maternal ferritin concentrations or transferrin saturation with child's respiratory or allergy outcomes.ConclusionHigher maternal transferrin concentrations during pregnancy, reflecting lower serum iron levels, were associated with an increased risk of child's physician‐diagnosed inhalant allergy but not lung outcomes. Underlying mechanisms and clinical implications need to be explored.

Prenatal exposure to bisphenol analogues and digit ratio in children at ages 4 and 6 years: A birth cohort study.

Bisphenol analogues (BPs), including bisphenol A (BPA), have been shown to exhibit similar endocrine disrupting activities. However, epidemiological evidence on the reproductive and developmental toxicities of BPs other than BPA is scarce. The second to fourth digit ratio (2D:4D), an endocrine-sensitive endpoint, has been suggested to be a biomarker of prenatal sex steroid exposure and associated with reproductive outcomes in later life. Using the data of 545 mother-child pairs from the Shanghai-Minhang Birth Cohort Study, we prospectively assessed the effects of prenatal exposure to BPs on 2D:4D in children at ages 4 and 6 years. Single-spot urine samples were collected in the third trimester and analyzed for BPs. Digit lengths were measured using a vernier caliper in children at ages 4 and 6 years, and the 2D:4D values for both hands were calculated. A multivariable linear regression model was applied to examine associations between prenatal BPs exposure and 2D:4D digit ratios at each age separately. The generalized estimating equation (GEE) model was used to deal with repeated 2D:4D measures obtained at ages 4 and 6 years. We found that prenatal exposure to BPA alternatives including BPF, BPS, and BPAF was associated with higher digit ratio in boys and/or girls (feminizing), while TCBPA, a halogenated bisphenol, was associated with lower 2D:4D in boys (masculinizing). These associations were more pronounced at 4 years of age, and tended to remain after further considering the potential confounding from prenatal co-exposure to other BPs and childhood BPs exposure. Our study provides epidemiological evidence that BPs exposure during pregnancy may alter the digit development in children, indicative of disrupted reproductive development in later life. Given these new findings, further studies are needed to corroborate our results.

Late-career unemployment and risk of frailty among older adults in Taiwan: An 8-year population-based cohort study.

To evaluate whether late-career unemployment is associated with increased physical frailty among older adults in Taiwan by the design of a population-based cohort study. Data were retrieved from the Taiwan Longitudinal Study on Aging. The study examined data from the period 1999 to 2007. A total of 652 subjects were included in the final analysis, and they were categorized as normally employed or unemployed depending on their employment status in 1999. Frailty was defined using the Fried criteria. Multiple confounding factors were adjusted in a multilevel analysis. The average age of the participants in 1999 was 59.0 years. A total of 491 participants were normally employed, and 161 participants were unemployed. After adjustment for gender, age, level of education, income, marital status, and number of chronic diseases, late-career unemployment was associated with increased frailty [odds ratio (OR) = 1.61; 95% confidence interval (CI) = 1.00-2.59]. The risk of developing frailty was higher for participants who were unemployed during late career and had poor self-rated health [OR = 3.54; 95% CI = 1.37-9.20]. Late-career unemployment is associated with increased frailty, especially for those who also have poor self-rated health. Older adults should be encouraged to maintain normal employment during the later stages of their career before retirement. Employers should apply strategies to prevent possible late-career unemployment, and the government should provide resources and help to unemployed older workers so that they can minimize poor health outcomes in late life. Geriatr Gerontol Int 2021; 21: 353-358.

Adverse Childhood Experiences and Rate of Memory Decline From Mid to Later Life: Evidence From the English Longitudinal Study of Ageing.

Evidence on the role of early-life adversity in later-life memory decline is conflicting. We investigated the relationships between adverse childhood experiences (ACEs) and memory performance and rate of decline over a 10-year follow-up among middle-aged and older adults in England. Data were from biennial interviews with 5,223 participants aged 54 years or older in the population-representative English Longitudinal Study of Ageing from 2006/2007 to 2016/2017. We examined self-reports of 9 ACEs prior to age 16 years that related to abuse, household dysfunction, and separation from family. Memory was assessed at each time point as immediate and delayed recall of 10 words. Using linear mixed-effects models with person-specific random intercepts and slopes and adjusted for baseline age, participants' baseline age squared, sex, ethnicity, and childhood socioeconomic factors, we observed that most individual and cumulative ACE exposures had null to weakly negative associations with memory function and rate of decline over the 10-year follow-up. Having lived in residential or foster care was associated with lower baseline memory (adjusted β=-0.124 standard deviation units; 95% confidence interval: -0.273, -0.025) but not memory decline. Our findings suggest potential long-term impacts of residential or foster care on memory and highlight the need for accurate and detailed exposure measures when studying ACEs in relation to later-life cognitive outcomes.

Talking with parents of children with learning disabilities: Parents’ ideas about the Circle of Security parenting programme

Accessible Summary The Circle of Security Parenting (COS‐P) programme can be helpful for some parents of children with learning disabilities to think about their relationship with their child. Parenting a child with learning disabilities is different, and COS‐P can highlight this difference. This can feel painful for parents and may stop them engaging with the programme. AbstractBackgroundBackground: The promotion of secure attachment relationships in childhood leads to better outcomes in later life (British Psychological Society 2017, Incorporating Attachment Theory into Practice: Clinical Practice Guideline for Clinical Psychologists Working with People who have Intellectual Disabilities). The Circle of Security Parenting Programme (COS‐P) provides a clear framework for reflecting on attachment relationships (Cooper et al 2009, Zero to Three, 37, 27).MethodsMethods: Semi‐structured interviews were conducted with parents of children with learning disabilities who attended a COS‐P programme to find out about their experiences of the course and how applicable it was to them. The data were analysed using thematic analysis.FindingsFindings: Four key themes were identified: these related to (1) COS‐P concepts are relevant to all children but (2) parenting a child with a learning disability is different and (3) COS‐P can create a focus on their child as different, which can be painful, and (4) changes recommended to make COS‐P suitable for parents of children with learning disabilities.ConclusionsConclusions: This paper outlines the benefits and challenges of COS‐P in sharing concepts related to attachment, whilst highlighting differences for parents of children and young people with learning disabilities, which can be painful.

Women's fasting habits and dietary diversity during Ramadan in rural Bangladesh

Little is known about fasting practices and dietary changes during Ramadan in low‐ and lower‐middle‐income countries. Although pregnant women are exempt from fasting, they may still fast. This is of interest as dietary habits during pregnancy may affect the development of the unborn child. In a community‐based sample of young women in rural Sylhet division, Bangladesh, we described fasting practices and beliefs (n = 852). We also examined reported food group consumption and minimally adequate dietary diversity for women (MDD‐W) by Ramadan occurrence (n = 1,895) and by fasting adherence (n = 558) using logistic regression with Hindu women as a seasonal control.During Ramadan in 2018, 78% of pregnant Muslim women fasted every day. Over 80% of Muslim women believe that they should fast during pregnancy and over 50% expect positive health effects on the mother and the unborn child. We found strong evidence that Muslim women have more diverse diets during Ramadan, with higher odds of MDD‐W (OR [95% CI]: 5.0 [3.6, 6.9]) and increased consumption of pulses, dairy, fruit, and large fish. Dietary diversity increased to a lesser extent on non‐fasting days during Ramadan. Ramadan appears to improve dietary quality in both fasting and non‐fasting Muslim women in a rural population in Bangladesh. These results help to interpret findings from studies on Ramadan during pregnancy on later‐life outcomes and thus contribute to a better understanding of intrauterine influences of maternal nutrition on healthy child development.

Childhood self-control forecasts the pace of midlife aging and preparedness for old age

The ability to control one's own emotions, thoughts, and behaviors in early life predicts a range of positive outcomes in later life, including longevity. Does it also predict how well people age? We studied the association between self-control and midlife aging in a population-representative cohort of children followed from birth to age 45 y, the Dunedin Study. We measured children's self-control across their first decade of life using a multi-occasion/multi-informant strategy. We measured their pace of aging and aging preparedness in midlife using measures derived from biological and physiological assessments, structural brain-imaging scans, observer ratings, self-reports, informant reports, and administrative records. As adults, children with better self-control aged more slowly in their bodies and showed fewer signs of aging in their brains. By midlife, these children were also better equipped to manage a range of later-life health, financial, and social demands. Associations with children's self-control could be separated from their social class origins and intelligence, indicating that self-control might be an active ingredient in healthy aging. Children also shifted naturally in their level of self-control across adult life, suggesting the possibility that self-control may be a malleable target for intervention. Furthermore, individuals' self-control in adulthood was associated with their aging outcomes after accounting for their self-control in childhood, indicating that midlife might offer another window of opportunity to promote healthy aging.

A Four-Country Study on the Relationship Between Parental Educational Homogamy and Children's Health from Infancy to Adolescence.

This study explores the relationship between parental educational similarity - educational concordance (homogamy) or discordance (heterogamy) - and children's health outcomes. Its contribution is threefold. First and foremost, I use longitudinal data on children's health outcomes tracking children from age 1 to 15, thus being able to assess whether the relationship changes at key life-course and developmental stages of children. This is an important addition to the relevant literature, where the focus is solely on outcomes at birth. Second, I look at different health outcomes, namely height-for-age (HFA) and BMI-for-age (BFA) z-scores, alongside their dichotomized counterparts, stunting and thinness. Third, I conduct the same set of analyses in Ethiopia, India, Peru, and Vietnam, thus providing multi-context evidence from countries at different levels of development and with different socio-economic characteristics and gender dynamics. Results reveal important heterogeneity across contexts. In Ethiopia and India, parental educational homogamy is associated with worse health outcomes in infancy and childhood, while associations are positive in Peru and, foremost, Vietnam. Complementary estimates from matching techniques show that these associations tend to fade after age 1, except in Vietnam, where the positive relationship persists through adolescence, thus supporting the homogamy-benefit hypothesis not only at birth, but also across the early life course. Insights from this study contribute to the inequality debate on the intergenerational transmission of advantage and disadvantage and shed additional light on the relationship between early-life conditions and later-life outcomes in critical periods of children's lives.

How Did China's 'Later Marriage'' Policy Affect the Timing of First Marriage and Later-Life Outcomes?

We study the consequences of later marriage on later-life outcomes. China's family planning policies in the early 1970s---before the One-Child Policy (OCP)---regulated not only childbirth but also marriage. The recommended minimum marriage age of 25 years for men and 23 years for women was effectively relaxed when the government formally introduced the OCP and put greater emphasis on directly controlling fertility rather than marriage. As a result, the marriage age, which had been increasing steadily since 1970, suddenly started to decline in the early 1980s. This policy shift provides us with an opportunity to apply a regression probability jump and kink (RPJK) design for the identification purpose. Using data from the 2000 census, we find that later-married men have fewer children and that later-married women are more likely to participate in the labor market. We find no consistent evidence that later marriage improves education, probably because most Chinese people marry after completing their education.

The Consequences of Chronic Pain in Mid-Life: Evidence from the National Child Development Survey

Using data from all those born in a single week in 1958 in Britain we track the consequences of short pain and chronic pain in mid-life (age 44) on health, wellbeing and labor market outcomes in later life. We examine data taken at age 50 in 2008, when the Great Recession hit and then five years later at age 55 in 2013. We find those suffering both short-term and chronic pain at age 44 continue to report pain and poor general health in their 50s. However, the associations are much stronger for those with chronic pain. Furthermore, chronic pain at age 44 is associated with a range of poor mental health outcomes, pessimism about the future and joblessness at age 55 whereas short-duration pain at age 44 is not. Uniquely, we also show that pain experienced in childhood, at ages 11 and 16, reported by a parent and a teacher respectively, collected decades earlier, predicts pain in mid-life, indicating just how persistent pain can be over the life-course.