Damien Bricard

Mediating role of education and lifestyles in the relationship between early-life conditions and health: evidence from the 1958 British cohort.

The paper focuses on the long-term effects of early-life conditions with comparison to lifestyles and current socioeconomic factors on health status in a cohort of British people born in 1958. Using the longitudinal follow-up data at age 23, 33, 42 and 46, we build a dynamic model to investigate the influence of each determinant on health and the mediating role of education and lifestyles in the relationship between early-life conditions and later health. Direct and indirect effects of early-life conditions on adult health are explored using auxiliary linear regressions of education and lifestyles and panel Probit specifications of self-assessed health with random effects addressing individual unexplained heterogeneity. Our study shows that early-life conditions are important parameters for adult health, their contribution to health disparities increases from 17.8% to 23% when mediating effects are identified. They also shape other health determinants: the contribution of lifestyles reduces from 28% down to 22% when indirect effects of early-life conditions are distinguished. Noticeably, the absence of father at the time of birth and experience of financial hardships represent the lead factors for direct effects on health. The absence of obesity at 16 influences health both directly and indirectly working through lifestyles.

MEDIATING ROLE OF EDUCATION AND LIFESTYLES IN THE RELATIONSHIP BETWEEN EARLY-LIFE CONDITIONS AND HEALTH: EVIDENCE FROM THE 1958 BRITISH COHORT: MEDIATING ROLE OF EDUCATION AND LIFESTYLES

The paper focuses on the long-term effects of early-life conditions with comparison to lifestyles and educational attainment on health status in a cohort of British people born in 1958. Using the longitudinal follow-up data at age 23, 33, 42 and 46, we build a dynamic model to investigate the influence of each determinant on health and the mediating role of education and lifestyles in the relationship between early-life conditions and later health. Direct and indirect effects of early-life conditions on adult health are explored using auxiliary linear regressions of education and lifestyles and panel Probit specifications of self-assessed health with random effects addressing individual unexplained heterogeneity. Our study shows that early-life conditions are important parameters for adult health accounting for almost 20% of explained health inequality when mediating effects are identified. The contribution of lifestyles reduces from 32% down to 25% when indirect effects of early-life conditions and education are distinguished. Noticeably, the absence of father at the time of birth and experience of financial hardships represent the lead factors for direct effects on health. The absence of obesity at 16 influences health both directly and indirectly working through lifestyles.

Inequality of Opportunities in Health and the Principle of Natural Reward: Evidence from European Countries

This paper aims to quantify and compare inequalities of opportunity in health across European countries considering two alternative normative ways of treating the correlation between effort, as measured by lifestyles, and circumstances, as measured by parental and childhood characteristics, championed by Brian Barry and John Roemer. This study relies on regression analysis and proposed several measures of inequality of opportunities. Data from the Retrospective Survey of SHARELIFE, which focuses on life histories of European people aged 50 and over, are used. In Europe at the whole, inequalities in opportunities stand for almost 50% of the health inequality due to circumstances and efforts in Barry scenario and 57.5% in Roemer scenario. The comparison of the magnitude of inequalities of opportunity in health across European countries shows considerable inequalities in Austria, France, Spain, Germany, whereas Sweden, Poland, Belgium, the Netherlands and Switzerland present the lowest inequalities of opportunities. The normative principle on the way to treat the correlation between circumstances and effort makes little difference in Spain, Austria, Greece, France, Czech Republic, Sweden and Switzerland whereas it would matter the most in Belgium, the Netherlands, Italy, Germany, Poland and Denmark. In most countries, inequalities of opportunity in health are mainly driven by social background affecting adult health directly, and so would require policies compensating for poorer initial conditions. On the other hand, our results suggest a strong social and family determinism of lifestyles in Belgium, the Netherlands, Italy, Germany, Poland and Denmark, which emphasises the importance of inequalities of opportunities in health within those countries and calls for targeted prevention policies.

Disadvantaged Social Groups and the Cigarette Epidemic: Limits of the Diffusion of Innovations Vision

The original four-stage model of the cigarette epidemic has been extended with diffusion of innovations theory to reflect socio-economic differences in cigarette use. Recently, two revisions of the model have been proposed: (1) separate analysis of the epidemic stages for men and women, in order to improve generalization to developing countries, and; (2) addition of a fifth stage to the smoking epidemic, in order to account for the persistence of smoking in disadvantaged social groups. By developing a cohort perspective spanning a 35-year time period in France and the USA, we uncover distinctive features which challenge the currently held vision on the evolution of smoking inequalities within the framework of the cigarette epidemic. We argue that the reason for which the model may not be fit to the lower educated is that the imitation mechanism underlying the diffusion of innovations works well with regard to adoption of the habit, but is much less relevant with regard to its rejection. Based on those observations, we support the idea that the nature and timing of the epidemic differs enough to treat the stages separately for high and low education groups, and discuss policy implications.

Changes in Smoking Behavior over Family Transitions: Evidence for Anticipation and Adaptation Effects

The study of changes in smoking behaviors over the life course is a promising line of research. This paper aims to analyze the temporal relation between family transitions (partnership formation, first childbirth, separation) and changes in smoking initiation and cessation. We propose a discrete-time logistic model to explore the timing of changes in terms of leads and lags effects up to three years around the event in order to measure both anticipation and adaptation mechanisms. Retrospective biographical data from the Santé et Itinéraires Professionnels (SIP) survey conducted in France in 2006 are used. Partnership formation was followed for both genders by a fall in smoking initiation and an immediate rise in smoking cessation. Childbirth was associated with increased smoking cessation immediately around childbirth, and additionally, females showed an anticipatory increase in smoking cessation up to two years before childbirth. Couple separation was accompanied by an anticipatory increase in smoking initiation for females up to two years prior to the separation, but this effect only occurred in males during separation. Our findings highlight opportunities for more targeted interventions over the life course to reduce smoking, and therefore have relevance for general practitioners and public policy elaboration.