Gabriella Conti

Child and adolescent mental health worldwide: evidence for action

Mental health problems affect 10-20% of children and adolescents worldwide. Despite their relevance as a leading cause of health-related disability in this age group and their longlasting effects throughout life, the mental health needs of children and adolescents are neglected, especially in low-income and middle-income countries. In this report we review the evidence and the gaps in the published work in terms of prevalence, risk and protective factors, and interventions to prevent and treat childhood and adolescent mental health problems. We also discuss barriers to, and approaches for, the implementation of such strategies in low-resource settings. Action is imperative to reduce the burden of mental health problems in future generations and to allow for the full development of vulnerable children and adolescents worldwide.

Early childhood investments substantially boost adult health.

Look After the Child Investing in children has been demonstrated to improve their lives, both during the school-age years and afterward, as assessed by outcomes such as employment and income; furthermore, these investments often help those in the most need. Campbell et al. (p. 1478) report that these investments can also lead to improved adult health. Results from a randomized and intensive intervention that involved 122 children in four cohorts recruited in the 1970s suggest that full-day child care for the first 5 years of life has produced adults in their 30s with better metabolic and cardiovascular health measures. Large investments in preschool children’s education, health care, and nutrition provide long-term health benefits. High-quality early childhood programs have been shown to have substantial benefits in reducing crime, raising earnings, and promoting education. Much less is known about their benefits for adult health. We report on the long-term health effects of one of the oldest and most heavily cited early childhood interventions with long-term follow-up evaluated by the method of randomization: the Carolina Abecedarian Project (ABC). Using recently collected biomedical data, we find that disadvantaged children randomly assigned to treatment have significantly lower prevalence of risk factors for cardiovascular and metabolic diseases in their mid-30s. The evidence is especially strong for males. The mean systolic blood pressure among the control males is 143 millimeters of mercury (mm Hg), whereas it is only 126 mm Hg among the treated. One in four males in the control group is affected by metabolic syndrome, whereas none in the treatment group are affected. To reach these conclusions, we address several statistical challenges. We use exact permutation tests to account for small sample sizes and conduct a parallel bootstrap confidence interval analysis to confirm the permutation analysis. We adjust inference to account for the multiple hypotheses tested and for nonrandom attrition. Our evidence shows the potential of early life interventions for preventing disease and promoting health.

Understanding the Early Origins of the Education–Health Gradient A Framework That Can Also Be Applied to Analyze Gene–Environment Interactions

In this article, we develop a framework for analyzing the causal effects of interventions in the presence of latent factors that could affect outcomes, even in the absence of interventions. This framework will be useful in situations in which genes are included among the latent factors. We estimate the model and study the early origins of observed later-life disparities by education. We determine the role played by cognitive, noncognitive, and early health endowments. We identify the causal effect of education on health and health-related behaviors. We show that family background characteristics and cognitive, noncognitive, and health endowments developed by age 10 are important determinants of health disparities at age 30. We also show that not properly accounting for personality traits results in overestimation of the importance of cognitive ability in determining later health. Selection on preexisting traits explains more than half of the observed differences in poor health and obesity. Education has an important causal effect in explaining differences in smoking rates. There are significant gender differences. We go beyond the current literature, which typically estimates mean effects, to compute distributions of treatment effects. We show that the effect of education on health varies among individuals who are similar in their observed characteristics, and how a mean effect can hide gains and losses for different individuals. This analysis highlights the crucial role played by promotion of good health at an early age and the importance of prevention in the reduction of health disparities. We speculate about how the model can be applied to genetic studies.

Transcriptional Modulation of the Developing Immune System by Early Life Social Adversity

To identify molecular mechanisms by which early life social conditions might influence adult risk of disease in rhesus macaques (Macaca mulatta), we analyze changes in basal leukocyte gene expression profiles in 4-mo-old animals reared under adverse social conditions. Compared with the basal condition of maternal rearing (MR), leukocytes from peer-reared (PR) animals and PR animals provided with an inanimate surrogate mother (surrogate/peer reared, SPR) show enhanced expression of genes involved in inflammation, cytokine signaling, and T-lymphocyte activation, and suppression of genes involved in several innate antimicrobial defenses including type I interferon (IFN) antiviral responses. Promoter-based bioinformatic analyses implicate increased activity of CREB and NF-κB transcription factors and decreased activity of IFN response factors (IRFs) in structuring the observed differences in gene expression. Transcript origin analyses identify monocytes and CD4+ T lymphocytes as primary cellular mediators of transcriptional up-regulation and B lymphocytes as major sources of down-regulated genes. These findings show that adverse social conditions can become embedded within the basal transcriptome of primate immune cells within the first 4 mo of life, and they implicate sympathetic nervous system-linked transcription control pathways as candidate mediators of those effects and potential targets for health-protective intervention.

Survey Design and the Analysis of Satisfaction

We analyze the effect of survey design on reported job satisfaction by exploiting two quasi-experiments in the British Household Panel Survey: a change in question design and parallel use of different interview modes. We show that apparently minor differences in survey design lead to substantial biases in econometric results, particularly on gender differences. The common empirical finding that women care less about wages and prefer to work fewer hours than men appears largely an artifact of survey design rather than a true behavioral difference.

Personality and the education–health gradient: A note on “Understanding differences in health behaviors by education”

We test the robustness of the results of Cutler and Lleras-Muney (2010) on the role of personality in explaining the education-health gradient by using alternative measures of child personality available in the National Child Development Study. We show that, alternatively to the authors, conclusions, personality contributes to the education-health gradient to an extent nearly as large as that of cognition.

Early Health Shocks, Intra‐Household Resource Allocation and Child Outcomes

An open question in the literature is whether families compensate or reinforce the impact of child health shocks. Discussions usually focus on one dimension of child investment. This paper examines multiple dimensions using household survey data on Chinese child twins whose average age is 11. We find that, compared with a twin sibling who did not suffer from negative early health shocks at ages 0-3, the other twin sibling who did suffer negative health shocks received RMB 305 more in terms of health investments, but received RMB 182 less in terms of educational investments in the 12 months prior to the survey. In terms of financial transfers over all dimensions of investment, the family acts as a net equalizer in response to early health shocks for children. We estimate a human capital production function and establish that, for this sample, early health shocks negatively affect child human capital, including health, education, and socioemotional skills. Compensating investments in health as measured by BMI reduce the adverse effects of health shocks by 50%, but exacerbate the adverse impact of shocks on educational attainment by 30%.

The Effects of Two Influential Early Childhood Interventions on Health and Healthy Behaviour

This paper examines the long-term impacts on health and healthy behaviors of two of the oldest and most widely cited U.S. early childhood interventions evaluated by the method of randomization with long-term follow-up: the Perry Preschool Project (PPP) and the Carolina Abecedarian Project (ABC). There are pronounced gender effects strongly favoring boys, although there are also effects for girls. Dynamic mediation analyses show a significant role played by improved childhood traits, above and beyond the effects of experimentally enhanced adult socioeconomic status. These results show the potential of early life interventions for promoting health.

Understanding conscientiousness across the life course: An economic perspective.

We discuss recent developments in the literature on the role of conscientiousness on healthy aging within an economic framework that helps to systematize and interpret the existing evidence.

Who benefits from free health insurance: evidence from Mexico

We present the first comprehensive evidence on the health impacts of the introduction and expansion of a large non-contributory health insurance program in Mexico, the Seguro Popular (SP). SP provided access to health services without co-pays to individuals with no Social Security protection. To identify the impacts of the program we use its staggered rollout across municipalities between 2002 and 2010. Our intent-to-treat estimates show that SP reduced infant mortality by 10% in poor municipalities. We are unable to detect program impacts on mortality for children ages 1-4, adults or elderly. The decline in infant mortality is driven by reductions in deaths due to perinatal conditions, congenital malformations, diarrhea and respiratory infections. Also in poor municipalities, the introduction of SP is associated with an immediate 7% increase in obstetric-related hospital admissions and with a 6% increase in hospital admissions due to diarrhea and respiratory infections among infants. The decline in infant mortality attributed to SP closes 84% of the gap in infant mortality rates between poor and rich Mexican municipalities.