Steven A. Haas

Childhood Socioeconomic Position and Objectively Measured Physical Capability Levels in Adulthood: A Systematic Review and Meta-Analysis

Background Grip strength, walking speed, chair rising and standing balance time are objective measures of physical capability that characterise current health and predict survival in older populations. Socioeconomic position (SEP) in childhood may influence the peak level of physical capability achieved in early adulthood, thereby affecting levels in later adulthood. We have undertaken a systematic review with meta-analyses to test the hypothesis that adverse childhood SEP is associated with lower levels of objectively measured physical capability in adulthood. Methods and Findings Relevant studies published by May 2010 were identified through literature searches using EMBASE and MEDLINE. Unpublished results were obtained from study investigators. Results were provided by all study investigators in a standard format and pooled using random-effects meta-analyses. 19 studies were included in the review. Total sample sizes in meta-analyses ranged from N = 17,215 for chair rise time to N = 1,061,855 for grip strength. Although heterogeneity was detected, there was consistent evidence in age adjusted models that lower childhood SEP was associated with modest reductions in physical capability levels in adulthood: comparing the lowest with the highest childhood SEP there was a reduction in grip strength of 0.13 standard deviations (95% CI: 0.06, 0.21), a reduction in mean walking speed of 0.07 m/s (0.05, 0.10), an increase in mean chair rise time of 6% (4%, 8%) and an odds ratio of an inability to balance for 5s of 1.26 (1.02, 1.55). Adjustment for the potential mediating factors, adult SEP and body size attenuated associations greatly. However, despite this attenuation, for walking speed and chair rise time, there was still evidence of moderate associations. Conclusions Policies targeting socioeconomic inequalities in childhood may have additional benefits in promoting the maintenance of independence in later life.

Health Selection and the Process of Social Stratification: The Effect of Childhood Health on Socioeconomic Attainment

This study investigates whether childhood health acts as a mechanism through which socioeconomic status is transferred across generations. The study uses data from the Panel Study of Income Dynamics to track siblings and to estimate fixed-effects models that account for unobserved heterogeneity at the family level. The results demonstrate that disadvantaged social background is associated with poor childhood health. Subsequently, poor health in childhood has significant, direct, and large adverse effects on educational attainment and wealth accumulation. In addition, childhood health appears to have indirect effects on occupational standing, earnings, and wealth via educational attainment and adult health status. The results further show that socioeconomic health gradients are best understood as being embedded within larger processes of social stratification.

The Long-Term Effects of Poor Childhood Health: An Assessment and Application of Retrospective Reports

This study assesses retrospective childhood health reports and examines childhood health as a predictor of adult health. The results suggest that such reports are of reasonable reliability as to warrant their judicious use in population research. They also demonstrate a large positive relationship between childhood and adult health. Compared with excellent, very good, or good childhood health, poor childhood health is associated with more than three times greater odds of having poor adult self-rated health and twice the risk of a work-limiting disability or a chronic health condition. These associations are independent of childhood and current socioeconomic position and healthrelated risk behaviors.

Health and the educational attainment of adolescents: evidence from the NLSY97.

This article examines the mechanisms linking health to the educational attainment of adolescents. In particular, it investigates the role of cognitive/academic achievement and a variety of psychosocial adjustment factors in explaining this relationship. Using data from the National Longitudinal Survey of Youth 1997 cohort (NLSY97), we estimate models of timely high school completion and of post-secondary enrollment using both standard logit estimation and sibling fixed-effects models. We find that, net of sociodemographic background and stable unobserved family characteristics, adolescents who experience worse health are substantially less likely to complete high school by their 20th birthday and to transition to post-secondary education. Cognitive/academic achievement and psychosocial factors appear to explain a large portion of these health-related educational deficits. However, adolescent health continues to be significantly associated with these key educational transitions. The findings highlight a potentially important role of health selection processes in generating socioeconomic inequalities in early adolescence to young adulthood.

Towards a sociology of disease

We argue for a sociology of health, illness, and disease. Under the influence of Talcott Parsons, the social study of health began as medical sociology and then morphed into sociology of health and illness, focusing largely on the social aspects of health-related topics. Social scientists have been reluctant to tackle disease in its physiological and biological manifestations. The result is an impoverishment of sociological analysis on at least three levels: social scientists have rarely made diseases central to their inquiries; they have been reluctant to include clinical endpoints in their analysis; and they have largely bracketed the normative purpose of health interventions. Consequently, social scientists tend to ignore what often matters most to patients and health care providers, and the social processes social scientists describe remain clinically unanchored. A sociology of disease explores the dialectic between social life and disease; aiming to examine whether and how social life matters for morbidity and mortality and vice versa. Drawing from specific advances in science and technology studies and social epidemiology, we point to ways that sociologists can participate as health researchers.

Health and the Structure of Adolescent Social Networks.

Much research has explored the role of social networks in promoting health through the provision of social support. However, little work has examined how social networks themselves may be structured by health. This article investigates the link between individuals’ health and the characteristics of their social network positions. We first develop theoretical predictions for how health may influence the structure of adolescent networks. We then test these predictions using longitudinal analysis of the National Longitudinal Study of Adolescent Health (Add Health). We find important relationships between the health status of adolescents and the characteristics of the social network positions within which they are embedded. Overall we find that adolescents in poor health form smaller local networks and occupy less central global positions than their healthy peers. These results also have implications for social network research, expanding the scope of factors responsible for the network positions individuals occupy.

Lifecourse social conditions and racial disparities in incidence of first stroke

PURPOSE 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. METHODS 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. RESULTS 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). CONCLUSIONS 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.

Life course determinants of racial and ethnic disparities in functional health trajectories

Previous research has documented racial/ethnic disparities in functional health trajectories in old age, though little work has investigated the relative contribution of early and later life insults in their genesis. This paper uses two-part latent curve models to investigate the life course determinants of racial/ethnic disparities in functional health trajectories in the USA. We find that blacks and Hispanics have both a greater probability of having any limitation at baseline and more limitations on average among those who have any. Over time, there is convergence in trajectories between Hispanics and non-Hispanic whites, though the black-white gap remains constant. In addition, we find that disparities result from differential exposure to poor childhood health, early life socioeconomic deprivation, as well as adult health and socioeconomic attainment. However, the impact of childhood insults is largely mediated by more contemporaneous factors. We also find little evidence that the impact of life course factors varies across groups.

Race/Ethnic and Nativity Disparities in Later Life Physical Performance: The Role of Health and Socioeconomic Status Over the Life Course

OBJECTIVES We examine race/ethnic and nativity differences in objective measures of physical performance (i.e., peak expiratory flow, grip strength, and gait speed) in a nationally representative sample of older Whites, Blacks, and Hispanics. We also examine whether detailed measures of childhood and adult health and socioeconomic status (SES) mediate race/ethnic differences in physical performance. METHOD We use data from the Health and Retirement Study, a population-based sample of older Americans born before 1947, and 3 measures of physical performance. Nested ordinary least squares models examine whether childhood and adult health and SES mediate race/ethnic differences in performance. RESULTS We find large and significant race/ethnic and nativity differences in lung function, grip strength, and gait speed. Adjusting for childhood and current adult health and SES reduces race/ethnic differences in physical performance but does not eliminate them entirely. Childhood health and SES as well as more proximal levels of SES are important determinants of race/ethnic disparities in later life physical performance. DISCUSSION The analysis highlights that a large proportion of race/ethnic and nativity disparities result from health and socioeconomic disadvantages in both early life and adulthood and thus suggests multiple intervention points at which disparities can be reduced.

Validity and stability of self-reported health among adolescents in a longitudinal, nationally representative survey.

OBJECTIVES. The goals of this study to assess (1) the stability of self-reported health among a nationally representative sample of youth in adolescence over a period of 6 years, (2) the concordance of self-reported health between parents and children, and (3) the validity of self-reported health across a range of physical and emotional indicators of adolescent well-being. METHODS. This study uses data from rounds 1 to 7 (1997–2003) of the National Longitudinal Survey of Youth, 1997 Cohort (NLSY97). The sample consists of 6748 youth born between January 1, 1980, and December 31, 1984. Data on one of the youths’ parents were also included in the baseline of the survey. Analyses were conducted using polychoric correlations and ordinal logistic regression. RESULTS. Self-reported health of adolescents over a 7-year period indicated moderate stability (40% agreement after 7 years for girls and 41% for boys). Concordance was also present between parents and their children, although the association was higher among same-gender pairings (mother-daughter and father-son concordances). Adolescents’ self-reported health was also linked with the presence or absence of chronic health conditions, emotional problems, and with being overweight or obese but not with sensory conditions or physical deformity. CONCLUSIONS. Self-reported health is stable from early and middle adolescence to young adulthood. Self-reported health is also a valid measure of a variety of physical and emotional dimensions of adolescent well-being. The stability and validity of self-reported health do not differ by the gender of the child, although there is slightly greater concordance when the reporting parent is the same gender as the child.