Exploring the intergenerational persistence of mental health: Evidence from three generations

This paper uses data from the 1970 British Cohort Study to quantify the intergenerational persistence of mental health, and the long-run economic costs associated with poor parental mental health. We find a strong and significant intergenerational correlation that is robust to different covariate sets, sample restrictions, model specifications and potential endogeneity. Importantly, the intergenerational persistence is economically relevant, with maternal mental health associated with lasting effects on the child's educational attainment, future household income and the probability of having criminal convictions. These results do not disappear after controlling for children's own childhood and adulthood mental health.     

Teenage pregnancy contextualized: understanding reproductive intentions in a Brazilian shantytown

This paper presents the results of a socio-anthropological study with women from a low-income community in Belo Horizonte, Minas Gerais State, Brazil. Through the use of qualitative methods it looks at teenage pregnancy from the young mothers' perspective and the contribution of their socioeconomic environment. It shows the importance of different actors in their fertility decision and identifies contradictory cultural norms that recriminate teenage sexual activity while seeing motherhood as a ritual of passage to adulthood. Following criticisms of insufficient family planning programs and negative health and economic outcomes for the lives of youngsters, the paper argues that motherhood stands as a successful activity through which they fulfill the collectively recognized ideal of womanhood, also carrying a sense of achievement in an environment where lack of opportunities prevail long before pregnancy occurs. Improving formal knowledge and economic well-being are possible solutions to provide these girls with goals that go beyond parenthood while within reach of their economic reality.     

Childhood influences on adult health: a review of recent work from the British 1946 national birth cohort study, the MRC National Survey of Health and Development

Research in this study has shown that growth in utero and early-life development were associated with a range of adult outcomes, including blood pressure, respiratory function and schizophrenia. It has also been shown that childhood social and educational factors are strongly associated with adult mental and physical health, and with adult health-related behaviour. It is suggested that the observed long-term effects of early-life physical development do not represent an inevitable outcome of childhood development, but one which is mediated by the chain of social factors that also begins in early life. The conclusions emphasise that since the social and economic circumstances that affect child health have changed greatly in recent years in some ways which are particularly adverse, we need now to be aware of the implications of such change not only for the health of children today, but also for their health in adulthood.     

Multiple Service System Involvement and Later Offending Behavior: Implications for Prevention and Early Intervention

Objectives. We investigated patterns of childhood and adolescent experiences that correspond to later justice system entry, including persistence into adulthood, and explored whether timing of potential supports to the child or onset of family poverty, according to developmental periods and gender, would distinguish among latent classes.Methods. We constructed a database containing records for 8587 youths from a Midwestern metropolitan region, born between 1982 and 1991, with outcomes. We used data from multiple publicly funded systems (child welfare, income maintenance, juvenile and criminal justice, mental health, Medicaid, vital statistics). We applied a latent class analysis and interpreted a 7-class model.Results. Classes with higher rates of offending persisting into adulthood were characterized by involvement with multiple publicly funded systems in childhood and adolescence, with the exception of 1 less-urban, predominantly female class that had similarly high system involvement coupled with lower rates of offending.Conclusions. Poverty and maltreatment appear to play a critical role in offending trajectories. Identifying risk factors that cluster together may help program and intervention staff best target those most in need of more intensive intervention.Crime has devastating effects on individuals, families, and communities. Prevention and early intervention have the potential to save millions of dollars in justice system and victim costs.1 A vast literature has documented offense trajectories and risk and protective factors, but most of this research has focused on individual or peer characteristics in relation to types and persistence of offending.2,3 Scant research has viewed offender typology and offense trajectory from the perspective of public service systems encountered. Not only do these data contain markers of risk, but they may also help identify promising systems to use as platforms for purposes of prevention and early intervention. Furthermore, it is important to understand whether key clusters of system involvement, along with individual and community factors, might inform models of collaboration to improve outcomes.Although the connection between child welfare involvement and entry into juvenile and criminal justice systems has been well documented,4,5 evidence that offending risk accumulates with involvement in multiple systems is relatively limited. Children with child welfare system contact are likely to be poor and to experience other risk factors for criminal behavior. For example, children who were involved with both income maintenance and child welfare systems were about twice as likely to have delinquency petitions as other youths,6 and a sample of youths with income maintenance and child welfare histories had an average of 3 delinquency petitions per child.7The relation between timing of service involvement and offending behavior has been largely unstudied. Adolescent and persistent child maltreatment have been found to be predictive of delinquency, as compared to maltreatment limited to early childhood.8 Repeated maltreatment reports have been associated with an increased likelihood of a range of adult outcomes such as perpetration of maltreatment and mental health service use, even controlling for delinquency and mental health treatment during adolescence.9 It is unknown, however, whether the timing of a child’s or family’s involvement with income maintenance or publicly funded mental health is related to later offending. Although contact with a system such as mental health occurs in recognition of a need, contact is not synonymous with adequate or timely service.10 For example, 1 study found that mental health and substance use services appeared to magnify the risk of juvenile justice entry for youths with child welfare system involvement,11 when in reality youths contacting those systems may receive little or low-quality care.     

Breast feeding and later psychosocial adjustment

The relationship between the duration of breast feeding and psychosocial outcomes measured between the ages of 15 and 18 years was examined in a birth cohort of 999 New Zealand children. During the period from birth to 1 year, information was collected on maternal breast-feeding practices. Between the ages of 15 and 18 years, sample members were assessed using a range of psychosocial measures, including measures of the quality of parent-child relationships, juvenile delinquency, substance abuse and mental health. Children who were breast fed for a longer duration were more likely to report higher levels of parental attachment and tended to perceive their mothers as being more caring and less overprotective towards them compared with bottle-fed children. No association was found between the extent of breast feeding and subsequent rates of juvenile offending, substance use and mental health in later life. Mothers who elected to breast feed were also more likely to be older, better educated, living with a partner, less likely to smoke during pregnancy, and to come from advantaged socio-economic backgrounds characterised by better living standards and a higher family income. Rates of breast feeding were also greater among mothers who gave birth to a first-born child of higher birthweight. After adjustment for these maternal and perinatal factors, the duration of breast feeding remained significantly associated with adolescent perceptions of maternal care, with increasing duration of breast feeding being associated with higher levels of perceived maternal care during childhood. It is concluded that: (a) it is unlikely that breast feeding is associated with reduced risks of psychiatric disorder in later life; (b) breast feeding may lead to closer parent-child relationships; and (c) it is unlikely that the association between breast feeding and cognitive development is mediated by intervening processes relating to improved psychosocial adjustment in breast-fed children.     

Childhood and family influences on body mass index in early adulthood: findings from the Ontario Child Health Study

ABSTRACT: BACKGROUND: Overweight and obesity are steadily increasing worldwide with the greatest prevalence occurring in high-income countries. Many factors influence body mass index (BMI); however multiple influences assessed in families and individuals are rarely studied together in a prospective design. Our objective was to model the impact of multiple influences at the child (low birth weight, history of maltreatment, a history of childhood mental and physical conditions, and school difficulties) and family level (parental income and education, parental mental and physical health, and family functioning) on BMI in early adulthood. METHODS: We used data from the Ontario Child Health Study, a prospective, population-based study of 3,294 children (ages 4--16 years) enrolled in 1983 and followed up in 2001 (N = 1,928; ages 21--35 years). Using multilevel models, we tested the association between family and child-level variables and adult BMI after controlling for sociodemographic variables and health status in early adulthood. RESULTS: At the child level, presence of psychiatric disorder and school difficulties were related to higher BMI in early adulthood. At the family level, receipt of social assistance was associated with higher BMI, whereas family functioning, having immigrant parents and higher levels of parental education were associated with lower BMI. We found that gender moderated the effect of two risk factors on BMI: receipt of social assistance and presence of a medical condition in childhood. In females, but not in males, the presence of these risk factors was associated with higher BMI in early adulthood. CONCLUSION: Overall, these findings indicate that childhood risk factors associated with higher BMI in early adulthood are multi-faceted and long-lasting. These findings highlight the need for preventive interventions to be implemented at the family level in childhood.     

Teenage pregnancy and frequent use of alcohol and drugs in the home environment

OBJECTIVE: To assess individual and family factors associated to teenage pregnancy, including frequent use of alcohol and illicit drugs by family members. METHODS: Case-control study conducted with a sample of 408 sexually active female adolescents (aged 13-17 years) in school from the city of Marília (Southeastern Brazil) in 2003-2004. Cases consisted of 100 primigravid teenagers assisted in prenatal care programs in health units. Controls were 308 nulligravid students from state public schools. Standardized instruments identified demographic and educational factors, contraceptive behavior, mental health problems, and family characteristics. Statistical analysis included chi-square tests and logistic regression models. RESULTS: Low paternal education (p=0.01), lack of information on sexuality and fertilization (p=0.001) and the use of illicit drugs by a resident family member (p=0.006) were independent risk factors. Family income per capita and asking the partner to use a condom were confounders. CONCLUSIONS: The frequent use of illicit drugs by a resident family member is a factor strongly associated to teenage pregnancy, regardless of other risk factors. The expectation of going to college constitutes a protective factor, mainly in the presence of low maternal education.     

Unemployment and psychosocial adjustment in young adults: causation or selection?

This study investigates the relationships between unemployment following school leaving and psychosocial adjustment problems (mental health, substance use, crime, suicidal behaviours and teenage pregnancy) in a birth cohort of over 1000 New Zealand born young people. The data were gathered during the course of the Christchurch Health and Development Study (CHDS). The CHDS is a longitudinal study of a birth cohort of 1265 children born in the Christchurch (NZ) urban region who have been studied from birth to age 21. Data were gathered by personal interview on: (a) exposure to unemployment and (b) personal adjustment over the period from age 16 to age 21. Measures of personal adjustment included mental health (depression, anxiety), substance use, crime, suicidal behaviours and (for females) teenage pregnancy. Data were analysed using a fixed effects regression model that took into account both observed and non-observed sources of confounding and the possibility of reverse causal associations between personal adjustment and unemployment. Before adjustment for confounding and reverse causality there were significant (p < 0.001) associations between exposure to unemployment and measures of mental health, substance use, crime, suicidal behaviours and teenage pregnancy. Adjustment for confounding factors and reverse causality reduced these associations quite substantially and after control for sources of confounding a number of associations became nonsignificant. Nonetheless, after such control, exposure to unemployment remained significantly (p < 0.05) associated with suicidal ideation, substance abuse and criminal behaviours. It is concluded that, in part, the associations between unemployment and personal adjustment are spurious and reflect the presence of confounding factors that are related to both unemployment and adjustment. Nonetheless, the findings suggest that exposure to unemployment may be associated with increased risks of suicidal thoughts, crime and substance use.     

The lasting impact of childhood health and circumstance

We quantify the lasting effects of childhood health and economic circumstances on adult health, employment and socioeconomic status, using data from a birth cohort that has been followed from birth into middle age. Controlling for parental income, education and social class, children who experience poor health have significantly lower educational attainment, poorer health, and lower social status as adults. Childhood health and circumstance appear to operate both through their impact on initial adult health and economic status, and through a continuing direct effect of prenatal and childhood health in middle age. Overall, our findings suggest more attention be paid to health as a potential mechanism through which intergenerational transmission of economic status takes place: cohort members born into poorer families experienced poorer childhood health, lower investments in human capital and poorer health in early adulthood, all of which are associated with lower earnings in middle age-the years in which they themselves become parents.     

Teenage children of teenage mothers: psychological, behavioural and health outcomes from an Australian prospective longitudinal study

In many industrialised countries teenage pregnancy and teenage parenthood have in recent years been identified as social and public health problems that need to be tackled. A number of studies have looked at various outcomes for teenage mothers and their offspring, and many report a strong association with poverty for the mother both before and after having a child. Few studies, however, adequately control for socioeconomic circumstances when examining health and related outcomes. Most studies have focused on perinatal outcomes in the offspring with few looking at later health and development. In Australia, where the rate of teenage pregnancy is relatively high compared to other comparable countries, teenage pregnancy is a not prominent policy concern. As such, Australia offers the opportunity to study the outcomes of teenage parenthood in a country where there may be less stigma than in countries that portray teenage parenthood as a major health and/or social problem. This paper reports findings from the Mater-University Study of Pregnancy (MUSP) and its outcomes, a prospective study of women, and their offspring, who received antenatal care at a major public hospital (Mater Misericordiae Hospital) in South Brisbane, Australia, between 1981 and 1984. We have examined the associations of maternal age (< or =18 years (n=460) versus >18 years (n=4800)) at first antenatal visit with offspring psychological, behavioural and health characteristics when the offspring--the teenage children of teenage mothers--were aged 14 years. Multiple logistic regression was used to determine the effect of maternal and family characteristics on associations between maternal age and childhood outcomes at age 14. Results show that the 14 year old offspring of mothers who were aged 18 years and younger compared to those who were offspring of older mothers were more likely to have disturbed psychological behaviour, poorer school performance, poorer reading ability, were more likely to have been in contact with the criminal justice system and were more likely to smoke regularly and to consume alcohol. However, maternal age was not associated with health outcomes in their offspring at age 14 years. Indicators of low socioeconomic position and maternal depression were also associated with poorer psychological, cognitive and behavioural outcomes among 14 year olds. In addition children from poorer socioeconomic backgrounds and whose mothers were depressed were more likely to have self-reported poor health, asthma, to have been admitted to hospital twice or more since birth and to be bed-wetters at age 14. The associations between maternal age and psychological distress, school performance, and smoking and alcohol use were all largely explained by socioeconomic factors, maternal depression, family structure and maternal smoking. These findings confirm that not all teenage mothers and their offspring have adverse outcomes, and that many if not the majority have good outcomes.     

A comparison of pregnancy and child health outcomes between teenage and adult mothers in the slums of Nairobi, Kenya

The study assessed and compared pregnancy and child health outcomes of teenage (aged less than 20 years) and adult (20-34 years of age) mothers. A total of 226 teenage and 205 adult mothers met the study criteria out of the 3,256 women in the reproductive age group (15-49 years) and 318 adolescent girls (12-14 years of age) covered by the Nairobi Cross-sectional Slums Survey (NCSS). The main comparison involved socio-demographic variables, events during pregnancy, obstetric outcome, child morbidity and mortality and care provided during an illness episode. Results showed that a significantly higher percentage of teenage mothers and their partners had lower educational achievement compared with adult mothers and their partners. They were more likely to be economically disadvantaged than the adult mothers. Teenage mothers and their parents were also less likely to have ever been married. The two groups of mothers were comparable in terms of the rate and timing of antenatal care visits, place of delivery, rate of operative deliveries, reported size of the baby at birth, child vaccination status and reported morbidity and health care practice during an illness episode. The index child was alive during the survey period for 89.4% of the teenage and 96.6% of the adult mothers (OR = 3.36; 95% CI = 1.34, 8.79; P = 0.004). Child survival rates in the two groups of mothers were found to be quite similar after controlled analysis for the influence of socio-economic factors. The study concluded that bad obstetric outcomes were not associated with maternal age. Although teenage and adult mothers were not significantly different on child health practices, children born to the former group died most frequently probably due to their poor socioeconomic achievements.     

Long-Term Consequences of Adolescent Gang Membership for Adult Functioning

Objectives. We examined the possible public health consequences of adolescent gang membership for adult functioning.Methods. Data were drawn from the Seattle Social Development Project, a longitudinal study focusing on the development of positive and problem outcomes. Using propensity score matching and logistic regression analyses, we assessed the effects of adolescent gang membership on illegal behavior, educational and occupational attainment, and physical and mental health at the ages of 27, 30, and 33 years.Results. In comparison with their nongang peers, who had been matched on 23 confounding risk variables known to be related to selection into gang membership, those who had joined a gang in adolescence had poorer outcomes in multiple areas of adult functioning, including higher rates of self-reported crime, receipt of illegal income, incarceration, drug abuse or dependence, poor general health, and welfare receipt and lower rates of high school graduation.Conclusions. The finding that adolescent gang membership has significant consequences in adulthood beyond criminal behavior indicates the public health importance of the development of effective gang prevention programs.Research has consistently shown that gang membership has proximal adverse consequences during adolescence that, in turn, lead to significant social and economic costs.1–3 Active gang members are much more likely than their nongang peers to engage in criminal behavior,2,4,5 especially serious and violent offending6; in addition, they are more likely to be involved in drug use and selling,5 have more difficulties in school,4 and are more likely to be violently victimized.3 However, with few exceptions, there is scant research on possible broader, long-term public health consequences of gang membership.7–9Levitt and Vankatesh,8 in a 10-year follow-up of a sample of Chicago youths, found that those who reported being in a gang during adolescence were more likely to be arrested and incarcerated as adults, were more likely to rely on illegal income, and had obtained less formal education than their nongang peers. When they controlled for background characteristics such as home environment and early school performance, only the relationship between adolescent gang membership and illegal income in adulthood remained significant.In an ethnographic study, Hagedorn10 conducted follow-up interviews of 228 Milwaukee-based founding male gang members several years after his initial study. Two thirds of the sample did not have a high school diploma or general equivalency diploma (GED), fewer than 32% were employed, and more than 63% had been incarcerated.In a quantitative study involving a community sample, Thornberry et al.9 examined the extent to which gang membership negatively affected the timeliness of developmental transitions into adulthood, such as completion of schooling and establishment of a career. They found that, after control for individual and environmental risks, male respondents who had been short-term or long-term gang members in adolescence had a greater likelihood of cohabitation before marriage at the age of 22 years than male respondents who had not been gang members. Long-term gang members also had significantly higher rates of unstable employment, school dropout, early pregnancy, and teenage parenthood at the follow-up. Female gang members were more likely to experience untimely or problematic transitions, including unstable employment, teenage pregnancy, and early motherhood. Both male and female former gang members were more likely to report adult arrests.Recently, Krohn et al.11 found that there was an indirect positive relationship between adolescent gang membership and engagement in street crime and arrest in adulthood. Specifically, gang membership was related to precocious transitions into adulthood that then predicted disrupted family relationships and economic instability. They found that this path eventually led to criminal behaviors at the age of 30 years. In our study, we extended these investigations by assessing the effects of gang membership on adult functioning holistically, examining possible later adult outcomes.Life course theory12–14 provides a framework to understand how gang membership in adolescence may affect illegal behavior, educational and occupational attainment, and physical and mental health in adulthood. This theory emphasizes the strong connection between childhood events and experiences in adulthood (trajectories), as well as significant events that create a disruption in a trajectory (turning points). Although we did not directly test a trajectory change model in this study, life course theory would suggest that joining a gang during adolescence may initiate a negative developmental cascade into both criminal and noncriminal domains, including decreased educational and occupational attainment and poor physical and mental health.15,16 Indeed, Melde and Esbensen reported that “youth who join gangs experience noteworthy changes in their emotions, attitudes, and behavior,”17^(p539) suggesting that gang membership may serve as a significant turning point in an individual’s life course.One such life course theory, the social development model,18 provides specific mechanisms through which these consequences may operate. This model articulates the mechanisms of socialization and identifies parallel but separate causal paths for prosocial and antisocial processes consisting of opportunities for involvement, actual involvement, skills, rewards, bonding, and adoption of beliefs. Participation in the prosocial path is seen to increase subsequent positive outcomes and decrease risk behaviors. By contrast, participation in the antisocial path is seen to decrease positive outcomes and increase problem behaviors. From the perspective of this model, gang membership in adolescence may serve as a turning point, drastically changing the opportunity structure for young people. As gang-involved youths move through subsequent cycles of socialization, they are likely to experience reduced prosocial functioning across several domains and escalated problem behaviors as they transition into adulthood, even if they are no longer members of a gang.According to Krohn and Thornberry,

it is reasonable to expect that being a member of a gang during adolescence will be associated with disrupted transitions from adolescence to adulthood and, ultimately, will adversely impact life chances.7^(p149)

They noted that the challenge is to discover empirically to what extent gang membership contributes to negative outcomes in adulthood over and above general delinquency and other risk factors in adolescence. This was precisely the aim of our study.     

Associations of childhood circumstances with physical and mental functioning in adulthood

The aim of this study was to examine the associations of parental education and specific childhood circumstances with adult physical and mental functioning. Self-reported data were collected in 2000, 2001 and 2002 among middle-aged women (n=7,171) and men (n=1,799) employed by the City of Helsinki. Functioning was measured by the physical and mental component summaries of the Short-Form 36 Health Survey (SF-36). The lowest quartile of the scores on each component summary was considered to indicate limited functioning. Adult socio-economic circumstances were measured by their own education. Among women parental education was inversely associated with physical functioning. The association remained after adjusting for specific childhood circumstances but disappeared after adjustment for own education. In contrast, parental education was positively associated with mental functioning among women, and the association remained after adjusting for specific childhood circumstances and the own education. Among women childhood adversities such as own chronic disease, parental mental problems, economic difficulties and having been bullied in childhood were associated with both physical and mental functioning. Parental drinking problems were associated with adult mental functioning among women. Among men, chronic disease, economic difficulties and having been bullied in childhood were associated with physical functioning. Parental mental problems, economic difficulties and having being bullied in childhood were also associated with mental functioning among men. These results suggest that the effect of parental education on physical functioning is mediated through one's own education. The association between parental education and mental functioning and the effects of several specific childhood circumstances may suggest a latency effect. Some evidence of cumulative effects of childhood and adulthood circumstances were found among women in physical functioning. Specific childhood circumstances are therefore important determinants of adult functioning. These circumstances provide detailed information on the association of childhood circumstances with adult functioning over and above parental education.     

Impact of childhood and adulthood socioeconomic position on cause specific mortality: the Oslo Mortality Study

OBJECTIVE: To study the impact of childhood and adulthood social circumstances on cause specific adult mortality. DESIGN: Census data on housing conditions from 1960 and Personal Register income data for 1990 were linked to 1990-94 death registrations, and relative indices of inequality were computed for housing conditions in 1960 and for household income in 1990. PARTICIPANTS: The 128 723 inhabitants in Oslo aged 31-50 years in 1990. MAIN RESULTS: Adulthood mortality was strongly associated with both childhood and adulthood social circumstances among both men and women. Cardiovascular disease mortality was more strongly associated with childhood than with adulthood social circumstances, while the opposite was found for psychiatric and accidental/violent mortality. Smoking related cancer mortality was related to both adulthood and childhood social circumstances in men, but considerably more strongly to adult social circumstances. CONCLUSIONS: Childhood social circumstances have an important influence on cardiovascular disease risk in adulthood. Current increases in child poverty that have been seen in Norway over the past two decades could herald unfavourable future trends in adult health.     

The perinatal and infant health status of Native Hawaiians.

Hawaii vital record data for 1979 through 1990 were analyzed to examine potentially differing relationships between maternal and infant risks and outcomes in native Hawaiian and White infants. Despite high rates of inadequate prenatal care and teenage and unmarried childbearing, the Hawaiian low-birth-weight rate was below the US average. Hawaiian infants experienced an elevated risk of mortality, particularly among those of normal birthweight during the postneonatal period. Public health initiatives to reduce infant mortality must go beyond preventing teenage pregnancy and low birthweight to address Hawaiian infants' unique pattern of risk factors and the social and economic environment in which such risks abound.     

The status of low-income neighborhoods in the post-welfare reform environment: mapping the relationship between poverty and place

It has long been recognized that children and adults living in poverty are at risk for a number of negative outcomes. As inequality in the distribution of wealth, income and opportunity has grown in the U.S. during the post-welfare reform era, impoverished children and their families have tended to become increasingly concentrated in urban low-income neighborhoods. Research evidence demonstrates that living in these neighborhoods affects family well-being in several key areas: economic and employment opportunity, health and mental health condition, crime and safety, and children's behavioral and educational outcomes. Using the neighborhood indicator approach, public and nonprofit social service agencies will be better positioned to develop a comprehensive and integrated service delivery model at the neighborhood level by using neighborhood assessment to locate services and utilize neighborhood intervention strategies.     

Childhood cognitive ability and adult mental health in the British 1946 birth cohort

We examined whether childhood cognitive ability was associated with two mental health outcomes at age 53 years: the 28 item General Health Questionnaire (GHQ-28) as a measure of internalising symptoms of anxiety and depression, and the CAGE screen for potential alcohol abuse as an externalising disorder. A total of 1875 participants were included from the Medical Research Council National Survey of Health and Development, also known as the British 1946 birth cohort. The results indicated that higher childhood cognitive ability was associated with reporting fewer symptoms of anxiety and depression GHQ-28 scores in women, and increased risk of potential alcohol abuse in both men and women. Results were adjusted for educational attainment, early socioeconomic status (SES) and adverse circumstances, and adult SES, adverse circumstances, and negative health behaviours. After adjusting for childhood cognitive ability, greater educational attainment was associated with reporting greater symptoms of anxiety and depression on the GHQ-28. Although undoubtedly interrelated, our evidence on the diverging effects of childhood cognitive ability and educational attainment on anxiety and depression in mid-adulthood highlights the need for the two to be considered independently. While higher childhood cognitive ability is associated with fewer internalising symptoms of anxiety and depression in women, it places both men and women at higher risk for potential alcohol abuse. Further research is needed to examine possible psychosocial mechanisms that may be associated with both higher childhood cognitive ability and greater risk for alcohol abuse. In addition, the underlying mechanisms responsible for the gender-specific link between childhood cognitive ability and the risk of experiencing internalising disorders in mid-adulthood warrants further consideration.     

Life Course Outcomes on Mental and Physical Health: The Impact of Foster Care on Adulthood

Objective. We compared the prevalence rates of mental health and physical health problems between adults with histories of childhood foster care and those without.Methods. We used 2003–2005 California Health Interview Survey data (n = 70 456) to test our hypothesis that adults with childhood histories of foster care will report higher rates of mental and physical health concerns, including those that affect the ability to work, than will those without.Results. Adults with a history of childhood foster care had more than twice the odds of receiving Social Security Disability Insurance because they were unable to work owing to mental or physical health problems for the past year, even after stratifying by age and adjusting for demographic and socioeconomic characteristics.Conclusions. Childhood foster care may be a sentinel event, signaling the increased risk of adulthood mental and physical health problems. A mental and physical health care delivery program that includes screening and treatment and ensures follow-up for children and youths who have had contact with the foster care system may decrease these individuals’ disproportionately high prevalence of poor outcomes throughout their adulthood.More than 250 000 US children enter foster care every year and almost 20% of them reside in California.1 Children living in foster care, compared with other children, disproportionately come from low-income families, are ethnic and racial minorities,2 and have higher rates of physical, psychological, and social problems.3–6 The current literature suggests that the psychosocial concerns noted for some children who enter foster care persist as they get older and are manifested as severe social problems, including high rates of teen pregnancy, substance abuse, and arrests.7,8 Disproportionately high percentages of children who have a history of foster care, compared with those who do not, exhibit mental health problems.9,10At age 18 years, when adolescents “age out” or are emancipated from the foster care system, the newly independent young adults have very little support and encounter astonishingly high rates of unemployment and homelessness.11,12 Mental health, social, and other concerns appear to continue among children who have experienced foster care throughout their youth.Although the idea that a childhood event could have adulthood risks and ramifications is not new, there is a resurgence of interest in this paradigm, as it may be possible to intervene and reduce or prevent adulthood sequellae.13 Almost a decade ago, a study using a sample drawn from a large Southern California managed care program (i.e., Kaiser Permanente’s Adverse Childhood Experiences or ACE) examined the prevalence of several adverse childhood events (e.g., psychological, physical, and sexual abuse) and household dysfunction (e.g., parental substance abuse, mental illness, incarceration, and domestic violence) and found a correlation between the number of adverse childhood events and several adulthood risk factors for death (e.g., smoking, obesity, depressed mood, alcoholism, and drug use).14The life course approach, the idea that an event or injury occurring in childhood could manifest health risks and ramifications later in adulthood, notes that the timing of an event in the life trajectory is important. There are critical periods in a lifetime when a dramatic event at a point in childhood is more likely to have a serious effect in adulthood, but the same dramatic event may have lesser effects if it occurs at another time point. For example, some investigations have found that adults’ health status and morbidity and mortality rates were linked to their father’s job and education levels when they were children.15–17Researchers studying homeless populations have found that childhood histories of foster care are correlated with the presence of adulthood mental disorders.18–20 Yet, these studies used samples consisting of only homeless adults. Are these findings generalizable to all adults with histories of childhood foster care? We compared prevalence rates of mental health and physical health problems between 2 groups of adults: those with histories of childhood foster care and those without. Accordingly, we hypothesized that adults who have had childhood histories of foster care, compared with those who have not, will report higher rates of mental and physical health concerns, including those that affect the ability to work.     

Socioeconomic position and self-rated health: the contribution of childhood socioeconomic circumstances, adult socioeconomic status, and material resources

OBJECTIVES: We examined socioeconomic inequalities in self-rated health by analyzing indicators of childhood socioeconomic circumstances, adult socioeconomic position, and current material resources. METHODS: We collected data on middle-aged adults employed by the City of Helsinki (n=8970; 67% response rate). Associations between 7 socioeconomic indicators and health self-ratings of less than "good" were examined with sequential logistic regression models. RESULTS: After adjustment for age, each socioeconomic indicator was inversely associated with self-rated health. Childhood economic difficulties, but not parental education, were associated with health independently of all other socioeconomic indicators. The associations of respondents' own education and occupational class with health remained when adjusted for other socioeconomic indicators. Home ownership and economic difficulties, but not household income, were the material indicators associated with health after full adjustment. CONCLUSIONS: Own education and occupational class showed consistent associations with health, but the association with income disappeared after adjustment for other socioeconomic indicators. The effect of parental education on health was mediated by the respondent's own education. Both childhood and adulthood economic difficulties showed clear associations with health and with conventional socioeconomic indicators.