Self-Perceived Health in Early Self-Perceived Health in Early Adulthood: An examination of Adulthood: An examination of

distal, childhood effectsdistal, childhood effects John Cairney, PhDJohn Cairney, PhD

Centre for Addiction and Mental HealthCentre for Addiction and Mental HealthDepartment of Psychiatry and Public Health SciencesDepartment of Psychiatry and Public Health Sciences

University of TorontoUniversity of TorontoTerrance J. Wade, PhDTerrance J. Wade, PhD

Department of Community Health SciencesDepartment of Community Health Sciences Brock UniversityBrock University

Laurie Corna, BALaurie Corna, BADepartment of Public Health SciencesDepartment of Public Health Sciences

University of TorontoUniversity of Toronto

Review: Previous WorkReview: Previous Work• Self-perceived (assessed/rated) health (SPH) is a Self-perceived (assessed/rated) health (SPH) is a

powerful determinant of health service use, functional powerful determinant of health service use, functional health status and mortality health status and mortality (Benyamini & Idler 1999; Idler 2003) (Benyamini & Idler 1999; Idler 2003)

• The independent association with mortality in The independent association with mortality in particular, raises the question of what determines SPH particular, raises the question of what determines SPH

– Physical Health Status (chronic health problems, physical Physical Health Status (chronic health problems, physical functioning)functioning)

– Mental Health StatusMental Health Status– Life style factors (smoking, alcohol use) Life style factors (smoking, alcohol use) (Cairney 2000; Wade, (Cairney 2000; Wade,

Pevalin and Vingilis 2000)Pevalin and Vingilis 2000)

– Social and Economic Disadvantage Social and Economic Disadvantage (Warren 1994; Cairney 2000; (Warren 1994; Cairney 2000; Wade, Pevalin and Vingilis 2000)Wade, Pevalin and Vingilis 2000)

Review: Current ProjectReview: Current Project

• Position in the social structure (income, education) appears to be an important predictor of SPH in both young adults (Vingilis, Wade & Seeley

2002; Wade, Pevalin & Vingilis 2000) and in later life (Cairney 2000; Cairney and Arnold 1996)

• However, very little work has examined the pathways connecting position in the social structure to SPH (but see Cairney 2000; Wade, Pevalin and Vingilis 2000)

Review: Current ProjectReview: Current Project• In addition, like most work in the social

determinants of health, social structure is narrowly conceived in terms of current status

• A life course approach forces a consideration of the reproduction of inequality across generations (Reynolds and Ross 1998)

• Very little work explores whether SES of origin influences health outcomes in adulthood directly, or indirectly through other factors (e.g. lifestyle behaviours)

Review: Previous WorkReview: Previous Work• Finally, previous research has focused on specific Finally, previous research has focused on specific

segments of the life course (old age, adolescence) of the life course (old age, adolescence) • Longitudinal analyses have been short-term (1-5 year Longitudinal analyses have been short-term (1-5 year

periods) and again have focused on particular periods) and again have focused on particular developmental/transitional periods (e.g. retirement)developmental/transitional periods (e.g. retirement)

• We know of no work that has:We know of no work that has:(1) examined predictors of SPH from childhood to (1) examined predictors of SPH from childhood to

early adulthood, and;early adulthood, and;(2) examined the combined contribution of SES of (2) examined the combined contribution of SES of

origin and achieved status in predicting both origin and achieved status in predicting both health risk factors, and SPH in adulthoodhealth risk factors, and SPH in adulthood

MethodologyMethodology• Secondary Analysis of 2-Waves of a Secondary Analysis of 2-Waves of a

Longitudinal Sample of Children Aged 4 to Longitudinal Sample of Children Aged 4 to 11 Years (Wave 1)11 Years (Wave 1)

• 17-Year interval between Waves:17-Year interval between Waves:

Wave 1 Wave 2 Wave 3

(Baseline)

1983 ------- 2000

N=1694 N=1694

Data SourceData Source

• Ontario Child Health Study (OCHS Ontario Child Health Study (OCHS 1983; 2000)1983; 2000)

• Outcome Measures:Outcome Measures: – Self-rated Health (5-point scale)Self-rated Health (5-point scale)– General Health (SF-36)General Health (SF-36)– Mental Health (SF-36)Mental Health (SF-36)

Data SourceData Source• Distal Factors:Distal Factors:

– Family Structure in 1983 (single vs. two-parent)Family Structure in 1983 (single vs. two-parent)– Family Household Income in 1983 ($)Family Household Income in 1983 ($)

• Proximal Factors:Proximal Factors:– Education (years of educ; 8-24)Education (years of educ; 8-24)– Household Income ($)Household Income ($)– Weight (BMI)Weight (BMI)– Chronic Health Problems (count: 0-8)Chronic Health Problems (count: 0-8)– Self-Esteem (Rosenberg 1965)Self-Esteem (Rosenberg 1965)– Smoking (1-5 (never smoked))Smoking (1-5 (never smoked))– Alcohol Consumption (average drinks per day)Alcohol Consumption (average drinks per day)

MethodologyMethodology

• Secondary data analysis

• Series of staged OLS regressions to estimate pathways between predictor variables and outcome

• Data are weighted for non-response etc

Family Structure in 1983

Family Income 1983

Income in 2000

Education in 2000

BMI (2000)

Chronic Health Problems (2000)

Self-Esteem

Smoking

Alcohol Consumption

-.29***

R2=.09

.10***

.102***

R2=.04

R2=.09

R2=.04

.08**

.16*

**

.29***

R2=.03

R2=.07

R2=.14

R2=.07

-.11***

.36***

.07**

-.06*

-.06*

-.05*

-.21***

-.05* -.08**

-.07**

-.06*

Figure 1. Childhood SES, Current SES and Risk Factors

Family Structure in 1983

Family Income 1983

Income in 2000

Education in 2000

BMI (2000)

Chronic Health Problems (2000)

Self-Esteem

Smoking

Alcohol Consumption

Self-Rated Health

-.29***

R2=.09

.10***

.102***

R2=.04

R2=.24

R2=.09

R2=.04

.08**

.16*

**

.29***

.06**

R2=.03

R2=.07

R2=.14

R2=.07

-.08***

-.24***

-.31***

-.10***

-.11***

.36***

.07**

-.06*

-.06*

-.05*

-.21***

-.05* -.08**

-.07**

-.06*

Figure 2. Self-Rated Health

Family Structure in 1983

Family Income 1983

Income in 2000

Education in 2000

BMI (2000)

Chronic Health Problems (2000)

Self-Esteem

Smoking

Alcohol Consumption

General Health Perceptions

-.29***

R2=.09

.10***

.102***

R2=.04

R2=.32

R2=.09

R2=.04

.08**

.16*

**

.29***

R2=.03

R2=.07

R2=.14

R2=.07

-.34***

-.39***

-.08***

-.11***

.36***

.07**

-.06*

-.06*

-.05*

-. 21***

-.05* -.08**

-.07**

-.06*

Figure 3. General Health Perceptions

Family Structure in 1983

Family Income 1983

Income in 2000

Education in 2000

BMI (2000)

Chronic Health Problems (2000)

Self-Esteem

Smoking

Alcohol Consumption

General Mental Health

-.29***

R2=.09

.10***

.102***

R2=.04

R2=.37

R2=.09

R2=.04

.08**

.16*

**

.29***

-.05*

R2=.03

R2=.07

R2=.14

R2=.07

.06**

-.09***

-.58***

-.09***

-.11***

.36***

.07**

-.06*

-.06*

-.05*

-. 21***

-.05* -.08**

-.07**

.06**

.05*

-.06*

Figure 4. General Mental Health

DiscussionDiscussion• Children from single parent families (SPF) suffer

educational and income deficits in adulthood• These same deficits are associated with the risky

lifestyle behaviours, and chronic health problems, which in turn influence perceived mental and physical well-being

• However, the impact of family structure is also direct – children from SPFs are more likely to smoke, weigh more, and report more chronic health problems in adulthood. Thus, there are negative consequences associated with SPFs that affect more than just SES attainment

DiscussionDiscussion• The effect of FS is independent of income in 1983;

what other disadvantages associated with FS might be at work?

• Our findings support Link and Phelan’s (1995) argument regarding social conditions as fundamental causes

• The relationship between FS and lifestyle, for example, supports the idea that disadvantaged social circumstances puts individuals “at risk for risks”

• Negative or disadvantaged trajectories begin in childhood and extend across the life course