Self-Perceived Health in Early Adulthood: An examination of distal, childhood effects John Cairney, PhD Centre for Addiction and Mental Health Centre for Addiction and Mental Health Department of Psychiatry and Public Health Sciences University of Toronto Terrance J. Wade, PhD Department of Community Health Sciences Brock University Brock University Laurie Corna, BA Department of Public Health Sciences University of Toronto

Review: Previous Work Self-perceived (assessed/rated) health (SPH) is a powerful determinant of health service use, functional health status and mortality (Benyamini & Idler 1999; Idler 2003)Self-perceived (assessed/rated) health (SPH) is a powerful determinant of health service use, functional health status and mortality (Benyamini & Idler 1999; Idler 2003) The independent association with mortality in particular, raises the question of what determines SPHThe independent association with mortality in particular, raises the question of what determines SPH –Physical Health Status (chronic health problems, physical functioning) –Mental Health Status –Life style factors (smoking, alcohol use) (Cairney 2000; Wade, Pevalin and Vingilis 2000) –Social and Economic Disadvantage (Warren 1994; Cairney 2000; Wade, Pevalin and Vingilis 2000)

Review: 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 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 Work Finally, previous research has focused on specific of the life course (old age, adolescence)Finally, previous research has focused on specific segments of the life course (old age, adolescence) Longitudinal analyses have been short-term (1-5 year periods) and again have focused on particular developmental/transitional periods (e.g. retirement)Longitudinal analyses have been short-term (1-5 year periods) and again have focused on particular 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 early adulthood, and; early adulthood, and; (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 adulthood health risk factors, and SPH in adulthood

Methodology Secondary Analysis of 2-Waves of a Longitudinal Sample of Children Aged 4 to 11 Years (Wave 1)Secondary Analysis of 2-Waves of a Longitudinal Sample of Children Aged 4 to 11 Years (Wave 1) 17-Year interval between Waves:17-Year interval between Waves: Wave 1 Wave 2 Wave 3 (Baseline) N=1694

Data Source Ontario Child Health Study (OCHS 1983; 2000)Ontario Child Health Study (OCHS 1983; 2000) Outcome Measures:Outcome Measures: –Self-rated Health (5-point scale) –General Health (SF-36) –Mental Health (SF-36)

Data Source Distal Factors:Distal Factors: –Family Structure in 1983 (single vs. two-parent) –Family Household Income in 1983 ($) Proximal Factors:Proximal Factors: –Education (years of educ; 8-24) –Household Income ($) –Weight (BMI) –Chronic Health Problems (count: 0-8) –Self-Esteem (Rosenberg 1965) –Smoking (1-5 (never smoked)) –Alcohol Consumption (average drinks per day)

Methodology 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*** R 2 =.09.10***.102*** R 2 =.04 R 2 =.09 R 2 =.04.08**.16***.29*** R 2 =.03 R 2 =.07 R 2 =.14 R 2 = ***.36***.07** -.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*** R 2 =.09.10***.102*** R 2 =.04 R 2 =.24 R 2 =.09 R 2 =.04.08**.16***.29***.06** R 2 =.03 R 2 =.07 R 2 =.14 R 2 = *** -.24*** -.31*** -.10*** -.11***.36***.07** -.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*** R 2 =.09.10***.102*** R 2 =.04 R 2 =.32 R 2 =.09 R 2 =.04.08**.16***.29*** R 2 =.03 R 2 =.07 R 2 =.14 R 2 = *** -.39*** -.08*** -.11***.36***.07** -.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*** R 2 =.09.10***.102*** R 2 =.04 R 2 =.37 R 2 =.09 R 2 =.04.08**.16***.29*** -.05* R 2 =.03 R 2 =.07 R 2 =.14 R 2 =.07.06** -.09*** -.58*** -.09*** -.11***.36***.07** -.06* -.05* -. 21*** -.05* -.08** -.07**.06**.05* -.06* Figure 4. General Mental Health

Discussion 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

Discussion 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 Phelans (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