1. The health of grandparents caring for their grandchildren: The role of early and mid-life conditions Di Gessa G, Glaser K and Tinker A Institute of Gerontology, Department of Social Science, Health & Medicine, King’s College London United Kingdom

2. Outline Background Aim and objectives Data and Methods Results Conclusion

3. Background Grandparents play crucial role in family life Evidence of the impact of childcare on grandparents’ health is mixed:  Custodial/Primary grandchild carers experience poorer health;  Higher quality of life, lower depression and loneliness among grandparents providing grandchild care (vs no care).

4. Background /2 Most studies are cross-sectional and samples consist mostly of US grandparents; Focus on primary and custodial care; Few studies have studied the link between grandchild care and grandparents’ health using a cumulative advantage/disadvantage framework.

5. Aim and objectives Examine the effects of caring for grandchildren on health among European grandparents i)Using longitudinal data ii)Using life history data, and controlling for cumulative experiences across the life course (paid work histories; health and socio-economic position in childhood).

6. Data 3 waves of multidisciplinary comparable surveys, representative of individuals 50+ – Survey of Health, Ageing and Retirement in Europe (SHARE) (N~27,000); France, Austria, Germany, Sweden, Denmark, Switzerland, The Netherlands, Italy, Spain, Greece, Belgium – Household response rate: 62%, with individual response rates higher than 85%; – First wave collected in 2004/05.  Focus on grandparents

7. Data /2 Waves 1, 2 provide information on grandparents, including demographic and socio-economic characteristics, health, and household characteristics. Wave 3 collects retrospective life history information about childhood conditions, and life events in adulthood.

8. Data /3 « During the last 12 months, have you looked after your grandchild[ren] without the presence of the parents? » If so i) «how often?» [daily, weekly, monthly, less often] ii) «about how many hours?» Intensive grandparental childcare if grandchildren were looked after by grandparents on a daily basis or at least 15 hours per week

9. Overview of Analysis Latent Health w2 Baseline Characteristics (w1) Age; Gender; Education; Household type, Country; Wealth quintiles; Number & Age of grandchildren; Childcare; Paid work and social engagement; Latent Health; Health behaviour (BMI, smoking); Depression; Cognitive function; Latent childhood disadvantage classes Number of unions; In paid work >75%; Has never worked; Has suffered i. Hunger; ii. ‘Adverse’ event; iii. Long periods of ill health

10. Measures  We used Latent Class Analysis in order to classify respondents into childhood conditions advantage/ disadvantage subgroups; [Dysfunctional parent; One parent dead; Occupation of breadwinner; Books in HH; toilet; Hot water; Bath; Heating; Poor health; In hospital or bed for one month or more; With severe illness at age of 10 ]  We used a Latent Variable to represent the concept of ‘somatic’ health; [Self-rated health, Self report of conditions (cancer, lung, heart, stroke, diabeter), Self report of limiting disability, Activities of Daily Living, Instrumental activities of daily living]

11. Sample and Methods Sample: ~16,000 grandparents aged 50+ at baseline; ~ 9,700 grandparents at 24-month follow-up; ~ 7,200 with history data. ~ 6,500 complete cases (~41%) Analysis Linear regression of the latent variable health at follow-up, controlling for both baseline and history socio-economic and demographic characteristics.

12. Results – descriptive /1 Grandparental childcareWave 1Wave 2 Not looking after50.2 Not intensive36.136.8 Intensive13.713.0 Total15,8879,644 Distribution of grandparent childcare, by wave Source: SHARE 2004/05, 2006 Countries: France, Austria, Germany, Sweden, Denmark, Switzerland, The Netherlands, Italy, Spain, Greece, Belgium

13. Results – descriptive /2 Not looking after Not intensive Intensive SRH fair/poor 46.930.536.7 ADL limitations 16.96.97.4 Depressed 30.520.727.2 In couple >80% 71.078.983.2 Never worked (W) 27.914.429.1 Suffered hunger 13.68.99.5 Childhood advantage 19.233.517.3 Poor 73.558.775.8 Distribution of selected grandparent’s characteristics, by childcare

14. Results – linear regression /1 Beta coefficients from models of ‘good’ health at wave 2 Younger grandparents in higher education, and in the higher wealth quintiles at baseline are less likely to report poor health at wave 2; No gender differences; No household composition differences; age and number of grandchildren not significant; Social engagement at baseline not significant.

15. Results – linear regression /2 Latent health0.558< 0.001 In lowest cognitive quintile– 0.0490.005 Depressed– 0.094< 0.001 Obese– 0.077< 0.001 Smoking– 0.0090.543 2 or more marital unions– 0.0180.352 In paid work for < 75% of working life– 0.0220.114 Has never worked– 0.0460.019 Has suffered long periods of ill health– 0.154<0.001 Has suffered hunger– 0.0220.228 Has suffered any ‘adverse’ event– 0.0190.298 Poor but in good health at 100.0010.932 Poor and in poor health at age 10 – 0.0390.054 Not intensive0.0330.010 Intensive0.0330.019

16. Conclusions Using waves 1, 2 and history data i)Provision of childcare –both intensive and non-intensive –positively associated with good health over time; ii)Such relationship remains even when accounting for childhood and adulthood disadvantage; iii)Expected relationships between baseline health, socio-economic and demographic characteristics and health at follow-up.

17. Limitations & Future work Attrition can bias results, especially in the older population where the most ‘disadvantaged’ have a higher probability of dropping out of the study;  Multiple Imputations, Sensitivity analysis “Selection effect” of grandparents who look after grandchildren. Unmeasured factor?

18. Thanks for your attention! Questions, comments and feedback are welcome.

20. Childhood 3 classes Class proportion: 68%; 24%; 8% Classification accuracy: 0.84 Average Latent Class probability 123 10.940.040.02 2 0.960.02 30.090.060.85

21. Childhood /2 Figure 1. Conditional Response Probabilities

22. Somatic Health We used: Self rated health Self report of long-term health problems Self report of heart failure, chronic lung disease, stroke, diabetes, and cancer Activities of Daily Living Instrumental activities of daily living CFITLIRMSEA Unidimensional model 0.9770.9690.037