The emergence of health inequalities in early adulthood: evidence on timing and mechanisms from a West of Scotland cohort

Abstract

BackgroundEvidence is inconsistent as to whether or not there are health inequalities in adolescence according to socio-economic position (SEP) and whether or when they emerge in early adulthood. Despite the large health inequalities literature, few studies have simultaneously compared the relative importance of ‘health selection’ versus ‘social causation’ at this life-stage. This study followed a cohort through the youth-adult transition to: (1) determine whether, and if so, when, health inequalities became evident according to both class of origin and current SEP; (2) compare the importance of health selection and social causation mechanisms; and (3) investigate whether these phenomena vary by gender.MethodsData are from a West-of-Scotland cohort, surveyed five times between age 15 (in 1987, N=1,515, response=85%) and 36. Self-reported physical and mental health were obtained at each survey. SEP was based on parental occupational class at 15, a combination of own education or occupational status at 18 and own occupational class (with an additional non-employment category) at older ages. In respect of when inequalities emerged, we used the relative index of inequality to examine associations between both parental and own current SEP and health at each age. In respect of mechanisms, path models, including SEP and health at each age, investigated both inter and intra-generational paths from SEP to health (‘causation’) and from health to SEP (‘selection’). Analyses were conducted separately for physical and mental health, and stratified by gender.ResultsAssociations between both physical and mental health and parental SEP were non-significant at every age. Inequalities according to own SEP emerged for physical health at 24 and for mental health at 30. There was no evidence of selection based on physical health, but some evidence of associations between mental health in early adulthood and later SEP (intra-generational selection). Paths indicated intra-generational (males) and inter-generational (females) social causation of physical health inequalities, and intra-generational (males and females) and inter-generational (females) social causation of mental health inequalities.ConclusionsThe results suggest complex and reciprocal relationships between SEP and health and highlight adolescence and early adulthood as a sensitive period for this process, impacting on future life-chances and health.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-015-2674-5) contains supplementary material, which is available to authorized users.

The role of social position and depressive symptoms in adolescence for life-course trajectories of education and work: a cohort study

“…The activity state ‘outside the labour market’ was also more dominant among women than men, which, as noted above, most likely due to parental leave and sick leave. These findings are similar to those of Sweeting et al [6] based on a Scottish cohort of participants born in 1972 where the main reason for non-employment among men was unemployment and among women caring for home or family. The proportion of full-time employment in women is lower than among men, which most likely is due to women working part time and taking more responsibility for unpaid labour in the home [65, 67, 68].…”

“…The typical trajectories showing the highest level of education together with stable full-time employment were used as reference categories because those individuals were, based on existing evidence [6], assumed to be best off socioeconomically and health wise. The analysis was modelled in two steps: the first step investigated the crude (i.e.…”

“…There is a vast amount of studies confirming this intergenerational social reproduction of class and status [2–7]. For example, the levels of parental education, income, and social class are associated with the children’s adult socioeconomic positions and career paths [6, 8–11]. Young people’s socioeconomic background have also shown to predict (un)successful transitions from school to work [12].…”

Timing of poverty in childhood and adolescent health: Evidence from the US and UK

“…Second, adolescence is a time of rapid physical, social, emotional and cognitive development, so health conditions and behaviours that affect or reflect developmental processes during adolescence can have long term consequences ( Due et al, 2011 , Sawyer et al, 2012 , Viner et al, 2012 , Viner et al, 2015 ). Finally, poor physical or mental health in adolescence may present challenges to educational and occupational success, which can have lasting impacts on young people's life chances ( Haas, 2006 , Miech et al, 1999 , Sweeting et al, 2016 ). One potentially key determinant of adolescent health and behaviour is the socioeconomic status (SES) of the household in which the young person grew up.…”

“…One potentially key determinant of adolescent health and behaviour is the socioeconomic status (SES) of the household in which the young person grew up. Children in more disadvantaged households tend to have poorer outcomes ( Chen et al, 2006 , Due et al, 2011 , Emerson et al, 2005 , Hanson and Chen, 2007 , Joinson et al, 2016 , McLeod and Shanahan, 1993 ), although some studies suggest that adolescence can be a period of relative equality in health ( Siahpush and Singh, 2000 , Sweeting et al, 2016 , West et al, 1990 ), if not behaviour ( Green et al, 2016 ). This study focuses on associations between childhood SES and two adolescent health outcomes (physical health limitations and mental distress), and a health behaviour (smoking).…”