Childhood socioeconomic status and adult health
Sheldon Cohen,1 Denise Janicki-Deverts1Edith Chen,2 and Karen A. Matthews 3
− Discuss the link childhood and adolescent SES and adult health
− explore different environmental, behavioral, and physiological pathways that might explain how early SES
would influence adult health.
− address the ages when SES exposures matter most for setting adult health trajectories
− role of exposure duration in SES influences on later health.
− it is possible that childhood SES does not itself play a role in adult health, but merely represents a
marker of future adult SES
− poorer childhood conditions were not associated with mortality attributable to cancers unrelated to
smoking or to prostate cancer.
− Poorer SES during childhood place indiv. At moderate risk for adult CVD independent of adult SES
− CASE STUDY: Sweden SES data from Census, compared indiv. Born from 1944-1960 and died
o Indiv. From manual childhood social classes were more likely to die from all causes than
India. From non-manual social classes
o May be due to sick children becoming sick adults in contrast to childhood exposures
influencing adult mortality
− CASE STUDY: Johns Hopkins University students
o Analyzed childhood (CH) SES with health outcomes
o Low CH SES caused 2.4-fold increase risk of CHD
− CASE STUDY: New Zealand
o Indiv. Were followed through their life, CH SES was based on parental occupation
o Control for perinatal health and adult SES, showed lower CH SES was assoc. with poorer dental hlt
− CASE STUDY: association of early life SES with adult host resistance to cold
o 23% got cold,susceptibility to colds decreased in a graded fashion with the number of
childhood years during which participants’ parents owned their homes. This decreased
risk was attributable to both lower risk of infection and lower risk of illness in infected
− access to and affordability of health care is another explanation for the interaction between SES hierarchy
during childhood and adolescence and its affect on adult health
− inverse association between childhood socioeconomic conditions and adult morbidity and mortality
risk has been derived from research conducted in countries that have adopted systems of
nationalized health care such as Sweden, Norway, Finland, Great Britain, Scotland, New Zealand,
and South Korea
− childhood SES Physical environ. mechanisms (psychological/ health behav./ physiological) adult
physical health outcomes
− childhood SES Psychosocial environ. mechanisms (psychological/ health behav) physiolocal adult
physical health outcomes
− Unlike physical exposures, however, psychosocial exposures do not directly influence physiological
mechanisms. Rather, effects are all indirect via psychological factors (e.g., psychological stress,
negative affect) and health related behaviors.
− Prevalence of adult depression increases with decreasing SES
− Early psychosocial exposures associated with lower SES are also thought to alter biological systems
in a manner that can influence health decades later.
− Three broad conceptual models hypothesize when during childhood and adolescence and for what
duration SES related physical and psychosocial exposures have the most important implications for
adult health: timing , accumulation, and change models.
o Timing model
SES factors have greatest influence on adult health in experience during specific
developmental periods Link between early life SES and adult health depends on identification of
sensitive periods (when indiv. Are more vulnerable to SES exposures)
o Accumulation model
effects of low SES add up through life
risk for poor adult health increases with increasing intensity of socioeconomic
disadvantage and with increasing duration of exposure to such disadvantage.
In contrast to the timing model, the accumulation model is indifferent to when
during childhood and adolescence the SES-related exposures occur.
Rather, the accumulation model considers risk in proportion to the total dosage
of exposure to SES-related adversities over the course of childhood and
the accumulation model predicts that those experiencing low SES throughout
both childhood and adolescence are at greater risk for adult morbidity and
mortality than are those experiencing low SES during only parts of their
childhood or adolescence.
age is totally irrelevant.
The only thing that matters is the magnitude and duration of exposure.
o Change Model
direction of SES mobility across childhood and adolescence has implications for
adult health outcomes.
upward mobility, a change from lower to higher levels of SES, would result in
better adult health.
negative effects of low SES during early childhood would be partly or wholly
remediated by higher SES later in childhood or adolescence.
In contrast, downward mobility—a fall in SES over childhood and adolescence
—would result in poorer adult health.
− The first decade of twenty-first century marked by several global outbreaks of:
SARS, avian influenza, cholera, swine flu, and E coli food poisoning.
o Therefore increase in disease surveillance and outbreak investigtion
− Traditional epidemiology mainly uses statistical analysis of disease occurrence and
health behavious to inform health polity and biomed. interventions.
− Visible minorities role play an important role in health outcomes, in the operation
of health services, and in health research.
− Transmission and reactivation of TB is linked to social conditions of the most
socio-economically disadvantaged groups
− some infectious diseases operate on two mutually-reinforcing levels
− 1 level interaction
o occurs between two or more pathogens resulting in the locational or temporal clustering
of certain health problems.
o Two or more pathogens can interact on a biochemical and genetic level and accelerate
their negative impact on the health of an individual.
o Ex. of such synergistic interactions is HIV and TB.
o 13 million people living with HIV/AIDS worldwide are co-infected with TB
o TB enhances the progression of AIDS
o Most common cause of deat