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Accumulation of disadvantage from adolescence to midlife: A 26-year follow-up study of 16-year old adolescents
National Institute for Health and Welfare, Finland.
2017 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

There is a wide range of evidence that childhood conditions are associated with adult wellbeing and disadvantage. However, in many cases, there is still a lack of knowledge on how and why these associations are formed. The life-course perspective examines these longitudinal mechanisms linking wellbeing and disadvantage in different life phases and tries to understand the continuities and discontinuities of individual lives. Information on these longitudinal associations is needed in order to be able to affect adverse life paths. For several decades, it has been suggested that disadvantage is a multidimensional concept that encompasses several dimensions of life such as health, social relations, socioeconomic factors and risky behaviour. Different forms of disadvantage are known to correlate, but less is known about how these disadvantages are interlocked in time. Accumulation of disadvantage refers to these processes, where previous disadvantages affect subsequent disadvantage. Mortality can be seen as an extreme end point of accumulation of disadvantage. The multidimensional approach to disadvantage is still underutilized in research in many ways. Often the focus has been in socioeconomic and health related forms of disadvantage or in risky behaviour, but rarely studies have taken several different dimensions of life into account simultaneously. The general aim of this study was to examine accumulation of disadvantage from adolescence to midlife in a life-course perspective. This study approaches the concept of disadvantage from a multidimensional perspective covering life dimensions of health, social relations, socioeconomic factors and risky behaviour. This study is a part of wider follow-up study Stress, Development and Mental Health –Study (TAM-project), which is carried out at the National Institute for Health and Welfare (THL). The study has prospectively followed up a Finnish urban age cohort at the ages of 16, 22, 32 and 42. The original study population included all Finnish speaking ninth-grade pupils attending secondary schools in the spring of 1983 in Tampere, Finland. In the first phase of the study, 2194 pupils (96.7%) aged 16 years completed a self-administered questionnaire during school hours. In three later phases the study cohort was followed up using postal questionnaires when the subjects were 22 (n=1656, 75.5%), 32 (n=1471, 67.0%) and 42 (n=1334, 60.7%) years old. This study examined multidimensional disadvantage using life-course models of clustered disadvantage, chain of risk and accumulation and found support for all of them. According to the results of this study, several individual and clustered forms of disadvantage in adolescence were associated with mortality before midlife. Lack of educational plans or uncertainty of them at age 16 was the strongest single predictor of mortality. Multiple simultaneous forms of disadvantage related to social relations, risky behaviour and own and parental socioeconomic factors were associated with mortality. This was the case also when disadvantage extended to many dimensions of disadvantage simultaneously. We found that poor family relationships in adolescence played a role in chains of disadvantages lasting all the way to midlife. The pathways from poor family relationships to economic adversity in midlife were shaped by low education and poor mental health in 5 early adulthood in women. In men this association was found to be shaped by early adult education, but it was explained by poor school performance already at age 16, indicating that those men with poor family relationships are already in adolescence on a disadvantage trajectory that will continue into adulthood regardless of whether they have problems in family relationships. The pathways to poor mental health in midlife were shaped mainly by mental health in early adulthood and in women also by heavy drinking. In the final life-course model we focused on accumulation of heavy drinking and examined it by using trajectory models. The results indicate that women of the steady high alcohol trajectory from adolescence to midlife had an increased risk of experiencing almost all measured disadvantages at age 42 (health, social relations, socioeconomic factors). In men, those who increased their drinking or drank steadily heavily had an increased risk for experiencing health and economic disadvantage in midlife. Frequent heavy drinking in adolescence did not leave 'a scar' that would associate with midlife disadvantage, if the drinking was reduced after adolescence. Childhood and adolescent disadvantages have long-term effects on wellbeing/disadvantage all the way to midlife, but they do not inexorably determine people's lives, also conditions in other life phases shape the life course. This provides many possibilities for preventive actions that should be targeted, not only to early years of life, but to later life phases as well. Our results highlight the importance of targeting interventions to improving the family relationships, supporting the educational career of the disadvantaged and preventing detrimental alcohol use

Place, publisher, year, edition, pages
Helsinki: University of Helsinki, 2017. , 103 p.
Series
Dissertationes Scholae Doctoralis Ad Sanitatem Investigandam Universitatis Helsinkiensis, ISSN 2342-317X ; 8/2017
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
URN: urn:nbn:se:uu:diva-318832ISBN: 978-951-51-2869-0 (print)ISBN: 978-951-51-2870-6 (electronic)OAI: oai:DiVA.org:uu-318832DiVA: diva2:1085375
Opponent
Supervisors
Available from: 2017-04-12 Created: 2017-03-28 Last updated: 2017-04-12Bibliographically approved
List of papers
1. A 26-year follow-up study of heavy drinking trajectories from adolescence to mid-adulthood and adult disadvantage
Open this publication in new window or tab >>A 26-year follow-up study of heavy drinking trajectories from adolescence to mid-adulthood and adult disadvantage
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2013 (English)In: Alcohol and Alcoholism, ISSN 0735-0414, E-ISSN 1464-3502, Vol. 48, no 4, 452-7 p.Article in journal (Refereed) Published
Abstract [en]

AIMS: The aim of the study was to identify heavy drinking trajectories from age 16 to 42 years and to examine their associations with health, social, employment and economic disadvantage in mid-adulthood.

METHODS: Finnish cohort study's participants who were 16 years old in 1983 were followed up at age 22, 32 and 42 (n = 1334). Heavy drinking was assessed at every study phase and based on these measurements trajectories of heavy drinking were identified. The trajectory groups were then examined as predictors of disadvantage at age 42.

RESULTS: Five distinct heavy drinking trajectories were identified: moderate (35%), steady low (22%), decreasing (9%), increasing (11%) and steady high (23%). Frequencies of the trajectory groups differed by gender. Using the moderate trajectory as a reference category, women in the steady high trajectory had an increased risk of experiencing almost all disadvantages at age 42. In men, increasing and steady high groups had an increased risk for experiencing health and economic disadvantage.

CONCLUSION: Steady high female drinkers and steady high and increasing male drinkers had the highest risk for disadvantage in mid-adulthood. By identifying heavy drinking trajectories from adolescence to mid-adulthood we can better predict long-term consequences of heavy alcohol use and plan prevention and intervention programmes.

National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:uu:diva-318825 (URN)10.1093/alcalc/agt026 (DOI)23531717 (PubMedID)
Available from: 2017-03-28 Created: 2017-03-28 Last updated: 2017-04-12
2. Nuoruusiän huono-osaisuus ja sen kasautumisen yhteys kuolleisuuteen. Seurantatutkimus 16-vuotiaista nuorista
Open this publication in new window or tab >>Nuoruusiän huono-osaisuus ja sen kasautumisen yhteys kuolleisuuteen. Seurantatutkimus 16-vuotiaista nuorista
2011 (Finnish)In: Sosiaalilääketieteellinen Aikakauslehti, Vol. 48, no 3, 168-181 p.Article in journal (Refereed) Published
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:uu:diva-318831 (URN)
Available from: 2017-03-28 Created: 2017-03-28 Last updated: 2017-04-12
3. Pathways from poor family relationships in adolescence to economic adversity in mid-adulthood
Open this publication in new window or tab >>Pathways from poor family relationships in adolescence to economic adversity in mid-adulthood
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2016 (English)In: Advances in Life Course Research, ISSN 1569-4909, E-ISSN 1879-6974Article in journal (Refereed) In press
Abstract [en]

Previous studies have found that troubled childhood family conditions have long-term detrimental effects on a person’s economic situation in adulthood. However, the mechanisms behind these effects are unclear. The aim of this study was to examine the associations between poor adolescent family relationships and the economic adversity in mid-adulthood and whether different adversities in early adulthood mediate this association.

Participants of a Finnish cohort study at 16 years in 1983 were followed up when aged 22, 32 and 42 (N = 1334). Family relationships were measured according to adolescents’ perceived lack of emotional parental support (e.g. My mother is close to me (reversed)), lack of parental support in the individuation process and poor atmosphere at home. We analysed the direct effects of poor family relationships at age 16 on the economic adversity at age 42 and also indirect effects via various adversities at ages 22 and 32. The examined adversities were poor somatic and mental health, lack of an intimate relationship, low education and heavy drinking.

Poor adolescent family relationships were associated with economic adversity in mid-adulthood. For women, poor relationships were associated with their economic adversity (42y) through poor mental health and low education in early adulthood. For men, the effect was transmitted via low education, although this was not the case after adjusting for school achievement in adolescence.

The quality of family relationships in adolescence is associated with an individual’s economic situation well into mid-adulthood in women. Moreover, this association was not explained by family structure and parental SEP in adolescence. Early promotion of parent-child interaction, as well as health and education of individuals from troubled family conditions, might reduce economic inequality in adulthood.

National Category
Sociology
Identifiers
urn:nbn:se:uu:diva-318829 (URN)10.1016/j.alcr.2016.07.001 (DOI)
Available from: 2017-03-28 Created: 2017-03-28 Last updated: 2017-04-12

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