Intergenerational reproduction and self-assessed mental health in adulthood in China.

Physical and mental health disparities by socioeconomic status in China are well documented but the effects of the intergenerational reproduction in socioeconomic status on adult mental health have received little attention to date. We utilized cross-sectional data from the 2017 Chinese General Social Survey to examine the significance of intergenerational socioeconomic reproduction for differences in self-assessed mental health in a national sample of Chinese adults between the ages of 23 and 65. We documented substantial elasticities between the socioeconomic status of the survey respondents and their parents: father's education, mother's education and childhood social class were all associated with both respondent education and respondent household income. We also found that associations between parental socioeconomic status and their adult children's self-assessed mental health were partly explained by the children's own socioeconomic status. However, these pathways were noticeably moderated by age cohort. Among younger people, associations between parental socioeconomic status and mental health were mostly explained by educational attainment whereas among older people associations between parental socioeconomic status and mental health were mostly explained by household income. In general, parental socioeconomic status appear to have a greater influence on the mental health of people who grew up after the Chinese economic reform of the 1970s.

Intergenerational reproduction and adult self-rated physical health in China.

We used cross-sectional data from the 2017 Chinese General Social Survey to investigate whether and how Chinese parents utilize their socioeconomic resources to facilitate the acquisition of socioeconomic resources by their children that in turn affect the self-rated health of the adult children. We found that father's type of work unit (danwei) and father's membership in the Chinese Communist Party were not independently associated with the self-rated health of survey respondents. Father's education was associated with the self-rated health of women, especially younger women, and self-reported childhood social class was associated with the self-rated health of men and older women, most strongly so for younger men. Two thirds of the association between father's education and self-rated health among younger women was statistically explained by personal socioeconomic resources and almost a quarter of the association between self-reported childhood social class and self-rated health among younger men was statistically explained by personal socioeconomic resources. Our study illuminates the importance of intergenerational reproduction in fostering the good health of Chinese adults, especially for those who grew up after the Chinese economic reform of the 1970s.

Intergenerational reproduction and self-rated health in Canada.

Intergenerational processes in which the socioeconomic status of middle- and upper-class parents is reproduced in their children have been extensively documented by social scientists. We mobilized a unique dataset, the Longitudinal and International Study of Adults (LISA) linked to income data from the Canada Revenue Agency (CRA), to investigate the relevance of intergenerational socioeconomic reproduction for inequalities in self-rated health in a national sample of Canadians aged 25 to 50. We found strong intergenerational elasticities implicating both parental education and parental family income in the acquisition of both personal education and personal family income. Parental education was not significantly associated with self-rated health. Parental family income was significantly associated with self-rated health among women only, partly explained by the socioeconomic status of the women themselves. These results suggest that intergenerational reproduction plays a small role in the generation of high levels of self-rated health among Canadian women but not among Canadian men.

Les processus intergénérationnels dans lesquels le statut socioéconomique des parents de classe moyenne et supérieure est reproduit chez leurs enfants ont été largement documentés par les chercheurs en sciences sociales. Nous avons mobilisé un ensemble de données unique, l'Étude longitudinale et internationale des adultes liée aux données sur le revenu de l'Agence du revenu du Canada, pour étudier la pertinence de la reproduction socioéconomique intergénérationnelle pour les inégalités en matière de santé auto-évaluée dans un échantillon national de Canadiens âgés de 25 à 50 ans. Nous avons trouvé de fortes élasticités intergénérationnelles impliquant à la fois l'éducation des parents et le revenu familial des parents dans l'acquisition de l'éducation personnelle et du revenu familial personnel. L'éducation des parents n'était pas significativement associée à la santé auto-évaluée. Le revenu familial parental était significativement associé à la santé auto-évaluée chez les femmes uniquement, ce qui s'explique en partie par le statut socio-économique des femmes elles-mêmes. Ces résultats suggèrent que la reproduction intergénérationnelle joue un petit rôle dans la génération de niveaux élevés de santé auto-évaluée chez les femmes canadiennes mais pas chez les hommes canadiens.

Interactions between parental and personal socioeconomic resources and self-rated health: Adjudicating between the resource substitution and resource multiplication theories.

A small body of research has documented intriguing findings, mostly from the United States but also from Europe, which suggest that the positive health effects of socioeconomic resources in adulthood may be conditioned by socioeconomic circumstances in childhood. There are two competing theories in this literature. The first contends that socioeconomic resources have a stronger effect on adult health for people from disadvantaged backgrounds because socioeconomic resources in adulthood substitute or compensate for a paucity of health-related resources earlier in life. The second contends that socioeconomic resources have a stronger effect on adult health for people from advantaged backgrounds because socioeconomic resources in adulthood compound or multiply the health effects of socioeconomic resources earlier in life. We used survey data from the 2012 Longitudinal and International Study of Adults linked to current and historical income data from the Canada Revenue Agency to investigate interactions between parental and personal socioeconomic resources - education and income, treated separately - as predictors of self-rated health in a sample of Canadians aged 25 to 50. Consistent with the resource multiplication theory, we found that the presumed benefits of personal family income for self-rated health were stronger for women from wealthier backgrounds than for women from poorer backgrounds. We found no evidence to support either theory among men. Overall, none of the interactions involving the education of parents or their adult children reached statistical significance. Our results are indicative of the importance of distinguishing between education and income for adults and their parents when adjudicating between these two theories.

Socio-economic resources and adult mental health in Canada: controlling for time-invariant confounders and investigating causal directionality.

OBJECTIVE: The aim of this study was to investigate whether family income and education have a causal effect on psychological distress among Canadian adults. METHODS: We executed fixed-effects regression analyses using data from the Longitudinal and International Study of Adults (LISA). We investigated whether changes in family income and education from wave 2 (2014) to wave 3 (2016) corresponded with changes in psychological distress during this same time period. We also investigated whether changes in these socio-economic resources from wave 1 (2012) to wave 2 (2014) corresponded with lagged changes in psychological distress from wave 2 (2014) to wave 3 (2016). These models controlled for all time-invariant confounders with time-invariant effects, as well as the time-varying factors age, marital status, household size, and employment status. RESULTS: Obtaining a postsecondary degree corresponded with lagged decreases in psychological distress among women ages 18 to 32 (b = -1.97; 95% CI = -3.53, -0.42) and men over the age of 32 (b = -1.86; 95% CI = -3.57, -0.15). The effect of postsecondary education was stronger when considering adults who stayed married throughout the three waves (b = -2.29; 95% CI = -4.37, -0.21). CONCLUSION: Completing postsecondary education may have a lagged causal effect on psychological distress, and the life course timing for when postsecondary completion reduces distress is different for women and men.

RéSUMé: OBJECTIF: L'objectif de cette étude était de déterminer si le revenu familial et le niveau de scolarité ont un effet causal sur la détresse psychologique chez les adultes canadiens. MéTHODES: Nous avons exécuté des analyses de régression à effets fixes en utilisant les données de l'Étude longitudinale et internationale des adultes (ELIA). Nous cherchions à savoir si les changements dans le revenu familial et le niveau de scolarité de la deuxième vague (2014) à la troisième vague (2016) correspondaient à des changements dans la détresse psychologique au cours de cette même période. Nous cherchions également à savoir si les changements dans ces ressources socio-économiques de la première vague (2012) à la deuxième vague (2014) correspondaient à un futur changement de la détresse psychologique de la deuxième vague (2014) à la troisième vague (2016). Ces modèles contrôlaient tous les facteurs de confusion invariant dans le temps, ainsi que quelques facteurs variant dans le temps (l'âge, l'état matrimonial, la taille du ménage et la situation d'emploi). RéSULTATS: L'obtention d'un diplôme d'études postsecondaires correspondait à des diminutions futures de la détresse psychologique chez les femmes de 18 à 32 ans (b = −1,97; IC à 95% = −3,53, −0,42) et les hommes de plus de 32 ans (b = −1,86; IC à 95% = −3,57, −0,15). L'effet des études postsecondaires était plus grand chez les adultes qui sont restés mariés pendant les trois vagues (b = −2,29; IC à 95% = −4,37, − 0,21). CONCLUSION: L'accomplissement des études postsecondaires peut avoir un effet causal sur la détresse psychologique. On note aussi que la période de vie pendant laquelle cette réduction est observée est différente pour les hommes et les femmes.

Does household income mediate the association between education and health in Canada?

Objectives: The study aim was to investigate whether household income mediates the association between education and health in a nationally representative sample of Canadian adults. Methods: The data came from the Longitudinal and International Study of Adults linked to income data from the Canada Revenue Agency. Odds ratios and predicted probabilities from binary logistic regression models were used to describe associations between education and (a) self-rated health, (b) longstanding illness or health problem, (c) emotional, psychological or mental health problem and (d) symptoms of psychological distress. The Karlson-Holm-Breen decomposition method was used to investigate the potentially mediating role of household income in these associations. The analyses were conducted separately for women and men. Results: Education was significantly associated with all four health indicators for both women and men. Of the four health indicators, education was most strongly associated with self-rated health for both women and men. Education was more strongly associated with self-rated health and the presence of an emotional, psychological or mental health problem for women than for men. Curiously, men with a postgraduate degree were significantly more likely than men with a bachelor degree to report symptoms of psychological distress. Only modest proportions of the associations between education and health could be attributed to differences in household income. Education and household income manifested independent associations with all four health indicators among women and with three of four health indicators among men. Conclusions: Education and household income are joint and independent predictors of health in Canada. Accordingly, both should be included in research on socioeconomic health inequalities in this context.

Asian-White Health Inequalities in Canada: Intersections with Immigration.

Three approaches to addressing factors associated with immigration were applied in a cross-sectional investigation of Asian-White health inequalities in Canada. Ten cycles of the Canadian Community Health Survey (2001-2013) were combined to produce a sample of 8122 Asian women, 365,702 White women, 6830 Asian men and 298,461 White men aged 18 and older. Binary logistic regression modelling was applied to self-reported hypertension, diabetes, fair/poor self-rated health and fair/poor self-rated mental health. Before adjusting for factors associated with immigration, Asian Canadians had relatively low risks of hypertension and diabetes and relatively high risks of fair/poor mental health. After adjustment Asian Canadians had relatively high risks of diabetes, fair/poor health and fair/poor mental health. The inequalities in fair/poor mental health applied primarily to the immigrant population. Risks of fair/poor health and fair/poor mental health were especially high for Asian women born in China and White women born in Italy. Use of stark racial identity categories that ignore country of birth or origin can obscure notable racial-ethnic health inequalities.

Capital interplays and social inequalities in health.

We explore the ramifications of applying Pierre Bourdieu's theory of capitals to epidemiological research on socioeconomic health inequalities. Capitals are resources used by individuals and groups to maintain and enhance their positions in the social order. The notion of capital interplay refers to the interconnectedness of multiple forms of capital in the production of good health. We provide definitions of economic, cultural and social capitals and describe a variety of causally distal processes-namely, capital acquisition, multiplier and transmission interplays-from which new hypotheses can be developed to guide future study of socioeconomic health inequalities in modern societies.

Black, White, Black and White: mixed race and health in Canada.

Objectives: To document inequalities in hypertension, self-rated health, and self-rated mental health between Canadian adults who identify as Black, White, or Black and White and determine whether differences in educational attainment and household income explain them. Design: The dataset was comprised of ten cycles (2001-2013) of the Canadian Community Health Survey. The health inequalities were examined by way of binary logistic regression modeling of hypertension and multinomial logistic regression modeling of self-rated health and self-rated mental health. Educational attainment and household income were investigated as potentially mediating factors using nested models and the Karlson-Holm-Breen decomposition technique. Results: Black respondents were significantly more likely than White respondents to report hypertension, a disparity that was partly attributable to differences in income. White respondents reported the best and Black respondents reported the worst overall self-rated health, a disparity that was entirely attributable to income differences. Respondents who identified as both Black and White were significantly more likely than White respondents to report fair or poor mental health, a disparity that was partly attributable to income differences. After controlling for income, Black respondents were significantly less likely than White respondents to report fair or poor mental health. Educational attainment did not contribute to explaining any of these associations. Conclusion: Canadians who identify as both Black and White fall between Black Canadians and White Canadians in regards to self-rated overall health, report the worst self-rated mental health of the three populations, and, with White Canadians, are the least likely to report hypertension. These heterogeneous findings are indicative of a range of diverse processes operative in the production of Black-White health inequalities in Canada.

Infusing fundamental cause theory with features of Pierre Bourdieu's theory of symbolic power.

The theory of fundamental causes is one of the more influential attempts to provide a theoretical infrastructure for the strong associations between indicators of socioeconomic status (education, income, occupation) and health. It maintains that people of higher socioeconomic status have greater access to flexible resources such as money, knowledge, prestige, power, and beneficial social connections that they can use to reduce their risks of morbidity and mortality and minimize the consequences of disease once it occurs. However, several key aspects of the theory remain underspecified, compromising its ability to provide truly compelling explanations for socioeconomic health inequalities. In particular, socioeconomic status is an assembly of indicators that do not necessarily cohere in a straightforward way, the flexible resources that disproportionately accrue to higher status people are not clearly defined, and the distinction between socioeconomic status and resources is ambiguous. I attempt to address these definitional issues by infusing fundamental cause theory with features of a well-known theory of socioeconomic stratification in the sociological literature-Pierre Bourdieu's theory of symbolic power.

Inequalities in Hypertension and Diabetes in Canada: Intersections between Racial Identity, Gender, and Income.

A growing body of research from the United States informed by intersectionality theory indicates that racial identity, gender, and income are often entwined with one another as determinants of health in unexpectedly complex ways. Research of this kind from Canada is scarce, however. Using data pooled from ten cycles (2001-2013) of the Canadian Community Health Survey, we regressed hypertension (HT) and diabetes (DM) on income in subsamples of Black women (n = 3,506), White women (n = 336,341), Black men (n = 2,806) and White men (n = 271,260). An increase of one decile in income was associated with lower odds of hypertension and diabetes among White men (ORHT = .98, 95% CI (.97, .99); ORDM = .93, 95% CI (.92, .94)) and White women (ORHT = .95, 95% CI (.95, .96); ORDM = .90, 95% CI (.89, .91)). In contrast, an increase of one decile in income was not associated with either health outcome among Black men (ORHT = .99, 95% CI (.92, 1.06); ORDM = .99, 95% CI (.91, 1.08)) and strongly associated with both outcomes among Black women (ORHT = .86, 95% CI (.80, .92); ORDM = .83, 95% CI (.75, .92)). Our findings highlight the complexity of the unequal distribution of hypertension and diabetes, which includes inordinately high risks of both outcomes for poor Black women and an absence of associations between income and both outcomes for Black men in Canada. These results suggest that an intersectionality framework can contribute to uncovering health inequalities in Canada.

Margins of freedom: a field-theoretic approach to class-based health dispositions and practices.

Pierre Bourdieu's theory of practice situates social practices in the relational interplay between experiential mental phenomena (habitus), resources (capitals) and objective social structures (fields). When applied to class-based practices in particular, the overarching field of power within which social classes are potentially made manifest is the primary field of interest. Applying relational statistical techniques to original survey data from Toronto and Vancouver, Canada, we investigated whether smoking, engaging in physical activity and consuming fruit and vegetables are dispersed in a three-dimensional field of power shaped by economic and cultural capitals and cultural dispositions and practices. We find that aesthetic dispositions and flexibility of developing and established dispositions are associated with positioning in the Canadian field of power and embedded in the logics of the health practices dispersed in the field. From this field-theoretic perspective, behavioural change requires the disruption of existing relations of harmony between the habitus of agents, the fields within which the practices are enacted and the capitals that inform and enforce the mores and regularities of the fields. The three-dimensional model can be explored at: http://relational-health.ca/margins-freedom.

Inter-categorical intersectionality and leisure-based physical activity in Canada.

Leisure-based physical activity is socially stratified in Canada. To date, inequalities in physical activity by race or ethnicity, gender, class or sexual orientation, in Canada and elsewhere, have largely been investigated as distinct, additive phenomena. Informed by intersectionality theory, this paper examines whether racial identity, gender, class and sexuality 'intersect' with one another to predict physical activity in data from Cycles 2.1 and 3.1 of the Canadian Community Health Survey (n= 149 574). In particular, we apply the intersectional principle of multiplicativity which suggests that people's experiences of their gender identities are raced, classed and sexualized; their racial experiences are gendered, classed and sexualized, and so forth. We find that the positive effect of income on being physically active is strong among visible minority men, of moderate strength among White men and women and weak to non-existent among visible minority women. We also find that a lesbian, gay or bisexual orientation corresponds with a higher likelihood of being physically active among women (especially among less educated women) but not among men. These multiplicative findings undermine additive approaches to investigating social inequalities in leisure-based physical activity and pave the way for future intersectional analyses of axes of inequality and their diverse, intersecting effects.

Black-White health inequalities in Canada at the intersection of gender and immigration.

OBJECTIVES: Intersectionality theory proposes that each combination of social categories derived from gender, race and nationality, such as immigrant White man or native-born Black woman, is associated with unique social experiences. We tested the potential of intersectionality theory for explicating racial inequalities in Canada by investigating whether Black-White health inequalities are conditioned by gender and immigrant status in a synergistic way. METHODS: Our dataset comprised 10 cycles (2001-2013) of the Canadian Community Health Survey. We used binary logistic regression to model Black- White inequalities in hypertension, diabetes, self-rated health, self-rated mental health and asthma separately for native-born women, native-born men, immigrant women and immigrant men. RESULTS: After controlling for potentially confounding factors we found that immigrant Black women had significantly higher odds of hypertension, diabetes and fair/poor self-rated health than immigrant White women. Native-born Black women and immigrant Black men had higher odds of hypertension and diabetes than native-born White women and immigrant White men respectively, and native-born White women were more likely than native-born Black women to report asthma. There were no statistically significant health differences between native-born Black and White men. Socio-economic status, smoking, physical activity and body mass index were implicated in some but not all of these racial health inequalities. None of the three-way interactions between racial identity, gender and immigration status was statistically significant. CONCLUSION: We found relatively high risks of ill health for Black Canadians in three of the four samples. Overall, however, we found little support for the intersectional hypothesis that Black-White health inequalities in Canada are conditioned by gender and immigrant status in a synergistic way.

Politics and population health: Testing the impact of electoral democracy.

This study addresses questions of whether and why electoral democracies have better health than other nations. After devising a replicable approach to missing data, we compare political, economic, and health-related data for 168 nations collected annually from 1960 through 2010. Regression models estimate that electoral democracies have 11 years of longer life expectancy on average and 62.5% lower rates of infant mortality. The association with life expectancy reduces markedly after controlling for GDP, while a combination of factors may explain the democratic advantage in infant health. Results suggest that income inequality associates independently with both health outcomes but does not mediate their associations with democracy.

South Asian-White health inequalities in Canada: intersections with gender and immigrant status.

OBJECTIVES: We apply intersectionality theory to health inequalities in Canada by investigating whether South Asian-White health inequalities are conditioned by gender and immigrant status in a synergistic way. DESIGN: Our dataset comprised 10 cycles (2001-2013) of the Canadian Community Health Survey. Using binary logistic regression modeling, we examined South Asian-White inequalities in self-rated health, diabetes, hypertension and asthma before and after controlling for potentially explanatory factors. Models were calculated separately in subsamples of native-born women, native-born men, immigrant women and immigrant men. RESULTS: South Asian immigrants had higher odds of fair/poor self-rated health, diabetes and hypertension than White immigrants. Native-born South Asian men had higher odds of fair/poor self-rated health than native-born White men and native-born South Asian women had lower odds of hypertension than native-born White women. Education, household income, smoking, physical activity and body mass index did little to explain these associations. The three-way interaction between racial identity, gender and immigrant status approached statistical significance for hypertension but not for self-rated health and asthma. CONCLUSION: Our findings provide modest support for the intersectionally inspired principle that combinations of identities derived from race, gender and nationality constitute sui generis categories in the manifestation of health outcomes.

Black-White Health Inequalities in Canada.

Little is known about Black-White health inequalities in Canada or the applicability of competing explanations for them. To address this gap, we used nine cycles of the Canadian Community Health Survey to analyze multiple health outcomes in a sample of 3,127 Black women, 309,720 White women, 2,529 Black men and 250,511 White men. Adjusting for age, marital status, urban/rural residence and immigrant status, Black women and men were more likely than their White counterparts to report diabetes and hypertension, Black women were less likely than White women to report cancer and fair/poor mental health and Black men were less likely than White men to report heart disease. These health inequalities persisted after controlling for education, household income, smoking, physical activity and body-mass index. We conclude that high rates of diabetes and hypertension among Black Canadians may stem from experiences of racism in everyday life, low rates of heart disease and cancer among Black Canadians may reflect survival bias and low rates of fair/poor mental health among Black Canadian women represent a mental health paradox similar to the one that exists for African Americans in the United States.

Capital interplays and the self-rated health of young men: results from a cross-sectional study in Switzerland.

INTRODUCTION: We apply capital interplay theory to health inequalities in Switzerland by investigating the interconnected effects of parental cultural, economic and social capitals and personal educational stream on the self-rated health of young Swiss men who live with their parents. METHODS: We apply logistic regression modelling to self-rated health in original cross-sectional survey data collected during mandatory conscription of Swiss male citizens in 2010 and 2011 (n = 23,975). RESULTS: In comparison with sons whose parents completed mandatory schooling only, sons with parents who completed technical college or university were significantly more likely to report very good or excellent self-rated health. Parental economic capital was an important mediating factor in this regard. Number of books in the home (parental cultural capital), family economic circumstances (parental economic capital) and parental ties to influential people (parental social capital) were also independently associated with the self-rated health of the sons. Although sons in the highest educational stream tended to report better health than those in the lowest, we found little evidence for a health-producing intergenerational transmission of capitals via the education stream of the sons. Finally, the positive association between personal education and self-rated health was stronger among sons with relatively poorly educated parents and stronger among sons with parents who were relatively low in social capital. CONCLUSIONS: Our study provides empirical support for the role of capital interplays, social processes in which capitals interpenetrate or co-constitute one another, in the intergenerational production of the health of young men in Switzerland.