BILAVER, LUCY
Family Income at Birth & Childhood Obesity: The Developmental Origins of an Obesity Gradient
Presented: Chicago IL, Academy Health Annual Research Meeting, June 2009
Cohort(s): Children of the NLSY79
ID Number: 6316
Publisher: AcademyHealth

Permission to reprint the abstract has not been received from the publisher.

Research Objective: To investigate whether family income gradients in childhood overweight begin at birth. The majority of the work detailing inverse obesity gradients by parental income and socioeconomic status(SES) has relied on cross-sectional data. Given the evidence that obesity is a condition with developmental origins, this work will explore the effect of family income and SES during pregnancy on the development of childhood overweight. The analysis will also also test whether racial disparities exist after controlling for conditions during the prenatal period. Principal Findings: Total net family income and the family specific poverty threshold was used to create a poverty income ratio (PIR). The PIR was categorized into tertiles. In 2006, having family income in the low or middle PIR tertile was associated with 1.7 and 1.9 times the odds of overweight (BMI>95th percentile) compared with children in the upper tertile. There was no association between birth PIR tertile and childhood overweight status. In 1996, the opposite was true. Current family PIR had no association with childhood overweight status while PIR during the prenatal period was associated with a significant negative gradient. In models stratified by survey year and race, there was evidence of some racial disparities in PIR, but the results were inconsistent. During the mid-1990's, for example, Hispanic youth displayed a strong negative gradient in both current and prenatal PIR. There was no income gradient in overweight status among African American youth in this data.

DEMBE, ALLARD E.
SAVAGEAU, JUDITH A.
ERICKSON, J. BIANCA
BANKS, STEVEN M.
Social Inequalities in Occupational Health Care
Presented: AcademyHealth Annual Research Meeting, "Disparities in Health and Health Care : Race, Ethnicity & Patients' Experiences with Health Care" Washington, D.C., June 2002
Cohort(s): NLSY97
ID Number: 4747
Publisher: AcademyHealth

Permission to reprint the abstract has not been received from the publisher.

Research Objective: This study is aimed at determining whether there are disparities in the incidence of occupational injuries and illnesses and in medical care for those disorders, based on workers' race, ethnicity, and socioeconomic status (SES). Few previous studies have investigated social inequalities in occupational health. Based on existing fragmentary evidence, we hypothesize that Blacks, Hispanics, and workers with low SES have a disproportionately high incidence of occupational injuries and illnesses, receive inferior medical care, suffer more severe disability, return to work more slowly, and are less likely to receive compensation benefits than are whites and those with high SES.

Study Design: Retrospective cross-sectional analysis of two existing national population-based surveys: the National Ambulatory Medical Care Survey (NAMCS) and National Longitudinal Survey of Youth (NLSY). Pilot studies by us have demonstrated the usefulness of these databases in providing new information about occupational health care. This study will result in descriptive analyses of work-related cases from each database, including stratified sub-analyses comparing patient experiences among racial, ethnic, and socioeconomic patient groups, and selected multivariate analyses to assess the interactive effect of patient sociodemographic characteristics with employment experiences, medical services, and vocational outcomes.

Population Studied: The NAMCS covers physician-reported data for a nationally representative sample of 46,875 ambulatory medical care visits made in 1997-1998. 1,179 of those visits (2.5%) were for diagnosis and treatment of work-related conditions. Our analysis of the NLSY covers the experiences of 7,508 persons aged 33-4 who were interviewed in 1 998, of which 563 (7.5%) self-reported experiencing an occupational injury or illnesses in the 2-year period preceding the interview.

Principal Findings: Both analyses suggest that there are significant disparities among the social groups studied. In the NAMCS, Hispanics with work-related conditions required insurer authorization for care 57% more often than non-Hispanics, and Blacks 1 4% more often than whites. On average, Blacks saw a physician during their visit 6% less often than whites, and Hispanics 5% less often than non-Hispanics. Blacks had blood pressure measured at the visit 32% less often than whites, and Hispanics 11 % less often than non-Hispanics. The NLSY analysis indicated that following a work-related condition, Blacks were 1 6% more likely to miss work, had 28% more missed work days, and were 18% more likely to lose wages than non-Blacks. Similar patterns were observed among Hispanics compared to non-Hispanics, and low-SES (as indicated by educational attainment and family income) compared to high-SES workers.

Conclusions: Preliminary data from two national health care surveys indicates disparities in occupational health and health care for work-related conditions based on patients' race, ethnicity, and SES. These studies have demonstrated the usefulness of national survey databases as a novel source for collecting information about the health and vocational experiences of injured workers.

Implications for Policy, Delivery or Practice: This study helps demonstrate the barriers that Black, Hispanic, and low-SES workers face in accessing occupational health care, and their susceptibility to more severe vocational impacts following a work-related injury. These findings will help alert policymakers and public health advocates to the need to devise specific strategies for protecting the health and earning capacity of minority and low-wage workers.

FRANK, RICHARD G.
MEARA, ELLEN
Impact of Maternal Depression and Substance Abuse on Cognitive, Behavioral, and Educational Outcomes of Children
Presented: Washington, DC, AcademyHealth Research Conference, June 9-10, 2008
Cohort(s): Children of the NLSY79
ID Number: 6271
Publisher: AcademyHealth

Permission to reprint the abstract has not been received from the publisher.

Study Design: We use instrumental variables models (IV) to estimate causal links between maternal behavioral health (symptoms of depression, evidence of alcohol abuse or dependence, and heavy use of marijuana) and measures of cognitive, behavioral, and educational outcomes in children (age-standardized test scores in math and reading, behavioral problems, measures of delinquency, expulsion, grade repetition, and completion of high school by age 18). Specifically, we use information on the mental health status and alcoholism of maternal grandparents and the presence of symptoms of mental and addictive disorders early in a mother’s life as instruments for depression and substance abuse in motherhood in models of child outcomes described above. Our models of child outcomes also control for maternal demographics and household characteristics. Population Studied: Two cohorts of children born to mothers in the initial cohort of the 1979 National Longitudinal Survey of Youth (NLSY), a national household survey of high school students aged 14-22 in 1979. We follow 3,228 children aged 1-5 in 1987 and 2,737 children aged 1-5 in 1992, observing them through age 18-22 (Cohort 1) and 13-17 (Cohort 2).

GREEN, LISA H.
Race/Ethnicity, Socioeconomic Experience and Adult Health
Presented: San Diego, AcademyHealth Annual Research Meeting, June 2004
Cohort(s): NLSY79
ID Number: 4721
Publisher: AcademyHealth

Permission to reprint the abstract has not been received from the publisher.

Research Objective: To better elucidate the role of socioeconomic experience in the race/ethnicity and health relationship among working-age adults, this study examines multiple domains of socioeconomic experience within a lifecourse paradigm. The aims of this study are to identify the racial/ethnic differences in global health outcomes among working age adults, and to determine what role individual-level socioeconomic experience has in explaining these differences. Study Design: Sex and sex-race stratified multivariate linear regression models were used to examine the impact of education, occupational prestige and 19 year income on five health outcomes (SF-12 Physical and Mental Health Summary Scores, depression, major morbidities and minor morbidities) measured at age 40. Data were drawn from the National Longitudinal Survey of Youth 1979 for the years 1979-2000.... Those who have reached age 40 and answered the age 40 health module were included (n=3,154) in this study.

Principal Findings: In sex stratified models, socioeconomic factors alone fully accounted for observed disparities, and provided a protective effect for major and minor morbidities among black and Mexican respondents, compared to white counterparts. Income in particular played a strong role in explaining racial/ethnic differences. The sex and race stratified models revealed that socioeconomic factors impact different population groups in different ways. Income appeared to have a lagged effect among black men and women, and no effect on Mexican men and women. Education exhibited a gradient effect for most sex-race categories and occupational prestige had minimal to no effect on health outcomes of respondents, compared to white counterparts. Income in particular played a strong role in explaining racial/ethnic differences. In sex and race stratified models, income appeared to have a lagged effect among black men and women, and no effect on Mexican men and women. Education exhibited a gradient e ffect for most sex-race categories and occupational prestige had minimal to no effect on health outcomes.

Conclusions: This study addresses gaps in the literature on whether more complex and perhaps more robust definitions of socioeconomic experience attenuate observed racial/ethnic disparities in health, and on how such socioeconomic patterns over the life course predict health in adulthood. Health status is also key to understanding the health of working adults, where morbidity is relatively low and mortality is disproportionately dominated by HIV, injury and homicide. The working age population represents the most productive segment of the U.S. population, both economically and socially, and represents a much overlooked subgroup ripe for preventive health intervention. Understanding the health differentials and needs during this productive time period, prior to more significant and rapid health declines in later life, are critical. Prior reviews have examined mortality or disease endpoints (e.g. cardiovascular, cancer, other morbidity) with substantially less attention paid to more global concepts of health. Additional research capturing both the longitudinal and contextual dimensions of socioeconomic experience in a broader population is still needed.

HAN, EUNA
NORTON, EDWARD C.
POWELL, LISA M.
Direct and Indirect Effects of Teenage Body Weight on Adult Wages
Presented: Chicago, IL, Academy Health Annual Research Meeting, June 28-30, 2009
Cohort(s): NLSY79
ID Number: 6297
Publisher: AcademyHealth

Permission to reprint the abstract has not been received from the publisher.

Research Objective: This paper examines the direct effect of BMI on wages and the indirect effects operating through education and occupation choice, particularly for late-teen BMI and adult wages. In addition to the direct effect of BMI in the late teenage years between age 16 and 20 on long-term wages in the early thirties, late teen BMI is hypothesized to also affect wages in the early thirties indirectly through its effect on education and occupation choice in the early thirties.

Study Design: We present an empirical model that predicts wages as a function of BMI (the direct effect), education and occupation choice (indirect effects of BMI), and other factors. The effect of a unit change in late teen BMI on the logarithm of wages in the early career stage is the full derivative of the logarithm of wages in the early career with respect to late teen BMI, taking into account the indirect effect of late teen BMI through education and occupation choice in the early career. To calculate the indirect effects, we estimate the effect of late teen BMI on the stock of education accumulated by the time an individual reaches their early 30s using OLS. We specify education in the early thirties as a function of late teen BMI and other factors in the early thirties. We then estimate reduced form models of the effect of late teen BMI on occupation choice among white-collar, service, sales, managerial or professional specialty jobs, and blue-collar jobs (based on Census occupational codes), and choice of jobs requiring social interactions with colleagues or customers (based on the Dictionary of Occupation Titles).

SCHMEISER, MAXIMILIAN D.
Impact of Long Term Participation in the Supplemental Nutrition Assistance Program on Child Obesity
Presented: Chicago IL, Academy Health Annual Research Meeting, June 2009
Cohort(s): Children of the NLSY79
ID Number: 6313
Publisher: AcademyHealth

Permission to reprint the abstract has not been received from the publisher.

Research Question: • Does participation in the SNAP program increase obesity among children ages 5 to 18? • Focus on percent of time over past 5 years child participated in SNAP since obesity is a stock measure which takes time to adjust to changes in behavior • Use an Instrumental Variables (IV) strategy to identify causal effect of SNAP participation on child obesity

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