Accumulation of disadvantage from adolescence to midlife : A 26-year follow-up study of 16-year old adolescents
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
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