A Structural Approach to Understanding the Long-Term Health Effects of Childhood Poverty Restricted; Files Only
Dore, Emily (Spring 2024)
Abstract
Research has repeatedly shown that individual-level measures of childhood socioeconomic status (SES), such as parental income, education, occupation, or wealth, are positively associated with adult health. This is a powerful finding that points to the importance of early intervention to improve long-term health, especially for children who grew up in poverty. Less explored is the role of structural and political context in shaping childhood SES and its relationship to adult health. An understanding of structural and political conditions places individual-level behaviors, choices, and outcomes into a social context that impacts access and opportunities differently for people based on demographic characteristics, including place of residence. Illuminating structural and political determinants of health along the life span could improve interventions by broadening their reach to the population level, complimenting interventions that concentrate on individual behavioral changes.
This dissertation highlights the importance of a structural approach to understanding life course health by illuminating the work that has already been done and making new theoretical and empirical contributions to the literature. The first chapter is a scoping review of an emerging field that examines the impact of childhood exposure to social and economic policies on adult health. In general, findings from the 18 articles identified suggest that more equity-centered and generous policies have positive effects on long-term health. The second chapter is a descriptive study of state-variation in the relationship between childhood SES and self-rated health. This study identifies important differences in the size of health disparities by childhood SES across states and examines potential reasons for these findings. The final chapter examines the long-term health impact of welfare reform exposure in childhood, as one example of a policy exposure that has not yet been analyzed in this way. This study found little evidence of welfare reform on long-term health but elaborates on future avenues of research. Taken together, the chapters of this dissertation suggest that childhood social, economic, and political context plays a role in shaping long-term health and should be considered more often by researchers and policymakers as a way to improve population health.
Table of Contents
Introduction 1
Chapter 1: The Long-Term Health Effects of Childhood Exposure to Social and Economic Policies: A Scoping Review 17
Figure 1: Flowchart of the Search Process 44
Table 1: Summary of Studies 45
Chapter 2: Geographical Variation in the Long Arm of Childhood 51
Table 1: Weighted Descriptive Statistics of Study Sample 82
Table 2: Association Between Childhood SES and Poor Health 82
Figure 1: Probability of Reporting Poor Health by Parental Education and State 83
Figure 2: Difference in the Probability of Reporting Poor Health by Parental Education and State, Unadjusted and Adjusted for Own Education, State Gini Coefficient, State TANF-to-Poverty Ratio 84
Figure 1: Probability of Reporting Poor Health by Parental Education and State—Only States with Significant Differences in Childhood SES Predictiveness for Poor Adult Health 86
Figure 2A. Difference in the Probability of Reporting Poor Health by Parental Education and State, Unadjusted and Adjusted for Own Education, State Gini Coefficient, State TANF-to-Poverty Ratio—Only States with Significant Differences in Childhood SES Predictiveness for Poor Adult Health 87
Figure 3A. Probability of Reporting Poor Health by Parental Education and State—Only Stayers 88
Figure 4A. Probability of Reporting Poor Health by Parental Education and State—Only Individuals 25 Years and Older 90
Figure 5A. Difference in Probability of Reporting Poor Health by Parental Education and State, Unadjusted and Adjusted for Own Education, State Gini Coefficient, State TANF-to-Poverty Ratio—Only Individuals 25 Years and Older 92
Figure 6A. Probability of Reporting Poor Health by Parental Education and State—Without Survey Weights 94
Figure 7A. Probability of Reporting Poor Health by Parental Education and State—Controlling for Current State 96
Chapter 3: The Long-Term Health Effects of Welfare Reform 98
Table 1: Weighted Descriptive Statistics of Study Sample 138
Table 2: Estimated Effects of Welfare Reform in Childhood on Adult Health 139
Table 3: Estimated Effects of Welfare Reform in Childhood on Adult Health by Race/Ethnicity-Welfare Participation Groups 140
Table 4: Difference in Health with a One-Year Increase in Welfare Reform Exposure by Race/Ethnicity-Welfare Participation Groups 141
Figure 1. Timeline of Economic Policies Relevant to Health 142
Figure 2. Conceptual Framework 143
Figure 3. Predicted Levels of Psychological Distress by Welfare Reform Exposure and Race/Ethnicity 144
Conclusion 145
About this Dissertation
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File download under embargo until 22 May 2025 | 2024-02-27 14:51:31 -0500 | File download under embargo until 22 May 2025 |
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