Childhood adversities and health variations among middle-aged men: a retrospective lifecourse study
Jon Ivar ElstadNOVA - Norwegian Social Research Box 3223 Elisenberg, 0208 Oslo, Norway
Correspondence: Jon Ivar Elstad, NOVA - Norwegian Social Research, Box 3223 Elisenberg, 0208 Oslo, Norway, tel: +47 22 54 12 88, fax: +47 22 54 12 01, Email: jon.i.elstad{at}nova.no
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Abstract |
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Background: Using a lifecourse approach, this study examines whether childhood adversities act on adult health as latent or pathway effects, and whether not only childhood ill health and material deprivation, but also an adverse psychosocial environment in terms of stressful relations with parents contribute to later ill health. Methods: Lifecourse interviews with 380 men born in 1946 were conducted. Outcome variables were perceived health, number of medical conditions, and activity limitations. Ordinal scales indicating levels of exposures as regards childhood health/growth, childhood material deprivation, stressful relations with parents, educational level, and unhealthy adult behaviours were made. Statistical analyses were performed by non-parametric correlation, logistic regression and OLS regression with dummy variables. Results: Simple regression analyses showed a consistent pattern of more negative health outcomes with higher exposures on each of the lifecourse health determinants, but associations were relatively often not statistically significant. In multivariate analyses, the overall pattern remained with few alterations. The lifecourse determinants differed somewhat in their effects on the three health outcomes. Stressful relations with parents were significantly associated with perceived health and activity limitations. Conclusions: Childhood adversities influence later health to a large extent as latent effects. Stressful relations with parents were relatively important for two of the health outcomes, suggesting that not only ill health and material deprivation during childhood, but also an adverse psychosocial environment contributes to ill health among middle-aged men.
Key points
- The study asks whether childhood adversities influence middle-aged men's health through latent or pathway effects.
- Adjusted for adult circumstances, childhood health problems were associated with activity limitations and medical problems among men aged 55.
- Stressful relations to parents during childhood had direct negative effects on perceived overall health and activity limitations.
- Results indicate that childhood adversities often affect adult health as latent effects.
- Health promotion policies should consider that childhood psychosocial difficulties may have longterm negative health consequences
Keywords: childhood adversities, latent and pathway effects, lifecourse, middle-aged men, stressful relations with parents
The lifecourse perspective on health argues that not only exposures during adulthood, but in early life as well, are important for health in middle age.1–7 Studies have focused on pre-natal and infancy conditions,8 childhood health,9–11 and material and social environments during childhood,12–16 and examined how such circumstances influence later adult health.
One issue raised by the lifecourse approach is whether childhood disadvantages act on later health primarily in terms of latent or pathway effects.3,6,7 Latent effects imply that childhood adversities produce lasting damage which has negative consequences for future health more or less unaffected by later circumstances, while pathway effects mean that childhood disadvantages are connected to later ill health primarily because they tend to be followed by more unhealthy exposures during the adult career. Another issue is what kind of childhood circumstances are crucial. Ill health in early life could lead to impaired biological functioning with elevated chances of falling ill in later life, while material deprivation during childhood could increase the organism's susceptibility during adulthood. These factors could also hinder educational achievement and lead to less favourable occupational careers, and thereby be linked to health problems later in life as pathway effects.17,18 A psychosocial link between childhood and later ill health has also been suggested. Problematic social and personal relations in the family or in other important childhood arenas could nurture feelings of insecurity and other forms of problematic psychological functioning.15,19,20 Such experiences could generate personality characteristics21 which persist into adulthood in terms of less self-esteem, inadequate coping strategies, and less ability to obtain social support, with possible negative effects on adult health.22–24 An unfavourable early psychosocial environment could also hamper school performance and increase chances of unhealthy behaviours and thus be connected to later ill health as pathway effects.
Using data on a sample of Norwegian middle-aged men, this study seeks to explore these themes. Associations between three types of health outcomes in late middle age and various exposures during childhood and adulthood are analysed. The latent or pathway effect issue is addressed by examining whether the impact of childhood adversities is relatively independent or mediated by circumstances during adulthood. It is furthermore asked whether not only health and material situation during childhood, but also children's psychosocial environment in terms of their relations with parents, contribute to variations in later health.
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Data and Methods |
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Study sample
In 2001, a nationwide random sample of 596 men born in 1946 was drawn from the census register. Personal interviews conducted by the interview organization of Statistics Norway were obtained with 380 respondents (64%).25 The interviews covered many aspects of the respondents’ current situation (age 55), and retrospective questions were asked about various circumstances during childhood (age approximately 10-12), young adulthood (age 25), and middle adulthood (age 40).
Outcome variables
Perceived health at age 55 was elicited by a question about present self-assessed overall health, with five response alternatives (very good to very poor), dichotomized into good/very good and below good. Respondents were moreover asked about current longstanding diseases and illnesses. They were presented a list of diagnoses and also asked an open question about having any other longstanding health problem. The variable number of medical conditions counts the number of answers as regards hypertension, stroke, infarction, angina pectoris, other heart disease, chronic bronchitis, emphyzema, asthma, rheumatoid arthritis, osteo-arthritis and similar conditions, rheumatism, recurrent/frequent back pain, migraine, sciatica, epilepsy, multiple sclerosis, deafness or impaired hearing, diabetes or other endocrine diseases, and diseases of the digestive system such as ulcer and hernia. The third outcome variable, activity limitations, was formed from a question about degree of restricted activity due to longstanding health problems, dichotomized into no/little or some/very much.
Explanatory variables
Fifteen indicators were used to measure potentially health-detrimental circumstances during childhood and adulthood. Health, growth, and material situation during childhood were indicated by questions about longstanding illness, hospital stays, memory of stature at age 10–12, adult stature, economic situation in childhood family, crowded dwelling, and lack of food during childhood. Four indicators assessed the quality of respondents’ relations with their parents during childhood. Respondents were asked, separately for each parent, whether their father/mother was strict, easy to talk to, supportive, demanding, loving, quarrelsome, and whether they loved their father/mother during childhood. Answers to these seven items were added and used to form indicators of primarily positive versus highly negative memories of relations with father and with mother. Indicators were also formed for corporal punishment during childhood and violence/drunkenness among parents (two items combined). Adult socioeconomic status was indicated by respondents’ education, classified in three levels: high (approximately equivalent to college or university), medium (high school and similar), and basic. Educational information was provided by the educational register. Information about occupations and incomes during adulthood were also available in the data, but as education, occupation and income were highly interrelated and tended to suppress each other in the multivariate analyses, only educational level was used to indicate social position during adulthood. Finally, health-related behaviours during adulthood were measured by three indicators formed from questions about daily smoking at age 25 and 40, physical exercise at age 25 and 40, and current bodymass index (calculated from self-reports about height and weight), which could indicate unhealthy diets in adulthood.
These 15 indicators were subsequently used to form ordinal scales representing level of exposures as regards childhood health/growth, childhood material deprivation, stressful relations with parents, and unhealthy adult behaviours. The scales were made by adding the number of negative poles on the relevant indicators (all of them dichotomies). The scales ranged from 0 to 4 as regards childhood health/growth and stressful relations with parents and 0 to 3 as regards childhood material deprivation and unhealthy adult behaviours. Value 0 on the scales was classified as low level, value 1 as some, and values 2, 3 and 4 as high level of exposure. Educational level was also used in the same manner as an ordinal scale.
Missing answers were few, ranging from zero to 15 respondents with missing information about relations with their fathers. Due to missing answers and their aggregation, number of respondents included in each analysis were usually less than 380.
Statistical analyses
The distribution of the sample on the 15 indicators was described, and associations with the three outcome variables were analysed by percentage tabulations as regards perceived health and activity limitations and mean values as regards number of medical conditions. Non-parametric correlation analysis (Spearman's rho) was used to describe the interrelationships between the five ordinal scales representing childhood and adulthood determinants of health. The relationships between the health outcomes and the ordinal scales were analysed by binary logistic regression as regards perceived health and activity limitations, and by OLS regression with dummy variables as regards number of medical conditions, as this outcome variable can be considered a metric scale.
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Perceived health below good and some/very much activity limitations because of longstanding health problems were reported by 26% and 33%, respectively (table 1), while average number of reported medical conditions were 1.11 (range 0–7, 58% had at least one condition). Table 1 shows furthermore that the more unfavourable situations on each of the 15 indicators were practically always associated with reporting less good health on all three outcome variables, however, to varying degrees (only one exception: medical conditions as regards relations with mother).
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The correlational analyses (table 2) show that five of the ten bivariate associations between the five ordinal scales for lifecourse health determinants were significantly associated (i.e. p<0.05, one-tailed tests). Childhood material deprivation was associated with stressful relations with parents, and educational level was clearly associated with unhealthy adult behaviours. There were also significant associations across the lifecourse: childhood health/growth and childhood material deprivation were associated with educational achievement, and stressful relations with parents with unhealthy adult behaviours.
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Table 3 analyses the effects of the five lifecourse determinants on perceived health and activity limitations, both unadjusted (each health determinant separately) and adjusted for the other determinants. Unadjusted odds ratios (ORs) for reporting perceived health below good increased systematically with higher levels of exposures on each health determinant. Confidence intervals were, however, relatively large, and the ORs were statistically significant only as regards stressful relations to parents, educational achievement, and unhealthy adult behaviours. The ORs were sometimes reduced in the adjusted analysis, rendering fewer of them statistically significant. The adjusted analysis model was clearly significant (Model chi-square = 37.14, df = 10, p<0.001), and overall the pattern of higher ORs with higher level of exposures remained also in the adjusted analysis. As to activity limitations (right part of table 3), the pattern of higher ORs with higher levels of exposures was also evident in the unadjusted analyses, but only the ORs for unfavourable childhood health/growth, high level of stressful relations with parents, and basic education were significant. The adjusted model (model chi-square = 21.84, df = 10, p=0.016) reduced some of the coefficients without altering the main pattern. Only two ORs were significant in the adjusted analysis: high levels of exposures as to childhood health/growth and stressful relations with parents.
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As to number of medical conditions (table 4), the unadjusted regression coefficients show also the same basic relationship with level of exposures on the five childhood and adulthood determinants, but only education and childhood health/growth were of statistical significance. Also in the adjusted analysis, these two determinants had relatively strong associations, while the effects of unhealthy adult behaviours disappeared completely, and the coefficients for stressful relations with parents were irregular. The adjusted model explained some 9% of the variation in number of medical conditions (p=0.001).
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Discussion |
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Interpretations
In line with many other studies, this study exemplifies the value of a lifecourse approach for explaining health variations in late adulthood and has relevance for several issues discussed by this approach. It has been argued that ‘advantages and disadvantages tend to cluster cross-sectionally and accumulate longitudinally’.4 This tendency is also present in this study. Childhood material deprivation was associated with stressful relations with parents, educational level correlated with unhealthy adult behaviours, and childhood adversities were to some extent related to health-detrimental circumstances during adulthood. However, the associations between the five lifecourse determinants were often relatively weak and sometimes absent. It may be that the clustering hypothesis points to a tendency which nevertheless does not preclude that many lifecourse disadvantages occur relatively unrelated to other disadvantages.
As regards the latent or pathway issue, it can be noted that the coefficients for childhood adversities obtained in the unadjusted analyses either remained relatively unaffected or decreased only modestly in the multivariate analyses which also included adult exposures. Thus, the negative impact of childhood adversities on later health was not primarily transmitted via these adult exposures. From these analyses, it seems therefore that childhood adversities act to a large extent as latent effects. The meaning of this could be further explored, however. It does not imply that no mediation of effects through time occurs. Rather, these findings should be interpreted more restrictively, as indicating that the negative effects of childhood adversities were not primarily transmitted via unfavourable social positions during adulthood (as indicated by educational level) or by harmful health behaviours. This does not preclude that the negative effects of childhood adversities have been mediated by other pathways, for instance in terms of enduring poor biological functioning or in terms of problematic psychosocial adjustment during the lifecourse.
The introductory discussion raised the question whether an unfavourable psychosocial environment in childhood is a separate influence on later health and not reducible to other childhood adversities such as failing health or material hardships. Given that stressful relations with parents are important aspects of the child's psychosocial environment, the results of this study support this conjecture. Stressful relations with parents had significant effects on both perceived health and activity limitations, also after adjustment for other childhood and adulthood adversities. It has been argued that a new ‘epidemiological transition’ is emerging in Western societies in the sense that psychosocial pathways to health inequalities have become more important than before.26–28 These analyses suggest that such pathways are not necessarily a new development, as they seem to have been present also in a Norwegian cohort of men born in the immediate aftermath of the Second World War.
Three health outcomes were analysed in this study, in order to get a broader view of the health impact of lifecourse exposures than had been obtained if only one outcome had been examined. All three outcome variables were, however, similar in the sense that they were self-reported and unspecific (i.e. not referring to a specific disease), but it can be suggested that they reflect different health aspects. Perceived health is primarily an overall subjective self-assessment, related with well-being, but also with illnesses and later mortality.29–31 Activity limitations reflect self-evaluated functional capability, but also the objective severity of the health problems,31,32 while reports of medical conditions relate to (primarily somatic) diseases and illnesses which usually have been diagnosed by doctors and which vary considerably in seriousness.33 Although many coefficients did not pass a 5% significance level, the overall pattern of results suggested that each health determinant had some impact on all three health outcomes, but there were some differences in their effects. It may be supposed that the three outcomes are differently located on a subjective–objective continuum, and this could be the reason why, for instance, childhood health/growth and education (probably related to material hardships during adulthood) were relatively strong predictors for number of medical conditions, while stressful relations with parents, which probably have links to adult psychosocial adjustment, appeared more important for perceived health.
Limitations
One limitation of this study is the sample size. Often, the coefficients themselves suggested fairly clear associations, but, due to small subgroups, confidence intervals were large and p-values exceeded 0.05. An example is material deprivation during childhood, which regularly has been found to be connected to ill health later in life. Also in these data, exposures to childhood material deprivation were consistently associated with more negative health on all three outcomes (table 3, table 4), but the coefficients do not qualify as statistically significant. It is hardly reasonable to reject the relevance of childhood material deprivation because of this. Generally, the sample size means that the interpretations should be regarded as tentative.
A sample bias is possible. In 2001, about 12% of the original cohort of Norwegian men born in 1946 were already dead and could not be included in the gross sample. The overall response rate (64%) varied to some extent with educational level.25 The analysed sample had therefore quite certainly a higher social standing on average than the gross sample, and this social bias was probably even more marked if compared with the original birth cohort. In these analyses, the effects of childhood material deprivation and educational level were sometimes relatively low, compared for instance with the effects of stressful relations with parents. One may speculate that part of this pattern arose because of sample bias. Men born in 1946 who had experienced high levels of material deprivation during childhood and particularly unfavourable occupational careers (and perhaps also had especially unhealthy adult behaviours) were probably under-represented in the analysed sample. This could have led to an underestimation of the ‘true’ effects of these health determinants.
The validity of the measurements is also a possible source of error. Respondents were asked to give self-reports not only about their current situation, but also about circumstances which occurred several decades earlier. This might imply many recall errors. Generally, ‘hard data’ (e.g. type of dwelling in childhood) seem better remembered than ‘soft data’ (e.g. subjective experiences).34–37 If memory failures are random, they could dilute the associations and bias them towards zero, but if recall bias differs between subgroups in the sample, this could lead to an overestimation of the associations.38 So-called ‘negative affectivity’,13,39 i.e. a tendency to report all kind of circumstances in negative terms, could produce inflated correlations both in retrospective and cross-sectional surveys. Artificially strong coefficients could occur if respondents with health problems were more conscious about past exposures and therefore reported them more completely than those without health problems.38
One cannot preclude that such tendencies are present in these data. Thus, the scale for stressful relations with parents was based on relatively subjective questions which could lead to an inflated correspondence with the relatively subjective variable perceived health, while this effect could be less as regards the scales for childhood material deprivation and childhood health/growth which were based on comparatively more objective questions. The burden of present health problems could spur more reports of adversities during childhood, but respondents could also have under-reported socially stigmatized unhealthy behaviours. There are, however, also some reasons to believe that such tendencies have not been very widespread. If negative affectivity was prominent, one would, for instance, predict that the interrelationship between the different types of childhood adversities would have been stronger than observed here (table 2). When middle-aged men are asked about their childhood, one would assume that they usually report recollections established a long time ago, and it seems unlikely that they would revise their memories drastically because of health problems acquired in more recent times.
The limitations cannot be disregarded, but overall the results seem plausible. Also previous studies indicate that negative effects of childhood adversities often persist into adulthood relatively independent of variations in adult circumstances.6,13,40,41 The relatively important role for stressful relations with parents which emerged in this study is compatible both with theoretical propositions about how problematic personal relations in early life may have enduring effects on health19,22 and with previous empirical findings indicating that parents’ divorce, family strife, and various forms of neglect and psychological insults during childhood have negative consequences for health and mortality during adulthood.6,13,42–44 Such findings, together with the present study, suggest that children's psychosocial environment could be a separate and not unimportant determinant for health in later life.
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Acknowledgments |
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This study was supported by a grant from The Research Council of Norway. Participation in the European Science Foundation's Programme Social Variations in Health Expectancy in Europe, Working Group I Life-course influences on health, has been helpful when working with this paper.
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Footnotes |
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Source of financial support: The Research Council of Norway
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1 Kuh D, Ben-Shlomo Y, Editors. A life course approach to chronic disease epidemiology. Oxford: Oxford University Press, 1997.
2 Wadsworth MEJ. Health inequalities in the life course perspective. Soc Sci Med 1997;44:859–69.[CrossRef][Web of Science][Medline]
3 Power C, Hertzman C. Social and biological pathways linking early life and adult disease. Br Med Bull 1997;53:210–21.
4 Blane D. The life course, the social gradient, and health. In: Marmot M, Wilkinson RG, editors. Social determinants of health. Oxford: Oxford University Press, 1999:64–80.
5 European Science Foundation. Social variations in health expectancy. An ESF interdisciplinary programme in the social and medical sciences. An ESF interdisciplinary programme in the social and medical sciences. Strasbourg: European Science Foundation, 2000.
6 Hertzman C, Power C, Matthews S, Manor O. Using an interactive framework of society and lifecourse to explain self-rated health in early adulthood. Soc Sci Med 2001;53:1575–85.[CrossRef][Web of Science][Medline]
7 Ben-Shlomo Y, Kuh D. A life course approach to chronic disease epidemiology: conceptual models, empirical challenges and interdisciplinary perspectives. Int J Epidemiol 2002;31:285–93.
8 Barker DJP, editor. Fetal and infant origins of adult disease. London: British Medical Journal, 1992.
9 Wadsworth MEJ. Serious illness in childhood and its association with later-life achievement. In: Wilkinson RG, editor. Class and health. Research and longitudinal data. London, New York: Tavistock Publications, 1986:50–74.
10 Wadsworth MEJ, Kuh DJL. Childhood influences on adult health: a review of recent work from the British 1946 national birth cohort study, the MRC National Survey of Health and Development. Paediatr Perinatal Epidemiol 1997;11:2–20.[CrossRef][Web of Science][Medline]
11 Blackwell DL, Hayward MD, Crimmins EM. Does childhood health affect chronic morbidity in later life? Soc Sci Med 2001;52:1269–84.[CrossRef][Web of Science][Medline]
12 Lundberg O. Childhood living conditions, health status, and social mobility: a contribution to the health selection debate. Eur Sociol Rev 1991;7:149–62.
13 Lundberg O. Childhood conditions, sense of coherence, social class and adult ill health: exploring their theoretical and empirical relations. Soc Sci Med 1997;44:821–31.[CrossRef][Web of Science][Medline]
14 Schwartz JE, Friedman HS, Tucker JS, Tomlinson-Keasey C, Wingard DL, Criqui MH. Sociodemographic and psychosocial factors in childhood as predictors of adult mortality. Am J Public Health 1995;85:1237–45.
15 Bosma H, van de Mheen HD, Mackenbach JP. Social class in childhood and general health in adulthood: questionnaire study of contribution of psychological attributes. BMJ 1999;318:18–22.
16 Van de Mheen H, Stronks K, van den Bos J, Mackenbach JP. The contribution of childhood environment to the explanation of socio-economic inequalities in health in adult life: a retrospective study. Soc Sci Med 1997;44:13–24.
17 Power C, Bartley M, Davey Smith G, Blane D, Davey Smith G, Blane D. Transmission of social and biological risk across the life course. In: Blane D, Brunner E, Wilkinson R, Editors. Health and social organization. Towards a health policy for the 21st century. London, New York: Routledge, 1996:188–203.
18 Kuh D, Power C, Blane D, Bartley M. Social pathways between childhood and adult health. In: Kuh D, Ben-Shlomo Y, Editors. A life course approach to chronic disease epidemiology. Oxford: Oxford University Press, 1997:169–98.
19 Fonagy P. Patterns of attachment, interpersonal relationships and health. In: Blane D, Brunner E, Wilkinson R, editors. Health and social organization. Towards a health policy for the 21st century. London, New York: Routledge, 1996:125–51.
20 Repetti RL, Taylor SE, Seeman TE. Risky families: Family social environments and the mental and physical health of offspring. Psychol Bull 2002;128:330–66.[CrossRef][Web of Science][Medline]
21 Rutter M. Pathways from childhood to adult life. J Child Psychol Psychiatry 1989;30:23–51.[Web of Science][Medline]
22 Antonovsky A. Unraveling the mystery of health. How people manage stress and stay well. San Fransisco: Jossey-Bass Publishers, 1987.
23 Cohen S, Herbert TB. Health psychology - psychological factors and physical disease from the perspective of human psychoneuroimmunology. Annual Rev Psychol 1996;47:113–42.[CrossRef][Web of Science][Medline]
24 Kelly S, Hertzman C, Daniels M. Searching for the biological pathways between stress and health. Annual Rev Public Health 1997;18:437–62.
25 Hougen HC, Kleven Ø, Opdahl S. Undersøkelse om livsløp og helse blant 55-årige menn 2001. Dokumentasjonsrapport. [Survey of life course and health among men aged 55, 2001. Documentary report.] Notater 02/61. Oslo: Statistics Norway, 2002.
26 Wilkinson RG. Unhealthy societies. The afflictions of inequality. London, New York: Routledge, 1996.
27 Williams SJ. ’Capitalising’ on emotions? Rethinking the inequalities in health debate. Sociology 1998;32:121–39.
28 Elstad JI. The psycho-social perspective on social inequalities in health. Sociol Health Illness 1998;20:598–618.[CrossRef]
29 Barsky AJ, Cleary PD, Klerman GL. Determinants of perceived health-status of medical outpatients. Soc Sci Med 1992;34:1147–54.[CrossRef][Web of Science][Medline]
30 Idler EL, Benyamini Y. Self-rated health and mortality–a review of 27 community studies. J Health Soc Behav 1997;38:21–37.[CrossRef][Web of Science][Medline]
31 Manor O, Matthews S, Power C. Self-rated health and limiting longstanding illness: inter-relationships with morbidity in early adulthood. Int J Epidemiol 2001;30:600–7.
32 Cohen G, Forbes J, Garraway M. Interpreting self reported limiting longterm illness. BMJ 1995;311:722–4.
33 Blaxter M. A comparison of measures of inequality in morbidity. In: Fox J, Editor. A comparison of measures of inequality in morbidity. Gower: Aldershot, 1989:199–230.
34 Berney LR, Blane DB. Collecting retrospective data: accuracy of recall after 50 years judged against historical records. Soc Sci Med 1997;45:1519–25.[CrossRef][Web of Science][Medline]
35 Krieger N, Okamoto A, Selby JV. Adult female twins’ recall of childhood social class and father's education: a validation study for public health research. Am J Epidemiol 1998;147:704–8.
36 Scott J, Alwin D. Retrospective versus prospective measurement of life histories in longitudinal research. In: Giele JZ, Elde GH jr, editors. Methods of life course research. Qualitative and quantitative approaches. Thousand Oaks: SAGE, 1998:98–127.
37 Van de Mheen H, Stronks K, Looman CWN, Mackenbach JP. Research note: Recall bias in self-reported childhood health: differences by age and educational level. Sociol Health Illness 1998;20:241–54.[CrossRef]
38 Neugebauer R, Ng S. Differential recall as a source of bias in epidemiologic research. J Clin Epidemiol 1990;43:1337–41.[CrossRef][Web of Science][Medline]
39 Watson D, Pennebaker JW. Health complaints, stress, and distress: exploring the central role of negative affectivity. Psychol Rev 1989;96:234–54.[CrossRef][Web of Science][Medline]
40 Rahkonen O, Lahelma E, Huuhka M. Past or present? Childhood living conditions and current socioeconomic status as determinants of adult health. Soc Sci Med 1997;44:327–36.[CrossRef][Web of Science][Medline]
41 Poulton R, Caspi A, Milne BJ, et al. Association between children's experience of socioeconomic disadvantage and adult health: a life-course study. Lancet 2002;360:1640–5.[CrossRef][Web of Science][Medline]
42 Tucker JS, Friedman HS, Schwartz JE, et al. Parental divorce: Effects on individual behavior and longevity. J Personality Social Psychol 1997;73:381–91.[CrossRef][Web of Science][Medline]
43 Felitti VJ, Anda RF, Nordenberg D. Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults - the adverse childhood experiences (ACE) study. Am J Prev Med 1998;14:245–58.[CrossRef][Web of Science][Medline]
44 Hansagi H, Brandt L, Andreasson S. Parental divorce: psychosocial well-being, mental health and mortality during youth and young adulthood–a longitudinal study of Swedish conscripts. Eur J Public Health 2000;10:86–92.
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