Early-life school, neighborhood, and family influences on adult health: a multilevel cross-classified analysis of the Aberdeen children of the 1950s study

Abstract

Lifetime exposures to adverse social environments influence adult health, as do exposures in early life. It is usual to examine the influences of school on teenage health and of adult area of residence on adult health. We examined the combined long-term association of the school attended, as well as the area of residence in childhood, with adult health. A total of 6,285 children from Aberdeen, Scotland, who were aged 5-12 years in 1962, were followed up at a mean age of 47 years in 2001. Cross-classified multilevel logistic regression was used to estimate the associations of family, school, and area of residence with self-reported adult health and mental health, adjusting for childhood family-, school-, and neighborhood-level factors, as well as current adult occupational position. Low early-life social position (as determined by the father's occupational level) was associated with poor adult self-rated health but not poor mental health. There were small contextual associations between childhood school environment (median odds ratio = 1.08) and neighborhood environment (median odds ratio = 1.05) and adult self-rated health. The share of the total variance in health at the family level was 10.1% compared with 89.6% at the individual level. Both socioeconomic context and composition in early life appear to have an influence on adult health, even after adjustment for current occupational position.

Keywords: family; median odds ratio; neighborhood; schools.

Figure 1.

Flow chart of participants in the Aberdeen Children of the 1950s Study who were included in the analysis. The eligible sample is those who participated in the 1962 survey and were attending a mainstream primary school and residing in Aberdeen, Scotland. The proportion of eligible subjects with complete data is 76.9%.

Figure 2.

Diagram for the 4-level classification models of individuals, sibling groups, areas, and schools in the Aberdeen Children of the 1950s Study. Areas are enumeration districts from the 1961 census, and schools are primary schools in Aberdeen, Scotland, in 1962. Individuals are nested within sibling groups, and sibling groups are nested within areas. One cross-classification arises from individuals from the same sibling group not attending the same school. This cross-classification does not exist for sibling groups containing 1 child nor for sibling groups containing 4 children, because all 4 children in these sibling groups attended the same school. The cross-classification occurs for sibling groups of 2 or 3 children; 130 (16%) sibling groups of 2 children attended different schools, and 13 (19%) sibling groups of 3 children attended different schools. There is a further cross-classification of areas and schools where individuals from the same area attend different schools. None of the 104 areas was nested within a school; all areas had some children who attended different schools. The absence of arrows displays these cross-classifications; where an arrow exists, it displays the typical nested multilevel model structure (25). IQR, interquartile range.