1. Early Life Events and Health and Labor Market Outcomes in Adulthood Rucker C. Johnson Robert F. Schoeni University of California, Berkeley University of Michigan

2. Background & Objective Background –Long reach of early-life events Fetal origins hypothesis; “programming” –Large body of empirical evidence Early-life health shocks persist and/or make future health status more sensitive to assaults Objective –Investigate linkages between health & economic status in initial stages of life, and health, education, & income in adulthood

3. Unique Aspects of the Study Nationally representative data of the U.S. Childhood measures are not based on long recalls Superior measures of income in childhood & adulthood Data spanning substantial share of life course: 35 yrs Sufficient sample of low-income and minority population to examine disparities Comparisons within families: sibling fixed effects First evidence of the link between birth outcomes & adult health for a nationally representative U.S. sample

4. Research Questions Does low birth weight affect cognition, education, labor market outcomes, & adult health? Does childhood family income affect adult health, education, and labor market earnings? Does low birth weight interact with… –childhood family income, health insurance, and parental health behaviors? Does education causally affect health status? Can early life factors account for racial disparities in adult health?

5. Preview of Findings Significant & substantive relationship between low birth weight & cognition, education, adult health, & labor market outcomes –Effect of low birth weight on adult health… is smaller for families with health insurance at birth increases with age –Effect on earnings only partially explained by effect on education –Robust to sibling fixed effects Unobserved fixed family effects account for substantial share of education-health relationship, but remaining linkage is still strong Racial gaps in health completely explained by a few early life factors

6. 6 What We Do

7. 7

8. 8 Conceptual Issue Sibling models account for time invariant family factors –Parents’ permanent income, tastes for health care, risk tolerance, etc. But genetic differences among siblings remain –Interpretation of estimates: “effects” of poor birth outcome, not low birth weight per se Reallocation of resources within the family not examined directly

9. 9 Conceptual Framework EARLY-TO-MID ADULT HEALTH:  Self-assessed Health EARLY LIFE Economic status Neighborhood factors Biologic factors Behavioral risk factors Medical care EARLY-TO-MID ADULT SES Economic status Neighborhood factors Biologic factors Behavioral risk factors Medical care EARLY-LIFE HEALTH & COGNITIVE DEVELOPMENT:  Prenatal Health – Low Birth Weight  Child Health— (Self-assessed health 0-16)  Health conditions—e.g., asthma—retrospective onset info Latent Health?  Cognitive & non-cognitive Skills — childhood

10. Sample Selection: Adult Sample –Male PSID sample members born 1951-1975 & followed through 2003 2,745 boys in 1,444 families –1,187 families have at least 2 boys 26,407 person-year observations –Key dependent variable is general health status Health data available 1984-2003 –Sample largely in their 20s, 30s, and 40s

11. Health Measures & Models Birth weight –Low birth weight reported by the mother in 1985: <5.5 lbs Health measure – general health status (GHS) –Multiplicative, multi-attribute health utility model was used to assign scores & quantify distance between GHS categories Method was used in Healthy People 2000 –Interval health values are: [95, 100] for excellent, [85, 95) for very good, [70,85) for good, [30,70) for fair, and [1,30) for poor health. –Alternative measures were examined Fair/poor/good, non-scaled GHS, specific conditions in adulthood Retrospective self-assessed GHS and conditions in childhood Models –Interval regression with & without sibling fixed effect

12. 12 Series of Relationships Investigated Adult health –low birth weight –childhood family income –health insurance, parental health behaviors, parental education, fertility preferences –interactions of the above factors Educational attainment –low birth weight Labor market earnings –low birth weight –childhood family income

13. 13 Child Sample Child Development Supplement of the CDS –Waves I (1997) & II (2002) –PSID children 0-12 in 1997, 5-17 in 2002 Birth outcomes –Actual birth weight; gestation; NICU Childhood outcomes –Cognition (Woodcock Johnson), self-assessed health

14. 14 Table 1. Effects of Socioeconomic Factors on Birth Outcomes: All PSID Births 1968-2003

15. 15 Table 2. Effects of Socioeconomic Factors on Birth Outcomes: Child Sample

16. 16 Among Siblings, Child with Poor Birth Outcome Is More Likely to be in Good/Fair/Poor Health in Childhood… Restricted to siblings with at least one sib with divergent birth outcomes.

17. 17 …and Has Lower Cognitive Ability in Childhood Restricted to siblings with at least one sib with divergent birth outcomes.

18. 18 Among Brothers, the Low Birth Weight Sibling Is More Likely to be in Poor/Fair Health in Adulthood… Age Group Restricted to boys with at least one brother with divergent birth weight.

19. 19 …More Likely to Have Dropped Out of High School….. Restricted to persons with at least one sibling with divergent birth weight.

20. 20 … More Likely Not to Have Positive Earnings…. Age Group Restricted to boys with at least one brother with divergent birth weight.

21. 21 … and Has Lower Earnings Age Group Restricted to boys with at least one brother with divergent birth weight.

22. 22 Table 4. Effects of Birth Outcomes, Family Income, & Health Insurance Coverage During Pregnancy on Child Health: Child Sample, Including Girls

23. 23 Table 5. Effects of Birth Outcomes and Family Income During Pregnancy on Child Achievement in Reading: Child Sample

24. 24 Table 6. Effects of Birth Outcomes and Family Income During Pregnancy on Child Achievement in Math: Child Sample

25. 25 Table 7. Birth Weight, Childhood Family Income, and Educational Attainment

26. 26 Table 8. Birth Weight and Adult Health

27. 27 Table 9. Birth Weight and Adult Health Over the Life Course

28. 28 Table 10. Childhood Family Income & Health Insurance, Birth Weight, & Adult Health

29. 29 Table 11. Birth Weight, Education, and Adult Health

30. 30 Table 12. Childhood Factors and Racial Health Disparities in Adulthood

31. 31 Table 12. Childhood Factors and Racial Health Disparities in Adulthood

32. 32 Table 13. Birth Weight and Adult Labor Market Outcomes

33. 33 Table 14. Birth Weight and Adult Labor Market Outcomes Over the Life Course

34. 34 Table 15. Childhood Family Income & Health Insurance, Birth Weight, Education, & Adult Labor Market Outcomes

35. 35 Table 15. Childhood Family Income & Health Insurance, Birth Weight, Education, & Adult Labor Market Outcomes

36. 36 Table 15. Childhood Family Income & Health Insurance, Birth Weight, Education, & Adult Labor Market Outcomes

37. 37 Table 15. Childhood Family Income & Health Insurance, Birth Weight, Education, & Adult Labor Market Outcomes

38. Summary Being born low weight…. –ages you by 12 years, –increases the odds of dropping out of high school by 4 percentage points, and –lowers labor force participation by 6 percentage points, and –reduces labor market earnings by 16% (at age 35) Effects on health are mitigated by having health insurance in childhood Somewhat greater confidence that the education-health connection is causal Racial gap in adult health accounted for by disparities in early life factors

39. 39 Consistent with Large and Fairly Convincing Body of Evidence from Diverse Populations Animal studies –Experimental manipulation of early life conditions Social epidemiological evidence –Most strongly for the UK Very recent economic literature, typically comparing sibs or twins –Dutch born 1812-1912 –Norwegians born 1967-1997 –Canadians born in Manitoba 1978-1985 –Brits born the week of March 3, 1958 –Minnesotan twins –US women born in the 1960s –US children born around 1918

40. 40 Additional Findings Retrospectively reported health in childhood is … –strongly related to low birth weight –accounts for 20% of the birth weight effect on adult health Prevalence of childhood conditions is related to low birth weight –Will next look at conditions at birth Onset of conditions in adulthood strongly related to low birth weight –Conditions: hypertension, diabetes, stroke, asthma

41. Implications Long reach of childhood experiences –Interventions in early-life may have long run benefits Intergenerational transmission of health & well-being reproduces disparities across generations