The truly disadvantaged? Midlife outcome dynamics of individuals with experiences of out-of-home care

Brännström, Lars; Forsman, Hilma; Vinnerljung, Bo; Almquist, Ylva B.

doi:10.1016/j.chiabu.2016.11.009

Cited by 40 publications

(29 citation statements)

References 49 publications

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“…Additional mental health illnesses associated with accessing social support systems not specifically mentioned may have contributed to difficulties integrating fully and positively into society. The findings from the current study are similar to studies completed in the UK, Israel and the Nordic countries (Brännström et al., ; Kääriälä & Hiilamo, ; Melkman, ). Social determinants for adolescence as a whole may explain needs and gaps in care particularly for young adults who have been in foster care.…”

Section: Discussionsupporting

confidence: 91%

“…Although much statistical evidence indicates poorer health outcomes among young adults formerly in foster care as compared to their nonfoster care peers (Brännström, Forsman, Vinnerljung, & Almquist, ) little experiential evidence exists to describe how young adults who have been in foster care manage their health within the constructs of the social determinants of health. Social determinants of health (SDOH) such as employment and housing ultimately impact health outcomes (Office of Disease Prevention and Health Promotion [ODPHP], ).…”

Section: Introductionmentioning

confidence: 99%

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The influence of social determinants of health among young adults after they have left foster care in the US

Collins

Thomas

2018

Journal of Clinical Nursing

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Healthcare providers facilitate healthcare access for young adults who have been in foster care through evaluation of social determinants. Assessment and care planning based on social determinants for those who have been in foster care are critical to ensure the efficacy of interventions designed to address health outcomes. Social support systems are key factors for young adults formerly in foster care to access resources, substantiating the need for ongoing assessment and development of these support systems.

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Section: Discussionsupporting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

The influence of social determinants of health among young adults after they have left foster care in the US

Collins

Thomas

2018

Journal of Clinical Nursing

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“…A previous study based on sequence analysis found that children with OHC experience are more likely to follow adverse socioeconomic and health-related trajectories, particularly trajectories characterised by greater complexity and longer duration of disadvantage [13]. That study built the trajectories on four indicators – low educational attainment, social welfare receipt, unemployment, and mental health problems – and the follow-up stretched across ages 39–55.…”

Section: Discussionmentioning

confidence: 99%

“…A chain-of-risk model does, however, suggest that single exposures restricted to a certain stage of life do not sufficiently address the complexity of the life course. Previous research has shown that children who are placed in OHC have increased risks of following disadvantaged socioeconomic and health-related trajectories across adulthood [13] and that they are also more likely to experience a greater accumulation of such adversities over time [14]. Moreover, studies of such life-long trajectories in the general population show that individuals with sustained disadvantage have higher risks of mortality, both from all causes and from specific causes such as cardiovascular diseases, cancers, and external causes [15, 16].…”

Section: Introductionmentioning

confidence: 99%

Do trajectories of economic, work- and health-related disadvantages explain child welfare clients’ increased mortality risk? A prospective cohort study

Almquist

Brännström

2019

BMC Public Health

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Background Past research has shown that individuals who have had experiences of out-of-home care (OHC) in childhood have increased risks of premature mortality. Prior studies also suggest that these individuals are more likely to follow long-term trajectories that are characterised by economic, work-, and health-related disadvantages, compared to majority population peers. Yet, we do not know the extent to which such trajectories may explain their elevated mortality risks. The aim of this study is therefore to examine whether trajectories of economic, work-, and health-related disadvantages in midlife mediate the association between OHC experience in childhood and subsequent all-cause mortality. Methods Utilising longitudinal Swedish data from a 1953 cohort ( n = 14,294), followed from birth up until 2008 (age 55), this study applies gender-specific logistic regression analysis to analyse the association between OHC experience in childhood (ages 0–19; 1953–1972) and all-cause mortality (ages 47–55; 2000–2008). A decomposition method developed for non-linear regression models is used to estimate mediation by trajectories of economic, work-, and health-related disadvantages (ages 39–46; 1992–1999), as indicated by social welfare receipt, unemployment, and mental health problems. To account for selection processes underlying placement in OHC, an alternative comparison group of children who were investigated by the child welfare committee but not placed, is included. Results The results confirm that individuals with experience of OHC have more than a two-fold increased risk of all-cause mortality, for men (OR: 2.10, 95% CI: 1.42–3.11) and women (OR: 2.23, 95% CI: 1.39–3.59) alike. Approximately one-third (31.1%) of the association among men, and one-fourth (27.4%) of the association among women, is mediated by the long-term trajectories of economic, work-, and health-related disadvantages. The group who were investigated but not placed shows similar, yet overall weaker, associations. Conclusions Individuals who come to the attention of the child welfare services, regardless of whether they are placed in out-of-home care or not, continue to be at risk of adverse outcomes across the life course. Preventing them from following trajectories of economic, work-, and health-related disadvantages could potentially reduce their risk of premature death.

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“…Nevertheless, drawing inspiration from cumulative inequality theory, we presume that disadvantages in multiple life domains in childhood and adolescence may hamper the individual's health development both directly and through the exposure to subsequent risk factors that in turn have negative health consequences. The notion of cumulative life-course processes that encompasses a multidimensional approach to social, economic, and health-related factors has received empirical support in other cohort studies [20,[24][25][26][27][28].…”

Section: Disadvantaged Youth Have Poorer Health As Adultsmentioning

confidence: 99%

Prevailing over Adversity: Factors Counteracting the Long-Term Negative Health Influences of Social and Material Disadvantages in Youth

Almquist¹,

Landstedt²,

Jackisch³

et al. 2018

Preprint

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Disadvantaged circumstances in youth tend to translate into poor health development. Yet, the fact that this is not always the case has been seen as indicative of differential resilience. The current study highlights factors outside the context of the family with the potential to counteract the long-term negative influences of social and material adversity in adolescence on general health status. This study was based on two waves of questionnaire data from the Northern Swedish Cohort. From the wave in 1981 (age 16), indicators of social and material conditions as well as factors related to school, peers, and spare time, were derived. From the wave in 2008 (age 43), information about self-rated health was used. Ordinal logistic regression models (n=908) showed that adversity in youth was associated with poorer self-rated health in midlife among men and women alike, net of health status at baseline. However, having an advantaged situation with regard to school, peers, or spare time appeared to protect against the detrimental influences of disadvantaged circumstances in the family context on subsequent health. This suggests that health-promoting interventions may benefit from focusing on contexts outside the family in their effort to strengthen processes of resilience among disadvantaged youths.

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The truly disadvantaged? Midlife outcome dynamics of individuals with experiences of out-of-home care

Cited by 40 publications

References 49 publications

The influence of social determinants of health among young adults after they have left foster care in the US

The influence of social determinants of health among young adults after they have left foster care in the US

Do trajectories of economic, work- and health-related disadvantages explain child welfare clients’ increased mortality risk? A prospective cohort study

Prevailing over Adversity: Factors Counteracting the Long-Term Negative Health Influences of Social and Material Disadvantages in Youth

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