Does schooling attained by adult children affect parents' psychosocial well-being in later life? Using Mexico's 1993 compulsory schooling law as a quasi-experiment

Higher adult child educational attainment may benefit older parents' psychosocial well-being in later life. This may be particularly important in low- and middle-income countries, where recent generations have experienced comparatively large increases in educational attainment. We used data from the 2012 Mexican Health and Aging Study, a nationally representative study of adults aged ≥50 years and leveraged the exogenous variation in adult child education induced by Mexico's compulsory schooling law passed in 1993. We employed two-stage least squares (2SLS) regression to estimate the effects of increased schooling among adult children on parents' (respondents') depressive symptoms and life satisfaction scores, controlling for demographic and socioeconomic characteristics. We considered heterogeneity by parent and child gender and other sociodemographic characteristics. Our study included 7186 participants with an average age of 60.1 years; 54.9% were female. In the 2SLS analyses, increased schooling among oldest adult children was associated with fewer depressive symptoms (β = -0.25; 95% CI: -0.51, 0.00) but no difference in life satisfaction (β = 0.01; 95% CI: -0.22, 0.25). Stratified models indicated differences in the magnitude of association with depressive symptoms for mothers (β = -0.27, 95% CI: -0.56, 0.01) and fathers (β = -0.18, 95% CI: -0.63, 0.26) and when considering increased schooling of oldest sons (β = -0.37; 95% CI: -0.73, -0.02) and daughters (β = -0.05, 95% CI: -0.23, 0.13). No parent and child gender differences were found for life satisfaction. Power was limited to detect heterogeneity across other sociodemographic characteristics in the second stage although first-stage estimates were larger for urban (vs. rural) dwelling and more (vs. less) highly educated respondents. Results were similar when considering the highest educated child as well as increased schooling across all children. Our findings suggest that longer schooling among current generations of adult children, particularly sons, may benefit their older parents' psychosocial well-being.

The local impacts of coal and oil power plant retirements on air pollution and cardiorespiratory health in California: An application of generalized synthetic control method

BACKGROUND

This study capitalized on coal and oil facility retirements to quantify their potential effects on fine particulate matter (PM2.5) concentrations and cardiorespiratory hospitalizations in affected areas using a generalized synthetic control method.

METHODS

We identified 11 coal and oil facilities in California that retired between 2006 and 2013. We classified zip code tabulation areas (ZCTA) as exposed or unexposed to a facility retirement using emissions information, distance, and a dispersion model. We calculated weekly ZCTA-specific PM2.5 concentrations based on previously estimated daily time-series PM2.5 concentrations from an ensemble model, and weekly cardiorespiratory hospitalization rates based on hospitalization data collected by the California Department of Health Care Access and Information. We estimated the average differences in weekly average PM2.5 concentrations and cardiorespiratory hospitalization rates in four weeks after each facility retirement between the exposed ZCTAs and the synthetic control using all unexposed ZCTAs (i.e., the average treatment effect among the treated [ATT]) and pooled ATTs using meta-analysis. We conducted sensitivity analyses to consider different classification schemes to distinguish exposed from unexposed ZCTAs, including aggregating outcomes with different time intervals and including a subset of facilities with reported retirement date confirmed via emission record.

RESULTS

The pooled ATTs were 0.02 μg/m3 (95% confidence interval (CI): -0.25 to 0.29 μg/m3) and 0.34 per 10,000 person-weeks (95%CI: -0.08 to 0.75 per 10,000 person-weeks) following the facility closure for weekly PM2.5 and cardiorespiratory hospitalization rates, respectively. Our inferences remained the same after conducting sensitivity analyses.

CONCLUSIONS

We demonstrated a novel approach to study the potential benefits associated with industrial facility retirements. The declining contribution of industrial emissions to ambient air pollution in California may explain our null findings. We encourage future research to replicate this work in regions with different industrial activities.

Increased adult child schooling and older parents' health behaviors in Europe: A quasi-experimental study

There is growing evidence that adult child educational attainment is associated with older parents' physical health and longevity. Scholars have hypothesized that these associations may be driven by health-behavior pathways, whereby adult children with more education may share information about healthy lifestyles, role-model healthier behaviors, and/or have more economic resources to support leisure-based physical activity or the purchase of healthy foods for older parents. However, this relationship has not been comprehensively evaluated with methods capable of addressing the confounding bias expected for observational studies on this topic. We estimated the association between increased adult child schooling and older parents' health behaviors using data from the Survey for Health, Aging and Retirement in Europe (SHARE) (n = 8195). We leveraged changes to compulsory schooling laws that would have impacted respondents' adult children as quasi-experiments and estimated the association between increased schooling among oldest adult children and respondents' (parents') body mass index, obesity, physical inactivity, excessive drinking, and current smoking using two-stage least squares regression. Each year of increased schooling among oldest adult children was associated with a lower risk of current smoking (β: −0.029, 95% CI: −0.056, −0.003), physical inactivity (β: −0.034, 95% confidence interval [CI]: −0.077, 0.009), obesity (β: −0.038, 95% CI: −0.065, −0.011) and lower body mass index (β: −0.37, 95% CI: −0.73, −0.02). The direction of associations with excessive drinking varied by parent gender (β: −0.027, 95% CI: −0.046, −0.007 for mothers; β: 0.068, 95% CI: −0.011, 0.148 for fathers). Increases in adult child schooling may have upward influences on parents' late-life health behaviors, although there may be some differences by parent gender. Findings should be replicated across other global settings and studies should directly evaluate parent health behaviors as mediators of the relationship between increased adult child schooling and older parents’ longevity.

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Growing research suggests adult child education influences parents' mortality.

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This association may be due to health behavior pathways, but evidence is scarce.

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We conducted a quasi-experimental study of this topic using European data.

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Increased child schooling was associated with improved health behaviors for older parents.

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Associations with older parents' risk of excessive drinking varied by parent gender.

Maternal depression and economic well-being: A quasi-experimental approach

Maternal depression is associated with adverse impacts on the health of women and their children. However, further evidence is needed on the extent to which maternal depression influences women's economic well-being and how unmeasured confounders affect estimates of this relationship. In this study, we aimed to measure the association between maternal depression and economic outcomes (income, employment, and material hardship) over a 15-year time horizon. We conducted longitudinal analyses using the Fragile Families and Child Wellbeing Study, an urban birth cohort study in the United States. We assessed the potential contribution of time-invariant unmeasured confounders using a quasi-experimental approach and also investigated the role of persistent versus transient depressive symptoms on economic outcomes up to 15 years after childbirth. In models that adjusted for time-invariant unmeasured confounders, maternal depression was associated with not being employed (an adjusted risk difference of 3 percentage points (95% CI 0.01 to 0.05)) and experiencing any material hardship (an adjusted risk difference of 14 percentage points (95% CI 0.12 to 0.16)), as well as with reductions in the ratio of household income to poverty by 0.10 units (95% CI -0.16 to -0.04) and annual household income by $2114 (95% CI -$3379 to -$850). Impacts at year 15 were strongest for those who experienced persistent depression. Results of our study strengthen the case for viewing mental health support services as interventions that may also foster economic well-being, and highlight the importance of including economic impacts in assessments of the cost-effectiveness of mental health interventions.

Estimating the impact of donor programs on child mortality in low- and middle-income countries: a synthetic control analysis of child health programs funded by the United States Agency for International Development

Background

Significant levels of funding have been provided to low- and middle-income countries for development assistance for health, with most funds coming through direct bilateral investment led by the USA and the UK. Direct attribution of impact to large-scale programs funded by donors remains elusive due the difficulty of knowing what would have happened without those programs, and the lack of detailed contextual information to support causal interpretation of changes.

Methods

This study uses the synthetic control analysis method to estimate the impact of one donor’s funding (United States Agency for International Development, USAID) on under-five mortality across several low- and middle-income countries that received above average levels of USAID funding for maternal and child health programs between 2000 and 2016.

Results

In the study period (2000–16), countries with above average USAID funding had an under-five mortality rate lower than the synthetic control by an average of 29 deaths per 1000 live births (year-to-year range of − 2 to − 38). This finding was consistent with several sensitivity analyses.

Conclusions

The synthetic control method is a valuable addition to the range of approaches for quantifying the impact of large-scale health programs in low- and middle-income countries. The findings suggest that adequately funded donor programs (in this case USAID) help countries to reduce child mortality to significantly lower rates than would have occurred without those investments.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12963-021-00278-9.

The effects of an air quality alert program on premature mortality: A difference-in-differences evaluation in the region of Paris

BACKGROUND

Daily exposure to air pollution has been shown to increase cardiovascular and respiratory mortality. While increases in short-term exposure to air pollutants at any daily concentrations has been shown to be associated to adverse health outcomes, days with extreme levels, also known as air pollution peaks based on specific thresholds, have been used to implement air quality alerts in various cities across the globe.

OBJECTIVES

We aimed at evaluating the potential effects of the Air Quality Alerts (AQA) system on different causes of premature mortality in Paris, France.

METHODS

Air quality alerts (AQA) based on particulate matter (PM₁₀) levels and related interventions were implemented in the region of Paris in 2008 and were revised to be more stringent in 2011. In this study, we applied a difference-in-differences (DID) approach coupled with propensity-score matching (PSM) to daily mortality data for the period 2000 to 2015 to evaluate the effects of the Paris AQA program on different causes of premature mortality for the entire population and for adults > 75 years old.

RESULTS

Overall, results did not show evidence of a reduction in mortality of the PM₁₀ AQA program when first implemented in 2008 with initial thresholds (80 µg/m³); DID estimates were slightly above 1 for cardiovascular and respiratory mortality. However, when evaluating the drastic reduction in revised thresholds in 2011 (50 µg/m³) to trigger interventions, we identified a reduction in cardiovascular (DID = 0.84, 95% CI: 0.755 to 0.930) mortality, but no change in respiratory mortality was detected (DID = 0.97, 95% CI: 0.796, 1.191).

DISCUSSION

Our study suggests that AQA may not have health benefits for the population when thresholds are set at high daily PM₁₀ levels. Given that such policies are implemented in many other metropolitan areas across the globe, evaluating the effectiveness of AQA is important to provide public authorities and researchers a rationale for defining specific thresholds and extending the scope of these policies to lower air pollution levels.

The Association Between Same-Sex Marriage Legalization and Youth Deaths by Suicide: A Multimethod Counterfactual Analysis

PURPOSE

To estimate the association between same-sex marriage legalization and deaths by suicide among youth.

METHODS

The study used country-level suicide data sourced from the Global Burden of Disease Study for all 36 Organisation for Economic Co-operation and Development countries for the period 1991-2017. We analyzed the suicide rates of all youth, male youth, and female youth aged 10-24 years using multiple policy-evaluation methods-difference-in-differences, matrix completion, and generalized synthetic control via expectation-maximization-to estimate the impact of same-sex marriage legalization at the country level. Secondary analysis considered several covariate specifications, evaluated the immediacy and persistence of the estimated associations, and assessed whether any observed association was limited to early adopters of same-sex marriage.

RESULTS

The state-of-the-art matrix completion analysis indicated that same-sex marriage legalization was associated with a decline in the youth suicide rate of 1.191 deaths per 100,000 individuals (95% CI = -1.66, -.64; p < .001), corresponding to a reduction of 17.90% compared to the youth suicide rate at the time of legalization. This decline was most pronounced in males for whom the suicide rate fell by 1.993 (CI = -2.76, -1.12; p < .001) compared to a decrease of .348 for female youth (CI = -.60, -.06; p = .02), corresponding to decreases of 19.98% and 10.90%, respectively. These associations persisted after legalization, but to differing degrees depending on model specification.

CONCLUSIONS

Developed countries that are yet to legalize same-sex marriage have an opportunity to put downward pressure on youth suicide.

The effect of mass vaccination campaigns against polio on the utilization of routine immunization services: A regression discontinuity design

BACKGROUND

In most low and middle-income countries (LMIC), vaccines are primarily distributed by routine immunization services (RI) at health facilities. Additional opportunities for vaccination are also provided through mass vaccination campaigns, conducted periodically as part of disease-specific initiatives. It is unclear whether these campaigns are detrimental to RI services, or wether they may stimulate the utilization of RI.

METHODS

Unobserved confounders and reverse causality have limited existing evaluations of the effects of mass vaccination campaigns on RI services. We explored the use of a regression discontinuity design (RDD) to measure these effects more precisely. This is a quasi-experimental method, which exploits random variations in birth dates to identify the causal effects of vaccination campaigns. We applied RDD to survey data on a nationwide vaccination campaign against Polio conducted in Bangladesh.

RESULTS

We compared systematically the children born immediately before vs. after the vaccination campaign. These two groups had similar background characteristics, but differed by their exposure to the vaccination campaign. Contrary to previous studies, exposure to the campaign had positive effects on RI utilization. Children exposed to the campaign received between 0.296 and 0.469 additional doses of DPT vaccine by age 4months than unexposed children.

CONCLUSIONS

RDD constitutes a promising tool to assess the effects of mass vaccination campaigns on RI services. It could be tested in additional settings, using larger and more precise datasets. It could also be extended to measure the effects of other disease-specific interventions on the functioning of health systems, in particular those that occur at a discrete point in time and/or include age-related eligibility criteria.