title: The emergence of health inequalities in early adulthood: evidence on timing and mechanisms from a West of Scotland cohort.
abstract: BACKGROUND
  Evidence is inconsistent as to whether or not there are health inequalities in adolescence according to socio-economic position (SEP) and whether or when they emerge in early adulthood. Despite the large health inequalities literature, few studies have simultaneously compared the relative importance of 'health selection' versus 'social causation' at this life-stage. This study followed a cohort through the youth-adult transition to: (1) determine whether, and if so, when, health inequalities became evident according to both class of origin and current SEP; (2) compare the importance of health selection and social causation mechanisms; and (3) investigate whether these phenomena vary by gender.
  
  
  METHODS
  Data are from a West-of-Scotland cohort, surveyed five times between age 15 (in 1987, N=1,515, response=85%) and 36. Self-reported physical and mental health were obtained at each survey. SEP was based on parental occupational class at 15, a combination of own education or occupational status at 18 and own occupational class (with an additional non-employment category) at older ages. In respect of when inequalities emerged, we used the relative index of inequality to examine associations between both parental and own current SEP and health at each age. In respect of mechanisms, path models, including SEP and health at each age, investigated both inter and intra-generational paths from SEP to health ('causation') and from health to SEP ('selection'). Analyses were conducted separately for physical and mental health, and stratified by gender.
  
  
  RESULTS
  Associations between both physical and mental health and parental SEP were non-significant at every age. Inequalities according to own SEP emerged for physical health at 24 and for mental health at 30. There was no evidence of selection based on physical health, but some evidence of associations between mental health in early adulthood and later SEP (intra-generational selection). Paths indicated intra-generational (males) and inter-generational (females) social causation of physical health inequalities, and intra-generational (males and females) and inter-generational (females) social causation of mental health inequalities.
  
  
  CONCLUSIONS
  The results suggest complex and reciprocal relationships between SEP and health and highlight adolescence and early adulthood as a sensitive period for this process, impacting on future life-chances and health.
authors.affiliation: MRC/CSO Social & Public Health Sciences Unit, University of Glasgow, 200 Renfield Street, Glasgow, G2 3QB, UK. helen.sweeting@glasgow.ac.uk.
authors.forename: Helen
authors.initials: H
authors.lastname: Sweeting
authors.affiliation: MRC/CSO Social & Public Health Sciences Unit, University of Glasgow, 200 Renfield Street, Glasgow, G2 3QB, UK. michael.green@glasgow.ac.uk.
authors.forename: Michael
authors.initials: M
authors.lastname: Green
authors.affiliation: MRC/CSO Social & Public Health Sciences Unit, University of Glasgow, 200 Renfield Street, Glasgow, G2 3QB, UK. mbenzeval@essex.ac.uk.|Institute for Social and Economic Research, University of Essex, Colchester, CO4 3SQ, UK. mbenzeval@essex.ac.uk.
authors.forename: Michaela
authors.initials: M
authors.lastname: Benzeval
authors.affiliation: MRC/CSO Social & Public Health Sciences Unit, University of Glasgow, 200 Renfield Street, Glasgow, G2 3QB, UK. patbwest@gmail.com.
authors.forename: Patrick
authors.initials: P
authors.lastname: West
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D004522:Educational Status; D004651:Employment / Q000706:statistics & numerical data*; D005260:Female; D006304:Health Status; D054624:Health Status Disparities; D006306:Health Surveys; D006801:Humans; D008297:Male; D008603:Mental Health; D012606:Scotland / Q000453:epidemiology; D064890:Social Determinants of Health; D055815:Young Adult