title: Pathways from parental educational attainment to adolescent blood pressure.
abstract: Lower parental education is associated with higher adolescent blood pressure (BP). We examined the contribution of modifiable risk factors from infancy to adolescence that could potentially explain the link between parental education and SBP and DBP in the offspring.
  
  
  
  In a prospective Chinese birth cohort, 'Children of 1997' of 5604 adolescents (68% follow-up), we analyzed the relation between parental educational attainment and sex-specific, age-specific and height-specific BP z-scores at ∼13 years. Using mediation analysis, we examined the contribution of household income at birth (both absolute income and relative income deprivation), exposures during infancy (breastfeeding and early life second-hand smoking), lifestyles during childhood (diet, physical activity and screen-time), weight or BMI status during fetal, infancy, childhood and puberty, pubertal stage as well as parental BMI.
  
  
  
  We found that adolescent BMI, but not birth weight or infant growth or childhood BMI, mediated the inverse association of parental education with adolescent SBP (proportion mediated: 24%), followed by maternal BMI (proportion mediated: 18%). Factors explaining the link between parental education and DBP were less clear. Absolute income, breastfeeding, childhood diet and physical activity, pubertal stage and paternal BMI did not mediate the association between parental education and adolescent BP.
  
  
  
  Low parental education is a risk factor for high SBP and, to a lesser extent, DBP in adolescents. Important mediators of this relation include adolescent and maternal body weight.
authors.affiliation: aSchool of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China bCity University of New York School of Public Health and Hunter College, New York, New York cDepartment of Social and Behavioral Sciences, Harvard School of Public Health, Boston, Massachusetts, United States.
authors.forename: Man Ki
authors.initials: MK
authors.lastname: Kwok
authors.forename: Catherine Mary
authors.initials: CM
authors.lastname: Schooling
authors.forename: Subu V
authors.initials: SV
authors.lastname: Subramanian
authors.forename: Gabriel M
authors.initials: GM
authors.lastname: Leung
authors.forename: Ichiro
authors.initials: I
authors.lastname: Kawachi
mesh_terms: D000293:Adolescent; D044466:Asian People; D001724:Birth Weight; D001794:Blood Pressure; D001795:Blood Pressure Determination; D015992:Body Mass Index; D001942:Breast Feeding; D002648:Child; D002657:Child Development; D002675:Child, Preschool; D002681:China / Q000453:epidemiology; D003971:Diastole; D004032:Diet; D004522:Educational Status; D004781:Environmental Exposure; D015444:Exercise; D005260:Female; D006801:Humans; D006973:Hypertension / Q000453:epidemiology* / Q000209:etiology / Q000503:physiopathology; D007182:Income; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D010290:Parents / Q000193:education*; D011446:Prospective Studies; D011627:Puberty / Q000502:physiology; D012307:Risk Factors; D013599:Systole; D014028:Tobacco Smoke Pollution
chemical_list: D014028:Tobacco Smoke Pollution