Di Gessa G, Glaser K and Tinker A

1. The health of grandparents caring for their grandchildren: The role of early and mid-life conditions Di Gessa G, Glaser K and Tinker A Institute of Gerontology, Department of Social Science, Health & Medicine, King’s College London United Kingdom

2. Outline • Background • Aim and objectives • Data and Methods • Results • Conclusion

3. Background • Grandparents play crucial role in family life • Evidence of the impact of childcare on grandparents’ health is mixed: • Custodial/Primary grandchild carers experience poorer health; • Higher quality of life, lower depression and loneliness among grandparents providing grandchild care (vs no care).

4. Background /2 • Most studies are cross-sectional and samples consist mostly of US grandparents; • Focus on primary and custodial care; • Few studies have studied the link between grandchild care and grandparents’ health using a cumulative advantage/disadvantage framework.

5. Aim and objectives Examine the effects of caring for grandchildren on health among European grandparents • Using longitudinal data • Using life history data, and controlling for cumulative experiences across the life course (paid work histories; health and socio-economic position in childhood).

6. Data 3 waves of multidisciplinary comparable surveys, representative of individuals 50+ • Survey of Health, Ageing and Retirement in Europe (SHARE) (N~27,000);France, Austria, Germany, Sweden, Denmark, Switzerland,The Netherlands, Italy, Spain, Greece, Belgium • Household response rate: 62%, with individual response rates higher than 85%; • First wave collected in 2004/05. • Focus on grandparents

7. Data /2 • Waves 1, 2 provide information on grandparents, includingdemographic and socio-economic characteristics, health, and household characteristics. • Wave 3 collects retrospective life history information about childhood conditions, and life events in adulthood.

8. Data /3 «During the last 12 months, have you looked after your grandchild[ren] without the presence of the parents?» If so i) «how often?» [daily, weekly, monthly, less often] ii) «about how many hours?» Intensive grandparental childcare if grandchildren were looked after by grandparents on a daily basis or at least 15 hours per week

9. Overview of Analysis Latent childhood disadvantage classes Number of unions; In paid work >75%; Has never worked; Has suffered i. Hunger; ii. ‘Adverse’ event; iii. Long periods of ill health Latent Health w2 Baseline Characteristics (w1) Age; Gender; Education; Household type, Country; Wealth quintiles; Number & Age of grandchildren; Childcare; Paid work and social engagement; Latent Health; Health behaviour (BMI, smoking); Depression; Cognitive function;

10. Measures • We used Latent Class Analysis in order to classify respondents into childhood conditions advantage/ disadvantage subgroups; [Dysfunctional parent; One parent dead; Occupation of breadwinner; Books in HH; toilet; Hot water; Bath; Heating; Poor health; In hospital or bed for one month or more; With severe illness at age of 10 ] • We used a Latent Variableto represent the concept of ‘somatic’ health; [Self-rated health, Self report of conditions (cancer, lung, heart, stroke, diabeter), Self report of limiting disability, Activities of Daily Living, Instrumental activities of daily living]

11. Sample and Methods Sample: • ~16,000 grandparents aged 50+ at baseline; • ~ 9,700 grandparents at 24-month follow-up; • ~ 7,200 with history data. • ~ 6,500 complete cases (~41%) Analysis Linear regression of the latent variable health at follow-up, controlling for both baseline and history socio-economic and demographic characteristics.

12. Results – descriptive /1 Distribution of grandparent childcare, by wave • Source: SHARE 2004/05, 2006 • Countries: France, Austria, Germany, Sweden, Denmark, Switzerland, The Netherlands, Italy, Spain, Greece, Belgium

13. Results – descriptive /2 Distribution of selected grandparent’s characteristics, by childcare

14. Results – linear regression /1Beta coefficients from models of ‘good’ health at wave 2 • Younger grandparents in higher education, and in the higher wealth quintiles at baseline are less likely to report poor health at wave 2; • No gender differences; • No household composition differences; age and number of grandchildren not significant; • Social engagement at baseline not significant.

15. Results – linear regression /2

16. Conclusions Using waves 1, 2 and history data • Provision of childcare –both intensive and non-intensive –positively associated with good health over time; • Such relationship remains even when accounting for childhood and adulthood disadvantage; • Expected relationships between baseline health, socio-economic and demographic characteristics and health at follow-up.

17. Limitations & Future work • Attrition can bias results, especially in the older population where the most ‘disadvantaged’ have a higher probability of dropping out of the study;  Multiple Imputations, Sensitivityanalysis • “Selection effect” of grandparents who look after grandchildren. Unmeasured factor?

18. Thanks for your attention! Questions, comments and feedback are welcome.

20. Childhood 3 classes • Class proportion: 68%; 24%; 8% • Classification accuracy: 0.84 • Average Latent Class probability

21. Childhood /2 Figure 1. Conditional Response Probabilities

22. Somatic Health We used: • Self rated health • Self report of long-term health problems • Self report of heart failure, chronic lung disease, stroke, diabetes, and cancer • Activities of Daily Living • Instrumental activities of daily living