Could teacher-perceived parental interest be an important factor in understanding how education relates to later physiological health? A life course approach

Education is associated with later health, and notably with an indicator of physiological health measuring the cost of adapting to stressful conditions, named allostatic load. Education is itself the result of a number of upstream variables. We examined the origins of educational attainment through the lens of interactions between families and school i.e. parents’ interest in their child’s education as perceived by teachers. This study aims to examine whether parental interest during a child’s educational trajectory is associated with subsequent allostatic load, and whether education or other pathways mediate this relationship. We used data from 9 377 women and men born in 1958 in Great Britain and included in the National Child Development Study to conduct secondary data analyses. Parental interest was measured from questionnaire responses by teachers collected at age 7, 11 and 16. Allostatic load was defined using 14 biomarkers assayed in blood from a biosample collected at 44 years of age. Linear regression analyses were carried out on a sample of 8 113 participants with complete data for allostatic load, missing data were imputed. Participants whose parents were considered to be uninterested in their education by their teacher had a higher allostatic load on average in midlife in both men (β = 0,41 [0,29; 0,54]) and women (β = 0,69 [0,54; 0,83]). We examined the role of the educational and other pathways including psychosocial, material/financial, and behavioral variables, as potential mediators in the relationship between parental interest and allostatic load. The direct link between parental interest and allostatic load was completely mediated in men, but only partially mediated in women. This work provides evidence that parents’ interest in their child’s education as perceived by teachers is associated with subsequent physiological health in mid-life and may highlight a form of cultural dissonance between family and educational spheres.


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Education is associated with later health, and notably with allostatic load (AL), an indicator of 23 physiological health measuring the cost of adapting to stressful conditions. However, education 24 is itself constructed by a number of upstream variables. We examined the origins of educational 25 attainment through the prism of interactions between families and school i.e. teacher-perceived 26 parental interest in their child education (PI). This study aims to examine whether PI is 27 associated with AL, and whether education is a possible mediator of the relationship. 28 We used data from the National Child Development Study. Linear regression analyses on a 29 total of 7850 participants revealed that people whose parents were considered to be uninterested One of the most consistent findings in the field of social epidemiology is that 40 educational attainment is associated with health. Across countries, and over time, lower 41 educational attainment has been associated with poorer health outcomes (1). These associations 42 are often explained by the fact that well educated people are less likely to experience the harsh 43 material conditions or psychosocial distress caused by economic hardship and tend to have 44 healthier lifestyles compared to the less educated (2). However, the mechanisms through which 45 education relates to health, remain poorly understood.

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The concept of embodiment rests upon a key set of mechanisms likely to underlie the 48 relationship between social variables like education and health. This concept "refers to how we, 49 like any living organism, literally incorporate, biologically, the world in which we live, 50 including our societal and ecological circumstances"(3). Allostatic load (AL) is an example of 51 how endogenous mechanisms, by which daily interactions and relationships are perceived and 52 interpreted by the central nervous system, may over time lead to multi-system physiological 53 wear-and-tear. It measures the consequence of a prolonged activation of the stress response 54 system by external challenges, leading to physiological imbalances across systems (4). Previous 55 research has shown that AL is associated with physical and functioning decline, cardiovascular 56 events, and mortality (5,6) 57 58 Life course research indicates that the dynamic processes of adaptive allostasis most likely 59 begin in early life (7,8). Early life socioeconomic conditions are associated with physiological 60 wear-and-tear through educational attainment (9). As such, educational attainment "is an 61 excellent marker of the 'healthfulness' of accumulated childhood experience''(10) as the social 62 environment in early life, partly operating through education, may be associated with different 63 physiological responses, leading to physiological wear-and-tear in more disadvantaged social 64 groups, which in turn affects health. The question is, which elements of the early life 65 environment upstream of education are likely to be involved in the embodiment dynamic, 66 leading to physiological wear-and-tear? 67 This early life social environment, is complex and can be examined through the three 68 dimensions of economic capital, social capital and cultural capital (11,12). Economic capital 69 refers to the material resources and financial support, social capital concerns interpersonal   We hypothesize that teacher-perceived parental interest (PI) may capture early life stressors 90 linked to dissonance between the home and school environment and thus be related to 91 physiological wear-and-tear, partly through education. In this study, we take a life course 92 approach to (i) test whether PI is associated with AL, and (ii) we explored four pathways 93 through which PI may be differentially embodied during childhood, adolescence and early 94 adulthood, leading to physiological wear-and-tear, as measured by AL.   The AL score was constructed based on previous work using the NCDS using the initial 116 definition of AL (19) : in order to represent four physiological systems, 14 available biomarkers 117 were used: the neuroendocrine system (salivary cortisol t1, salivary cortisol t1-t2); the immune 118 and inflammatory system (insulin-like growth factor-1 (IGF1), C-reactive protein (CRP), 119 fibrinogen, Immunoglobulin E (IgE)); the metabolic system (high-density lipoprotein (HDL), 120 low-density lipoprotein (LDL), triglycerides, glycosylated hemoglobin (HbA1C)); the 121 cardiovascular and respiratory systems: (systolic blood pressure (SBP), diastolic blood pressure 122 (DBP), heart rate, peak expiratory flow). Using sex-specific quartiles, each biomarker was 123 dichotomized into "high" (coded as 1) and "low" (coded as 0) risk. The sum of these 14 124 dichotomized biomarkers resulted in an overall AL score ranging from 0 to 14, where a higher 125 score represented a higher AL. We also recoded AL into a 3 category variable where a score of 126 0-2 was considered to be "low", 3-4 as "middle ", and 5-14 as "high" as used previously within 127 this cohort (20). Little interest. Based on this, we created a new binary variable for PI aiming to identify parents 135 "interested" or with "low/no interest" in their child's education We grouped the "overly 136 concerned" and "very interested" categories together to represent the "interested" category, 137 while grouping the "some interest" with "little interest" categories together to represent "low/no 138 interest ". We hypothesized that interest from both parents at any one age belongs to the 139 category "interested". However, if only one of the parents was considered to be interested or if 140 neither were, we considered this to belong to the category "low/no interest". We conducted a 141 sensitivity analyze for studying the stability of PI, using a series of regression analyses to 142 identify whether changes to the ungrouped categories (Overly concerned; Very interested; Some 143 interest; and Little interest) had an effect on AL. We observed no change to the results (S1 Table   144 A). father <14 year/father lefts school ≥15 year and mother <14 year), and parenting practices 156 including reading to the child and outdoor activities, measured at age 7 157 ("Frequent/Occasionally, Hardly ever ) (21).

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Other prior confounding variables potentially associated with PI and AL were selected. At ages 159 7, 11, and 16, a binary adverse childhood experiences variable (ACEs) was constructed, as well 160 as a binary childhood pathologies variable. Using data collected at 7y, a birth order variable 161 was created (Single child/Elder/2nd place or more), and an assessment of the child's cognitive In order to determine whether any observed associations between PI and AL were due particularities. Also, this allows us to take into account sex/gender differences in health.

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First, descriptive and bivariate statistics were carried out using the Chi2 test, considering 188 AL as a categorical variable in three groups, in order to ascertain any association between the 189 covariates and AL. Second, to study the association between PI and AL, regression coefficients 190 and 95% confidence intervals (CI) were estimated using linear regressions where AL was 191 entered as a continuous variable. We compared regression coefficients across nested models to 192 observe the change in effect according to subsequent adjustments.  Table B).

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Descriptive and bivariate analyses from the bivariate analyses by AL group of the 235 nonimputed subsample are given in Table 1 in men and women. The majority of our population 236 (78% in men and 75% in women) had a low [0-2] or medium [3][4] AL. Additionally, 47% of 237 the cohort members' two parents were perceived by the teacher as taking interest in their child's 238 education, while 42% were described as uninterested or not very interested.

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In general men and women with a high AL at 44y were more likely to have parents described

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Cohort members whose parents were perceived as uninterested or not very interested in their 316 child's education, as reported by the children's teachers, had a higher AL compared to 317 individuals whose parents were considered by the teacher to be interested. other cohorts to explore this association and ascertain its potential contextual specificity.

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The main weakness of this study is that our variable measuring parental interest is one- to consider that this measurement is reliable in our analysis (35). The choice of the statistical 391 models and the variables tested are based on a priori theoretical and conceptual considerations.

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Therefore, it is possible that we overlooked variables or assumptions, other factor may 393 contribute in the relationship between PI and AL. Lastly, NCDS 58 is a UK cohort, with unique 394 cultural and historical aspects. It is therefore necessary to take precautions when extrapolating 395 our results.

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Despite these limitations, this study has a number of strengths. It is a longitudinal population-