Lundberg O
Swedish Institute for Social Research, Stockholm University, Sweden.
Soc Sci Med. 1997 Mar;44(6):821-31. doi: 10.1016/s0277-9536(96)00184-0.
In order to expand our knowledge of how health inequalities are generated, a broader range of possible mechanisms has to be studied. Two mechanisms of potential importance here are childhood conditions and sense of coherence. Drawing on theoretical arguments and empirical findings in these two research fields, a conceptual model of the relationships between childhood conditions, sense of coherence, adult social class and adult health is presented. On the basis of this model, this paper sets out to analyse (1) the degree to which a low sense of coherence is based in childhood experiences, (2) the degree to which the impact of childhood conditions on adult health is mediated through sense of coherence, and (3) the importance of sense of coherence for class differences in ill health. The analyses are carried out on both cross-sectional data (n = 4390) and panel data (n = 3773) from the Swedish Level of Living Surveys in 1981 and 1991. The analyses indicate that childhood family size and the experience of a broken home are unrelated to sense of coherence later in life, while economic hardship has a small and indirect effect, mediated via class position in adulthood. Only dissension in the childhood family was found to have a direct, although fairly modest, effect on sense of coherence. Furthermore, it is demonstrated that sense of coherence does not mediate the effect of childhood factors on adult health. Rather, childhood conditions and adult sense of coherence appear to be complementary and additive risk factors for illness in adulthood. The results presented here also suggest that sense of coherence may be a factor involved in the shaping of class inequalities in health.
为了拓展我们对健康不平等现象产生方式的认识，必须研究更广泛的可能机制。这里有两个潜在重要机制，即童年状况和连贯感。借鉴这两个研究领域的理论观点和实证研究结果，本文提出了一个关于童年状况、连贯感、成年社会阶层与成年健康之间关系的概念模型。基于此模型，本文旨在分析：（1）低连贯感在多大程度上基于童年经历；（2）童年状况对成年健康的影响在多大程度上通过连贯感来介导；（3）连贯感对健康不良方面的阶层差异的重要性。分析使用了1981年和1991年瑞典生活水平调查的横断面数据（n = 4390）和面板数据（n = 3773）。分析表明，童年家庭规模和家庭破裂经历与晚年的连贯感无关，而经济困难有一个小的间接影响，通过成年后的阶级地位来介导。仅发现童年家庭中的不和对连贯感有直接影响，尽管影响相当适度。此外，研究表明连贯感并未介导童年因素对成年健康的影响。相反，童年状况和成年连贯感似乎是成年期疾病的互补性和累加性风险因素。本文呈现的结果还表明，连贯感可能是塑造健康方面阶层不平等的一个因素。
