Reserve Capacity and other Adolescent Pathways in Socioeconomic Inequalities in Mortality and Education: A Three-Generation Study in Finland

Paulyn Jean Acacio-Claro

Research output: Book/ReportDoctoral thesisCollection of Articles


Studies have extensively shown that low socioeconomic status (SES) has cumulative adverse effects on morbidity and mortality. In addition, recent evidence showed that grandparents’ socioeconomic capital could also be transmitted to their grandchildren. This implies that transmission of low SES across generations of families could perpetuate a cycle of socioeconomic disadvantage, creating further health and socioeconomic inequalities.

The strong SES-health connection was theorised to occur through different intermediate pathways in the life-course. An integrative framework emphasised the role of psychosocial resources called “reserve capacity” in causing health inequalities. This framework specifies that low SES increases one’s exposure to environmental stressors and depletes “reserve capacity.” Thus, negative emotional and physiological responses are triggered, affecting health via altered biological and behavioural pathways. We propose that similar processes also affect attained educational level and ultimately, one’s future SES. We also extend the reserve capacity framework to include health-promoting behaviours because of their underlying psychosocial resources.

Using 1985-1995 data from the Adolescent Health and Lifestyle Surveys (AHLS) linked with data from the registries of Statistics Finland, we determined the existence of socioeconomic inequalities in mortality and education. Moreover, we assessed the roles of reserve capacity and other intermediate pathways in adolescence such as pubertal timing and school achievement in these life-course trajectories. We further studied if grandparents’ socioeconomic circumstances affected their grandchildren’s education.

The AHLS dataset contained information on representative samples of 12- to 18year old Finns while the linked data from the registries updated until 2009 had relevant mortality and socioeconomic information for the AHLS participants, their parents and grandparents. Cox and multinomial logistic regression models as well as structural equation models were fitted to answer the aims of this dissertation.

In general, we found the existence of socioeconomic inequalities in mortality and education in our setting. We also found that reserve capacity and school achievement were both good and independent predictors of mortality and education. In Study I, high reserve capacity and good school achievement reduced the risk of mortality. Among boys, these also mitigated the negative effect of low SES on mortality. In Study II, both reserve capacity and school achievement independently predicted educational attainment and mediated the effect of family SES on education. We also found out that the socioeconomic circumstances of grandparents predicted their grandchildren’s educational outcomes, providing evidence on the origin of socioeconomic inequalities. The direct effects of reserve capacity and school achievement on education were further confirmed in Study III. Additionally, we have shown that pubertal timing was a potential biological pathway which influenced adolescents’ educational trajectories. Moreover, indirect pathways from family SES to education existed through reserve capacity and school achievement. In this study, we have also provided evidence that a low family SES increased the probabilities of low reserve capacity, delayed pubertal timing and low school achievement.

Consistent with previous research, all the studies clearly showed that family SES directly influenced health and one’s future education. Important mechanisms in adolescence, however, namely, reserve capacity, pubertal timing and school achievement, mediated the relationships of family SES with these outcomes. Even though family SES also influenced these pathways, reserve capacity and school achievement are amenable to policies and public health measures and thus, could be improved to reduce health risks, avert untimely mortality and improve the socioeconomic status of subsequent generations. Our findings suggest that strengthening multiple generations of families and schools in building reserve capacities (e.g., improving perceived health, encouraging health-promoting behaviour and providing social support), and supporting the school performance of adolescents, particularly those with disadvantaged socioeconomic backgrounds, could likely reduce socioeconomic inequalities in health and education.
Original languageEnglish
Place of PublicationTampere
PublisherTampereen yliopisto
ISBN (Electronic)978-952-03-1555-9
ISBN (Print)978-952-03-1554-2
Publication statusPublished - 2020
Publication typeG5 Doctoral dissertation (articles)

Publication series

NameTampere University Dissertations - Tampereen yliopiston väitöskirjat
ISSN (Print)2489-9860
ISSN (Electronic)2490-0028


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