Children with an immigrant background have generally poorer school outcomes than nonimmigrant children. Immigrant generation and age at migration play a significant role in shaping these outcomes. To capture the complexity of this population's experiences, we define immigrant background as a compound variable including immigrant generation, age at migration, and exogamous family setting (i.e. children born to one immigrant and one nonimmigrant parent). We study the relationship between immigrant background and completion of secondary education by ages 21-23. Using Finnish register data, we find that, overall, individuals with an immigrant background are more likely than nonimmigrants to have completed only basic education by these ages regardless of sex. First-generation immigrants, particularly those who migrated at older ages, have the lowest likelihood of completing secondary education. However, second-generation immigrants and those with an exogamous family background are more likely than nonimmigrants to graduate from the academic track, irrespective of sex, with stronger associations among women. Across all generations, women are more likely than men to continue into the academic track of upper secondary education, a pattern consistent among both nonimmigrant and immigrant individuals, and across income levels. These findings highlight the importance of considering refined measures of immigrant background, such as the one proposed in this study, that simultaneously account for immigrant generation, age at migration of the first generation, and exogamous family settings in order to better capture the growing complexity of immigrant experiences and their relationship to educational outcomes.

Immigrants and their descendants are increasingly forming families across Europe, yet little is known about how immigration background shapes first union entry in emerging immigration contexts. Here, we examine whether immigrant generation, age at arrival, and sending region are associated with entry into opposite-sex first unions for women in Finland from 1987 to 2020. Treating cohabitation and direct marriage as competing events, we estimate cause-specific hazards in separate accelerated failure time models. We find a systematic bifurcation in union entry: while nearly all immigrant groups forgo the modal Finnish path of first entering a nonmarital cohabitation, specific subgroups—including the second generation, first generation arriving during adolescence, and women from the Former Soviet Union, Eastern Europe, North America, South Asia, and the Middle East and North Africa—exhibit accelerated transitions to direct marriage. While these findings demonstrate heterogeneity in the pathways by which immigrant women enter unions, with no single narrative of delay or convergence capturing the full picture, the overall pattern of later and less cohabitation and higher levels of direct marriage suggest that immigrant women face substantively different cultural, institutional, and social capital conditions than nonimmigrant women.

BACKGROUND:Evidence regarding the link between parental education and adolescents' COVID-19 vaccination status mostly originates from non-representative survey studies, and the results are mixed. Although some register-based studies have shown a positive association with higher parental education and adolescent COVID-19 vaccine uptake, the factors behind these differences remain largely unexplored. METHODS:We used total population-level Finnish register data on 12-17-year-olds (N = 360,281) linked with their parents and household members. Logistic regression models were employed to analyse the association between parental education and the likelihood of receiving the first COVID-19 vaccine dose by the end of 2022. The Karlson-Holm-Breen (KHB) method was used to quantify the extent to which parental age, family structure, household income, migration background, previous COVID-19 infection, presence of risk group household members, and parental COVID-19 vaccination status confounded or mediated the association. RESULTS:Adolescents with at least one parent with upper tertiary education had higher COVID-19 vaccine uptake (92 %) than those whose parents had only basic education (58 %), with an odds ratio [OR] of 8.60 (95 % CI 8.20-9.02) in the baseline model. Together the adjustments confounded or mediated over 80 % of the association, with parental COVID-19 vaccine uptake and household income being the strongest explanatory factors. For example, adjusting for parental COVID-19 vaccination status attenuated the OR to 3.85 (95 % CI 3.61-4.12). In the fully adjusted model, the OR remained at 1.55 (95 % CI 1.45-1.67). The results were highly similar when using household income as the socioeconomic status measure. CONCLUSION:Parental education was a strong predictor of adolescents' COVID-19 vaccine uptake in Finland. Parental vaccination status emerged as an important mediator of the association, possibly indicating general vaccine hesitancy. Other factors behind the educational differences included household income, migration background, and parental age.

BACKGROUND:Previous evidence on season-of-birth differences in atopic diseases is partially mixed, and the etiology behind them is not well understood. For example, outdoor temperature may be an important modifier of the association but has been previously neglected. METHODS:We assess how the month of birth is associated with medication use for atopic diseases at ages 0-15 and how outdoor temperatures after birth modify these associations for 0.55 million Finns born during 1995-2004. We used Finnish register data on purchases of medications used for allergic rhinitis, eczema, asthma, and food allergies. We predicted month-of-birth associations with medication use using extensive controls for observed and unobserved confounders and assessed effect modification by 3-month mean outdoor temperature after birth. RESULTS:Approximately half of the children had at least one purchase of medication used for atopic diseases. For children born in spring or summer, the probability of medication use was moderately lower than for children born in the autumn or winter. Among children born in the autumn or winter, exposure to the coldest outdoor temperatures in the first 3 months of life was associated with a nearly 10-percentage-point increase in the risk for medication use compared with the warmest temperatures. CONCLUSIONS:Behind the moderate overall associations between month of birth and childhood atopic diseases, there was notable variation by environmental conditions after birth, with cold weather after birth being particularly harmful. Future studies should assess what specific exposures do the outdoor temperatures affect, and in turn how they affect the development of atopic diseases.

Background Low family socioeconomic position is a well-established determinant of poor health in youth. Much less is known about the social patterning of youth medication use, and the current evidence is mixed. Furthermore, previous studies have not assessed important confounders of the associations. We analyse differences in youth medication use by childhood family income and medication type.Methods Administrative register data on full Finnish cohorts born in 1979-2003 (n=1 490 666) and survival analysis were used to assess the risk of using common prescription medications between ages 16 and 20 according to mean household income in ages 11-15, accounting for several observed familial characteristics including parental health. We also compared siblings with discordant childhood income exposures to assess whether any differences are explained by unobserved familial confounding.Results For each 10% increase in childhood family income, there was a 0.6%-1.7% increase in the probability of using the most common prescription medications: antibiotics, painkillers, and allergy and asthma medications. In contrast, a 10% increase in childhood income was related to a 2.5% decrease in the probability of psychotropic medication use. In sibling comparisons, childhood income was not associated with any type of medication use.Conclusion Apart from psychotropics, the results may indicate medication underuse among youth from low-income families. The sibling comparisons suggest that moderate differences in childhood income are unlikely to cause differences in youth medication use and thus, in contexts of relative income equality, income differences in medication use are likely to reflect other, unobserved, family factors shared by siblings.

Depression and other mental health disorders are increasing while childlessness is increasing. However, this relationship has rarely been studied. We examine how depression, as measured by antidepressant use, is related to childlessness. We add to the previous research by examining both the role of current partnership status and having a partner with depression as a mechanism.We use Finnish total population register data for cohorts born in 1977-1980. We estimate discrete time event history models for the likelihood of having a child with average marginal effects separately for men and women. Depression was measured annually with a time-varying indicator of having at least one purchase of antidepressants in the preceding year.We find a positive association between depression and childlessness; the annual probability of having a child was 2.7 percentage points lower for women with depression and 1.6 percentage points for men with depression in age-controlled models. When controlling for all background variables such as education, the likelihood of having a child was 1.9 percentage points lower for women with depression and 0.3 percentage points lower for men with depression. In total, 41% of men and 26% of women who had used antidepressant medication between ages 18-38 remained childless at age 39, compared to 30% of men and 22% of women who had not used antidepressant medication. We also find that a partner’s depression increases the probability of being childless, and the likelihood of being childless is even higher if both an individual and their partner had depression.

The association between having older siblings and decreased risk for atopic symptoms is well-established. This has been interpreted as evidence for the microbiota hypothesis, i.e. that increased early-childhood microbial exposure caused by siblings protects from immune hypersensitivities. However, possible confounders of the association have received little attention. We used register data on Finnish cohorts born in 1995-2004 (N = 559,077) to assess medication purchases for atopic diseases: antihistamines, eczema medication, asthma medication and Epinephrine. We modelled the probability of atopic medication purchases at ages 0-15 by birth order controlling for important observed confounders and all unobserved genetic and environmental characteristics shared by siblings in a within-family fixed effects model. We further studied medication purchases among first-borns according to the age difference with younger siblings to assess whether having younger siblings in early childhood is beneficial. Having older siblings was associated with a lower probability of atopic medication purchases. Compared to first-borns, the probability was 10-20% lower among second-borns, 20-40% lower among third-borns, and 30-70% lower among subsequent children, depending on medication type. Confounding accounted for up to 75% of these differences, particularly for asthma and eczema medication, but significant differences by birth order remained across all medication types. Among first-borns, a smaller age difference with younger siblings was related to a lower likelihood of atopic medication use. Our results, based on designs that account for unobserved confounding, show that exposure to siblings in early childhood, protects from atopic diseases, and thus strongly support the microbiota hypothesis.

Objectives Residential long-term care (LTC) use has declined in many countries over the past years. This study quantifies how changing rates of entry, exit, and mortality have contributed to trends in life expectancy in LTC (i.e., average time spent in LTC after age 65) across sociodemographic groups.Methods We analyzed population-register data of all Finns aged >= 65 during 1999-2018 (n = 2,016,987) with dates of LTC and death and sociodemographic characteristics. We estimated transition rates between home, LTC, and death using Poisson generalized additive models, and calculated multistate life tables across 1999-2003, 2004-2008, 2009-2013, and 2014-2018.Results Between 1999-2003 and 2004-2008, life expectancy in LTC increased from 0.75 (95% CI: 0.74-0.76) to 0.89 (95% CI: 0.88-0.90) years among men and from 1.61 (95% CI: 1.59-1.62) to 1.83 (95% CI: 1.81-1.85) years among women, mainly due to declining exit rates from LTC. Thereafter, life expectancy in LTC decreased, reaching 0.80 (95% CI: 0.79-0.81) and 1.51 (95% CI: 1.50-1.53) years among men and women, respectively, in 2014-2018. Especially among women and nonmarried men, the decline was largely due to increasing death rates in LTC. Admission rates declined throughout the study period, which offset the increase in life expectancy in LTC attributable to declining mortality in the community. Marital status differences in life expectancy in LTC narrowed over time.Discussion Recent declines in LTC use were driven by postponed LTC admission closer to death. The results suggest that across sociodemographic strata older adults enter LTC in even worse health and spend a shorter time in care than before.

AIMS Harmful alcohol consumption is influenced by both genetic susceptibility and the price of alcohol. Many previous studies have observed that genetic susceptibility to consumption of alcohol is more predictive in less restrictive drinking conditions. We assess whether such a pattern applies when the prices of alcoholic beverages are decreased. DESIGN Data consist of genetically informed population-representative surveys (FINRISK 1992, 1997, 2002 and Health 2000) linked to administrative registers. We analysed the interaction between a polygenic score (PGS) for alcoholic drinks per week consumed and price reduction in predicting the incidence of alcohol-related hospitalizations and deaths in difference-in-difference and interrupted time-series frameworks. SETTING Individuals in Finland were followed quarter-yearly from 1 March 2000 to 31 May 2008. PARTICIPANTS N=22,152 individuals (607,132 person-quarter-years, 1399 outcome events) aged 30-79 years. INTERVENTION A natural experiment stemming from the alcohol tax reduction in March 2004 and import deregulation in May 2004. MEASUREMENTS Outcome was quarter-yearly measured alcohol-related death or hospitalization. The independent variables of main interest were PGS and a price reform indicator. We adjusted for gender, age, age squared, season, ten first principal components of the genome, data collection round and genotyping batch. FINDINGS Both alcohol price reduction and one standard deviation change in PGS were associated with alcohol-related health outcomes; odds ratios (ORs) were 1.32 (95% confidence interval [CI], 1.13; 1.53) and 1.26 (95% CI, 1.12; 1.42) in the 8-year follow-up, respectively. The association between PGS and alcohol-related morbidity was similar before and after the alcohol price reform (PGS*price reform interaction OR 0.96, 95% CI, 0.81; 1.14). These results were robust across different follow-up periods and measurement and analysis strategies. CONCLUSIONS Although the decrease of alcohol price in Finland in 2004 substantially increased overall alcohol-related morbidity and mortality, the genetic susceptibility to alcohol consumption did not become more manifest in predicting them.

Abstract Background Residential long-term care (LTC) coverage has declined in many countries over the past decade. However, it is unclear to what extent the decline is attributable to a smaller proportion of older people entering or shorter time spent in LTC, and if the change has been similar across sociodemographic groups. This study analysed changes in life expectancy in LTC at age 65, the proportion ever entering, and years spent in LTC among those who entered, and quantified the contributions of changing rates of admission, mortality and exit to the change in life expectancy in LTC. Methods We analysed linked population register data that covered all Finnish residents aged 65+ between 1999 and 2018 (n = 2,016,987) on dates of entries to and exits from LTC, dates of death, and sociodemographic characteristics. We estimated transition rates between home, LTC and death, and calculated multistate life tables by sex, marital status and education across four periods 1999-2003, 2004-2008, 2009-2013 and 2014-2018. Results Life expectancy in LTC increased from 0.75 to 0.89 years among men and from 1.61 to 1.83 years among women between 1999-2003 and 2003-2008. The increase was mainly attributable to declining rates of exit from LTC, and thereby longer time spent in LTC for those who entered. Life expectancy in LTC started declining in 2009-2013 and reached 0.80 years among men and 1.51 years among women in 2014-2018. The decline mainly related to an increasing death rate in LTC. In all periods, declining mortality in the community contributed to an increase in life expectancy in LTC, but this was offset by steady declines in admission rates. Life expectancy in LTC changed similarly across marital status and education groups. Conclusions Recent declines in LTC use - driven by lower rates of entry and higher mortality in LTC when entered - imply that across sociodemographic strata it is has become more difficult to find LTC placement and older people enter LTC in ever worse health. Key messages • Overall LTC use increased in early 2000s despite declining admission rates. The increase was mainly due to declining exit rate from LTC indicating longer time spent in LTC for those who entered. • The recent shortening of life expectancy in LTC derives from entering LTC at a later stage and closer to death, indicating greater level of disability and worse health at the time of entry.

BACKGROUND:Alcohol-related deaths may be among the most important reasons for the shorter life expectancy of people with depression, yet no study has quantified their contribution. We quantify the contribution of alcohol-related deaths to the life-expectancy gap in depression in four European countries with differing levels of alcohol-related mortality.METHODS:We used cohort data linking population registers with health-care and death records from Denmark, Finland, Sweden and Turin, Italy, in 1993-2007 (210,412,097 person years, 3046,754 deaths). We identified psychiatric inpatients with depression from hospital discharge registers in Denmark, Finland, and Sweden and outpatients with antidepressant prescriptions from prescription registers in Finland and Turin. We assessed alcohol-related and non-alcohol-related deaths using both underlying and contributory causes of death, stratified by sex, age and depression status. We quantified the contribution of alcohol-related deaths by cause-of-death decomposition of the life-expectancy gap at age 25 between people with and without depression.RESULTS:The gap in life expectancy was 13.1-18.6 years between people with and without inpatient treatment for depression and 6.7-9.1 years between those with and without antidepressant treatment. The contribution of alcohol-related deaths to the life-expectancy gap was larger in Denmark (33.6%) and Finland (18.1-30.5%) - i.e., countries with high overall alcohol-related mortality - than in Sweden (11.9%) and Turin (3.2%), and larger among men in all countries. The life-expectancy gap due to other than alcohol-related deaths varied little across countries.CONCLUSIONS:Alcohol contributes heavily to the lower life expectancy in depression particularly among men and in countries with high overall alcohol-related mortality.

Poor mental health among the unemployed-the long-term unemployed in particular-is established, but these associations may be driven by confounding from unobserved, time-invariant characteristics such as past experiences and personality. Using longitudinal register data on 2,720,431 residents aged 30-60 years, we assessed how current unemployment and unemployment history predict visits to specialized care due to psychiatric conditions and self-harm in Finland in 2008-2018. We used linear ordinary-least-squares and fixed-effects models. Prior to adjusting for time-invariant characteristics, current unemployment was associated with poor mental health, and the risk increased with longer unemployment histories. Accounting for all time-invariant characteristics with the fixed-effects models, these associations attenuated by approximately 70%, yet current unemployment was still associated with a 0.51 (95% confidence interval: 0.48, 0.53) percentage-point increase in the probability of poor mental health among men and women. Longer unemployment histories increased the probability among men in their 30s but not among older men or among women. The results indicate that selection by stable characteristics may explain a major part of the worse mental health among the unemployed and especially the long-term unemployed. However, even when controlling for this selection, current unemployment remains associated with mental health.

Background Successful transitions from unemployment to employment are an important concern, yet little is known about health-related selection into employment. We assessed the association of various physical and psychiatric conditions with finding employment, and employment stability. Methods Using total population register data, we followed Finnish residents aged 30–60 with an unemployment spell during 2009–2018 ( n = 814,085) for two years from the onset of unemployment. We predicted any, stable, and unstable employment by health status using Cox proportional hazards models. The data on specialized health care and prescription reimbursement were used to identify any alcohol-related conditions and poisonings, psychiatric conditions and self-harm, injuries, and physical conditions. We further separated physical conditions into cancer, diabetes, heart disease, and neurological conditions, and psychiatric conditions into depression, anxiety disorders and substance use disorders. Results The likelihood of any employment was lower among those who had any of the assessed health conditions. It was lowest among those with alcohol-related or psychiatric conditions with an age-adjusted hazard ratio of 0.45 (95% confidence interval 0.44, 0.46) among men and 0.39 (0.38, 0.41) among women for alcohol-related and 0.64 (0.63, 0.65) and 0.66 (0.65, 0.67) for psychiatric conditions, respectively. These results were not driven by differences in socioeconomic characteristics or comorbidities. All the included conditions were detrimental to both stable and unstable employment, however alcohol-related and psychiatric conditions were more harmful for stable than for unstable employment. Conclusions The prospects of the unemployed finding employment are reduced by poor health, particularly alcohol-related and psychiatric conditions. These two conditions may also lead to unstable career trajectories. The selection process contributes to the health differentials between employed and unemployed people. Unemployed people with health problems may therefore need additional support to improve their chances of employment.

BACKGROUND:Although intrahousehold transmission is a key source of Coronavirus Disease 2019 (COVID-19) infections, studies to date have not analysed socioeconomic risk factors on the household level or household clustering of severe COVID-19. We quantify household income differences and household clustering of COVID-19 incidence and severity.METHODS AND FINDINGS:We used register-based cohort data with individual-level linkage across various administrative registers for the total Finnish population living in working-age private households (N = 4,315,342). Incident COVID-19 cases (N = 38,467) were identified from the National Infectious Diseases Register from 1 July 2020 to 22 February 2021. Severe cases (N = 625) were defined as having at least 3 consecutive days of inpatient care with a COVID-19 diagnosis and identified from the Care Register for Health Care between 1 July 2020 and 31 December 2020. We used 2-level logistic regression with individuals nested within households to estimate COVID-19 incidence and case severity among those infected. Adjusted for age, sex, and regional characteristics, the incidence of COVID-19 was higher (odds ratio [OR] 1.67, 95% CI 1.58 to 1.77, p < 0.001, 28.4% of infections) among individuals in the lowest household income quintile than among those in the highest quintile (18.9%). The difference attenuated (OR 1.23, 1.16 to 1.30, p < 0.001) when controlling for foreign background but not when controlling for other household-level risk factors. In fact, we found a clear income gradient in incidence only among people with foreign background but none among those with native background. The odds of severe illness among those infected were also higher in the lowest income quintile (OR 1.97, 1.52 to 2.56, p < 0.001, 28.0% versus 21.6% in the highest quintile), but this difference was fully attenuated (OR 1.08, 0.77 to 1.52, p = 0.64) when controlling for other individual-level risk factors-comorbidities, occupational status, and foreign background. Both incidence and severity were strongly clustered within households: Around 77% of the variation in incidence and 20% in severity were attributable to differences between households. The main limitation of our study was that the test uptake for COVID-19 may have differed between population subgroups.CONCLUSIONS:Low household income appears to be a strong risk factor for both COVID-19 incidence and case severity, but the income differences are largely driven by having foreign background. The strong household clustering of incidence and severity highlights the importance of household context in the prevention and mitigation of COVID-19 outcomes.

Background Research evidence on the association between neighbourhood characteristics and individual mental health at older ages is inconsistent, possibly due to heterogeneity in the measurement of mental-health outcomes, neighbourhood characteristics and confounders. Register-based data enabled us to avoid these problems in this longitudinal study on the associations between socioeconomic and physical neighbourhood characteristics and individual antidepressant use in three national contexts. Methods We used register-based longitudinal data on the population aged 50+ from Turin (Italy), Stockholm (Sweden), and the nine largest cities in Finland linked to satellite-based land-cover data. This included individual-level information on sociodemographic factors and antidepressant use, and on neighbourhood socioeconomic characteristics, levels of urbanicity, green space and land-use mix (LUM). We assessed individual-level antidepressant use over 6 years in 2001–2017 using mixed-effects logistic regression. Results A higher neighbourhood proportion of low-educated individuals predicted lower odds for antidepressant use in Turin and Stockholm when individual-level sociodemographic factors were controlled for. Urbanicity predicted increased antidepressant use in Stockholm (OR=1.02; 95% CI 1.01 to 1.03) together with more LUM (OR=1.03; 1.01–1.05) and population density (OR=1.08; 1.05–1.10). The two latter characteristics also predicted increased antidepressant use in the Finnish cities (OR=1.05; 1.02–1.08 and OR=1.14; 1.02–1.28, respectively). After accounting for all studied neighbourhood and individual characteristics of the residents, the neighbourhoods still varied by odds of antidepressant use. Conclusions Overall, the associations of neighbourhood socioeconomic and physical characteristics with older people’s antidepressant use were small and inconsistent. However, we found modest evidence that dense physical urban environments predicted higher antidepressant use among older people in Stockholm and the Finnish cities.

Better mental health is observed among women with a partner, children, or employment as compared with women without a partner, children, or employment, respectively. Moreover, women who fulfill all three roles are generally healthier than those with fewer roles. Because of significant changes in work-family life constellations over age, understanding these health differentials requires a life course approach. We linked work-family trajectories to mental health in mid-life for Finnish women using longitudinal registry data. Panel data from an 11% random sample of the population residing in Finland in any year between 1987 and 2007 and followed up until 2013 were used. Work-family combinations were based on partnership status, motherhood status, and employment status. Purchases of prescribed psychotropic medication were used as a measure of mental health. We used sequence analysis to identify 7 distinct groups of women based on their work-family trajectories between ages 20 to 42 years. The associations of typologies of trajectories with mental health at age 43 years were estimated with logistic regression models. Compared to employed mothers with a partner, all other women were more likely to have purchased any psychotropic medication at age 43; especially women without a partner, children or employment and lone mothers had worse mental health. These disadvantages remained after controlling for psychotropic medication purchases earlier in life (to account for potential health selection). Adjusting for age at motherhood did not contribute to the better mental health of employed mothers with a partner. Women combining partnership, motherhood, and employment during early working ages had better mental health later in life than women with other work-family trajectories even after adjusting for mental health earlier in life. Interventions to improve the mental health of women living alone in mid-life, including lone mothers, and individuals without employment, may be needed. Keywords: Work-family life; Mental health; Finland; Life course approach; Sequence analysis; Psychotropic medication use

Background: The reasons for the shorter life expectancy of people with depression may vary by age. We quantified the contributions of specific causes of death by age to the life-expectancy gap in four European countries. Methods: Using register-based cohort data, we calculated annual mortality rates in between 1993 and 2007 for psychiatric inpatients with depression identified from hospital-care registers in Denmark, Finland and Sweden, and between 2000 and 2007 for antidepressant-treated outpatients identified from medication registers in Finland and Turin, Italy. We decomposed the life-expectancy gap at age 15 years by age and cause of death. Results: The life-expectancy gap was especially large for psychiatric inpatients (12.1 to 21.0 years) but substantial also for antidepressant-treated outpatients (6.3 to 14.2 years). Among psychiatric inpatients, the gap was largely attributable to unnatural deaths below age 55 years. The overall contribution was largest for suicide in Sweden (43 to 45%) and Finland (37 to 40%). In Denmark, 'other diseases' (25 to 34%) and alcohol-attributable causes (10 to 18%) had especially large contributions. Among antidepressant-treated outpatients, largest contributions were observed for suicide (18% for men) and circulatory deaths (23% for women) in Finland, and cancer deaths in Turin (29 to 36%). Natural deaths were concentrated at ages above 65 years. Limitations: The indication of antidepressant prescription could not be ascertained from the medication registers. Conclusions: Interventions should be directed to self-harm and substance use problems among younger psychi-atric inpatients and antidepressant-treated young men. Rigorous monitoring and treatment of comorbid somatic conditions and disease risk factors may increase life expectancy for antidepressant-treated outpatients, especially women.

Socioeconomic disadvantage in childhood is common among youth not in education, employment or training (NEETs). However, the evidence on other adverse childhood experiences as determinants of NEET remains scarce. We use Finnish longitudinal register data on a 20% random sample of households with 0-14-year-old children in 2000 to assess the childhood determinants of NEET. For an analytical sample of 99,137 children born 1986-1993, family socioeconomic resources, parental psychiatric disorders and substance abuse, parental death, living in a single-parent household and out-of-home placement under age 13 were used to predict NEET at the age of 18. We show that family socioeconomic disadvantage is strongly associated with NEET (e.g. odds ratio for parental basic education 5.33, 95% confidence interval 4.77, 5.95), whereas associations between adverse childhood experiences and NEET are more moderate (e.g. odds ratio for parent hospitalised for psychiatric disorder 1.86, 95% confidence interval 1.63, 2.12) and largely explained by socioeconomic factors. These associations were mostly similar by gender. The results suggest that parental socioeconomic resources are more important than adverse childhood experiences for the educational and employment transitions of young adults. Thus, supportive social policy for socioeconomically disadvantaged families may smooth these transitions.

Although the chil dren of first-gen eration immi grants tend to have bet ter health than the native popu lation, the health advantage of the chil dren of immi grant fami lies dete ri o rates over generations. It is, how ever, poorly under stood where on the gen erational health assimi lation spectrum chil dren with one immi grant and one native par ent (i.e., exogamous fam i lies) lie, to what extent family resources explain health assimi lation, and whether the pro cess of assimi lation varies across health con di tions. We seek to extend our under stand ing of the pro cess of health assimi lation by ana lyz ing the phys i cal and mental health of immi grant gen erations, assessing the role of exog a-mous family arrange ments, and testing the con tri butions of family material and social resources to chil dren's out comes. We use regis ter-based longi tudinal data on all children residing in Finland, born in 1986-2000, and alive in 2000; these data are free of report -ing bias and loss to fol low-up. We esti mate the risk of receiv ing inpatient and out patient care for somatic con di tions, psy chopath o log i cal dis orders, and injuries by immi grant gen eration status. Our results show evi dence of a neg ative health assimi lation pro cess, with both first-and sec ond-gen eration immi grant chil dren hav ing a higher prev alence of phys i cal prob lems and par tic u larly mental health prob lems than native chil dren that is only par tially explained by family resources. We find that the chil dren of exogamous fami lies are at espe cially high risk of devel op ing psy chopath o log i cal dis orders. These results provide strong support for the hypothe sis that chil dren of exog amous fami lies con stitute a spe cific health risk group and that the impact on chil dren's health of fam-ily social and material resources seems to be sec ond ary to other unob served factors.