Reviewer’s report
Title: 
Mechanisms linking teenage mothers’ educational attainment with self-
reported health at age 50
Version: 
1 
Date: 
14 Oct 2020
Reviewer's report:
Comments:
Thank you for the opportunity to review this paper. It is well-written, easy to
understand, and covers a topic that has been largely overlooked. I have a few
comments and questions:
1) There are several sentences in the introduction that need references:
a. P3. Line2-3: "Teenage childbearing is associated with adverse health and
socioeconomic disadvantage for women and their children in the United States"
b. P3. Lines 3-5: "On the one hand, the disadvantage faced by teenage mothers
may be due to the background characteristics that selected them into early
childbearing."
c. P3. Lines 5-7: "Alternatively, the experience of teenage motherhood itself -
e.g., truncated education, time out of the labour force, discrimination by peers -
may also contribute to worse outcomes."
d. P3. Lines 11-13: "Attaining additional education after the birth of a child
during the teen years is a modifiable social influence factor that may support
women's health and well-being across the life course.
e. P3. Lines 24-25: what programs are you referring to here specifically "Despite
decades of community- and school-based programming in the United States
aimed toward supporting pregnant and parenting teens"
f. P5. Lines 10-11: "Second, human capital theory emphasizes the health returns
to the skills, abilities, and knowledge developed by greater educational
attainment."
g. P5. Lines 11-14: "Third, credentialing theory expands upon human capital
theory to consider how high school and/or college degrees signal an individual's
skills, abilities, and knowledge to important social actors."
h. P6. Lines 2-7: You have no references regarding education -> physical
activity. "Finally, higher levels of education may directly influence women's
health behaviours by providing a learned appreciation for the importance of
health behaviours, such as engaging in regular physical activity. Although
participating in regular physical activity may have direct positive impacts on
women's health later in life, such as reducing risk for obesity and stress-related
diseases and increasing cardiovascular health, it can also serve as a marker of
women's health behaviours in adulthood."
2) You include the variable "Enrolled in school at Wave 1" - which would be
before the birth of their first child. There is likely a big difference in high school
completion among those who were and were not enrolled in school before they
had their first child (15% not enrolled). In your introduction you discuss
programs aimed at keeping young women in school after adolescent childbirth -
are there also programs available to encourage return to school after childbirth
among women who had already left school before having their first child?
3) There are several variables that you adjust for, but do not give any
justification for these adjustment. For example, why did you include self-esteem
score at Wave 2? Is there a known relationship between adolescent childbearing
and self-esteem, or self-esteem and high school completion, or early adult self-
esteem and health at age 50? If yes, please include citations for this. If not, please
remove this as a covariate. Similarly for number of siblings at Wave 1 and
race/ethnicity. Specifically for race/ethnicity - what are you adjusting for here? Is
there a relationship between race and your exposure/outcome, and if yes, is this
due to biologic mechanisms or structural racism? 
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