# Intergenerational transmission of health care habits in France

Damien Bricard

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Damien Bricard. Intergenerational transmission of health care habits in France. 2013. [hal-05301861]

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# Intergenerational transmission of health care
habits in France

Damien Bricard, PSL, Université Paris-Dauphine, Leda-Legos, France

## ABSTRACT

This article explores the intergenerational transmission of health care habits and related differences in health care use at the family level. Our study is based on a sample of 4,608 individuals who responded to the 2010 French Health, Health Care and Insurance Survey and completed the specific questions on health care use and childhood living conditions. The results provide evidence of an intergenerational transmission of health care habits. More precisely, we reveal a correlation between health care habits across generations and the transmission of the likelihood of visiting a doctor, which is reflected by differences in doctor visits for the individual's children.

JEL: I12, J13, J62

**Keywords:** inequalities in health-care use; health-care norms; intergenerational transmission of health; family economics; cultural economics

## Introduction

Access to health care is considered a basic right and is promoted to achieve equity in health (Fleurbaey and Schokkaert, 2009; Fleurbaey and Schokkaert, 2011). However, there is substantial evidence of income-related and education-related inequalities in health care use in France and other European countries (Or et al., 2009; Bago d'Uva and Jones, 2009; Jusot et al.,
2012; Devaux and de Looper, 2012). These inequalities are larger in the use of specialist and preventive care than in the use of generalists and are particularly important in France.

Two sets of explanations related to factors influencing individual demand for care have been proposed<fnref n="1" />. First, the results of the ECuity project and more recent studies confirmed the role of direct cost of care as inequalities in health care use, in particular the use of specialists, increase with the level of co-payments and the lack of health insurance (Bago d’Uva and Jones, 2009; Or et al., 2009; Jusot et al., 2012). A second explanation, in line with the health capital model (Grossman, 2000) is the existence of informational barriers and differences in health preferences across educational and social groups, which may induce differences in health investment decisions (Cutler and Lleras-Muney, 2010).

While economic theory traditionally treats preferences as a given, a growing literature has studied the endogenous formation of preferences (Akerlof, 1997; Becker and Mulligan, 1997; Manski, 2000; Bisin and Verdier, 2001). Two sources of transmission have been proposed to explain this process: vertical transmission ("intergenerational effects") and horizontal transmission ("contemporaneous effects"). According to the vertical transmission hypothesis, preferences may evolve as a result of cultural transmission, by which a process of socialization transmits preferences across generations. Horizontal transmission consists of the social diffusion of beliefs, norms and habits among a single generation through the influence of peers and a process of imitation in which individuals imitate other “successful” individuals.

In particular, health-related norms or preferences seem to be socially constructed through cultural transmission or the influence of social capital (Costa-Font and Miladovsky, 2008; Marmot and Wilkinson, 2006; Kawachi et al., 2008; Folland, 2008). A growing body of literature provides evidence of the horizontal transmission of health norms and preferences.

<footnote n="1">¹ For determinants related to the organization of the health care system, see Bago d’Uva and Jones (2009), Or et al. (2009) and Jusot et al. (2012).</footnote>
Several studies have demonstrated the influence of social capital, as measured by social participation or contextual measures of social relationships, on health status, health-related behaviors and health care use (Islam, 2007; Sirven and Debrand, 2008; Iversen, 2008; Jusot et al., 2008; Laporte et al., 2008; Scheffler and Brown, 2008; d'Hombres et al., 2010). Several studies have also demonstrated the existence of peer influences on health-related behaviors, such as smoking or obesity (Clark and Etilé, 2006; Clark and Loheac, 2007; Etilé, 2007).

The intergenerational transmission of health has also been hypothesized, in particular to explain the persistence of health inequalities through generations (Ahlburg, 1998). Beyond a common genetic inheritance, the vertical transmission of health seems to be due to the long-term effect of social background and childhood conditions on health, social reproduction phenomena and the transmission of health-related preferences (Currie and Stabile, 2003; Case et al., 2005; Lindeboom et al., 2009; Trannoy et al., 2010). Among the studies that have explored the intergenerational transmission of health, some have provided evidence of the transmission of health-related behaviors such as exercising, smoking, alcohol consumption and obesity (Rosa-Dias, 2009; Jusot et al., 2010; Rosa-Dias, 2010; Bricard and Jusot, 2012; Tubeuf et al., 2012). However, to the best of our knowledge, the transmission of health preferences through health care use has never been explored due to a lack of data.

This article proposes to fill this gap in the literature and investigate the intergenerational transmission of health care habits based on a representative health survey, the 2010 French Health, Health Care and Insurance Survey, which was designed to specifically assess the health care habits of respondents and the health care habits of their children. To begin, we propose to explore the determinants of parental health care habits during childhood and the respondents' health care habits during adulthood. We then analyze the data in two steps. First, we focus on the long-term effect of parental habits during childhood on health care habits in adulthood to assess the transmission of health care habits across generations. Then, we analyze the long-term
effect of parental habits during childhood on the health care use of their descendants to assess
the reproduction of such behavior among the next generation.

I. Data

This study is based on the 2010 French Health, Health Care and Insurance Survey (ESPS survey). The survey, which is representative of the French population, has been coordinated by the Institute for Research and Information in Health Economics (IRDES) since 1988. It contains data on health status, access to health care services, health insurance and the economic and social status of individuals aged 18 years and above. The 2010 survey included several questions on living conditions during childhood and parents' health status and health-related behaviors when the respondent was 12 years old. This set of questions on childhood conditions was previously introduced in the 2006 ESPS survey, and a comprehensive description of the questionnaire can be found in Bricard et al. (2010) and Jusot et al. (2013).

The 2010 version attempts to explore the intergenerational transmission of health care
habits and includes two specific questions on parental health care habits concerning the
respondent's health as a child and his health care habits during adulthood. Our sample is
restricted to the 4,608 individuals who responded to the specific survey questions on childhood
living conditions (see tables A.1 and A.2 in Annex A for descriptive statistics).

Parental and individual health care habits

We assess parental health care habits during childhood using a retrospective question
based on the respondent’s perception of parental health care behaviors:

"During your childhood, what did your parents do when you first start to feel sick? ...1. wait and see if the problem improved by itself; 2. try to treat yourself with drugs; 3. go to the
doctor immediately; 4. try to use home remedies or alternative medicine" (the individual can select multiple responses).

The respondents were asked a second question concerning his perceptions of his health care habits in adulthood:

"Personally, what do you do when you first start to feel sick? ..." (the same list of responses is presented, and the individual selects *one* of them).

The first retrospective question is used to proxy for the respondent's health care use during his childhood as this information is not directly observable in our data. Moreover, even if the respondent's health care use during childhood was observable, parental preferences would not be easily determined from his health care use in the absence of complete information on his health status during childhood. Conversely, the subjective question on parental decisions regarding their child's use of care during childhood permits direct assessment of parental preferences as the question directly controls for the need for care. The same argument can be applied to the second question, which allows us to directly assess a respondent's health care habits. More precisely, these indicators for health care habits could also be interpreted as determinants of the likelihood that the respondent will consult a doctor as some studies employ them as psychosocial variables explaining doctor visits (Van der Meer and Mackenbach, 1998).

The subjectivity of these questions may induce several types of reporting bias that may, in particular, artificially induce concordance between the respondents' parents' attitudes and their own attitudes. However, regarding the technical difficulties of identifying social interactions from the direct observation of behaviors, the literature has emphasized the validity of employing subjective data (Manski, 2000; Senik, 2005). We also rely on the fact that these questions are asked in different sections of the questionnaire, which may reduce this bias.
We then assume that the retrospective question provides us with information on parental preferences regarding health care and habits and the second question provides information on a respondent's own preferences and habits in adulthood. Thus, it allows us to explore the association between those two measures to analyze the influence of parental habits on individual habits in adulthood and thereby explore the transmission of health care habits across generations. We will also explore the implications that this intergenerational transmission may have on doctor visits in childhood among the next generation.

The question concerning parental habits during childhood offers multiple response items. We consider them to represent different individual childhood experiences. As a consequence, we would like to distinguish individuals having only one experience from those having several experiences. For this purpose, we will use this question to determine the percentages of each possible response given by the individuals surveyed.

<table><caption>Table 1: Descriptive statistics of the report of parental health care habits during childhood (4,608 obs.)</caption><thead><tr><th rowspan="2"></th><th colspan="2">Several possible answers</th><th>As a share of individual answers</th></tr><tr><th>Frequency</th><th>%</th><th>%</th></tr></thead><tbody><tr><td>Wait before visiting</td><td>1 448</td><td>31.28</td><td>18.53</td></tr><tr><td>Self-care behavior</td><td>1 431</td><td>30.89</td><td>17.29</td></tr><tr><td>See a doctor right away</td><td>2 691</td><td>58.23</td><td>48.89</td></tr><tr><td>Use of alternative medicine</td><td>1 290</td><td>27.88</td><td>15.29</td></tr></tbody></table>

Table 1 reports the distribution of the variable concerning parental health care habits in the sample. It shows that more than half of the respondents reported that their parents were more likely to see a doctor immediately when they began to feel sick, which represents 48.9% of individual experiences during childhood. The remaining responses were selected by approximately 30% of the respondents. When considered jointly with other items, each of these remaining response items represents a lower share of individuals' experiences; 18.5% report that their parents waited before visiting a doctor, 17.3% would select self-care, and just 15.3% would use alternative medicine. This last figure concerning the use of alternative medicine as
the initial response to illness reflects the particular importance of complementary and alternative medicine among health care habits in France (Fisher and Ward, 1994).

<table><caption>Table 2: Descriptive statistics of the report of individual health care habits during adulthood (4,608 obs.)</caption><thead><tr><th rowspan="2"></th><th colspan="2">Individual habits during<br>adulthood (one possible answer)</th></tr><tr><th>Frequency</th><th>%</th></tr></thead><tbody><tr><td>Wait before visiting</td><td>2 120</td><td>46.01</td></tr><tr><td>Self-care behavior</td><td>1 419</td><td>30.79</td></tr><tr><td>See a doctor right away</td><td>839</td><td>18.21</td></tr><tr><td>Use of alternative medicine</td><td>230</td><td>4.99</td></tr></tbody></table>

Table 2 reports the distribution of individual health care habits during adulthood. In contrast with parental health care habits during childhood, 46% of the respondents report that they are more likely to wait before visiting a doctor when they feel ill. Consulting a doctor immediately after feeling ill represents 18.2% of the responses, which is less common than reporting self-care behavior, which accounts for 30.8% of responses. Only 5% of respondents report using alternative medicine as their initial response to signs of illness.

## The health care use of respondents' children

To assess the influence of parental health care habits during childhood on individual use of care, we investigate the use of care by the respondents' children. Health care use is measured by the annual number of visits to a doctor. This information is collected by matching administrative data to the 2010 ESPS survey. The data provide detailed health care use information for each individual belonging to the respondent's household during the calendar year of the interview. For the purposes of this study, we focus on the annual number of visits to a general practitioner and the annual number of visits to a specialist.

To explore the long-term effect of inherited health care habits, we use information on the health care consumption of the respondents' children. Information on doctor visits is available for 1,944 children who belong to 1,099 different households. We include children aged 16 years
or younger at the time of the survey, as they are more likely to be influenced by parental choice than older children.

Table 3 reports the distributions of the variables on health care use among children. It shows that 92.7% of children have visited a doctor at least once during the past year, 86.4% have visited a general practitioner (GP), and a lower percentage, 55.1%, have consulted a specialist. The average annual number of visits is 5.68 for any doctor, 3.99 for GP visits and 1.69 for specialist visits.

<table><caption>Table 3: Descriptive statistics of children's use of health care (1,944 obs.)</caption><thead><tr><th></th><th></th><th>Mean</th></tr></thead><tbody><tr><td rowspan="2">Doctor visits (Total)</td><td>Probability of any visit</td><td>0.927</td></tr><tr><td>Number of visits</td><td>5.677</td></tr><tr><td rowspan="2">General Practitioner (GP) visits</td><td>Probability of any visit</td><td>0.864</td></tr><tr><td>Number of visits</td><td>3.987</td></tr><tr><td rowspan="2">Specialist visits</td><td>Probability of visits</td><td>0.551</td></tr><tr><td>Number of visits</td><td>1.690</td></tr></tbody></table>

## Social background variables

Due to the specific questionnaire on childhood conditions introduced in the 2010 wave of the ESPS survey, social background is measured by a large set of variables. It contains various indicators: parents' socioeconomic status, the family's economic status during the respondent's childhood and parents' health status during the respondent's childhood. Parents' socioeconomic status is measured by both professional status and the education levels of both parents. Professional status is measured using six categories for the father, namely, farmer, craftsman, manager, associate professional, office worker and elementary occupations. For the mother, professional status is measured by a binary variable indicating whether the mother worked. Four levels are available for education: dropped out or primary school, secondary school 1, secondary school 2 and university degree. In addition, the respondent reported whether he considered his family's financial situation to be very comfortable, comfortable, difficult, or very
difficult when he was 12. Finally, parents' health is measured by the respondent's retrospective
report of each of his parents' health status when he was 12 years old. We use a binary indicator
that isolates parents suffering from poor or very poor health.

***Current socioeconomic status***

Individuals' current socioeconomic status is measured by their education level, professional status, household income by quintile and indicators for family structure. The education level is measured as follows: drop out or primary school, first level of secondary school, second level of secondary school and university degree. Individual professional status is measured using the same categorical items as the father's professional status. Income is measured as household income (from all sources) divided by the OECD equivalent scale (1 for the first household composition category, 0.5 for the second and 0.3 for the third and following one). We created an income quintile and a sixth category for those who did not provide any income information. This indicator allows us to capture the non-linearity in the association between these items and the health care variables and to control for the non-response category.

We retain two binary indicators for family structure: living as a couple and the presence of children in the household.

***Other individual variables and the accessibility of health care***

To account for differences in the need for health care, we introduce several indicators to proxy for health care needs: age, sex, self-assessed health (SAH) and reported functional limitations, chronic conditions and long-term conditions.

We also include a control for the supply of general practitioners and medical specialists at
the time of the survey. It consists of four density measures of the number of physicians per
100.000 inhabitants at the department level: one for GPs in sector 1², one for GPs in sector 2, one for specialists in sector 1 and one for specialists in sector 2. To control for the supply of health care services during childhood, we also include physician density variables at the time the individuals were 12 years old<fnref n="3" />. The region of birth and the region of residence are also measured and correspond to regional development and planning zones (ZEAT).

## II. Determinants of parental and individual health care habits

To begin the analysis, we explore the determinants of both parental health care habits for the individual during childhood and individual health care habits during adulthood.

### Determinants of parental health care habits during childhood

### ESTIMATION STRATEGY

In this section, we explore the parental determinants of health care habits. We consider $Hab^{par}_{ij}^*$ the propensity for the parents of individual i to select alternative j:

$$Hab^{par}_{ij}^* = \alpha_j \cdot Need^{ind}_i + \beta_j \cdot X^{par}_i + u_{ij}, \quad j=1, 2, 3, 4 \quad (\text{Eq 1})$$

where $Need^{ind}_i$ represents demographic variables for individual i, $X^{par}_i$ represents the parental socioeconomic variables that may affect their health care habits and $u_{ij}$ are other unobservables affecting parental habits.

The previous section reveals that individuals may recall different experiences, and we propose to summarize this information based on the percentage of individual experiences each

<footnote n="2">² There are two types of physicians in France whose fees differ. The cost of visiting doctors in sector 1 corresponds to the statutory fee. Thus, the co-payment is covered by all complementary insurance contracts. Doctors in sector 2 are allowed to charge additional fees, which are only covered by certain supplementary insurance contracts.</footnote>

<footnote n="3">³ We use historical data for GPs' and specialists' density at a regional level (http://www.ecosante.fr), which permits us to consider observations extending back to 1971. A dummy variable is added in the case of individuals born abroad or in non-metropolitan France.</footnote>
experience represents. This creates a vector of proportion variables that sum to one and can be
analyzed using a fractional multinomial logit, which is an extension of the fractional logit
proposed for percentage variables (Papke and Wooldridge, 1996). This model is preferred to
several independent probit models or a multivariate probit model as it allows us to address the
multiple response items variable using our transformed variables. We also assessed the
robustness of the results using these alternative solutions and obtained very similar results.

RESULTS

The results of the fractional multinomial logit model for parental health care habits during childhood are presented in Table 4. The results correspond to the marginal effects of determinants being associated with the corresponding alternative.

Women are found to report a higher parental use of self-care behavior and a lower parental use of alternative medicine than their male counterparts. We find interesting results concerning differences according to individuals' ages, which must be interpreted as a cohort effect because the parental habits refer to a specific period of childhood for all individuals. The results demonstrate that the youngest cohorts are less likely to report that their parents waited before consulting and parental use of alternative medicine and are more likely to report that their parents would go to the doctor immediately. Self-care behavior is not found to vary across birth cohorts.

Most of the parental socioeconomic characteristics are found to be significantly associated
with parental health care habits during childhood. The leading factor explaining the likelihood
that a parent will take the child to see a doctor is the family's financial situation when the
respondent was 12. A more comfortable financial situation is associated with an increase in the
probability of visiting the doctor rapidly; specifically, there is a 0.25 percentage-point increase
in this probability for a family with very a comfortable financial situation relative to one in a
very difficult financial situation. We also find an effect of maternal education; individuals whose mothers had a university degree are more likely to report that their parents waited before consulting a doctor or engaged in self-care than to report that their parents consulted a doctor immediately or used alternative medicine. This underlines the potential existence of informational barriers and differences in health knowledge that explain health care use. Finally, the results concerning social class are in line with the literature on health care expenditures in France, which has demonstrated that farmers behave atypically with respect to health care use (Raynaud, 2002); the sons of farmers are less likely to report that their parents went to the doctor immediately than the sons of workers employed in elementary jobs. We also find that the sons of managers are less likely to report parental use of alternative medicine during their childhood.

<table><caption>Table 4: Marginal effects of parental determinants of health care habits during childhood</caption><thead><tr><th rowspan="2">Invidual variables</th><th colspan="2">Wait before visiting</th><th colspan="2">Self-care behavior</th><th colspan="2">See a doctor right away</th><th colspan="2">Use of alternative medicine</th></tr><tr><th>M.E.</th><th>S.E.</th><th>M.E.</th><th>S.E.</th><th>M.E.</th><th>S.E.</th><th>M.E.</th><th>S.E.</th></tr></thead><tbody><tr><td>Sex (vs: Men): Women</td><td>0.008</td><td>0.009</td><td>0.021</td><td>0.009</td><td>-0.008</td><td>0.013</td><td>-0.021</td><td>*** 0.008</td></tr><tr><td>Age (ref: more than 70)</td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>less than 30</td><td>-0.112</td><td>*** 0.033</td><td>0.017</td><td>0.029</td><td>0.164</td><td>*** 0.042</td><td>-0.069</td><td>*** 0.026</td></tr><tr><td>30 – 39</td><td>-0.057</td><td>** 0.026</td><td>0.002</td><td>0.024</td><td>0.092</td><td>*** 0.035</td><td>-0.036</td><td>*</ 0.021</td></tr><tr><td>40 – 49</td><td>-0.006</td><td>0.018</td><td>-0.006</td><td>0.017</td><td>0.056</td><td>** 0.025</td><td>-0.044</td><td>*** 0.015</td></tr><tr><td>50 – 59</td><td>0.003</td><td>0.016</td><td>-0.004</td><td>0.016</td><td>0.033</td><td>0.023</td><td>-0.033</td><td>** 0.013</td></tr><tr><td>60 – 69</td><td>0.019</td><td>0.016</td><td>-0.021</td><td>0.017</td><td>0.012</td><td>0.025</td><td>-0.010</td><td>0.013</td></tr><tr><td>Parental variables</td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>Father's education level (vs primary school or drop out)</td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>Secondary school 1</td><td>0.002</td><td>0.015</td><td>0.010</td><td>0.014</td><td>0.023</td><td>0.020</td><td>-0.035</td><td>*** 0.013</td></tr><tr><td>Secondary school 2</td><td>0.030</td><td>0.023</td><td>-0.008</td><td>0.021</td><td>-0.036</td><td>0.032</td><td>0.014</td><td>0.022</td></tr><tr><td>University degree</td><td>0.052</td><td>** 0.022</td><td>0.024</td><td>0.022</td><td>-0.071</td><td>** 0.033</td><td>-0.004</td><td>0.022</td></tr><tr><td>Other or non response</td><td>-0.025</td><td>0.019</td><td>0.004</td><td>0.016</td><td>0.015</td><td>0.023</td><td>0.007</td><td>0.013</td></tr><tr><td>Father's social class (vs elementary jobs)</td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>Farmer</td><td>0.074</td><td>*** 0.015</td><td>0.029</td><td>** 0.014</td><td>-0.147</td><td>*** 0.023</td><td>0.043</td><td>*** 0.012</td></tr><tr><td>Craftmen</td><td>0.022</td><td>0.018</td><td>-0.034</td><td>*</ 0.018</td><td>0.005</td><td>0.025</td><td>0.006</td><td>0.015</td></tr><tr><td>Manager</td><td>0.035</td><td>*</ 0.018</td><td>0.026</td><td>0.017</td><td>-0.013</td><td>0.026</td><td>-0.048</td><td>*** 0.018</td></tr><tr><td>Associate prof.</td><td>0.000</td><td>0.018</td><td>0.019</td><td>0.016</td><td>-0.013</td><td>0.025</td><td>-0.007</td><td>0.016</td></tr><tr><td>Office worker</td><td>0.029</td><td>0.019</td><td>0.027</td><td>0.018</td><td>-0.022</td><td>0.026</td><td>-0.034</td><td>*</ 0.018</td></tr><tr><td>No male head or non response</td><td>0.044</td><td>** 0.020</td><td>0.000</td><td>0.019</td><td>-0.033</td><td>0.028</td><td>-0.011</td><td>0.017</td></tr><tr><td>Mother's education level (vs primary school or drop out)</td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>Secondary school 1</td><td>-0.006</td><td>0.015</td><td>-0.008</td><td>0.014</td><td>0.039</td><td>*</ 0.021</td><td>-0.026</td><td>** 0.013</td></tr><tr><td>Secondary school 2</td><td>0.011</td><td>0.021</td><td>0.027</td><td>0.019</td><td>0.027</td><td>0.029</td><td>-0.064</td><td>*** 0.021</td></tr><tr><td>University degree</td><td>0.055</td><td>** 0.023</td><td>0.069</td><td>*** 0.021</td><td>-0.083</td><td>** 0.035</td><td>-0.042</td><td>*</ 0.023</td></tr><tr><td>Other or non response</td><td>-0.042</td><td>*</ 0.021</td><td>0.009</td><td>0.018</td><td>0.034</td><td>0.027</td><td>-0.002</td><td>0.016</td></tr><tr><td>Mother's activity (vs working)</td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>Inactive</td><td>0.010</td><td>0.011</td><td>0.014</td><td>0.011</td><td>-0.030</td><td>*</ 0.016</td><td>0.006</td><td>0.009</td></tr><tr><td>Family financial situation (vs very difficult)</td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>Very comfortable</td><td>-0.114</td><td>*** 0.026</td><td>-0.037</td><td>0.024</td><td>0.250</td><td>*** 0.038</td><td>-0.099</td><td>*** 0.024</td></tr></tbody></table>
<table><thead><tr><th></th><th></th><th></th><th></th><th></th><th></th><th></th><th></th><th></th><th></th><th></th><th></th></tr></thead><tbody><tr><td>Comfortable</td><td>-0.085</td><td>***</td><td>0.017</td><td>-0.034</td><td>*</td><td>0.018</td><td>0.197</td><td>***</td><td>0.027</td><td>-0.078</td><td>***</td><td>0.014</td></tr><tr><td>Difficult</td><td>-0.047</td><td>***</td><td>0.017</td><td>-0.017</td><td></td><td>0.017</td><td>0.131</td><td>***</td><td>0.027</td><td>-0.066</td><td>***</td><td>0.013</td></tr><tr><td>Non response</td><td>-0.093</td><td>*</td><td>0.048</td><td>-0.086</td><td>*</td><td>0.048</td><td>0.251</td><td>***</td><td>0.062</td><td>-0.072</td><td>**</td><td>0.036</td></tr><tr><td colspan="12"><strong>Parental health status (vs very good, good, fair)</strong></td></tr><tr><td>Father poor or very poor health</td><td>0.007</td><td></td><td>0.020</td><td>-0.012</td><td></td><td>0.020</td><td>-0.015</td><td></td><td>0.029</td><td>0.020</td><td></td><td>0.016</td></tr><tr><td>Mother poor or very poor health</td><td>0.032</td><td>*</td><td>0.019</td><td>-0.022</td><td></td><td>0.020</td><td>-0.002</td><td></td><td>0.028</td><td>-0.008</td><td></td><td>0.016</td></tr><tr><td colspan="12"><strong>Childhood physician density</strong></td></tr><tr><td>Density of GP's</td><td>0.001</td><td>*</td><td>0.001</td><td>0.000</td><td></td><td>0.001</td><td>0.000</td><td></td><td>0.001</td><td>-0.002</td><td>**</td><td>0.001</td></tr><tr><td>Density of specialists</td><td>-0.001</td><td></td><td>0.001</td><td>0.000</td><td></td><td>0.001</td><td>0.000</td><td></td><td>0.001</td><td>0.001</td><td>*</td><td>0.001</td></tr><tr><td colspan="12"><strong>Birth region (ref: Parisian region)</strong></td></tr><tr><td>Bassin parisien</td><td>-0.031</td><td></td><td>0.033</td><td>0.024</td><td></td><td>0.031</td><td>-0.022</td><td></td><td>0.045</td><td>0.029</td><td></td><td>0.030</td></tr><tr><td>North</td><td>-0.070</td><td>*</td><td>0.038</td><td>0.007</td><td></td><td>0.036</td><td>-0.005</td><td></td><td>0.052</td><td>0.067</td><td>**</td><td>0.033</td></tr><tr><td>East</td><td>-0.023</td><td></td><td>0.032</td><td>0.040</td><td></td><td>0.030</td><td>-0.099</td><td>**</td><td>0.043</td><td>0.082</td><td>***</td><td>0.028</td></tr><tr><td>West</td><td>0.011</td><td></td><td>0.033</td><td>0.024</td><td></td><td>0.031</td><td>-0.059</td><td></td><td>0.045</td><td>0.025</td><td></td><td>0.029</td></tr><tr><td>South west</td><td>-0.037</td><td></td><td>0.032</td><td>0.005</td><td></td><td>0.030</td><td>-0.028</td><td></td><td>0.044</td><td>0.061</td><td>**</td><td>0.029</td></tr><tr><td>East Centre</td><td>-0.011</td><td></td><td>0.029</td><td>0.042</td><td></td><td>0.027</td><td>-0.113</td><td>***</td><td>0.040</td><td>0.083</td><td>***</td><td>0.025</td></tr><tr><td>Mediterranean</td><td>-0.091</td><td>***</td><td>0.031</td><td>-0.037</td><td></td><td>0.030</td><td>0.036</td><td></td><td>0.043</td><td>0.091</td><td>***</td><td>0.029</td></tr><tr><td>Non Metropolitan France</td><td>0.010</td><td></td><td>0.052</td><td>0.047</td><td></td><td>0.047</td><td>-0.112</td><td></td><td>0.070</td><td>0.055</td><td></td><td>0.043</td></tr><tr><td><strong>Obs.</strong></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td>4,608</td></tr></tbody></table>

Notes: results from fractional multinomial logit model; Significance levels: *** 1%, **5%, *10%.

Finally, we observe a relatively minor effect of the accessibility of care. A greater density of GPs in the birth region is associated with a decrease in the probability of parental use of alternative medicine. Finally, the region of birth is found to influence parental health care habits, which suggests the existence of regional norms concerning health care. Individuals born in the Mediterranean, East, East Center, North and South West regions are more likely to report parental use of alternative medicine than individuals born in the Parisian region. Individuals born in the East Center and East are less likely to report that their parents consulted the doctor immediately, whereas those born in the Mediterranean region are less likely to wait before consulting a doctor.

## Determinants of individual health care habits during adulthood

### ESTIMATION STRATEGY

In adulthood, we also ask individuals to report their health care habits. We consider $Hab^{ind}_{ij}$ the propensity for individual i to select alternative j:

$$Hab^{ind}_{ij} = \alpha_j \cdot Need^{ind}_i + \beta_j \cdot X^{ind}_i + v_{ij} \qquad j=1,2,3,4 \qquad (\text{Eq 2})$$
where Need<sup>ind</sup><sub>i</sub> represents demographic variables and several measures of individual health for individual i, X<sup>ind</sup><sub>i</sub> are the individual socioeconomic variables that may affect his health care habits and v<sub>ij</sub> are other unobservables affecting individual habits.

The general question of health care habits in adulthood is operationalized using a four-category variable. We model the individual determinants of adult health care habits using a multinomial logit regression.

## RESULTS

The results of the multinomial logit for health care habits in adulthood are presented in Table 5. The results correspond to the marginal effect of the determinants being associated with the corresponding alternative.

Women are found to be more likely to report self-care behavior during adulthood, which is in line with what they experienced during childhood. They are also less likely to wait before visiting or to go to the doctor immediately. However, in contrast to childhood experience, women are more likely to report the use of alternative medicine.

<table><caption>Table 5: Marginal effects of individual determinants of health care habits during adulthood</caption><thead><tr><th rowspan="2">Individual variables</th><th colspan="2">Wait before visiting</th><th colspan="2">Self-care behavior</th><th colspan="2">See a doctor right away</th><th colspan="2">Use of alternative medicine</th></tr><tr><th>M.E.</th><th>S.E.</th><th>M.E.</th><th>S.E.</th><th>M.E.</th><th>S.E.</th><th>M.E.</th><th>S.E.</th></tr></thead><tbody><tr><td>Sex (vs: Men): Women</td><td>-0.063 ***</td><td>0.017</td><td>0.065 ***</td><td>0.015</td><td>-0.027 **</td><td>0.013</td><td>0.025 ***</td><td>0.008</td></tr><tr><td><strong>Age (vs: more than 70)</strong></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>less than 30</td><td>0.009</td><td>0.035</td><td>0.071 **</td><td>0.033</td><td>-0.094 ***</td><td>0.027</td><td>0.014</td><td>0.016</td></tr><tr><td>30 - 39</td><td>-0.108 ***</td><td>0.034</td><td>0.136 ***</td><td>0.031</td><td>-0.050 **</td><td>0.024</td><td>0.023</td><td>0.015</td></tr><tr><td>40 - 49</td><td>-0.121 ***</td><td>0.032</td><td>0.142 ***</td><td>0.030</td><td>-0.042 *</td><td>0.023</td><td>0.021</td><td>0.015</td></tr><tr><td>50 - 59</td><td>-0.021</td><td>0.029</td><td>0.051 *</td><td>0.028</td><td>-0.053 ***</td><td>0.020</td><td>0.023 *</td><td>0.013</td></tr><tr><td>60 - 69</td><td>0.014</td><td>0.028</td><td>0.020</td><td>0.028</td><td>-0.049 **</td><td>0.019</td><td>0.015</td><td>0.013</td></tr><tr><td><strong>Self-assessed health (vs: Poor. very poor)</strong></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>Very good</td><td>0.005</td><td>0.041</td><td>0.002</td><td>0.039</td><td>-0.018</td><td>0.028</td><td>0.010</td><td>0.018</td></tr><tr><td>Good</td><td>0.015</td><td>0.037</td><td>0.001</td><td>0.035</td><td>-0.018</td><td>0.024</td><td>0.002</td><td>0.016</td></tr><tr><td>Fair</td><td>0.035</td><td>0.034</td><td>-0.004</td><td>0.033</td><td>-0.029</td><td>0.021</td><td>-0.002</td><td>0.015</td></tr><tr><td>Non response</td><td>-0.041</td><td>0.094</td><td>-0.080</td><td>0.092</td><td>0.120 **</td><td>0.053</td><td>0.002</td><td>0.040</td></tr><tr><td><strong>Functional limitations (vs:No)</strong></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>Heavy</td><td>0.004</td><td>0.037</td><td>-0.021</td><td>0.036</td><td>0.028</td><td>0.023</td><td>-0.010</td><td>0.017</td></tr><tr><td>Weak</td><td>0.003</td><td>0.023</td><td>-0.014</td><td>0.021</td><td>0.000</td><td>0.016</td><td>0.011</td><td>0.010</td></tr><tr><td>Non response</td><td>0.069</td><td>0.055</td><td>-0.065</td><td>0.054</td><td>0.006</td><td>0.037</td><td>-0.010</td><td>0.027</td></tr><tr><td><strong>Chronic conditions (vs: No)</strong></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>Yes</td><td>-0.001</td><td>0.020</td><td>-0.031 *</td><td>0.018</td><td>0.029 **</td><td>0.015</td><td>0.003</td><td>0.009</td></tr><tr><td>Non response</td><td>-0.037</td><td>0.036</td><td>0.025</td><td>0.032</td><td>-0.004</td><td>0.027</td><td>0.015</td><td>0.014</td></tr><tr><td>Long term affection (vs: No): Yes</td><td>-0.036</td><td>0.023</td><td>-0.024</td><td>0.022</td><td>0.082 ***</td><td>0.015</td><td>-0.021 *</td><td>0.011</td></tr><tr><td><strong>Educational level (vs: primary school or drop out)</strong></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr></tbody></table>
<table><tbody><tr><td>Secondary school 1</td><td>0.000</td><td>0.024</td><td>0.028</td><td>0.024</td><td>-0.015</td><td>0.016</td><td>-0.013</td><td>0.010</td></tr><tr><td>Secondary school 2</td><td>0.036</td><td>0.029</td><td>0.062 **</td><td>0.027</td><td>-0.058 ***</td><td>0.021</td><td>-0.040 ***</td><td>0.013</td></tr><tr><td>University degree</td><td>0.035</td><td>0.032</td><td>0.032</td><td>0.030</td><td>-0.042 *</td><td>0.024</td><td>-0.025 *</td><td>0.014</td></tr><tr><td>Other or non response</td><td>0.060</td><td>0.076</td><td>0.088</td><td>0.067</td><td>-0.086</td><td>0.063</td><td>-0.062</td><td>0.048</td></tr><tr><td colspan="9"><strong>Social class (vs: elementary jobs)</strong></td></tr><tr><td>Farmer</td><td>-0.047</td><td>0.043</td><td>0.021</td><td>0.041</td><td>0.006</td><td>0.028</td><td>0.020</td><td>0.018</td></tr><tr><td>Craftmen</td><td>0.083 **</td><td>0.035</td><td>-0.001</td><td>0.034</td><td>-0.086 ***</td><td>0.028</td><td>0.003</td><td>0.017</td></tr><tr><td>Manager</td><td>0.016</td><td>0.031</td><td>-0.009</td><td>0.029</td><td>0.001</td><td>0.023</td><td>-0.008</td><td>0.016</td></tr><tr><td>Associate prof.</td><td>-0.006</td><td>0.026</td><td>0.027</td><td>0.023</td><td>-0.038 *</td><td>0.020</td><td>0.017</td><td>0.011</td></tr><tr><td>Office worker</td><td>0.031</td><td>0.022</td><td>-0.003</td><td>0.020</td><td>-0.027 *</td><td>0.016</td><td>-0.001</td><td>0.010</td></tr><tr><td>Inactive</td><td>-0.020</td><td>0.039</td><td>-0.016</td><td>0.037</td><td>0.029</td><td>0.026</td><td>0.007</td><td>0.015</td></tr><tr><td colspan="9"><strong>Income (vs: 1st quintile)</strong></td></tr><tr><td>2nd quintile</td><td>-0.013</td><td>0.027</td><td>0.070 ***</td><td>0.025</td><td>-0.053 ***</td><td>0.019</td><td>-0.004</td><td>0.011</td></tr><tr><td>3rd quintile</td><td>-0.016</td><td>0.028</td><td>0.067 ***</td><td>0.026</td><td>-0.044 **</td><td>0.020</td><td>-0.006</td><td>0.012</td></tr><tr><td>4th quintile</td><td>-0.039</td><td>0.029</td><td>0.094 ***</td><td>0.027</td><td>-0.058 ***</td><td>0.022</td><td>0.003</td><td>0.012</td></tr><tr><td>5th quintile</td><td>-0.018</td><td>0.030</td><td>0.061 **</td><td>0.028</td><td>-0.033</td><td>0.022</td><td>-0.011</td><td>0.013</td></tr><tr><td>Non response</td><td>-0.068 **</td><td>0.029</td><td>0.067 **</td><td>0.027</td><td>-0.006</td><td>0.020</td><td>0.007</td><td>0.012</td></tr><tr><td colspan="9"><strong>Insurance situation (vs: No complementary health coverage)</strong></td></tr><tr><td>Private complem. health cov.</td><td>0.015</td><td>0.040</td><td>0.013</td><td>0.038</td><td>0.018</td><td>0.029</td><td>-0.047 ***</td><td>0.013</td></tr><tr><td>Means-tested complem. health cov.</td><td>-0.006</td><td>0.046</td><td>-0.036</td><td>0.044</td><td>0.080 **</td><td>0.033</td><td>-0.038 **</td><td>0.015</td></tr><tr><td>Living in couple</td><td>-0.010</td><td>0.017</td><td>0.025</td><td>0.016</td><td>0.000</td><td>0.013</td><td>-0.016 **</td><td>0.007</td></tr><tr><td>Living with children</td><td>0.036 *</td><td>0.019</td><td>-0.010</td><td>0.018</td><td>-0.028 *</td><td>0.015</td><td>0.002</td><td>0.008</td></tr><tr><td colspan="9"><strong>Adulthood physician density</strong></td></tr><tr><td>Dens. of GP's in sector 1</td><td>0.001</td><td>0.001</td><td>-0.001</td><td>0.001</td><td>0.000</td><td>0.001</td><td>0.000</td><td>0.000</td></tr><tr><td>Dens. of GP's in sector 2</td><td>0.000</td><td>0.003</td><td>0.002</td><td>0.002</td><td>-0.002</td><td>0.002</td><td>0.000</td><td>0.001</td></tr><tr><td>Dens. of specialists in sector 1</td><td>0.000</td><td>0.001</td><td>0.000</td><td>0.001</td><td>0.000</td><td>0.001</td><td>0.000</td><td>0.000</td></tr><tr><td>Dens. of specialists in sector 2</td><td>0.000</td><td>0.001</td><td>0.000</td><td>0.001</td><td>0.001</td><td>0.000</td><td>0.000</td><td>0.000</td></tr><tr><td colspan="9"><strong>Adulthood region (ref: Parisian region)</strong></td></tr><tr><td>Bassin parisien</td><td>-0.064 **</td><td>0.038</td><td>0.077 **</td><td>0.034</td><td>-0.005</td><td>0.028</td><td>-0.008</td><td>0.017</td></tr><tr><td>North</td><td>-0.116 **</td><td>0.052</td><td>0.089 *</td><td>0.048</td><td>0.051</td><td>0.038</td><td>-0.024</td><td>0.024</td></tr><tr><td>East</td><td>-0.075 *</td><td>0.045</td><td>0.062</td><td>0.041</td><td>-0.015</td><td>0.034</td><td>0.028</td><td>0.019</td></tr><tr><td>West</td><td>-0.031</td><td>0.041</td><td>0.064 *</td><td>0.037</td><td>-0.027</td><td>0.031</td><td>-0.006</td><td>0.018</td></tr><tr><td>South west</td><td>-0.053</td><td>0.050</td><td>0.088 *</td><td>0.046</td><td>-0.048</td><td>0.038</td><td>0.013</td><td>0.022</td></tr><tr><td>East Centre</td><td>0.017</td><td>0.036</td><td>0.020</td><td>0.034</td><td>-0.049 *</td><td>0.028</td><td>0.012</td><td>0.016</td></tr><tr><td>Mediterranean</td><td>-0.062</td><td>0.053</td><td>0.088 *</td><td>0.049</td><td>-0.047</td><td>0.041</td><td>0.020</td><td>0.023</td></tr><tr><td><strong>Obs.</strong></td><td></td><td></td><td></td><td></td><td></td><td></td><td>4608</td><td></td></tr><tr><td><strong>Pseudo R<sup>2</sup></strong></td><td></td><td></td><td></td><td></td><td></td><td></td><td>0.0849</td><td></td></tr></tbody></table>

Notes: results from multinomial logit model; Significance levels: *** 1%, **5%, *10%.

We also find differences according to age. More precisely, we find that younger age groups are less likely to wait before visiting a doctor than the oldest age group, except for the youngest group. Younger age groups are also less likely to immediately visit the doctor relative to the oldest age group. The former individuals also seek alternatives to visiting a doctor by using more self-care behavior. These age effects essentially capture the differences in need among individuals, except for those having long-term or chronic conditions, who are more likely to go to the doctor immediately.

Concerning education levels, we find similar results to those obtained for maternal education, as more educated individuals are less likely to use alternative medicine or to visit the doctor immediately and more likely engage in self-care. However, we find no effect of education associated with waiting before visiting a doctor. Health care habits are also related to
social class categories as craftsmen are more likely to wait before visiting the doctor than doing
so immediately. Farmers no longer exhibit health care habits that differ from other
socioprofessional categories, but the effect concerning craftsmen confirms the differences in
health care norms for self-employed workers.

Income is related to health care habits in adulthood in a different way than in childhood,
and wealthier individuals are more likely to engage in self-care than visit the doctor
immediately relative to individuals belonging to the first income quintile. Insurance status is
also associated with health care habits as individuals with means-tested complementary health
coverage are more likely to visit the doctor immediately than individuals without insurance
coverage. Individuals without insurance coverage are consequently more likely to use
alternative medicine than those with insurance.

Finally, family structure is linked to habits as living as a couple is associated with a lower
probability of using alternative medicine. Individuals with children are also more likely to wait
before they visit a doctor than doing so immediately.

To complete the analysis of the determinants of health care habits, we find no direct effect
of the available supply of health services as measured by the physician density variables, but we
find regional disparities such as a lower probability of waiting before visiting a doctor and a
higher probability of self-care behavior for individuals living in the *Bassin parisien* and the
North than individuals living in the Parisian region.

### III. Empirical strategy

We explore the intergenerational transmission of health care habits in two steps. In the
first, we study the correlation between parental and individual health care habits to test for the
presence of an intergenerational transmission of health care preferences. Then, robustness
checks are performed to improve the reliability of the results. In a second step, we explore the association between inherited parental preferences and the use of health care among the respondents' children to assess the reproduction of health care behavior among the next generation.

### Transmission of health care habits across generations

In this section of the analysis, we are specifically interested in the influence of parental habits during childhood on individual health care habits in adulthood, which we interpret as an intergenerational transmission of health care habits.

In equation (Eq 3), we assess the possibility that parental habits influence their children's habits. We also consider (Eq 4) that captures the determinants of parental health care habits.

$$Hab_{ij}^{ind} = \alpha_j \cdot Need_{i}^{ind} + \beta_j \cdot X_{i}^{ind} + \gamma_j \cdot Hab_{ij}^{par} + e_{ij}, \quad j=1,2,3,4 \quad (\text{Eq 3})$$

$$Hab_{ij}^{par} = \alpha_j \cdot Need_{i}^{par} + \beta_j \cdot X_{i}^{par} + u_{ij}, \quad j=1,2,3,4 \quad (\text{Eq 4})$$

To estimate the correlation between parents' health care habits and those of their children, we must consider both observed and unobserved characteristics that could commonly explain individual and parental habits. In particular, the correlation may be due to similar shared characteristics, such as socioeconomic circumstances or the environment that are determinants of health care habits observed in the previous section. This concern is minimized in our study by the inclusion of a comprehensive set of socioeconomic and environment variables concerning both parents and their children.

The second issue is that the intergenerational correlation may be spurious because of unobserved characteristics explaining both childhood and adulthood health care behavior. In this case, we would observe a correlation between $u_{ij}$ and $e_{ij}$. For example, such an effect may
result from unobserved health status during childhood that may explain both childhood and adulthood health care behaviors. The use of a large set of health variables such as chronic conditions that may originate in childhood minimizes this potential problem. We also attempt to minimize this issue by employing a subjective measure of health care habits that asks respondents about their behaviors when ill. To assess the extent of this potential problem, we conduct seemingly unrelated regressions for both the parental and individual equations (Eq 3 and Eq 4) that consider each alternative habit separately. Several Breusch-Pagan tests of residual independence are conducted (Table 6). In our case, we find that it is unnecessary to address the correlated unobserved heterogeneity once our set of observable characteristics are taken into account as the tests are rejected for each alternative habit. However, we control for observed parental characteristics in the individual equation.

<table><caption>Table 6: Breusch-Pagan tests for independency of residuals</caption><thead><tr><th>Model for alternative :</th><th>Correlation</th><th>Chi 2</th><th>p-value</th></tr></thead><tbody><tr><td>Wait before</td><td>-0.0023</td><td>0.025</td><td>0.873</td></tr><tr><td>Self-care behavior</td><td>0.0047</td><td>0.101</td><td>0.750</td></tr><tr><td>See a doctor right away</td><td>-0.0028</td><td>0.036</td><td>0.851</td></tr><tr><td>Use of alternative medicine</td><td>0.0020</td><td>0.019</td><td>0.890</td></tr></tbody></table>

Then, the equation for the health care habits of an individual in adulthood ($Hab^{ind}$) is written as follows:

$$Hab^{ind} *_{ij} = \alpha_j \cdot Need^{ind} + \beta_j \cdot X^{ind} + \gamma_j \cdot Hab^{par} + \delta_j \cdot X^{par} + e_{ij}, \quad j=1,2,3,4 \quad (\text{Eq 5})$$

where $Need^{ind}$ represents demographic variables and several measures of individual health, $X^{ind}$ and $X^{par}$ represent the individual and parental socioeconomic variables, respectively, $Hab^{par}$ are the parental health care habits during childhood and $e_{ij}$ are other unobservables affecting individual habits.

To estimate the transmission of health care habits across generations, we rely on the two variables for parental habits we presented in the descriptive section. The first represents the raw
information as given by the respondents, implying the use of four dummy variables. The second is a transformed outcome variable calculated as the share of childhood experiences that each parental habit represents.

For each parental habit variable, we propose two different ways of measuring the correlation between individual habits. The first relies on four different estimates of a multinomial logit that include the parental habit variables separately. This approach provides a more illustrative depiction of the correlation of habits across generations. The second is an adjusted version that includes all parental habit categories in a single model.

### Robustness to heterogeneity and socialization

We are interested in checking the robustness of our previous results to different sources of heterogeneity and the possibility of both regional and generational influences.

On the one hand, we consider different sources of heterogeneity. First, we test the possibility that there are differences in transmission according to the respondent's gender. Then, we test the potential for heterogeneity in transmission according to the health status of the individuals in adulthood. We consider a group of ill individuals having at least poor or very poor health, a substantial or weak functional limitation, a chronic condition or a long-term condition and compare them to a group of individuals in good health. We also consider the possibility that there are differences in transmission according to environmental changes by comparing individuals residing in the same region in adulthood and childhood and individuals who moved to a different region. We finally consider the possibility of a generational change in the transmission process and perform separate analyses for younger individuals under 50 years old and older individuals.
On the other hand, we would like to assess the possibility that both regional and generational norms affect individual habits and compete with the transmission across generations. The region of residence and birth cohort have been found to be important determinants of habits, and we may also expect other individuals from the same region and cohort to influence the respondents. Theories of habit formation often assume that children may be affected by other local role models, in addition to parents (Dohmen et al., 2012). Using the average habits of a reference group to measure social interaction does not permit us to identify this effect because of the reflection problem explained by Manski (2000). We attempt to minimize this problem using lagged reference group behavior, measured as average parental habits in the reference group. Then, in addition to age in decades and region of residence dummies, we include a variable for the average parental habits of respondents living in the same region and born in the same decade. We exclude the parental habits of respondents when calculating the reference group average.

## Implications for children's doctor visits

In this last section of the analysis, we assess the implications that this intergenerational transmission has on the individual use of care among the respondents' children. We directly analyze the transmission by examining the childhood health care use of the respondents' children. Then, the health care demand as an adult is considered from a family perspective as a parent may influence the health care use of his children (Jacobson, 2000).

We employ an equation similar to that used to estimate the transmission of health care habits but introduce a vector capturing health problems for the respondent's child (Need<sup>c/child</sup>). Then, the propensity for child h of individual i to visit the doctor is:

$$Visit_{hi}^{c/child} = \alpha. Need_{h}^{c/child} + \beta. Need_{i}^{ind} + \gamma. X_{i}^{ind} + \delta. Hab_{ij}^{par} + \theta. X_{i}^{par} + f_{hi}, \quad (Eq 5)$$
As in the previous analysis, we control for health factors influencing the demand for health care (*Need<sup>child</sup>*, *Need<sup>ind</sup>*). We also control for individual socioeconomic status (*X<sup>ind</sup>*), which may impact different aspects of health care demand: income, professional status, education level and insurance coverage. Supply side aspects are also considered through the introduction of physician density variables. To control for social background during childhood being correlated with parental habits, we also include parental variables (*X<sup>par</sup>*).

This model will help us to improve our understanding of the transmission of health care
habits across generations as it measures the association between the parental habits of two
successive generations.

We are interested in estimating two different outcomes: the probability of any visit and the number of visits. We estimate the probability of any visit using a logit model. To estimate the number of visits, we employ a negative binomial model as the data exhibit overdispersion; the variance in the variable of interest is greater than its expected value.

IV. Results

Transmission of health care habits across generations

The results of the multinomial logit models are presented as the marginal effects of parental habits being associated with alternatives in adulthood (Table 7). The hypothesis of intergenerational transmission of health care habits is confirmed by the positive and significant marginal effects of the corresponding parental health care habits during childhood.

Column (1) of Table 7 reports an increase in the probability that an individual will report any specific health care habits if he had experienced his parents engaging in them during his childhood. However, the size of the intergenerational correlation varies across habits. The increase in the likelihood of sharing a behavior reaches 14.9 percentage points for waiting
before visiting a doctor compared to 11.8 percentage points and 10.1 percentage points for self-care and seeing a doctor immediately, respectively. The correlation is lower for the use of alternative medicine, as it represents a 4.1 percentage-point increase.

Column (2) of Table 7 presents the results when we adjust for the other experiences the individuals had during childhood. The results are similar except for the intergenerational correlation associated with seeing a doctor immediately, which only reflects a 4.6 percentage-point increase compared to the 10.1 percentage-point increase observed in the unadjusted results. As expected, the other experiences that the individuals had during childhood are negatively associated with the associated individual habit in adulthood.

Column (3) of Table 7 confirms the increase in the probability that an individual will report specific health care habits he had experienced during childhood. The results when parental habits are measured in terms of their prevalence are even greater than those reported in Column (1). The marginal effect implicitly measures the difference in probability between reporting a specific habit in isolation relative to not reporting this habit. The results for the size of the intergenerational correlation change, but those concerning the ranking of the habits do not. The intergenerational correlation is still large, and waiting before visiting a doctor in childhood is associated with a 23.9 percentage-point increase in the probability of reporting the same habits in adulthood. Moreover, the results reveal a 17.3 percentage-point increase and an 11.7 percentage-point increase for engaging in self-care and visiting the doctor immediately, respectively. The use of alternative medicine has a lower intergenerational correlation, with an increase in the likelihood that the behavior is repeated by the respondents of 6.3 percentage points.

Column (4) of Table 7 presents the results adjusted for the share of other parental habits experienced during childhood. They are not directly comparable as they include a comparison
with a reference category, but they nevertheless confirm that parental habits experienced during childhood are more likely to be associated with the respective individual habit in adulthood. We present the complete results of this last model in Table A.3 in Appendix A.

<table><caption>Table 7: Marginal effects of parental health care habits during childhood on individual habits in adulthood</caption><thead><tr><th rowspan="3"></th><th colspan="4">Raw variable of parental habits</th><th colspan="4">Share variable of parental habits</th></tr><tr><th colspan="2">(1)</th><th colspan="2">(2)</th><th colspan="2">(3)</th><th colspan="2">(4)</th></tr><tr><th>M.E.</th><th>S.E.</th><th>M.E.</th><th>S.E.</th><th>M.E.</th><th>S.E.</th><th>M.E.</th><th>S.E.</th></tr></thead><tbody><tr><td colspan="9"><strong>Multinomial alternative for individual habit : Wait before visiting</strong></td></tr><tr><td colspan="9"><strong>Parental habit during childhood :</strong></td></tr><tr><td>Wait before visiting</td><td>0.149 ***</td><td>0.015</td><td>0.149 ***</td><td>0.018</td><td>0.239 ***</td><td>0.023</td><td>0.229 ***</td><td>0.023</td></tr><tr><td>Self-care behavior</td><td></td><td></td><td>-0.056 ***</td><td>0.018</td><td></td><td></td><td>-0.020</td><td>0.025</td></tr><tr><td>See a doctor right away</td><td></td><td></td><td>-0.040 **</td><td>0.020</td><td></td><td></td><td>ref.</td><td></td></tr><tr><td>Use of alternative medicine</td><td></td><td></td><td>-0.051 ***</td><td>0.018</td><td></td><td></td><td>-0.023</td><td>0.027</td></tr><tr><td colspan="9"><strong>Multinomial alternative for individual habit : Self-care behavior</strong></td></tr><tr><td colspan="9"><strong>Parental habit during childhood :</strong></td></tr><tr><td>Wait before visiting</td><td></td><td></td><td>-0.067 ***</td><td>0.017</td><td></td><td></td><td>-0.087 ***</td><td>0.023</td></tr><tr><td>Self-care behavior</td><td>0.118 ***</td><td>0.014</td><td>0.134 ***</td><td>0.015</td><td>0.173 ***</td><td>0.021</td><td>0.159 ***</td><td>0.021</td></tr><tr><td>See a doctor right away</td><td></td><td></td><td>0.008</td><td>0.018</td><td></td><td></td><td>ref.</td><td></td></tr><tr><td>Use of alternative medicine</td><td></td><td></td><td>0.006</td><td>0.016</td><td></td><td></td><td>0.020</td><td>0.025</td></tr><tr><td colspan="9"><strong>Multinomial alternative for individual habit : See a doctor right away</strong></td></tr><tr><td colspan="9"><strong>Parental habit during childhood :</strong></td></tr><tr><td>Wait before visiting</td><td></td><td></td><td>-0.067 ***</td><td>0.015</td><td></td><td></td><td>-0.142 ***</td><td>0.019</td></tr><tr><td>Self-care behavior</td><td></td><td></td><td>-0.060 ***</td><td>0.014</td><td></td><td></td><td>-0.134 ***</td><td>0.020</td></tr><tr><td>See a doctor right away</td><td>0.101 ***</td><td>0.012</td><td>0.046 ***</td><td>0.016</td><td>0.117 ***</td><td>0.012</td><td>ref.</td><td></td></tr><tr><td>Use of alternative medicine</td><td></td><td></td><td>0.004</td><td>0.014</td><td></td><td></td><td>-0.059 ***</td><td>0.019</td></tr><tr><td colspan="9"><strong>Multinomial alternative for individual habit : Use of alternative medicine</strong></td></tr><tr><td colspan="9"><strong>Parental habit during childhood :</strong></td></tr><tr><td>Wait before visiting</td><td></td><td></td><td>-0.015 *</td><td>0.008</td><td></td><td></td><td>0.001</td><td>0.011</td></tr><tr><td>Self-care behavior</td><td></td><td></td><td>-0.019 **</td><td>0.008</td><td></td><td></td><td>-0.005</td><td>0.012</td></tr><tr><td>See a doctor right away</td><td></td><td></td><td>-0.014</td><td>0.009</td><td></td><td></td><td>ref.</td><td></td></tr><tr><td>Use of alternative medicine</td><td>0.041 ***</td><td>0.007</td><td>0.041 ***</td><td>0.008</td><td>0.063 ***</td><td>0.010</td><td>0.062 ***</td><td>0.010</td></tr><tr><td><strong>Obs.</strong></td><td colspan="2">4608</td><td colspan="2">4608</td><td colspan="2">4608</td><td colspan="2">4608</td></tr><tr><td><strong>Pseudo R<sup>2</sup></strong></td><td colspan="2">0.0872</td><td colspan="2">0.0872</td><td colspan="2">0.0872</td><td colspan="2">0.0849</td></tr></tbody></table>

Notes: these results are adjusted with need variables, individual and parental socioeconomic variables such as in Eq 5; columns (1) and (3) are from four different estimates of multinomial logit including parental habits separately; columns (2) and (4) are from a multinomial model adjusted with all parental habits categories; we present full results of model in column (4) in Table A.3 in Appendix A; Significance levels: *** 1%, **5%, *10%.

### Robustness to heterogeneity and socialization

Robustness checks for heterogeneity in the transmission of habits across generations reveal that the results are sensitive to a change in the region of residence from childhood to adulthood. Table 8 presents results separated according to whether the respondent still lives in
the same region in adulthood as he did in childhood. The results exhibit a substantial reduction in the transmission of habits across generations for all habits in the case of individuals living in a different region. Remarkably, the intergenerational correlation for self-care only represents a 10.2 percentage-point increase among those living in a different region compared to a 19.7 percentage-point increase among respondents living in the same region. These results underline the importance of environmental and health care supply factors in explaining health care habits. In contrast, we do not observe noticeable differences in transmission according to gender, health status or birth cohort (Table A.4 in Appendix A).

<table><caption>Table 8: Heterogeneity in the transmission of health care habits according to change in the region</caption><thead><tr><th rowspan="2"></th><th colspan="2">Same region</th><th colspan="2">Different region</th></tr><tr><th>M.E.</th><th>S.E.</th><th>M.E.</th><th>S.E.</th></tr></thead><tbody><tr><td colspan="5"><strong>Multinomial alternative for individual habit : Wait before visiting</strong></td></tr><tr><td colspan="5"><strong>Parental habit during childhood :</strong></td></tr><tr><td>Wait before visiting</td><td>0.243 ***</td><td>0.029</td><td>0.198 ***</td><td>0.040</td></tr><tr><td>Self-care behavior</td><td>-0.022</td><td>0.031</td><td>-0.038</td><td>0.042</td></tr><tr><td>See a doctor right away</td><td>ref.</td><td></td><td>ref.</td><td></td></tr><tr><td>Use of alternative medicine</td><td>0.001</td><td>0.034</td><td>-0.082 *</td><td>0.046</td></tr><tr><td colspan="5"><strong>Multinomial alternative for individual habit : Self-care behavior</strong></td></tr><tr><td colspan="5"><strong>Parental habit during childhood :</strong></td></tr><tr><td>Wait before visiting</td><td>-0.072 **</td><td>0.029</td><td>-0.125 ***</td><td>0.038</td></tr><tr><td>Self-care behavior</td><td>0.197 ***</td><td>0.026</td><td>0.102 ***</td><td>0.036</td></tr><tr><td>See a doctor right away</td><td>ref.</td><td></td><td>ref.</td><td></td></tr><tr><td>Use of alternative medicine</td><td>-0.009</td><td>0.032</td><td>0.081 *</td><td>0.042</td></tr><tr><td colspan="5"><strong>Multinomial alternative for individual habit : See a doctor right away</strong></td></tr><tr><td colspan="5"><strong>Parental habit during childhood :</strong></td></tr><tr><td>Wait before visiting</td><td>-0.166 ***</td><td>0.025</td><td>-0.091 ***</td><td>0.031</td></tr><tr><td>Self-care behavior</td><td>-0.158 ***</td><td>0.026</td><td>-0.083 **</td><td>0.033</td></tr><tr><td>See a doctor right away</td><td>ref.</td><td></td><td>ref.</td><td></td></tr><tr><td>Use of alternative medicine</td><td>-0.060 ***</td><td>0.023</td><td>-0.050</td><td>0.033</td></tr><tr><td colspan="5"><strong>Multinomial alternative for individual habit : Use of alternative medicine</strong></td></tr><tr><td colspan="5"><strong>Parental habit during childhood :</strong></td></tr><tr><td>Wait before visiting</td><td>-0.005</td><td>0.015</td><td>0.019</td><td>0.018</td></tr><tr><td>Self-care behavior</td><td>-0.017</td><td>0.016</td><td>0.018</td><td>0.017</td></tr><tr><td>See a doctor right away</td><td>ref.</td><td></td><td>ref.</td><td></td></tr><tr><td>Use of alternative medicine</td><td>0.068 ***</td><td>0.013</td><td>0.051 ***</td><td>0.017</td></tr><tr><td><strong>Obs.</strong></td><td colspan="2">3030</td><td colspan="2">1578</td></tr><tr><td><strong>Pseudo R<sup>2</sup></strong></td><td colspan="2">0.0974</td><td colspan="2">0.1314</td></tr></tbody></table>

Notes: these results are adjusted with need variables, individual and parental socioeconomic variables such as in Eq 5; from separated estimations on sample of individuals living in the same region in adulthood as in childhood or not using multinomial model such as in column (4) of Table 8 using share of parental habits; Significance levels: *** 1%, **5%, *10%.

Finally, we are concerned about the possibility of regional and generational norms competing with parental transmission. Table 9 reports the marginal effects adjusted by the average parental habits of individuals living in the same region and born during the same
decade. The results are not affected by the introduction of regional and generational norms except for the use of alternative medicine, which is found to be significantly associated with average parental use of alternative medicine among the reference group. However, this does not change the transmission in the use of alternative medicine.

<table><caption>Table 9: The impact of regional and generational parental habits</caption><thead><tr><th rowspan="2"></th><th colspan="2">Wait before visiting</th><th colspan="2">Self-care behavior</th><th colspan="2">See a doctor right away</th><th colspan="2">Use of alternative medicine</th></tr><tr><th>M.E.</th><th>S.E.</th><th>M.E.</th><th>S.E.</th><th>M.E.</th><th>S.E.</th><th>M.E.</th><th>S.E.</th></tr></thead><tbody><tr><td colspan="9"><strong>Parental habit during childhood:</strong></td></tr><tr><td>Wait before visiting</td><td>0.238 ***</td><td>0.024</td><td>-0.108 ***</td><td>0.025</td><td>-0.130 ***</td><td>0.020</td><td>0.000</td><td>0.012</td></tr><tr><td>Self-care behavior</td><td>-0.010</td><td>0.027</td><td>0.145 ***</td><td>0.023</td><td>-0.130 ***</td><td>0.022</td><td>-0.006</td><td>0.012</td></tr><tr><td>See a doctor right away</td><td>ref.</td><td></td><td>ref.</td><td></td><td>ref.</td><td></td><td>ref.</td><td></td></tr><tr><td>Use of alternative medicine</td><td>-0.035</td><td>0.029</td><td>0.031</td><td>0.027</td><td>-0.052 ***</td><td>0.020</td><td>0.055 ***</td><td>0.011</td></tr><tr><td colspan="9"><strong>Average parental habit during childhood:</strong></td></tr><tr><td>Wait before visiting</td><td>0.312</td><td>0.265</td><td>-0.291</td><td>0.255</td><td>-0.037</td><td>0.187</td><td>0.016</td><td>0.122</td></tr><tr><td>Self-care behavior</td><td>0.559 *</td><td>0.311</td><td>-0.302</td><td>0.291</td><td>-0.310</td><td>0.237</td><td>0.054</td><td>0.138</td></tr><tr><td>See a doctor right away</td><td>ref.</td><td></td><td>ref.</td><td></td><td>ref.</td><td></td><td>ref.</td><td></td></tr><tr><td>Use of alternative medicine</td><td>-0.004</td><td>0.222</td><td>-0.076</td><td>0.216</td><td>-0.084</td><td>0.147</td><td>0.164 **</td><td>0.081</td></tr><tr><td><strong>Obs.</strong></td><td colspan="8">4,075</td></tr><tr><td><strong>Pseudo R<sup>2</sup></strong></td><td colspan="8">0.0891</td></tr></tbody></table>

Notes: these results are adjusted with need variables, individual and parental socioeconomic variables such as in Eq 5; estimation using multinomial model such as in column (4) of Table 8 using share of parental habits; Significance levels: *** 1%, **5%, *10%.

## Implications for children's doctor visits

Finally, we are interested in the implications that this intergenerational transmission of health care habits has on the individual use of care among the respondents' children. Table 10 reports the marginal effects of parental health care habits during childhood on their children's doctor visits. These results confirm the hypothesis that health care behavior is reproduced during the childhood of the next generation. More precisely, we find that inherited parental habits are associated with the probability of visiting the doctor but not with the number of visits. We find that parental habits of waiting before visiting the doctor and using alternative medicine are significantly associated with a decrease in the probability of visiting a doctor in general and a GP in particular. The parental habit of waiting before visiting the doctor is associated with a 6.2 percentage-point and a 5.9 percentage-point decrease in the probability of visiting any
doctor and a GP, respectively. We also find that the parental use of alternative medicine during childhood is associated with a 4.4 percentage-point and a 6.4 percentage-point decrease in the probability of visiting any doctor and a GP, respectively. Other effects of parental habits concerning specialist visits confirm these results but are only significant at the 10% level.

Tables A.5 to A.7 in Appendix A report the marginal effects associated with other determinants related to the doctor visits of respondents' children. These results globally confirm the determinants of health care habits during childhood found above. However, the number of visits to a GP or specialist is generally primarily related to the need variables and insurance status.

<table><caption>Table 10: Marginal effects of parental health care habits during childhood on the children use of care</caption><thead><tr><th rowspan="2"></th><th colspan="2">Doctor visits (Total)</th><th colspan="2">General Practitioner (GP) visits</th><th colspan="2">Specialist visits</th></tr><tr><th>M.E.</th><th>S.E.</th><th>M.E.</th><th>S.E.</th><th>M.E.</th><th>S.E.</th></tr></thead><tbody><tr><td colspan="7"><strong>Probability of any visit</strong></td></tr><tr><td colspan="7"><strong>Parental habit during childhood (vs: See a doctor right away)</strong></td></tr><tr><td>Wait before visiting</td><td>-0.062 ***</td><td>0.021</td><td>-0.059 **</td><td>0.030</td><td>-0.025</td><td>0.042</td></tr><tr><td>Self-care behavior</td><td>-0.028</td><td>0.018</td><td>-0.013</td><td>0.027</td><td>-0.069 *</td><td>0.040</td></tr><tr><td>Use of alternative medicine</td><td>-0.044 **</td><td>0.020</td><td>-0.064 **</td><td>0.030</td><td>-0.036</td><td>0.049</td></tr><tr><td><strong>Obs.</strong></td><td colspan="2">1944</td><td colspan="2">1944</td><td colspan="2">1944</td></tr><tr><td><strong>Pseudo R<sup>2</sup></strong></td><td colspan="2">0.1826</td><td colspan="2">0.1279</td><td colspan="2">0.0920</td></tr><tr><td colspan="7"><strong>Number of visits</strong></td></tr><tr><td colspan="7"><strong>Parental habit during childhood (vs: See a doctor right away)</strong></td></tr><tr><td>Wait before visiting</td><td>-0.584</td><td>0.450</td><td>-0.315</td><td>0.346</td><td>-0.280</td><td>0.221</td></tr><tr><td>Self-care behavior</td><td>-0.336</td><td>0.408</td><td>-0.315</td><td>0.305</td><td>0.059</td><td>0.230</td></tr><tr><td>Use of alternative medicine</td><td>-0.596</td><td>0.563</td><td>-0.157</td><td>0.441</td><td>-0.420 *</td><td>0.249</td></tr><tr><td><strong>Obs.</strong></td><td colspan="2">1944</td><td colspan="2">1944</td><td colspan="2">1944</td></tr></tbody></table>

Notes: Parental habits correspond to the share of experiences during childhood. Probability of any visit estimated using a logit model; Number of visits estimated using a negative binomial model; Clustered on household membership (1,099 households). Complete results are presented in Table A.5, A.6 and A.7 in Appendix E. Legend: * p<0.1; ** p<0.05; *** p<0.01.

## V. Conclusion

This study provides evidence of the intergenerational transmission of health care habits. Using a French health survey partly designed for this purpose, our results reveal a correlation between health care habits across generations. More precisely, we find that a child is more likely to visit a doctor immediately if his parents behaved similarly during his childhood. We
also find that inherited parental preferences are likely to influence the probability that an
individual will send his children to the doctor, which confirms the hypothesis of behavioral
transmission across generations.

There are several possible reasons for this positive intergenerational correlation between
health care habits across generations. One explanation is that preferences are transmitted or
socially constructed (Manski, 2000; Bisin and Verdier, 2001). It may reflect either intentional or
unintentional parental influence (Waldkirch et al., 2004). Parents may intend to invest in the
child's human capital through health investments (Jacobson, 2000). Individuals observe their
parents' choices during childhood and are influenced by their consumption or habits. It may
also reflect learning information from parental habits concerning the health care system, such as
knowledge of pathways to care. More important, it may reflect unintended reasons, such as the
sharing of other preferences such as time or risk preferences.

Other explanations may weaken the positive expected correlation or even lead to a
negative correlation. On the one hand, incongruous parental health care habits during childhood
may cause health problems in adulthood and may involve a change in the individual's health
care habits in adulthood. This hypothesis was assessed by examining the heterogeneity in
transmission according to the presence of illness. This hypothesis does not change our results.
On the other hand, we would expect differences in transmission according to environmental
changes. For example, the individual would be more willing to change his habits if he moved
away from his childhood region as an adult because of changes in the accessibility of health
care and social norms. We confirm the relevance of this hypothesis and find a weaker
transmission in the case of a change in the region of residence. By contrast, we find little
evidence of socialization through the influence of regional and generational norms that do not
affect parental transmission.
These results suggest that social background and parental habits have a long-term
influence on adult health care use that contributes to the intergenerational transmission of health
inequalities. This process indicates that specific prevention and health promotion policies
targeting underprivileged populations are potential avenues to reduce inequalities of opportunity
in health, as well as government interventions designed to improve equality of opportunity in
education or, more globally, living conditions.

Acknowledgements

I gratefully acknowledge the financial support of the Health Chair, a joint initiative by PSL,
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Appendix A: Supplementary tables

<table><caption>Table A.1: Descriptive statistics for individual variables (4,608 obs)</caption><thead><tr><th></th><th>Freq.</th><th>%</th><th></th><th></th></tr></thead><tbody><tr><td><strong>Sex</strong></td><td></td><td></td><td><strong>Income</strong></td><td></td></tr><tr><td>Women</td><td>2737</td><td>59,40</td><td>1st quintile</td><td>905 19,64</td></tr><tr><td>Men</td><td>1871</td><td>40,60</td><td>2nd quintile</td><td>742 16,10</td></tr><tr><td><strong>Age</strong></td><td></td><td></td><td>3rd quintile</td><td>771 16,73</td></tr><tr><td>less than 30</td><td>580</td><td>12,59</td><td>4th quintile</td><td>707 15,34</td></tr><tr><td>30 - 39</td><td>865</td><td>18,77</td><td>5th quintile</td><td>900 19,53</td></tr><tr><td>40 - 49</td><td>898</td><td>19,49</td><td>Non response</td><td>583 12,65</td></tr><tr><td>50 - 59</td><td>839</td><td>18,21</td><td><strong>Insurance situation</strong></td><td></td></tr><tr><td>60 - 69</td><td>629</td><td>13,65</td><td>No complementary health coverage</td><td>174 3,78</td></tr><tr><td>more than 70</td><td>797</td><td>17,30</td><td>Private complementary health coverage</td><td>3918 85,03</td></tr><tr><td><strong>Self-assessed health</strong></td><td></td><td></td><td>Means-tested complementary health coverage</td><td>516 11,20</td></tr><tr><td>Very good</td><td>880</td><td>19,10</td><td><strong>Family situation</strong></td><td></td></tr><tr><td>Good</td><td>2121</td><td>46,03</td><td>Living in couple</td><td>3086 66,97</td></tr><tr><td>Fair</td><td>1177</td><td>25,54</td><td>Living with children</td><td>1954 42,40</td></tr><tr><td>Poor, very poor</td><td>387</td><td>8,40</td><td><strong>Adulthood physician density</strong></td><td></td></tr><tr><td>Non response</td><td>43</td><td>0,93</td><td>Dens. of GP's in sector 1</td><td>80,54</td></tr><tr><td><strong>Functional limitations</strong></td><td></td><td></td><td>Dens. of GP's in sector 2</td><td>5,54</td></tr><tr><td>Heavy</td><td>345</td><td>7,49</td><td>Dens. of specialists in sector 1</td><td>50,53</td></tr><tr><td>Weak</td><td>852</td><td>18,49</td><td>Dens. of specialists in sector 2</td><td>29,86</td></tr><tr><td>No</td><td>3309</td><td>71,81</td><td><strong>Adulthood region</strong></td><td></td></tr><tr><td>Non response</td><td>102</td><td>2,21</td><td>Parisian region</td><td>639 13,87</td></tr><tr><td><strong>Chronic conditions</strong></td><td></td><td></td><td>Bassin parisien</td><td>873 18,95</td></tr><tr><td>Yes</td><td>1734</td><td>37,63</td><td>North</td><td>348 7,55</td></tr><tr><td>No</td><td>2639</td><td>57,27</td><td>East</td><td>431 9,35</td></tr><tr><td>Non response</td><td>235</td><td>5,10</td><td>West</td><td>722 15,67</td></tr><tr><td><strong>Long term affection</strong></td><td></td><td></td><td>South west</td><td>530 11,50</td></tr><tr><td>Yes</td><td>941</td><td>20,42</td><td>East Centre</td><td>583 12,65</td></tr><tr><td>No</td><td>3667</td><td>79,58</td><td>Mediterranean</td><td>482 10,46</td></tr><tr><td><strong>Educational level</strong></td><td></td><td></td><td></td><td></td></tr><tr><td>Primary school or drop out</td><td>858</td><td>18,62</td><td></td><td></td></tr><tr><td>Secondary school 1</td><td>1772</td><td>38,45</td><td></td><td></td></tr><tr><td>Secondary school 2</td><td>838</td><td>18,19</td><td></td><td></td></tr><tr><td>University degree</td><td>1092</td><td>23,70</td><td></td><td></td></tr><tr><td>Other or non response</td><td>48</td><td>1,04</td><td></td><td></td></tr><tr><td><strong>Social class</strong></td><td></td><td></td><td></td><td></td></tr><tr><td>Farmer</td><td>168</td><td>3,65</td><td></td><td></td></tr><tr><td>Craftmen</td><td>246</td><td>5,34</td><td></td><td></td></tr><tr><td>Manager</td><td>586</td><td>12,72</td><td></td><td></td></tr><tr><td>Associate prof.</td><td>838</td><td>18,19</td><td></td><td></td></tr><tr><td>Office worker</td><td>1396</td><td>30,30</td><td></td><td></td></tr><tr><td>Elementary jobs</td><td>1142</td><td>24,78</td><td></td><td></td></tr><tr><td>Inactive</td><td>232</td><td>5,03</td><td></td><td></td></tr></tbody></table>
<table><caption>Table A.2: Descriptive statistics for parental variables (4,608 obs)</caption><thead><tr><th></th><th>Frequency</th><th>%</th></tr></thead><tbody><tr><td><strong>Father's education level</strong></td><td></td><td></td></tr><tr><td>Primary school or drop out</td><td>2332</td><td>50.61</td></tr><tr><td>Secondary school 1</td><td>840</td><td>18.23</td></tr><tr><td>Secondary school 2</td><td>273</td><td>5.92</td></tr><tr><td>University degree</td><td>411</td><td>8.92</td></tr><tr><td>Other or non response</td><td>752</td><td>16.32</td></tr><tr><td><strong>Father's social class</strong></td><td></td><td></td></tr><tr><td>Farmer</td><td>548</td><td>11.89</td></tr><tr><td>Craftmen</td><td>437</td><td>9.48</td></tr><tr><td>Manager</td><td>606</td><td>13.15</td></tr><tr><td>Associate prof.</td><td>424</td><td>9.20</td></tr><tr><td>Office worker</td><td>324</td><td>7.03</td></tr><tr><td>Elementary jobs</td><td>1872</td><td>40.63</td></tr><tr><td>No male head or non response</td><td>397</td><td>8.62</td></tr><tr><td><strong>Mother's education level</strong></td><td></td><td></td></tr><tr><td>Primary school or drop out</td><td>2708</td><td>58.77</td></tr><tr><td>Secondary school 1</td><td>812</td><td>17.62</td></tr><tr><td>Secondary school 2</td><td>358</td><td>7.77</td></tr><tr><td>University degree</td><td>284</td><td>6.16</td></tr><tr><td>Other or non response</td><td>446</td><td>9.68</td></tr><tr><td><strong>Mother's activity</strong></td><td></td><td></td></tr><tr><td>Working</td><td>3313</td><td>71.90</td></tr><tr><td>Inactive</td><td>1295</td><td>28.10</td></tr><tr><td><strong>Family financial situation</strong></td><td></td><td></td></tr><tr><td>Very comfortable</td><td>258</td><td>5.60</td></tr><tr><td>Comfortable</td><td>2226</td><td>48.31</td></tr><tr><td>Difficult</td><td>1673</td><td>36.31</td></tr><tr><td>Very difficult</td><td>390</td><td>8.46</td></tr><tr><td>Non response</td><td>61</td><td>1.32</td></tr><tr><td><strong>Father's health status</strong></td><td></td><td></td></tr><tr><td>Very good, good, fair</td><td>4334</td><td>94.05</td></tr><tr><td>Poor or very poor health</td><td>274</td><td>5.95</td></tr><tr><td><strong>Mother's health status</strong></td><td></td><td></td></tr><tr><td>Very good, good, fair</td><td>4321</td><td>93.77</td></tr><tr><td>Poor or very poor health</td><td>287</td><td>6.23</td></tr><tr><td><strong>Childhood physician density</strong></td><td></td><td></td></tr><tr><td>Density of GP's</td><td></td><td>63.58</td></tr><tr><td>Density of specialists</td><td></td><td>44.02</td></tr><tr><td><strong>Birth region</strong></td><td></td><td></td></tr><tr><td>Parisian region</td><td>547</td><td>11.87</td></tr><tr><td>Bassin parisien</td><td>878</td><td>19.05</td></tr><tr><td>North</td><td>417</td><td>9.05</td></tr><tr><td>East</td><td>424</td><td>9.20</td></tr><tr><td>West</td><td>649</td><td>14.08</td></tr><tr><td>South west</td><td>412</td><td>8.94</td></tr><tr><td>East Centre</td><td>455</td><td>9.87</td></tr><tr><td>Mediterranean</td><td>281</td><td>6.10</td></tr><tr><td>Non Metropolitan France</td><td>545</td><td>11.83</td></tr></tbody></table>
<table><caption>Table A.3: Multinomial logit marginal effects for health care habits in adulthood</caption><thead><tr><th>Individual variables</th><th>Wait before visiting</th><th>Self-care behavior</th><th>See a doctor right away</th><th>Use of alternative medicine</th></tr><tr><th></th><th>M.E.</th><th>M.E.</th><th>M.E.</th><th>M.E.</th></tr></thead><tbody><tr><td>Sex (vs: Men): Women</td><td>-0.066 ***</td><td>0.060 ***</td><td>-0.024 *</td><td>0.029 ***</td></tr><tr><td>Age (vs: more than 70)</td><td></td><td></td><td></td><td></td></tr><tr><td>less than 30</td><td>0.030</td><td>0.025</td><td>-0.060</td><td>0.005</td></tr><tr><td>30 - 39</td><td>-0.100 **</td><td>0.099 **</td><td>-0.018</td><td>0.019</td></tr><tr><td>40 - 49</td><td>-0.131 ***</td><td>0.133 ***</td><td>-0.028</td><td>0.027 *</td></tr><tr><td>50 - 59</td><td>-0.028</td><td>0.052 *</td><td>-0.050 ***</td><td>0.027 **</td></tr><tr><td>60 - 69</td><td>0.005</td><td>0.024</td><td>-0.046 **</td><td>0.016</td></tr><tr><td>Self-assessed health (vs: Poor, very poor)</td><td></td><td></td><td></td><td></td></tr><tr><td>Very good</td><td>0.027</td><td>-0.009</td><td>-0.032</td><td>0.015</td></tr><tr><td>Good</td><td>0.035</td><td>-0.011</td><td>-0.030</td><td>0.006</td></tr><tr><td>Fair</td><td>0.049</td><td>-0.013</td><td>-0.041 *</td><td>0.005</td></tr><tr><td>Non response</td><td>-0.022</td><td>-0.095</td><td>0.116 **</td><td>0.002</td></tr><tr><td>Functional limitations (vs:No)</td><td></td><td></td><td></td><td></td></tr><tr><td>Heavy</td><td>0.000</td><td>-0.024</td><td>0.032</td><td>-0.008</td></tr><tr><td>Weak</td><td>0.004</td><td>-0.016</td><td>0.001</td><td>0.011</td></tr><tr><td>Non response</td><td>0.076</td><td>-0.059</td><td>-0.006</td><td>-0.011</td></tr><tr><td>Chronic conditions (vs: No)</td><td></td><td></td><td></td><td></td></tr><tr><td>Yes</td><td>-0.005</td><td>-0.031 *</td><td>0.033 **</td><td>0.004</td></tr><tr><td>Non response</td><td>-0.036</td><td>0.033</td><td>-0.008</td><td>0.011</td></tr><tr><td>Long term affection (vs: No): Yes</td><td>-0.036</td><td>-0.024</td><td>0.081 ***</td><td>-0.021 **</td></tr><tr><td>Educational level (vs: primary school or drop out)</td><td></td><td></td><td></td><td></td></tr><tr><td>Secondary school 1</td><td>0.000</td><td>0.028</td><td>-0.019</td><td>-0.010</td></tr><tr><td>Secondary school 2</td><td>0.031</td><td>0.066 **</td><td>-0.061 ***</td><td>-0.037 ***</td></tr><tr><td>University degree</td><td>0.019</td><td>0.041</td><td>-0.033</td><td>-0.027 *</td></tr><tr><td>Other or non response</td><td>0.047</td><td>0.096</td><td>-0.084</td><td>-0.059</td></tr><tr><td>Social class (vs: elementary jobs)</td><td></td><td></td><td></td><td></td></tr><tr><td>Farmer</td><td>-0.042</td><td>0.020</td><td>0.011</td><td>0.010</td></tr><tr><td>Craftmen</td><td>0.079 **</td><td>-0.002</td><td>-0.076 ***</td><td>-0.001</td></tr><tr><td>Manager</td><td>-0.001</td><td>-0.007</td><td>0.016</td><td>-0.008</td></tr><tr><td>Associate prof.</td><td>-0.014</td><td>0.034</td><td>-0.035 *</td><td>0.015</td></tr><tr><td>Office worker</td><td>0.029</td><td>-0.001</td><td>-0.024</td><td>-0.003</td></tr><tr><td>Inactive</td><td>-0.015</td><td>-0.019</td><td>0.029</td><td>0.005</td></tr><tr><td>Income (vs: 1st quintile)</td><td></td><td></td><td></td><td></td></tr><tr><td>2nd quintile</td><td>-0.015</td><td>0.071 ***</td><td>-0.051 ***</td><td>-0.004</td></tr><tr><td>3rd quintile</td><td>-0.026</td><td>0.073 ***</td><td>-0.042 **</td><td>-0.005</td></tr><tr><td>4th quintile</td><td>-0.037</td><td>0.092 ***</td><td>-0.057 ***</td><td>0.002</td></tr><tr><td>5th quintile</td><td>-0.021</td><td>0.064 **</td><td>-0.033</td><td>-0.011</td></tr><tr><td>Non response</td><td>-0.067 **</td><td>0.069 **</td><td>-0.006</td><td>0.004</td></tr><tr><td>Insurance situation (vs: No complementary health coverage)</td><td></td><td></td><td></td><td></td></tr><tr><td>Private complementary health coverage</td><td>0.012</td><td>0.013</td><td>0.021</td><td>-0.046 ***</td></tr><tr><td>Means-tested complementary health coverage</td><td>-0.009</td><td>-0.027</td><td>0.074 **</td><td>-0.037 **</td></tr><tr><td>Living in couple</td><td>-0.009</td><td>0.025</td><td>-0.002</td><td>-0.015 **</td></tr><tr><td>Living with children</td><td>0.038 **</td><td>-0.011</td><td>-0.031 **</td><td>0.004</td></tr><tr><td>Adulthood physician density</td><td></td><td></td><td></td><td></td></tr><tr><td>Dens. of GP's in sector 1</td><td>0.001</td><td>-0.001</td><td>0.000</td><td>0.000</td></tr><tr><td>Dens. of GP's in sector 2</td><td>0.000</td><td>0.001</td><td>-0.001</td><td>0.000</td></tr><tr><td>Dens. of specialists in sector 1</td><td>0.000</td><td>0.000</td><td>0.000</td><td>-0.001</td></tr><tr><td>Dens. of specialists in sector 2</td><td>0.000</td><td>0.000</td><td>0.000</td><td>0.000</td></tr><tr><td>Adulthood region (vs: Parisian region)</td><td></td><td></td><td></td><td></td></tr><tr><td>Bassin parisien</td><td>-0.042</td><td>0.089 **</td><td>-0.033</td><td>-0.013</td></tr><tr><td>North</td><td>-0.118 *</td><td>0.110 *</td><td>0.025</td><td>-0.018</td></tr><tr><td>East</td><td>-0.122 **</td><td>0.115 **</td><td>-0.001</td><td>0.008</td></tr><tr><td>West</td><td>-0.010</td><td>0.061</td><td>-0.033</td><td>-0.019</td></tr><tr><td>South west</td><td>0.002</td><td>0.042</td><td>-0.057</td><td>0.014</td></tr><tr><td>East Centre</td><td>0.022</td><td>0.015</td><td>-0.039</td><td>0.002</td></tr><tr><td>Mediterranean</td><td>-0.053</td><td>0.097 *</td><td>-0.065</td><td>0.021</td></tr></tbody></table>
<table><thead><tr><th colspan="5">Parental variables</th></tr></thead><tbody><tr><td colspan="5"><strong>Father's education level (vs: primary school or drop out)</strong></td></tr><tr><td>Secondary school 1</td><td>0.027</td><td>-0.035 *</td><td>0.000</td><td>0.007</td></tr><tr><td>Secondary school 2</td><td>0.038</td><td>-0.049</td><td>0.011</td><td>-0.001</td></tr><tr><td>University degree</td><td>0.020</td><td>-0.021</td><td>0.002</td><td>-0.001</td></tr><tr><td>Other or non response</td><td>0.034</td><td>-0.031</td><td>-0.010</td><td>0.007</td></tr><tr><td colspan="5"><strong>Father's social class (vs: elementary jobs)</strong></td></tr><tr><td>Farmer</td><td>-0.001</td><td>-0.019</td><td>0.009</td><td>0.011</td></tr><tr><td>Craftmen</td><td>-0.022</td><td>0.017</td><td>0.017</td><td>-0.012</td></tr><tr><td>Manager</td><td>0.010</td><td>-0.014</td><td>0.001</td><td>0.002</td></tr><tr><td>Associate prof.</td><td>-0.015</td><td>0.014</td><td>0.012</td><td>-0.011</td></tr><tr><td>Office worker</td><td>0.022</td><td>-0.027</td><td>-0.011</td><td>0.016</td></tr><tr><td>No male head or non response</td><td>-0.019</td><td>0.031</td><td>-0.003</td><td>-0.010</td></tr><tr><td colspan="5"><strong>Mother's education level (vs: primary school or drop out)</strong></td></tr><tr><td>Secondary school 1</td><td>-0.015</td><td>0.016</td><td>0.002</td><td>-0.003</td></tr><tr><td>Secondary school 2</td><td>0.005</td><td>0.015</td><td>-0.050 *</td><td>0.030 **</td></tr><tr><td>University degree</td><td>0.041</td><td>-0.043</td><td>-0.024</td><td>0.027</td></tr><tr><td>Other or non response</td><td>-0.003</td><td>-0.005</td><td>0.012</td><td>-0.004</td></tr><tr><td><strong>Mother's activity (vs: active): Inactive</strong></td><td>-0.004</td><td>-0.014</td><td>0.015</td><td>0.002</td></tr><tr><td colspan="5"><strong>Family financial situation (vs: very difficult)</strong></td></tr><tr><td>Very comfortable</td><td>-0.043</td><td>-0.006</td><td>0.055 *</td><td>-0.005</td></tr><tr><td>Comfortable</td><td>0.018</td><td>-0.044 *</td><td>0.030</td><td>-0.004</td></tr><tr><td>Difficult</td><td>0.028</td><td>-0.056 **</td><td>0.039 *</td><td>-0.010</td></tr><tr><td>Non response</td><td>-0.090</td><td>-0.018</td><td>0.131 ***</td><td>-0.023</td></tr><tr><td colspan="5"><strong>Parental health status (vs: very good, good, fair)</strong></td></tr><tr><td>Father poor or very poor health</td><td>0.040</td><td>-0.018</td><td>-0.026</td><td>0.004</td></tr><tr><td>Mother poor or very poor health</td><td>0.054 *</td><td>0.012</td><td>-0.054 **</td><td>-0.012</td></tr><tr><td colspan="5"><strong>Childhood physician density</strong></td></tr><tr><td>Density of GP's</td><td>0.001</td><td>0.001</td><td>-0.001</td><td>0.000</td></tr><tr><td>Density of specialists</td><td>-0.001</td><td>0.000</td><td>0.000</td><td>0.001</td></tr><tr><td colspan="5"><strong>Birth region (vs: Parisian region)</strong></td></tr><tr><td>Bassin parisien</td><td>-0.094 *</td><td>-0.017</td><td>0.077 *</td><td>0.034</td></tr><tr><td>North</td><td>-0.050</td><td>-0.032</td><td>0.061</td><td>0.020</td></tr><tr><td>East</td><td>0.018</td><td>-0.073</td><td>0.013</td><td>0.042 *</td></tr><tr><td>West</td><td>-0.089</td><td>0.000</td><td>0.048</td><td>0.042</td></tr><tr><td>South west</td><td>-0.133 **</td><td>0.044</td><td>0.073</td><td>0.016</td></tr><tr><td>East Centre</td><td>-0.053</td><td>0.007</td><td>0.020</td><td>0.026</td></tr><tr><td>Mediterranean</td><td>-0.030</td><td>-0.050</td><td>0.068</td><td>0.011</td></tr><tr><td>Non Metropolitan France</td><td>-0.056</td><td>0.018</td><td>0.016</td><td>0.022</td></tr><tr><td colspan="5"><strong>Parental habit during childhood (vs: See a doctor right away)</strong></td></tr><tr><td>Wait before visiting</td><td>0.229 ***</td><td>-0.087 ***</td><td>-0.142 ***</td><td>0.001</td></tr><tr><td>Self-care behavior</td><td>-0.020</td><td>0.159 ***</td><td>-0.134 ***</td><td>-0.005</td></tr><tr><td>Use of alternative medicine</td><td>-0.023</td><td>0.020</td><td>-0.059 ***</td><td>0.062 ***</td></tr><tr><td><strong>Obs.</strong></td><td colspan="4">4608</td></tr><tr><td><strong>Pseudo R<sup>2</sup></strong></td><td colspan="4">0.0849</td></tr></tbody></table>

Notes: Parental habits correspond to the share of experiences during childhood; Legend: * p<0.1; ** p<0.05; *** p<0.01
<table><caption>Table A.4: Heterogeneity in the transmission of health care habits according to gender, sickness status and birth cohort</caption><thead><tr><th rowspan="2"></th><th colspan="2">Women</th><th colspan="2">Men</th><th colspan="2">Sick</th><th colspan="2">Not sick</th><th colspan="2">Less than 50 y.o.</th><th colspan="2">More than 50 y.o.</th></tr><tr><th>M.E.</th><th>S.E.</th><th>M.E.</th><th>S.E.</th><th>M.E.</th><th>S.E.</th><th>M.E.</th><th>S.E.</th><th>M.E.</th><th>S.E.</th><th>M.E.</th><th>S.E.</th></tr></thead><tbody><tr><td colspan="14"><strong>Multinomial alternative for individual habit : Wait before visiting</strong></td></tr><tr><td colspan="14"><strong>Parental habit during childhood :</strong></td></tr><tr><td>Wait before visiting</td><td>0.240 ***</td><td>0.029</td><td>0.211 ***</td><td>0.037</td><td>0.214 ***</td><td>0.032</td><td>0.238 ***</td><td>0.034</td><td>0.208 ***</td><td>0.035</td><td>0.255 ***</td><td>0.031</td></tr><tr><td>Self-care behavior</td><td>-0.007</td><td>0.031</td><td>-0.038</td><td>0.040</td><td>0.007</td><td>0.036</td><td>-0.042</td><td>0.034</td><td>-0.062 *</td><td>0.034</td><td>0.028</td><td>0.037</td></tr><tr><td>See a doctor right away</td><td>ref.</td><td></td><td>ref.</td><td></td><td>ref.</td><td></td><td>ref.</td><td></td><td>ref.</td><td></td><td>ref.</td><td></td></tr><tr><td>Use of alternative medicine</td><td>0.020</td><td>0.035</td><td>-0.081 *</td><td>0.042</td><td>0.018</td><td>0.038</td><td>-0.061</td><td>0.040</td><td>-0.073</td><td>0.046</td><td>0.013</td><td>0.034</td></tr><tr><td colspan="14"><strong>Multinomial alternative for individual habit : Self-care behavior</strong></td></tr><tr><td colspan="14"><strong>Parental habit during childhood :</strong></td></tr><tr><td>Wait before visiting</td><td>-0.106 ***</td><td>0.030</td><td>-0.045</td><td>0.035</td><td>-0.065 **</td><td>0.030</td><td>-0.106 ***</td><td>0.035</td><td>-0.080 **</td><td>0.036</td><td>-0.090 ***</td><td>0.030</td></tr><tr><td>Self-care behavior</td><td>0.151 ***</td><td>0.028</td><td>0.173 ***</td><td>0.033</td><td>0.124 ***</td><td>0.029</td><td>0.191 ***</td><td>0.031</td><td>0.176 ***</td><td>0.031</td><td>0.150 ***</td><td>0.029</td></tr><tr><td>See a doctor right away</td><td>ref.</td><td></td><td>ref.</td><td></td><td>ref.</td><td></td><td>ref.</td><td></td><td>ref.</td><td></td><td>ref.</td><td></td></tr><tr><td>Use of alternative medicine</td><td>-0.025</td><td>0.034</td><td>0.078 **</td><td>0.037</td><td>-0.023</td><td>0.034</td><td>0.048</td><td>0.038</td><td>0.025</td><td>0.044</td><td>0.019</td><td>0.030</td></tr><tr><td colspan="14"><strong>Multinomial alternative for individual habit : See a doctor right away</strong></td></tr><tr><td colspan="14"><strong>Parental habit during childhood :</strong></td></tr><tr><td>Wait before visiting</td><td>-0.135 ***</td><td>0.025</td><td>-0.155 ***</td><td>0.032</td><td>-0.154 ***</td><td>0.029</td><td>-0.131 ***</td><td>0.028</td><td>-0.146 ***</td><td>0.030</td><td>-0.145 ***</td><td>0.027</td></tr><tr><td>Self-care behavior</td><td>-0.137 ***</td><td>0.026</td><td>-0.128 ***</td><td>0.033</td><td>-0.138 ***</td><td>0.032</td><td>-0.138 ***</td><td>0.027</td><td>-0.137 ***</td><td>0.027</td><td>-0.135 ***</td><td>0.031</td></tr><tr><td>See a doctor right away</td><td>ref.</td><td></td><td>ref.</td><td></td><td>ref.</td><td></td><td>ref.</td><td></td><td>ref.</td><td></td><td>ref.</td><td></td></tr><tr><td>Use of alternative medicine</td><td>-0.066 ***</td><td>0.025</td><td>-0.048</td><td>0.030</td><td>-0.056 *</td><td>0.029</td><td>-0.054 **</td><td>0.025</td><td>-0.041</td><td>0.029</td><td>-0.067 **</td><td>0.027</td></tr><tr><td colspan="14"><strong>Multinomial alternative for individual habit : Use of alternative medicine</strong></td></tr><tr><td colspan="14"><strong>Parental habit during childhood :</strong></td></tr><tr><td>Wait before visiting</td><td>0.002</td><td>0.016</td><td>-0.010</td><td>0.016</td><td>0.006</td><td>0.015</td><td>-0.001</td><td>0.017</td><td>0.018</td><td>0.017</td><td>-0.020</td><td>0.015</td></tr><tr><td>Self-care behavior</td><td>-0.006</td><td>0.016</td><td>-0.007</td><td>0.017</td><td>0.006</td><td>0.016</td><td>-0.012</td><td>0.017</td><td>0.023</td><td>0.015</td><td>-0.043 **</td><td>0.020</td></tr><tr><td>See a doctor right away</td><td>ref.</td><td></td><td>ref.</td><td></td><td>ref.</td><td></td><td>ref.</td><td></td><td>ref.</td><td></td><td>ref.</td><td></td></tr><tr><td>Use of alternative medicine</td><td>0.070 ***</td><td>0.015</td><td>0.051 ***</td><td>0.013</td><td>0.061 ***</td><td>0.015</td><td>0.067 ***</td><td>0.014</td><td>0.090 ***</td><td>0.016</td><td>0.035 ***</td><td>0.013</td></tr><tr><td><strong>Obs.</strong></td><td colspan="2">2737</td><td colspan="2">1871</td><td colspan="2">2128</td><td colspan="2">2480</td><td colspan="2">2343</td><td colspan="2">2265</td></tr><tr><td><strong>Pseudo R<sup>2</sup></strong></td><td colspan="2">0.0961</td><td colspan="2">0.1236</td><td colspan="2">0.1110</td><td colspan="2">0.0851</td><td colspan="2">0.0983</td><td colspan="2">0.1054</td></tr></tbody></table>

Notes: Parental habits correspond to the share of experiences during childhood; these results are adjusted with need variables, individual and parental socioeconomic variables such as in Eq 5; from separated estimations on sub-sample using multinomial model such as in column (4) of Table 8 using share of parental habits; Significance levels: *** 1%, **5%, *10%.
<table><caption>Table A.5: Marginal effects for doctor visits (total) of the individual's child</caption><thead><tr><th rowspan="2">Individual's child variables</th><th colspan="2">Probability of any visit</th><th colspan="2">Number of visits</th></tr><tr><th>M.E.</th><th>S.E.</th><th>M.E.</th><th>S.E.</th></tr></thead><tbody><tr><td>Sex (vs: Men): Women</td><td>-0.013</td><td>0.011</td><td>-0.173</td><td>0.206</td></tr><tr><td>Age</td><td>-0.021 ***</td><td>0.006</td><td>-1.217 ***</td><td>0.090</td></tr><tr><td>Age-squared</td><td>0.001 ***</td><td>0.000</td><td>0.054 ***</td><td>0.005</td></tr><tr><td>Self-assessed health (vs: Poor, very poor and fair)</td><td></td><td></td><td></td><td></td></tr><tr><td>Very good</td><td>-0.053</td><td>0.033</td><td>-1.559 ***</td><td>0.430</td></tr><tr><td>Good</td><td>-0.025</td><td>0.033</td><td>-0.587</td><td>0.401</td></tr><tr><td>Functional limitations (vs:No)</td><td></td><td></td><td></td><td></td></tr><tr><td>Yes</td><td>0.076 **</td><td>0.037</td><td>1.735 ***</td><td>0.460</td></tr><tr><td>Non response</td><td>0.066 *</td><td>0.040</td><td>0.555</td><td>0.577</td></tr><tr><td>Chronic conditions (vs: No)</td><td></td><td></td><td></td><td></td></tr><tr><td>Yes</td><td>0.010</td><td>0.021</td><td>1.202 ***</td><td>0.341</td></tr><tr><td>Non response</td><td>-0.032</td><td>0.033</td><td>0.680</td><td>0.609</td></tr><tr><td>Long term affection (vs: No): Yes</td><td>0.041</td><td>0.055</td><td>2.142 ***</td><td>0.735</td></tr><tr><td>Individual variables</td><td></td><td></td><td></td><td></td></tr><tr><td>Sex (vs: Men): Women</td><td>0.011</td><td>0.016</td><td>0.203</td><td>0.344</td></tr><tr><td>Age (vs: more than 50)</td><td></td><td></td><td></td><td></td></tr><tr><td>less than 30</td><td>0.013</td><td>0.040</td><td>1.855 **</td><td>0.729</td></tr><tr><td>30 - 39</td><td>0.002</td><td>0.028</td><td>0.433</td><td>0.595</td></tr><tr><td>40 - 49</td><td>0.004</td><td>0.022</td><td>0.226</td><td>0.511</td></tr><tr><td>Self-assessed health (vs: Poor, very poor)</td><td></td><td></td><td></td><td></td></tr><tr><td>Very good</td><td>-0.025</td><td>0.054</td><td>-0.841</td><td>0.777</td></tr><tr><td>Good</td><td>-0.053</td><td>0.052</td><td>-1.128</td><td>0.732</td></tr><tr><td>Fair</td><td>-0.091 *</td><td>0.051</td><td>-1.009</td><td>0.660</td></tr><tr><td>Non response</td><td>-0.135 **</td><td>0.063</td><td>-1.721</td><td>1.248</td></tr><tr><td>Functional limitations (vs: No)</td><td></td><td></td><td></td><td></td></tr><tr><td>Heavy</td><td>0.059</td><td>0.043</td><td>1.433 **</td><td>0.662</td></tr><tr><td>Weak</td><td>0.030</td><td>0.020</td><td>0.371</td><td>0.474</td></tr><tr><td>Non response</td><td>0.033</td><td>0.034</td><td>0.275</td><td>0.863</td></tr><tr><td>Chronic conditions (vs: No)</td><td></td><td></td><td></td><td></td></tr><tr><td>Yes</td><td>0.010</td><td>0.016</td><td>-0.037</td><td>0.325</td></tr><tr><td>Non response</td><td>-0.006</td><td>0.028</td><td>-0.692</td><td>0.609</td></tr><tr><td>Long term affection (vs: No): Yes</td><td>-0.034</td><td>0.022</td><td>-0.380</td><td>0.486</td></tr><tr><td>Educational level (vs: primary school or drop out)</td><td></td><td></td><td></td><td></td></tr><tr><td>Secondary school 1</td><td>-0.012</td><td>0.027</td><td>-0.686</td><td>0.640</td></tr><tr><td>Secondary school 2</td><td>-0.004</td><td>0.029</td><td>-0.843</td><td>0.685</td></tr><tr><td>University degree</td><td>-0.002</td><td>0.030</td><td>-0.803</td><td>0.729</td></tr><tr><td>Other or non response</td><td>-0.073</td><td>0.094</td><td>1.192</td><td>2.088</td></tr><tr><td>Social class (vs: elementary jobs)</td><td></td><td></td><td></td><td></td></tr><tr><td>Farmer</td><td>-0.080 *</td><td>0.044</td><td>-3.117 **</td><td>1.284</td></tr><tr><td>Craftmen</td><td>-0.061 **</td><td>0.030</td><td>-0.791</td><td>0.762</td></tr><tr><td>Manager</td><td>-0.011</td><td>0.028</td><td>-0.019</td><td>0.577</td></tr><tr><td>Associate prof.</td><td>0.004</td><td>0.024</td><td>0.681</td><td>0.444</td></tr><tr><td>Office worker</td><td>0.000</td><td>0.020</td><td>0.875 **</td><td>0.372</td></tr><tr><td>Inactive</td><td>-0.010</td><td>0.025</td><td>-0.296</td><td>0.553</td></tr><tr><td>Income (vs: 1st quintile)</td><td></td><td></td><td></td><td></td></tr><tr><td>2nd quintile</td><td>0.022</td><td>0.018</td><td>-0.100</td><td>0.402</td></tr><tr><td>3rd quintile</td><td>0.000</td><td>0.019</td><td>-0.003</td><td>0.416</td></tr><tr><td>4th quintile</td><td>0.068 ***</td><td>0.026</td><td>0.360</td><td>0.475</td></tr><tr><td>5th quintile</td><td>0.048 *</td><td>0.026</td><td>0.306</td><td>0.528</td></tr><tr><td>Non response</td><td>0.031</td><td>0.021</td><td>-0.280</td><td>0.490</td></tr><tr><td>Insurance situation (vs: No complementary health coverage)</td><td></td><td></td><td></td><td></td></tr><tr><td>Private complementary health coverage</td><td>0.014</td><td>0.042</td><td>3.719 ***</td><td>0.612</td></tr><tr><td>Means-tested complementary health coverage</td><td>0.054</td><td>0.044</td><td>4.683 ***</td><td>0.655</td></tr><tr><td>Living in couple (vs: No): Yes</td><td>0.022</td><td>0.017</td><td>0.311</td><td>0.351</td></tr><tr><td>Adulthood physician density</td><td></td><td></td><td></td><td></td></tr><tr><td>Dens. of GP's in sector 1</td><td>-0.001</td><td>0.001</td><td>0.016</td><td>0.019</td></tr></tbody></table>
<table><tbody><tr><td>Dens. of GP's in sector 2</td><td>0.000</td><td>0.002</td><td>-0.003</td><td>0.046</td></tr><tr><td>Dens. of specialists in sector 1</td><td>0.001 ***</td><td>0.001</td><td>0.004</td><td>0.013</td></tr><tr><td>Dens. of specialists in sector 2</td><td>0.000</td><td>0.000</td><td>0.013</td><td>0.008</td></tr><tr><td colspan="5"><strong>Adulthood region (vs: Parisian region)</strong></td></tr><tr><td>Bassin parisien</td><td>-0.009</td><td>0.030</td><td>-0.677</td><td>0.698</td></tr><tr><td>North</td><td>0.006</td><td>0.050</td><td>0.513</td><td>1.043</td></tr><tr><td>East</td><td>-0.006</td><td>0.037</td><td>0.194</td><td>0.910</td></tr><tr><td>West</td><td>-0.027</td><td>0.032</td><td>-0.540</td><td>0.768</td></tr><tr><td>South west</td><td>-0.021</td><td>0.042</td><td>-0.235</td><td>0.893</td></tr><tr><td>East Centre</td><td>-0.048</td><td>0.029</td><td>-2.344 ***</td><td>0.697</td></tr><tr><td>Mediterranean</td><td>-0.047</td><td>0.044</td><td>-1.194</td><td>1.040</td></tr></tbody></table>

Parental variables

<table><tbody><tr><td colspan="5"><strong>Father's education level (vs: primary school or drop out)</strong></td></tr><tr><td>Secondary school 1</td><td>-0.033 *</td><td>0.017</td><td>-0.641 *</td><td>0.347</td></tr><tr><td>Secondary school 2</td><td>0.043</td><td>0.032</td><td>0.048</td><td>0.590</td></tr><tr><td>University degree</td><td>0.000</td><td>0.031</td><td>0.287</td><td>0.571</td></tr><tr><td>Other or non response</td><td>0.019</td><td>0.022</td><td>0.826 *</td><td>0.438</td></tr></tbody></table>

<table><tbody><tr><td colspan="5"><strong>Father's social class (vs: elementary jobs)</strong></td></tr><tr><td>Farmer</td><td>-0.014</td><td>0.023</td><td>0.251</td><td>0.561</td></tr><tr><td>Craftmen</td><td>-0.061 ***</td><td>0.021</td><td>-0.615</td><td>0.521</td></tr><tr><td>Manager</td><td>-0.005</td><td>0.023</td><td>0.433</td><td>0.466</td></tr><tr><td>Associate prof.</td><td>-0.038 *</td><td>0.020</td><td>0.076</td><td>0.452</td></tr><tr><td>Office worker</td><td>-0.042 **</td><td>0.020</td><td>0.018</td><td>0.451</td></tr><tr><td>No male head or non response</td><td>-0.058 **</td><td>0.023</td><td>-1.378 ***</td><td>0.530</td></tr></tbody></table>

<table><tbody><tr><td colspan="5"><strong>Mother's education level (vs: primary school or drop out)</strong></td></tr><tr><td>Secondary school 1</td><td>0.038 **</td><td>0.017</td><td>0.129</td><td>0.320</td></tr><tr><td>Secondary school 2</td><td>0.007</td><td>0.024</td><td>-0.355</td><td>0.504</td></tr><tr><td>University degree</td><td>0.006</td><td>0.029</td><td>-0.212</td><td>0.584</td></tr><tr><td>Other or non response</td><td>-0.011</td><td>0.021</td><td>-0.671</td><td>0.483</td></tr><tr><td>Mother's activity (vs: active): Inactive</td><td>0.018</td><td>0.015</td><td>0.081</td><td>0.317</td></tr></tbody></table>

<table><tbody><tr><td colspan="5"><strong>Family financial situation (vs: very difficult)</strong></td></tr><tr><td>Very comfortable</td><td>-0.004</td><td>0.028</td><td>-0.384</td><td>0.755</td></tr><tr><td>Comfortable</td><td>0.032</td><td>0.022</td><td>0.238</td><td>0.559</td></tr><tr><td>Difficult</td><td>0.049 **</td><td>0.022</td><td>0.367</td><td>0.547</td></tr><tr><td>Non response</td><td>-0.079</td><td>0.064</td><td>0.637</td><td>1.701</td></tr></tbody></table>

<table><tbody><tr><td colspan="5"><strong>Parental health status (vs: very good, good, fair)</strong></td></tr><tr><td>Father poor or very poor health</td><td>-0.030</td><td>0.020</td><td>-0.737</td><td>0.485</td></tr><tr><td>Mother poor or very poor health</td><td>0.063 **</td><td>0.030</td><td>0.081</td><td>0.441</td></tr></tbody></table>

<table><tbody><tr><td colspan="5"><strong>Childhood physician density</strong></td></tr><tr><td>Density of GP's</td><td>0.000</td><td>0.001</td><td>0.010</td><td>0.018</td></tr><tr><td>Density of specialists</td><td>0.000</td><td>0.001</td><td>-0.027 *</td><td>0.016</td></tr></tbody></table>

<table><tbody><tr><td colspan="5"><strong>Birth region (vs: Parisian region)</strong></td></tr><tr><td>Bassin parisien</td><td>-0.008</td><td>0.046</td><td>-1.066</td><td>0.929</td></tr><tr><td>North</td><td>0.013</td><td>0.057</td><td>-1.380</td><td>1.095</td></tr><tr><td>East</td><td>-0.027</td><td>0.043</td><td>-1.791 *</td><td>0.944</td></tr><tr><td>West</td><td>0.064</td><td>0.049</td><td>-0.670</td><td>0.914</td></tr><tr><td>South west</td><td>0.017</td><td>0.045</td><td>-0.805</td><td>0.889</td></tr><tr><td>East Centre</td><td>0.038</td><td>0.039</td><td>0.385</td><td>0.990</td></tr><tr><td>Mediterranean</td><td>0.094 *</td><td>0.051</td><td>0.981</td><td>0.805</td></tr><tr><td>Non Metropolitan France</td><td>-0.032</td><td>0.066</td><td>-2.567 *</td><td>1.383</td></tr></tbody></table>

<table><tbody><tr><td colspan="5"><strong>Parental habit during childhood (vs: See a doctor right away)</strong></td></tr><tr><td>Wait before visiting</td><td>-0.062 ***</td><td>0.021</td><td>-0.584</td><td>0.450</td></tr><tr><td>Self-care behavior</td><td>-0.028</td><td>0.018</td><td>-0.336</td><td>0.408</td></tr><tr><td>Use of alternative medicine</td><td>-0.044 **</td><td>0.020</td><td>-0.596</td><td>0.563</td></tr></tbody></table>

<table><tbody><tr><td colspan="5"><strong>Obs</strong></td></tr><tr><td></td><td>1944</td><td></td><td></td><td>1944</td></tr><tr><td colspan="5"><strong>Pseudo R²</strong></td></tr><tr><td></td><td>0.1826</td><td></td><td></td><td></td></tr></tbody></table>

<table><tbody><tr><td colspan="5"><strong>Pseudo R²</strong></td></tr><tr><td></td><td>0.1826</td><td></td><td></td><td></td></tr></tbody></table>

Notes: Parental habits correspond to the share of experiences during childhood. Probability of any visit estimated using a logit model; Number of visits estimated using a negative binomial model; Clustered on household membership (1,099 households). Legend: * p<0.1; ** p<0.05; *** p<0.01.
<table><caption>Table A.6: Marginal effects for GP's visits of the individual's child</caption><thead><tr><th rowspan="2">Individual's child variables</th><th colspan="2">Probability of any visit</th><th colspan="2">Number of visits</th></tr><tr><th>M.E.</th><th>S.E.</th><th>M.E.</th><th>S.E.</th></tr></thead><tbody><tr><td><strong>Sex (vs: Men): Women</strong></td><td>-0.026 *</td><td>0.014</td><td>-0.270 *</td><td>0.156</td></tr><tr><td><strong>Age</strong></td><td>-0.018 **</td><td>0.008</td><td>-0.889 ***</td><td>0.075</td></tr><tr><td><strong>Age-squared</strong></td><td>0.001 *</td><td>0.000</td><td>0.038 ***</td><td>0.004</td></tr><tr><td><strong>Self-assessed health (vs: Poor, very poor and fair)</strong></td><td></td><td></td><td></td><td></td></tr><tr><td>Very good</td><td>-0.106 **</td><td>0.042</td><td>-1.117 ***</td><td>0.344</td></tr><tr><td>Good</td><td>-0.058</td><td>0.041</td><td>-0.493</td><td>0.324</td></tr><tr><td><strong>Functional limitations (vs:No)</strong></td><td></td><td></td><td></td><td></td></tr><tr><td>Yes</td><td>0.073 *</td><td>0.041</td><td>0.547</td><td>0.363</td></tr><tr><td>Non response</td><td>0.043</td><td>0.045</td><td>0.245</td><td>0.430</td></tr><tr><td><strong>Chronic conditions (vs: No)</strong></td><td></td><td></td><td></td><td></td></tr><tr><td>Yes</td><td>-0.018</td><td>0.027</td><td>0.460 *</td><td>0.267</td></tr><tr><td>Non response</td><td>-0.023</td><td>0.045</td><td>0.762</td><td>0.487</td></tr><tr><td><strong>Long term affection (vs: No): Yes</strong></td><td>0.045</td><td>0.062</td><td>0.454</td><td>0.566</td></tr><tr><td><strong>Individual variables</strong></td><td></td><td></td><td></td><td></td></tr><tr><td><strong>Sex (ref: Men): Women</strong></td><td>-0.020</td><td>0.022</td><td>0.189</td><td>0.258</td></tr><tr><td><strong>Age (vs: more than 50)</strong></td><td></td><td></td><td></td><td></td></tr><tr><td>less than 30</td><td>0.040</td><td>0.061</td><td>1.213 **</td><td>0.620</td></tr><tr><td>30 - 39</td><td>0.037</td><td>0.044</td><td>-0.009</td><td>0.510</td></tr><tr><td>40 - 49</td><td>0.032</td><td>0.035</td><td>-0.209</td><td>0.437</td></tr><tr><td><strong>Self-assessed health (vs: Poor, very poor)</strong></td><td></td><td></td><td></td><td></td></tr><tr><td>Very good</td><td>-0.048</td><td>0.066</td><td>-1.194 **</td><td>0.585</td></tr><tr><td>Good</td><td>-0.060</td><td>0.064</td><td>-1.267 **</td><td>0.560</td></tr><tr><td>Fair</td><td>-0.085</td><td>0.062</td><td>-1.038 **</td><td>0.516</td></tr><tr><td>Non response</td><td>-0.215 **</td><td>0.089</td><td>-2.219 **</td><td>0.951</td></tr><tr><td><strong>Functional limitations (vs:No)</strong></td><td></td><td></td><td></td><td></td></tr><tr><td>Heavy</td><td>-0.002</td><td>0.058</td><td>0.700</td><td>0.511</td></tr><tr><td>Weak</td><td>0.027</td><td>0.030</td><td>-0.064</td><td>0.363</td></tr><tr><td>Non response</td><td>0.105 *</td><td>0.054</td><td>0.960</td><td>0.652</td></tr><tr><td><strong>Chronic conditions (vs: No)</strong></td><td></td><td></td><td></td><td></td></tr><tr><td>Yes</td><td>0.020</td><td>0.023</td><td>0.266</td><td>0.257</td></tr><tr><td>Non response</td><td>-0.018</td><td>0.043</td><td>-0.808 *</td><td>0.482</td></tr><tr><td><strong>Long term affection (vs: No): Yes</strong></td><td>-0.031</td><td>0.033</td><td>-0.433</td><td>0.382</td></tr><tr><td><strong>Educational level (vs: primary school or drop out)</strong></td><td></td><td></td><td></td><td></td></tr><tr><td>Secondary school 1</td><td>-0.007</td><td>0.040</td><td>-0.177</td><td>0.486</td></tr><tr><td>Secondary school 2</td><td>-0.034</td><td>0.042</td><td>-0.676</td><td>0.529</td></tr><tr><td>University degree</td><td>0.003</td><td>0.045</td><td>-0.486</td><td>0.577</td></tr><tr><td>Other or non response</td><td>-0.052</td><td>0.136</td><td>1.385</td><td>1.423</td></tr><tr><td><strong>Social class (vs: elementary jobs)</strong></td><td></td><td></td><td></td><td></td></tr><tr><td>Farmer</td><td>-0.189 ***</td><td>0.072</td><td>-2.543 **</td><td>1.014</td></tr><tr><td>Craftmen</td><td>-0.075 *</td><td>0.041</td><td>-1.167 *</td><td>0.611</td></tr><tr><td>Manager</td><td>-0.098 ***</td><td>0.038</td><td>-0.735</td><td>0.461</td></tr><tr><td>Associate prof.</td><td>-0.025</td><td>0.032</td><td>-0.044</td><td>0.364</td></tr><tr><td>Office worker</td><td>0.012</td><td>0.027</td><td>0.474 *</td><td>0.286</td></tr><tr><td>Inactive</td><td>-0.003</td><td>0.038</td><td>-0.235</td><td>0.402</td></tr><tr><td><strong>Income (vs: 1st quintile)</strong></td><td></td><td></td><td></td><td></td></tr><tr><td>2nd quintile</td><td>0.032</td><td>0.026</td><td>-0.172</td><td>0.317</td></tr><tr><td>3rd quintile</td><td>0.037</td><td>0.029</td><td>-0.149</td><td>0.326</td></tr><tr><td>4th quintile</td><td>0.082 **</td><td>0.034</td><td>0.228</td><td>0.362</td></tr><tr><td>5th quintile</td><td>0.078 **</td><td>0.037</td><td>0.479</td><td>0.429</td></tr><tr><td>Non response</td><td>0.046</td><td>0.030</td><td>0.020</td><td>0.376</td></tr><tr><td><strong>Insurance situation (vs: No complementary health coverage)</strong></td><td></td><td></td><td></td><td></td></tr><tr><td>Private complementary health coverage</td><td>0.004</td><td>0.067</td><td>1.928 ***</td><td>0.546</td></tr><tr><td>Means-tested complementary health coverage</td><td>0.070</td><td>0.069</td><td>2.864 ***</td><td>0.579</td></tr><tr><td><strong>Living in couple</strong></td><td>0.038</td><td>0.023</td><td>0.102</td><td>0.269</td></tr><tr><td><strong>Adulthood physician density</strong></td><td></td><td></td><td></td><td></td></tr><tr><td>Dens. of GP's in sector 1</td><td>-0.002</td><td>0.001</td><td>0.017</td><td>0.015</td></tr></tbody></table>
<table><tbody><tr><td>Dens. of GP's in sector 2</td><td>-0.003</td><td>0.003</td><td>-0.031</td><td>0.035</td></tr><tr><td>Dens. of specialists in sector 1</td><td>0.002 **</td><td>0.001</td><td>-0.002</td><td>0.010</td></tr><tr><td>Dens. of specialists in sector 2</td><td>0.000</td><td>0.001</td><td>0.002</td><td>0.008</td></tr><tr><td colspan="5"><strong>Adulthood region (vs: Parisian region)</strong></td></tr><tr><td>Bassin parisien</td><td>-0.049</td><td>0.048</td><td>-0.585</td><td>0.540</td></tr><tr><td>North</td><td>-0.020</td><td>0.070</td><td>0.018</td><td>0.791</td></tr><tr><td>East</td><td>-0.025</td><td>0.056</td><td>-0.405</td><td>0.705</td></tr><tr><td>West</td><td>-0.055</td><td>0.049</td><td>-0.593</td><td>0.579</td></tr><tr><td>South west</td><td>-0.083</td><td>0.064</td><td>-0.513</td><td>0.696</td></tr><tr><td>East Centre</td><td>-0.075 *</td><td>0.044</td><td>-1.362 **</td><td>0.543</td></tr><tr><td>Mediterranean</td><td>-0.107 *</td><td>0.064</td><td>-1.476 *</td><td>0.775</td></tr></tbody></table>

Parental variables

<table><tbody><tr><td colspan="5"><strong>Father's education level (vs: primary school or drop out)</strong></td></tr><tr><td>Secondary school 1</td><td>-0.066 ***</td><td>0.024</td><td>-0.564 **</td><td>0.284</td></tr><tr><td>Secondary school 2</td><td>0.020</td><td>0.038</td><td>0.020</td><td>0.428</td></tr><tr><td>University degree</td><td>-0.011</td><td>0.046</td><td>0.395</td><td>0.452</td></tr><tr><td>Other or non response</td><td>0.030</td><td>0.032</td><td>0.910 ***</td><td>0.345</td></tr><tr><td colspan="5"><strong>Father's social class (vs: elementary jobs)</strong></td></tr><tr><td>Farmer</td><td>-0.036</td><td>0.037</td><td>0.156</td><td>0.488</td></tr><tr><td>Craftmen</td><td>-0.079 ***</td><td>0.029</td><td>-0.333</td><td>0.432</td></tr><tr><td>Manager</td><td>-0.006</td><td>0.032</td><td>0.217</td><td>0.360</td></tr><tr><td>Associate prof.</td><td>-0.051 *</td><td>0.028</td><td>-0.232</td><td>0.340</td></tr><tr><td>Office worker</td><td>0.025</td><td>0.030</td><td>0.269</td><td>0.327</td></tr><tr><td>No male head or non response</td><td>-0.050</td><td>0.035</td><td>-0.948 **</td><td>0.402</td></tr></tbody></table>

<table><tbody><tr><td colspan="5"><strong>Mother's education level (vs: primary school or drop out)</strong></td></tr><tr><td>Secondary school 1</td><td>0.065 ***</td><td>0.024</td><td>0.289</td><td>0.250</td></tr><tr><td>Secondary school 2</td><td>0.040</td><td>0.033</td><td>-0.509</td><td>0.400</td></tr><tr><td>University degree</td><td>0.046</td><td>0.042</td><td>-0.047</td><td>0.475</td></tr><tr><td>Other or non response</td><td>-0.018</td><td>0.032</td><td>-0.568</td><td>0.368</td></tr></tbody></table>

<table><tbody><tr><td colspan="5"><strong>Mother's activity (vs: active): Inactive</strong></td></tr><tr><td colspan="5"><strong>Family financial situation (vs: very difficult)</strong></td></tr><tr><td>Very comfortable</td><td>-0.052</td><td>0.041</td><td>-0.602</td><td>0.533</td></tr><tr><td>Comfortable</td><td>0.018</td><td>0.034</td><td>0.418</td><td>0.432</td></tr><tr><td>Difficult</td><td>0.016</td><td>0.033</td><td>0.460</td><td>0.418</td></tr><tr><td>Non response</td><td>-0.084</td><td>0.109</td><td>0.634</td><td>1.257</td></tr></tbody></table>

<table><tbody><tr><td colspan="5"><strong>Parental health status (vs: very good, good, fair)</strong></td></tr><tr><td>Father poor or very poor health</td><td>-0.025</td><td>0.030</td><td>-0.214</td><td>0.355</td></tr><tr><td>Mother poor or very poor health</td><td>0.138 ***</td><td>0.041</td><td>0.563 *</td><td>0.324</td></tr></tbody></table>

<table><tbody><tr><td colspan="5"><strong>Childhood physician density</strong></td></tr><tr><td>Density of GP's</td><td>0.000</td><td>0.001</td><td>0.023</td><td>0.014</td></tr><tr><td>Density of specialists</td><td>-0.001</td><td>0.001</td><td>-0.037 ***</td><td>0.013</td></tr></tbody></table>

<table><tbody><tr><td colspan="5"><strong>Birth region (vs: Parisian region)</strong></td></tr><tr><td>Bassin parisien</td><td>-0.028</td><td>0.067</td><td>-1.419 **</td><td>0.720</td></tr><tr><td>North</td><td>0.000</td><td>0.081</td><td>-1.399</td><td>0.855</td></tr><tr><td>East</td><td>-0.036</td><td>0.062</td><td>-1.564 **</td><td>0.739</td></tr><tr><td>West</td><td>0.054</td><td>0.067</td><td>-1.297 *</td><td>0.723</td></tr><tr><td>South west</td><td>0.078</td><td>0.064</td><td>-1.152 *</td><td>0.697</td></tr><tr><td>East Centre</td><td>0.008</td><td>0.057</td><td>-0.947</td><td>0.668</td></tr><tr><td>Mediterranean</td><td>0.084</td><td>0.063</td><td>0.484</td><td>0.647</td></tr><tr><td>Non Metropolitan France</td><td>-0.041</td><td>0.099</td><td>-1.906 **</td><td>1.076</td></tr></tbody></table>

<table><tbody><tr><td colspan="5"><strong>Parental habit during childhood (vs: See a doctor right away)</strong></td></tr><tr><td>Wait before visiting</td><td>-0.059 **</td><td>0.030</td><td>-0.315</td><td>0.346</td></tr><tr><td>Self-care behavior</td><td>-0.013</td><td>0.027</td><td>-0.315</td><td>0.305</td></tr><tr><td>Use of alternative medicine</td><td>-0.064 **</td><td>0.030</td><td>-0.157</td><td>0.441</td></tr></tbody></table>

<table><tbody><tr><td>Obs.</td><td>1944</td><td></td><td></td><td></td></tr><tr><td>Pseudo R²</td><td>0.1279</td><td></td><td></td><td></td></tr></tbody></table>

Notes: Parental habits correspond to the share of experiences during childhood. Probability of any visit estimated using a logit model; Number of visits estimated using a negative binomial model; Clustered on household membership (1,099 households). Legend: * p<0.1; ** p<0.05; *** p<0.01.
<table><caption>Table A.7: Marginal effects for specialist visits of the individual's child</caption><thead><tr><th rowspan="2">Individual's child variables</th><th colspan="2">Probability of any visit</th><th colspan="2">Number of visits</th></tr><tr><th>M.E.</th><th>S.E.</th><th>M.E.</th><th>S.E.</th></tr></thead><tbody><tr><td>Sex (vs: Men): Women</td><td>0.017</td><td>0.022</td><td>0.068</td><td>0.105</td></tr><tr><td>Age</td><td>-0.007</td><td>0.010</td><td>-0.311 ***</td><td>0.055</td></tr><tr><td>Age-squared</td><td>0.001</td><td>0.001</td><td>0.016 ***</td><td>0.003</td></tr><tr><td>Self-assessed health (vs: Poor, very poor and fair)</td><td></td><td></td><td></td><td></td></tr><tr><td>Very good</td><td>-0.100 **</td><td>0.048</td><td>-0.489 **</td><td>0.216</td></tr><tr><td>Good</td><td>-0.024</td><td>0.046</td><td>-0.087</td><td>0.196</td></tr><tr><td>Functional limitations (vs:No)</td><td></td><td></td><td></td><td></td></tr><tr><td>Yes</td><td>0.164 ***</td><td>0.059</td><td>0.953 ***</td><td>0.241</td></tr><tr><td>Non response</td><td>0.111 *</td><td>0.066</td><td>0.469</td><td>0.323</td></tr><tr><td>Chronic conditions (vs: No)</td><td></td><td></td><td></td><td></td></tr><tr><td>Yes</td><td>0.104 **</td><td>0.041</td><td>0.758 ***</td><td>0.180</td></tr><tr><td>Non response</td><td>-0.022</td><td>0.067</td><td>-0.127</td><td>0.298</td></tr><tr><td>Long term affection (vs: No): Yes</td><td>0.193 **</td><td>0.086</td><td>1.121 ***</td><td>0.312</td></tr><tr><td>Individual variables</td><td></td><td></td><td></td><td></td></tr><tr><td>Sex (vs: Men): Women</td><td>0.043</td><td>0.032</td><td>0.046</td><td>0.165</td></tr><tr><td>Age (vs: more than 50)</td><td></td><td></td><td></td><td></td></tr><tr><td>less than 30</td><td>0.101</td><td>0.083</td><td>0.533</td><td>0.444</td></tr><tr><td>30 - 39</td><td>0.001</td><td>0.068</td><td>0.256</td><td>0.341</td></tr><tr><td>40 - 49</td><td>-0.043</td><td>0.054</td><td>0.153</td><td>0.264</td></tr><tr><td>Self-assessed health (vs: Poor, very poor)</td><td></td><td></td><td></td><td></td></tr><tr><td>Very good</td><td>0.004</td><td>0.092</td><td>0.375</td><td>0.453</td></tr><tr><td>Good</td><td>-0.055</td><td>0.088</td><td>0.206</td><td>0.432</td></tr><tr><td>Fair</td><td>-0.018</td><td>0.082</td><td>0.183</td><td>0.408</td></tr><tr><td>Non response</td><td>0.156</td><td>0.143</td><td>1.109</td><td>0.739</td></tr><tr><td>Functional limitations (vs:No)</td><td></td><td></td><td></td><td></td></tr><tr><td>Heavy</td><td>0.085</td><td>0.073</td><td>0.835 **</td><td>0.419</td></tr><tr><td>Weak</td><td>-0.006</td><td>0.044</td><td>0.337</td><td>0.222</td></tr><tr><td>Non response</td><td>-0.199 **</td><td>0.083</td><td>-1.078 **</td><td>0.500</td></tr><tr><td>Chronic conditions (vs: No)</td><td></td><td></td><td></td><td></td></tr><tr><td>Yes</td><td>-0.050</td><td>0.035</td><td>-0.260</td><td>0.178</td></tr><tr><td>Non response</td><td>0.013</td><td>0.059</td><td>0.003</td><td>0.255</td></tr><tr><td>Long term affection (vs: No): Yes</td><td>0.042</td><td>0.050</td><td>0.139</td><td>0.246</td></tr><tr><td>Educational level (vs: primary school or drop out)</td><td></td><td></td><td></td><td></td></tr><tr><td>Secondary school 1</td><td>-0.060</td><td>0.063</td><td>-0.402</td><td>0.337</td></tr><tr><td>Secondary school 2</td><td>0.019</td><td>0.067</td><td>-0.095</td><td>0.346</td></tr><tr><td>University degree</td><td>0.026</td><td>0.072</td><td>-0.187</td><td>0.376</td></tr><tr><td>Other or non response</td><td>-0.065</td><td>0.201</td><td>-0.631</td><td>1.171</td></tr><tr><td>Social class (vs: elementary jobs)</td><td></td><td></td><td></td><td></td></tr><tr><td>Farmer</td><td>0.007</td><td>0.123</td><td>-0.591</td><td>0.621</td></tr><tr><td>Craftmen</td><td>0.021</td><td>0.061</td><td>0.294</td><td>0.335</td></tr><tr><td>Manager</td><td>0.110 *</td><td>0.058</td><td>0.598 **</td><td>0.301</td></tr><tr><td>Associate prof.</td><td>0.063</td><td>0.046</td><td>0.627 ***</td><td>0.225</td></tr><tr><td>Office worker</td><td>0.082 **</td><td>0.037</td><td>0.502 ***</td><td>0.193</td></tr><tr><td>Inactive</td><td>-0.052</td><td>0.058</td><td>-0.199</td><td>0.329</td></tr><tr><td>Income (vs: 1st quintile)</td><td></td><td></td><td></td><td></td></tr><tr><td>2nd quintile</td><td>0.049</td><td>0.038</td><td>-0.014</td><td>0.191</td></tr><tr><td>3rd quintile</td><td>0.014</td><td>0.042</td><td>0.171</td><td>0.218</td></tr><tr><td>4th quintile</td><td>0.073</td><td>0.050</td><td>0.237</td><td>0.255</td></tr><tr><td>5th quintile</td><td>0.039</td><td>0.058</td><td>0.056</td><td>0.279</td></tr><tr><td>Non response</td><td>-0.059</td><td>0.046</td><td>-0.277</td><td>0.247</td></tr><tr><td>Insurance situation (vs: No complementary health coverage)</td><td></td><td></td><td></td><td></td></tr><tr><td>Private complementary health coverage</td><td>0.272 ***</td><td>0.079</td><td>2.242 ***</td><td>0.376</td></tr><tr><td>Means-tested complementary health coverage</td><td>0.229 ***</td><td>0.081</td><td>2.089 ***</td><td>0.395</td></tr><tr><td>Living in couple</td><td>0.014</td><td>0.036</td><td>0.285 *</td><td>0.171</td></tr><tr><td>Adulthood physician density</td><td></td><td></td><td></td><td></td></tr><tr><td>Dens. of GP's in sector 1</td><td>0.000</td><td>0.002</td><td>0.002</td><td>0.009</td></tr></tbody></table>
<table><tbody><tr><td>Dens. of GP's in sector 2</td><td>-0.002</td><td>0.004</td><td>0.013</td><td>0.021</td></tr><tr><td>Dens. of specialists in sector 1</td><td>0.001</td><td>0.001</td><td>0.005</td><td>0.006</td></tr><tr><td>Dens. of specialists in sector 2</td><td>0.002 *</td><td>0.001</td><td>0.009 **</td><td>0.004</td></tr><tr><td colspan="5"><strong>Adulthood region (vs: Parisian region)</strong></td></tr><tr><td>Bassin parisien</td><td>-0.074</td><td>0.067</td><td>-0.072</td><td>0.351</td></tr><tr><td>North</td><td>-0.043</td><td>0.102</td><td>-0.090</td><td>0.475</td></tr><tr><td>East</td><td>-0.029</td><td>0.084</td><td>0.431</td><td>0.442</td></tr><tr><td>West</td><td>-0.062</td><td>0.071</td><td>-0.037</td><td>0.369</td></tr><tr><td>South west</td><td>0.010</td><td>0.088</td><td>0.138</td><td>0.441</td></tr><tr><td>East Centre</td><td>-0.074</td><td>0.070</td><td>-0.687 *</td><td>0.381</td></tr><tr><td>Mediterranean</td><td>-0.060</td><td>0.101</td><td>-0.007</td><td>0.516</td></tr></tbody></table>

Parental variables

<table><tbody><tr><td colspan="5"><strong>Father's education level (vs: primary school or drop out)</strong></td></tr><tr><td>Secondary school 1</td><td>-0.032</td><td>0.035</td><td>-0.100</td><td>0.175</td></tr><tr><td>Secondary school 2</td><td>0.003</td><td>0.058</td><td>-0.071</td><td>0.276</td></tr><tr><td>University degree</td><td>-0.008</td><td>0.056</td><td>-0.085</td><td>0.309</td></tr><tr><td>Other or non response</td><td>-0.026</td><td>0.042</td><td>-0.068</td><td>0.220</td></tr></tbody></table>

<table><tbody><tr><td colspan="5"><strong>Father's social class (vs: elementary jobs)</strong></td></tr><tr><td>Farmer</td><td>0.018</td><td>0.049</td><td>0.252</td><td>0.267</td></tr><tr><td>Craftmen</td><td>-0.110 **</td><td>0.049</td><td>-0.287</td><td>0.238</td></tr><tr><td>Manager</td><td>-0.022</td><td>0.048</td><td>0.242</td><td>0.272</td></tr><tr><td>Associate prof.</td><td>-0.032</td><td>0.045</td><td>0.149</td><td>0.216</td></tr><tr><td>Office worker</td><td>-0.059</td><td>0.051</td><td>-0.304</td><td>0.243</td></tr><tr><td>No male head or non response</td><td>-0.108 **</td><td>0.048</td><td>-0.633 **</td><td>0.275</td></tr></tbody></table>

<table><tbody><tr><td colspan="5"><strong>Mother's education level (vs: primary school or drop out)</strong></td></tr><tr><td>Secondary school 1</td><td>-0.034</td><td>0.034</td><td>-0.153</td><td>0.172</td></tr><tr><td>Secondary school 2</td><td>0.002</td><td>0.051</td><td>0.077</td><td>0.225</td></tr><tr><td>University degree</td><td>0.018</td><td>0.056</td><td>-0.099</td><td>0.275</td></tr><tr><td>Other or non response</td><td>0.005</td><td>0.043</td><td>-0.166</td><td>0.220</td></tr><tr><td>Mother's activity (vs: active): Inactive</td><td>0.028</td><td>0.032</td><td>-0.035</td><td>0.157</td></tr></tbody></table>

<table><tbody><tr><td colspan="5"><strong>Family financial situation (vs: very difficult)</strong></td></tr><tr><td>Very comfortable</td><td>-0.051</td><td>0.071</td><td>-0.198</td><td>0.374</td></tr><tr><td>Comfortable</td><td>0.016</td><td>0.058</td><td>-0.247</td><td>0.287</td></tr><tr><td>Difficult</td><td>0.059</td><td>0.058</td><td>-0.118</td><td>0.288</td></tr><tr><td>Non response</td><td>0.051</td><td>0.141</td><td>0.171</td><td>0.679</td></tr></tbody></table>

<table><tbody><tr><td colspan="5"><strong>Parental health status (vs: very good, good, fair)</strong></td></tr><tr><td>Father poor or very poor health</td><td>-0.069</td><td>0.050</td><td>-0.626 **</td><td>0.247</td></tr><tr><td>Mother poor or very poor health</td><td>-0.060</td><td>0.049</td><td>-0.593 **</td><td>0.263</td></tr></tbody></table>

<table><tbody><tr><td colspan="5"><strong>Childhood physician density</strong></td></tr><tr><td>Density of GP's</td><td>-0.006 ***</td><td>0.002</td><td>-0.019 *</td><td>0.010</td></tr><tr><td>Density of specialists</td><td>0.004 **</td><td>0.002</td><td>0.013 *</td><td>0.008</td></tr></tbody></table>

<table><tbody><tr><td colspan="5"><strong>Birth region (vs: Parisian region)</strong></td></tr><tr><td>Bassin parisien</td><td>0.061</td><td>0.096</td><td>0.400</td><td>0.466</td></tr><tr><td>North</td><td>0.136</td><td>0.115</td><td>0.455</td><td>0.535</td></tr><tr><td>East</td><td>-0.001</td><td>0.093</td><td>-0.011</td><td>0.479</td></tr><tr><td>West</td><td>0.143</td><td>0.095</td><td>0.694</td><td>0.441</td></tr><tr><td>South west</td><td>0.105</td><td>0.099</td><td>0.547</td><td>0.450</td></tr><tr><td>East Centre</td><td>0.112</td><td>0.088</td><td>0.915 **</td><td>0.454</td></tr><tr><td>Mediterranean</td><td>0.203 **</td><td>0.092</td><td>0.740 *</td><td>0.437</td></tr><tr><td>Non Metropolitan France</td><td>-0.241 *</td><td>0.145</td><td>-0.596</td><td>0.740</td></tr></tbody></table>

<table><tbody><tr><td colspan="5"><strong>Parental habit during childhood (vs: See a doctor right away)</strong></td></tr><tr><td>Wait before visiting</td><td>-0.025</td><td>0.042</td><td>-0.280</td><td>0.221</td></tr><tr><td>Self-care behavior</td><td>-0.069 *</td><td>0.040</td><td>0.059</td><td>0.230</td></tr><tr><td>Use of alternative medicine</td><td>-0.036</td><td>0.049</td><td>-0.420 *</td><td>0.249</td></tr></tbody></table>

<table><tbody><tr><td><strong>Obs.</strong></td><td>1944</td><td></td><td></td><td></td></tr></tbody></table>

<table><tbody><tr><td><strong>Pseudo R<sup>2</sup></strong></td><td>0.0920</td><td></td><td></td><td></td></tr></tbody></table>