Search

BACKGROUND In this paper, we use the Health and Retirement Study (HRS) to examine the relationship between an estimated measure of pulse wave velocity (ePWV) and cognitive impairment with no dementia and dementia, respectively. METHODS We modeled the relationship between ePWV and cognitive status in 2006/2008 using data from 8,492 men and women (mean age 68.6 years) controlling for age, blood pressure, sociodemographic, and socioeconomic characteristics (sex, race and ethnicity, education, income, wealth), health behaviors (smoking and physical activity), body mass index (BMI), health status and related medication use (history of cardiovascular disease, diabetes, and stroke), and cerebrovascular disease (CVD)-related biomarkers (C-reactive protein, cystatin-C, hemoglobin A1c, total cholesterol, high-density lipoprotein [HDL] cholesterol). We assess cognitive function with the 27-item Langa-Weir Telephone Interview for Cognitive Status (TICS) scale. ePWV is derived from an equation based on participant age and resting blood pressure. RESULTS In a model that controlled for the constituent components of ePWV (age, age squared, systolic and diastolic blood pressure), ePWV is associated with increased odds of having cognitive impairment with no dementia (OR = 2.761) and dementia (OR = 6.344) relative to a group with no cognitive impairment or dementia. After controlling for the constituent components of ePWV, sociodemographic and socioeconomic characteristics, health behaviors, BMI, health status and medication use, and CVD-related biomarkers, ePWV remains significantly associated with dementia (OR = 3.969) but not cognitive impairment with no dementia (OR = 1.782). CONCLUSIONS These findings suggest that ePWV may be a novel research tool and biomarker of vascular aging that can be used in large, population-representative studies to examine cognitive aging and dementia risk. [ABSTRACT FROM AUTHOR]

Population health research finds women's mortality risk associated with childlessness, low parity (one child), and high parity (6+ children) in a U-shaped pattern, although U.S. studies are inconsistent overall and by race/ethnicity. Parity, however, is contingent on women's biophysiological likelihood of (in)fecundity as well as voluntary control practices that limit fertility. No studies have empirically examined infecundity differentials among women and their potential contribution to the parity–post-reproductive mortality relationship or the race/ethnic-related mortality gap. We examine 7,322 non-Hispanic Black and White women, born 1920–1941, in the Health and Retirement Study, using zero-inflation methods to estimate infecundity risk and parity by race/ethnicity. We estimate proportional hazards models [t0 1992/1998, t1 2018] to examine associations of infecundity risk, parity, early-life-course health and social statuses, and post-reproductive statuses with all-cause mortality. We find Black women's infecundity probability to be twice that of White women and their expected parity 40% higher. Infecundity risk increases mortality risk for all women, but parity–post-reproductive mortality associations differ by race/ethnicity. White women with one and 5+ children (U-shaped curve) have increased mortality risk, adjusting for infecundity risk and early-life factors; further adjustment for post-reproductive health and social status attenuates all parity-related mortality risk. Black women's parity–post-reproductive mortality associations are not statistically significant. Black women's post-reproductive mortality risk is anchored in earlier-life conditions that elevate infecundity risk. Results suggest a need to focus upstream to better elucidate race/ethnic-related social determinants of reproductive health, infecundity, parity, and mortality. [ABSTRACT FROM AUTHOR]

Variable military service-related experiences, such as combat exposure, psychiatric disorders (PD), and traumatic brain injuries (TBI), may differentially affect the likelihood of having health care professional-identified high blood pressure (i.e., hypertension). PURPOSE: Compare the odds of self-reported hypertension among non-combat and combat veterans with and without PD/TBI to non-veterans and each other. METHODS: We used data from men from the 2011 Behavioral Risk Factor Surveillance System and distinguished: non-veterans (n = 21,076); non-combat veterans with no PD/TBI (n = 3,150); combat veterans with no PD/TBI (n = 1,979); and veterans (combat and non-combat) with PD and/or TBI (n = 805). Multivariable, hierarchical logistic regression models included exogenous demographic, socioeconomic attainment and family structure, health behavior and conditions, and methodological control variables. RESULTS: One-third of men reported having been told at least once by a medical professional that they had high blood pressure. Bivariate analyses indicated that each veteran group had a higher prevalence of self-reported hypertension than non-veterans (design-based F = 45.2, p<0.001). In the fully adjusted model, no statistically significant differences in the odds of self-reported hypertension were observed between non-veterans and: non-combat veterans without PD/TBI (odds ratio [OR] = 0.92); combat veterans without PD/TBI (OR = 0.87); veterans with PD and/or TBI (OR = 1.35). However, veterans with PD and/or TBI had greater odds of reporting hypertension than both combat and non-combat veterans without PD/TBI (p<0.05). DISCUSSION: Military service-related experiences were differentially associated with a survey-based measure of hypertension. Specifically, veterans self-reporting PD and/or TBI had significantly higher odds of self-reporting hypertension (i.e., medical provider-identified high blood pressure). [ABSTRACT FROM AUTHOR]

Background: Carotid-femoral pulse wave velocity (cfPWV), the referent measure of aortic stiffness, is an established measure of vascular aging. In studies where cfPWV cannot be measured, alternative methods are needed to help promote research on vascular aging. This study examines the construct validity of a measure of PWV estimated from age and blood pressure (ePWV). The specific aims of the study are to: 1) explore the strength of association between ePWV, cfPWV, and other established measures of vascular aging; 2) examine the sensitivity and specificity of elevated ePWV (≥10m/s) in relation to elevated cfPWV (≥10m/s). Methods: We measured cfPWV in two-hundred and fifty-two adults (mean age 57±12 years, 48% female) and calculated each participant's ePWV from their age and brachial blood pressure. Additional measures of vascular aging included: carotid intima-media thickness (cIMT); carotid stiffness measured as elastic modulus (cEp); and carotid augmentation index (cAIx). Results: The correlations between cfPWV and measures of vascular aging were: cEp (r = 0.36), cIMT (r = 0.49), and cAIx (r = 0.04). The correlations between ePWV and measures of vascular aging were: cEp (r = 0.45), cIMT (r = 0.60), and cAIx (r = 0.24). The correlation between ePWV and cfPWV was (r = 0.67). The sensitivity and specificity of elevated ePWV (≥ 10 m/s) for concomitantly identifying high cfPWV (≥ 10 m/s) were 85.4% and 73.0% respectively. Conclusion: ePWV is associated with established measures of vascular aging, such as carotid thickness, carotid stiffness and carotid augmentation index. ePWV may be a useful tool to help promote research on vascular aging. [ABSTRACT FROM AUTHOR]

Military suicide prevention efforts would benefit from population-based research documenting patterns in risk factors among service members who die from suicide. We use latent class analysis to analyze patterns in identified risk factors among the population of 2660 active-duty military service members that the Department of Defense Suicide Event Report (DoDSER) system indicates died by suicide between 2008 and 2017. The largest of five empirically derived latent classes was primarily characterized by the dissolution of an intimate relationship in the past year. Relationship dissolution was common in the other four latent classes, but those classes were also characterized by job, administrative, or legal problems, or mental health factors. Distinct demographic and military-status differences were apparent across the latent classes. Results point to the need to increase awareness among mental health service providers and others that suicide among military service members often involves a constellation of potentially interrelated risk factors. [ABSTRACT FROM AUTHOR]

Background and Objectives The gold standard method for the assessment of vascular aging is carotid–femoral pulse wave velocity (cfPWV). cfPWV can be estimated from 2 commonly assessed clinical variables—age and blood pressure. This analysis uses data from the Health and Retirement Study to examine the relationship between estimated pulse wave velocity (ePWV) and mortality among 9,293 middle age and older adults. Research Design and Methods Cox proportional hazard models were used to predict mortality occurring over a 10- to 12-year period. Controls were included for sociodemographic characteristics (age, gender, race, ethnicity, wealth, income, and education), health status (history of cardiovascular disease [CVD], diabetes, and stroke and related medication use), health behaviors (smoking, physical activity, and body mass index), and CVD-related biomarkers (systolic and diastolic blood pressure, C-reactive protein, cystatin c, hemoglobin A1c, total cholesterol, and high-density lipoprotein cholesterol). Results By 2018, 26.19% of the weighted analytic sample were reported as deceased. In the fully specified models that control for age, age-squared, systolic and diastolic blood pressure, sociodemographic variables, health status and behaviors, and biomarkers, ePWV was associated with a greater likelihood of mortality. Discussion and Implications An estimate of PWV derived from age and blood pressure is independently associated with an increased likelihood of death in a representative sample of middle age and older adults in the United States. [ABSTRACT FROM AUTHOR]

Young Men who have Sex with Men (MSM) continue to face disproportionate HIV risk. Despite its well accepted role in HIV prevention, pre-exposure prophylaxis (PrEP) uptake remains below desired goals. Systemic barriers to PrEP access, including insurance complexity, cost, and wait times to start PrEP may contribute to low PrEP engagement. We conducted in-depth interviews and designed a discrete choice experiment (DCE) to assess preferences for and barriers to PrEP access in the United States. Methods: We conducted in-depth interviews with 18 MSM aged 18–30 years old who were not on PrEP and created a DCE based on the results. For the DCE, a convenience sample of young MSM in the United States who reported recent condomless anal sex was recruited through social media applications. Consenting participants provided sociodemographic information and responded to a series of 10 choice tasks about PrEP access. Preferences were analyzed utilizing marginal willingness-to-pay (mWTP) methods. Results: In-depth interviews revealed preferences for highly effective PrEP and concerns about barriers to access due to insurance coverage and privacy. The online DCE was completed by 236 eligible MSM aged 18–30. The most-preferred PrEP package—with all elements significantly preferred over other options—was insurance covered, could be maintained confidential from parents and employers, was available immediately, and had an online option. Need to take out new insurance or add a supplemental insurance in order to cover PrEP significantly detracted from willingness to pay for a PrEP program. Attributes most associated with willingness to pay for PrEP were PrEP being covered by an insurance the client already has and insurance coverage that was private. Conclusions: Young MSM at high risk for HIV in the United States who are not currently on PrEP showed strong preferences for PrEP options that were covered by insurance and could be kept confidential from parents and employers. Lack of these options may present major barriers to PrEP access among young MSM who are at particularly high risk. Rapid access to PrEP, as well as the option of receiving some care online, may also enhance PrEP uptake. [ABSTRACT FROM AUTHOR]

We draw upon the life-course perspective and examine whether Attention Deficit Hyperactivity Disorder (ADHD) moderates the age pattern of adult mortality using data from the 2007 and 2012 National Health Interview Survey Sample Adult File linked to National Death Index data through 2015. Overall, 7.0% of respondents died by 2015. Discrete-time hazard analysis indicates that the log odds of mortality were significantly lower among 18 and 19 year old adults ever diagnosed with ADHD and significantly higher among 46 to 64 year old adults ever diagnosed with ADHD, with a crossover occurring at age 33. Results were similar among men and women. It is not known specifically which risks drive changes in the risk of mortality documented among persons with ADHD during the transition to adulthood, the increased risk of mortality in midlife, or whether some risks operate more or less at particular ages. Additional research can lead to targeted, age- and life-course stage-focused interventions for specific risks and contribute to the reduction of ADHD-related mortality. [ABSTRACT FROM AUTHOR]

Research increasingly considers how collective narratives/experiences of HIV influence understandings of and responses to COVID-19 among men who have sex with men and how these discussions articulate with the larger literature on the social significance of epidemics. Drawing on interviews with 30 men who have sex with men, as well as discussion of epidemics as dramaturgical events, this study aimed to determine how men living in the USA make sense of COVID-19 in the light of their collective knowledge and/or memories of the HIV pandemic. Participants experienced progressive revelations regarding COVID-19's seriousness and constructed frameworks with which to manage the unpredictability of infection. Participants also believed that the initial public response to COVID-19 on the part of the US federal government, health officials and the scientific community, although inadequate, was stronger and more extensive than the response had been to HIV. As communities and the USA negotiated their pandemic responses, participants negotiated their own personal responses with incomplete, uncertain, dynamic and conflicting information. This study provides evidence regarding the social organisation of a contemporary pandemic and how individuals perceive and guard against risk, assign responsibility for virus transmission and acquisition, and navigate the threat of a potentially deadly infection. [ABSTRACT FROM AUTHOR]

Research consistently reports a veteran mortality disadvantage relative to nonveterans, but has not considered the contribution of service-connected disability to this differential. We use data from the 1986 and 1989 National Health Interview Survey-2011 Linked Mortality Files (N = 124,122) to estimate multivariate Cox regression models of the association between veteran status and mortality, taking service-connected disability status into account. Bivariate analyses demonstrate higher mortality risk, lower socioeconomic status, and poorer health and functioning among veterans with a service-connected disability than among nonveterans and veterans without a service-connected disability. Multivariate models confirm a mortality disadvantage for all veteran service-connected disability subgroups, which is reduced by the inclusion of exogenous sociodemographic variables and substantially mediated by the health/functional limitation status measures. Results indicate that service-connected disability status accounts for some variation in, and may have a cumulative effect on, the veteran mortality disadvantage. When possible, future research should account for service-connected disability status when studying veteran–nonveteran mortality differentials. [ABSTRACT FROM AUTHOR]

Objective: To document inter- and intra-cohort changes in adult ADHD and examine whether changes vary by gender. Method: We analyze data from the 2007 and 2012 U.S. National Health Interview Survey. Results: The prevalence of ADHD among adults aged 18 to 64 years increased from 3.41% in 2007 to 4.25% in 2012. As expected, patterns of inter- and intra-cohort change varied by gender. At younger ages, inter-cohort gender differences are more distinct due to a spike in prevalence among boys/men born in or after 1980. Consistent with a gender-specific historical period effect, recent intra-cohort increases among women have narrowed the gender gap. Conclusion: The gender gap in the prevalence of ADHD among adults decreased by 31.1% from 2007 to 2012 due to increased prevalence among adult women of all ages. We discuss these results in relation to diagnostic practice, adult health and well-being, data limitations and needs, and directions for future research. [ABSTRACT FROM AUTHOR]

Objective: Informed by a social determinants of health framework, we investigate the relationship between self-reported ADHD diagnosis status and adult health, and whether observed associations are attenuated by biomedical and socioeconomic factors. Method: Using 2007 National Health Interview Survey data (N = 19,104), we present multivariate logistic regression analyses of associations between self-reported ADHD diagnosis status and five adult health outcomes. Results: ADHD diagnosis was significantly associated with higher odds of injury, physical health conditions, functional limitations, fair/poor health, and psychological distress in fully specified models (adjusted odds ratios [AORs] = 1.62-2.36). Inclusion of controls for exogenous demographic characteristics, psychiatric comorbidities and health behaviors, and adult social and economic statuses attenuated but did not eliminate observed associations between ADHD and poorer adult health. Conclusion: Research on adult health outcomes for those with ADHD should include consideration of the mechanisms by which a diagnosis of ADHD leads to cumulative social disadvantages that independently contribute to poorer health outcomes. [ABSTRACT FROM AUTHOR]

Background: An extensive public health literature associates military service with increased alcohol consumption and problematic drinking. However, few well-controlled population-based studies compare alcohol use among nonveterans and veterans with diverse military service experiences, and no such study examines everyday drinking. Methods: We use population-representative data from the 2010 and 2011 Behavioral Risk Factor Surveillance System and distinguish four groups of men: nonveterans; non-combat veterans without a psychiatric disorder (PD) or traumatic brain injury (TBI); combat veterans without a PD or TBI; and veterans (non-combat and combat combined) with a PD and/or TBI. We estimate hierarchical multivariate logistic regression models of current drinking (N = 21,947) and daily drinking (among current drinkers; N = 11,491). Results from supplemental analyses are discussed. Results: Relative to nonveterans, non-combat veterans with no PD or TBI and veterans with a PD and/or TBI, respectively, but not combat veterans with no PD or TBI, are more likely to be current drinkers. Among current drinkers, non-combat and combat veterans with no PD or TBI, respectively, are less likely than nonveterans to be daily drinkers. Conversely, among current drinkers, veterans with a PD and/or TBI are more likely to be daily drinkers than nonveterans, non-combat veterans with no PD or TBI, and combat veterans with no PD or TBI. Conclusion: We document heterogeneous and countervailing influences of military service experiences on current and daily drinking. Results indicate that harmful military service experience may be associated with an increased risk of current, moderate daily drinking, which may represent a form of self-medication. [ABSTRACT FROM AUTHOR]

Recent studies examine veteran status differences in mortality, but none consider heterogeneity in military-veteran health care coverage. We use data from the 1997-2009 (2011) National Health Interview Survey-Linked Mortality Files (N = 624,610) to estimate Cox regression models of the association between veteran status and mortality taking into account the type of military-veteran health care coverage and sex/gender. Descriptive analyses provide further evidence that veterans who only use Veterans Affairs (VA) health care services are a distinctly disadvantaged subpopulation with substantially increased mortality risk. Results from multivariate analyses confirm a veteran mortality disadvantage, reveal that this disadvantage varies by type of military-veteran health coverage, and demonstrate that the disadvantage is largely but not totally explained by demographic, socioeconomic, and health status differences between groups. Results further indicate that the veteran mortality disadvantage is most pronounced among male veterans who only use VA health care or who have no military-veteran health coverage, respectively, relative to male non-veterans with no military-veteran health care coverage. There is a mortality disadvantage among female veterans who have no military-veteran health care coverage, and a mortality advantage among female non-veterans with military-veteran health care coverage, relative to female non-veterans with no military-veteran health care. Based on these findings, we argue that in order to fully understand veteran status differences in morbidity and mortality, future studies must move beyond the analysis of veteran- and VA-only samples, and should take into account variable connections of subpopulations to the military, resultant differences in types of health care coverage, and sex/gender. [ABSTRACT FROM AUTHOR]

Abstract: The components of sexual orientation, including but not limited to sexual desires, attractions, behaviors, and identities, are generally assumed to align in predictable ways. However, ample research from sociology and other social and behavioral science disciplines shows that for many people, these components do not align as expected. In this article, we focus on individuals who identify as heterosexual and experience same‐sex sexual desires, attractions, and/or behaviors. First, we briefly review the available quantitative data on the prevalence of such experiences and use data from one high‐quality national survey—the National Survey of Family Growth (NSFG)—to show that self‐identified heterosexuals account for as much as one‐half of the same‐sex sexuality that is reported. Then, we turn to recent qualitative literature and draw attention to the contexts within which heterosexually identified men and women experience same‐sex sexuality, how they make sense of these experiences, and the interpretive strategies they use to reconcile their same‐sex sexuality with their heterosexual identities and their gendered presentations of self. Finally, we conclude by discussing the significance of this research and pointing to several paths forward for sociologists and other researchers. [ABSTRACT FROM AUTHOR]

The dominant approach to studying historical race-related fertility differences has been to limit samples to first-married and younger women. We argue that studying historical race-related fertility differences in the context of remarriage is also important: remarriage and fertility patterns are both rooted in the biosocial conditions that produce racial disparities in health. We employ a multiple causes framework that attributes variation in fertility patterns to voluntary limitation and involuntary factors (infecundity/subfecundity). We use data from the 1910 Integrated Public Use Microdata Series and estimate zero-inflated negative binomial models that simultaneously distinguish those who are infecund (vs. fecund) and estimate the number of remarital births among the fecund. Our approach allows us to evaluate historical remarital (in)fertility differences, accounting for marital, socioeconomic, and geographic influences on fecundity and fertility, while empirically accounting for the influence of children "missing" from the household due to mortality and fostering/aging out. Consistent with past studies that emphasized poorer African American health as a major influence on involuntary infertility, we find that African American women were more likely than white women to be in the always-zero (infecund) group and to have fewer remarital births. Supplemental analyses nuance these findings but indicate that these results are robust. Overall, we find support for a multiple-causes perspective: while the findings are consistent with the adoption of deliberate fertility control among urban and higher-status women at higher parities, remarital fertility differences in 1910 also reflected greater infecundity/subfecundity among subgroups of women, especially African American women. [ABSTRACT FROM AUTHOR]

Household crowding, or having more household members than rooms in one's residence, could potentially affect a child's educational attainment directly through a number of mechanisms. We use U.S. longitudinal data from the Panel Study of Income Dynamics to derive new measures of childhood crowding and estimate negative associations between crowding during one's high school years and, respectively, high school graduation by age 19 and maximum education at age 25. These negative relationships persist in multivariate models in which we control for the influence of a variety of factors, including socioeconomic status and housing-cost burden. Given the importance of educational attainment for a range of midlife and later-life outcomes, this study suggests that household crowding during one's high school years is an engine of cumulative inequality over the life course. [ABSTRACT FROM AUTHOR]

The article explores the impact of economic development and health disparities on the fertility decline of whites and African Americans in the U.S. South. Emphasis is given to topics such as the use of demographic transition theory in research, maternal health problems and risks for women during childbearing, and the influence of plantation housing, sanitation and nutrition.

This analysis uses data from the Survey of Income and Program Participation (SIPP) to examine whether veteran and disability statuses are jointly associated with poverty and material hardship among households that include an older adult. Compared to households that do not include a person with a disability or veteran, disabled nonveteran households are more likely to be in poverty and to experience home hardship, medical hardship, and bill-paying hardship. Disabled veteran households are not significantly different in terms of poverty, but exhibit the highest odds of home hardship, medical hardship, bill-paying hardship, and food insufficiency. The implications for social work practice are discussed. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study is to determine the extent to which men’s later-life cognitive trajectories vary by veteran status. Method: We use Health and Retirement Study (HRS) data to estimate growth curve models examining men’s later-life cognitive trajectories by veteran status, war service status, and period of service. Analyses control for early-life characteristics that influence selection into military service and later-life cognition, and mid- to late-life characteristics that potentially mediate the relationship between military service and later-life cognition. Results: Veterans have higher cognition scores relative to nonveterans around retirement age, but their cognition scores decline more rapidly with increasing age, such that cognition scores are similar in both groups among the oldest old. Veterans who served during the Korean War have lower cognition scores around retirement age, but less steep age-related declines, than veterans who served during World War II. Discussion: Findings are discussed in relation to the extant literature, future research, potential service needs, and study limitations. [ABSTRACT FROM AUTHOR]

The expansion of e-government is reshaping how disadvantaged groups access the social safety net, yet very little is known about clients’ experiences with modernized systems. We examine client experiences applying to the Supplemental Nutritional Assistance Program in one state that has recently moved to an “online-only” system. Overall, more than half of the 26 applicants stated a preference for the traditional caseworker model, even though some of them identified benefits to the modernized, online system. Based on respondents’ experiences, we identified four points where the system proved problematic for applicants: (a) Accessing the call centers; (b) completing an eligibility interview; (c) using the paperless system to submit documentation; and (d) obtaining personal assistance to complete the application materials. Findings are relevant for state administrators of social safety net programs, e-government researchers in the public management and public administration fields, and social stratification researchers interested in how institutional processes influence patterns of inequality. [ABSTRACT FROM PUBLISHER]

Copyright of Substance Use & Misuse is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Veterans are a sizable and policy-relevant demographic group in the United States, yet little is known about their economic well-being. Although having a work-limiting disability is known to be associated with material hardship, no known study compares material hardship between veteran households and nonveteran households or investigates whether work-limiting disability moderates the association between veteran status and material hardship. This study uses data from the Survey of Income and Program Participation to examine how household work-limiting disability status moderates the relationship between veteran status and the likelihood of material hardship. Results suggest the following: nondisabled-veteran households report lower or equivalent levels of material hardship than do households with no veteran or disabled member; regardless of whether a veteranis present, households that include a disabled person have higher levels of every type of hardship than other households do; and disabled-veteran households experience statistically significantly more hardship than nondisabled-veteran households do. [ABSTRACT FROM AUTHOR]

We explore racial differences in multigenerational living arrangements in 1910, focusing on trigenerational kin structures. Coresidence across generations represents a public function of the family, and we observe this across different ages or life-course stages through which adults came to be at risk for providing simultaneous household support for multiple generations of kin dependents. Using data from the 1.4 percent 1910 Integrated Public Use Microdata Sample, our comparisons adjust for marital turnover, including widow(er)hood/divorce and remarriage, as rates are known to be historically higher among African Americans in this period. Across subgroups defined by age and sex, we find that African Americans are virtually always as likely as or more likely than European Americans (of both native and foreign parentage) to live as grandparents in trigenerational households. Widow(er)hood/divorce generally increased the likelihood of trigenerational coresidence, while remarriage sometimes increased, sometimes decreased, and sometimes had no association with this living arrangement. Also, we find that the life-course staging of household kin support in 1910 differed across race/generation partly due to different economic and demographic circumstances, suggesting more complexity in kin support than previously considered. We discuss these findings in relation to the histories of African American and European American families as well as their implications for future research. [ABSTRACT FROM AUTHOR]

Despite decades of research, little is known about the contours of material hardship and how the social processes underlying specific domains of hardship are similar and different. We use qualitative interview data to examine five different domains of material hardship: housing, bill-paying, food, medical, and clothing hardships. While mothers use social program participation, reliance on social networks, and individual strategies to mitigate hardships, the dominance of these strategies and their specific applications differ across hardship domains. These results complement recent research that identifies each domain of hardship as unique and suggest that domain-specific hardship mitigation approaches are necessary. [ABSTRACT FROM AUTHOR]

Objectives. This study examines differences in the relationship between veteran status and men's trajectories of health conditions, activities of daily living limitations, and self-rated health. Methods. We use data on 12,631 men drawn from the 1992–2006 waves of the Health and Retirement Study to estimate growth curve models that examine differences in health trajectories between nonveterans and veterans, veterans with and without wartime service, and war service veterans who served during World War II, Korea, Vietnam, and multiple wars. Results. The results indicate that veterans have better health at the mean age of 66.2 years, but experience greater age-related changes in health than nonveterans. Similarly, men who served during wartime have better health at the mean age, but more age-related changes in health than men who did not serve during wartime. Among war veterans, Vietnam veterans are in poorer health at the mean age, but they experience less substantial age-related health changes than men who served during previous wars. Discussion. Although veterans experience better health relative to nonveterans around retirement age, they have poorer health than nonveterans among the oldest old. These findings inform our understanding of the veteran–nonveteran health-mortality paradox found in previous research and suggest a health crossover among veterans and nonveterans in later life. [ABSTRACT FROM PUBLISHER]

We used data from the Fragile Families and Child Wellbeing Study (N = 2,679 ) to examine the impact of men's past military service on the likelihood that a couple will marry within 5 years of a nonmarital birth. Logistic regression analyses showed that men's past military service increased marriage odds by 54% for couples with Black fathers even after controlling for potential mediators. But veteran status had no effect on couples with White or Hispanic fathers. As a result, the large Black-White gap in postbirth marriage evident among couples with civilian fathers did not exist among couples with veteran fathers. Our findings bolster other evidence that military service exerts lasting and unique pro-marriage effects on Blacks. [ABSTRACT FROM AUTHOR]

The authors use data from the 1992 National Health and Social Life Survey to examine the association between incarceration and living arrangements, net of a range of sociodemographic and early life characteristics. Relative to living with a spouse and child(ren), there is evidence that a history of incarceration is strongly associated with several nonnuclear living arrangements, including living alone, as a sole adult with child(ren), with a partner and child(ren), with a partner but no child, and with other family but no spouse, partner, or child. These living arrangements may be indicative of lower levels of social integration, which have potentially serious consequences for these individuals as well as their families and communities. The authors discuss these results with reference to the decades-long, unprecedented mass incarceration that is ongoing in the United States today. [ABSTRACT FROM AUTHOR]

We examine how changes in maternal work hours affect adolescent children's school participation and performance outcomes using data from interviews in 1998 and 2001 with approximately 1700 women who, in May 1995, were welfare-reliant, single mothers of adolescents living in neighborhoods of concentrated poverty in Cuyahoga (Cleveland), Los Angeles, Miami-Dade, and Philadelphia counties. Analyses control for a broad array of mothers' characteristics, including their psychological and physical health, experiences with domestic violence and substance abuse, as well as unobserved time-invariant characteristics. In fixed-effects models, we find unfavorable effects of increased maternal work hours on three of six outcomes: skipping school, performing above average, and parental contact about behavior problems. Adolescent-aged sons seem to be particularly sensitive to changes in mothers' hours of work. [ABSTRACT FROM AUTHOR]

Welfare reformers sought to reduce “dependency,” or reliance on state-supported cash benefits and deployed a discourse of “self-sufficiency” to promote the legitimacy of efforts to remove welfare recipients from publicly funded cash assistance through either wage labor or marriage. We use longitudinal, qualitative interview data collected from 38 initially welfare-reliant women to examine what self-sufficiency means to them and their perspectives on how work and marriage affect their ability to be self-sufficient. Grounded theory analysis revealed that for these women, self-sufficiency means formal independence from both the state (i.e., Temporary Assistance to Needy Families [TANF]) and men (i.e., marriage). Although they value marriage as an institution and would ideally marry, they do not consider marriage to be a likely route to self-sufficiency given the pool of men available to them. Rather, they embrace their own market-based wage labor as the means by which they can attain some measure of independence. Taking our lead from the women in this study, we challenge the emphasis on marriage in current welfare policy. We argue that employment training that results in better jobs for women and men and work supports that make low-wage work pay are clearly the appropriate direction for policy aimed at the welfare-reliant and working poor. [ABSTRACT FROM AUTHOR]

The 1996 Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) encouraged states to reduce welfare caseloads. Caseload reduction can be accomplished by promoting exit for work, marriage, or other private means of support and by diverting new applicants. Most research on caseload decline has focused on welfare-to-work outcomes; less is known about processes of diversion. This study employs administrative records and ethnographic data to examine diversion in West County, New York, from 1999 to 2003. Findings demonstrate a high level of diversion and suggest that application is an ongoing and at times remedial process rather than an event. Diversion occurs at all points of the expanded TANF (Temporary Assistance to Needy Families) intake process and is associated with one-time lump sum payments as well as the hassle factor engendered by new eligibility requirements. The encumbered lives of applicants and TANF staff discretion are also implicated as factors contributing to diversion. We conclude with an analysis of the implications of TANF diversion for access to benefits. [ABSTRACT FROM AUTHOR]

Significant racial disparities in health outcomes have been consistently documented in the United States. Life-course and population-health models are often used to explain these disparities, but they generally do not take incarceration effects into account. Incarceration may have direct effects on health, but it is more likely to indirectly affect health by shaping employment, income, and marital trajectories. The authors contend that the failure of health researchers to take incarceration effects into account is problematic given the large increase in the incarceration of Black men over the past few decades. Moreover, because large numbers of incarcerated Black men are not present in research samples, racial disparities in health outcomes may be underestimated. Incarceration effects should be included in life-course and population-health models, study designs, and policy development processes. [ABSTRACT FROM AUTHOR]

This study uses a life-course framework and data from the Health and Retirement Study and the Study of Assets and Health Dynamics Among the Oldest-Old to examine three hypotheses related to (dis)continuity in the effects of early-life disadvantage (African American race and low paternal education) and military service on later-life mortality. Specifically, the authors consider whether military service (and age at enlistment) mediates or moderates the effects of early-life disadvantage on later-life mortality and whether mid-to late-life marital status, socioeconomic status, health status, and health behaviors mediate the effects of military service on mortality. The authors find very little evidence to support the notion that any mortality benefits accrue to men as a consequence of military service overall or enlistment at any particular age. Most of the evidence is consistent with life-course disruption and continuity of disadvantage interpretations. [ABSTRACT FROM AUTHOR]

We use longitudinal, qualitative interview data collected from 38 initially welfare-reliant women in Cleveland, Ohio to examine the factors driving instability in child-care arrangements when women transitioned from welfare to work. Grounded theory analysis revealed that decisions about care were circumscribed by scarce social and economic resources, women went to extraordinary lengths to patch together arrangements that typically involved multiple providers, relative care was central to patchworks of care, and patchworks of child care were often highly unstable. These complex arrangements and their instability were influenced by mothers’ desires to find the most suitable arrangements for their children within resource and job constraints, dissatisfaction with providers, difficulties accessing subsidies, and changes in provider availability. Findings suggest that policymakers must consider instability in patchworks of multiple child-care providers as they consider alternatives for meeting low-wage working women's and children's needs for safe, affordable, accessible, and enriching nonmaternal child care. [ABSTRACT FROM AUTHOR]

Using data from 8 random assignment studies and employing meta-analytic techniques, this article provides systematic evidence that welfare and work policies targeted at low-income parents have small adverse effects on some school outcomes among adolescents ages 12 to 18 years at follow-up. These adverse effects were observed mostly for school performance outcomes and occurred in programs that required mothers to work or participate in employment-related activities and those that encouraged mothers to work voluntarily. The most pronounced negative effects on school outcomes occurred for the group of adolescents who had a younger sibling, possibly because of the increased home and sibling care responsibilities they assumed as their mothers increased their employment. [ABSTRACT FROM AUTHOR]

Welfare reform and related policy changes have altered the context in which welfare-reliant women make choices about employment and family care. Using data from longitudinal qualitative interviews, we examined women's experiences of work-family tradeoffs and how they think their employment affected their children. Women identified multiple co-occurring costs and benefits of work for themselves and their children. Benefits included.' increased income,' increased self-esteem, feelings of independence, and social integration; and the ability to model work and self-sufficiency values for children. Costs included: working without increased income; overload, exhaustion, and stress; and less time and energy to be with, supervise, and support children. The relevance of these findings for family policy specialists and practitioners who work with low-income families is discussed. [ABSTRACT FROM AUTHOR]

Four years into the implementation of the 1996 federal welfare reform legislation, promising to "change welfare as we know it," a critical question remains unanswered: How are formerly welfare-reliant families faring as they make the transition to work? Drawing on longitudinal, ethnographic data collected under the auspices of Manpower Demonstration Research Corporation's Project on Devolution and Urban Change, we examine changes in women's employment and income, and their families' well-being. This paper provides insights into how stable employment accompanied by increases in family income may improve family well-being. However, few families in the sample had income increases that were significant enough to change their material circumstances substantially. This paper also shows that not all families benefited from the move to employment-those who had unstable, low wage jobs without much gain in income experienced fewer benefits than those who had stable employment. Sometimes families relying on low- wage, unstable jobs were worse off than they were on welfare. The effects of such employment on single parents, and their increased absence from the household, often contributed to greater disruption in family routines, causing children to be worse off. [ABSTRACT FROM AUTHOR]

Objectives. This study examined the influence of sociodemographic, clinical, and attitudinal variables on the use of alternative therapists by people in care for HIV. Methods. Bivariate and multivariate analyses of baseline data from the nationally representative HIV Cost and Services Utilization Study were conducted. Results. Overall, 15.4% had used an alternative therapist, and among users, 53.9% had fewer than 5 visits in the past 6 months. Use was higher for people who were gay/lesbian, had incomes above $40000, lived in the Northeast and West, were depressed, and wanted more information about and more decisionmaking involvement in their care. Among users, number of visits was associated with age, education, sexual orientation, insurance status, and CD4 count. Conclusions. Among people receiving medical care for HIV, use of complementary care provided by alternative therapists is associated with several sociodemographic, clinical, and attitudinal variables. Evaluation of the coordination of provider-based alternative and standard medical care is needed. (Am J Public Health. 2003;93:980-987) [ABSTRACT FROM AUTHOR]

In this article the authors examine how the pursuit of self-sufficiency in the context of welfare reform may unintentionally encourage some women to develop alternative dangerous dependencies on abusive or potentially abusive men. In this article, the authors argue that women may become increasingly dependent in a variety of ways on men who are currently or were formerly abusive to them as they struggle to meet the mandates of welfare reform while facing time limits. Using data from the Cleveland, Ohio, site of the ethnographic component of the Manpower Demonstration Research Corp. Project on Devolution and Urban Change, the authors describe a hierarchy of dangerous dependencies that some women with histories of domestic violence experienced as welfare reform unfolded in their lives. Specifically, they document how some women ended up relying on men who have been abusive to them, either for instrumental assistance or for more direct financial assistance. They also document how some extremely disadvantaged and vulnerable women became enmeshed in even more dangerous dependencies, as they fell through public and private safety nets into drug addiction and sex work, often losing their children to the state or to their formerly abusive partners in the process.

Presents a study which provided a social demographic account of remarriage in the U.S. using the data from the 1910 Public Use Microdata Series. Theoretical framework of the study; Components of remarriage processes; Operationalization and hypotheses; Results; Estimation of family functions and remarriage; Discussion.

Objective: To distinguish the effects of drug abuse, mental disorders, and problem drinking on antiretroviral therapy (ART) and highly active ART (HAART) use.Design: Prospective population-based probability sample of 2,267 (representing 213,308) HIV-infected persons in care in the United States in early 1996.Measurements: Self-reported ART from first (January 1997-July 1997) to second (August 1997-January 1998) follow-up interviews. Drug abuse/dependence, severity of abuse, alcohol use, and probable mental disorders assessed in the first follow-up interview. Adjusted odds ratios (AORs) and 95% confidence intervals (CIs) estimated from weighted models for 1) receipt of any ART, and 2) receipt of HAART among those on ART.Results: Of our study population, ART was reported by 90% and HAART by 61%. Over one third had a probable mental disorder and nearly half had abused any drugs, but drug dependence (9%) or severe abuse (10%) was infrequent. Any ART was less likely for persons with dysthymia (AOR, 0.74; CI, 0.58 to 0.95) but only before adjustment for drug abuse. After full adjustment with mental health and drug abuse variables, any ART was less likely for drug dependence (AOR, 0.58; CI, 0.34 to 0.97), severe drug abuse (AOR, 0.52; CI, 0.32 to 0.87), and HIV risk from injection drug use (AOR, 0.55; CI, 0.39 to 0.79). Among drug users on ART, only mental health treatment was associated with HAART (AOR, 1.57; CI, 1.11 to 2.08).Conclusions: Drug abuse-related factors were greater barriers to ART use in this national sample than mental disorders but once on ART, these factors were unrelated to type of therapy. [ABSTRACT FROM AUTHOR]

Examines the sociohistorical and demographic perspectives on U.S. remarriage in 1910. Changes in the pool of person eligible to remarry; Decreases in marriage resulting from declines in mortality and probability of widowhood; Ways that remarriage influences family life and shapes the life course of persons within families.