Search

The 2014 Native Hawaiian and Pacific Islander National Health Interview Survey (NHPI NHIS) is the first federal survey designed exclusively to measure the health of the noninstitutionalized civilian NHPI population of the United States.

Introduction This study identifies associations between sleep outcomes and sexual orientation net of sociodemographic and health-related characteristics, and produces estimates generalizable to the US adult population. Participants/methods We used 2013-2015 National Health Interview Survey data (46,909 men; 56,080 women) to examine sleep duration and quality among straight, gay/lesbian, and bisexual US adults. Sleep duration was measured as meeting National Sleep Foundation age-specific recommendations for hours of sleep per day. Sleep quality was measured by 4 indicators: having trouble falling asleep, having trouble staying asleep, taking medication to help fall/stay asleep (all ≥4 times in the past week), and having woken up not feeling well rested (≥4 days in the past week). Results In the adjusted models, there were no differences by sexual orientation in the likelihood of meeting National Sleep Foundation recommendations for sleep duration. For sleep quality, gay men were more likely to have trouble falling asleep, to use medication to help fall/stay asleep, and to wake up not feeling well rested relative to both straight and bisexual men. Gay/lesbian women were more likely to have trouble staying asleep and to use medication to help fall/stay asleep relative to straight women. Finally, bisexual women were more likely to have trouble falling and staying asleep relative to straight women. Conclusions Sexual minority women and gay men report poorer sleep quality compared with their straight counterparts.

Married people show better health and lower mortality risk than the unmarried (Waite & Gallagher, 2000), but the benefits depend on the quality of the relationship, with poor quality relationships no better and perhaps worse than no relationship (Umberson, Williams, Powers, Liu, & Needham, 2006; Williams, 2003). Marital quality is important across the life span but seems to be particularly important in later life as health tends to decline and the effects of adversity accumulate (Carstensen, 1992; Henry, Berg, Smith, & Florsheim, 2007; Umberson et al., 2006). Marital adversity has been found to accelerate the decline in physical and mental health with age and to increase the risk of dying (Birditt & Antonucci, 2008; Coyne et al., 2001; Hibbard & Pope, 1993; Waite, Luo, & Lewin, 2009). At the same time, poor health can act as a stressor in the marriage, leading to declines in marital quality (Booth & Johnson, 1994; Wickrama, Lorenz, Conger, & Elder, 1997). Most of the research examining the link between physical health and marital quality has investigated how negative interactions in marriage lead to declines in physical health (Choi & Marks, 2008; Kiecolt-Glaser & Newton, 2001; Uchino, Cacioppo, & Kiecolt-Glaser, 1996), with larger effects at older ages (Umberson et al., 2006). Conversely, high-quality marriages can help individuals to cope with stressors and thereby maintain good physical health (Ditzen, Hoppmann, & Klumb, 2008; Warner & Kelley-Moore, 2012). However, the causal mechanisms connecting martial quality and physical health operate in both directions. Indeed, among adults age less than 55, decrements in health have been associated with deterioration in marital happiness (Booth & Johnson, 1994; Wickrama et al., 1997). Furthermore, although decrements in one’s own health have been linked to modest decrements in marital quality, decrements in one’s partner’s health have been linked to quite substantial declines in marital quality (Yorgason, Booth, & Johnson, 2008). This process may be particularly important in later life, when chronic illness becomes common (Yang, 2008). The pathways linking poor health with marital quality in later life have been little examined at the population level, despite the importance of martial quality to individuals and society. In this study, we examine one set of hypothesized pathways. We argue that reduced engagement in sex with one’s spouse, an enriching marital role, is associated with worse marital relationship quality among those whose own health is poor and those whose spouse has physical health problems. Also, marital relationship quality is worse among those with the psychological distress that often accompanies poor physical health in either spouse (Blazer, 2009; Bruce, 2000; Hagedoorn et al., 2001). We develop a conceptual model that links physical health, couple sexual activity, psychological well-being, and marital quality. In our model, ongoing sexual activity mediates the association between physical health and marital quality, as does psychological well-being. We conceptualize sexuality activity and psychological well-being as mediators because especially at older ages the biggest challenges to health come from chronic conditions, which develop slowly over years. In contrast, poor mental health as reflected, for example, in depression, may alter relatively quickly in response to the current situation (Hughes & Waite, 2009; Luo, Hawkley, Waite, & Caccioppo, 2012) as can sexual behavior (Carpenter, Nathanson, & Kim, 2009). Note that although we use the term marital quality for convenience, our analysis includes cohabitors as well. We test a series of hypotheses based on this model using data on both members of older adults in marital and cohabitational dyads from the second wave of the nationally representative National Social Life, Health and Aging Study. Couple Sexual Activity As a Mediator of the Physical Health–Marital Quality Association Poor physical health may be associated with marital quality indirectly through spousal engagement in marital roles. Poor physical health of one or one’s partner may affect the roles partners take in a relationship and the interaction between them in these roles. Hence, in this framework, poor physical health affects marital happiness through poor role performance and less positive (or more negative) interactions. Sexual Behavior Health problems have been linked to problems carrying out social and family roles (Northouse, Mood, Templin, Mellon, & George, 2000). In particular, the health problems of one or one’s partner can interfere with either partner’s desire for or ability to engage in sexual relations (DeLamater & Moorman, 2007; Karraker, DeLamater, & Schwartz, 2011; Laumann, Das, & Waite, 2008). It is important to note that the physical health problems of men may be especially important regarding sexual relations (Lindau et al., 2007). Physical health has been shown to affect satisfaction with sex in a middle-aged population (Carpenter et al., 2009). The link between health problems and sexual activity may help explain the observed association between increased age and decreased engagement in partnered sexual activity (Call, Sprecher, & Schwartz, 1995; Donnelly, 1993), which has been associated with low marital satisfaction (Call et al., 1995; DeLamater & Moorman, 2007; Donnelly, 1993). We hypothesize that marital quality is lower among those with less engagement in partnered sex. Physical Health, Psychological Health, and Marital Quality The impact of poor physical health on psychological distress has been well documented among individuals and in relationships. At the individual level, poor physical health, as indicated by morbidity and frailty, increases the risk for poor psychological health (Blazer, 2009; Bruce, 2000; Ormel, Rijsdijk, Sullivan, van Sonderen, & Kempen, 2002). At the relationship level, one’s partner’s poor physical health, and his or her associated poor psychological health, predicts poor psychological health in the physically healthy partner (Hagedoorn et al., 2001). According to the stress generation model, individuals experiencing psychological distress cause stressful interactions with spouses, which leads to poor marital quality (Davila, Bradbury, Cohan, & Tochluk, 1997; Hammen, 1991). Thus, in this framework, poor physical health leads to stress, which increases the risk of poor psychological health, which in turn increases chances of negative interactions and ultimately poor marital quality. Evidence for this theory has been found among older adults at both the individual and relationship levels. Psychological distress has been shown to mediate the association between one’s own and one’s spouse’s poor health and low marital happiness (Yorgason et al., 2008). Psychologically distressed people have also been shown to have more negative spousal interactions (Kramer, 1993; Rehman, Gollan, & Mortimer, 2008). Though the association between psychological ill health and marital distress is found across the life span (Gierveld, van Groenou, Hoogendoorn, & Smit, 2009; Hawkins & Booth, 2005; Horwitz, White, & Howell-White, 1996; Ross, 1995), it seems to be stronger in older adults (Whisman, 2007). Thus, we hypothesize that psychological health—one’s own and one’s partner’s—mediates the association between physical health—one’s own and one’s partner’s—and marital quality. Dimensions of marital quality. Marital quality consists of both positive and negative dimensions, which are distinct constructs, not merely opposite poles of a single dimension (Fincham, Beach, & Kemp-Fincham, 1997; Fincham & Linfield, 1997). Most research to date has focused mainly on the positive dimension, and on the physical and psychological health correlates of sexual engagement (Carpenter et al., 2009) or, separately, of marital quality. For this reason, we know little about how physical health, psychological well-being, and the sexual engagement of the couple operate together to predict both positive and negative marital quality in a population sample. Conceptual Framework Our conceptual model of the associations among physical health, partnered sexual behavior, psychological health, and marital quality is shown in Figure 1. In this model, poor physical health—either one’s own or one’s partner’s—is linked to lower levels of both one’s own and one’s partner’s psychological health and greater likelihood of low levels of partnered sex. In turn, infrequent partnered sex and poor psychological health are both associated with poor marital quality. Note that this model reflects one set of hypothesized relationships. We discuss alternative models later in the article. We test the following hypotheses: Figure 1. Conceptual model of the associations among physical health, sexual activity, psychological health, and marital quality. 1. We hypothesize frequency of sex with one’s spouse mediates the association between physical health—one’s own and one’s partner’s—and marital quality. 2. We hypothesize that psychological health—one’s own and one’s partner’s—mediates the association between physical health—one’s own and one’s partner’s—and marital quality.

Objectives. To assess the extent to which lesbian, gay, and bisexual (LGB) adults aged 18 to 64 years experience barriers to health care. Methods. We used 2013 National Health Interview Survey data on 521 gay or lesbian (291 men, 230 women), 215 bisexual (66 men, 149 women), and 25 149 straight (11 525 men, 13 624 women) adults. Five barrier-to-care outcomes were assessed (delayed or did not receive care because of cost, did not receive specific services because of cost, delayed care for noncost reasons, trouble finding a provider, and no usual source of care). Results. Relative to straight adults, gay or lesbian and bisexual adults had higher odds of delaying or not receiving care because of cost. Bisexual adults had higher odds of delaying care for noncost reasons, and gay men had higher odds than straight men of reporting trouble finding a provider. By contrast, gay or lesbian women had lower odds of delaying care for noncost reasons than straight women. Bisexual women had higher odds than gay or lesbian women of reporting 3 of the 5 barriers investigated. Conclusions. Members of sexual minority groups, especially bisexual women, are more likely to encounter barriers to care than their straight counterparts.

Little is known about the non-genitally-focused sexual behavior of those experiencing sexual difficulties. The objective of this study was to review the theory supporting a link between sexual touching and difficulties with sexual arousal and orgasm, and to examine associations between these constructs among older adults in the United States. The data were from the 2005–2006 National Social Life Health and Aging Project, which surveyed 3,005 community-dwelling men and women ages 57–85 years. The 1,352 participants who had had sex in the past year reported on their frequency of sexual touching and whether there had been a period of several months or more in the past year when they were unable to climax, had trouble getting or maintaining an erection (men) or had trouble lubricating (women). Women also reported how of ten they felt sexually aroused during partner sex in the last 12 months. The odds of being unable to climax were greater by 2.4 times (95% CI 1.2–4.8) among men and 2.8 times (95% CI 1.4–5.5) among women who sometimes, rarely or never engaged in sexual touching, compared to those who always engaged in sexual touching, controlling for demographic factors and physical health. These results were attenuated but persisted after controlling for emotional relationship satisfaction and psychological factors. Similar results were obtained for erectile difficulties among men and subjective arousal difficulties among women, but not lubrication difficulties among women. Infrequent sexual touching is associated with arousal and orgasm difficulties among older adults in the United States.

INTRODUCTION Research is needed on chronic health conditions among lesbian, gay, and bisexual populations. The objective of this study was to examine 10 diagnosed chronic conditions, and multiple (≥2) chronic conditions (MCC), by sexual orientation among US adults. METHODS The 2013 National Health Interview Survey was used to generate age-adjusted prevalence rates and adjusted odds ratios of diagnosed chronic conditions and MCC for civilian, noninstitutionalized US adults who identified as gay/lesbian, straight, or bisexual, and separately for men and women. Chronic conditions were selected for this study on the basis of previous research. RESULTS Hypertension and arthritis were the most prevalent conditions for all groups. Gay/lesbian adults had a 4.7 percentage-point higher prevalence of cancer than bisexual adults, and a 5.6 percentage-point higher prevalence of arthritis and a 2.9 percentage point higher prevalence of hepatitis than straight adults. The prevalence of chronic obstructive pulmonary disease was 8.1 percentage points higher among bisexual adults than among gay/lesbian adults and 7.0 percentage points higher than among straight adults. These differences remained in the multivariate analyses. Additional differences were found in the sex-stratified analyses. No significant differences were found in MCC by sexual orientation. CONCLUSION After age adjustment and controlling for sociodemographic characteristics, only a few significant health disparities for diagnosed chronic conditions were found by sexual orientation, and none for MCC. However, for conditions where differences were found, magnitudes were relatively large. Further examination of these differences among gay/lesbian and bisexual adults could yield a better understanding of why these disparities exist.

To provide national estimates for indicators of health-related behaviors, health status, health care service utilization, and health care access by sexual orientation using data from the 2013 National Health Interview Survey (NHIS).NHIS is an annual multipurpose health survey conducted continuously throughout the year. Analyses were based on data collected in 2013 from 34,557 adults aged 18 and over. Sampling weights were used to produce national estimates that are representative of the civilian noninstitutionalized U.S. adult population. Differences in health-related behaviors, health status, health care service utilization, and health care access by sexual orientation were examined for adults aged 18-64, and separately for men and women.Based on the 2013 NHIS data, 96.6% of adults identified as straight, 1.6% identified as gay or lesbian, and 0.7% identified as bisexual. The remaining 1.1% of adults identified as ''something else,'' stated ''I don't know the answer,'' or refused to provide an answer. Significant differences were found in health-related behaviors, health status, health care service utilization, and health care access among U.S. adults aged 18-64 who identified as straight, gay or lesbian, or bisexual.NHIS sexual orientation data can be used to track progress toward meeting the Healthy People 2020 goals and objectives related to the health of lesbian, gay, and bisexual persons. In addition, the data can be used to examine a wide range of health disparities among adults identifying as straight, gay or lesbian, or bisexual.

If youth development initiatives are going to focus on outcomes that we know are important in settings that we know can change these outcomes, the first outcomes should be educational, and the first setting should be school. School reform presents the most feasible, defensible, and informed opportunity for public policy to improve the life chances of children and youth in disadvantaged communities. This chapter introduces First Things First (FTF), a school reform framework grounded in research about how young people develop and how schools promote students' engagement and learning. The chapter explores four critical features of FTF that focus on students: (1) continuity of care; (2) increased instructional time; (3) high, clear, and fair standards; and (4) enriched opportunities for students. The critical features of FTF are implemented through three strategies: small learning communities, a family advocate system, and instructional improvement.

The National Social Life, Health, and Aging Project (NSHAP) was designed to test the overarching hypothesis that individuals with strong, functioning sexual and intimate relationships will have better trajectories of health and well-being than those whose relationships function less well or who lack such relationships. Wave I of NSHAP, fielded in 2005–06, contained detailed measures of sexuality in addition to measures of health and functioning. Continued measurement of sexuality and intimacy, including additions and enhancements to the Wave I measures, was central to Wave 2. We define sexuality broadly as the dynamic outcome of physical capacity, motivation, attitudes, opportunity for partnership, and sexual conduct (Bullivant et al., 2004; Lindau, Laumann, Levinson, & Waite, 2003). This definition encompasses all sexual orientations. Intimacy describes a quality or condition of a dyadic relationship involving close personal familiarity and feelings of warmth, closeness, and common or shared fate. Sexual activity and functioning are determined by the interaction of each partner’s sexual capacity, motivation, conduct, and attitudes and are further shaped by the quality and condition of the dyadic relationship itself. We also view individual sexual expression as an essential component of both physical and mental health. Physical health and disease directly affect a person’s capacity for sexual expression. In turn, we hypothesize that sexual activity, broadly defined, may ameliorate loss of function that can occur with age and the progression of disease (Galinsky & Waite, 2014). Likewise, loss of sexuality is the hallmark of some mental states, such as depression, and in turn satisfying sexual relationships can buffer the effects of everyday stressors. Some components of sexuality and sexual expression may be more important than others in each of these mechanisms. The first wave of NSHAP provided evidence that sexual interest persists into later adulthood among a substantial percentage of both men and women (Waite, Laumann, Das, & Schumm, 2009). Nonetheless, more than a quarter of older men and between two fifths and one half of older women report that they lacked interest in sex for several months or more in the past year (Waite et al., 2009). However, many of the Wave 1 sexuality measures, including those on lack of interest in sex, were only asked of those with a current (or recent) partner. In Wave 2, all sexuality questions except those that directly referred to a sexual or romantic partner were asked of all respondents, substantially expanding the population for which we can assess sexuality. This article will focus on measures of sexuality and physical contact that are new in NSHAP Wave 2. In “Sexuality: Measures of Partnerships, Practices, Attitudes, and Problems in the National Social Life, Health, and Aging Study” Waite and coworkers (2009) discuss Wave 1 measures of sexuality, many of which were repeated in Wave 2. Here, we first present the theory and rationale motivating the decision to add the new items and to reconceptualize some of the original ones, then describe the measures, and finally present distributions across gender and age groups.

Oxytocin (OT) and vasopressin (AVP) are two closely related peptides with well-known physiological functions, including contractile and antidiuretic properties. They play a key role in regulating blood pressure and in facilitating the allostatic response to external stressors (Gimpl & Fahrenholz, 2001; Szczepanska-Sadowska, 2008). Importantly, for the National Social Life and Aging Project (NSHAP), both of these hormones, but in particular OT, have also been shown to play an important role in mediating and modulating social behaviors such as pair-bonding, attachment, sexuality, and care-taking (Reyes & Mateo, 2008; Wismer Fries, Ziegler, Kurian, Jacoris, & Pollak, 2005). The social role of OT and AVP in humans has been examined primarily in small convenience samples due to the special challenges associated with protein hormone measurement. There is no single ideal experimental protocol for discerning the relationships between these neuropeptides, physiology, and behavior among the everyday lives of people living in their homes. Here, we present a method for gathering data from a large representative population of community-dwelling older adults living in the United States. For reasons detailed below, this is a conservative method, risking failing to detect associations between social peptides, health, and social life. Thus, if analysts do detect such relationships, their work will call for further study in more controlled laboratory settings designed to reveal underlying mechanisms. Studies of central action of these social peptides, including brain binding and production, require highly invasive measurements of cerebrospinal fluid or post-mortem brain analysis. Animal models are optimal. Novel radiolabeled ligands in positron emission tomography could be developed. In these approaches, the neuroendocrinology is sophisticated and focus on where the peptides are having their immediate effects, but the behavior and physiology is far removed from the natural variation of everyday life and the human subjects who participate are not representative of the larger population. Measuring peripheral levels of OT and AVP affords better behavioral measurement, yet does not directly measure at the site of action. OT and AVP are released from the posterior pituitary into the blood stream, from where they diffuse in saliva or pool in urine. There is evidence, albeit currently debated, that peripheral release is coordinated with central release of OT and that peripheral measures correlate to endocrine expression in the brain, although this is not necessarily the case for AVP (Carter et al., 2007; Wotjak et al., 1998). Moreover, peripheral measures pose their own challenges. Neuropeptides are delicate hormones with a short half-life. Blood draws provide both the most acute and most invasive peripheral measurement, and the sample must be immediately treated with an anticoagulant, centrifuged cold, and frozen for storage, impractical in our large survey with field interviewers who are not medical personnel. Saliva is perhaps the least invasive measurement, but quantities of OT are very low, provide the most challenging results, and great care must be taken to immediately freeze the sample to protect the peptides. Although saliva reflects OT released across several minutes, it correlates closely to OT measured in plasma (Hoffman, Brownley, Hamer, & Bulik, 2012). Urine provides a biological sample that integrates neuropeptide concentrations pooled across a longer time-span of at least 1hr, the time frame of our home interview. Urine is less invasive than blood draws thus lowering the barrier to participation and has less challenging handling requirements since the pH environment of the urine helps to stabilize the protein (Anestis, 2010). Urinary OT and AVP have been successfully used to measure effects of social interactions on peptide secretion in laboratory settings (Moses & Steciak, 1986; Polito, Goldstein, Sanchez, Cool, & Morris, 2006; Seltzer & Ziegler, 2007; Seltzer, Ziegler, & Pollak, 2010). Urine specimens are therefore a useful noninvasive method of gathering biomeasures during a field study of psychosocial measures and health, especially large-scale population surveys in the home. However, the short half-life, challenging storage requirements, including immediate and sustained low temperatures pose special challenges for handling in the field. A method to measure OT and AVP in large populations in the field is needed to test and advance the understanding of the social and health properties of these peptides. Levels of any urinary hormone must be standardized based on creatinine levels to control for variation in urine concentration. Creatinine is secreted at a steady rate from creatine degradation in muscle tissue, and its levels directly reflect urine concentration (Barr et al., 2004; Cuthbertson, 1944). In addition to altered kidney function, the thirst response decreases as individuals age, leading to reduced fluid consumption and greater risk of dehydration among older adults. For example, dehydration is a leading cause of hospitalization for individuals older than 65 years (Lavizzo-Mourey, 1987; Sheehy, Perry, & Cromwell, 1999). We describe here a field method for collecting urine pooled during highly standardized home interviews of older adults and measuring urinary OT, AVP, and creatinine. In addition to standardizing urine concentration, we show that creatinine, a marker of mild dehydration in this home dwelling population, can be used to solve issues of assay interference. Finally, we determined the effects of two freeze-thaw cycles on the assayed levels of these peptides.