Search

Objectives: We estimate associations between unemployment trajectories from ages 27-49 and physical and mental health at age 50. Methods: Data are from the U.S. National Longitudinal Survey of Youth, 1979 ( N=6434). Group-based trajectory models are used to identify unemployment trajectories. Generalized linear models with a modified Bolck, Croon, and Hagenaars (BCH) correction are used to regress health on unemployment trajectory groups. Results: We identified “Consistently Low (70%),” “Decreasing Mid-Career (18%),” and “Persistently High (12%)” unemployment trajectories. Experiencing Decreasing Mid-Career or Persistently High trajectories was associated with worse physical and mental health at age 50 than Consistently Low trajectories. Experiencing a Persistently High trajectory was associated with worse physical and mental health than a Decreasing Mid-Career trajectory. Discussion: Timing and likelihood of unemployment are associated with midlife health. Mid-Career unemployment is associated with worse physical and mental health at age 50, but not to the same degree as Persistently High unemployment.

Introduction: Heart transplantation is the definitive treatment for end-stage heart failure. Left ventricular assist devices (LVADs) are a continually improving technology that extends life for some candidates on the heart transplant waiting list. Research Questions: Our objective is to compare Black-White differences in LVAD implantation and heart transplant outcomes during a period of technological innovation when the pulsatile flow LVAD was largely replaced by the continuous flow LVAD between 1999-2014. Design: We used transplant registry data from the United Network for Organ Sharing (N = 5,550) to identify Black and White patients with heart failure who used an LVAD as a bridge-to-transplant (BTT). Using logistic regression, we compared Black-White differences in access to newer LVAD technology and timing of implantation relative to wait listing for heart transplantation. We used competing-risks event history models to predict transplant outcomes across race, LVAD type, and timing of LVAD implantation. Results: Black and White candidates were equally likely to receive newer continuous flow LVADs, but Black candidates received LVADs later in the disease course (i.e. after transplant listing). This later timing of technological intervention contributed to poorer wait list outcomes among black transplant candidates, including lower likelihood of receiving a heart transplant and greater likelihood of being removed from the wait list due to worsening health. Discussion: Delayed LVAD implantation is more common among Black patients and is associated with poorer transplant outcomes.

Chronic pain is associated with reduced work participation, but longitudinal data on the work impact of chronic pain are limited. We used data from the National Longitudinal Survey of Youth-1997 cohort to analyze how pain interference in early adulthood was associated with subsequent exit from the labor force in a longitudinal survey. Pain interference at age 29 and employment status were self-reported at subsequent biennial interviews. Exit from the labor force, return to employment, and development of new health-related work limitations after age 29 were analyzed using survival analysis methods. Among 5819 respondents, 10% and 3% endorsed "a little" or "a lot" of pain interference at age 29, respectively. During follow-up (median of 26 months until censoring or labor force exit), 43% of respondents had exited the labor force at least once and 10% developed a new work-related health limitation. The highest pain interference group (compared with no pain interference) had higher hazard of labor force exit (hazard ratio: 1.26; 95% confidence interval: 1.01-1.57; P = 0.044) and of developing new health-related work limitations (hazard ratio: 2.45; 95% confidence interval: 1.64-3.67; P0.001), with similar results for the group experiencing "a little" pain interference at age 29. In this nationally representative cohort, any level of pain interference reported at age 29 was found to predict increased hazards of subsequent labor force exit and health-related work limitation. Early identification and treatment of pain problems among young workers can help reduce burdens of future unemployment and disability.

ObjectiveObesity is associated with chronic pain, but the contribution of body mass index (BMI) trajectories over the life course to the onset of pain problems remains unclear. We retrospectively analyzed how BMI trajectories during the transition to adulthood were associated with a measure of pain interference obtained at age 29 in a longitudinal birth cohort study.MethodsData from the National Longitudinal Survey of Youth, 1997 Cohort (follow-up from 1997 to 2015), were used to determine BMI trajectories from age 14 to 29 via group trajectory modeling. At age 29, respondents described whether pain interfered with their work inside and outside the home over the past four weeks (not at all, a little, or a lot). Multivariable ordinal logistic regression was used to evaluate pain interference according to BMI trajectory and study covariates.ResultsAmong 7,875 respondents, 11% reported “a little” and 4% reported “a lot” of pain interference at age 29. Four BMI trajectory groups were identified, varying in starting BMI and rate of weight gain. The “obese” group (8% of respondents) had a starting BMI of 30 kg/m2 and gained an average of 0.7 kg/m2/y. On multivariable analysis, this group was the most likely to have greater pain interference, compared with “high normal weight” (odds ratio [OR] = 1.47, 95% confidence interval [CI] = 1.14–1.88), “low normal weight” (OR = 1.45, 95% CI = 1.13–1.87), and “overweight” trajectories (OR = 1.33, 95% CI = 1.02–1.73).ConclusionsObesity and rapid weight gain during the transition to adulthood were associated with higher risk of pain interference among young adults.

Using time-varying, prospectively measured income in a nationally representative sample of Baby-Boomer men (the National Longitudinal Survey of Youth – 1979 [NLSY79]), we identify eight group-based trajectories of income between ages 25–49 and use multinomial treatment models to describe the associations between group-based income trajectories and mental and physical health at midlife. We find remarkable rigidity in income trajectories: less than 25% of our sample experiences significant upward or downward mobility between the ages of 25 to 49 and most who move remain or move into poverty. Men’s physical and mental health at age fifty is strongly associated with their income trajectories, and some upwardly mobile men achieve the same physical and mental health as the highest earning men after adjusting for selection. The worse physical and mental health of men on other income trajectories is largely attributable to their early life disadvantages, health behaviors, and cumulative work experiences.

Purpose: Living kidney donation is safe and effective, but patients in need of a transplant continue to outnumber donors. Disincentives to living donation include lost income, risk of job loss, perioperative complications, and unreimbursed medical expenses. Methods: This study uses US registry and follow-up data on living kidney donors from 2013 to 2015 to identify social predictors of return to work across gender following living kidney donation. Results: Using logistic regression, we find that predictors of return to work following living kidney donation differ for women and men. Among women, age, education, smoking status, and procedure type are associated with return to work. Among men, education, procedure type, and hospital readmission within 6 weeks postdonation are associated with return to work. Notably, single and divorced men are less likely to return to work compared to married men (odds ratio [OR] for single men 0.51, 95% confidence interval [CI], 0.37-0.69, P < .001; OR for divorced men 0.51, 95% CI, 0.34-0.75, P = .006). Marital status is not associated with return to work for women. Single and divorced men’s greater odds of not returning to work are robust to controls for relevant pre- and postdonation characteristics. Conclusions: Single and divorced men’s lack of social support may present an obstacle to work resumption following living kidney donation.

We used over 20 years of data to estimate differences in mothers’ wealth across marital biography, following a marital first birth. Our study is the first to account for the selection of mothers into divorce or remarriage when estimating the role that marital history plays in wealth accumulation. Mothers who remained stably married to the biological father of their firstborn child reported greater wealth in their forties than mothers who divorced and did not remarry. Those who married at younger ages, women of color, and women from lower-income families were less likely to remain stably married. Net of selection, mothers who remained remarried had the same wealth as continuously married mothers. Thus the characteristics that predispose mothers to divorce, and not divorce per se, are linked to lower wealth. Once these selection effects were accounted for, we concluded that divorce was not necessarily detrimental to mothers’ economic security, a new finding that contradicts past studies.

Despite numerous changes in women’s employment in the latter half of the twentieth century, women’s employment continues to be uneven and stalled. Drawing from data on women’s weekly work hours in the National Longitudinal Survey of Youth (NLSY79), we identify significant inequality in women’s labor force experiences across adulthood. We find two pathways of stable full-time work for women, three pathways of part-time employment, and a pathway of unpaid labor. A majority of women follow one of the two full-time work pathways, while fewer than 10 % follow a pathway of unpaid labor. Our findings provide evidence of the lasting influence of work–family conflict and early socioeconomic advantages and disadvantages on women’s work pathways. Indeed, race, poverty, educational attainment, and early family characteristics significantly shaped women’s work careers. Work–family opportunities and constraints also were related to women’s work hours, as were a woman’s gendered beliefs and expectations. We conclude that women’s employment pathways are a product of both their resources and changing social environment as well as individual agency. Significantly, we point to social stratification, gender ideologies, and work–family constraints, all working in concert, as key explanations for how women are “tracked” onto work pathways from an early age.

Despite evidence that first-birth timing influences women’s health, the role of marital status in shaping this association has received scant attention. Using multivariate propensity score matching, we analyze data from the National Longitudinal Survey of Youth 1979 to estimate the effect of having a first birth in adolescence (prior to age 20), young adulthood (ages 20–24), or later ages (ages 25–35) on women’s midlife self-assessed health. Findings suggest that adolescent childbearing is associated with worse midlife health compared to later births for black women but not for white women. Yet, we find no evidence of health advantages of delaying first births from adolescence to young adulthood for either group. Births in young adulthood are linked to worse health than later births among both black and white women. Our results also indicate that marriage following a nonmarital adolescent or young adult first birth is associated with modestly worse self-assessed health compared to remaining unmarried.

We use the National Longitudinal Survey of Adolescent to Adult Health to examine union and parenthood differences across same and opposite-sex couples in systolic and diastolic blood pressure (SBP and DBP), C-reactive protein (CRP), and abdominal adiposity (waist circumference) among partnered (dating, cohabiting, married) young adults ages 25-33. Relative to women dating men, women cohabiting with women reported lower DBP and were less likely to have high CRP. Mothers reported lower SBP and DBP than non-mothers, but were more likely to have high waist circumference if they lived with a biological or step-child. Among men, nonresidential fathers reported higher DBP than nonfathers, and married men were more likely to have high waist circumference than men dating an opposite-sex partner. Same-sex cohabitation was neither a risk factor nor a health resource for men. Although the sample sizes for same-sex couples are quite small compared with those for opposite-sex couples, this study provides initial insight that occupying a sexual minority status while partnered is associated with some health benefits and few or no health risks relative to those who are dating an opposite sex partner.

We use more than 20 years of data from the National Longitudinal Survey of Youth 1979 to examine wealth trajectories among mothers following a nonmarital first birth. We compare wealth according to union type and union stability, and we distinguish partners by biological parentage of the firstborn child. Net of controls for education, race/ethnicity, and family background, single mothers who enter into stable marriages with either a biological father or stepfather experience significant wealth advantages over time (more than $2,500 per year) relative to those who marry and divorce, cohabit, or remain unpartnered. Sensitivity analyses adjusting for unequal selection into marriage support these findings and demonstrate that race (but not ethnicity) and age at first birth structure mothers’ access to later marriage. We conclude that not all single mothers have equal access to marriage; however, marriage, union stability, and paternity have distinct roles for wealth accumulation following a nonmarital birth.

Social bonds, social integration, and primary group relations are central constructs in sociological theory and have been prime considerations within sociological analyses. This chapter begins with a description of prominent conceptualizations of social support. It discusses current knowledge of this topic, paying particular attention to the challenges of assessing both the mechanisms underlying the association between social support and mental health and the causal direction of this association. The chapter considers how the relationship between social support and well-being is importantly influenced by one's social location. The perception of being loved and wanted, valued and esteemed, and able to count on others must be a function of one's history of supportive and unsupportive experiences, with both early life and recent experiences representing major influences. Social support tends to matter for psychological distress and depression independent of stress level. However, it tends to matter more where stress exposure is relatively high.

The transition to adulthood in the US has become increasingly diverse over the last fifty years, leaving young adults without a normative pathway to adulthood. Using Waves I and III of The National Longitudinal Study of Adolescent Health (N=7,803), I draw from a cumulative advantages/ disadvantages (CAD) perspective to examine the relationships between union formation, parenthood, college attendance, full-time employment, home-leaving, and changes in health-promoting behaviors between adolescence and young adulthood. I find that men and women who marry, cohabit, or attend college during the transition from adolescence to young adulthood report fewer losses in healthy behaviors over time. When the sample is divided into mutually exclusive “pathways to adulthood”, two higher-risk groups emerge for both men and women: single parents and those transitioning into fulltime work without attending college or forming families. These groups experience greater losses in healthy behaviors over time even after adjusting for family of origin characteristics and may be at long-term risk for persistently low engagement in health-promoting behaviors.

Using American Community Survey data from 2001, 2005, and 2010, this paper assesses the relationships between employment, race, and poverty for households headed by single women across different economic periods. While poverty rates rose dramatically among single-mother families between 2001 and 2010, surprisingly many racial disparities in poverty narrowed by the end of the decade. This was due to a greater increase in poverty among whites, although gaps between whites and Blacks, whites and Hispanics, and whites and American Indians remained quite large in 2010. All employment statuses were at higher risk of poverty in 2010 than 2001 and the risk increased most sharply for those employed part-time, the unemployed, and those not in the labor force. Given the concurrent increase in part-time employment and unemployment between 2000 and 2010, findings paint a bleak picture of the toll the last decade has had on the well being of single-mother families.

Healthy behaviors including adequate exercise and sleep, eating breakfast, maintaining a healthy weight, and not smoking or binge drinking inhibit chronic disease. However, little is known about how these behaviors change across life course stages, or the social factors that shape healthy behaviors over time. I use multilevel growth models and waves I-III of the National Longitudinal Study of Adolescent Health (N=10,775) to evaluate relationships between adolescents’ psychosocial resources, social support, and family of origin characteristics during adolescence and healthy behavior trajectories through young adulthood (ages 13-24). I find that healthy behaviors decline dramatically during the transition to young adulthood. Social support resources, such as school connectedness and support from parents, as well as living with non-smoking parents, are associated with higher levels of healthy behaviors across adolescence and adulthood. Social support from friends is associated with lower engagement in these behaviors, as is living in a single parent family or with a smoking parent during adolescence. Findings indicate that psychosocial, social support, and family of origin resources during adolescence exert a persistent, though generally not cumulative, influence on healthy behavior trajectories through young adulthood.

We use data from the Fragile Families and Child Wellbeing Study (N = 3,572) to examine relationships between maternal depression and mothers' time investments with their 5-year-old children in outings, trips to playgrounds or parks, time spent reading with the child, and time spent playing indoors with the child. We also examine whether mothers' self-assessments of neighborhoods are associated with time investments in children. Findings indicate that persistent maternal depression is associated with fewer time investments in all four activities with 5-year-old children. Mothers' fear of children playing outdoors and self-assessments of neighborhood collective efficacy are associated with indoor and outdoor activities with children, but do not mediate the relationships between maternal depression and maternal time investments. In sum, maternal depression and neighborhood context play significant but largely independent roles in regulating mothers' time spent in primary child-care activities.

As nonmarital childbearing becomes a dominant pathway to family formation, understanding its long-term consequences for children’s well-being is increasingly important. Analysis of linked mother-child data from the 1979 National Longitudinal Survey of Youth indicates a negative association of having been born to a never-married mother with adolescent self-assessed health but not with depressive symptoms. We also consider the role of mothers’ subsequent union histories in shaping the adolescent health outcomes of youth born to unmarried mothers. With two exceptions, unmarried mothers’ subsequent unions appear to have little consequence for the health of their offspring during adolescence. Adolescents whose mothers subsequently married and remained with their biological fathers reported better health, yet adolescents whose mothers continuously cohabited with their biological fathers without subsequent marriage reported worse adolescent mental health compared with adolescents whose mothers remained continually unpartnered.

We contribute to research on the relationships between gender, work, and health by using longitudinal, theoretically driven models of mothers’ diverse work pathways and adjusting for unequal selection into these pathways. Using the National Longitudinal Study of Youth-1979 ( N = 2,540), we find full-time, continuous employment following a first birth is associated with significantly better health at age 40 than part-time work, paid work interrupted by unemployment, and unpaid work in the home. Part-time workers with little unemployment report significantly better health at age 40 than mothers experiencing persistent unemployment. These relationships remain after accounting for the unequal selection of more advantaged mothers into full-time, continuous employment, suggesting full-time workers benefit from cumulating advantages across the life course and reiterating the need to disentangle health benefits associated with work from those associated with pre-pregnancy characteristics.