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Objective: Our study assesses how women and men's health indicators are shaped by their spouse's retirement. Background: The retirement process can reshape the health of a retiree, but these effects can also extend onto the health of spouses. Although past research has largely focused on how men's retirement might negatively shape their wife's health outcomes, it is possible that wives' retirement has detrimental effects on their husband's health as well. Method: Using data from the Health and Retirement Study (HRS), we employ a fuzzy regression discontinuity design to identify the causal effects of spousal retirement on indicators of physical and mental health in married older adults. Results: Our results suggested that men, not women, experience the most negative spousal spillover effects of retirement on their health outcomes. We found the most support for spillover effects on spouses' physical health outcomes. Additionally, men who are not working when their spouse retires experienced the most negative health effects. Conclusion: Women and men's health is differentially affected by spousal retirement, where men might be the most negatively affected by their spouses' transition in the US context. These results contradict conventional wisdom that undergirds numerous untested assumptions underlying prior research on this significant life transition. [ABSTRACT FROM AUTHOR]

The Positivity Resonance Theory of coexperienced positive affect describes moments of interpersonal connection characterized by shared positive affect, caring nonverbal synchrony, and biological synchrony. The construct validity of positivity resonance and its longitudinal associations with health have not been tested. The current longitudinal study examined whether positivity resonance in conflict interactions between 154 married couples predicts health trajectories over 13 years and longevity over 30 years. We used couples' continuous ratings of affect during the interactions to capture coexperienced positive affect and continuous physiological responses to capture biological synchrony between spouses. Video recordings were behaviorally coded for coexpressed positive affect, synchronous nonverbal affiliation cues (SNAC), and behavioral indicators of positivity resonance (BIPR). To evaluate construct validity, we conducted a confirmatory factor analysis to test a latent factor of positivity resonance encompassing coexperienced positive affect, coexpressed positive affect, physiological linkage of interbeat heart intervals, SNAC, and BIPR. The model showed excellent fit. To evaluate associations with health and longevity, we used dyadic latent growth curve modeling and Cox proportional hazards modeling, respectively, and found that greater latent positivity resonance predicted less steep declines in health and increased longevity. Associations were robust when accounting for initial health symptoms, sociodemographic characteristics, health-related behaviors, and individually experienced positive affect. We repeated health and longevity analyses, replacing latent positivity resonance with BIPR, and found consistent results. Findings validate positivity resonance as a multimodal construct, support the utility of the BIPR measure, and provide initial evidence for the characterization of positivity resonance as a positive health behavior. [ABSTRACT FROM AUTHOR]

This study focuses on two main questions. First, do non-cohabiting relationships have an effect on mental and physical health? And second, do non-cohabiting relationships affect health in a similar way as cohabitation and marriage? To differentiate between the selection effects of healthier individuals into a couple relationship and the causal effects of couple relationships on health, we test hypotheses about the accumulation of health effects over time. We apply fixed-effects estimation techniques to data from the German Socio-economic Panel. For women, mental health improves after establishing a non-cohabiting relationship and remains similar after starting cohabitation and after getting married. For men, only marriage improves mental health status. The impacts of couple relationships on physical health primarily depend on the duration of the relationship and slowly accumulate over time. In addition, effects are stronger for younger adults. [ABSTRACT FROM AUTHOR]

Sexual concurrency, or having temporally overlapping sexual partnerships, has important consequences for relationship quality and individual health, as well as the health and well-being of others embedded in larger sexual networks. Although married and cohabiting couples have similar, almost universal expectations of sexual exclusivity, the former report significantly lower rates of engaging in sexual concurrency than the latter. Given that this difference in behavior occurs despite similar expectations of sexual fidelity, sexual exclusivity can provide an important test of whether marriage has a causal effect on relationship behavior. Using data from the National Longitudinal Study of Adolescent to Adult Health, I estimate an instrumental variable model testing whether observed differences in sexual concurrency between marital and cohabiting relationships are attributable to marriage itself via a recent implementation of the special regressor method, an estimator for binary choice models with endogenous regressors. I find evidence that, relative to cohabitation, marriage reduces the likelihood that an individual will engage in concurrent sexual relationships. Finding an effect of marriage in a recent cohort of young adults suggests that, despite changes in marriage and cohabitation, marriage still influences individual behavior. [ABSTRACT FROM AUTHOR]

Background: Little is known about the impact of activities of daily living (ADL) disability on personal and spouse depression symptoms among Chinese.Methods: We used data from the baseline and 2013 follow-up surveys of the China Health and Retirement Longitudinal Study, a nationally representative survey in 17,708 adults aged 45 years and older, to evaluate cross-sectional and prospective association between ADL disability and depression symptoms of subjects and their spouses. The derived basic ADL scale (BADL) and the Center for Epidemiologic Studies Depression Scale short form were utilized to assess ADL disability and depressive symptoms, respectively. Logistic regression was used to calculate odds ratio (OR) and 95% confidence interval (CI), adjusting for depression risk factors and taking into account the complex survey design and response rate.Results: There were 15,890 subjects included in the study. Prevalence of baseline depression symptoms was 29.5% (95%CI 27.9-31.1%), 58.0% (95%CI 54.5-61.4%) and 73.6% (95%CI 70.4-76.8%) in subjects with BADL scores of 0, 1 and ≥2, respectively, and 27.0% (95%CI 25.3-28.7%), 34.2% (95%CI 30.0-38.4%) and 43.8% (95%CI 39.1-48.5%) in subjects without ADL disability while having spouses with BADL scores of 0, 1 and ≥2, respectively. Prospectively, BADL score ≥2 was associated with higher risk of depression symptoms of subjects (OR 1.63, 95% CI 1.03-2.57) and their spouses (OR 1.50, 95% CI 1.01-2.22).Limitations: Bias might be introduced because of observational study design, and findings may not be generalizable to younger population.Conclusions: ADL disability might have potential to increase risk of depression symptoms of middle-aged and older Chinese adults and their spouses. [ABSTRACT FROM AUTHOR]

This study investigates the marriage protection and selection effects among middle-aged and elderly Japanese. Using 9 years of a longitudinal data set from a nationally representative survey in Japan from 2005 to 2013, we extract 15,242 respondents aged 50-59 years in the baseline year. We utilize positive self-rated health to present subjective health status and lifestyle diseases to present objective health status. Using dynamic panel data approach to control for endogeneity issue, we find that being married does protect respondents’ subjective health, in terms of a higher probability of self-ratings of “very good” or “good” health statuses. Nonetheless, we find that marriage deteriorated their objective health in terms of a higher probability of having lifestyle diseases. Regarding the selection effect, better subjective health is found to select middle-aged and elderly Japanese into marriage, but such influence is fairly modest. Although objective health status also selects respondents into marriage, it positively affects women but adversely affects men. The findings provide a more comprehensive understanding of the relationship between marriage and health, which may have substantial implications for health-related public policies for middle-aged and elderly people in Japan. [ABSTRACT FROM AUTHOR]

Background: Huntington’s disease is a progressive, incurable neurodegenerative disorder and it is not possible to delay onset or progression of the disease. Consequently, the disease leads to functional decline and loss of independency and finally to institutionalization. Objective: The aim of this study is to identify factors which are associated with nursing home admission in patients with Huntington’s disease. Methods: The Unified Huntington’s Disease Rating Scale (UHDRS) and the UHDRS-For Advanced Patients (UHDRS-FAP) were administered in 28 nursing home residents and 12 patients receiving day-care. Comparisons between the two groups were performed using Mann-Whitney U tests and Chi-square tests. The significantly different findings were fitted in individual univariate logistic regression models to determine which components were most predictive of institutionalization. Results: Day-care participants were more often married than nursing home residents (p = 0.006) and were functionally more independent: the Functional Assessment Scale (p = 0.022) of the UHDRS was significantly higher. Not being married was more predictive for nursing home admission than functional capacity in the regression models. Conclusions: Our results suggest that being married is protective for nursing home placement. Possibly, a caregiver living with a patient can assist with activities of daily living which the patient could not have done independently, resulting in being able to live at home longer. Providing support to unmarried patients, who do not have a caregiver living with them, by home care services specialized in Huntington’s disease might increase the chance of the best possible care before institutionalization and postpone nursing home admission. [ABSTRACT FROM AUTHOR]

Marriage promotion initiatives presume substantial health benefits of marriage. Current literature, however, has provided inconsistent results on whether these benefits would be shared by people unlikely to marry. We investigate whether the physical and mental health benefits of marriage depend on the likelihood of marriage. Whereas prior studies have compared health benefits of marriage across a single predictor of marriage chances, we define the likelihood of marriage as a composite of demographic, economic, and health characteristics. Using the National Longitudinal Survey of Youth 1979, we find that married adults are only modestly healthier than unmarried adults in both physical and mental dimensions. People with a higher likelihood of marriage generally do not reap greater health benefits from marriage than their counterparts. The only exception is that continuous marriage is more strongly associated with improved mental health among men who are more likely to be married. [ABSTRACT FROM AUTHOR]

This study used data from three waves of the National Longitudinal Study of Adolescent to Adult Health and fixed effects regression to consider whether associations between change in union status and change in body mass index (BMI) were moderated by race‐ethnicity. The results indicated that intimate unions were differentially associated with gains in BMI along racial‐ethnic lines, especially for women. When compared with White women, marriage was associated with larger increases in BMI for Black, Hispanic, and Multiracial women, and cohabitation was associated with larger increases for Black and Hispanic women. In contrast, marriage and cohabitation were associated with less weight gain for Asian when compared with White women. Among men, racial‐ethnic differences in the relationship between union status and BMI were similarly patterned but less pronounced. The results suggest that marital status further exacerbates racial‐ethnic disparities in BMI from adolescence to young adulthood. [ABSTRACT FROM AUTHOR]

Objective: To examine daily patterns of exercise among older husbands and wives, as well as how conjoint exercise was related to daily marital functioning outcomes. Background: Healthy lifestyle practices are becoming more common as people prepare to live healthily into their later years. Exercise may provide unique relationship benefits for individuals and couples. Method: The sample of 191 older couples was drawn from the broader Life and Family Legacies Study, and the present study included data from across 14 days. Multivariate multilevel models were estimated in SAS using the Proc Mixed procedure to examine associations between exercise and daily positive marital events, daily negative marital events, and satisfaction with daily marital interactions. Results: Individual exercise on a given day was associated with more positive marital events and higher daily marital satisfaction; patterns in these results were more consistent for wives than for husbands. Conjoint exercise on a given day was also associated with nearly all marital outcomes for both husbands and wives. Conclusion: Exercise may provide unique relationship benefits for individuals and couples. Results indicated that relationships benefit from both individual and especially conjoint couple exercise. Implications: Couples who exercise conjointly may experience more positive marital interactions. [ABSTRACT FROM AUTHOR]

Background: This cross-sectional study examined the actor and partner effects of beliefs about AIDS-related death on quality of life in Chinese married couples in which both were living with HIV.Methods: A total of 49 married couples in central China who were both infected with HIV completed measures to assess their beliefs about AIDS-related death and quality of life.Results: In the actor-partner interdependence model, the husband-wife dyad showed congruence in their beliefs about AIDS-related death (r = .40) and quality of life-mental health summary (r = .31), respectively, within the couple. Both actor and partner effects of beliefs about AIDS-related death on the quality of life-mental health summary, rather than the quality of life-physical health summary, were significant within the husband-wife dyad.Conclusions: Our findings indicate the dyadic interdependence of beliefs about AIDS-related death and the quality of life-mental health summary in married couples. Psychosocial interventions that target a reduction of negative death beliefs and enhancement of well-being in the context of HIV should treat the couple as a unit. [ABSTRACT FROM AUTHOR]

Married people tend to be healthier than both the previously (bereaved, divorced, and separated) and never married, but the mechanisms through which this occurs remain unclear. To this end, research has increasingly focused on how psychological stress experienced by unmarried versus married individuals may differentially impact physiological systems related to health. One key system that is modulated by stress is the hypothalamic-pituitary-adrenal (HPA) axis, of which cortisol is a key hormonal product. Increased cortisol production and disruption of cortisol’s daily rhythm have been linked to poorer health outcomes. This study examined the association between current marital status and these two indices of cortisol in a community sample of 572 healthy men and women aged 21–55. It also tested whether marriage buffers against the effect of stress (perceived stress by marital status interaction) on cortisol production. Participants provided salivary cortisol samples during waking hours on three nonconsecutive separate days to calculate diurnal cortisol levels and slopes. Married individuals had lower cortisol levels than either their never married or previously married counterparts. Differences in cortisol levels were due at least in part to currently married individuals having a more rapid decline in cortisol through the afternoon hours compared to individuals who were never married (but not those who were previously married). Furthermore, there was an interaction between perceived stress and marital status in predicting cortisol levels. Specifically, higher stress was associated with higher cortisol levels for previously married individuals but not for the married or never married. The results of this study support cortisol as one candidate mechanism accounting for the association of marital status and health. [ABSTRACT FROM AUTHOR]

Marital health advantages and the increase of interracial marriage (intermarriage) are well documented, but few studies investigate the health of intermarried people. We address this issue using aggregated data from the 2000–2013 Current Population Survey (CPS) and find that people with racial/ethnic minority spouses report lower self-rated health than those married to whites. Spousal race significantly moderated the association between respondent’s race and self-rated health such that minorities in same-race marriages had lower odds of reporting better health than those intermarried to whites. However, we found no differences in self-rated health among minorities intermarried to other minorities. There was also limited evidence that gender and socioeconomic status (SES) moderated the interaction between respondent’s race and spousal race. Our findings highlight the effects of marriage on the self-rated health of respondents and their spouse as well as the importance of examining differences in couple’s racial composition when investigating racial disparities in spousal health. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to create a Japanese version of the eight-item version of modified medical outcomes study social support survey (mMOS-SS), investigate psychometric property, and determine the standard values for Japanese citizens by using a nationally representative sample from the general population.Methods: A stratified two-stage sampling was conducted with 4000 Japanese men and women who were in the age group of 25-74 as of January 01, 2014. From February to March 2014, placement method was conducted using self-administered questionnaire. Consequently, 2067 questionnaires were gathered (a collection rate of 51.7%). Thus, the target of analysis was 952 males and 1100 females.Results: The results of factor analysis showed that each of the samples exhibited two types of factors, i.e., emotional and instrumental, just as was the case with the original version. The Cronbach's alpha ranged from 0.90 to 0.95 for each of the samples for both total score and the subscales. On comparing the groups by married versus unmarried and living alone versus not living alone, those not living alone and married people had significantly higher scores (p < 0.05) for each group except for married females less than 50 years. There was a significant positive correlation among mental health, life satisfaction, and self-rated health.Conclusion: This study revealed that the eight-item Japanese version of the mMOS-SS had the same psychometric properties as those found in the research results of the English version. [ABSTRACT FROM AUTHOR]

Objectives: This study focuses on East Asian countries and investigates the difference in the marriage premium on the health-marriage protection effect (MPE) between younger and older generations and the intra-couple education concordance effect (ECE) on the health of married individuals. This study used inter-country comparative data from China, Japan, and Korea. Methods: This study focused on individuals (n = 7,938) in China, Japan, and Korea who were sampled from the 2010 East Asian Social Survey. To investigate MPE and ECE, four health indicators were utilized: a physical and mental components summary (PCS and MCS), self-rated health status (Dself), and happiness level (Dhappy). Ordinary least squares regression was conducted by country- and gender-specific subsamples. Results: We found that the MPE on PCS, MCS, and Dself was more significant for the older generation than for the younger generation in both China and Japan, whereas the results were inconclusive in Korea. With regard to the ECE on happiness (Dhappy), for both men and women, couples tend to be happier when both the husband and the wife are well educated (“higher balanced marriage”) compared to couples with a lower level of educational achievement (“lower balanced marriage”). Significant benefits from a “higher balanced marriage” on MCS and Dself were observed for women only. In contrast, no statistically significant differences in health status were observed between “higher balanced marriage” couples and couples with different levels of educational achievements (“upward marriage” or “downward marriage”). Conclusions: This study found that (1) the MPE was more significant for the older generation, and (2) the health gap, particularly the happiness gap, between higher- and lower-balanced married couples was significant. The inter-country comparative findings are useful to explain how the role of marriage (and therefore of family) on health has been diluted due to the progress of industrialization and modernization. [ABSTRACT FROM AUTHOR]

Marriage is a social tie associated with health advantages for adults and their children, as lower rates of preterm birth and low birth weight are observed among married women. In this study the author tested 2 competing hypotheses explaining this marriage advantage-marriage protection versus marriage selection--using a sample of recent births to single, cohabiting, and married women from the National Survey of Family Growth, 2006-2010. Propensity score matching and fixed effects regression results demonstrated support for marriage selection, as a rich set of early life selection factors account for all of the cohabiting-married disparity and part of the single-married disparity. Subsequent analyses demonstrated that prenatal smoking mediates the adjusted single-married disparity in birth weight, lending some support for the marriage protection perspective. The study's findings sharpen our understanding of why and how marriage matters for child well-being and provide insight into pre-conception and prenatal factors describing intergenerational transmissions of inequality via birth weight. [ABSTRACT FROM AUTHOR]

Background: Concurrent sexual partnerships play a key role in sustaining the HIV epidemic in Zimbabwe. Married couples are at an increased risk of contracting HIV from sexual networks produced by concurrent sexual partnerships. Addressing these partnerships is an international HIV prevention priority. Methods: Our qualitative study presents the socioeconomic factors that contribute to the occurrence of concurrent sexual partnerships among married people in Zimbabwe. We conducted 36 in-depth interviews and four focus group discussions with married men and women in Zimbabwe in 2008 to understand the organizations of concurrent sexual partnerships. Data were analyzed using framework analysis. Results: Our study indicates that relationship dissatisfaction played a key role in the engagement of concurrent sexual partnerships. Depending on the source of the dissatisfaction, there were four possible types of concurrent sexual relationships that were formed: sex worker, casual partner, regular girlfriend or informal polygyny which was referred to as "small house". These relationships had different levels of intimacy, which had a bearing on practicing safer sex. Participants described three characteristics of hegemonic masculinity that contributed to the sources of dissatisfaction leading to concurrent sexual activity. Similarly, various aspects of emphasized femininity were described as creating opportunities for the occurrence of concurrent sexual relationships. Economic status was also listed as a factor that contributed to the occurrence of concurrent sexual partnerships. Conclusion: Marital dissatisfaction was indicated as a contributing factor to the occurrence of concurrent sexual relationships. There were several reports of satisfying marital relationships in which affairs did not occur. Lessons from these marriages can be made part of future HIV prevention interventions targeted at preventing concurrent sexual partnerships by married couples. [ABSTRACT FROM AUTHOR]

The aims of this investigation are to determine whether loneliness is associated with a person's own sleep quality and sleep quality of their partner, and to test stress as a potential mediator. Participants were 255 couples in married (75%) or cohabiting relationships who completed self-report measures of loneliness, sleep quality, stress, and depression. Results of Actor–Partner Interdependence analyses replicated findings in the literature showing an association between loneliness and poor sleep quality. The more lonely a male participant was, the lower his partner's sleep quality. In addition, the more lonely participants were, the higher they rated their partner's sleep disturbance. There were significant indirect effects of loneliness on poor sleep quality through increased stress, even after controlling for depression. [ABSTRACT FROM AUTHOR]

Objectives Married people live longer and are healthier than unmarried people. This can be explained in terms of marriage protection and marriage selection. The aim of the present study was to examine the direct effect of marriage selection on health status. Methods Data were collected from the archives of the Lower Silesian Medical Center (DOLMED) in Wrocław, Poland. The sample consisted of 2,265 adult (never married or currently married) men. Subjects were assigned to categories for selected variables, including age, level of education, military category upon conscription, height, hearing acuity, and visual acuity. Military category, objective data gathered upon military conscription at age 18, was used to assess initial health status. To identify any relationships between marital status and health status, generalized linear models with binomially distributed dependent variable were used. Results The never-married subjects were more likely to have been assigned to lower military categories, which indicates that their health status at age 18 was inferior to those conscripts who would later marry. Hearing acuity and visual acuity were generally worse in never-married subjects than in married subjects. Never-married subjects were also more likely to be short and less likely to be tall. Conclusions The results provide evidence for direct health-related marriage selection in men between 25 and 60 years of age. Poor health status reduces the likelihood of marriage. Am. J. Hum. Biol. 26:747-752, 2014. © 2014 Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

Adding to the growing literature explicating the links between romantic relationships and health, this study examined how both couple-level characteristics, particularly union type (e.g., dating, cohabiting, or marriage) and interracial pairing, and interpersonal characteristics (e.g., partner strain and support), predicted young adults' physical and mental health. Using dyadic data from a sample of 249 young, primarily Black couples, we hypothesized and found support for the importance of couple-level context, partner behavior, and their interaction in predicting health. Interracial couples (all Black/non-Black pairings) reported worse health than monoracial Black couples. Union type, however, did not directly predict health but was a significant moderator of partner strain. That is, the negative association between partner strain and self-reported health was stronger for cohabiting and married couples versus their dating counterparts, suggesting that coresidence, more so than marital status, may be important for understanding partner effects on physical health. For psychological distress, however, partner support proved equally beneficial across union types. [ABSTRACT FROM AUTHOR]

The amount of time families spend at work increased substantially over the course of the 20th century, but the health implications of these shifts remain poorly understood. Using the NLSY79, we examine potential consequences of men's and women's work time on the health of their spouse. We also investigate three mechanisms through which spousal hours might affect health: resources from the job, stress, and time for physical activity and exercise. Husbands' long (50+) hours predict better health for wives, due in part to greater resources. Wives' moderately long (41–49) hours of work predict worse health for husbands, due in part to husbands' reduced exercise time. Our gendered findings highlight persistent inequities in work and family life that constrain the family health–promoting benefits of women's labor. [ABSTRACT FROM PUBLISHER]

We document and interpret differences in life evaluation and in hedonic experience between those who live with children and those who do not; most previous literature has concluded that those with children have worse lives. For a sample of 1.8 million Americans of all ages, and without controls for other circumstances, we find little difference in subjective wellbeing between people with and without children. Among those most likely to be parents, life evaluation and all hedonic experiences except stress are markedly better among those living with a child. However, within this group, people who live with children are more likely to be married, richer, better educated, more religious, and healthier, all of which have well-documented positive associations with evaluative and hedonic wellbeing. With statistical controls for these background factors, the presence of a child has a small negative association with life evaluation, although it is associated with more of both positive and negative hedonics. These patterns are replicated in the English-speaking countries of the world, but not in other regions. We argue that the causal effect of children on parental wellbeing, which is the target for most of the literature, is not well defined. Instead, we interpret our rich-country results within a theory of children and wellbeing in which adults sort into parenthood according to their preferences. In poor, high-fertility countries, we find evidence that at least some people have children even when it diminishes their personal wellbeing. [ABSTRACT FROM AUTHOR]

Background: Despite efforts to promote HIV counseling and testing (HCT) among couples, few couples know their own or their partners’ HIV status. We assessed trends in HCT uptake among married individuals in Rakai district, southwestern Uganda. Methods: We analysed data for 21,798 married individuals aged 15-49 years who were enrolled into the Rakai Community Cohort Study (RCCS) between 2003 and 2009. Married individuals were interviewed separately but were retrospectively linked to their partners at analysis. All participants had serologic samples obtained for HIV testing, and had the option of receiving HCT together (couples’ HCT) or separately (individual HCT). Individuals were categorized as concordant HIV-positive if both partners had HIV; concordant HIV-negative if both did not have HIV; or HIV-discordant if only one of the partners had HIV. We used χ2 tests to assess linear trends in individual and couples’ HCT uptake in the entire sample and conducted multinomial logistic regression on a sub-sample of 10,712 individuals to assess relative risk ratios (RRR) and 95% Confidence Intervals (95% CI) associated with individual and couples’ HCT uptake. Analysis was done using STATA version 11.0. Results: Uptake of couples’ HCT was 27.2% in 2003/04, 25.1% in 2005/06, 28.5% in 2006/08 and 27.8% in 2008/09 (χ2 for trend = 2.38; P = 0.12). Uptake of individual HCT was 57.9% in 2003/04, 60.2% in 2005/06, 54.0% in 2006/08 and 54.4% in 2008/09 (χ2 for trend = 8.72; P = 0.003). The proportion of couples who had never tested increased from 14.9% in 2003/04 to 17.8% in 2008/09 (χ2 for trend = 18.16; P < 0.0001). Uptake of couples’ HCT was significantly associated with prior HCT (Adjusted [Adj.] RRR = 6.80; 95% CI: 5.44, 8.51) and being 25-34 years of age (Adj. RRR = 1.81; 95% CI: 1.32, 2.50). Uptake of individual HCT was significantly associated with prior HCT (Adj. RRR = 6.26; 95% CI: 4.24, 9.24) and the female partner being HIV-positive (Adj. RRR = 2.46; 95% CI: 1.26, 4.80). Conclusion: Uptake of couples’ HCT remained consistently low (below 30%) over the years, while uptake of individual HCT declined over time. These findings call for innovative strategies to increase demand for couples’ HCT, particularly among younger couples and those with no prior HCT. [ABSTRACT FROM AUTHOR]

Recent efforts to promote marriage among the socioeconomically disadvantaged are based on the assumption that marriage is equally beneficial for persons with varying levels of socioeconomic status. Using 3 waves of data from a sample of married adults (the National Survey of Families and Households; N = 1,849), the authors evaluated whether the health benefits of marital happiness and the health costs of marital conflict might vary by education and income levels. They found that increases in marital happiness were associated with increases in self-rated health for individuals with more education. In addition, increases in marital conflict were linked to greater increases in functional impairment for persons with lower income. Although the results were not consistent and effect sizes were modest, the evidence nonetheless tentatively suggests that higher levels of marital happiness may be less beneficial for health and that higher levels of marital conflict may be more detrimental to health among persons with lower socioeconomic status. [ABSTRACT FROM AUTHOR]

Objective: To examine the relationship between socioeconomic factors affecting contraceptive use among tribal women of Bangladesh with focusing on son preference over daughter. Materials and methods: The study used data gathered through a cross sectional survey on four tribal communities resided in the Rangamati Hill District of the Chittagong Hill Tracts, Bangladesh. A multistage random sampling procedure was applied to collect data from 865 currently married women of whom 806 women were currently married, non-pregnant and had at least one living child, which are the basis of this study. The information was recorded in a pre-structured questionnaire. Simple cross tabulation, chi-square tests and logistic regression analyses were performed to analyzing data. Results: The contraceptive prevalence rate among the study tribal women was 73%. The multivariate analyses yielded quantitatively important and reliable estimates of likelihood of contraceptive use. Findings revealed that after controlling for other variables, the likelihood of contraceptive use was found not to be significant among women with at least one son than those who had only daughters, indicating no preference of son over daughter. Multivariate logistic regression analysis suggests that home visitations by family planning workers, tribal identity, place of residence, husband's education, and type of family, television ownership, electricity connection in the household and number of times married are important determinants of any contraceptive method use among the tribal women. Conclusion: The contraceptive use rate among the disadvantaged tribal women was more than that of the national level. Door-step delivery services of modern methods should be reached and available targeting the poor and remote zones. [ABSTRACT FROM AUTHOR]

Although there is substantial evidence linking marital quality to physical health, few studies have been longitudinal. This study examined data from the Marital Instability Over the Life Course Study; 1,681 married individuals followed for 20 years were included in these analyses. In order to control for life course effects, participants were divided into 2 cohorts: early life and midlife. On the basis of latent growth curve analysis, the results indicated that initial values of marital happiness and marital problems were significantly associated with the initial value of physical health among both cohorts. In addition, the slope of marital happiness was significantly associated with the slope of physical health among the younger cohort, and the slope of marital problems was significantly associated with the slope of physical health among the midlife cohort. These results provide evidence of the significant association between positive and negative dimensions of marital quality and physical health over the life course. [ABSTRACT FROM AUTHOR]

The purpose of this study was to qualitatively examine how cultural, occupational, and familial systems impact physical activity within marriage as well as how the marital system itself affects activity. Employing principles derived from Bertalanffy's Systems Theory, we utilized interviews and photo-elicitation to guide our study of twelve spousal pairs. Findings highlighted cultural expectations to be the primary caregiver as negatively impacting wives while occupational pressures negatively influenced both spouses. This study demonstrated the utility of General Systems Theory to advance our understanding of spousal physical activity and underscored the need for health professionals to consider system influences. [ABSTRACT FROM AUTHOR]

This longitudinal study employed a dyadic approach to examine the impact of older spouses' functional health and psychological well-being on each other's psychological well-being, beyond the effects of own age and functional health. Participants were 71 community-living married couples ( M = 70 years old) who were individually interviewed about their health (i.e., functional ability) and psychological well-being (i.e., depressive symptomology, perceived stress, perceived control), then reinterviewed two years later to reassess their well-being. Results indicated both contagion of well-being between spouses and gender differences in the impact of spousal health and well-being on own well-being. Specifically, spousal stress predicted own stress and various spousal well-being measures predicted the other partner's well-being. Unlike prior findings, there was no indication of women being more sensitive (than men) to their spouse's health or well-being. Instead, aside from their own prior well-being, men's well-being was largely predicted by their wives' functional health and well-being, whereas the biggest predictor of women's well-being was their own functional health. Implications for healthcare providers addressing the potentially differing needs of older adults based upon their spouse's health and well-being are discussed. [ABSTRACT FROM AUTHOR]

We investigated the conditions under which married children live with their older parents in Japan. We focused on how needs and resources in each generation are associated with whether married couples live with their parents in parent-headed and child-headed households, and we also investigated difference in power relations between older and younger generations and between children and their spouses. We analyzed a nationally representative sample of older parents (n  =  3,853) and their married children (n  =  8,601) from the 1999 Nihon University Japanese Longitudinal Study of Aging (NUJLSOA). Mutinomial regression revealed that married children with relatively affluent parents tended to live with them in parent-headed households and that married children with parents who are in relatively poor health or who are widowed tended to live with them in child-headed households. We also found that less-educated married children tended to live in the households of their higher-income parents, suggesting that parents may be "purchasing" traditional arrangements with less-affluent children. In addition, children with an educational advantage over their spouses were more likely to have parents living with them in child-headed coresident households. We conclude that traditional multigenerational coresidence has become a commodity negotiated within families based on relative resources and needs within and across generations. [ABSTRACT FROM AUTHOR]

The present paper addresses the consistent finding that men derive more benefit from marriage in terms of both morbidity and mortality compared to women in U. S. society. Based on the evidence that spousal conflict adversely influences physiology and health, with greater negative impact on wives compared to husbands, we propose that the stronger impact of relationship negativity contributes to the decreased marriage benefit for women. Evidence bearing on two explanations for this differential impact of conflict is reviewed. The relational-interdependence view, proposed by Kiecolt-Glaser and Newton (2001), holds that women are more affected by marital conflict because of their more relationally interdependent self-representations. An alternative view, which we call the subordination-reactivity hypothesis, suggests that women experience greater physiological and psychological reactivity to marital discord because they typically occupy subordinate (lower status and less powerful) positions relative to their husbands. A review of the evidence on the physiological effects of social status is combined with that of the relationship between gender and status, both within society at large and interpersonal relationships specifically, to support the subordination-reactivity hypothesis. Specifically, there is evidence that low social status negatively impacts health and that women generally occupy subordinate status. The relational-interdependence view is re-evaluated and its intersection with the subordination-reactivity hypothesis is explored. Finally, implications and future directions are discussed. [ABSTRACT FROM AUTHOR]

Purpose: As shared family context may be an important influence on mental health, and gender differences in mental health, in later life we investigated how gender, family-related variables and gender roles were associated with mental health in older married couples. Methods: Using data on a sample of 2,511 married couples born between 1923 and 1953 (drawn from the British Household Panel Survey) we analysed differences in the mental health of husbands and wives by fertility history, length of marriage, presence of co-resident children, reported social support, hours of household work, attitudes to gender roles and health of husband and wife. Mental health in 2001 was measured using the General Health Questionnaire (GHQ-12). Multilevel modelling was used to assess effects in husbands and wives and variations between husbands and wives. Results: Results showed that although the mental health of married couples was correlated, wives had poorer mental health than their husbands. The gender difference was smaller in couples who lived with a child aged 16 or more (and had no younger co-resident children) and in couples in which both spouses had experienced early parenthood. The influence of individual and family characteristics on mental health also differed between husbands and wives. For husbands, early fatherhood and co-residence with a child or children aged 16 or more increased the odds of poor mental health. For wives, having had a child when aged 35 or more appeared protective while having traditional gender role attitudes increased the odds of poorer mental health. Conclusions: The role of family characteristics in the shared marital context has complex associations with mental health, some of which seem gender specific. Although wives express more mental distress, husbands in general show poorer mental health related to family characteristics. [ABSTRACT FROM AUTHOR]

Despite progress in identifying the covariates of divorce, there remain substantial gaps in the knowledge. One of these gaps is the relationship between health and risk of marital dissolution. I extend prior research by examining the linkages between work-related health limitations and divorce using 25 years of data (N = 7919) taken from the 1979 National Longitudinal Study of Youth (NLSY-79). I found that work-related health limitations among husbands, but not wives, were linked to an increased risk of divorce. In addition, I found that this relationship was moderated by education in a fashion that varies according to race. For White men, education exacerbated the effect of health limitations, but for Black men, education attenuated the effects of work-related health limitations. [ABSTRACT FROM AUTHOR]

The article investigates the health status of couples who cohabitate and commuter couples, married couples who do not reside together. The author notes previous research suggesting that marriage can have a positive effect on health and health behavior. He suggests the health and health behaviors of cohabitating couples and people in commuter marriages will be greater than the health and health behavior than cohabitating couples. The author comments that living without a partner negatively affects the health of women more than men.

The article describes a research study that explored the process of how change occurred for one distressed couple and a specific therapist in a naturalistic setting. Quantitative and qualitative data were collected on the couple at multiple points in the therapy. A research team comprised of five members met regularly to analyze the data and collectively they arrived at a theory of change for the couple posttherapy. Conclusions are made related to how change occurred for the couple with an emphasis on the role of extratherapeutic events, client motivational factors, the therapeutic alliance, hope and expectancy factors, therapist factors, specific techniques and interventions, and other surprise factors that contributed to change. [ABSTRACT FROM AUTHOR]

Substantial previous research indicates that married persons enjoy better mental and physical health than others. One prominent explanation for these patterns is that married persons practice better health behaviors, including lower levels of alcohol consumption, particularly heavy drinking. However, studies of marital status differences in health behaviors have ignored the role of religious homo/heterogamy and attendance, important potential confounding and moderating factors. Focusing on alcohol behavior, we analyze 1977–1994 General Social Survey data, finding that lower levels of drinking are especially pronounced among homogamous conservative couples, and to a lesser extent among mixed-faith unions with one conservative partner. Controlling for other background characteristics, nonconservatives married to nonconservatives do not consistently consume less alcohol than unmarried persons, suggesting that much of the apparent marital status effect on drinking is actually due to religious factors. Contrary to some prior theory and research, these patterns are broadly consistent for both men and women. [ABSTRACT FROM AUTHOR]

Abstract: A positive relationship between socio-economic status (SES) and health, the “health–wealth gradient”, is repeatedly found in many industrialized countries. This study analyzes competing explanations for this gradient: causal effects from health to wealth (health causation) and causal effects from wealth to health (wealth or social causation). Using six biennial waves of couples aged 51-61 in 1992 from the US Health and Retirement Study, we test for causality in panel data models incorporating unobserved heterogeneity and a lag structure supported by specification tests. In contrast to tests relying on models with only first order lags or without unobserved heterogeneity, these tests provide no evidence of causal wealth health effects. On the other hand, we find strong evidence of causal effects from both spouses’ health on household wealth. We also find an effect of the husband’s health on the wife’s mental health, but no other effects from one spouse’s health to health of the other spouse. [Copyright &y& Elsevier]

The article focuses on a study seeking to estimate the proportion of heterosexually transmission of HIV that occurs within married or cohabiting couples in urban Zambia and Rwanda. The method and setting of the research which used data from several demographic health surveys and data collected through voluntary counseling and testing of married couples from Lusaka, Zambia and Kigali, Rwanda is explained. Results show that intervention for married couples significantly reduced heterosexual transmission of HIV in Zambia and Rwanda. Researchers recommend the promotion of voluntary counseling and testing for married and cohabiting couples to prevent the spread of HIV among heterosexuals in urban Zambia and Rwanda.

The authors collected saliva samples from 15 married couples and 13 women staying with a female companion (N = 43) during an 8-day stay at a spa resort in Nagano, Japan. To examine changes in endocrinological stress markers, the authors evaluated participants' levels of salivary cortisol and chromogranin A (CgA) by enzyme-linked immunosorbent assay. By the eighth day, women staying with their husbands had significantly increased levels of cortisol and CgA. During the protocol, the authors observed no significant variation in levels of cortisol or CgA for either the women who were staying with same-sex companions or the male spouses. These findings suggest that the effects of long-term stays in a spa resort are more beneficial for married women staying with their husbands than for either married men or women staying with female companions. [ABSTRACT FROM AUTHOR]

The objective of this study was to find out whether the educational achievements of family members and people in the municipality have an impact on a person's mortality, net of the well-known strong influence of his or her own education. Using register data, discrete-time hazard models for all-cause mortality in 1980–2003 were estimated for all Norwegian men and women born between 1950 and 1973 (i.e. age 30–53). There were 23,692 deaths during the 19.1 million person-years of follow-up. The education of a former or current spouse had the clearest beneficial effect, although own education was more important. Mortality was also negatively associated with the education of the oldest sibling and to a lesser extent with that of the sibling-in-law and father-in-law. The average education in the municipality was not generally related to mortality, but a beneficial effect was seen among men with college education. In contrast to this, parents’ education affected mortality adversely, especially among women. The data did not allow causal pathways to be identified, but possible mechanisms were discussed. For example, it was argued that others’ education may affect mortality favourably through transmission of knowledge, imitation of behaviour, economic support, and the quality of health services. In some societies, childhood health might also be an issue. On the other hand, having better-educated family members or living in a community with many better-educated people, who typically also have higher incomes, may trigger psychosocial stress. However, one should be careful to interpret the observed relationships as reflecting purely causal effects. Various unobserved factors may influence the person's choice of spouse and place of residence as well as mortality, and having parents with higher (lower) education may signal that the person has had special problems (resources) during childhood or adolescence, which also may have implications for later health. [Copyright &y& Elsevier]

Few studies have examined the influence of marriage on health-related behavior in Asian populations. The present study examined the effect of marital status on smoking in Korea. Data from two rounds of a nationally representative survey (1999 and 2003) were analyzed (57,246 women and 52,769 men). Marital status-specific prevalence ratios for smoking were estimated using log binomial regression after adjusting for age, survey year, occupation and education level. Smoking prevalence declined with age for men, but rose for women. Smoking rates were higher for unmarried men and women compared to their married counterparts. However, the gap in smoking rates between unmarried and married women (especially younger women <45 years) was much greater than the gap between unmarried and married men. The study found that marital status had a stronger protective influence on smoking in women than men, which contrasts with the gender pattern reported previously in western studies. The findings suggest the influence of a culture which discourages married women from smoking, and “liberates” divorced women from cultural sanctions against smoking in marriage. [Copyright &y& Elsevier]

Retirement is often viewed as an event when someone completely withdraws from paid employment. The purpose of the present study was to examine the patterns of retirement transitions evidenced in married couples in the Health and Retirement Study over an 8-year period (1992 to 2000). The sample consisted of White and Black married couples (N = 1,1 18) where both spouses were working and at least one spouse was aged 51 to 61 at baseline. A variety of complex retirement patterns were found. Husbands were more likely than wives to show a linear pattern (i.e., a transition directly from work to complete retirement). Transitions were related within couples. Policy and practice implications are discussed. [ABSTRACT FROM AUTHOR]

Married women in rural Papua New Guinea are at risk for HIV primarily because of their husbands' extramarital relationships. Labor migration puts these men in social contexts that encourage infidelity. Moreover, many men do not view sexual fidelity as necessary for achieving a happy marriage, but they view drinking and "looking for women" as important for male friendships. Although fear of HIV infection is increasing, the concern that men most often articulated about the consequences of extramarital infidelity was possible violent retaliation for "stealing" another man's wife. Therefore, divorced or separated women who exchange sex for money are considered to be "safe" partners. Interventions that promote fidelity will fail in the absence of a social and economic infrastructure that supports fidelity. (Am J Public Health. 2007,97:1006-1014. doi: 10.2105/AJPH.2006.088559) [ABSTRACT FROM AUTHOR]

Recent studies linking marital status and health increasingly focus on marital trajectories to examine the relationship from a life course perspective. However, research has been slow to bridge the theoretical concept of a marital trajectory with its measurement. This study uses retrospective and prospective data to model the age-dependent effects of marital sequences, timing, transitions, and durations on physical health. Results indicate that marriage duration is associated with lower rates of disease for men and women; however, the effect is time dependent and contingent on other trajectory components. For females, marriage timing, and the cumulative number of divorce transitions ale also important for health. For males, divorce duration and widowhood transitions play an integral role in this process. The authors also find that marital typologies have no effect when the number of transitions is taken into account. [ABSTRACT FROM AUTHOR]

Sociological theories on family formation and families and health suggest that married and cohabiting partners will resemble each other in health status, positively or negatively. The family is often seen as a health-enhancing agent for individuals. However, there are large health differences among families. This study aims to answer the question whether it is the case that the healthy live with the healthy and individuals with poor health have partners who are also in poor health. Moreover, it examines whether resemblance in health is a consequence of partner choice - educational homogamy in particular - behaviour or shared circumstances. Younger and older couples are compared to investigate whether health resemblance increases over the lifecourse. Analyses of a nationally representative sample of almost 12,000 Dutch couples show that partners are indeed significantly alike with regard to several health indicators. Respondents whose partner reports poor health are almost three times more likely to report poor health than respondents whose partner is in good health. There is a strong accumulation of health problems within households. Partner selection with regard to education causes part of the partner resemblance in health. Less support is found for the hypotheses that risk behaviour, mutual influence or the effects of shared circumstances cause similarity between partners' health status. Surprisingly, partners in older couples, who have been together for a longer time, do not resemble each other significantly more than partners in younger couples. The implications of these findings for sociological theory and social inequalities in health are discussed. [ABSTRACT FROM AUTHOR]

Calls for increased inclusion of men in matters of reproductive health emphasize the need for research into vasectomy acceptability and decision making. Vasectomy is a safe, simple and effective method of contraception, but is underused worldwide. METHODS: Focus group discussions and in-depth interviews were conducted with potential and actual sterilization clients and their partners in the Kigoma Region of Tanzania. Content analysis was used to search for emergent themes related to vasectomy decision making. RESULTS: Six themes emerged as overarching factors contributing to the vasectomy decision-making process: economics, spousal influence, religion, provider reputation and availability, uncertainty about the future, and poor vasectomy knowledge and understanding. There was substantial communication between partners regarding the vasectomy decision, and wives had a strong influence on the outcome; however, men and women agreed that husbands would resist vasectomy if wives initially raised the topic. Vasectomy acceptance is limited by the scarcity of skilled vasectomy providers and by the fact that men and women hold many of the same misunderstandings about vasectomy, including a fear of decreased sexual performance as a result of the procedure. CONCLUSIONS: Spousal discussions are important in the decision to get a vasectomy, but these discussions should be initiated by the male partner. Programs need to educate men about contraceptive options, including vasectomies. Detailed, culturally relevant knowledge of the barriers and facilitators individuals experience during their decisionmaking process will enable vasectomy promotion programs to more successfully target appropriate populations. [ABSTRACT FROM AUTHOR]

Objectives: This study examined the influence of marital status and inviting both partners together on participation in colorectal cancer screening. Setting: Data were from a subset of participants from the UK Flexible Sigmoidoscopy Trial (1996–1999). Methods: Marital status was self-reported, and co-invitation of partner was obtained from the trial database. Screening intentions were assessed in 16,527 adults aged 55–64 years. Attendance was recorded in the 4130 respondents who were subsequently invited. Results: Multivariate analyses, controlling for age and educational level, indicate that married (or cohabiting) people have more positive intentions (odds ratio [OR] = 1.26; 95% confidence interval [CI] 1.14–1.38) and higher attendance rates at screening (OR = 1.23; 95% CI 1.04–1.45) than nonmarried people. After adjusting for the marriage effect, inviting partners together (co-invitation) significantly increased screening intentions among women (OR = 1.17; 95% CI 1.04–1.31) but not men (OR = 0.97; 95% CI 0.85–1.10). Co-invitation significantly increased attendance at screening in both genders (OR = 1.34; 95% CI 1.14–1.58). Conclusions: In this age group, married adults are more likely to participate in colorectal cancer screening than the non-married, and inviting both members of a couple together further increases screening uptake. The positive effect of marriage was as strong for women as men. [ABSTRACT FROM AUTHOR]

Background: Married persons are healthier and live longer than single, divorced, and widowed persons. Time trends in self-rated health (SRH) by marital status and cohabitation have remained largely unstudied. We aim to assess the levels and trends of SRH by official marital status and cohabitation, and to study the causes of these differences. Methods: Two nationally representative cross-sectional surveys were conducted 20 years apart in Finland. Data on self-reported marital status, SRH, education, smoking, and long-standing illness were collected from Finns aged 30-64 years in 1978-80 (Mini-Finland Health Survey, N = 6102, response rate 96%) and 2000-01 (Health 2000 Survey, N = 5871, response rate 92%). Results: SRH has improved in the last 20 years, but differences between marital status groups have not reduced. In 2000-01, non-married persons reported worse SRH than married persons. Among men, single [cumulative odds ratio (COR) = 1.55; 95% confidence interval (95% CI) 1.22-1.99] and divorced (COR = 1.55; 95% CI 1.17-2.05) persons showed the poorest SRH, while among women widows (1.53; 95% CI 1.04-2.26) were the most disadvantaged group. The SRH of cohabiting persons did not significantly differ from that of married persons. Differences in educational structure, smoking, and the prevalence of long-term illness explain part of the marital status differences in SRH among men, but less so among women. Among both single men and women as well as among widowed women, SRH had improved slightly less than in the other groups. Conclusion: The challenges on public health posed by growing numbers of currently not married people are likely to increase. [ABSTRACT FROM AUTHOR]

Drawing on 5 waves of the Health and Retirement Study, we examine the influence of the marital life course on the prevalence and incidence of cardiovascular disease among 9,434 middle-aged individuals. Results show that compared to continuously married persons, both men and women with a marital loss have significantly higher prevalence of cardiovascular disease at baseline. Men and women, however, differ in the effects of marital loss on the incidence of cardiovascular disease over the course of the study. Women with a marital loss have a higher risk of cardiovascular disease in late midlife compared to continuously married women, whereas marital loss is not associated with men’s risk of cardiovascular disease. Emotional distress and socioeconomic status account for the higher risk of cardiovascular disease among divorced women. [ABSTRACT FROM AUTHOR]