Cross-National Sources of Health Inequality: Education and Tobacco Use in the World Health Survey

The spread of tobacco use from the West to other parts of the world, especially among disadvantaged socioeconomic groups, raises concerns not only about the indisputable harm to global health but also about worsening health inequality. Arguments relating to economic cost and diffusion posit that rising educational disparities in tobacco use—and associated disparities in health and premature mortality—are associated with higher national income and more advanced stages of cigarette diffusion, particularly among younger persons and males. To test these arguments, we use World Health Survey data for 99,661 men and 123,953 women from 50 low-income to upper-middle–income nations. Multilevel logistic regression models show that increases in national income and cigarette diffusion widen educational disparities in smoking among young persons and men but have weaker influences among older persons and women. The results suggest that the social and economic patterns of cigarette adoption across low- and middle-income nations foretell continuing, and perhaps widening, disparities in mortality.     

Gender, Social Change, and Living Arrangements Among Older Egyptians During the 1990s

We compare older Egyptian women’s and men’s propensities to live with unmarried children only, any ever-married children, and alone, and we assess “kin-keeping” versus “modernization” hypotheses about the effects of social change on living arrangements during 1988–2000. Socioeconomic differences among women and men accounted for much of their crude differences in living arrangements during the period. Propensities to live with any ever-married children declined, and propensities to live alone or with unmarried children only rose. Compared to men, women continued to live more often with any ever-married children and less often with unmarried children only, and the 1988 gender gap in solitary residence disappeared by 2000. Increasing coresidential demands from unmarried dependent children, less frequent coresidential support from ever-married children, and rapidly increasing rates of solitary living especially among older men suggest emerging needs for non-coresidential instrumental support, especially among older Egyptians who are economically disadvantaged.

Familial Influences on Poverty Among Young Children in Black Immigrant,U.S.-born Black,and Nonblack Immigrant Families

This study examines how familial contexts affect poverty disparities between the children of immigrant and U.S.-born blacks, and among black and nonblack children of immigrants. Despite lower gross child poverty rates in immigrant than in U.S.-born black families, accounting for differences in family structure reveals that child poverty risks among blacks are highest in single-parent black immigrant families. In addition, within two-parent immigrant families, child poverty declines associated with increasing assimilation are greater than the respective declines in single-parent families. The heads of black immigrant households have more schooling than those of native-black households. However, increased schooling has a weaker negative association with child poverty among the former than among the latter. In terms of racial disparities among the children of immigrants, poverty rates are higher among black than nonblack children. This black disadvantage is, however, driven by the outcomes of first-generation children of African and Hispanic-black immigrants. The results also show that although children in refugee families face elevated poverty risks, these risks are higher among black than among nonblack children of refugees. In addition, the poverty-reducing impact associated with having an English-proficient household head is about three times lower among black children of immigrants than among non-Hispanic white children of immigrants.     

Gender Differences in Physical Performance,Body Composition,and Dietary Intake in Homebound Elders

ABSTRACT

Considering that the most vulnerable subgroup of elders for poor nutritional status and functional decline is the increasing number of home-bound women, we examined gender differences in physical performance, body composition, and dietary intake in a randomly recruited sample of 345 home-bound elders (81% women, 48% black > 65% income < $750/month). After controlling for demographic and health-related factors, the results from multivariate analyses indicated that women were more likely than men to report the lowest nutrient intake and were 2.9 times more likely to be at the worst level of overall physical performance. These results suggest a heightened vulnerability of homebound older women to poor physical performance, low dietary intake, and increased Body Mass Index (BMI). Prospective research is now needed to examine the interrelationships between physical performance, dietary intake, and body composition among the growing homebound older population.     

Gender difference in physical performance, body composition and dietary intake in homebound elders

Considering that the most vulnerable subgroup of elders for poor nutritional status and functional decline is the increasing number of homebound women, we examined gender differences in physical performance, body composition, and dietary intake in a randomly recruited sample of 345 homebound elders (81% women, 48% black, > 65% income < $750/month). After controlling for demographic and health-related factors, the results from multivariate analyses indicated that women were more likely than men to report the lowest nutrient intake and were 2.9 times more likely to be at the worst level of overall physical performance. These results suggest a heightened vulnerability of homebound older women to poor physical performance, low dietary intake, and increased Body Mass Index (BMI). Prospective research is now needed to examine the interrelationships between physical performance, dietary intake, and body composition among the growing homebound older population.     

Cancer Screening Utilization Among U.S. Women: How Mammogram and Pap Test Use Varies Among Heterosexual,Lesbian, and Bisexual Women

Existing research on cancer screening utilization among sexual minority women in the U.S. has mostly relied on non-random samples that combine lesbian and bisexual women into a single group. We respond to these limitations by examining the relationship between sexual orientation and cancer screening among a sample of U.S. women from the Behavioral Risk Factor Surveillance System (BRFSS). Our analytic sample includes 2273 lesbian, 1689 bisexual, and 174,839 heterosexual women interviewed in 15 U.S. states between 2000 and 2010. We examine two cancer screening measures: timely mammogram and pap tests, defined as having had a mammogram in the past 2 years for women aged 40 and older, and having had a pap test in the past 3 years for women aged 21–65. For mammogram, results showed that rates of timely use did not significantly differ by sexual orientation. However, lesbian and bisexual women report significantly lower rates of timely pap testing than heterosexual women. Logistic regression results on timely pap testing showed that lower pap test use for bisexual women is primarily driven by their poorer socioeconomic status relative to heterosexual women, while the significantly lower odds of timely pap testing for lesbian women were unaffected by control measures. Better understanding of cancer screening utilization disparities among lesbian and bisexual women is necessary to address morbidity and mortality disparities by sexual orientation.     

Gender differences in the associations of self esteem, stress and social support with functional health status among older adults with heart disease

This study explored and compared the role of self esteem, stress and social support in maintenance or improvement in physical and psychosocial functioning over 12 months in older men and women with cardiovascular disease. Data from 502 adults over 60 years of age showed that self esteem and stress were both significantly associated with functioning when demographic and clinical factors were controlled. Men were significantly more likely than women to maintain or improve in functioning. Self esteem, stress, compliance with medication regimens, and marital status were significantly associated with maintenance or improvement of functioning among women. Only age and stress were significantly associated with maintenance or improvement in functioning among men. Findings indicated that: (1) stress and self esteem were stronger predictors of functioning, especially among women, than demographic and clinical factors; and (2) women in the highest quartile of the self esteem distribution were approximately five times as likely to maintain or improve their functioning as women in the lowest quartile.     

Black–White Disparities in Adult Mortality: Implications of Differential Record Linkage for Understanding the Mortality Crossover

Mortality rates among black individuals exceed those of white individuals throughout much of the life course. The black–white disparity in mortality rates is widest in young adulthood, and then rates converge with increasing age until a crossover occurs at about age 85 years, after which black older adults exhibit a lower mortality rate relative to white older adults. Data quality issues in survey-linked mortality studies may hinder accurate estimation of this disparity and may even be responsible for the observed black–white mortality crossover, especially if the linkage of surveys to death records during mortality follow-up is less accurate for black older adults. This study assesses black–white differences in the linkage of the 1986–2009 National Health Interview Survey to the National Death Index through 2011 and the implications of racial/ethnic differences in record linkage for mortality disparity estimates. Match class and match score (i.e., indicators of linkage quality) differ by race/ethnicity, with black adults exhibiting less certain matches than white adults in all age groups. The magnitude of the black–white mortality disparity varies with alternative linkage scenarios, but convergence and crossover continue to be observed in each case. Beyond black–white differences in linkage quality, this study also identifies declines over time in linkage quality and even eligibility for linkage among all adults. Although linkage quality is lower among black adults than white adults, differential record linkage does not account for the black–white mortality crossover.     

Surveying Older Adults’ Opinions on Housing: Recommendations for Policy

There is paucity of research investigating opinions and attitudes of seniors 55 years of age and older in relation to housing accommodation and services sensitive to the needs of the senior population. We describe the results of a cross-sectional survey soliciting opinions and attitudes of seniors with respect to a variety of housing issues including home ownership and home modifications. The objectives of the survey were to improve our understanding of older adults’ views and concerns about housing, and to collect information intended to provide policy makers with recommendations regarding housing services, improved access, and safety for older adults as indicated by the individual residents. Most respondents indicated a strong desire to stay and age in their own homes, and continue owning their homes. There was general agreement among those surveyed that other forms of accommodations such as seniors’ housing, congregate homes, small self-contained houses placed on the same lot as the home of a close family member, and residential care facilities were alternative housing options that are less preferred. Winter weather conditions in northern British Columbia were reported to be an important impediment for safety, community participation, and access to facilities and services. Policy implications related to housing tenure and housing conditions as important social determinants of health for seniors are discussed.     

Caregiving and Care-Receiving:

Many aspects of aging are women's issues. Yet research on aging has, until recently, focussed little attention of gender differences in the experience of growing old. Older women are more likely than older men to be poor, widowed, living alone in poor health, receiving assistance from both formal and informal supports, as well as being institutionalized in long-term care facilities. This secondary analysis of data from the 1982 Survey of the Elderly in the Waterloo Region attempts to address a gap in our knowledge concerning gender differences in the giving and receiving of social support in later years. Gender differences in (1) need for social support, (2) turning to formal assistance, (3) amount of formal assistance used, and (4) amount of informal assistance received were examined using analysis of variance and logistic regression procedures. The profile of social support that emerged suggests both similarities and differences in the way elderly men and women experience the giving and receiving of social support. Older women in this sample were found to be disadvantaged in the areas of income, health, years lived alone, and loneliness, relative to older men. Low-income was related to formal service use for older women, but not for older     

Racial/Ethnic and Nativity Patterns of U.S. Adolescent and Young Adult Smoking

We document racial/ethnic and nativity differences in U.S. smoking patterns among adolescents and young adults using the 2006 Tobacco Use Supplement to the Current Population Survey (n = 44,202). Stratifying the sample by nativity status within five racial/ethnic groups (Asian American, Mexican–American, other Hispanic, non-Hispanic black, and non-Hispanic white), and further by sex and age, we compare self-reports of lifetime smoking across groups. U.S.-born non-Hispanic whites, particularly men, report smoking more than individuals in other racial/ethnic/nativity groups. Some groups of young women (e.g., foreign-born and U.S.-born Asian Americans, foreign-born and U.S.-born Mexican–Americans, and foreign-born blacks) report extremely low levels of smoking. Foreign-born females in all of the 25–34 year old racial/ethnic groups exhibit greater proportions of never smoking than their U.S.-born counterparts. Heavy/moderate and light/intermittent smoking is generally higher in the older age group among U.S.-born males and females, whereas smoking among the foreign-born of both sexes is low at younger ages and remains low at older ages. Taken together, these findings highlight the importance of considering both race/ethnicity and nativity in assessments of smoking patterns and in strategies to reduce overall U.S. smoking prevalence and smoking-attributable health disparities.     

Older women and family care in Hong Kong: differences in filial expectation and practices

Cultural aspects of aging have great importance on how older women and men are being treated, in particular in Asia where patriarchal practices dominate. Further, changes in the structure of the Chinese family alter this supportive function, and changes in traditional values affect the nature of the care and support provided to older women and men. This proposition was investigated by a quantitative study involving a survey of 390 older persons in Hong Kong. There are great discrepancies in informal support for older women and men. Older women are less likely to live with adult children; more likely to need financial assistance; and more likely to receive poor informal support. There is evidence that informal support for the elderly is changing in Hong Kong, and older women are being disadvantaged, experiencing insufficient and unavailability of informal support.     

Early life exposures and the occurrence and timing of heart disease among the older adult Puerto Rican population

Few studies have examined the effects of early life conditions on the timing of the onset of heart disease. We use the remarkable example of a representative sample of the population of older Puerto Ricans aged 60– 74 who lived in the countryside during childhood (n = 1,438) to examine the effects of seasonal exposures to poor nutrition and infectious diseases during late gestation on the timing of the onset and the probability of ever experiencing adult heart disease. Cox and log logistic hazard models controlling for childhood conditions (self-reported childhood health status and socioeconomic status [SES], rheumatic fever, and knee height) and adult risk factors (adult SES, obesity, smoking, texercise, and self-reported diabetes) showed that the risk of onset of heart disease was 65% higher among those born during high-exposure periods compared with unexposed individuals. However, there were no significant differences in median time of onset for those ever experiencing heart disease. As a comparison, we found that there were no significant seasonality effects for those who lived in urban areas during childhood. We conclude that early exposures in utero have important ramifications for adult heart disease among the older Puerto Rican population. We show, however, that while exposure is associated with the probability of ever experiencing adult heart disease, it is not associated with the timing of onset among those who do experience it.     

Public Policy,Health Care and Older Women

For the first time in history, long life has become a problem. The most serious problem facing the older generation is the availability and affordability of health care. While the life expectancy of both men and women cbntinues to increase, the older population of the U.S. is becoming increasingly feminine. In the last two decades there has been a dramatic fall in poverty among the aged, yet for many elderly persons and especially older women, Social Security benefits barely keep them above the poverty level. Access to medical care has improved with Medicaid and Medicare, but not to the extent the aging population had anticipated. Proposals for universal health care have been put forth by politicians, legislators and professional organizations, some of which acknowledge the unique health problems of aging women while others are discriminatory to the aged in general and women in particular. Many believe women must assert themselves if their health care needs are to be adequately and fairly addressed. To this end, more women than ever are becoming involved in the political process, running for and being elected to local, state and national offices. It is anticipated that these women will be sensitive to the health care needs of older women and put forth efforts to develop and implement policies which address these needs.     

Informal Networks Social Capital of Fathers: What Does the Social Engagement Survey Tell Us?

Using the General Social Survey on Social Engagement conducted by Statistics Canada in 2003, this paper examines social capital derived from informal networks and its variation among men categorized as: (1) men with no children, and (2) men living with children in (a) intact, (b) step, and (c) lone parent families. The focus on men stems from a concern that their role in families has not been as extensively studied as that of women. The results show that married men living with children have higher social capital – measured in terms of the number of friends, relatives, and neighbors, and in their level of trust in them – than lone fathers or step fathers in cohabiting unions. Compared to child-free men, married fathers have higher social capital but also tend to have friends who are more similar to themselves in age, education, or income.     

The Marriage Wealth Premium Revisited: Gender Disparities and Within-Individual Changes in Personal Wealth in Germany

This study examines the association between marriage and economic wealth of women and men. Going beyond previous research that focused on household wealth, I examine personal wealth, which allows identifying gender disparities in the association between marriage and wealth. Using unique data from the German Socio-Economic Panel Study (2002, 2007, and 2012), I apply random-effects and fixed-effects regression models to test my expectations. I find that both women and men experience substantial marriage wealth premiums not only in household wealth but also in personal wealth. However, I do not find consistent evidence for gender disparities in these general marriage premiums. Additional analyses indicate, however, that women’s marriage premiums are substantially lower than men’s premiums in older cohorts and when only nonhousing wealth is considered. Overall, this study provides new evidence that women and men gain unequally in their wealth attainment through marriage.     

Just Like in Their Home Country? A Multinational Perspective on Living Arrangements of Older Immigrants in the United States

Older immigrants are more likely to share residence with their adult children and other family members than are U.S.-born older adults. Because socioeconomic factors only partially explain these differences and direct measures of cultural preferences are seldom available, the persistently high rates of intergenerational coresidence among the older foreign-born are often interpreted as driven by cultural preferences and/or a lack of assimilation. To challenge this interpretation, this study investigates the extent to which older immigrants’ living arrangements deviate from those of older adults in their home countries. The analysis combines data on immigrants from the 2008–2012 American Community Survey (ACS) with census data from three major immigrant-sending countries: Mexico, the Dominican Republic, and Vietnam. Despite persistent differences from U.S.-born whites, coresidence in later life is significantly less common than in the sending countries among the older foreign-born who migrated as young adults, and especially among those who migrated as children. The older foreign-born who migrated after age 50, however, are more likely to coreside and less likely to live independently than the older adults in their home countries. The similarity of these patterns across the three immigrant subgroups suggests that the unusually high coresidence among late-life immigrants is driven by U.S. family reunification policy and not simply by cultural influences.     

Black business transformation,black well-being,and public policy

This article examines public policy and social welfare issues related to a recent trend in black business ownership: the decline of black-owned businesses in ‘traditional’ personal services serving a predominantly black clientele, and the corresponding increase of black-owned businesses in ‘emerging’ capital- and knowledge-intensive fields. It is argued that, while the growth of black business ownership in emerging fields is a sign of black economic progress, overall trends in black business ownership are not entirely positive. For one thing, the divergent trends in traditional and emerging black-owned firms reflect widening socioeconomic disparities within black communities. Moreover, the decline of traditional black-owned firms bodes ill for disadvantaged blacks in inner-cities. After reviewing the development of black business enterprise in the United States, trends in black business ownership since the 1970s are examined. Patterns of change in traditional personal services and emerging business services are then linked to social and economic transformations that have enabled many blacks to participate in the larger national economy. The article concludes by discussing the implications of declines in traditional black businesses for black well-being and for public policy.     

Sex Differences in the Relationship between Military Service Status and Functional Limitations and Disabilities

This paper examines the relationship between military service status (active duty, veteran, never served), sex, and six functional limitations/disabilities using data from the 5% sample of the 2000 U.S. Census. We estimate multivariate logistic regression models separately for men and women, and evaluate sex differences by comparing coefficients across models using a Wald chi-square test and computing predicted probabilities. For both men and women, the highest rates of functional limitation/disability are observed among veterans, while the lowest rates are recorded among active duty personnel. The increased odds of functional limitations/disabilities associated with veteran status is higher among women than men, whereas the decreased odds of functional limitations/disabilities associated with active duty status is lower among women than men. The predicted probabilities, which are based on a subgroup of 40–49 year olds with select sociodemographic characteristics, indicate that veteran women’s probabilities of many types of functional limitations/disabilities equal or exceed those of veteran men. Overall, the findings suggest women experience a more detrimental effect of past military service and a less beneficial effect of current military service. More life course analysis with longitudinal data that accounts for factors that influence sex-differentiation with respect to selection into military service, experiences in the military, and the short- and long-term consequences of military service is needed to fully understand sex differences in the relationship between military service and functional limitations/disabilities.     

Contraception,attitude-practice,and fertility differentials among US Hispanic,African–American and white women

Hispanic fertility (primarily among nationals from Mexico, Central and South America in the US) is higher today than it is in Mexico and the other nations of origin (Frank and Heuveline 2005). It persists into the second and third generations, with only moderate signs of declining to replacement. Meanwhile, the fertility rates of African–Americans, American Indians Cubans, and Puerto Ricans have all declined to replacement, only slightly above the non-Hispanic white population. This study attempts to clarify the question why African–American fertility has declined to replacement, but Hispanic fertility has not. The data used are from Cycle 6 of the National Survey of Family Growth (NSFG) of 2002. Differences in physiological or marital-status factors are found not to explain these fertility differences; however, there are significant differences in the practice of contraception during early childbearing years. Slightly less effective methods if contraception is used, and less recourse to abortion if a pregnancy is undesired, all imply higher fertility for Hispanic women. Underlying contraceptive behaviour are sets of attitudes and motives that favour, permit, or seek childbearing. A much higher percentage of Hispanic than African–American women report that they wanted their last birth and intend to have another in the future. Hispanic women of all socio-economic statuses are considerably more pronatal in their attitudes, particularly with respect to the births of first and second children.