Cigarette Use and the Narrowing Sex Differential in Mortality

What explains the recent reversal in many countries of century‐long trends toward a growing female advantage in mortality? And might the reversal indicate that new roles and statuses of women have begun to harm their health relative to men? Using data on 21 high‐income countries that separate smoking deaths from other deaths, this study answers the first question by showing that the reversal in the direction of change in the sex differential results from increased levels of smoking among women relative to men. Using additional cross‐national data on cigarette consumption and indicators of gender equality, this article answers the second question in the negative by showing that the declining female advantage in smoking mortality results from patterns of the diffusion of cigarette use rather than from improvements in women's status. Evidence of continued improvement in the female mortality advantage net of smoking deaths, and the likely decline of smoking among women in the future, imply that the recent narrowing of the differential will reverse.     

Economic development and labor force participation of older persons

The effect of economic development on labor force participation rates of older men and women is examined using national data for 134 countries. The analysis provides new insights into the evolution of retirement patterns with rising personal income, slowing population growth, the aging of the population, and shifts in the composition of employment. The analysis indicates a negative relationship between per capita income and labor force participation rates. This relationship is stronger for older men than for older women and is most apparent among middle income countries. An older population is associated with lower participation rates for older men and higher widow rates produce higher participation rates among older women. Industrial changes such as a decline in the proportion of the labor force employed in agriculture lower the proportion of older persons in the labor force. Finally, national social security policies are shown to impact the proportion of older persons that remains in the labor force.     

Life Course Changes in Smoking by Gender and Education: A Cohort Comparison Across France and the United States

Widening of educational disparities and a narrowing female advantage in mortality stem in good part from disparities in smoking. The changes in smoking and mortality disparities across cohorts and countries have been explained by an epidemic model of cigarette use but are also related to life course changes. To better describe and understand changing disparities over the life course, we compare age patterns of smoking in three cohorts and two nations (France and the US) using smoking history measures from the 2010 French health barometer (N = 20,940) and the 2010 US National Health Interview Survey Sample Adult File (N = 20,444). The results demonstrate statistically significant widening of gender and educational differences from adolescence to early and middle adulthood, thus accentuating the disparities already emerging during adolescence. In addition, the widening disparities over the life course have been changing across cohorts: age differences in educational disparities have grown in recent cohorts (especially in France), while age differences in gender disparities have narrowed. The findings highlight the multiple sources of inequality in smoking and health in high-income nations.     

Educational Attainment by Life Course Sexual Attraction: Prevalence and Correlates in a Nationally Representative Sample of Young Adults

Researchers know relatively little about the educational attainment of sexual minorities, despite the fact that educational attainment is consistently associated with a range of social, economic, and health outcomes. We examined whether sexual attraction in adolescence and early adulthood was associated with educational attainment in early adulthood among a nationally representative sample of US young adults. We analyzed waves I and IV restricted data from the National Longitudinal Study of Adolescent Health (n = 14,111). Sexual orientation was assessed using self-reports of romantic attraction in waves I (adolescence) and IV (adulthood). Multinomial regression models were estimated and all analyses were stratified by gender. Women attracted to the same-sex in adulthood only had lower educational attainment compared to women attracted only to the opposite-sex in adolescence and adulthood. Men attracted to the same-sex in adolescence only had lower educational attainment compared to men attracted only to the opposite-sex in adolescence and adulthood. Adolescent experiences and academic performance attenuated educational disparities among men and women. Adjustment for adolescent experiences also revealed a suppression effect; women attracted to the same-sex in adolescence and adulthood had lower predicted probabilities of having a high school diploma or less compared to women attracted only to the opposite-sex in adolescence and adulthood. Our findings challenge previous research documenting higher educational attainment among sexual minorities in the US. Additional population-based studies documenting the educational attainment of sexual-minority adults are needed.     

Social Networks and Support,Gender, and Racial/Ethnic Disparities in Hypertension Among Older Adults

Using data from the 2001 NHIS and the 2005–2006 and 2007–2008 NHANES, we examine how self-reporting a previous diagnosis of hypertension among adults aged 65+ differs by race/ethnicity for men and women; we explore the extent to which disparities are driven by group differences in social risk factors, particularly social support and integration; and last, whether these relationships mimic patterns seen for measured hypertension at interview. Findings indicate that rates of ever-diagnosed hypertension in both samples are highest among black seniors and older women and lowest among Mexican-American men, with the gender gap lowest among whites and substantially higher among blacks and Mexican-Americans. However, replication analyses of NHANES models using measured hypertension, instead of a self-report of having ever been diagnosed with hypertension, suggests that reporting bias and measurement error contribute to observed disparities, as racial/ethnic differences in hypertension rates are smaller when measured hypertension is examined, especially among women. Logistic regression models also show that while adjusting for group differences in measures of support and integration mediates some of the disparity in measured hypertension between Mexican-American and white seniors, adjusting for support and integration amplifies black-white disparities in both ever diagnosed and measured hypertension—driven primarily by adjustment for attendance at religious services, which reduces hypertension risk for all older adults but is more commonly reported among black seniors, especially women.     

Examining Sexual Orientation Disparities in Unmet Medical Needs Among Men and Women

Using the National Longitudinal Study of Adolescent Health (N = 13,810), this study examines disparities in unmet medical needs by sexual orientation identity during young adulthood. We use binary logistic regression and expand Andersen’s health care utilization framework to identify factors that shape disparities in unmet medical needs by sexual orientation. We also investigate whether the well-established gender disparity in health-seeking behaviors among heterosexual persons holds for sexual minorities. The results show that sexual minority women are more likely to report unmet medical needs than heterosexual women, but no differences are found between sexual minority and heterosexual men. Moreover, we find a reversal in the gender disparity between heterosexual and sexual minority populations: heterosexual women are less likely to report unmet medical needs than heterosexual men, whereas sexual minority women are more likely to report unmet medical needs compared to sexual minority men. Finally, this work advances Andersen’s model by articulating the importance of including social psychological factors for reducing disparities in unmet medical needs by sexual orientation for women.     

Social Integration and Health Insurance Status Among African American Men and Women

Using 2010 national data, we investigate the relationship between social integration and health insurance for African American adults. During the previous year 21.6% of men and 19.8% of women lacked continuous health insurance. The effect of marital status, income, and employment on insurance coverage differed by age and gender. Additionally, frequency of church attendance was positively associated with continuous health insurance for women aged 51–64. Spiritual/religious identity was marginally associated with insurance status for men aged 36–50. As provisions of the Affordable Care Act take effect, implementation programs should expand enrollment efforts to include the conjugal unit and the church.     

Prenatal Health,Educational Attainment,and Intergenerational Inequality: The Northern Finland Birth Cohort 1966 Study

In this article, we study the effects of prenatal health on educational attainment and on the reproduction of family background inequalities in education. Using Finnish birth cohort data, we analyze several maternal and fetal health variables, many of which have not been featured in the literature on long-term socioeconomic effects of health despite the effects of these variables on birth and short-term health outcomes. We find strong negative effects of mother’s prenatal smoking on educational attainment, which are stronger if the mother smoked heavily but are not significant if she quit during the first trimester. Anemia during pregnancy is also associated with lower levels of attained education. Other indicators of prenatal health (pre-pregnancy obesity, mother’s antenatal depressed mood, hypertension and preeclampsia, early prenatal care visits, premature birth, and small size for gestational age) do not predict educational attainment. Our measures explain little of the educational inequalities by parents’ class or education. However, smoking explains 12%—and all health variables together, 19%—of the lower educational attainment of children born to unmarried mothers. Our findings point to the usefulness of proximate health measures in addition to general ones. They also point to the potentially important role played by early health in intergenerational processes.     

Changes in assortative mating: The impact of age and education, 1970–1890

Data from the U.S. Census and Current Population Survey are used to examine trends in the propensity to marry or to cohabit by the age and educational attainment of potential partners. Marriage rates declined sharply across all age and educational combinations between 1970 and 1980 and declined more sharply for less-educated persons between 1980 and 1990. The rise in cohabitation compensated somewhat for the decline in marriage rates, but the compensation was unequally spread among age and educational combinations. Highly educated men were more likely, and highly educated women were no more or less likely, to marry than to cohabit with less-educated partners in 1970 and 1980. By 1990, however, educational assortative-mating patterns between these two types of unions were similar. In 1990, marriages and cohabitations involving women who were better educated than their partners were more common than those involving women who were less educated than their partners. In addition, men and women in their early 20s tend to have partners better educated than themselves, but persons in their 30s tend to cross the less-than-high-school/ more-than-high-school educational barrier when partners differ in educational attainment.     

The Role of Relative Cohort Size and Relative Income in the Demographic Transition

This paper summarizes the results of other analyses by the author with regard to the importance of relative cohort size (RCS) in determining male relative income (the income of young adults relative to prime-age workers) and general patterns of economic growth, and in turn influencing fertility in the currently more-developed nations. It then goes on to demonstrate that these same effects appear to have been operating in all of the one hundred-odd nations which have experienced the fertility transition since 1950. Parameter estimates based on the experience of all 189 countries identified by the United Nations between 1950 and 1995 are used to simulate the effects on fertility of migration from Third to First World countries. This exercise suggests that we get the best of all possible outcomes with migration: population is reduced in “overcrowded” Third World nations, total world population growth is substantially reduced, and scores of children are given the opportunity of growing up with all the educational and health advantages of U.S. residents.     

Social,behavioral, and biological factors,and sex differences in mortality

Few studies have examined whether sex differences in mortality are associated with different distributions of risk factors or result from the unique relationships between risk factors and mortality for men and women. We extend previous research by systematically testing a variety of factors, including health behaviors, social ties, socioeconomic status, and biological indicators of health. We employ the National Health and Nutritional Examination Survey III Linked Mortality File and use Cox proportional hazards models to examine sex differences in adult mortality in the United States. Our findings document that social and behavioral characteristics are key factors related to the sex gap in mortality. Once we control for women’s lower levels of marriage, poverty, and exercise, the sex gap in mortality widens; and once we control for women’s greater propensity to visit with friends and relatives, attend religious services, and abstain from smoking, the sex gap in mortality narrows. Biological factors—including indicators of inflammation and cardiovascular risk—also inform sex differences in mortality. Nevertheless, persistent sex differences in mortality remain: compared with women, men have 30% to 83% higher risks of death over the follow-up period, depending on the covariates included in the model. Although the prevalence ofriskfactors differs by sex, the impact of those riskfactors on mortality is similar for men and women.     

Female fertility history and mid-late-life health: Findings from China

China’s middle-aged and older women suffer from poorer health than men. Using national baseline data from the China Health and Retirement Longitudinal Study (CHARLS), a survey conducted from 2011 to 2012, this article applies logistic models to investigate the association between female fertility history (parity, early childbearing, late childbearing) and middle-aged and late-life health. We find that parity is related to the mid-late-life health of women. Women with four children or more are more likely to suffer from activities of daily living (ADL) impairment and poorer self-rated health than those with one to three children. Early childbearing is associated with ADL impairment; however, the correlation is mediated by socioeconomic status. Early childbearing is related to self-rated health in later life by an indirect-only mediation effect via educational attainment and personal income.     

Gender differences in economic well-being among the elderly of java

With populations aging rapidly in many developing nations, issues of economic dependency among the elderly are of increasing importance. Using data from a 1986 survey of the elderly on Java, Indonesia, I describe gender differences in economic well-being and identify characteristics associated with economic disadvantage. At both the individual and the household level, older women have fewer resources than older men. Even within categories of support (work income and remittances), women have lower levels of well-being. Gender differences in household-level economic well-being are due primarily to differences in household structure and in levels of skills. Gender differences in individual receipts (from all sources) are more complicated, but can be understood more clearly with reference to gender differences in skills levels (literacy, language, job skills), current work status and authority, and domestic authority.     

<Emphasis Type="Bold">Women’s Progress for Men’s Gain? Gender-Specific Changes in the Return to Education as Measured by Family Standard of Living, 1990 to 2009–2011</Emphasis>

This study investigates gender-specific changes in the total financial return to education among persons of prime working ages (35–44 years) using U.S. Census data from 1990 and 2000, and the 2009–2011 American Community Survey. We define the total financial return to education as the family standard of living as measured by family income adjusted for family size. Our results indicate that women experienced significant progress in educational attainment and labor market outcomes over this time period. Ironically, married women’s progress in education and personal earnings has led to greater improvement in the family standard of living for married men than for women themselves. Gender-specific changes in assortative mating are mostly responsible for this paradoxical trend. Because the number of highly educated women exceeds the number of highly educated men in the marriage market, the likelihood of educational marrying up has substantially increased for men over time while women’s likelihood has decreased. Sensitivity analyses show that the greater improvement in the family standard of living for men than for women is not limited to prime working-age persons but is also evident in the general population. Consequently, women’s return to education through marriage declined while men’s financial gain through marriage increased considerably.     

Socio-demographic Differences in Self-reported Psychological Distress Among 25- to 64-Year-Old Finns

Background Mental health problems are a major public health issue worldwide. The aim of this study was to assess the relative importance of socio-demographic characteristics associated with different domains of psychological distress in Finland. Methods Data source was a nationwide survey “Health Behaviour and Health among the Finnish Adult Population” (AVTK), from years 2002 to 2003 (N = 5425; response rate 66%). Psychological distress was measured by self-reported questions of general mental health (MHI-5), depression, insomnia and stress. Socio-demographic factors included education, employment status, partnership and children living in the household. Main analyses were conducted by multivariate logistic regression. Results Education, employment and partnership were associated with most of the psychological distress outcomes. Respondents with a lower educational level had poor mental health in both genders but less insomnia and stress in men. Those with an intermediate education had the least stress in women. The unemployed and retired were at a higher risk for poor mental health and depression. Moreover, employment status was associated with insomnia and stress in men. Respondents not having a partner showed a higher risk of psychological distress according to all measures. Not having children living in the household was associated with insomnia in women and with less stress in men. Conclusions Socio-demographic factors, such as having a partner and employment status, are associated with several measures of psychological distress indicating the importance of social and economic factors to psychological well-being. The association of education and of having children living at home varies by the domain of psychological distress measure.     

Discrimination Against Older Women in Health Care

Growing awareness of apparent gaps in health care received by women and men raises concern over possible discrimination. This literature review examines this issue for elderly women, whose health care is obtained in a system that also may be permeated with age discrimination. Physicians tend to spend more time with women and older patients, suggesting that discrimination may not be an issue in the physician-patient relationship or may work in favor of older women. However, this may simply reflect elderly women's poorer health. Gender and age disparities in medical treatments received provide a more compelling argument that the health care system is a source of discrimination against older women, who are less likely than others to receive available treatments for cardiac, renal, and other conditions. The history of medical treatment of menopause suggests that stereotypes of older women have been advantageous for segments of the health care system. Finally, in addition to discrimination that has its source within the health care system itself, societal-wide inequities, particularly economic, are extremely detrimental to older women's health care. As we respond to the health care crisis, we must be alert to the potential to rectify those structures and tendencies that can lead to discrimination against women and the aged. Health care reform presents a unique opportunity to ensure health care equity.     

Gender differences in environmental behaviors in China

China represents the third largest economy and the highest level of national carbon dioxide emissions when compared to other nations across the globe. Yet, little social science research has focused on the environmentally oriented behaviors of Chinese nationals, key to understanding levels of environmental impact. This study examines, in China, gender differences in environmentally oriented behaviors, environmental knowledge, and general environmental concern. Making use of path analyses, we identify a pattern of gender differences similar to common findings in the West: women demonstrated greater participation in environmental behaviors inside of the home (e.g., recycling), while outside of the home (e.g., environmental organization donations) no gendered patterns were exhibited. However, Chinese women expressed lower levels of concern than men—a finding opposite of most Western studies. Also distinct from other settings, in China, higher levels of knowledge regarding environmental issues did, indeed, translate into pro-environmental behaviors—thereby not exhibiting the knowledge-behavior gap demonstrated elsewhere.     

Behavioral Risk Disparities in a Random Sample of Self-Identifying Gay and Non-Gay Male University Students

This Internet-based study was designed to compare health risk behaviors of gay and non-gay university students from stratified random cross-sectional samples of undergraduate students. Mean age of the 4,167 male participants was 20.5 (±2.7) years. Of these, 206 (4.9%) self-identified as gay and 3,961 (95.1%) self-identified as heterosexual. After adjusting for selected characteristics and clustering within university, gay men had higher odds of reporting: multiple sexual partners; cigarette smoking; methamphetamine use; gamma-hydroxybutyrate (GHB) use; other illicit drug use within the past 30 days and during lifetime; and intimate partner violence (IPV). Understanding the health risk behaviors of gay and heterosexual men is crucial to identifying associated factors and intervening upon them using appropriate and tailored strategies to reduce behavioral risk disparities and improve health outcomes.     

Demographic and economic correlates of health in old age

In this paper we examine disparities in the ability to function among older Americans. We place special emphasis on two goals: (I) understanding the quantitatively large socioeconomic status-health gradient, and (2) the persistence in health outcomes over long periods. We find that there exist strong contemporaneous and long-run feedbacks from health to economic status. In light of these feedbacks, it is important to distinguish among alternative sources of income and the recipient of income in the household. This research also demonstrates that health outcomes at old age are influenced by health attributes of past, concurrent, and future generations of relatives. Finally, we find that the demographic and economic differences that exist among them explain functional health disparities by race and ethnicity, but not by gender.