Racial and Ethnic Disparities in Health Insurance Coverage: Dynamics of Gaining and Losing Coverage Over the Life-Course

Health insurance coverage varies substantially between racial and ethnic groups in the United States. Compared to non-Hispanic whites, African Americans and people of Hispanic origin had persistently lower insurance coverage rates at all ages. This article describes age- and group-specific dynamics of insurance gain and loss that contribute to inequalities found in traditional cross-sectional studies. It uses the longitudinal 2008 Panel of the Survey of Income and Program Participation (N = 114,345) to describe age-specific patterns of disparity prior to the Affordable Care Act (ACA). A formal decomposition on increment–decrement life tables of insurance gain and loss shows that coverage disparities are predominately driven by minority groups’ greater propensity to lose the insurance that they already have. Uninsured African Americans were faster to gain insurance compared to non-Hispanic whites, but their high rates of insurance loss more than negated this advantage. Disparities from greater rates of loss among minority groups emerge rapidly at the end of childhood and persist throughout adulthood. This is especially true for African Americans and Hispanics, and their relative disadvantages again heighten in their 40s and 50s.     

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.     

Childbearing Behavior Before and After the 1994 Population Policies in Ghana

Due to the high population growth rate in the mid-20th century, the government of Ghana introduced population policies to reduce the growth rate. Encouraging girls’ education and increasing contraceptive use were the two main policy measures to reduce population growth. In order to get a clear picture of the childbearing dynamics of Ghanaian women in response to the population policy of 1994, we analyzed individual reproductive histories from 1969 to 2003 using 2003 Ghana Demographic Health survey data to disentangle patterns by parity, calendar period, and educational groups. Exponential hazard regression models were used to estimate the relative risk of births. We find some evidence of a critical juncture in fertility trends, particularly for the fifth child. In addition, higher parity transition rates continuously declined for women with secondary or higher education and these educational levels were achieved by a higher share of the population after the policy was implemented. The 1994 population policy was successful if only by virtue of the increasing number of women with secondary or higher education. Belonging to this group is not only associated with lower fertility, but this suppressing effect strengthened in the years following the policy implementation. We also suspect that the increasing similarity between women with no education and with primary education reflects the diffusion of contraceptive knowledge and norms related to childbearing. The educational reform and contraceptive initiatives did result in increased education and contraceptive awareness and are therefore beneficial programs.     

Maternal Household Decision-Making Autonomy and Adolescent Education in Honduras

Maternal decision-making autonomy has been linked to positive outcomes for children’s health and well-being early in life in low- and middle-income countries throughout the world. However, there is a dearth of research examining if and how maternal autonomy continues to influence children’s outcomes into adolescence and whether it impacts other domains of children’s lives beyond health, such as their education. The goal of this study was to determine whether high maternal decision-making was associated with school enrollment for secondary school-aged youth in Honduras. Further, we aimed to assess whether the relationships between maternal autonomy and school enrollment varied by adolescents’ environmental contexts and individual characteristics such as gender. Our analytical sample included 6579 adolescents ages 12–16 living with their mothers from the Honduran Demographic and Health Survey (DHS) 2011–2012. We used stepwise logistic regression models to investigate the association between maternal household decision-making autonomy and adolescents’ school enrollment. Our findings suggest that adolescents, especially girls, benefit from their mothers’ high decision-making autonomy. Findings suggest that maternal decision-making autonomy promotes adolescents’ school enrollment above and beyond other maternal, household, and regional influences.     

Discrimination,Sleep, and Stress Reactivity: Pathways to African American-White Cardiometabolic Risk Inequities

This review provides a model explicating two related physiologic and behavioral pathways through which the chronic daily stress of the expectation and experience of discrimination exposure can shape life course cardiometabolic risk trajectories: sleep and stress reactivity. We argue that these two pathways work together jointly to shape African American-White disparities in cardiometabolic morbidities. The body’s ongoing anticipation of experiencing racism-related stressors disrupts sleep, a behavior highly responsive to stress reactivity, which is also elevated during stressful conditions. The constant feedback between sleep disruption and the body’s stress response can lead to higher allostatic load and disproportionate exposure to stress-related illness among African Americans earlier in their life course.     

An Alternative to Fixed Transition Probabilities for the Projection of Interprovincial Migration in Canada

Internal migration plays a critical role in subnational population projections. The multiregional model is often seen as a gold standard, for its capacity to project several interconnected regions simultaneously and coherently. However, undesirable effects may occur when assumptions of constant transition probabilities are used. This paper investigates these limits, explores a few solutions provided in the literature and describes the alternative methodology used by Statistics Canada in its most recent edition of population projections for the Canadian provinces and territories. Among other things, the new method is shown to improve the consistency between internal migration assumptions and results and to facilitate the projection of the uncertainty associated with this component.     

Highlighting Methodological Limitations in the Steps of Composite Indicators Construction

The paper opens the debate on the need to find a stable methodological framework in the construction of composite indicators (CIs) in order to address the methodological challenges including those of sensitivity and uncertainties related to methods used. As CIs are well-known to be essential in public debate, their methodological construction must be known by a large public. Illustrating CIs’ construction steps by a simple indicator, the paper aims to “democratize” this disciplinary field which is still a black box for some researchers but also to show how composite scores are sensitive to methods used and then, its impacts on policies. For example, in the Sustainable Development Indicator case, the geometric aggregation system is favorable to emerging countries which lead the ranking table whereas high income countries (which are leaders in the linear and equal weight system) except Australia, are misclassified. Uncertainty and sensitivity analysis confirm these results showing that the indexes’ scores seem to be influenced by the orientation (implied theoretical framework) given by its sponsors including policy makers. Regarding the validity of the index, correlation tests with some lights and well known indicators, reveal very consistent results.     

Work–Family Conflict and Well-Being Across Europe: The Role of Gender Context

This study analysed whether gender context is important to differences in the relationship between work–family conflict (WFC) and well-being across Europe. We hypothesised that in countries that support equality in work life and where norms support women’s employment, the relationship between WFC and low well-being is weaker than in countries with less support for gender equality. Cohabiting men and women aged 18–65 years from 25 European countries were selected from the European Social Survey. A multilevel analysis was conducted to investigate the relationship between well-being and WFC, and two measurements were used to represent gender context: gender equality in work life and norms regarding women’s employment. Contrary to the hypothesis, the results showed that the negative relationship was stronger in countries with high levels of gender equality in work life and support for women’s employment than in countries with a relatively low level of gender equality in work life and support for traditional gender relations. The context in which gender is constructed may be important when studying the relationship between WFC and well-being. In addition, emphasis should be placed on policies that equalise both the labour market and the work performed at home.     

Revolution Impact on Drinking Water Consumption: Real Case of Tunisia

Water is considered a major social and political issue. This article stands out by its quantification of the impact of socio-political disturbances on social behavior regarding the consumption of drinking water. It also allows the monitoring of fluctuation of the economic pattern through the main economic sectors during these disturbances by the study of a revolution impact—case of the revolution in Tunisia in January 2011, on the spatial, temporal and sectorial variation of the drinking water consumption. Six water users covering the whole consumption are considered in this study: connected and non connected household users, tourism, industries, collective and various other users. Among the results, in this coastal country, the relation between drinking water consumption by tourism, the touristic activities and the national economy are clearly established. All these components are similarly affected by the socio political disturbances but longer lasting fallouts hit only the most vulnerable regions of the country. Industrial activities that used drinking water seemed to be affected only when the socio political disturbance is at its paroxysm due to strikes, sit-ins of unemployed people, job seekers protests and companies closure. The revolution impacts such as weakening of the State’s authority when facing inappropriate and illegitimate social desires, anarchy, people displacement and refugees are the major causes of non-connected household drinking water waste or over-consumption (up to 89 %) and an alarming increase of the induced breakages (+445 % in 2012 compared to 2010).     

Subjective Well-Being in China: Associations with Absolute,Relative, and Perceived Economic Circumstances

Numerous studies examining the impact of income on subjective well-being (SWB) have found significant positive relationships exhibiting decreasing marginal returns. However, the impact of economic circumstances on SWB is better captured through a combination of income, wealth (per capita net worth), and perceived and relative economic conditions. Using data from the Chinese Household Income Project, I find that within rural and urban China, wealth significantly predicts SWB, exhibiting decreasing marginal returns independent of more common measures of economic circumstances such as income and occupational status. Within urban China, these associations decrease in magnitude and significance with the addition of objective relative measures of wealth and income. Finally, I find that subjective perceptions of relative standard of living are strongly associated with SWB independent of other measures. These results highlight the importance of using multiple objective and subjective measures of economic circumstances, demonstrating potential limitations of studies that have focused exclusively on income as a predictor of well-being. Results are interpreted within the context of China’s changing social and economic structure.