Do Marriage and Cohabitation Provide Benefits to Health in Mid-Life? The Role of Childhood Selection Mechanisms and Partnership Characteristics Across Countries

Age 19-30 Union Formation Trajectories across the Past 30 Years within the U.S.: Delineating Heterogeneity in Trajectories and its Historical and Sociodemographic Variation

Using data from Monitoring the FutureStudy that include 31 cohorts of high school seniors (1976 to 2006) who were followed from ages 19-30, weidentified heterogeneity in union formation trajectories andits covariates (cohort, sex, race/ethnicity, and parental education). We identified nine trajectorieswith approximately 40% following a single to married sequence (with variation in the timing of the sequence), about 35% remaining single, and the remaining respondents showing considerable heterogeneity.Recent cohortswere more likely to remain single and experience more transitions, women made earlier transitions, and Blackrespondents were less likely to follow pathways entailing marriage.

Workplace wellbeing in community pharmacy practice: A cross-sectional study in Can Tho, Vietnam

Background

Among pharmacy workers, low workplace wellbeing can lead to reduced effectiveness. However, to date, studies on this issue are limited within the community pharmacy setting in Vietnam.

Objectives

This study was conducted to identify the component aspects of workplace wellbeing and their associations with demographic characteristics.

Methods

The cross-sectional descriptive study was conducted in Can Tho, Vietnam. Self-administered questionnaires were hand-delivered to all pharmacy workers working at selected community pharmacies. The workplace wellbeing scale comprised 18 items.

Results

In total, 382 pharmacy workers participated in this study. Factor analysis revealed three fundamental aspects to workplace wellbeing: Factor 1 - perceived self-worth and job satisfaction, Factor 2 - positive emotions with work, and Factor 3 - negative emotions with work. Factor 1 showed a positive correlation with Factor 2, with a correlation coefficient (ρ) of 0.509, while both Factor 1 (ρ = -0.399) and Factor 2 (ρ = -0.416) demonstrated negative correlations with Factor 3. Higher income was associated with higher positive emotions with work (P = 0.008), higher perceived self-worth and job satisfaction (P = 0.013), and lower negative emotions with work (P < 0.001).

Conclusion

Workplace wellbeing of pharmacy workers in their professional environments was associated with financial aspects. These findings suggest that policies aimed at improving income for pharmacy workers could bring benefits to enhancing job satisfaction and workplace wellbeing.

Partnership Status, Health, and Mortality: Selection or Protection?

Married individuals have better health and lower mortality than nonmarried people. Studies show that when cohabitants are distinguished from other nonmarried groups, health differences between partnered and nonpartnered individuals become even more pronounced. Some researchers have argued that partnered individuals have better health and lower mortality because a partnership offers protective effects (protection); others have posited that partnered people have better health and lower mortality because healthy persons are more likely to form a union and less likely to dissolve it (selection). This study contributes to this debate by investigating health and mortality by partnership status in England and Wales and analyzing the causes of mortality differences. We use combined data from the British Household Panel Survey and the UK Household Longitudinal Study and apply a simultaneous-equations hazard model to control for observed and unobserved selection into partnerships. We develop a novel approach to identify frailty based on self-rated health. Our analysis shows that partnered individuals have significantly lower mortality than nonpartnered people. We observe some selection into and out of unions on unobserved health characteristics, but the mortality differences by partnership status persist. The study offers strong support for the marital protection hypothesis and extends it to nonmarital partnerships.

Chronic stress and coping mechanisms among nurses in Lango sub-region, northern Uganda

AIM

This study aimed to assess chronic stress and coping mechanisms among nurses in Lango sub-region, northern Uganda, conducted between May and June 2022.

DESIGN

Institutional-based cross-sectional design conducted between May and June 2022.

METHODS

The study included 498 participants recruited from six health facilities. A 12-Item Short Form Survey tool was used to collect data on chronic stress, while a researcher-developed questionnaire was used to collect data on coping strategies. Descriptive statistics, binary logistic regression and multiple regression were conducted for data analysis. A p-value of 0.05 was considered statistically significant.

RESULTS

Out of 498 participants, 153 (30.7%) were aged between 31 and 40 years, 341 (68.5%) were female, 288 (57.8%) were married, and 266 (53.4%) had less than Diploma. Of the 498 participants, 351 (70.5%) experienced chronic stress. The protective factors against chronic stress were being married (AOR: 0.132; 95% CI: 0.043-0.408; p < 0.001), optimizing shift length (AOR: 0.056; 95% CI: 0.027-0.115; p < 0.001), religiosity/Spirituality (AOR: 2.750; 95% CI: 1.376-5.497; p = 0.004), and regular exercise and breaks (AOR: 0.405; 95% CI: 0.223-0.737; p = 0.003).

Union Status and Disability Pension

A lot is known about the association between marital status and mortality, and some of these studies have included data on cohabitation. Studies on the association with health problems, rather than mortality, are often based on self-reported health outcomes, and results from these studies are mixed. As cohabitation is now widespread, more studies that include data on cohabitation are needed. We use Norwegian register data that include detailed information about union status and all cases of disability pensioning from 2005 to 2016. We employ Cox regression analysis and a within-family design in order to control for hard to measure childhood characteristics. Compared to the married, the cohabiting have a somewhat higher risk of receiving disability pension due to mental disorders, and for men also due to physical disorders. Receipt of disability pension is most common among the never married, especially for men. The association between union status and disability pensioning is stronger for mental than for physical disorders.

Life course partnership history and objectively measured physical functional ability in Danish middle-aged adults

BACKGROUND

Partnership break-up and living alone is associated with several negative health-related outcomes. Little is known about the association with physical functional ability in a life course perspective. The aim of this study is to investigate (1) the association between number of partnership break-ups and years living alone across 26 years of adult life respectively and objectively measured physical capability in midlife, (2) how the joint exposure of accumulated break-ups or years living alone respectively, and education relates to physical capability in midlife and (3) potential gender differences.

METHODS

Longitudinal study of 5001 Danes aged 48-62. Accumulated number of partnership break-ups and years living alone were retrieved from national registers. Handgrip strength (HGS) and number of chair rises (CR) were recorded as outcomes in multivariate linear regression analyses adjusted for sociodemographic factors, early major life events and personality.

RESULTS

Increasing number of years living alone was associated with poorer HGS and fewer CR. Concomitant exposure to short educational level and break-ups or long duration of time living alone respectively was associated with poorer physical capability compared with the groups with long educational level and no break-ups or few years lived alone.

CONCLUSION

Accumulated number of years living alone but not break-ups was associated with poorer physical functional ability. Joint exposure to a high number of years lived alone or break-ups respectively and having a short education was associated with the lowest levels of functional ability, which points towards an important target group for interventions. No gender differences were suggested.

Mental health benefits of cohabitation and marriage: A longitudinal analysis of Norwegian register data

The aim is to examine how mental health is affected by cohabitation and marriage. Individual fixed-effects models are estimated from Norwegian register data containing information about consultations with a general practitioner because of mental health conditions in 2006-19. Mental health, as indicated by annual number of consultations, improves over several years before cohabitation. For those marrying their cohabiting partner, there is a weak further reduction in consultations until the wedding, but no decline afterwards. In other words, formalization of the union does not seem to confer additional mental health benefits. However, marriage may be considered a marker of favourable earlier development in mental health. In contrast, there is further improvement after direct marriage, as well as stronger improvement over the years just preceding direct marriage. Patterns are quite similar for women and men. Overall, the results suggest that the mental health benefits of cohabitation and marriage are similar.Supplementary material for this article is available at: https://dx.doi.org/10.1080/00324728.2022.2063933. Note: numbers in brackets refer to supplementary notes that can be found at the end of the supplementary material.

Sleep hours and quality before and after baby: Inequalities by gender and partnership

While prior studies have examined sleep across the lifecourse, few studies have investigated sleep around the birth of a child, one of the most important events to cause sleep deprivation. This study investigates changes in sleep hours and quality, paying attention to differences by gender and partnership status. Using the UK Household Longitudinal Study, we follow approximately 1,000 participants as they transition into parenthood in a three-year window. We use OLS and logistic regression to analyze changes in sleep hours and sleep quality. Results suggest that women's sleep is reduced by an average of 0.7 hours (42 min) on becoming a mother. Whilst before parenthood women sleep more than men, after childbirth women and men sleep similar amounts. Cohabiting men experience a greater reduction in sleep by around 0.5 hours (30 min) than married men, to the level similar to women, suggesting that new cohabiting fathers may experience more sleep disturbances.

Sexual intimacy and relationship happiness in living apart together, cohabiting, and married relationships: evidence from Britain

Research on relationship happiness have traditionally compared cohabiting and married relationships. Studies including LAT relationships are scarce and have disregarded sexual aspects of the relationships. This paper compares how married, cohabitating, and LAT relationships in Britain differ with respect to sexual intimacy (defined as emotional closeness during sex, compatibility in terms of sexual preferences, and interest in having sex with a partner), and relationship happiness. Rich data from the British National Study of Sexual Attitudes and Lifestyles (NATSAL-3, 2010–2012) are used to estimate ordered logistic regression models. Cohabiting individuals share the same levels of sexual intimacy as those married, but they are less happy in their relationship than those married. LAT individuals enjoy overall greater sexual intimacy than coresidential individuals but they are less happy in their relationships. Women in LAT relationships feel less often emotionally close to their partner during sex than married women. By knitting the sex research with the demographic literature, this paper offers new insights in understanding the nature of partnerships, opening up new venues for future research.

Probability of males to outlive females: an international comparison from 1751 to 2020

OBJECTIVE

To measure sex differences in lifespan based on the probability of males to outlive females.

DESIGN

International comparison of national and regional sex-specific life tables from the Human Mortality Database and the World Population Prospects.

SETTING

199 populations spanning all continents, between 1751 and 2020.

PRIMARY OUTCOME MEASURE

We used the outsurvival statistic ( φ ) to measure inequality in lifespan between sexes, which is interpreted here as the probability of males to outlive females.

RESULTS

In random pairs of one male and one female at age 0, the probability of the male outliving the female varies between 25% and 50% for life tables in almost all years since 1751 and across almost all populations. We show that φ is negatively correlated with sex differences in life expectancy and positively correlated with the level of lifespan variation. The important reduction of lifespan inequality observed in recent years has made it less likely for a male to outlive a female.

CONCLUSIONS

Although male life expectancy is generally lower than female life expectancy, and male death rates are usually higher at all ages, males have a substantial chance of outliving females. These findings challenge the general impression that 'men do not live as long as women' and reveal a more nuanced inequality in lifespans between females and males.

Do characteristics of family members influence older persons' transition to long-term healthcare services?

BACKGROUND

Future demographic and economic changes warrant a better understanding of older persons' need for health-related long-term care services (LTC). LTC uptake among older people is likely to be influenced by the presence or absence of family members, but there is scarce research on the role played by partners with different caregiving potential. There is even less research on the contributions of adult children and their caregiving potential. The current study examines the extent to which transitions into LTC in older men and women differ according to the presence and caregiving potential of partners and children.

METHODS

Linked registry data for Norway on older persons (aged 65+), their partners, and their adult children are used to examine how characteristics of these family members influence transitions into LTC from 2010 to 2016, using logistic discrete-time hazard regression models. We observed around 215,000 transitions to LTC, corresponding to around 26.3% of individuals and 5.4% of the total person-years (4.0 million). Caregiving potential is measured in terms of employment, income, health and educational attainment for partners and education and geographical proximity for children.

RESULTS

Personal, partner and child(ren)'s resources are all associated with older persons' LTC uptake. Unpartnered and/or childless older people are more likely to use LTC than those with partners and/or child(ren). Older persons with resourceful partners and children are the least likely to transition into LTC. The geographical proximity of adult children appears to have only a minor influence on LTC use among older people.

CONCLUSIONS

Population ageing and strained public resources will likely challenge the future provision of formal old-age care. The role of family networks in the future provision of formal old-age care is expected to become progressively important in the years to come. Inequalities in the health, care and welfare of older persons with and without resourceful family members are likely to increase.

The gender pension gap in Germany: is divorce a gender-equaliser?

Germany is one of the few countries in Europe that has implemented a system of ‘divorce splitting’. Under this system, the pension credits that spouses have accumulated during their marriage are combined and then split equally between them upon divorce. This study examines how divorce affects public pension entitlements in Germany, and how these patterns are influenced by the system of divorce splitting. The data for our analysis comes from SHARE-RV, a direct linkage of the Survey of Health, Ageing and Retirement in Europe (SHARE) with administrative data of the research data centre of the German Pension Insurance Fund (Deutsche Rentenversicherung Bund). The data include information on the beneficiaries’ monthly earnings and employment biographies, as well as on their pension entitlements and the credits they received through divorce splitting. The results of the analysis, which was restricted to West German men and women born between 1935 and 1954, reveal that there are large gender gaps in public pension benefit levels. However, the investigation also shows that single and divorced West German women have larger personal pension entitlements than their married or widowed counterparts. Furthermore, the public pension entitlements of divorced men and women in West Germany are very similar. This can be attributed partially to the divorce-splitting system, which tends to increase the pension benefits of divorced women, while reducing the pension benefits of their male counterparts.

Cohabitation, Relationship Stability, Relationship Adjustment, and Children's Mental Health Over 10 Years

Understanding risk factors for relationship dissolution and poor relationship adjustment among couples has been an active area of research in relationship science. One risk factor, non-marital cohabitation, has shown to predict higher rates of relationship dissolution and relationship instability in some samples, but the associations among German parents with children over time are less clear. In this study, we examined the links between non-marital cohabitation and 10-year outcomes (relationship dissolution, relationship adjustment over time, and child internalizing and externalizing symptoms) in 220 German families with preschool-aged children at the initial assessment followed into adolescence. Families were assessed 7 times over the 10 years and retention at the 10-year follow-up was over 92%. After accounting for multiple testing, only mother’s report of better initial interparental communication predicted whether parents were likely to stay together over the course of the 10 years. Adolescents of parents who cohabited were at higher risk for externalizing symptoms 10 years later compared to children of married parents. In addition, although there were no differences between cohabiting couples and married couples at the initial assessment in relationship adjustment, cohabiting mothers who stayed with their partner over the 10 years showed significantly greater declines in relationship adjustment over the 10 years compared to married mothers. Findings indicate the need for further research that explores family structure and dynamics over time to inform refinement of prevention programs targeting relationships and children’s mental health.

Healthy ageing: Assessment of health-promoting lifestyle among the elderly population in Karachi Pakistan

BACKGROUND

The growth in the elderly population is predicted to expand exponentially and developing countries like Pakistan have about two-third of the global elderly population. It is vital to maintain the health of the elderly aged population to reduce disabilities and health-care cost.

AIM

This study aimed to determine the health promotion practices among the older aged population in Pakistan and to explore the factors associate with adopting healthy lifestyle practices.

MATERIALS AND METHODS

This was a cross-sectional study spanning from 2019 to 2020 conducted on 317 participants of age more than 60 years in Pakistan. The participants included healthy attendants of patients visiting the outpatient clinics of different disciplines in the Liaquat National Hospital Karachi through purposive sampling technique. The health-promoting practices were assessed using Health-Promoting Lifestyle Profile II Questionnaire. The factors that determined the healthy practices among the elderly population were identified using independent t-test and analysis of variance and Tukey test, with a significance level of P < 0.05. IBM SPSS Statistics 22 was used for data entry and analysis.

RESULTS

The highest subscale was detected from interpersonal relationships and spiritual growth. The lowest score was detected from physical activity. The scores differed significantly by occupation, education, and the marital status of the participants. Females, unmarried people, those who were less educated, and participants relying on others for financial support had lower health-promoting lifestyle scores.

CONCLUSION

The overall health-promoting practices were good among the old-aged population of Pakistan. These practices differed particularly for physical activity, spiritual growth, and interpersonal relationships.

Racial Disparities and COVID-19: Exploring the Relationship Between Race/Ethnicity, Personal Factors, Health Access/Affordability, and Conditions Associated with an Increased Severity of COVID-19

COVID-19 was recognized as a pandemic in the United States in March 2020. Since the emergence, research has explored conditions associated with the illness; however, racial disparities remain underexplored. The purpose of this paper is to explore disparities in conditions associated with an increased severity risk of COVID-19 including race, personal factors, healthcare accessibility, and affordability. Using data from the 2018 National Health Interview Survey (NHIS), univariate and multivariate analysis were performed. More Non-Hispanic (NH) Blacks (61.1%) and NH Whites (61.2%) had conditions associated with increased severity risk of COVID-19 compared to Hispanics (47.1%) (p < .001). Racial differences revealed a higher proportion of NH Blacks with increased severity risk of COVID-19 were female (p < .001), not married (p < .001), not employed for wages (p < .001), had accessibility issues with transportation (p < .001), and had affordability issues with paying for medicine (p < .001). A higher proportion of Hispanic persons had a health place change (p = .020), had accessibility issues (e.g. telephone (p < .001), longer wait times (p < .001), closed facility (p = .038)) and had affordability issue with worrying about pay (p < .001). Significant predictors that were positively associated with increased severity risk of COVID-19 for all racial/ethnic groups were being NH Black, older age, having appointment issues, and affordability issues with medicine. Differences in magnitude across racial group dynamics were observed. Racial disparities exist in conditions associated with increased severity risk of COVID-19. As future policies and interventions are developed, it is important to consider differentials across racial group dynamics.

Marital separation and contact with primary healthcare services for mental health problems: a register-based study

BACKGROUND

Marital separation is associated with mental health problems, but little is known about how this translates into healthcare use. In this study, we examine the relationship between marital separation and primary healthcare use for mental health problems.

METHODS

We used data covering the period from 2005 to 2015 from the Norwegian Population Register, Statistics Norway's Educational Registration System and the Norwegian Health Economics Database. Data were analyzed using logistic regression analysis. To control for time invariant characteristics, we estimated fixed-effect models.

RESULTS

Marital separation was associated with increased contact with primary healthcare services for mental health problems (MH-consultations). The prevalence of MH-consultations peaked during the year of marital separation. MH-consultations were more common following marital separation than prior to the separation. This pattern remained significant in the fixed-effect models.

CONCLUSIONS

Men and women who experienced marital separation were more likely to consult primary healthcare services for mental health problems than those who remained married. Our study suggests that several mechanisms are in play. The prevalence of MH-consultations of those who eventually separated were higher several years prior to the separation. This lends support to selection mechanisms, whereas the sharp rise in the prevalence of MH-consultations around the time of marital separation coupled to higher levels several years after separation, indicate that marital separation induces both transient stress and leads to more lasting strain.

Trends in self-rated health by union status and education, 2000-2018

Previous research has documented changes in health differentials by marital status over time. However, recent shifts in family patterns and continuing socioeconomic changes necessitate analyses of more recent changes in union status and self-rated health. Using pooled data from the 2000-2018 National Health Interview Survey (n = 788,829), this study examines educational differences in trends in self-rated health among married, cohabiting, previously-married, and never-married adults. The results of a series of logistic regression models show increasing divergence in self-rated health by union status and by education, driven mostly by declining self-assessed health in middle educational strata (high school graduate and some college), and among single adults, particularly never-married adults. The findings add to the growing evidence of increasing social class divide in family and health outcomes. Evolving trends in self-rated health by union status and education have important implications for programs promoting health and wellbeing across families.

Florida neighborhood analysis of social determinants and their relationship to life expectancy

BACKGROUND

Social determinants of health (SDOH) contribute to unequal life expectancy (LE). Only a handful of papers have analyzed these relationships at the neighborhood level as opposed to the county level. This study draws on both the SDOH and social vulnerability literature to identify relevant factors affecting LE.

METHODS

LE was calculated from mortality records for Florida from 2009 to 2013 for 3640 census tracts with reliable estimates. A spatial Durbin error model (SDEM) quantified the direction and magnitude of the factors to LE. The SDEM contains a spatial error term and jointly estimates both local and neighborhood associations. This methodology controls for non-independence between census tracts to provide unbiased statistical estimates.

RESULTS

Factors significantly related to an increase in LE, include percentage (%) of the population who identify as Hispanic (beta coefficient [β]: 0.06, p-value [P] < 0.001) and % of age dependent populations (% population < 5 years old and % population > 65) (β: 0.13, P < 0.001). Conversely, the following factors exhibited significant negative LE associations, % of households with no automobile (β: -0.05, P < 0.001), % of mobile homes (β: -0.02, P < 0.001), and % of female headed households (β: -0.11, P < 0.001).

CONCLUSIONS

Results from the SDEM demonstrate social vulnerability indicators account for additional geographic LE variability beyond commonly studied SDOH. Empirical findings from this analysis can help local health departments identify drivers of spatial health disparities at the local level.