The effects of family position and status on health

Effects of education on adult mortality: a global systematic review and meta-analysis

BACKGROUND

The positive effect of education on reducing all-cause adult mortality is known; however, the relative magnitude of this effect has not been systematically quantified. The aim of our study was to estimate the reduction in all-cause adult mortality associated with each year of schooling at a global level.

METHODS

In this systematic review and meta-analysis, we assessed the effect of education on all-cause adult mortality. We searched PubMed, Web of Science, Scopus, Embase, Global Health (CAB), EconLit, and Sociology Source Ultimate databases from Jan 1, 1980, to May 31, 2023. Reviewers (LD, TM, HDV, CW, IG, AG, CD, DS, KB, KE, and AA) assessed each record for individual-level data on educational attainment and mortality. Data were extracted by a single reviewer into a standard template from the Global Burden of Diseases, Injuries, and Risk Factors Study. We excluded studies that relied on case-crossover or ecological study designs to reduce the risk of bias from unlinked data and studies that did not report key measures of interest (all-cause adult mortality). Mixed-effects meta-regression models were implemented to address heterogeneity in referent and exposure measures among studies and to adjust for study-level covariates. This study was registered with PROSPERO (CRD42020183923).

FINDINGS

17 094 unique records were identified, 603 of which were eligible for analysis and included data from 70 locations in 59 countries, producing a final dataset of 10 355 observations. Education showed a dose-response relationship with all-cause adult mortality, with an average reduction in mortality risk of 1·9% (95% uncertainty interval 1·8-2·0) per additional year of education. The effect was greater in younger age groups than in older age groups, with an average reduction in mortality risk of 2·9% (2·8-3·0) associated with each additional year of education for adults aged 18-49 years, compared with a 0·8% (0·6-1·0) reduction for adults older than 70 years. We found no differential effect of education on all-cause mortality by sex or Socio-demographic Index level. We identified publication bias (p<0·0001) and identified and reported estimates of between-study heterogeneity.

INTERPRETATION

To our knowledge, this is the first systematic review and meta-analysis to quantify the importance of years of schooling in reducing adult mortality, the benefits of which extend into older age and are substantial across sexes and economic contexts. This work provides compelling evidence of the importance of education in improving life expectancy and supports calls for increased investment in education as a crucial pathway for reducing global inequities in mortality.

FUNDING

Research Council of Norway and the Bill & Melinda Gates Foundation.

Super-additive associations between parity and education level on mortality from cardiovascular disease and other causes: the Japan Collaborative Cohort Study

Background

While women’s parity status and education level have independent associations with cardiovascular and other diseases, no studies have evaluated the additive interaction of these two factors. Therefore, we examined the additive interaction between parity and education level on mortality from stroke, coronary heart disease, total cardiovascular disease, cancer, non-cardiovascular disease, and non-cancer causes, and all causes in Japanese women.

Methods

This study followed 41,242 women aged 40–79 years without a history of cardiovascular disease or cancer from 1988 to 1990 until 2009. Baseline parity and education level were classified into four categories, with highly educated parous women as the reference group. Cox proportional hazards regression analyses were performed to calculate the risk of mortality. We also assessed the additive interactions between parity and education level on mortality from cardiovascular disease and other causes using the relative excess risk due to interaction obtained using Cox models.

Results

During the median follow-up period of 19.1 years, we identified 6299 deaths. In a multivariable model adjusted for cardiovascular disease and other disease risk factors, nulliparous women with low education levels had increased multivariable-adjusted hazard ratios of 1.67 (95% confidence interval [CI] 1.13, 2.47) for stroke, 1.98 (95% CI 1.15, 3.39) for coronary heart disease, 1.71 (95% CI 1.34,2.18) for total cardiovascular disease, 1.69 (95% CI 1.33, 2.14) for non-cardiovascular and non-cancer, and 1.51 (95% CI 1.30, 1.75) for all-cause mortality when compared with highly educated parous women. Moreover, we observed significant additive interactions between parity and education level on total cardiovascular disease mortality (P = 0.04), non-cardiovascular disease and non-cancer mortality (P = 0.01), and all-cause mortality (P = 0.005).

Conclusions

Nulliparity and low education levels are super-additively associated with total cardiovascular disease, non-cardiovascular and non-cancer, and all-cause mortality risks, suggesting that nulliparous women with low education levels need specific support for preventing mortality related to cardiovascular and other diseases.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12905-022-01805-y.

Mental health, interpersonal trust and subjective well-being in a high violence context

This paper assesses whether two factors of wellbeing, social capital (interpersonal trust and social networks) and subjective well-being are associated with frequent mental distress and if there are any mediating effects by gender in a city of high urban violence. This paper relies on data that comes from a sample of over 1300 people representative by gender, race/ethnicity, and socioeconomic breakdown of the city of Cali in Colombia, which was collected in 2017 through face-to-face surveys. Our study uses logistic regression with fixed-effects at the district level to control for unobserved time-invariant factors. At the individual level, our analyses account for social and demographic context variables. The dependent variable is mental distress, defined as having 14 or more days feeling mentally ill in the previous 30-day period. Independent variables of interest are "interpersonal trust in unknown people" measured in a scale 0-10 and, social networks measured using the number of family members and close friends and subjective well-being through a question about life satisfaction in a scale 0-10. We find risk factors for mental health distress were low trust in unknown people, low life satisfaction, high levels of depression, living in cohabitation, being female, not having children, and living in middle socio-economic status. The odds of feeling mentally ill decreased as trust in unknown people increased by each unit in the trust scale (OR: 0.92). There were gender differences, with women's mental health being less likely to be affected by lack of interpersonal trust (OR: 0.94) than men (OR: 0.76). Our study suggests that actions aimed at fostering interpersonal trust in unknown people could positively affect mental health distress for both males and females. In the context of high urban violence, our study shows that men are more likely to benefit from such actions.

Adverse birth outcomes in relation to maternal marital and cohabitation status in Canada

PURPOSE

An increasing percentage of children are born to couples who cohabit but are not legally married. Using data from a nationally representative Canadian sample, we estimated associations of maternal marital and cohabitation status with stillbirth, infant mortality, preterm birth (PTB), and small- and large-for-gestational-age (SGA and LGA) birth.

METHODS

The 2006 Canadian Birth-Census Cohort was created by linking birth registration data with the 2006 long-form census. We used log-binomial regression to estimate risk ratios (RRs) for adverse birth outcomes associated with being single or living with a common-law partner. Analyses were adjusted for maternal age and education.

RESULTS

Data were analyzed for 130,931 singleton births. Adjusted RRs (95% confidence intervals) for single mothers compared with married mothers were 1.92 (1.51-2.42) for stillbirth, 2.08 (1.55-2.81) for infant mortality, 1.36 (1.27-1.46) for PTB, 1.31 (1.22-1.39) for SGA birth, and 0.95 (0.90-1.01) for LGA birth. Adjusted RRs for cohabiting mothers compared with married mothers were 0.93 (0.74-1.16) for stillbirth, 1.05 (0.81-1.35) for infant mortality, 1.09 (1.03-1.15) for PTB, 1.05 (0.99-1.10) for SGA birth, and 0.96 (0.92-1.00) for LGA birth.

CONCLUSIONS

In a nationally representative Canadian birth cohort, cohabiting and legally married women experienced similar birth outcomes, but most outcomes for single women were substantially worse.

Marriage and cancer prevention: Does marital status and inviting both spouses together influence colorectal cancer screening participation?

Objectives

This study examined the influence of marital status and inviting both partners together on participation in colorectal cancer screening.

Setting

Data were from a subset of participants from the UK Flexible Sigmoidoscopy Trial (1996–1999).

Methods

Marital status was self-reported, and co-invitation of partner was obtained from the trial database. Screening intentions were assessed in 16,527 adults aged 55–64 years. Attendance was recorded in the 4130 respondents who were subsequently invited.

Results

Multivariate analyses, controlling for age and educational level, indicate that married (or cohabiting) people have more positive intentions (odds ratio [OR] 1.26; 95% confidence interval [CI] 1.14–1.38) and higher attendance rates at screening (OR = 1.23; 95% CI 1.04–1.45) than non-married people. After adjusting for the marriage effect, inviting partners together (co-invitation) significantly increased screening intentions among women (OR = 1.17; 95% CI 1.04–1.31) but not men (OR = 0.97; 95% CI 0.85–1.10). Co-invitation significantly increased attendance at screening in both genders (OR = 1.34; 95% CI 1.14–1.58).

Conclusions

In this age group, married adults are more likely to participate in colorectal cancer screening than the non-married, and inviting both members of a couple together further increases screening uptake. The positive effect of marriage was as strong for women as men.

The Protective Effect of Marriage for Survival: A Review and Update

The theory that marriage has protective effects for survival has itself lived for more than 100 years since Durkheim’s groundbreaking study of suicide (Durkheim 1951 [1897]). Investigations of differences in this protective effect by gender, by age, and in contrast to different unmarried statuses, however, have yielded inconsistent conclusions. These investigations typically either use data in which marital status and other covariates are observed in cross-sectional surveys up to 10 years before mortality exposure, or use data from panel surveys with much smaller sample sizes. Their conclusions are usually not based on formal statistical tests of contrasts between men and women or between never-married, divorced/separated, and widowed statuses. Using large-scale pooled panel survey data linked to death registrations and earnings histories for U.S. men and women aged 25 and older, and with appropriate contrast tests, we find a consistent survival advantage for married over unmarried men and women, and an additional survival “premium” for married men. We find little evidence of mortality differences between never-married, divorced/separated, and widowed statuses.

Depressive symptoms in extended-care employees: children, social support, and work-family conditions

To examine the relation between having a child aged 18 years and under in the home and employee depressive symptoms, we analyzed cross-sectional data from four extended care facilities in Boston, MA (n = 376 employees). Results show that having a child is associated with slightly higher depressive symptoms. The strength of this relationship in our models is attenuated with the inclusion of social support at home (β = 1.08 and β = 0.85, with and without support, respectively) and may differ by gender. We recommend that future research examine the role of parenting and social support in predicting employee mental health.

Marital history, health and mortality among older men and women in England and Wales

BACKGROUND

Health benefits of marriage have long been recognised and extensively studied but previous research has yielded inconsistent results for older people, particularly older women. At older ages accumulated benefits or disadvantages of past marital experience, as well as current marital status, may be relevant, but fewer studies have considered effects of marital history. Possible effects of parity, and the extent to which these may contribute to marital status differentials in health, have also been rarely considered.

METHODS

We use data from the Office for National Statistics Longitudinal Study, a large record linkage study of 1% of the population of England & Wales, to analyse associations between marital history 1971-1991 and subsequent self-reported limiting long-term illness and mortality in a cohort of some 75,000 men and women aged 60-79 in 1991. We investigate whether prior marital status and time in current marital status influenced risks of mortality or long term illness using Poisson regression to analyse mortality differentials 1991-2001 and logistic regression to analyse differences in proportions reporting limiting long-term illness in 1991 and 2001. Co-variates included indicators of socio-economic status at two or three points of the adult life course and, for women, number of children borne (parity).

RESULTS

Relative to men in long-term first marriages, never-married men, widowers with varying durations of widowerhood, men divorced for between 10 and twenty years, and men in long-term remarriages had raised mortality 1991-2001. Men in long-term remarriages and those divorced or widowed since 1971 had higher odds of long-term illness in 1991; in 2001 the long-term remarried were the only group with significantly raised odds of long-term illness. Among women, the long-term remarried also had higher odds of reporting long-term illness in 1991 and in 2001 and those remarried and previously divorced had raised odds of long-term illness and raised mortality 1991-2001; this latter effect was not significant in models including parity. All widows had raised mortality 1991-2001 but associations between widowhood of varying durations and long-term illness in 1991 or 2001 were not significant once socio-economic status was controlled. Some groups of divorced women had higher mortality risks 1991-2001 and raised odds of long-term illness in 1991. Results for never-married women showed a divergence between associations with mortality and with long-term illness. In models controlling for socio-economic status, mortality risk was raised but the association with 1991 long-term illness was not significant and in 2001 never-married women had lower odds of reporting long-term illness than women in long-term first marriages. Formally taking account of selective survival in the 20 years prior to entry to the study population had minor effects on results.

CONCLUSIONS

Results were consistent with previous studies in showing that the relationship between marital experience and later life health and mortality is considerably modified by socio-economic factors, and additionally showed that taking women's parity into account further moderated associations. Considering marital history rather than simply current marital status provided some insights into differentials between, for example, remarried people according to prior marital status and time remarried, but these groups were relatively small and there were some disadvantages of the approach in terms of loss of statistical power. Consideration of past histories is likely to be more important for later born cohorts whose partnership experiences have been less stable and more heterogeneous.

Social capital as a determinant of self-rated health and psychological well-being

OBJECTIVE

To examine whether specific dimensions of social capital are related to self-rated health and psychological well-being.

METHODS

Cross-sectional data from a health survey representing the adult Finnish population (N = 8,028) were used. Logistic regression analysis was used to reveal and quantify the possible associations between three dimensions of social capital (social support; social participation and networks; trust and reciprocity) and two general health indicators (self-rated health and psychological well-being). The roles of age, gender, education, living arrangements, income, type of region, functional capacity, and long-standing illness were also assessed.

RESULTS

Good self-rated health was associated with high levels of social participation and networks and trust and reciprocity, but social support did not remain statistically significant after adjustment for socio-demographic factors, long-standing illness, and functional capacity. The association between social support and psychological well-being was explained by the other two dimensions of social capital. The strong positive association between trust and psychological well-being persisted after controlling for all the other factors in our model.

CONCLUSIONS

Our findings suggest that trust and reciprocity and social participation and networks contribute to good self-rated health and psychological well-being.

Parity-related mortality: shape of association among middle-aged and elderly men and women

Parity is associated with mortality among middle-aged women, while substantially less is known about this relationship for men and the elderly. Using the census-based Israel Longitudinal Mortality Study (ILMS) II (1995-2004) we sought to examine the parity-mortality relationship among men and women, middle-aged and elderly. In our study cohort of 71,733 married men and 62,822 married women ages 45-89 years at baseline, 19,437 deaths were reported. Mortality differentials by parity were assessed using Cox proportional hazard regression models adjusted stepwise for age, origin, education and number of rooms. Analyzes were carried out for middle-aged (45-64 years) and elderly (65-89 years) men and women separately. We observed a non-linear relationship between parity and mortality for all individuals even after adjustment for demographic and socio-economic variables. In fully adjusted models, for example, nulliparous middle-aged women experienced the highest mortality risks (hazard ratios [HR] = 1.57, 95% confidence intervals [CI] 1.24, 1.98) followed by those with one child (HR = 1.29, 95% CI 1.10, 1.51). These results were attenuated somewhat for nulliparous older women (HR = 1.25, 95% CI 1.11, 1.41). The detrimental effects of low and high parity on mortality among both men and women suggest a non pregnancy-related pathway that is likely mediated by biological and psychosocial factors and other lifestyle characteristics that have long-term consequences into older ages. Further research is warranted to examine the effects of parity by specific cause of death.

[Multiple roles and health among Korean women]

OBJECTIVES

Most studies about multiple roles and women's health suggested that combining with paid job, being married and having children was more likely to improve health status than in case of single or traditional roles. We investigated whether there was better health outcome in multiple roles among Korean women coinciding with previous studies of other nations.

METHODS

Data were from the 2005 Korea National Health & Nutritional Examination Survey, a subsample of women aged 25-59 years (N=2,943). Health status was assessed for self-rated poor health, perceived stress and depression, respectively based on one questionnaire item. The age-standardized prevalence of all health outcomes were calculated by role categories and socioeconomic status. Multiple logistic regression was used to assess the association of self rated health, perceived stress, and depression with multiple roles adjusted for age, education, household income, number of children and age of children.

RESULTS

Having multiple roles with working role was not associated with better health and psychological wellbeing. Compared to those with traditional roles, employed women more frequently experienced perceived stress, with marital and/or parental roles. Non-working single mothers suffered depression more often than women with traditional roles or other role occupancy. Socioeconomic status indicators were potent independent correlates of self-rated health and perceived stress.

CONCLUSIONS

Employment of women with other roles did not confer additional health benefit to traditional family responsibility. Juggling of work and family responsibility appeared more stressful than traditional unemployed parental and marital role in Korean women.

Autonomy, paternalism, and justice: ethical priorities in public health

With attention to the field of public health ethics growing, significant time has been devoted to identifying a sound ethical justification for paternalistic interventions that override individual autonomy to prevent people from adopting unhealthy behaviors. Efforts focused on specifying the conditions that warrant paternalism, however, are largely misplaced. On empirical and ethical grounds, public health should seek instead to expand individual autonomy to improve population health. To promote autonomy, the field should redirect current efforts toward clarifying principles of justice. Although public health's most highly visible stance is associated with an egalitarian conception of "social justice," it is imperative that public health professionals address gaping divisions in public understandings of justice. I present recommendations for initiating this process.

The Protective Effect of Marriage on Mortality in a Dynamic Society

PURPOSE

We sought to assess whether the protective effect of marriage on overall and cause-specific mortality has changed over time in a dynamic society.

METHODS

Data from the census-based Israel Longitudinal Studies (ILMS) I (1983-1992) and II (1995-2004) were analyzed. Cox proportional hazard modeling adjusting for sociodemographic factors was applied to 152,150 and 209,125 individuals, ages 45-89 years from the ILMS I and II, respectively. During each study period 31,749 (ILMS I) and 37,656 (ILMS II) deaths were reported.

RESULTS

Mortality inequalities by marital status remained significant and widened over time for middle-aged and elderly men and women. Changes in cause-specific mortality indicated a widening of cardiovascular disease mortality inequalities by marital status. An increasing trend was also noted for deaths from cancer (+25%) and other causes (+38%, p < 0.05) in middle-aged men, but not women (cancer = 0%; other causes = -3%).

CONCLUSIONS

The stronger beneficial effect of marriage over time may reflect societal changes that have differentially affected men and women.

Differences in mortality by marital status in Finland from 1976 to 2000: Analyses of changes in marital-status distributions, socio-demographic and household composition, and cause of death

Being currently not married is more common today than 25 years ago. Over this period relative differences in mortality by marital status have increased in several countries, mainly as a result of a sharp decline in mortality among the married. Using Finnish census data linked with death certificates, we show that these increases are not explained by the non-married population becoming more marginalized in socio-economic status or household composition. However, the increases in marital-status differences in mortality from accidental, violent, and alcohol-related causes of death in the 30-64 age group indicate that changes in the health-related behaviour of the non-married population may play a role. The public-health burden associated with not being married has also grown. At the end of the 1990s about 15 per cent of all deaths above the age of 30 would not have occurred if the non-married population had had the same age-specific mortality rates as the married population.

Sociodemographic determinants of the utilization of specific types of complementary and alternative medicine: an analysis based on a nationally representative survey sample

OBJECTIVES

To evaluate the relationships between selected sociodemographic factors and the use of particular types of complementary and alternative medicine (CAM) in the general U.S. population. CAMs make up a heterogeneous group of practices. Although it is well established that sociodemographic factors impact the use of conventional medicine, it is unclear which, if any, influence the use of particular types of CAM.

DESIGN

Data from a 1997-1998 nationally representative survey (n = 2055) was examined using descriptive and univariate analyses.

RESULTS

The impact of particular sociodemographic factors was found to vary by type of CAM considered. Whites used more CAM than non-Whites except in the case of prayer. Users of CAM tended to be better educated than nonusers with the exception of prayer, self-prayer, and use of a lay midwife. Women used more CAM than men, especially weight-change diet.

CONCLUSIONS

As with conventional medicine use, the patterns of CAM use vary by individual type of therapy considered. Analytically, grouping many heterogeneous practices into the CAM category hides important differences in use patterns.

Marital life course events and smoking behaviour in Sweden 1980–2000

The protective effect of marriage on smoking has been extensively established in the literature. However, less is known about the dynamics of how smoking behaviour is connected to various marital life course events, and whether there are any gender discrepancies in this respect. In this article the connection between the marital life course and smoking is analysed from a stress-related perspective controlling for other socio-economic characteristics. We use information on 81,000 individuals from the Swedish longitudinal micro-level ULF (Survey of Living Conditions) database 1980-2000, which is randomly drawn from the sample population of all Swedes aged 16-84. Logistic regressions on current smoking status and changes in smoking behaviour of participants in the panel part of the data are estimated. The marital life course is strongly linked to smoking behaviour with being or getting married indicating low smoking risks and marital disruption indicating high risks. The divorced smoke to a higher extent than the widowed and there are signs that getting divorced implies higher risks than becoming widowed, both of taking up/relapsing and, for women, not being able to quit. Further, the results indicate that the connection between smoking cessation and living with a partner is stronger for men, whereas women are more affected by the propensity to start smoking after marital disruption. The protective effect of being married on smoking decreases with the age difference between spouses in households where the wife is older than the husband. Taken together, the results yield a rather complex pattern of smoking behaviour over the marital life course. Further, perceived financial stress is strongly connected to smoking and not being able to quit. Controlling for this effect still leaves a socio-economic status gradient in smoking.

Behavioral science at the crossroads in public health: extending horizons, envisioning the future

The social and behavioral sciences are at a crossroads in public health. In this paper, we attempt to describe a path toward the further integration of the natural and behavioral sciences with respect to the study of behavior and health. Three innovations are proposed. First, we extend and modify the "stream of causation" metaphor along two axes: time, and levels of nested systems of social and biological organization. Second, we address the question of whether 'upstream' features of social context are causes of disease, fundamental or otherwise. Finally, we propose the concept of a risk regulator to advance the study of behavior and health in populations. To illustrate the potential of these innovations, we develop a multilevel framework for the study of health behaviors and obesity in social and biological context.

A comparative study of the patterning of women's health by family status and employment status in Finland and Sweden

The main aim of this study is to compare the patterning of health by family status and employment status among women in Finland and Sweden and to explore whether the patterning of health by family status is influenced by employment status and income. An additional aim was to identify which combinations of family status and employment status are especially disadvantageous for women's health . The data derived from comparable interview surveys carried out in 1994/1995. The analyses were restricted to ages 25-49; 2282 women in Finland and 2685 in Sweden. Firstly, age-adjusted prevalence percentages were presented by family status and employment status. Secondly, the patterning of health by family status and employment status, and the influence of adjusting for income, were studied by logistic regression analysis. The main results showed that women living in couples with children had the best health in both countries. Additional analyses showed that in Finland particularly poor health can be found among women who are simultaneously non-partnered and non-employed, whereas in Sweden poor health can be found among all non-employed groups of women. Income did not explain the poor health among the non-partnered and non-employed. This study confirmed that health is patterned by family status and employment status both among Finnish and Swedish women. It was found that non-employed women without a partner are likely to have poor health. In order to reduce inequalities in health among women, more efforts should be put on promoting health among these groups.

Combining Work and Family Life

Abstract. The aim of this paper is to investigate whether the combination of paid employment and taking care of children promotes or challenges the life satisfaction of married and divorced men and women in the UK, Estonia, and Finland. The UK sample stems from the National Child Development Study, at age 42 (N = 10280; 48% of men, 52% of women). The Estonian data come from a representative sample of 1164 participants (507 men, 657 women; mean age 42). The Finnish data stems from an ongoing longitudinal study on 1390 participants (447 men and 943 women; mean age = 41). The results showed that in all three countries women report higher levels of life satisfaction than men, couples are generally more satisfied than divorcees, and those who are employed are generally more satisfied with their lives than those who are not. Second, for men in general as well as for divorced women higher levels of life satisfaction appear to be associated with full-time work. Third, men and women pursuing a professional career are more satisfied with their lives than men and women in unskilled jobs. Finally, having a child shows no significant association with life satisfaction in any of our three countries, although there were significant interactions between gender, marital status, employment, and parenthood. Divorced women in all three countries appear to be more satisfied with their lives if they do not have children, especially after adjusting life satisfaction by occupational status. Findings are discussed with regard to role stress and role accumulation theories.

Premature mortality among lone fathers and childless men

This study focuses on male family situation and premature mortality. For a total of 682,919 men, we analysed mortality from different causes (1991-2000) among lone fathers, with and without custody of their children, and among childless men, with and without partners. Long-term cohabiting fathers with a child in their household were used as comparison group. We employed data from Swedish censuses, national health-data registers, and a Swedish register containing information about known biological relations between children and parents. We investigated the extent to which different kinds of relations were influenced by varying socioeconomic circumstances between groups, and also processes of health selection. The results suggest that lone non-custodial fathers and lone childless men face the greatest increase in risks, especially from injury and addiction, and also from all-cause mortality and ischaemic heart disease. Being a lone custodial father also entails increased risk, although generally to a much lesser extent, and not for all outcomes. The elevated risks found in all the subgroups considered diminished substantially when proxy variables to control for health-selection effects and socioeconomic circumstances were added to the initial model. Risks fell most in response to introduction of the socioeconomic variables, but health selection also played a major role, mostly in the cases of lone non-custodial fathers and lone childless men. However, even following these adjustments, significant risk increases, although greatly attenuated, remained for all the subgroups.

Partner's and own education: does who you live with matter for self-assessed health, smoking and excessive alcohol consumption?

This study analyses the importance of partner status and partner's education, adjusted for own education, on self-assessed health, smoking and excessive alcohol consumption. The relationship between socio-economic factors and health-related outcomes is traditionally studied from an individual perspective. Recently, applying social-ecological models that include socio-economic factors on various social levels is becoming popular. We argue that partners are an important influence on individual health and health-related behaviour at the household level. Therefore, we include partners in the analysis of educational health inequalities. Using data of almost 40,000 individuals (with almost 15,000 Dutch cohabiting couples), aged 25-74 years, who participated in the Netherlands Health Interview Survey between 1989 and 1996, we test hypotheses on the importance of own and partner's education. We apply advanced logistic regression models that are especially suitable for studying the relative influence of partners' education. Controlled for own education, partner's education is significantly associated with self-assessed health and smoking, for men and women. Accounting for both partners' education the social gradient in self-assessed health and smoking is steeper than based on own or partner's education alone. The social gradient in health is underestimated by not considering partner's education, especially for women.

Trends in social inequality in self-reported health in The Netherlands; does infant mortality in year of birth as a cohort indicator matter?

In this article, we study trends in self-reported health (general health and chronic conditions) and health inequality in the Netherlands between 1974 and 1998 using an age-period-cohort framework. We answer two questions: (1) to what extent can trends in self-reported health be explained by the current macro-context (period effect) and by infant mortality in year of birth (cohort effect)? And (2) do the effects of period and cohort differ for educational groups? Health indicators are self-reported poor health and chronic conditions. The use of 26 Dutch cross-sectional surveys makes it possible to estimate largely unbiased effects of period and cohort simultaneously (controlled for age effects) and thus to adequately describe trends in social inequality in health. Our results give rise to four conclusions. First, for men poor health has been more or less stable, for women there has been an increase. The prevalence of chronic conditions has increased for both sexes. Second, adding cohort specific experiences to a model including age and period effects is only relevant for women's poor health. Decreasing infant mortality in year of birth leads to better health and consequently the period effect initially found for women appears to be slightly underestimated. Third, we found no trends in social inequalities in self-reported health due to period effects. Fourth, our analyses do show socially unequal trends in health as a result of cohort specific experiences. Contrary to our hypothesis, we found that decreased infant mortality in year of birth makes for a stronger impact of educational differences on self-reported poor health. Concerning chronic conditions no trends for educational groups were found.

Mortality, severe morbidity, and injury in children living with single parents in Sweden: a population-based study

BACKGROUND

Growing up with one parent has become increasingly common, and seems to entail disadvantages in terms of socioeconomic circumstances and health. We aimed to investigate differences in mortality, severe morbidity, and injury between children living in households with one adult and those living in households with two adults.

METHODS

In this population-based study, we assessed overall and cause-specific mortality between 1991 and 1998 and risk of admission between 1991 and 1999 for 65085 children with single parents and 921257 children with two parents. We estimated relative risks by Poisson regression, adjusted for factors that might be presumed to select people into single parenthood, and for other factors, mainly resulting from single parenthood, that might have affected the relation between type of parenting and risk.

FINDINGS

Children with single parents showed increased risks of psychiatric disease, suicide or suicide attempt, injury, and addiction. After adjustment for confounding factors, such as socioeconomic status and parents' addiction or mental disease, children in single-parent households had increased risks compared with those in two-parent households for psychiatric disease in childhood (relative risk for girls 2.1 [95% CI 1.9-2.3] and boys 2.5 [2.3-2.8]), suicide attempt (girls 2.0 [1.9-2.2], boys 2.3 [2.1-2.6]), alcohol-related disease (girls 2.4 [2.2-2.7], boys 2.2 [2.0-2.4]), and narcotics-related disease (girls 3.2 [2.7-3.7], boys 4.0 [3.5-4.5]). Boys in single-parent families were more likely to develop psychiatric disease and narcotics-related disease than were girls, and they also had a raised risk of all-cause mortality.

CONCLUSIONS

Growing up in a single-parent family has disadvantages to the health of the child. Lack of household resources plays a major part in increased risks. However, even when a wide range of demographic and socioeconomic circumstances are included in multivariate models, children of single parents still have increased risks of mortality, severe morbidity, and injury.

Women, international migration and self-reported health. A population-based study of women of reproductive age

Although our knowledge of the relationship between migration and health in women is increasing, we still have a limited knowledge of the migration and health of women of reproductive age. A cross-sectional analysis of a simple random sample of 10,661 women aged 20-49 in Sweden in 1980-1985 and 9585 such women in 1992-1997 was carried out to assess their health. The risk factors for self-reported, poor health and psychosomatic complaints for female refugees and women from Finland, Southern Europe, Western countries and Sweden were examined. Country of birth was a significant risk factor for poor self-reported health and psychosomatic complaints, with women from Southern Europe, female refugees and Finnish women being at higher risk in this respect than Swedish women. The increased risk remained significant after adjustment for demographic and socio-economic factors. Swedish-born women, female refugees, and Finnish women reported poorer health and had more psychosomatic complaints (not Finns) in the 1990s than in the 1980s.

Socio-demographic factors and self-reported functional status: the significance of social support

BACKGROUND

The aim of the present work was to investigate the relative importance of socio-demographic and physical health status factors for subjective functioning, as well as to examine the role of social support.

METHODS

A cross-sectional health survey was carried out in a Greek municipality. 1356 adults of the general population were included in the study. Personal interviews were conducted with house-to-house visits. The response rate was 91.2%. Functioning has been measured by five indexes: 'The Social Roles and Mobility' scale (SORM), 'The Self-Care Restrictions' scale (SCR), 'The Serious Limitations' scale (SL), 'The Minor Self-care Limitations' scale (MSCR) and 'The Minor Limitations in Social Roles and Mobility' scale (MSORM).

RESULTS

Among the two sets of independent variables, the socio-demographic ones had significant influence on the functional status, except for MSORM. Allowing for these variables, the physical health status indicators had also significant effects on all functioning scales. Living arrangements and marital status had significant effects on four out of five indexes, while arthritis, Parkinson's disease, past stroke and kidney stones had significant effects on the SCR and SL scales.

CONCLUSIONS

These results suggest that socio-demographic factors are as important as physical health variables in affecting a person's ability to function normally in their everyday life. Social support appears to play a significant role in explaining differences in subjective functioning: people living alone or only with the spouse, particularly the elderly, seem to be in greater risk for disability problems and should be targeted by preventive programs in the community.

Social variation in self-rated health in Estonia: a cross-sectional study

Over the past 40 years Estonia has experienced similar developments in mortality to other former Soviet countries. The stagnation in overall mortality has been caused mainly by increasing adult mortality. However, less is known about the social variation in health. This study examines differences in self-rated health by eight main dimensions of the social structure on the basis of the Estonian Health Interview Survey, carried out in 1996/1997. A multistage random sample (n = 4711) of the Estonian population aged 15-79 was interviewed; the response rate was 78.3%. This study includes those respondents aged 25-79 (n = 4011) with analyses being performed separately for men and women. The study revealed that a low educational level, Russian nationality, low personal income and for men only, rural residence were the most influential factors underlying poor health. Education had the biggest independent effect on health ratings: for women with less than an upper secondary education the odds of having poor health were almost fourfold (OR = 3.88) when compared to those with a university education, and for men these odds were almost two and a half times (OR = 2.32). Material resources, in this study measured by personal income, were important factors in explaining some of the educational and ethnic differences (especially for Russian women) in poor self-rated health. Overall, we found no differences between men and women in their health ratings. On the contrary, when we controlled for physical health status, emotional distress and locus of control women reported better health than men. Health selection contributed to, but did not explain the differences by structural dimension. This study also showed a strong association of poor self-rated health with three correlates-physical health status, emotional distress and locus of control, although the influence of these correlates on poor health ratings was not seen equally in the different structural dimensions.

Socioeconomic differences in injury risks in childhood and adolescence: a nation-wide study of intentional and unintentional injuries in Sweden

STUDY OBJECTIVE

To measure socioeconomic differences in injuries among different age groups of children and adolescents.

SUBJECTS

Children under 20 living in Sweden between 1990 and 1994 (about 2.6 million).

METHOD

A cross sectional study based on record linkage between 15 Swedish national registers. Children were divided into four age groups and allocated to four household socioeconomic status groups. Absolute and relative risks were compiled using children of high/intermediate level salaried employees as the comparison group. Four diagnostic groups were considered: fall, traffic, interpersonal violence, and self inflicted injuries.

RESULTS

Injury incidences were relatively low and socioeconomic differences negligible in the 0-4 year olds. Thereafter, significant socioeconomic differences were observed in all diagnostic groups except falls. The highest absolute differences were in traffic injuries, especially among 15-19 year olds, and in self inflicted injuries among 15-19 year old girls. Relative differences were highest in both categories of intentional injuries for the age group 10-14. Social circumstances in the household other than family socioeconomic status affected the social pattern of intentional but not that of unintentional injuries.

CONCLUSIONS

Socioeconomic differences in injury risks are not necessarily constant over age. Inequalities are particularly high in absolute terms among adolescents 15-19 years old for traffic injuries and in relative terms among 10-14 year olds for intentional injuries.

Mortality, severe morbidity and injury among long-term lone mothers in Sweden

BACKGROUND

Being a lone mother often implies disadvantage in terms of both socioeconomic circumstances and health. Our aim was to examine differences in mortality, severe morbidity and injury between lone mothers and mothers living with partners, on the assumption that the disadvantaged socioeconomic circumstances contribute to poor health.

METHODS

The odds for receipt of hospital care or death between 1991 and 1994 were estimated for 26 619 lone mothers and 379 855 partnered mothers from data collected for the Swedish Population and Housing Census of 1990. We computed odds ratios by means of logistic regression, adjusting for confounders, mediators, and factors with an indeterminate position in various models. To control for health-selection effects, we only considered initially healthy women, as measured by non-hospitalization 4 years prior to follow-up. To reduce the impact of distress following divorce on health, we only included mothers who had been either lone or partnered for a period of > or =5 years.

RESULTS

Lone mothers showed increased risks of total mortality, lung cancer, suicide/ suicide attempt, inflicted violence, traffic injury and other accident, psychiatric disease, and addiction. The main explanation for increased risks seems for most outcomes to lie in deficient household resources, as indicated here by receipt of social-welfare benefit and housing situation. For all the initially elevated outcomes, except for total mortality, significant risk increases remained unaccounted for even in the full model. Relationships varied according to subgroup. Lone motherhood was not related to accident, suicide and addiction among medium- and high-grade non-manual workers. Although lone mothers in general showed no increased risk of ischaemic heart disease, those receiving social benefit were exposed to a significantly increased risk.

CONCLUSIONS

Our findings suggest that lone motherhood entails health disadvantages. Lack of household resources seems to play a major role in accounting for increased risks, but the risks are partly independent of socioeconomic circumstances, selection factors, and distress following divorce.

Combining a job and children: contrasting the health of married and divorced women in the Netherlands?

The research question of this paper is whether the combination of paid employment and taking care of children promotes or damages the health of married and divorced women in the Netherlands. To answer this question, data are used from 936 women aged 30-54 years who were either living with a partner (N = 431) or divorced and living alone 505). The findings show that combining a job outside the home and childcare does not harm women's health, irrespective of the length of the working week and the age of the children. In fact, some work-childcare combinations are associated with better health. This is true for both married and divorced women and especially holds true in the case of a part-time job and having older children. Two effects are responsible for the findings: enjoying good health enables mothers to work outside the home (selection effect) and working outside the home promotes mothers' health (health effect).

Multiple roles and health among British and Finnish women: the influence of socioeconomic circumstances

Two contrasting hypotheses have been presented to predict women's health variations. The Multiple burden hypothesis predicts that combining a paid job, being married, and having children is likely to be detrimental to women's health. The multiple attachment hypothesis predicts that multiple roles provide attachment to the community, which is likely to be beneficial to women's health. These hypotheses are examined in Britain and Finland, which have different patterns of women's employment participation. Lone mothers form a critical case, since they have fewer attachments and greater burdens, and therefore are expected to have poorer health. The socioeconomic position of lone mothers differs in Britain and Finland, but in both societies they are likely to have fewer attachments. We assess the extent to which health variations between women with different family and parental role combinations are because of the differences in their socioeconomic status and material circumstances. Comparable surveys from Britain and Finland from 1994 were used. Perceived general health and limiting long-standing illness were analysed for working age women (20-49 years) by family type and employment status. as well as other socioeconomic variables. In both countries, women living in two parent families and having children had better health than women living in other family types or on their own. Lone mothers form a disadvantaged group and showed overall worse health in both countries. Adjusting for employment status. education and household income weakened the association between family type and poor health. The findings are broadly in accordance with the multiple attachment hypothesis. Despite the more generous welfare state and high full-time employment among Finnish women, single lone mothers report poorer health than other women in Finland as well as in Britain. However, in Britain the disadvantaged social position of lone mothers accounts for a greater proportion of their poor health than in Finland.

Separation from children as a specific risk factor to fathers' health and lifestyles

OBJECTIVES

The study was to examine whether fathers living apart from their children following divorce or separation ("fathers without children") differ in their health-related lifestyles and attitudes, and in their health status, from fathers in intact family settings ("fathers with children").

METHODS

Data was acquired by means of a self-administered questionnaire within an exploratory cross-sectional survey.

RESULTS

Fathers without children differed in their lifestyle patterns, parameters of satisfaction, health, and health related orientations from fathers with children. Negative lifestyles could be observed in fathers who had a low income and saw their children only rarely.

CONCLUSIONS

Separation from their children is a major life crisis for fathers. Subgroups could be identified who had significant health risks. Due to study design, conclusions on causation are not possible. Longitudinal studies are necessary to yield more detailed impact for prevention.

Women's social networks and child survival in Mali

This paper explores the influence of women's social networks on child survival through a comparative investigation of two ethnic groups in Mali, West Africa. Data are drawn from a study of women's social networks and health conducted during the period 1996-97. Separate samples of 500 ever-married women aged 15-49 were surveyed at two geographically distinct sites representing Bamanan and Fulbe populations respectively. Consistent with known differences in economic risk, household structure, and cultural norms, descriptive analysis reveals a greater probability of child death among the Fulbe, and a larger mean size of total, material, practical and cognitive networks among the Bamanan. Cox regression models are used to examine the association between social network size, function and composition and the odds of child death (1-5 years). Among the various biological, household and community-level variables tested in the basic model, spacing exerts an expected negative effect on the odds of child death in both groups, while household SES predicts child survival only among Fulbe children. When variables representing the educational and psychosocial attributes of the mother are included, no effects are detected in either group. Controlling for these factors, the size of total, practical, cognitive and emotional networks are found to significantly increase the odds of child survival among the Fulbe only. Compositional variables, such as the extent to which natal kin, non-kin or husbands figure in a woman's network, nor the degree to which networks are located within household yield any significant results for the Fulbe. Among Bamanan women, however, the higher the proportion of network members living in the household, the lower the odds of child death. The paper concludes by discussing the methodological, conceptual and practical implications of these findings.

Socioeconomic status and the prevalence of health problems among married couples in late midlife

OBJECTIVES

This study analyzed the association between socioeconomic status (SES) and the prevalence of mutually occurring health problems among married couples in late midlife.

METHODS

Data consisted of 4746 married couples aged 51 to 61 years from the 1992 US Health and Retirement Study. Two health measures were used: (1) self-assessed health status and (2) an index of functional limitations and activity restrictions. SES indicators were household income, education, and insurance coverage.

RESULTS

In general, after adjustment for age cohort, a strong association was found between the health of a married individual and the health of his or her spouse. SES was highly associated with the joint occurrence of health problems among marriage partners.

CONCLUSIONS

Public health policy should pay particular attention to the interaction between health, SES, and interpersonal relationships.

Mortality among lone mothers in Sweden: a population study

BACKGROUND

An increasing number of lone mothers are experiencing financial and health disadvantages. Our aim was to assess mortality among lone mothers compared with mothers with partners.

METHODS

In this population-based study, overall and cause-specific mortality, between 1991 and 1995, was estimated for 90,111 lone mothers and 622,368 mothers with partners from data collected in the Swedish Population and Housing Census 1990. We estimated relative risks by Poisson regression, adjusted for socioeconomic status, and, to handle health-selection effects, we adjusted for previous inpatient history from 1987 to 1990.

FINDINGS

Lone mothers showed an almost 70% higher premature risk of death than mothers with partners. The excess risk remained significantly increased (relative risk 1.2 [95% CI 1.1-1.4]) after adjustments for socioeconomic status and previous severe somatic and psychiatric inpatient history. Increased mortality was especially pronounced for suicides (2.2 [1.5-3.1]), violence (3.0 [0.9-10.6]), and alcohol-related mortality (2.4 [1.4-4.1]) among mothers who were without a partner in 1985 and in 1990.

INTERPRETATION

The increase of lone mothers in society shows financial, social, and health disadvantages. Nevertheless, the increased mortality risk of lone mothers seems to be partly independent of socioeconomic status and health selection into lone motherhood. For long-term lone mothers the risks may be underestimated when adjusting for selection bias by taking hospital discharge history into account, since these events may be part of the consequences of the stress of lone motherhood.

Gender differences in illhealth in Finland: patterns, magnitude and change

The common wisdom about gender differences in illhealth has been encapsulated in the phrase "women are sicker, but men die quicker". Recently this wisdom has been increasingly questioned. The purpose of this study is first to analyse the patterns and magnitude of gender differences across various indicators of illhealth; second to examine changes over time in these differences and third to assess whether sociodemographic and socioeconomic, family status and social network determinants have any bearing on the differences. The data derive from nationally representative 1986 and 1994 Surveys on Living Conditions in Finland. Women showed poorer health for five out of eight indicators analysed; that is somatic symptoms, mental symptoms, disability among those 50 years or older, long-standing illness and limiting long-standing illness were more prevalent among women than men. Male excess was found for perceived health below good and extremely limiting long-standing illness among those 50 years or older. However, the male excess was statistically significant only for poor perceived health among those 50 years or older. Adjusting for a number of suggested determinants of health had a negligible effect on gender differences. Further analyses showed that gender differences in illhealth remained largely stable over the eight year study period which saw a steep increase of unemployment for both genders. Only in the case of mental and somatic symptoms have gender differences declined, with a simultaneous increase in the prevalence of such symptoms. Otherwise gender differences in illhealth turned out to be resistant to the deep labour market crisis over this relatively short period of time. Although women had poorer health than men for a number of health indicators, we also find gender equality and even male excess for some indicators. Furthermore, the results suggest that a male excess in illhealth is likely to be found with more severe domains of illhealth among elderly people.

Accidents, assaults, and marital status

Marriage may reduce the risk of accidents and assaults by promoting social control of health behavior. This study examines the impact of marital status on non-fatal accidents and assaults in young British women. Data is drawn from a large cohort study of the people born in 1958. Rate ratios of overall and specific incidence of non-fatal accidents and assaults are determined by negative binomial regression, with adjustment for socio-economic and behavioral confounders. The null hypothesis of no association between marital status and incidence of non-fatal accidents and assaults is rejected. It is suggested that, independent of parental status, more exposure to marriage and less exposure to marital dissolution may reduce accidents and assaults.

Social class differences in health and functional disability among older men and women

The aims of the study were to describe the health of older men and women and to investigate the social patterning of health and functional disability among older men and women, with special reference to social class differences. The data were derived from the 1994 nationwide Finnish Survey on Living Conditions (N = 1,448). Functional disability, limiting long-standing illness, and self-assessed health were used as health measures. Sociodemographic measures were social class, marital status, and urbanization. The age-adjusted social class differences were clear. Farmers and workers reported more functional disability and poorer health than did the white-collar class. Differences were somewhat smaller among women than among men. Social class was a stronger determinant than urbanization and marital status of functional disability and health.

Family status and self-reported health in West Germany

The goal of the study was to examine the association between family status and several health-related variables, such as perceived general health, health behavior and self-reported morbidity. Data were derived from Health Surveys conducted in West Germany in the framework of the German Cardiovascular Prevention Study. 25'229 males and 26'097 females, aged 25 to 69 years, were examined. Age-adjusted prevalence odds ratios, calculated by multiple logistic regression analysis, were used as effect measure. The reference category was "married, living with partner" throughout. For most health-related variables significantly higher prevalence odds ratios, indicating unhealthy conditions, were observed for "singles", including persons never married, persons living separated, and divorced or widowed persons. Two or more unhealthy health behaviors were found most frequently for divorced persons of either sex. Age-adjusted odds ratios for self-reporting of three or more chronic diseases were 1.31 (p < 0.01) for divorced males, and 1.66 (p < 0.001) for divorced females. Both men and women who were divorced or separated were characterized by an unfavourable health profile.

The self-reported health status of lone parents

A number of studies have shown that lone parents have poorer health status than the general population. However, what is missing from the existing literature is any systematic assessment of the contribution that lone parents' relatively poor socioeconomic circumstances make to their relative health disadvantage. This paper aims to fill this gap. It employs a large national dataset based on three consecutive years of the British General Household Survey (1992/1993 to 1994/1995) to assess the relative health status of lone parents in comparison to couple parents, and to evaluate the importance of different explanations for their health differences. The results confirm that lone parents, particularly lone mothers, have poor health status relative to parents living as couples. The observed health differences mirror variations in socioeconomic circumstances. However, even when a wide range of demographic and socioeconomic circumstances are included in multivariate models, lone mothers still have significantly poorer health than couple mothers for four out of five health variables. The paper concludes by discussing alternative explanations for the health differences between lone and couple parents--such as the absence of an intimate/confiding relationship, the stress and stigma associated with becoming a lone parent and health selection--and by highlighting future options for policy and research in this area.

Parenthood and lipid and lipoprotein levels in older men

PURPOSE

Parenthood for men and women has been associated with longevity, good physical health, and a deterrent effect on negative health behaviors which may affect subsequent mortality. However, decreased high density lipoprotein cholesterol (HDL-C) levels have been reported in women with greater numbers of pregnancies. Similar studies have not been reported in men. The present study examines the association of number of biological and nonbiological children with lipid and lipoprotein levels in men.

METHODS

Subjects included 1039 community-dwelling men aged 50-89 years. A standardized interview was used to obtain information on numbers of biological, adopted and stepchildren. Fasting total HDL, LDL cholesterol, and triglycerides were measured.

RESULTS

Men with five or more biological children were more obese than men without biological children. Alcohol consumption, cigarette smoking, and exercise did not vary in relation to the number of biological children. Only triglyceride levels were higher in men with four, five, or more children, and lower in men with one child as compared to men with no children, but this difference was no longer statistically significant after adjustment for obesity.

CONCLUSIONS

These results show no favorable effect of parenthood for men with regard to lifestyle, lipid, or lipoprotein levels. Increased triglyceride levels in men with more children appeared to be mediated by greater obesity in men with five or more biological children. These data also suggest that relations between parity and HDL-C levels found for women, could be associated with either the long term biologic consequences of pregnancy or the stress of childrearing.

Health inequalities in the life course perspective

Life history approaches to the study of inequalities in health provide evidence that the biological and the social beginnings of life carry important aspects of the child's potential for adult health. Biological programming may set the operational parameters for certain organs and processes. Social factors in childhood influence the processes of biological development, and are the beginnings of socially determined pathways to health in adult life. Life history studies of health are beginning to show the important factors associated with the development of these pathways, and the life stages at which intervention to reduce adult health inequalities may be most effective.

Marriage protection and marriage selection--prospective evidence for reciprocal effects of marital status and health

Married adults are generally healthier than unmarried adults. It has been hypothesized that marriage is associated with good health because marriage has beneficial effects on health (marriage protection effects) and/or because healthier individuals are more likely to marry and to stay married (marriage selection effects). To investigate these hypotheses, this study analyzes prospective panel data for a large national sample of women in the U.S. (the National Longitudinal Surveys of Young Women). The women were aged 24-34 yr at the beginning of two successive five-year follow-up intervals. Analyses of the prospective data indicate that there were significant marriage protection effects, but only among women who were not employed. Specifically, for women who were not employed, married women had better health trends than unmarried women in each follow-up interval. It appears that marriage had beneficial effects on health for women who did not have a job which could provide an alternative source of financial resources and social support. In addition, analyses of the prospective data provide limited evidence for marriage selection effects. Specifically, women who had better health initially were more likely to marry and less likely to experience marital dissolution, but only for women who were not employed full-time and only during the first follow-up interval. Thus, the prospective evidence suggests that, for women who were not employed, both marriage protection and marriage selection effects contributed to the marital status differential in health observed in cross-sectional data. In contrast, neither marriage protection nor marriage selection effects were observed for women who were employed full-time. As would be expected, the cross-sectional data show that marital status differentials in health were large and highly significant for women who were not employed, whereas marital status differentials in health were much smaller and often not significant for employed women. Women who were neither married nor employed had particularly poor health. Additional evidence indicates that the women who were neither married nor employed suffered from multiple interacting disadvantages, including poor health, low incomes, and sociodemographic characteristics which contributed to difficulty in obtaining employment.

Family life and health in adolescence: a role for culture in the health inequalities debate?

Until recently, the role of the family in the 'health inequalities' debate has been largely ignored. Using data from the youngest cohort in the West of Scotland Twenty-07 Study, three dimensions of family life (family structure, culture and conflict) are examined in respect of their association both with health when respondents were aged 15 and 18, and with labour market position at 18. Despite a strong association between family structure and material deprivation, those from intact, reconstituted and single parent families were largely undifferentiated in terms of health. By contrast, aspects of family functioning, particularly a poorer relationship and conflict with parent(s), were independently associated with lower self-esteem, poorer psychological well-being and (among females) more physical symptoms at both ages. In addition, both family culture and conflict were associated with labour market position over and above the effects of material deprivation, with those from family centred and lower conflict homes having a greater likelihood of being in tertiary education. While the relationships between the family and psychological well-being and, to a lesser extent, physical symptoms appeared to be mediated by self-esteem, those between the family and labour market position did not. These findings suggest that in adolescence family life may have more direct effects on health than material factors and, through social mobility, may be indirectly linked to health inequalities in adulthood. These family processes, we argue, are expressions of cultural influences, the scope of which to date has been too narrowly focused on health behaviours.

Work and health in mothers of young children

Although most mothers of young children work, we do not know much about the effect of this work on the mothers' health. The aim of this article is to review and discuss some of the findings on this subject, in order to understand whether paid and unpaid work are associated with mothers' health. Results from available studies show that, while employment tends to be associated with better physical and mental health in mothers, its effects are inconsistent when mothers of babies or young children are specifically examined. For physical health, employment is likely to have a negative effect for working-class mothers and a positive effect for middle-class ones. For mental health, the trend is unclear; mothers' psychological well-being is negatively affected, however, by the presence of one or more preschoolers, a lack of involvement by the husband, difficulties linked to child care, and the women's preferences concerning their professional status. Moreover, variables such as education, income, social class, housing, and marital status are likely to affect the health of mothers of young children, just as they affect the health of other women.