Marriage, Social Control, and Health Behavior: A Dyadic Analysis of Same-sex and Different-sex Couples

Who's Worried? Memory, Worries About Dementia, and Marital Strain in Midlife Same- and Different-Sex Marriages: A Dyadic Perspective

OBJECTIVES

Prior scholarship has highlighted the importance of marriage for cognition. However, little research has considered how cognition-related concerns may impact marriage. In this study, researchers examine how aging couples view each other's memory and worry about their potential development of dementia in the future. Additionally, researchers investigate whether these cognition-related concerns may strain marriage, and how these dynamics differ for men and women in same- and different-sex marriages.

METHODS

Researchers used 2 waves of dyadic data from the Health and Relationships Project (HARP; 2015-2022), including 594 respondents from 297 same- and different-sex married couples (aged 41-71 at Time 2). Researchers employed the Actor-Partner Interdependence Model (APIM) to explore associations between actor and partner reports of memory and dementia worry with marital strain.

RESULTS

Men and women in same- and different-sex marriages were equally likely to report worries about their own potential development of dementia. However, women reported more concerns about their spouse developing dementia in the future than men did, regardless of whether they were married to a man or a woman. Both partners' reports of memory and dementia worry played a complex role in influencing marital strain, with variations observed across couple types.

DISCUSSION

Concerns about cognitive decline and dementia are common in older populations, and for married couples, spouses have concerns about their own memory as well as that of their partner. Researchers finding identified the significance of concerns about a spouse's memory on marital dynamics among aging couples.

Couples-based health behavior change interventions: A relationship science perspective on the unique opportunities and challenges to improve dyadic health

Epidemiological studies indicate that better marital quality is associated with less morbidity and premature mortality. A number of interpersonal processes related to marital quality are also associated with health-relevant surrogate biomarkers across different physiological systems. Despite these replicated correlational findings, few interventions have harnessed interpersonal processes as potential interventions to enhance health. Building on Dr. Janice Kiecolt-Glaser's model of relationships and health, we propose that couples-based health behavior change interventions may represent an effective way to decrease dysregulation across autonomic, endocrine and immune systems and, ultimately, improve dyadic health. Given that the cohabiting partner is an essential part of the social context in which the behavior change is being pursued, it is important to consider the relational issues triggered by dyadic interventions. Using a relationship science perspective, this article reviews the literature on couples' concordance in health behaviors and health outcomes, the potential pathways underlying this concordance, theories of the couple as a self-sustaining social system, dyadic adaptation of individual self-regulation strategies, effective and ineffective social support and social control in couple relationships, the integration of relationship-building and health behavior change strategies, and the consideration of key moderators related to the nature of the relationship and the context surrounding the relationship. These findings highlight the importance of adopting a relationship science perspective when designing and testing dyadic interventions to improve health outcomes. The data reviewed provide insights on how to optimize couples-based health behavior change interventions to reduce physiological dysregulation and improve dyadic health.

Health-related social control among U.S. adults ages 30-80: Associations with alcohol use over four years

Health-related social control (HRSC) includes efforts to regulate or influence others' health behaviors and is an important way interpersonal relationships can affect individual-level health. This study used egocentric network data to describe the size and composition of HRSC networks, identify trajectories of HRSC receipt, and examine how HRSC is related to binge drinking and alcohol-related problems. Data come from a U.S. nationally representative sample of 1235 adults age 30 and older (baseline mean age = 52, 52% female, 64% White) who completed four annual surveys between 2019 and 2022. On average, 30% of adults' network members were HRSC agents who told or reminded them to do things to protect their health. At baseline, 50% of respondents identified a spouse/partner as a HRSC agent, 56% a relative, 46% a friend, and 12% someone else. Respondents' relationships with HRSC agents were generally strong, 93% of agents were described as people "whose opinion matters," and only 10% were described as hassling or making life difficult for the respondent. Growth mixture modeling identified five trajectories of HRSC receipt over the four-year period: Stable High (36% of sample), Stable Moderate (47%), Stable Low (14%), Decreasing (2%), and Increasing (2%). Binge drinking was relatively consistent for the three Stable HRSC classes (ranging from 11% to 15% of individuals), decreased steadily for the Increasing HRSC class (32%-16%), and fluctuated for the Decreasing HRSC class (decreasing from 10% to 2%, then increasing to 8%). For alcohol problems, the Increasing HRSC class showed the largest increase (2%-21%) before dropping to near-baseline levels (4%), whereas the Decreasing HRSC class fluctuated during the first three waves followed by no individuals reporting alcohol problems at the last wave. Results highlight the importance of examining heterogeneity in adults' HRSC experiences because of its implications for understanding social influences on health-related behaviors.

What impact does hearing impairment have on cognitive health in older married couples in China?

Hearing impairment is a common geriatric health problem and chronic stressor, and it is associated with poor cognitive outcomes. However, little is known about the impact of hearing impairment in married couples, particularly its potential spillover effects on the cognitive health among spouses of individuals with impairment. Drawing on a stress-proliferation perspective, we used actor-partner interdependence models to examine (1) whether an individual's hearing impairment influences their spouse's cognitive function; and (2) whether AL, symptoms of depression, and social participation serve as mediators for such an association. We utilized data from the 2015 (baseline) and 2018 (3-year follow-up) waves of the China Health and Retirement Longitudinal Study. 4434 couples were included at baseline, and 2190 couples remained after the 3-year follow-up. Hearing impairment among married women was associated with negative impacts on their spouses' cognitive function. Symptoms of depression and social participation may have served as potential mediators in this relationship. For married men, there was no statistically significant association between hearing impairment and spouses' cognitive function. Our findings suggest that hearing impairment among one spouse can lead to negative impacts on the other, but that this effect may depend on gender. Early diagnosis and couple-based interventions for hearing impairment are important for the cognitive health of both hearing-impaired individuals and their spouses.

Confirmation, Disconfirmation, and Communal Coping for Joint Physical Activity in Romantic Dyads

Most people in the United States do not engage in sufficient physical activity (PA). However, certain communication behaviors from romantic partners can motivate PA. Research indicates that confirming communication and communal coping (CC) in romantic relationships can increase PA efforts, but less research has examined the role of explicitly disconfirming communication or relationships between confirmation, disconfirmation, and CC on PA outcomes. We examined models in which shared PA appraisals mediate relationships between (a) confirmation and (b) disconfirmation and joint PA behavior in heterosexual, romantic dyads. Sex differences in actor and partner effects were also considered. Partners (N = 144) in 72 dyads completed assessments of key constructs. Results indicated that shared PA appraisals were critical in the confirmation model, mediating relationships between perceptions of confirmation and reports of joint PA. Unexpectedly, both partners' reports of partner disconfirmation were positively associated with their partners' reports of joint PA. Only one statistically significant sex difference emerged. Theoretical and pragmatic implications are discussed.

Unpacking Intersectional Inequities in Flu Vaccination by Sexuality, Gender, and Race-Ethnicity in the United States

Health care research has long overlooked the intersection of multiple social inequalities. This study examines influenza vaccination inequities at the intersection of sexuality, gender, and race-ethnicity. Using data from the 2013 to 2018 National Health Interview Survey (N = 166,908), the study shows that sexual, gender, and racial-ethnic identities jointly shaped flu vaccination. Specifically, White gay men had the highest vaccination rate (56%), while Black bisexual women had the lowest rate (23%). Across Black, Hispanic, and White individuals, sexual minority women had lower vaccination rates than heterosexual women, but sexual minority men had higher or similar vaccination rates than heterosexual men. Economic enabling, noneconomic enabling, and need-based factors together explained a substantial portion of these gaps. However, they cannot explain all the disadvantages faced by Black lesbian, bisexual, and heterosexual women and Black heterosexual men. Findings offer new evidence of hidden health care inequities and inform health policies from an intersectional perspective.

The impact of marital status on tumor aggressiveness, treatment, and screening among black and white men diagnosed with prostate cancer

PURPOSE

To examine the association of marital status with prostate cancer outcomes in a racially-diverse cohort.

METHODS

The study population consisted of men (1010 Black; 1070 White) with incident prostate cancer from the baseline North Carolina-Louisiana Prostate Cancer (PCaP) cohort. Marital status at time of diagnosis and screening history were determined by self-report. The binary measure of marital status was defined as married (including living as married) vs. not married (never married, divorced/separated, or widowed). High-aggressive tumors were defined using a composite measure of PSA, Gleason Score, and stage. Definitive treatment was defined as receipt of radical prostatectomy or radiation. Multivariable logistic regression was used to examine the association of marital status with (1) high-aggressive tumors, (2) receipt of definitive treatment, and (3) screening history among Black and White men with prostate cancer.

RESULTS

Black men were less likely to be married than White men (68.1% vs. 83.6%). Not being married (vs. married) was associated with increased odds of high-aggressive tumors in the overall study population (adjusted Odds Ratio (aOR): 1.56; 95% Confidence Interval (CI): 1.20-2.02) and both Black and White men in race-stratified analyses. Unmarried men were less likely to receive definitive treatment in the overall study population (aOR: 0.68; 95% CI: 0.54-0.85). In race-stratified analyses, unmarried Black men were less likely to receive definitive treatment. Both unmarried Black and White men were less likely to have a history of prostate cancer screening than married men.

CONCLUSION

Lower rates of marriage among Black men might signal decreased support for treatment decision-making, symptom management, and caregiver support which could potentially contribute to prostate cancer disparities.

Examining the role of social relationships on health and health behaviors in African American men with prostate cancer: a qualitative analysis

PURPOSE

Cancer survivor cohort studies document the positive impact of health behaviors on cancer survivorship by influencing quality of life, comorbidity burden, and cancer recurrence. Social networks can be instrumental in supporting health behavior changes. This study used qualitative interviews to explore how social networks may impact health and health behaviors of African American Prostate Cancer Survivors (AAPCS) enrolled in Men Moving Forward (MMF), a lifestyle intervention designed with and for AAPCS. Specifically, we sought to understand how different relationships within social networks influence health and health behaviors, and to identify potential mechanisms for this influence.

METHODS

Eighteen men who completed the MMF intervention participated in a semi-structured interview which explored social connections, health and health behaviors, stress, and the cancer experience. Interviews were recorded and transcribed, and thematic analysis was performed by two coders.

RESULTS

Participants described robust social networks of friends and family. Four distinct yet overlapping themes were identified that described how relationships influence health and health behaviors among AAPCS: (1) provision of knowledge, (2) health and behavior history, (3) encouragement and support, and (4) shared behavior.

CONCLUSIONS

These results provide initial insight into the types of relationships that influence health, and the intersecting and multifaceted mechanisms through which this influence occurs.

Pressurizing or encouraging: Health behaviors among long-distance couples

Couples in long-distance relationships face unique challenges that affect their health outcomes and relationship dynamics in ways that are different from couples in close proximal relationships (PR). The results of previous literature analyzing health outcomes for long-distance relationship (LDR) couples have been mixed, and factors such as couple satisfaction and gender of the individuals contribute to the variance. This study examined the good health practices of couples in LDRs, the ways in which partners influence each other's health, and the health outcomes of these couples as compared to couples in PRs. Multilevel multivariate analysis showed that couples in LDRs had better health practices than those in PRs, and men overall had poorer health practices than women. There was no main effect seen for LDRs when we examined strategies used for influencing health. There was a main effect for gender, though, and we found that women tend to use more collaborative and pressurizing strategies for influencing their partner's health. On health indices, we found that LDR couples tended to have lower levels of fatigue and sleep disturbance as compared to PR couples. In the adjusted model with covariates, which included age, income, couple satisfaction, and married or unmarried couples, we found that lower couple satisfaction and lower income significantly predicted poorer health on all health indices. These results are discussed in light of unequal gender roles, social control, and positive aspects of LDRs on health in an attempt to understand LDRs better and destigmatize the narrative of these relationships as 'less than' PRs. Implications for health and mental health practitioners are also discussed.

Who Cares? Unpaid Caregiving by Sexual Identity, Gender, and Partnership Status Among U.S. Adults

Recent scholarship indicates that sexual minority adults have higher caregiving rates than heterosexuals and that women are more likely to be caregivers than men. However, little research has addressed how gender and sexuality intersect in shaping caregiving status. This study uses data from the Behavioral Risk Factor Surveillance System and aggregates a probability-based sample of adults living in 36 U.S. states between 2015 and 2021. We examine who provides care among adult heterosexual, lesbian, gay, and bisexual men and women. Results reveal that women are more likely to be caregivers than men, but only among heterosexuals. We find little variation in caregiving by sexuality among women, but bisexual men are more likely than heterosexual men to be caregivers; the latter result appears to be driven by unpartnered, bisexual men. Lastly, we contextualize caregivers' experiences and reveal selected descriptive differences in patterns of care recipient-caregiver relationships across gender and sexual identity groups. Our findings advance understanding of caregiving and changing family ties in an era of population aging and increasing diversity in sexual identities.

The Changing Demography of Late-Life Family Caregiving: A Research Agenda to Understand Future Care Networks for an Aging U.S. Population

Repeated claims that a dwindling supply of potential caregivers is creating a crisis in care for the U.S. aging population have not been well-grounded in empirical research. Concerns about the supply of family care do not adequately recognize factors that may modify the availability and willingness of family and friends to provide care to older persons in need of assistance or the increasing heterogeneity of the older population. In this paper, we set forth a framework that places family caregiving in the context of older adults' care needs, the alternatives available to them, and the outcomes of that care. We focus on care networks, rather than individuals, and discuss the demographic and social changes that may alter the formation of care networks in the future. Last, we identify research areas to prioritize in order to better support planning efforts to care for the aging U.S. population.

Effects of Subjective Orgasm Experience in Sexual Satisfaction: A Dyadic Analysis in Same-Sex Hispanic Couples

Subjective orgasm experience (SOE) is a component of sexual health that refers to the perception, sensation and/or appraisal of orgasm at a psychological level. This construct has scarcely been studied in non-heterosexual individuals and couples, and never before from a dyadic perspective. In this study, in which 104 same-sex Hispanic couples participated (48 male-male and 56 female-female), we explored the dyadic influence of SOE dimensions on sexual satisfaction, the mediating role of relationship satisfaction on the association of both phases of sexual response, as well as the explanatory capacity that discrepancies in these dimensions had on sexual satisfaction. The results indicated that the orgasmic dimensions that gained more prominence were Affective and Sensory. A dyadic influence of both on sexual satisfaction was observed only in male couples, as well as a detriment of sexual satisfaction when there were discrepancies in them, especially in women. Moreover, relationship satisfaction was a significant mediator between all dimensions of SOE and sexual satisfaction in both types of couples. This work highlights the need to take into account the SOE of both partners and how this individual experience can affect other dimensions of a more interpersonal nature, such as sexual or relationship satisfaction.

Comparative Analysis of Gender and Age Patterns in Informal Care Received among Disabled Older Adults: A Cross-National Study across the United States, Mexico, China, and Indonesia

This paper examines cross-national differences by gender and age in receipt and sources of help for limitations with activities of daily living or instrumental activities of daily living among older adults in the United States, Mexico, China, and Indonesia. Respondents aged 50 + from the Health and Retirement Study, Mexican Health and Aging Study, China Health and Retirement Longitudinal Study, and Indonesia Family Life Survey are included. Descriptive methods, logistic and multinomial regression analyses are used to examine patterns in any help received and main source of help respectively. After controlling for age, marital status, and co-residence with child(ren), it is found that men in all four countries overwhelmingly relied on their spouse for care, while children are more likely to be the main source of care for women. Children as the main source of care increased with age in each country and among men and women, surpassing spouse in China and Indonesia, and to a lesser extent in Mexico, but not in the United States where spouse was found to be more likely to be main caregiver even among the oldest age groups. Caregiving for the disabled is important for the well-being of the care recipient and for caregivers. Our results shed light on the asymmetric burden of caregiving on female spouses, across four diverse and aging countries.

Examining the link between exercise-specific relational processes and physical activity, psychological distress, and relationship satisfaction among heterosexual and gay male couples

Despite the important role of romantic relationships in physical activity, little research has examined the role of gender and sexual orientation in exercise-specific relational processes. Utilizing cross-sectional, dyadic data from 462 heterosexual and gay couples, the present study examined how exercise encouragement, exercise discouragement, and frequency of exercise disagreements are related to physical activity, psychological distress, and relationship satisfaction. We included important covariates and examined gender and sexual orientation as moderators. Higher exercise encouragement was associated with more frequent physical activity (for gay men only), lower psychological distress (for women only), and higher relationship satisfaction regardless of gender and sexual orientation. Higher exercise discouragement was associated with more physical activity for all participants and higher levels of psychological distress for gay men only. Finally, more frequent exercise disagreements were associated with more psychological distress for all participants. These findings highlight important implications for physical activity promotion, prevention, and intervention.

How Older White Gay Men and Lesbians Leverage Advantages to Navigate Healthcare

A lifetime of disadvantages shapes how lesbians and gay men navigate healthcare as they age and their fears about end-of-life care. This paper investigates how a localized group of older white, college educated, and economically privileged gay men and lesbians conceptualize their approach to healthcare. Analyzing 23 in-depth interviews with gay men and lesbians over the age of 60 I consider how they utilize their advantages when aging and facing declining health. I pay particular attention to how discriminatory social and legal contexts shaped elders' current situations and ability to be "out" and engage with healthcare professionals. I utilize the theory of cumulative advantages and disadvantages as another way to understand literature on health inequalities and LGBTQ health work, finding that despite systemic inequalities some gay men and lesbian elders use their resources to find gay-friendly primary care physicians, age at home, and build social supports for caregiving as their health declines.

Partners in Health: Investigating Social Genetic Effects Among Married and Cohabiting Couples

Partners resemble each other in health behaviors and outcomes such as alcohol use, smoking, physical activity, and obesity. While this is consistent with social contagion theory suggesting partner influence, it is notoriously difficult to establish causality because of assortative mating and contextual confounding. We offer a novel approach to studying social contagion in health in long-term partnerships by combining genetic data of both partners in married/cohabiting couples with longitudinal data on their health behaviors and outcomes. We examine the influence of the partner's genetic predisposition for three health outcomes and behaviors (BMI, smoking, and drinking) among married/cohabiting couples. We use longitudinal data from the Health and Retirement Study and the English Longitudinal Study of Ageing with data on health outcomes and genotypes for both partners. Results show that changes over time in BMI, smoking, and drinking depend on the partner's genetic predispositions to these traits. These findings underline the importance of people's social surroundings for their health and highlight the potential of targeting health interventions at couples.

The impact of hearing loss on trajectories of depressive symptoms in married couples

Hearing loss is a prevalent chronic stressor among older adults and is associated with numerous adverse health outcomes. The life course principle of linked lives highlights that an individual's stressors can impact the health and well-being of others; however, there are limited large-scale studies examining hearing loss within marital dyads. Using 11 waves (1998-2018) of the Health and Retirement Study (n = 4881 couples), we estimate age-based mixed models to examine how 1) one's own hearing, 2) one's spouse's hearing, or 3) both spouses' hearing influence changes in depressive symptoms. For men, their wives' hearing loss, their own hearing loss, and both spouses having hearing loss are associated with increased depressive symptoms. For women, their own hearing loss and both spouses having hearing loss are associated with increased depressive symptoms, but their husbands' hearing loss is not. The connections between hearing loss and depressive symptoms within couples are a dynamic process that unfolds differently by gender over time.

Relationship Quality Change Among Partnered Older Adults During the COVID-19 Pandemic

OBJECTIVES

The coronavirus disease 2019 (COVID-19) pandemic dramatically changed social life, but we know less about whether partnered relationships changed during this time. Because high-quality intimate relationships are key to many older Americans' well-being, we explore whether, how, and for whom the pandemic changed relationship quality among partnered older Americans.

METHODS

Nationally representative data from 1,642 partnered adults aged 50 and older come from the 2020 National Social Life, Health, and Aging Project COVID-19 Study. Multinomial logistic regression analyses estimate the likelihood of reporting improved, unchanged, or worsened relationship quality since the pandemic began across sociodemographic groups.

RESULTS

Two thirds of respondents reported that relationship quality stayed the same during the pandemic, 22.8% reported their relationship quality got better, and 10.5% reported their relationship quality got worse. Although women and the oldest old were less likely to report improved relationship quality, Black respondents were more likely to do so, even after controlling for explanatory variables.

DISCUSSION

Resilience describes many partnered older adults' experiences during the first year of the pandemic, suggesting that they were able to protect their partnerships during this public health crisis.

Gender and Social Isolation across the Life Course

Social isolation has robust adverse effects on health, well-being, dementia risk, and longevity. Although most studies suggest similar effects of isolation on the health of men and women, there has been much less attention to gendered patterns of social isolation over the life course-despite decades of research suggesting gender differences in social ties. We build on theoretical frames of constrained choice and gender-as-relational to argue that gender differences in isolation are apparent but depend on timing in the life course and marital/partnership history. Results indicate that boys/men are more isolated than girls/women through most of the life course, and this gender difference is much greater for the never married and those with disrupted relationship histories. Strikingly, levels of social isolation steadily increase from adolescence through later life for both men and women.

Development and validation of tumor-size-stratified prognostic nomograms for patients with uterine sarcoma: A SEER database analysis

BACKGROUND

Tumor-size-stratified analysis on the prognosis of uterine sarcoma is insufficient. This study aimed to establish the tumor-size-stratified nomograms to predict the 3- and 5-year overall survival (OS) of patients with uterine sarcoma.

METHODS

The data analyzed in this study were obtained from the Surveillance, Epidemiology, and End Results (SEER) database. We collected data from patients with uterine sarcoma diagnosed between 2004 and 2015. According to the median tumor size of 7.8 cm, the enrolled patients were divided into two tumor size (TS) groups: TS <7.8 cm and TS ≥7.8 cm. Patients in each group were randomly divided into the training and validation cohorts with a ratio of 7:3. Chi-square test was used to compare differences between categorical variables. Multivariate Cox regression models were used to identify significant predictors. We calculated the concordance index (C-index) and the area under the receiver operating characteristics curve (AUC) to validate the nomograms.

RESULTS

Compared with TS <7.8 cm group, TS ≥7.8 cm group had more patients of 45-64 years group, higher black race prevalence, higher proportion of myometrium tumor, higher stage, and higher grade; In the TS <7.8 cm training cohort, six variables (age, race, marital status, tumor primary site, stage, and grade) were identified as significantly associated with OS in multivariate analysis. However in the TS ≥7.8 cm training cohort, only four variables (surgery on primary site, tumor size, stage, and grade) were significantly identified; The C-index of two nomograms were 0.80 and 0.73 in training cohorts, respectively, and the AUC values for 3- and 5-year OS predictions in training cohorts were all above 0.80. Similar results were observed in validation cohorts.

CONCLUSIONS

This study found that the significant prognostic factors were different between two tumor size groups of uterine sarcoma patients. The tumor-size-stratified nomograms, which we constructed and validated, might be useful to predict the probability of survival for patients with uterine sarcoma.

Close kin influence COVID-19 precautionary behaviors and vaccine acceptance of older individuals

The family plays a central role in shaping health behaviors of its members through social control and support mechanisms. We investigate whether and to what extent close kin (i.e., partner and children) have mattered for older people in taking on precautionary behaviors (e.g., physical distancing) and vaccination during the COVID-19 pandemic in Europe. Drawing on data from the Survey of Health, Ageing and Retirement in Europe (SHARE), we combine its Corona Surveys (June-August 2020 and June-August 2021) with pre-COVID information (October 2019-March2020). We find that having close kin (especially a partner) is associated with a higher probability of both adopting precautionary behaviors and accepting a COVID-19 vaccine. Results are robust to controlling for other potential drivers of precautionary behaviors and vaccine acceptance, as well as to accounting for co-residence with kin. Our findings suggest that policy makers and practitioners may differently address kinless individuals when promoting public policy measures.

Marital Stress and Emotion Work in Same-Sex and Different-Sex Marriages: The Moderating Role of Childhood Adversity

Adverse experiences in childhood may set the stage for future response to stress, emotion regulation, and interaction with partners in intimate relationships. Prior research suggests the influence of childhood adversity on stress response is gendered, yet we do not know much about how individuals with a history of significant childhood adversity respond to marital stress outside of a different-sex marriage context. This study examines the moderating role of childhood adversity on the association of daily marital stress with emotion work provision (intentional activities devoted to enhancing others' emotional well-being) and considers whether the association varies for men and women in same- and different-sex marriages. Specifically, I use ten days of dyadic diary data collected from 378 midlife same- and different-sex married couples (n=756 individuals) and conduct multilevel regression models. The results show marital stress is positively associated with emotion work provision, and that the association is stronger for respondents who report more adverse childhood experiences. For respondents with low childhood adversity, the association of marital stress with emotion work is greater for same-sex couples compared to different-sex couples; for those with high childhood adversity, the association is equally strong. Findings from this study suggest that both men and women in same- and different-sex relationships do more emotion work in response to increased daily marital stress. Furthermore, early experiences of adversity are linked to stress responses in adulthood, with differing implications for men and women in different-sex and same-sex unions.

Using an Intersectional Framework to Understand the Challenges of Adopting Pre-exposure Prophylaxis (PrEP) Among Young Adult Black Women

Introduction

There is limited functional knowledge and utilization of pre-exposure prophylaxis (PrEP) among young adult Black cisgender women (YBW).

Methods

We conducted four focus groups with YBW using an intersectional framework to explore multiple levels of factors that impede YBW awareness, interest, and utilization of PrEP in conjunction with their sexual and reproductive healthcare needs.

Results

Influences at the cultural-environmental level included a lack of information and resources to access to PrEP and medical mistrust in the healthcare system. At the social normative level, influences included attitudes towards the long-term effects on sexual and reproductive health and self-efficacy to follow the PrEP regimen. At the proximal intrapersonal level, influences included anticipated HIV stigma from family and peers along with the fear of rejection from their main partners.

Conclusions

Translation of these results indicated that interventions to increase PrEP utilization and adherence among YBW will require multi-level strategies to address barriers to integrating HIV prevention into sexual and reproductive healthcare.

Observed dyadic collaboration among couples coping with type 1 diabetes

Previous research linking collaboration to relationship and health outcomes has relied almost exclusively on individual self-report and failed to take into consideration the dyadic nature of collaboration. We enrolled couples (n = 193) in which one person had Type 1 diabetes (52% female; 91% non-Hispanic white) into the study and asked them to discuss a diabetes-related issue of high concern for 8 min. These videotaped interactions were coded for dyadic collaboration. Mood was measured before and after the discussion. After the discussion, patients and partners reported support provided and received during the discussion. Results showed that observed dyadic collaboration was related to improvements in mood and greater support exchanges for both patients and partners when self-reported collaboration was statistically controlled. Gender moderated the effects on partners, such that benefits of dyadic collaboration were stronger for women than men. Future research may benefit from including collaborative elements into couple-focused interventions. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Social media use for health, cultural characteristics, and demographics: A survey of Pakistani millennials

Objective

Over the last 10 years, an extensive body of literature has been produced to investigate the role of social media in health. However, little is known about the impact of cultural characteristics (e.g. masculinity, collectivism, and uncertainty avoidance) on social media use regarding health-related information, especially in developing countries like Pakistan. The present study employed Hofstede’s cultural characteristics framework and uses and gratification theory to examine how Pakistani millennials’ demographic attributes and cultural characteristics are associated with their social media use for health-related information.

Method

An online survey of 722 people aged 18–35 living in Pakistan was conducted in spring 2020 to examine the intensity and frequency of social media use, health-related use of social media, cultural characteristics, and demographic attributes.

Results

Results showed that cultural characteristics—masculinity, collectivism, and uncertainty avoidance—are strongly related with their perceptions of social media importance, usefulness, and perceived ease of access for health-related information even when controlling for demographic characteristics. Age and gender are also significantly associated with their perspectives on social media for health.

Conclusions

We found that communicating and sharing information is the most important motivation for Pakistani millennials to use social media in the area of health with WhatsApp and YouTube being most preferred social media sites for health-related issues.

Partners' Consensus About Joint Effort and COVID-19 Prevention Among Sexual Minority Men

The current study examined the relevance of relationship functioning to partners' agreement or consensus about joint effort surrounding COVID-19 prevention. Interdependence theory has been widely used to understand how relationship partners influence health behavior, including how sexual minority male (SMM) couples regulate HIV risk. Couples with better relationship functioning tend to be more successful at negotiating joint (shared) goals and subsequently accomplishing them. The study recruited 134 cis-male, SARS-CoV-2 negative adults in relationships with cis-male partners from phone-based social networking applications. Participants completed an online survey assessing relationship functioning (Perceived Relationship Components Questionnaire), COVID-19 prevention behaviors, and risk perceptions. Partners' consensus around joint COVID-19 prevention effort was assessed using an adapted version of the Preferences for Sexual Health Outcomes scale. Path analyses indicated that consensus for joint prevention effort predicted social distancing (B = 0.23; p = .001) and the number of other COVID-19 prevention behaviors engaged in (B = 0.17; p = .003) above and beyond perceived risk and relationship functioning. Relationship satisfaction predicted higher levels of consensus for joint COVID-19 prevention effort (B = 0.40; p = .029). Findings suggest that the theoretical foundations of successful HIV prevention interventions that utilize joint goal formation may generalize to the prediction of COVID-19 prevention behavior and may be leveraged to mitigate the risk of SARS-CoV-2 infection among SMM in relationships. Interventions that overlook the potential for dyadic regulation of health behavior may miss opportunities to capitalize on shared coping resources and fail to address relational barriers to prevention.

The Dyadic Health Influence Model

Relationship partners affect one another's health outcomes through their health behaviors, yet how this occurs is not well understood. To fill this gap, we present the Dyadic Health Influence Model (DHIM). The DHIM identifies three routes through which a person (the agent) can impact the health beliefs and behavior of their partner (the target). An agent may (a) model health behaviors and shape the shared environment, (b) enact behaviors that promote their relationship, and/or (c) employ strategies to intentionally influence the target's health behavior. A central premise of the DHIM is that agents act based on their beliefs about their partner's health and their relationship. In turn, their actions have consequences not only for targets' health behavior but also for their relationship. We review theoretical and empirical research that provides initial support for the routes and offer testable predictions at the intersection of health behavior change research and relationship science.

Marital Strain and Support and Subjective Well-Being in Later Life: Ascribing a Role to Childhood Adversity

Objectives: We integrate the life course perspective with the stress-process model to offer a framework for how childhood conditions moderate the relationship between marital support/strain and subjective well-being in older adulthood for men and women. Methods: Drawing on longitudinal data from the National Social Life, Health, and Aging Project (NSHAP), we use a series of lagged dependent-variable models and stratify the sample by gender. Results: Our results suggest that the benefits associated with greater marital support are stronger for those that did not live with both parents in childhood for men. Women raised in families that experienced financial hardship reported lower subjective well-being in the context of marital strain. Conclusion: Adverse experiences in childhood can be scarring or foster resilience related to well-being in the context of strained or supportive marriages.

The Dyadic Cancer Outcomes Framework: A general framework of the effects of cancer on patients and informal caregivers

It is widely acknowledged that cancer affects not only patients but also their friends and family members who provide informal, and typically unpaid, care. Given the dual impact that cancer often has on patients and their informal caregivers (i.e., family members, partners, or friends), an expanded dyadic framework that encompasses a range of health and psychosocial outcomes and includes primary caregivers with a range of relationships to the patients is critically needed. Moreover, an emphasis on the role of social and contextual factors may help the framework resonate with a broader range of patient-caregiver relationships and allow for the development of more effective dyadic interventions. This article describes the development of the Dyadic Cancer Outcomes Framework, which was created to guide future research and intervention development. Using an iterative process, we conducted a conceptual review of currently used dyadic and/or caregiving models and frameworks and developed our own novel dyadic framework. Our novel Dyadic Cancer Outcomes Framework highlights individual- and dyad-level predictors and outcomes, as well as incorporating the disease trajectory and the social context. This framework can be used in conjunction with statistical approaches including the Actor Partner Interdependence Model to evaluate outcomes for different kinds of partner-caregiver dyads. This flexible framework can be used to guide intervention development and evaluation for cancer patients and their primary caregivers, with the ultimate goal of improving health, psychosocial, and relationship outcomes for both patients and caregivers. Future research will provide valuable information about the framework's effectiveness for this purpose.

Health and Health Care of Sexual and Gender Minorities

Research on the social dimensions of health and health care among sexual and gender minorities (SGMs) has grown rapidly in the last two decades. However, a comprehensive review of the extant interdisciplinary scholarship on SGM health has yet to be written. In response, we offer a synthesis of recent scholarship. We discuss major empirical findings and theoretical implications of health care utilization, barriers to care, health behaviors, and health outcomes, which demonstrate how SGMs continue to experience structural- and interactional-level inequalities across health and medicine. Within this synthesis, we also consider the conceptual and methodological limitations that continue to beleaguer the field and offer suggestions for several promising directions for future research and theory building. SGM health bridges the scholarly interests in social and health sciences and contributes to broader sociological concerns regarding the persistence of sexuality- and gender-based inequalities.

Same-Sex Couples and Cognitive Impairment: Evidence From the Health and Retirement Study

OBJECTIVES

We provide the first nationally representative population-based study of cognitive disparities among same-sex and different-sex couples in the United States.

METHODS

We analyzed data from the Health and Retirement Study (2000-2016). The sample included 23,669 respondents (196 same-sex partners and 23,473 different-sex partners) aged 50 and older who contributed to 85,117 person-period records (496 from same-sex partners and 84,621 from different-sex partners). Cognitive impairment was assessed using the modified version of the Telephone Interview for Cognitive Status. Mixed-effects discrete-time hazard regression models were estimated to predict the odds of cognitive impairment.

RESULTS

The estimated odds of cognitive impairment were 78% (p < .01) higher for same-sex partners than for different-sex partners. This disparity was mainly explained by differences in marital status and, to a much lesser extent, by differences in physical and mental health. Specifically, a significantly higher proportion of same-sex partners than different-sex partners were cohabiting rather than legally married (72.98% vs. 5.42% in the study sample), and cohabitors had a significantly higher risk of cognitive impairment than their married counterparts (odds ratio = 1.53, p < .001).

DISCUSSION

The findings indicate that designing and implementing public policies and programs that work to eliminate societal homophobia, especially among older adults, is a critical step in reducing the elevated risk of cognitive impairment among older same-sex couples.

Female partner experiences of prostate cancer patients' engagement with a community-based football intervention: a qualitative study

Background

Prostate cancer is often labelled a couple’s disease wherein the partner plays an important role in the man’s illness management and related health promotion activities. The aim of this study was to explore partner experiences of prostate cancer patients’ engagement with a community-based football program.

Methods

Eight audio-visual recorded semi-structured focus group interviews were conducted with a total of 39 female partners of men with prostate cancer who participated in a community-based football program as part of the nationwide FC Prostate Community Trial (NCT02430792). Data was managed with the software program Nvivo 11 and analysed inductively to derive thematic findings.

Results

The four thematic findings were: 1) ‘Hope of a new beginning’ which included stories of hope that football would mitigate the negative effects of men’s prostate cancer treatment [s]; 2) ‘My new partner’ was characterized by attributing connections between physical activity and elevated mood as a by-product of men’s involvement in the program; 3) ‘Football first’ included assertions of the couples mutual commitment to the football program; and 4) ‘Invisible needs’ contrasted insecurity, and unforeseen challenges for partners feeling somewhat neglected. Overall, the results confirm the need for cohesion and flexibility amongst couple-dyads to ensure partners and men with prostate cancer benefit from their involvement in football programs.

Conclusions

This study indicates that partners of prostate cancer survivors’ engaging with community-based football align to idealized gender relations, roles and identities. In many instances, these gendered dimensions aided positive dyadic coping and long-term exercise adherence.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-11448-7.

A national longitudinal study of marital quality and cognitive decline among older men and women

We provide one of the first national longitudinal studies of the association between trajectories of marital quality and cognitive functioning among older adults, with close attention paid to gender differences. Data were drawn from the Health and Retirement Study (HRS) 2006-2016. Marital quality trajectories were assessed at three waves: 2006/2008, 2010/2012, and 2014/2016. Cognitive trajectories were assessed at five waves: 2008, 2010, 2012, 2014, and 2016. The final analytic sample included 7901 respondents age 50 and older (4334 men and 3567 women) who were either married or cohabiting during the study period. Results from parallel linear growth curve models suggest that among older adults, initial positive marital quality was associated with better initial cognition, and initial negative marital quality was associated with worse initial cognition. Results from multiple group analysis further suggest that marital quality was significantly associated with men's cognitive trajectories but not women's. Among men, an increase in positive marital quality was associated with a slower rate of cognitive decline, whereas an increase in negative marital quality was associated with a faster rate of cognitive decline. These findings suggest that older men who experience a decline in marital quality may be vulnerable to cognitive decline and that reducing marital strain and improving marital quality may protect men's cognitive health in later life.

Sexual Identity and Birth Outcomes: A Focus on the Moderating Role of Race-ethnicity

Race-ethnic disparities in birth outcomes are well established, and new research suggests that there may also be important sexual identity disparities in birth weight and preterm birth. This study uses the National Longitudinal Study of Adolescent to Adult Health and is the first to examine disparities in birth outcomes at the intersection of race-ethnicity and sexual identity. We use ordinary least sqaures and logistic regression models with live births (n = 10,318) as the unit of analysis clustered on mother ID (n = 5,105), allowing us to adjust for preconception and pregnancy-specific perinatal risk factors as well as neighborhood characteristics. Results show a striking reversal in the effect of lesbian or bisexual identity on birth outcomes across race-ethnicities: For white women, a bisexual or lesbian identity is associated with better birth outcomes than their white heterosexual counterparts, but for Black and Latina women, it is associated with worse birth outcomes than their heterosexual peers.

Hearing Impairment and Mental Health Among Married Couples

OBJECTIVES

Disablement is a significant health problem and chronic stressor for older adults and is associated with negative mental health outcomes. Although some research has explored how disability extends beyond individuals to influence the mental health of their support networks, less population-based research has assessed the consequences of hearing impairment, a growing public health concern that affects 72.4% of people aged 65 and older. Moreover, although much research has examined the negative individual impact of hearing impairment, less population-based research has assessed its consequences on spouses. To fill this gap, the current study builds on gender, marriage, and stress proliferation research to examine (a) the association between own hearing impairment and spouses' depressive symptoms, and (b) whether this association varies by the gender of the spouse.

METHOD

Fixed-effects regression models were conducted using data from 5,485 couples (10,970 individuals) from 10 waves of the Health and Retirement Study (1998-2016).

RESULTS

Wives' fair or poor hearing is significantly associated with an increase in husbands' depressive symptoms, net of controls. However, husbands' fair or poor hearing is not associated with an increase in wives' depressive symptoms.

DISCUSSION

These findings suggest that hearing impairment can proliferate from one spouse to the other, but that this proliferation depends on gender. Health care providers need to be aware of the implications for husbands when treating women with hearing impairment.

Investigating differential protective effects of marriage on substance use by sexual identity status

BACKGROUND

Research suggests that marriage is protective against substance use. However, few studies have examined whether this protective effect differs for sexual minorities, a population at increased risk for substance use. Using data from four waves of the cross-sectional U.S. National Alcohol Survey (NAS; 2000, 2005, 2010, and 2015), we investigated whether the protective effects of marriage varied by sexual identity.

METHODS

Sex-stratified logistic regression models were used to examine independent and interactive effects of current marital status (being married vs. not) and sexual minority status (lesbian/gay/bisexual vs. heterosexual) on high-intensity drinking, alcohol use disorder, and marijuana use in the past year.

RESULTS

Among both women and men, sexual minority status was generally associated with higher odds of these outcomes and marriage was consistently associated with lower odds. Differential effects of marriage by sexual identity with respect to marijuana use were found only among men; marriage was significantly associated with decreased odds of marijuana use among heterosexual men but increased odds among sexual minority men.

CONCLUSIONS

Marriage may be less consistently protective against hazardous drinking and marijuana use among sexual minorities than heterosexuals. Findings underscore the importance of both quantitative and qualitative studies designed to better understand disparities in substance use across both sexual identity and relationship statuses.

How Families Matter for Health Inequality during the COVID-19 Pandemic

We theorize that social conditions surrounding the COVID-19 pandemic have the potential to increase the importance of families for health and widen existing inequalities. We suggest three primary tenets important for understanding families and health during COVID-19. First, risks of specific COVID-19 outcomes and other health problems are unevenly distributed across families. Second, how families impact health during the COVID-19 pandemic is conditional on public policies, organizational decisions, and concurrent events. Third, many health inequalities driven by racism, sexism, classism, and other oppressive societal force are amplified during COVID-19, but the extent to which this is occurring is shaped by families and by the public policies, organizational decisions, and concurrent events that also impact families and health. As health disparities continue to emerge from this pandemic, we call on researchers and policy-makers to pay attention to the multiple ways that families matter.

Differences in how spouses influence each other's alcohol use in same- and different-sex marriages: A daily diary study

RATIONALE

Different-sex spouses influence each other's alcohol consumption, with women having more influence on their spouses than men. Because women drink less than men, this long-term influence partly explains why married men and women consume less alcohol than their unmarried peers. However, much less is known about possible gender differences in the ways spouses influence each other's alcohol use on a day-to-day basis in same-compared to different-sex marriages. Because sexual minority people are at higher risk for alcohol use disorders compared to their heterosexual counterparts, such knowledge could shed light on ways to reduce this risk and alcohol use disparities between sexual minority and heterosexual people.

METHOD

We use 10 days of diary data collected in 2014-2015 in the United States from 157 female same-sex, 106 male same-sex, and 115 different-sex married couples in midlife (ages 35-65) to examine how one spouse's drinking influences how much the other spouse drinks on the following day.

RESULTS

Men reported higher levels of daily drinking than women; after including covariates, men in different-sex marriages reported drinking at the highest levels. Results from actor-partner interdependence models show that men in same- and different-sex marriages drink more, and women in different-sex marriages drink less when their spouse drinks more the previous day. Female same-sex spouses did not change their drinking behaviors in response to their spouse's drinking.

CONCLUSIONS

Overall higher rates of drinking among men in same-sex marriages suggest an accumulation effect of drinking that may contribute to sexual minority health disparities. Women and men in different-sex marriages may be engaging in social control or navigating masculinity norms. Women in same-sex marriages may not feel the need to adjust to low levels of drinking by their spouses. Findings suggest that spousal influence over alcohol consumption unfolds differently in same-sex compared to different-sex marriages.

Marital Quality and Well-Being Among Older Adults: A Typology of Supportive, Aversive, Indifferent, and Ambivalent Marriages

A large body of work has linked marital quality to the health and well-being of older adults, but there is a lack of agreement on how to best measure dimensions of marital quality. Drawing on a stress-process life course perspective, we construct a typology of marriage type that captures the synergistic relationship between positive and negative marital qualities and health. Using data from Wave 1 (2005/2006) and Wave 2 (2010/2011) of the NSHAP survey from the United States, we examine the association between supportive, aversive, ambivalent, and indifferent marriages for older adults that remained married over the study period on multiple indicators of well-being (depression, happiness, and self-rated health; N = 769 males and 461 females). Results suggest that older adults in aversive marriages reported lower happiness (men and women) and physical health (men). There was less evidence that those in ambivalent and indifferent marriages reported worse well-being.

The impact of marital transitions on vegetable intake in middle-aged and older Japanese adults: a five-year longitudinal study

Background

Marital transitions are associated with adverse health events, such as mortality and cardiovascular disease. Since marital transitions (eg, becoming widowed) are unavoidable life events, it is necessary to identify modifiable intermediate outcomes. Thus, we examined the association between marital transitions and vegetable intake among middle-aged and older Japanese adults.

Methods

This longitudinal study included Japanese adults aged 40–79 years who received an annual health checkup between 2007 and 2011 (baseline) and 5 years later (follow-up). Marital transitions were classified as whether and what type of transition occurred during the 5-year period and comprised five groups: consistently married, married to widowed, married to divorced, not married to married, and remained not married. Changes in total vegetable, green and yellow vegetable, and light-colored vegetable intake from baseline to follow-up were calculated using the Food Frequency Questionnaire.

Results

Data from 4,813 participants were analyzed (mean age, 59.4 years; 44.1% women). Regarding marital transitions, 3,960 participants were classified as “consistently married,” 135 as “married to widowed,” 40 as “married to divorced,” 60 as “not married to married,” and 529 as “remained not married.” Multivariable linear regression analysis revealed that compared to consistently married, married to widowed was inversely associated with the change in total vegetable intake (β = −16.64, SE = 7.68, P = 0.030) and light-colored vegetable intake (β = −11.46, SE = 4.33, P = 0.008).

Conclusion

Our findings suggest that being widowed could result in a reduced intake of vegetables. Hence, dietary counseling according to marital situation is necessary.

Do relationships provide the same levels of protection against heavy drinking for lesbian and bisexual women? An intersectional approach

PURPOSE

Sexual minority women (SMW; e.g., lesbian, bisexual) are more likely than heterosexual women to be heavy drinkers, with bisexual women showing the highest risk. There is ample literature demonstrating that intimate relationships protect against stress-related health risk behaviors in the general population. However, very little research has focused on SMW's relationships and far less is known about the relationships of SMW of color. Using intersectionality theory as our framework, we tested two competing models to determine whether the effects of minority sexual identity (lesbian, bisexual) and race/ethnicity (African American, Latinx, White) are: 1) additive, or 2) multiplicative in the associations between relationship status and heavy drinking.

METHODS

Data are from a diverse sample of cisgender sexual minority women (N = 641) interviewed in Wave 3 of the CHLEW study, a 20-year longitudinal study of SMW's health.

RESULTS

Findings from two- and three-way interactions provide mixed evidence for both the additive and multiplicative hypotheses; support for each varied by sexual identity and race/ethnicity. Overall, we found that Latinx SMW, particularly single and bisexual Latinx SMW report the highest rates of heavy drinking compared to their cohabiting and lesbian counterparts, respectively. African American single SMW reported significantly higher rates of heavy drinking compared to their cohabiting counterparts.

CONCLUSION

Our findings suggest that the protective qualities of SMW's intimate relationships vary based on sexual identity and race/ethnicity-and the intersections between them. These results highlight that research among SMW that does not take into account multiple marginalized identities may obscure differences.

PUBLIC SIGNIFICANCE

Little research has focused on health within sexual minority women's relationships, particularly among sexual minority women of color. Given the potential additive or multiplicative effects of multiple sources of oppression such as heterosexism, racism, and sexism, understanding the potential protective effects of relationships is important. Our findings demonstrate that the protective qualities of intimate relationships among SMW vary based on sexual identity and race/ethnicity - and the intersections between them.

Couple BMI trajectory patterns during mid-later years: Socioeconomic stratification and later-life physical health outcomes

Although previous studies have documented spousal resemblance in health attributes, questions remain regarding the longitudinal resemblance of spouses' body mass index (BMI) and the possible formation of couple-level BMI trajectory patterns. Consequentially, we know little about how the longitudinal resemblance of spouses' BMI may link couples' varying socioeconomic experiences to their physical health outcomes in later years. Thus, the present study using prospective data from a sample of 255 couples in enduring marriages over a period of 26 years (from 1991 to 2017) examined (a) the existence of couple-level BMI trajectory patterns in mid-later years, (b) their social stratification into heterogeneous groups of couples associated with family economic hardship (FEH), and (c) differential later-life health outcomes of these groups. The results provided evidence for groups of couples with distinct BMI trajectory patterns. These groups were associated with latent groups of FEH trajectories, suggesting a persistent association between couple BMI and FEH. Couple BMI trajectory patterns were consequential for physical health consequences in later years. Two features of couple BMI trajectory patterns, severity and synchrony, were utilized to explain these associations. Taken together, the results provided evidence for a couple-level FEH-BMI-health process over the life course and emphasize the impact of severity and synchrony in couples' BMI for their health problems in later adulthood. Findings are discussed as they relate to health policies and interventions focusing on the well-being of married couples in later life, particularly the need for couple-focused obesity-related interventions and policies that mitigate economic hardship given its long-lasting health impacts. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

The Gender-as-Relational Approach for Theorizing About Romantic Relationships of Sexual and Gender Minority Mid- to Later-Life Adults

We deploy the "gender-as-relational" (GAR) approach to enhance the study of the long-term romantic relationships of sexual and gender minority mid- to later-life adults. The GAR approach states that gender within relationships is shaped by three key factors: own gender, partner's gender, and the gendered relational context. This approach highlights that the relationship dynamics of men, women, and gender nonconforming people are highly diverse, reflecting that gender is a social construct formed within interactions and institutions. We explicate how GAR can reorganize the study of sexual and gender diversity in three research areas related to aging and relationships-caregiving, marital health benefits, and intimacy-and discuss theory-driven methods appropriate for a GAR research agenda. A GAR framework reorients research by complicating taken-for-granted assumptions about how gender operates within mid- to later-life romantic relationships and queering understandings of aging and romantic relationships to include experiences outside of heteronormative and cisnormative categories.

"Go See Somebody": How Spouses Promote Mental Health Care

This study considers when, whether, and how spouses encourage professional mental health care by analyzing qualitative data from 90 in-depth interviews with gay, lesbian, and heterosexual spouses. Findings show that a majority of spouses are engaged in promoting each other's mental health care but that the strategies used to promote care vary by gender and the gender composition of the couple. The majority of gay men and lesbian women promote care by framing mental health problems as largely biochemical, fixable only with professional care or medicine, and work to destigmatize this care. Lesbian women uniquely emphasize the influence of a spouse's symptoms on marital quality as a reason to pursue care. Some heterosexual women and men also report seeing their spouse's mental health care as something for them to deal with on their own and thus do not encourage care. This study has important implications for researchers looking to understand why some individuals seek mental health care and others do not and provides policymakers insight into mental health interventions via spouses.

Families in Later Life: A Decade in Review

Later-life families encompass the legal, biological, romantic, and kin-like relationships of persons ages 65 and older. Research on older families has flourished over the past decade, as population aging has intensified concerns regarding the capacities of families to care for older adults and the adequacy of public pension systems to provide an acceptable standard of living. Shifting patterns of family formation over the past half-century have created a context in which contemporary older adults' family lives differ markedly from earlier generations. Decreasing numbers of adults are growing old with their first and only spouse, with rising numbers divorcing, remarrying, forming non-marital romantic partnerships, or living single by choice. Remarriage and the formation of stepfamilies pose challenges and opportunities as older adults negotiate complex decisions such as inheritance and caregiving. Family relationships are consequential for older adults' well-being, operating through both biological and psychosocial mechanisms. We synthesize research from the past decade, revealing how innovations in data and methods have refined our understanding of late-life families against a backdrop of demographic change. We show how contemporary research refines classic theoretical frameworks and tests emerging conceptual models. We organize the article around two main types of family relationships: (1) marriage and romantic partnerships and (2) intergenerational relationships. We discuss how family caregiving occurs within these relationships, and offer three promising avenues for future research: ethnic minority and immigrant families; older adults without close kin ("elder orphans"); and the potentials of rapidly evolving technologies for intergenerational relationships and caregiving.

Social Networks in Later Life: Similarities and Differences between Sexual-Minority and Heterosexual Older Adults

Community-based research suggests that lesbian, gay and bisexual (LGB) older adults are more socially isolated than their heterosexual counterparts. However, little is known about how social networks in late adulthood differ between LGB and heterosexual people at the population level. Using data from the 2015-16 National Social Life, Health and Aging Project (N=3,929), we compare the size, frequency of contact, composition, diversity, and density of core discussion networks as well as family and friend support across sexual orientation groups. We find that LGB people share a few network characteristics with their heterosexual counterparts, including network size, frequency of contact with network members, and proportion of non-spousal kin members in the network. However, their networks are less likely to include an intimate partner, are more likely to include friends, and have lower diversity and density. LGB people also report lower family support but higher friend support than heterosexual people.

Influence of Social Connections on Smoking Behavior across the Life Course

Although we know much about demographic patterns of smoking, we know less about people's explanations for when, how and why they avoid, develop, or alter smoking habits and how these explanations are linked to social connections across the life course. We analyze data from in-depth interviews with 60 adults aged 25-89 from a large southwestern U.S. city to consider how social connections shape smoking behavior across the life course. Respondents provided explanations for how and why they avoided, initiated, continued, and/or quit smoking. At various times, social connections were viewed as having both positive and negative influences on smoking behavior. Both people who never smoked and continuous smokers pointed to the importance of early life social connections in shaping decisions to smoke or not smoke, and viewed later connections (e.g., marriage, coworkers) as less important. People who quit smoking or relapsed tended to attribute their smoking behavior to social connections in adulthood rather than early life. People who changed their smoking behavior highlighted the importance of transitions as related to social connections, with more instability in social connections often discussed by relapsed smokers as a reason for instability in smoking status. A qualitative approach together with a life course perspective highlights the pivotal role of social connections in shaping trajectories of smoking behavior throughout the life course.