Bridget K. Gorman

The long arm of childhood: The influence of early-life social conditions on men’s mortality

Increasingly, social scientists are turning to childhood to gain a better understanding of the fundamental social causes of adult mortality. However, evidence of the link between childhood and the mortality of adults is fragmentary, and the intervening mechanisms remain unclear. Drawing on the National Longitudinal Survey of Older Men, our analysis shows that men’s mortality is associated with an array of childhood conditions, including socioeconomic status, family living arrangements, mother’s work status, rural residence, and parents’ nativity. With the exception of parental nativity, socioeconomic-achievement processes in adulthood and lifestyle factors mediated these associations. Education, family income, household wealth, and occupation mediated the influence of socioeconomic status in childhood. Adult lifestyle factors, particularly body mass, mediated the effects of family living arrangements in childhood, mother’s work status, and rural residence. Our findings bring into sharp focus the idea that economic and educational policies that are targeted at children’s well-being are implicitly health policies with effects that reach far into the adult life course.

Migration and infant death : Assimilation or selective migration among Puerto Ricans?

Using pooled origin/destination data from the Puerto Rican Maternal and Infant Health Study the authors examine the implications for infant mortality of migration from Puerto Rico to the US. An analysis restricted to the US mainland shows that children of migrants have lower risks of infant mortality than do children of mainland-born Puerto Rican women. A critical question is whether this pattern indicates that maternal exposure to US culture undermines infant health or whether it is largely a result of the selective migration of healthier or more advantaged mothers to the US. The authors findings show that mothers duration of US residence is positively related to infant mortality among the children of migrants suggesting that a process of negative assimilation is occurring. However inclusion of Puerto Rico in the analysis demonstrates the importance of selective migration in explaining the US mainland pattern: Infant mortality is substantially lower among recent migrants to the mainland than it is among nonmigrant women in Puerto Rico. The roles of socioeconomic status cultural orientation health habits and health care utilization in accounting for differences in infants survival chances by maternal migration status are assessed. (authors)

Gender Disparities in Adult Health: An Examination of Three Measures of Morbidity

Recent examinations of gender differences in physical health suggest that womens disadvantage may be smaller than previously assumed, varying by health status measure and age. Using data from the 1997–2001 National Health Interview Surveys, we examine gender-by-age differences in life-threatening medical conditions, functional limitations, and self-rated health and consider whether potential mediating mechanisms (e.g., socioeconomic status, behavioral factors) operate uniformly across health measures. The results show that the gender gap is smallest for life-threatening medical conditions and that men do increasingly worse with age. For self-rated health, men are more likely to report excellent health at younger ages, but with increasing age this gap closes. Only for functional limitations do we find a consistent pattern of female disadvantage: Women report more functional limitations than men, and the gap increases with age. The ability of explanatory mechanisms to account for these patterns varies by the health measure examined.

Gender, acculturation, and health among Mexican Americans.

This study examines whether the relationship between acculturation and physical health varies by gender among Mexican Americans, and if the mechanisms that mediate the acculturation-health relationship operate differently by gender. Using the 1998–2007 National Health Interview Study, we construct a composite measure of acculturation and estimate regression models for the total number of health conditions, hypertension, heart disease, and diabetes. Immigrants with the lowest levels of acculturation are the healthiest, but this association is stronger for men. Medical care plays a central role in accounting for gender and acculturation differences across health outcomes—increased access to and utilization of medical care is associated with worse health, which suggests that better health among recent arrivals (particularly men) partially results from their lack of knowledge about their own poor health.

Family structure differences in health care utilization among U.S. children.

This study explores the relationship between family structure and childrens access to health care using data from the 2001-2003 waves of the child sample files from the U.S. National Health Interview Survey. Specifically, we investigate the extent to which family structure types predict childrens utilization of preventive health care, and barriers to care. We then explore whether observed differences across family structures can be attributed to differences in demographic characteristics, socioeconomic status (SES), and child health status. Using logistic regression models, we document substantial variation in health care usage and barriers to health care across a variety of family structures. Of note is the finding that the children of single mothers demonstrate extremely different patterns of health care access than do the children of single fathers, and the importance of SES as a risk factor for diminished levels of access to health care varies by family type. SES plays a major role in mediating the relationship between access to care for children in single mother and cohabiting families (when contrasted against children in two married parent families), but less of a role for children living with stepparents, a single father, or with parents and other relatives.

Language proficiency and health status: are bilingual immigrants healthier?

Bilingual immigrants appear to have a health advantage, and identifying the mechanisms responsible for this is of increasing interest to scholars and policy makers in the United States. Utilizing the National Latino and Asian American Study (NLAAS; n = 3,264), we investigate the associations between English and native-language proficiency and usage and self-rated health for Asian and Latino U.S. immigrants from China, the Philippines, Vietnam, Mexico, Cuba, and Puerto Rico. The findings demonstrate that across immigrant ethnic groups, being bilingual is associated with better self-rated physical and mental health relative to being proficient in only English or only a native language, and moreover, these associations are partially mediated by socioeconomic status and family support but not by acculturation, stress and discrimination, or health access and behaviors.

A New Piece of the Puzzle: Sexual Orientation, Gender, and Physical Health Status

Although research has long documented the relevance of gender for health, studies that simultaneously incorporate the relevance of disparate sexual orientation groups are sparse. We address these shortcomings by applying an intersectional perspective to evaluate how sexual orientation and gender intersect to pattern self-rated health status among U.S. adults. Our project aggregated probability samples from the Behavioral Risk Factor Surveillance System (BRFSS) across seven U.S. states between 2005 and 2010, resulting in an analytic sample of 10,128 sexual minority (gay, lesbian, and bisexual) and 405,145 heterosexual adults. Logistic regression models and corresponding predicted probabilities examined how poor self-rated health differed across sexual orientation–by-gender groups, before and after adjustment for established health risk factors. Results reveal distinct patterns among sexual minorities. Initially, bisexual men and women reported the highest—and gay and lesbian adults reported the lowest—rates of poor self-rated health, with heterosexuals in between. Distinct socioeconomic status profiles accounted for large portions of these differences. Furthermore, in baseline and fully adjusted regression models, only among heterosexuals did women report significantly different health from men. Importantly, the findings highlight elevated rates of poor health experienced by bisexual men and women, which are partially attributable to their heightened economic, behavioral, and social disadvantages relative to other groups.

Families, Resources, and Adult Health: Where Do Sexual Minorities Fit?

Extensive research documents the relevance of families and socioeconomic resources to health. This article extends that research to sexual minorities, using 12 years of the National Health Interview Survey (N = 460,459) to examine self-evaluations of health among male and female adults living in same-sex and different-sex relationships. Adjusting for socioeconomic status eliminates differences between same- and different-sex cohabitors so that they have similarly higher odds of poor health relative to married persons. Results by gender reveal that the cohabitation disadvantage for health is more pronounced for different-sex cohabiting women than for men, but little difference exists between same-sex cohabiting men and women. Finally, the presence of children in the home is more protective for women’s than men’s health, but those protections are specific to married women. In all, the results elucidate the importance of relationship type, gender, and the presence of children when evaluating health.

Is Discrimination an Equal Opportunity Risk? Racial Experiences, Socioeconomic Status, and Health Status among Black and White Adults

Using the 2004 Behavioral Risk Factor Surveillance System, we explore the relationship between racial awareness, perceived discrimination, and self-rated health among black (n = 5,902) and white (n = 28,451) adults. We find that adjusting for group differences in racial awareness and discrimination, in addition to socioeconomic status, explains the black-white gap in self-rated health. However, logistic regression models also find evidence for differential vulnerability among black and whites adults, based on socioeconomic status. While both groups are equally harmed by emotional and/or physical reactions to race-based treatment, the negative consequences of discriminatory experiences for black adults are exacerbated by their poorer socioeconomic standing. In contrast, the association between racial awareness and self-rated health is more sensitive to socioeconomic standing among whites. Poorer health is more likely to occur among whites when they reflect at least daily on their own racial status—but only when it happens in tandem with mid-range educational achievement, or among homemakers.

Racial and ethnic differences in adult asthma prevalence, problems, and medical care

Objectives. We document the extent to which racial and ethnic differences exist in asthma prevalence among US adults, and among asthmatic adults, we document racial differences in asthma problems and asthma-related medical care. We also explore potential explanations for racial and ethnic disparities in each outcome. Design. Using data on a 24-state sample of white, black, Hispanic, Asian, and Native American adults from the 2004 Behavioral Risk Factor Surveillance System, we examine race/ethnic differences in asthma prevalence, problems (had an asthma attack last year; asthma symptoms; sleep difficulties; activities limited because of asthma), and asthma-related medical care (number of routine doctor visits; medication use; urgent doctor visits; visited an emergency room for asthma-related care last year). We then explore whether any observed disparities are due to differences in demographic characteristics, socioeconomic status, health behavior, and environmental conditions across racial/ethnic groups. Results. Asthma prevalence is lowest among Asian and Hispanic adults, and highest among black and Native American adults. Considerable racial/ethnic differences in asthma-related problems and medical care are also present, with Asians doing as well or better than whites, while blacks, Hispanics, and especially Native Americans report more asthma-related problems and medical care use. For some groups (i.e., Asians and Hispanics), we were mostly unable to explain away observed differences with white adults with adjustment for potential explanatory mechanisms, while for other groups (i.e., blacks and Native Americans) adjusting for socioeconomic status and air quality accounted for much of the observed disparity with whites.