Diana Worts

Social influences on trajectories of self-rated health: evidence from Britain, Germany, Denmark and the USA

Background This study investigates social inequalities in self-rated health dynamics for working-aged adults in four nations, representing distinct welfare regime types. The aims are to describe average national trajectories of self-rated health over a 7-year period, identify social determinants of cross-sectional and longitudinal health and compare cross-national patterns. Methods Data are from national household panel surveys in Britain, Germany, Denmark and the USA. The self-rated health of working-age respondents is measured for the years 1995–2001. Social indicators include education, occupational class, employment status, income, age, gender, minority status and marital status. Latent growth curve models are used to estimate both individual change and average national trajectories of self-rated health, conditioned on the social indicators. Results Ageing-vector graphs reveal general declines in health as people age. They also show differential patterns of change for specific national cohorts. Older cohorts in Denmark had poorer health and young cohorts in the USA had better health in 2001 than 1995. Social covariates predicted baseline health in all four countries, in ways that were consistent with welfare regime theories. Once inequalities in baseline health were accounted for, the few determinants of mean health decline occurred mainly in the USA, again in line with theoretical expectations. Finally, trajectories of health for those in average and advantaged social circumstances were similar, but disadvantaged individuals had much poorer health trajectories than ‘average’ individuals. The differences were greatest in the countries with lower levels of public transfers. Conclusion National differences in self-rated health trajectories and their social correlates may be attributed partly to welfare policies.

Individualization, opportunity and jeopardy in American women's work and family lives: A multi-state sequence analysis

Life course sociologists are increasingly concerned with how the general character of biographies is transformed over historical time--and with what this means for individual life chances. The individualization thesis, which contends that contemporary biographies are less predictable, less orderly and less collectively determined than were those lived before the middle of the 20th century, suggests that life courses have become both more internally dynamic and more diverse across individuals. Whether these changes reflect expanding opportunities or increasing jeopardy is a matter of some debate. We examine these questions using data on the employment, marital and parental histories, over the ages of 25-49, for five birth cohorts of American women (N=7150). Our results show that biographical change has been characterized more by growing differences between women than by increasing complexity within individual womens lives. Whether the mounting diversity of work and family life paths reflects, on balance, expanding opportunities or increasing jeopardy depends very much on the social advantages and disadvantages women possessed as they entered their prime working and childrearing years.

Falling short of the promise: poverty vulnerability in the United States and Britain, 1993-2003.

The welfare state promises to moderate the duration and concentration of poverty. The authors ask how well this promise has been fulfilled in the United States and Britain from 1993 to 2003. They examine two aspects of poverty vulnerability during this period of welfare reform: (1) its persistence and associated risk factors and (2) the efficacy of social transfers. After accounting for measurement error, sociodemographic characteristics, and the impact of redistributive programs, the authors find that poverty is often persistent and risk is concentrated, especially in the United States. Moreover, the British safety net appears to better protect those at risk.

Work-family life courses and markers of stress and inflammation in mid-life: evidence from the National Child Development Study

Abstract Background: This study investigated associations between work-family life courses and biomarkers of inflammation and stress in mid-life among British men and women. Gender differences in these associations were also explored. Methods: A novel statistical method—multi-channel sequence analysis—defined work-family life courses between the ages of 16 and 42 years, combining annual information on work, partnership and parenthood. Associations between work-family life courses and inflammation [C-reactive protein (CRP), fibrinogen and von Willebrand factor] and cortisol at age 44/45 years were tested using multivariate linear regression using multiply-imputed data on almost 6500 participants from the National Child Development Study 1958 British birth cohort. Results: Compared with those who combined strong ties to paid work with later transitions to stable family lives (‘Work, later family’ group), ‘Teen parents’ had higher CRP [40.6% higher, 95% confidence interval (CI): 5.6, 87.0] and fibrinogen (7.8% higher, 95% CI: 2.3, 13.5) levels, and homemakers (‘No paid work, early family’) had raised fibrinogen levels (4.7% higher, 95% CI: 0.7, 9.0), independent of childhood health and socioeconomic position, adult socioeconomic position, health behaviours and body mass index (BMI). Those who combined later transitions to stable family ties with a career break for childrearing had higher post-waking cortisol than the ‘Work, later family’ group; however, no associations were seen for other work-family types, therefore suggesting a null finding with cortisol. No statistically significant gender interactions in associations between work-family types and inflammatory or cortisol outcomes were found. Conclusions: Work-family life courses characterised by early parenthood or weak work ties were associated with a raised risk profile in relation to chronic inflammation.

Is being in paid work beyond state pension age beneficial for health? Evidence from England using a life-course approach

Background Given the current policy emphasis in many Western societies on extending working lives, we investigated the health effects of being in paid work beyond state pension age (SPA). Until now, work has largely focused on the health of those who exit the labour force early. Methods Our data come from waves 2–4 of the English Longitudinal Study of Ageing, including the life history interview at wave 3. Using logistic and linear regression models, we assessed the longitudinal associations between being in paid work beyond SPA and 3 measures of health (depression, a latent measure of somatic health and sleep disturbance) among men aged 65–74 and women aged 60–69. Our analyses controlled for baseline health and socioeconomic characteristics, as well as for work histories and health in adulthood and childhood. Results Approximately a quarter of women and 15% of men were in paid work beyond SPA. Descriptive bivariate analyses suggested that men and women in paid work were more likely to report better health at follow-up. However, once baseline socioeconomic characteristics as well as adulthood and baseline health and labour market histories were accounted for, the health benefits of working beyond SPA were no longer significant. Conclusions Potential health benefits of working beyond SPA need to be considered in the light of the fact that those who report good health and are more socioeconomically advantaged are more likely to be working beyond SPA to begin with.

Work-family life courses and metabolic markers in mid-life: evidence from the British National Child Development Study

Background Previous studies have found generally better health among those who combine employment and family responsibilities; however, most research excludes men, and relies on subjective measures of health and information on work and family activities from only 1 or 2 time points in the life course. This study investigated associations between work-family life course types (LCTs) and markers of metabolic risk in a British birth cohort study. Methods Multichannel sequence analysis was used to generate work-family LCTs, combining annual information on work, partnership and parenthood between 16 and 42 years for men and women in the British National Child Development Study (NCDS, followed since their birth in 1958). Associations between work-family LCTs and metabolic risk factors in mid-life (age 44–45) were tested using multivariate linear regression in multiply imputed data. Results Life courses characterised by earlier transitions into parenthood were associated with significantly increased metabolic risk, regardless of attachment to paid work or marital stability over the life course. These associations were only partially attenuated by educational qualifications, early life circumstances and adult mediators. The positive association between weak labour markets ties and metabolic risk was weaker than might be expected from previous studies. Associations between work-family LCTs and metabolic risk factors did not differ significantly by gender. Conclusions Earlier transitions to parenthood are linked to metabolic risk in mid-life.

Relationship between employment histories and frailty trajectories in later life: Evidence from the English Longitudinal Study of Ageing

Background Given the acceleration of population ageing and policy changes to extend working lives, evidence is needed on the ability of older adults to work for longer. To understand more about the health impacts of work, this study examined the relationship between employment histories before retirement and trajectories of frailty thereafter. Methods The sample comprised 2765 women and 1621 men from the English Longitudinal Study of Ageing. We used gendered typologies of life-time employment and a frailty index (FI). Multilevel growth curve models were used to predict frailty trajectories by employment histories. Results Women who had a short break for family care, then did part-time work till 59 years had a lower FI after 60 years than those who undertook full-time work until 59 years. Women who were largely family carers or non-employed throughout adulthood, had higher levels of frailty at 60 years but experienced a slower decline with age. Men who worked full-time but early exited at either 49 or 60 years had a higher FI at 65 years than those who worked full-time up to 65 years. Interaction between employment histories and age indicated that men in full-time work who experienced an early exit at 49 tended to report slower declines. Conclusions For women, experiencing distinct periods throughout the lifecourse of either work or family care may be advantageous for lessening frailty risk in later life. For men, leaving paid employment before 65 years seems to be beneficial for decelerating increases in frailty thereafter. Continuous full-time work until retirement age conferred no long-term health benefits.

Work-family life courses and BMI trajectories in three British birth cohorts

BACKGROUND/OBJECTIVES:Combining work and family responsibilities has previously been associated with improved health in mid-life, yet little is known about how these associations change over time (both biographical and historical) and whether this extends to body mass index (BMI) trajectories for British men and women. The purpose of this study was to investigate relationships between work-family life courses and BMI trajectories across adulthood (16–42 years) for men and women in three British birth cohorts.SUBJECTS/METHODS:Multiply imputed data from three nationally representative British birth cohorts were used—the MRC National Survey of Health and Development (NSHD; 1946 birth cohort, n=3012), the National Child Development Study (NCDS; 1958 birth cohort, n=9614) and the British Cohort Study (BCS; 1970 birth cohort, n=8140). A typology of work-family life course types was developed using multi-channel sequence analysis, linking annual information on work, partnerships and parenthood from 16 to 42 years. Work-family life courses were related to BMI trajectories using multi-level growth models. Analyses adjusted for indicators of prior health, birthweight, child BMI, educational attainment and socioeconomic position across the life course, and were stratified by gender and cohort.RESULTS:Work-family life courses characterised by earlier transitions to parenthood and weaker long-term links to employment were associated with greater increases in BMI across adulthood. Some of these differences, particularly for work-family groups, which are becoming increasingly non-normative, became more pronounced across cohorts (for example, increases in BMI between 16 and 42 years in long-term homemaking women: NSHD: 4.35 kg m–2, 95% confidence interval (CI): 3.44, 5.26; NCDS: 5.53 kg m–2, 95% CI: 5.18, 5.88; BCS: 6.69 kg m–2, 95% CI: 6.36, 7.02).CONCLUSIONS:Becoming a parent earlier and weaker long-term ties to employment are associated with greater increases in BMI across adulthood in British men and women.

Do work and family care histories predict health in older women

Abstract Background Social and policy changes in the last several decades have increased women’s options for combining paid work with family care. We explored whether specific combinations of work and family care over the lifecourse are associated with variations in women’s later life health. Methods We used sequence analysis to group women in the English Longitudinal Study of Ageing according to their work histories and fertility. Using logistic regression, we tested for group differences in later life disability, depressive symptomology and mortality, while controlling for childhood health and socioeconomic position and a range of adult socio-economic circumstances and health behaviours. Results Women who transitioned from family care to either part-time work after a short break from the labour force, or to full-time work, reported lower odds of having a disability compared with the reference group of women with children who were mostly employed full-time throughout. Women who shifted from family care to part-time work after a long career break had lower odds of mortality than the reference group. Depressive symptoms were not associated with women’s work and family care histories. Conclusion Women’s work histories are predictive of their later life disability and mortality. This relationship may be useful in targeting interventions aimed at improving later life health. Further research is necessary to explore the mechanisms linking certain work histories to poorer later life health and to design interventions for those affected.

Social change and women's health.

Over the past five decades, the organization of womens lives has changed dramatically. Throughout the industrialized world, paid work and family biographies have been altered as the once-dominant role of homemaker has given way to the role of secondary, dual, or even primary wage-earner. The attendant changes represent a mix of gains and losses for women, in which not all women have benefited (or suffered) equally. But little is known about the health consequences. This article addresses that gap. It develops a “situated biographies” model to conceptualize how life course change may influence womens health. The model stresses the role of time, both as individual aging and as the anchoring of lives in particular historical periods. “Situating” biographies in this way highlights two key features of social change in womens lives: the ambiguous implications for the health of women as a group, and the probable connections to growing social and economic disparities in health among them. This approach lays the groundwork for more integrated and productive population-based research about how historical transformations may affect womens health.