Ingrid Waldron

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

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

Why do Women Live Longer than Men

In the contemporary United States, males have 60 percent higher mortality than females. In Part I, published in the previous issue, we showed that 40 percent of this sex differential in mortality is due to a twofold elevation of arteriosclerotic heart disease among men. Major causes of higher rates of arteriosclerotic heart disease in men include greater cigarette smoking among men; probably a greater prevalence of the competitive, aggressive Coronary Prone Behavior Pattern among men; and possibly a protective role of female hormones. In addition, men have higher death rates for lung cancer and emphysema, primarily because more men smoke cigarettes. In Part II we analyze the other major causes of mens higher death rates: accidents, suicide, and cirrhosis of the liver. Each of these is related to behaviors which are encouraged or accepted more in men than in women in our society--for example, using guns, being adventurous and acting unafraid, working at hazardous jobs and drinking alcohol. We conclude with suggestions for reducing male mortality; for example, by changing the social conditions which foster in men the behaviors that elevate their mortality.

Employment and Women's Health Effects of Paid Employment on Women's Mental and Physical Health

This article reviews empirical evidence con- cerning the effects of paid employment on womens mental and physical health, with special attention to variations in the effects of employment depending on the character- istics of women and their jobs. We highlight methodolog- ical issues and focus primarily on studies with longitudinal data for representative samples of women. We conclude that womens employment does not have a negative effect on their health, on the average. Indeed, employment ap- pears to improve the health of unmarried women and married women who have positive attitudes toward em- ployment. Possible mediators linking employment to health outcomes are discussed. Current evidence suggests that increased social support from co-workers and super- visors may be one important mediator of the beneficial health effects of employment. Given the paucity of avail- able longitudinal studies, we encourage additional pro- spective research examining the mental and physical health consequences of employment according to job characteristics, personal characteristics, and disease out- come. We also recommend research on several promising mediators of employment-health relationships.

Patterns and causes of gender differences in smoking

In the early twentieth century in the United States and other Western countries, women were much less likely than men to smoke cigarettes, due in part to widespread social disapproval of womens smoking. During the mid-twentieth century, growing social acceptance of womens smoking contributed to increased smoking adoption by women. Increased social acceptance of womens smoking was part of a general liberalization of norms concerning womens behavior, reflecting increasing equality between the sexes. These historical trends were due in part to increases in womens employment. However, in the contemporary period employment appears to have little or no effect on womens smoking. Sex role norms and general expectations concerning gender-appropriate behavior have had a variety of effects on gender differences in smoking. First, general characteristics of traditional sex roles, including mens greater social power and generally greater restrictions on womens behavior, contributed to widespread social pressures against womens smoking. Second, traditional sex role norms and expectations have fostered gender differences in personal characteristics and experiences which influence smoking adoption. For example, rebelliousness has been more expected and accepted for males, and greater rebelliousness among adolescent males has contributed to greater smoking adoption by males. Finally, certain aspects of sex roles have contributed to gender differences in appraisal of the costs and benefits of smoking. For example, physical attractiveness is emphasized more for females and the contemporary beauty ideal is very slender, so females are more likely to view weight control as a benefit of smoking. Several other hypotheses concerning the causes of gender differences in smoking are not supported by the available evidence. For example, it appears that womens generally greater concern with health has not contributed significantly to gender differences in the prevalence of smoking. Similarly, it appears that sex differences in physiological responses to smoking have made only minor contributions to gender differences in smoking adoption or cessation.

Sex differences in illness incidence, prognosis and mortality: Issues and evidence

This paper reviews current research and presents new evidence concerning sex differences in morbidity and mortality. Attention is focused primarily on the following topics: (1) sex differences in incidence, prognosis and mortality for several major types of chronic disease, (2) causes of sex differences in morbidity and mortality, (3) sex differences in physician visits and (4) a methodological issue, whether there are sex differences in reporting morbidity. Relationships between sex differences in incidence, prognosis and mortality have been analyzed for various types of cancer, ischemic heart disease and rheumatoid arthritis. There was little or no correlation between sex differences in incidence and sex differences in prognosis. Sex differences in prognosis were generally smaller than sex differences in incidence. In most cases, sex differences in prognosis made a relatively small contribution to sex differences in mortality, and sex differences in incidence were the primary determinant of sex differences in mortality. These patterns indicate that the causes of sex differences in incidence frequently have little effect on sex differences in prognosis. Reasons for this are discussed in the text. The causes of sex differences in morbidity and mortality are discussed, with attention to the contributions of genetic and environmental factors, sex roles, sex differences in stress responses and sex differences in risk-taking and preventive behaviors. One conclusion is that, although men take more risks of certain types, there does not appear to be a consistent sex difference in propensity to take risks or to engage in preventive behavior. Rather sex differences in risk-taking and preventive behavior vary depending on the specific behavior and the culture considered. Sex differences in physician visit rates are influenced by a variety of biological and cultural factors. For example, womens more complex and demanding reproductive functions are a major reason for womens higher rates of physician visits, at least in Western countries. The importance of cultural factors is indicated by the cross-cultural and historical variation in sex differences in physician visit rates. In order to test whether there are sex differences in the reporting of health and illness, discrepancies between self-report and medically-evaluated morbidity measures have been assessed for males and females in twelve studies. These data indicate that sex differences in reporting vary depending on the particular type of morbidity measure considered. For example, for self-ratings of general health women may be more predisposed than men to rate their health poor, but no significant sex differences were observed in reporting of physician visits or hospital admissions. The evidence discussed in this paper illustrates the diversity and complexity of factors that influence sex differences in morbidity and mortality...

Interacting effects of multiple roles on women's health

Our study tests several hypotheses concerning the effects of employment, marriage, and motherhood on womens general physical health. These hypotheses predict how the health effect of each role varies, depending on specific role characteristics and the other roles a woman holds. Our analyses utilize longitudinal panel data for 3,331 women from the National Longitudinal Surveys of Young Women (follow-up intervals: 1978-83 and 1983-88). The Role Substitution Hypothesis proposes that employment and marriage provide similar resources (e.g., income and social support), and consequently, employment and marriage can substitute for each other in their beneficial effects on health. As predicted, we found that employment had beneficial effects on health for unmarried women, but little or no effect for married women. Similarly, marriage had beneficial effects on health only for women who were not employed. The Role Combination Strain Hypothesis proposes that employed mothers experience role strain, resulting in harmful effects on health. However, we found very little evidence that the combination of employment and motherhood resulted in harmful health effects. Contrary to the predictions of the Quantitative Demands Role Strain Hypothesis, it appears that neither longer hours of employment nor having more children resulted in harmful effects on health. As predicted by the Age-Related Parental Role Strain Hypothesis, younger age at first birth, particularly a teenage birth, appeared to result in more harmful health effects.

Recent trends in sex mortality ratios for adults in developed countries.

This paper analyzes changes in sex mortality ratios between 1979 and 1987 for adults in 23 developed countries. (A sex mortality ratio is the ratio of male to female death rates.) Previous analyses have shown that during the mid-twentieth century sex mortality ratios increased for all adult age groups. During the 1980s sex mortality ratios continued to increase for 25-34 year olds, but showed mixed trends for other adult age groups. For example, for older adults aged 55-64, sex mortality ratios increased in Southern and Eastern European countries and Japan, but sex mortality ratios decreased in Northern European and Anglophone countries. Trends in several causes of death contributed to these trends in sex mortality ratios. For example, for 25-34 year olds, increases in mens suicide rates and HIV or AIDS mortality contributed to the increases in sex mortality ratios. For older adults, it was hypothesized that decreasing sex differences in cigarette smoking in recent decades would result in decreasing sex differences in lung cancer and ischemic heart disease mortality during the 1980s. The predicted decrease in sex differences in lung cancer mortality was observed in many countries; women had more unfavorable lung cancer mortality trends than men in the Anglophone countries and Northern and Central Western European countries. In contrast, very little evidence was found for the predicted decrease in sex differences in ischemic heart disease. The paper presents additional data concerning the contributions of trends in specific causes of death to changes in sex mortality ratios and briefly reviews evidence concerning probable causes of the observed mortality trends. It appears that recent trends in sex mortality ratios have been influenced by changing sex differences in smoking and a variety of additional factors, such as the effects of improvements in health care interacting with inherent sex differences in vulnerability to ischemic heart disease.

The coronary-prone behavior pattern in employed men and women.

Abstract The Coronary-Prone Behavior Pattern is a hard-driving, aggressive style of life which previous work has shown to be associated with a substantially increased risk of coronary heart disease. A questionnaire, the Jenkins Activity Survey, yields a Type A score which is a measure of the Coronary-Prone Behavior Pattern. A previous factor analysis of questionnaire responses given by older employed white men yielded three factors designated Speed-and-Impatience, Job-Involvement and Hard-Driving-and-Competitive. Factor analyses for our sub-samples of younger and older employed white men and women all yielded factors closely related to the three factors derived previously. Factor analyses for the subsamples of black men and black women yielded factors which were similar but suggested some cultural differences. For employed women, maximum values of Type A and Speed-and-Impatience scores were observed at ages 30–35. The scores for employed men did not show this peak. We hypothesize that women who are more T...

Cross-cultural variation in blood pressure: A quantitative analysis of the relationships of blood pressure to cultural characteristics, salt consumption and body weight

This study has analyzed the relationships of cross-cultural variation in blood pressure to cultural characteristics, salt consumption and body weight. The data used were blood pressures for adults in 84 groups, ratings of cultural characteristics (based on anthropological data and made by raters who had no knowledge of the blood pressure data) and, where available, salt consumption and body mass index (weight/height2). Blood pressures were higher and the slopes of blood pressure with age were greater in groups which had greater involvement in a money economy, more economic competition, more contact with people of different culture or beliefs, and more unfulfilled aspirations for a return to traditional beliefs and values. Blood pressures were also higher in groups for which the predominant family type was a nuclear or father-absent family, as opposed to an extended family. For Negroes, groups who were descended from slaves had higher blood pressures than other groups. The correlations between blood pressures and involvement in a money economy were substantial and significant even after controlling for level of salt consumption and, for men, also after controlling for body mass index. For men there were also significant partial correlations between blood pressure and salt consumption, controlling for type of economy. For women there were significant partial correlations between blood pressure and body mass index, controlling for type of economy. In conclusion, cross-cultural variation in blood pressure appears to be due to multiple factors. One contributory factor appears to be psychosocial stress due to cultural disruption, including the disruption of cooperative relationships and traditional cultural patterns which frequently occurs during economic modernization. In addition, both the protective effects of very low salt consumption in some groups and differences in body weight appear to contribute to cross-cultural variation in blood pressure.

The coronary-prone behavior pattern, blood pressure, employment and socio-economic status in women

Abstract The Coronary-Prone Behavior Pattern is a hard-driving style of life which is associated with an increased risk of coronary heart disease. For the 40–59-yr old women in this study, the Coronary-Prone Behavior Pattern was associated with high occupational status. In contrast, the Coronary-Prone Behavior Pattern was not related to the occupational status of the womans husband or whether she was currently married. Thus the Coronary-Prone Behavior Pattern may be related to success in the traditional male occupational role, but not to a womans success in the marital role. The Coronary-Prone Behavior Pattern was more common among women employed full-time than among housewives and women employed part-time. Women with the Coronary-Prone Behavior Pattern did not prefer longer hours of employment; rather, these women were more likely to work longer hours than they preferred. Few of the women who were taking anti-hypertensive medication were employed full-time. Among women who were not under treatment for hypertension, full-time employment was associated with higher blood pressures. These findings suggest that full-time employment may contribute to increased blood pressures, and yet overt hypertension may be less common among employed women since women who become ill tend to leave their jobs.