The perplexing links between contraceptive sterilization and (dis)advantage in ten low-fertility countries.

This study investigated the association between contraceptive sterilization and socio-economic status (measured by educational attainment) in ten countries, using data from the 2006-10 National Survey of Family Growth and the 2004-10 Generations and Gender Surveys. The findings confirm that a long-standing association between socio-economic status and sterilization persists in the contemporary United States: female sterilization is associated with economic disadvantage, whereas male sterilization is associated with economic advantage. The latter association is found to be unique to the United States, but female sterilization is associated with disadvantage in most of the other countries studied. While basic demographic background factors such as early childbearing and parity can explain the observed associations in most of the countries, a strong gendered association between sterilization and socio-economic status remains in the United States and Belgium even after adjusting for these factors.

Case Report: Initial Successful Treatment of Migraine and Irritable Bowel Syndrome With a Low-FODMAP Diet.

OBJECTIVE: Migraine and irritable bowel syndrome (IBS) can be difficult-to-treat comorbidities that may be driven by underlying gut-brain axis dysfunction. This report describes utilization of a low-FODMAP (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols) diet (LFD) in a patient with refractory migraine and co-occurring IBS. METHODS: After unremarkable physical and neurological examinations, a 57-year-old woman with IBS and chronic migraine was started on a LFD under the guidance of a registered dietician. Psychometrically validated surveys administered at baseline and initial follow-up assessed patient-reported outcomes related to migraine and IBS symptoms. RESULTS: At baseline, the patient reported 80/90 migraine days with average pain of 8/10, a Migraine Disability Assessment (MIDAS) score of 33, and Headache Impact Test-6 (HIT-6) score of 64, the latter 2 scores indicating severe disability. Baseline IBS symptom severity was noted at 9/10. Within 1 week on a LFD, the patient's IBS symptoms and migraines improved in both frequency and intensity of episodes. After 5 weeks on a LFD elimination, the patient's clinical improvement continued and she reported significant reduction in migraines, with average pain of 1/10 and IBS severity of 3/10. The patient also improved from severe to minimal levels of disability on validated measures (MIDAS, HIT-6, and IBS Patient Global Impression of Change). CONCLUSION: This is the first case report detailing successful initial treatment of migraine and co-occurring IBS utilizing a dietician-guided LFD. There are a number of important reasons for potential improvement in these gut-brain axis disorders which are reviewed as well as an implication for long-term management and food reintroduction. Larger, randomized trials evaluating a LFD in diverse individuals with migraine and co-occurring IBS are warranted to help confirm these results.

Divorce, Repartnering, and Stepfamilies: A Decade in Review.

This article reviews key developments in the past decade of research on divorce, repartnering, and stepfamilies. Divorce rates are declining overall, but they remain high and have risen among people older than age 50. Remarriage rates have declined, but the overall proportion of marriages that are remarriages is rising. Transitions in parents' relationships continue to be associated with reduced child well-being, but shifting patterns of divorce and repartnering during the past decade have also reshaped the family lives of older adults. We review research on the predictors and consequences of these trends and consider what they reveal about the changing significance of marriage as an institution. Overall, recent research on divorce, repartnering, and stepfamilies points to the persistence of marriage as a stratified and stratifying institution and indicates that the demographic complexity of family life is here to stay.

Analysis of State Insurance Coverage for Nonpharmacologic Treatment of Low Back Pain as Recommended by the American College of Physicians Guidelines.

BACKGROUND: In 2017, the American College of Physicians (ACP) released guidelines encouraging nonpharmacologic treatment of chronic low back pain (LBP). These guidelines recommended utilization of treatments including multidisciplinary rehabilitation, acupuncture, mindfulness-based stress reduction (MBSR), tai chi, yoga, progressive relaxation, biofeedback, cognitive behavioral therapy (CBT), and spinal manipulation. OBJECTIVE: We aimed to determine status of insurance coverage status for multiple nonpharmacological pain therapies based on the 2017 Essential Health Benefits (EHB) benchmark plans across all states. METHODS: The 2017 EHB benchmark plans represent the minimum benefits required in all new policies in the individual and small group health insurance markets and were reviewed for coverage of treatments for LBP recommended by the ACP guidelines. Additionally, plans were reviewed for limitations and exclusionary criteria. RESULTS: In nearly all state-based coverage policies, chronic pain management and multidisciplinary rehabilitation were not addressed. Coverage was most extensive (supported by 46 states) for spinal manipulation. Acupuncture, massage, and biofeedback were each covered by fewer than 10 states, while MBSR, tai chi, and yoga were not covered by any states. Behavioral health treatment (CBT and biofeedback) coverage was often covered solely for mental health diagnoses, although excluded for treating LBP. CONCLUSION: Other than spinal manipulation, evidence-based, nonpharmacological therapies recommended by the 2017 ACP guidelines were routinely excluded from EHB benchmark plans. Insurance coverage discourages multidisciplinary rehabilitation for chronic pain management by providing ambiguous guidelines, restricting ongoing treatments, and excluding behavioral or complementary therapy despite a cohesive evidence base. Better EHB plan coverage of nondrug therapies may be a strategy to mitigate the opioid crisis. Recommendations that reflect current research-based findings are provided to update chronic pain policy statements.

Understanding Sterilization Regret in the United States: The Role of Relationship Context.

Although one fourth of sterilized reproductive-aged women in the U.S. express a desire to have their sterilization procedures reversed, the pathways leading to sterilization regret remain insufficiently understood. Particularly little is known about how cohabitation affects the likelihood of sterilization regret. This study used data from the 2006-2010 National Survey of Family Growth to investigate how relationship context shapes women's risk of sterilization regret. Our findings point to higher levels of regret among women who were cohabiting, rather than married or single at the time of sterilization. Experiencing post-sterilization union dissolution or post-sterilization union formation was also associated with an elevated risk of regret. Together, post-sterilization union instability and selected background characteristics largely explained elevated levels of regret observed among women who were cohabiting at the time of sterilization. An association between regret and post-sterilization union instability persisted, however, even when socioeconomic and reproductive background factors were controlled.

Desire for Sterilization Reversal Among U.S. Females: Increasing Inequalities by Educational Level.

CONTEXT: For decades, high reliance on female sterilization in the United States has been accompanied by a high level of desire for sterilization reversal, and less-educated women have been more likely than better educated women to use the method and desire a reversal. Little is known about how levels of and educational differentials in such desire have changed in recent decades. METHODS: Data from 4,147 women who reported being sterile from a tubal sterilization in the 1995, 2002 and 2006-2010 waves of the National Survey of Family Growth were analyzed using chi-square and Wald tests and binary logistic regression analyses. Predicted probabilities were calculated to determine the likelihood of desire for procedure reversal by wave and educational level. RESULTS: The prevalence of desire for sterilization reversal rose by 41%, from 18% in 1995 to 23% in 2002 and 25% in 2006-2010. Overall, women with a bachelor's degree were less likely than those who had not finished high school to desire a reversal (odds ratio, 0.2), and this educational differential was larger in 2006-2010 than in earlier waves. Predicted probabilities indicate that 9% of sterilized women with less than a high school education and 8% of those with a bachelor's degree expressed a desire for procedure reversal in 1995, as did 15% and 3%, respectively, in 2006-2010. CONCLUSION: Future research should consider how insurance coverage of all methods under the Affordable Care Act may affect use of sterilization and desire for reversal.

Stepfather families and the emotional well-being of adolescents.

Although approximately one-third of all children born in the United States are expected to spend some time living in a married or cohabiting stepfamily, our understanding of the implications of stepfamilies for the well-being of youth remains incomplete. Using data from the National Longitudinal Study of Adolescent Health, this research investigates adolescent depressive symptomatology and suicide ideation in stepfather families, paying careful attention to variation in pathways of stepfamily formation. I test multiple theoretical explanations for the effects of family structure on adolescent emotional well-being, including perspectives emphasizing economic deprivation, socialization and social control, stress and instability, and community connections. I also explore the possibility that observed associations between family structure and youth well-being might be spuriously produced by the preexisting selective characteristics of stepfamilies. The results of this research point to a complex relationship between stepfamily formation and adolescent emotional well-being, suggesting both positive and negative effects.

Work-family conflict and retirement preferences.

OBJECTIVES: This study investigates relationships between retirement preferences and perceived levels of work-family conflict. METHODS: Using the large sample of 52-54-year-old respondents to the 1992 Wisconsin Longitudinal Study, we estimated multinomial logistic regression models of preferences for partial and full retirement within the next 10 years. We examined the association between retirement preferences and perceived work-family conflict, evaluated the extent to which work-family conflict was a mediating mechanism between stressful work and family circumstances and preferences to retire, and explored potential gender differences in the association between work-family conflict and preferring retirement. RESULTS: Work-family conflict was positively related to preferences for both full and partial retirement. Yet work-family conflict did not appear to mediate relationships between stressful work and family environments and retirement preferences, nor did significant gender differences emerge in this association. DISCUSSION: Our analyses provide the first direct evidence of the role played by work-family conflict in the early stages of the retirement process, although we were not able to identify the sources of conflict underlying this relationship. Identifying the sources of this conflict and the psychological mechanisms linking work-family conflict to retirement preferences is an important task for future researchers.

The Growing Racial and Ethnic Divide in U.S. Marriage Patterns.

The United States shows striking racial and ethnic differences in marriage patterns. Compared to both white and Hispanic women, black women marry later in life, are less likely to marry at all, and have higher rates of marital instability. Kelly Raley, Megan Sweeney, and Danielle Wondra begin by reviewing common explanations for these differences, which first gained momentum in the 1960s (though patterns of marital instability diverged earlier than patterns of marriage formation). Structural factors-for example, declining employment prospects and rising incarceration rates for unskilled black men-clearly play a role, the authors write, but such factors don't fully explain the divergence in marriage patterns. In particular, they don't tell us why we see racial and ethnic differences in marriage across all levels of education, and not just among the unskilled. Raley, Sweeney and, Wondra argue that the racial gap in marriage that emerged in the 1960s, and has grown since, is due partly to broad changes in ideas about family arrangements that have made marriage optional. As the imperative to marry has fallen, alongside other changes in the economy that have increased women's economic contributions to the household, socioeconomic standing has become increasingly important for marriage. Race continues to be associated with economic disadvantage, and thus as economic factors have become more relevant to marriage and marital stability, the racial gap in marriage has grown.

Race, Ethnicity, and the Changing Context of Childbearing in the United States.

In what ways do childbearing patterns in the contemporary United States vary for white, black, and Hispanic women? Why do these differences exist? Although completed family size is currently similar for white and black women, and only modestly larger for Hispanic women, we highlight persistent differences across groups with respect to the timing of childbearing, the relationship context of childbearing, and the extent to which births are intended. We next evaluate key explanations for these differences. Guided by a "proximate determinants" approach, we focus here on patterns of sexual activity, contraceptive use, and post-conception outcomes such as abortion and changes in mothers' relationship status. We find contraceptive use to be a particularly important contributor to racial and ethnic differences in childbearing, yet reasons for varying use of contraception itself remain insufficiently understood. We end by reflecting on promising directions for further research.

Who is using long-acting reversible contraceptive methods? Findings from nine low-fertility countries.

CONTEXT: Long-acting reversible contraceptive (LARC) methods-IUDs and implants-are more effective than other reversible methods, yet are little used in the United States. Examining which U.S. women use LARC methods and how they differ from users in other low-fertility countries may help point the way toward increasing use. METHODS: Data from married or cohabiting women participating in the National Survey of Family Growth (2008-2010) and in eight countries' Generations and Gender Programme surveys (2004-2010) were used in bivariate and multinomial logistic regression analyses examining LARC use within each setting. RESULTS: The proportion of contraceptive use accounted for by LARC methods was generally greater in Europe (10-32%) than in the United States (10%) and Australia (7%). Compared with LARC use among comparable groups in other countries, use was particularly low among U.S. women who were married, were aged 40-44 or had had three or more children, yet was comparatively high among 18-24-year-olds. Among U.S. women, those aged 35-39 or 40-44 were more likely than 18-29-year-olds to rely on sterilization rather than on LARC methods (odds ratios, 3.0 and 10.7, respectively), those who had had three or more children were more likely to do so than were those who had had none or one (4.9), and women who had completed college were less likely than those who had not finished high school to do so (0.4). CONCLUSIONS: Certain subgroups of U.S. women may benefit from the reversibility and effectiveness of LARC methods.

Precarious employment, bad jobs, labor unions, and early retirement.

OBJECTIVES: We examined the extent to which involuntary job loss, exposure to "bad jobs," and labor union membership across the life course are associated with the risk of early retirement. METHODS: Using data from the Wisconsin Longitudinal Study, a large (N=8,609) sample of men and women who graduated from high school in 1957, we estimated discrete-time event history models for the transition to first retirement through age 65. We estimated models separately for men and women. RESULTS: We found that experience of involuntary job loss and exposure to bad jobs are associated with a lower risk of retiring before age 65, whereas labor union membership is associated with a higher likelihood of early retirement. These relationships are stronger for men than for women and are mediated to some extent by pre-retirement differences in pension eligibility, wealth, job characteristics, and health. DISCUSSION: Results provide some support for hypotheses derived from theories of cumulative stratification, suggesting that earlier employment experiences should influence retirement outcomes indirectly through later-life characteristics. However, midlife employment experiences remain associated with earlier retirement, net of more temporally proximate correlates, highlighting the need for further theorization and empirical evaluation of the mechanisms through which increasingly common employment experiences influence the age at which older Americans retire.

The association between retirement and emotional well-being: does prior work-family conflict matter?

OBJECTIVE: This study investigates whether the association between retirement and emotional well-being depends on prior experience of work-family conflict. METHODS: We use data from the 1993 and 2004 waves of the Wisconsin Longitudinal Study to estimate linear regression models of 2 dimensions of emotional well-being-depressive symptoms and positive psychological functioning. We also use fixed effects models to investigate whether key findings persist after controlling for stable, but unobserved, characteristics of individuals. RESULTS: Retirement is associated with relatively fewer depressive symptoms among individuals who reported high levels of work stress interfering with family life in late midlife. We find suggestive evidence of a similar association with respect to positive psychological functioning after accounting for unobserved characteristics of individuals. Among individuals reporting high levels of family stress spillover into work life at late midlife, our results suggest that retirement tends to be associated with better emotional well-being among men than among women. DISCUSSION: Retirement may come more as a relief than as a stressor for individuals previously experiencing high levels of work demands interfering with family life. However, particularly among women, retirement may not relieve the burdens of family life stressors.

Later-life Employment Preferences and Outcomes: The Role of Mid-life Work Experiences.

In this paper, we evaluate relationships between mid-life work experiences and the realization of preferences for full-time employment, part-time employment, and complete retirement at age 63-64. Using rich data from the Wisconsin Longitudinal Study, we demonstrate that the likelihood of achieving one's preferred employment status is related to earlier work experiences including employment stability in mid-life and self-employment, part-time employment, and private pension coverage across the life course. Despite large gender differences in work experiences across the life course, relationships between earlier work experiences and the likelihood of realizing later-life employment preferences are generally similar for men and women. We also find that these relationships are only partially mediated by economic and employment circumstances in late mid-life, suggesting the need for further evaluation of the cumulative pathways linking mid-life work experiences to the realization of later-life employment preferences.