Parity and post-reproductive mortality among U.S. Black and White women: Evidence from the health and retirement study.

Population health research finds women's mortality risk associated with childlessness, low parity (one child), and high parity (6+ children) in a U-shaped pattern, although U.S. studies are inconsistent overall and by race/ethnicity. Parity, however, is contingent on women's biophysiological likelihood of (in)fecundity as well as voluntary control practices that limit fertility. No studies have empirically examined infecundity differentials among women and their potential contribution to the parity-post-reproductive mortality relationship or the race/ethnic-related mortality gap. We examine 7,322 non-Hispanic Black and White women, born 1920-1941, in the Health and Retirement Study, using zero-inflation methods to estimate infecundity risk and parity by race/ethnicity. We estimate proportional hazards models [t0 1992/1998, t1 2018] to examine associations of infecundity risk, parity, early-life-course health and social statuses, and post-reproductive statuses with all-cause mortality. We find Black women's infecundity probability to be twice that of White women and their expected parity 40% higher. Infecundity risk increases mortality risk for all women, but parity-post-reproductive mortality associations differ by race/ethnicity. White women with one and 5+ children (U-shaped curve) have increased mortality risk, adjusting for infecundity risk and early-life factors; further adjustment for post-reproductive health and social status attenuates all parity-related mortality risk. Black women's parity-post-reproductive mortality associations are not statistically significant. Black women's post-reproductive mortality risk is anchored in earlier-life conditions that elevate infecundity risk. Results suggest a need to focus upstream to better elucidate race/ethnic-related social determinants of reproductive health, infecundity, parity, and mortality.

Birth in the U.S. Plantation South and Racial Differences in all-cause mortality in later life.

The American South has been characterized as a Stroke Belt due to high cardiovascular mortality. We examine whether mortality rates and race differences in rates reflect birthplace exposure to Jim Crow-era inequalities associated with the Plantation South. The plantation mode of agricultural production was widespread through the 1950s when older adults of today, if exposed, were children. We use proportional hazards models to estimate all-cause mortality in Non-Hispanic Black and White birth cohorts (1920-1954) in a sample (N = 21,941) drawn from REasons for Geographic and Racial Differences in Stroke (REGARDS), a national study designed to investigate Stroke Belt risk. We link REGARDS data to two U.S. Plantation Censuses (1916, 1948) to develop county-level measures that capture the geographic overlap between the Stroke Belt, two subregions of the Plantation South, and a non-Plantation South subregion. Additionally, we examine the life course timing of geographic exposure: at birth, adulthood (survey enrollment baseline), neither, or both portions of life. We find mortality hazard rates higher for Black compared to White participants, regardless of birthplace, and for the southern-born compared to those not southern-born, regardless of race. Race-specific models adjusting for adult Stroke Belt residence find birthplace-mortality associations fully attenuated among White-except in one of two Plantation South subregions-but not among Black participants. Mortality hazard rates are highest among Black and White participants born in this one Plantation South subregion. The Black-White mortality differential is largest in this birthplace subregion as well. In this subregion, the legacy of pre-Civil War plantation production under enslavement was followed by high-productivity plantation farming under the southern Sharecropping System.

Race, Remarital Status, and Infertility in 1910: More Evidence of Multiple Causes.

The dominant approach to studying historical race-related fertility differences has been to limit samples to first-married and younger women. We argue that studying historical race-related fertility differences in the context of remarriage is also important: remarriage and fertility patterns are both rooted in the biosocial conditions that produce racial disparities in health. We employ a multiple causes framework that attributes variation in fertility patterns to voluntary limitation and involuntary factors (infecundity/subfecundity). We use data from the 1910 Integrated Public Use Microdata Series and estimate zero-inflated negative binomial models that simultaneously distinguish those who are infecund (vs. fecund) and estimate the number of remarital births among the fecund. Our approach allows us to evaluate historical remarital (in)fertility differences, accounting for marital, socioeconomic, and geographic influences on fecundity and fertility, while empirically accounting for the influence of children "missing" from the household due to mortality and fostering/aging out. Consistent with past studies that emphasized poorer African American health as a major influence on involuntary infertility, we find that African American women were more likely than white women to be in the always-zero (infecund) group and to have fewer remarital births. Supplemental analyses nuance these findings but indicate that these results are robust. Overall, we find support for a multiple-causes perspective: while the findings are consistent with the adoption of deliberate fertility control among urban and higher-status women at higher parities, remarital fertility differences in 1910 also reflected greater infecundity/subfecundity among subgroups of women, especially African American women.

Fundamental resource dis/advantages, youth health and adult educational outcomes.

Recent studies find lasting effects of poor youth health on educational attainment but use young samples and narrow life course windows of observation to explore outcomes. We apply a life course framework to three sets of Health and Retirement Study birth cohorts to examine early health status effects on education and skills attainment measured late in life. The older cohorts that we study were the earliest recipients of U.S. policies promoting continuing education through the GI Bill, community college expansions and new credentials such as the GED. We examine a wide range of outcomes but focus on GEDs, postsecondary school entry and adult human capital as job-related training. We find that older U.S. cohorts had considerable exposure to these forms of attainment and that the effects of youth health on them vary by outcome: health selection and ascription group effects are weak or fade, respectively, in outcomes associated with delayed or adult attainment. However, poorer health and social disadvantage in youth and barriers associated with ascription carry forward to limit attainment of key credentials such as diplomas and college degrees. We find that the human capital - health gradient is dynamic and that narrow windows of observation in existing studies miss much of it. National context also matters for studying health-education linkages over the life course.

Extending public health: the Rockefeller Sanitary Commission and hookworm in the American South.

The Rockefeller Sanitary Commission for the Eradication of Hookworm Disease (1909-1914) fielded a philanthropic public health project that had three goals: to estimate hookworm prevalence in the American South, provide treatment, and eradicate the disease. Activities covered 11 Southern states, and Rockefeller teams found that about 40% of the population surveyed was infected. However, the commission met strong resistance and lacked the time and resources to achieve universal county coverage and meet project goals. We explore how these constraints triggered project changes that systematically reshaped project operations and the characteristics of the counties surveyed and treated. We show that county selectivity reduced the project's initial potential to affect hookworm prevalence estimates, treatment, and eradication in the American South.

Change in attitudes about employed mothers: exposure, interests, and gender ideology discrepancies.

Using a sample of continuously-married individuals (793 women and 847 men) and their spouses drawn from the first two waves of the NSFH, we examine change in individuals' attitudes about mothers' employment. We investigate hypotheses derived from three models of attitude change: the exposure model, the interest-based model, and the control model. We find support for hypotheses derived from all three. Consistent with exposure hypotheses, the adoption of fundamentalist beliefs reduces egalitarianism, while spouses' egalitarianism and spouses' education are positively related to individuals' own egalitarianism. As predicted in both exposure and interest hypotheses, women's entry into employment is positively related to women's egalitarianism, while wives' occupational prestige is positively related to men's egalitarianism. Congruent with the interest model, the presence of a young child is positively associated with women's egalitarianism. Consistent with the exposure model, the number of children in the home reduces men's egalitarianism, and a traditional division of housework decreases women's egalitarianism. Finally, consistent with the gender ideology discrepancy hypothesis, derived from the control model, individuals whose background, work, and family life are inconsistent with their gender ideology at wave 1 shift their gender ideology at wave 2 in a direction that is more compatible with their background, work, and family life: egalitarians with traditional life patterns at wave 1 are more traditional in their gender ideology at wave 2, and traditionals with egalitarian life patterns at wave 1 are more egalitarian at wave 2. We discuss the implications of these patterns for larger scale change in gender ideology.

Childhood adversity, educational trajectories, and self-reported health in later life among U.S. women and men at the turn of the century.

A major objective of current life course research is to specify the processes linking early childhood conditions to subsequent life course statuses that span educational, occupational, familial, and health domains across the life span. This study confronts at least two persistent challenges to the rigorous specification of the relationships among these variables. The first is that the point-in-time measurement of education as "years of schooling" masks considerable heterogeneity in the timing and curricular tracks of schooling and obscures our understanding of how and when education matters for life-course inequality. The second challenge involves inter dependencies between aspects of life-course inequality, including educational achievement and health. The intertwining of these variables across the life course, and their usual conceptualization and measurement, limit the interpretation of their relationship and its generalizability across studies. We use data from three waves of the National Survey of Families and Households between 1987-1988 and 2001-2002 to explore trajectories of self-reported health, applying latent class cluster analysis (finite mixture models) to deal directly with these measurement and specification issues. Generally, we find mediating effects of education in mid-to late-life health demonstrating the pivotal role of education in life course processes. Women's childhood backgrounds are more heterogeneous and temporally complex educational careers affect their self-assessed health more than men's. Late degrees are linked to poor health trajectories among women, but not men. Also, marital history, number of births and health behaviors are associated in expected ways with women's and men's health trajectories at midlife.

Identification of factors predictive of hospital readmissions for patients with heart failure.

OBJECTIVE: The objective was to evaluate whether severity of cardiac illness, cognitive functioning, and functional health of older adults with heart failure (HF) and psychosocial factors related to caregiving are predictive of hospital readmissions for those with HF. DESIGN: A prospective, descriptive, predictive design was used. SETTING: The study took place in 2 community hospitals in northeastern Ohio. SAMPLE: Originally 156 patient-caregiver dyads were interviewed within 7 to 10 days of hospital discharge, but only 128 dyads completed the study. Subjects had HF and their mean age was 77.3 years. Their caregivers were mostly women with a mean age of 64.8 years. RESULTS: Fourty-four percent of the patients were readmitted to the hospital within 3 months. Among patients, severity of illness was moderate, blood pressure was within normal limits, functional and cognitive status were high. For patients, the interaction of severity of cardiac illness and functional status predicted risk of hospital readmission. Among caregivers, depressive symptoms and perceived stress were low; informal social support and caregiving appraisal were high. The interaction of caregiver stress and depression were significant predictors of risk of hospital readmission. CONCLUSION: Nurses should consistently assess changes in patients' cardiac symptoms in addition to their ability to provide self-care. Since patients with HF are at high risk for readmission, further study is needed to determine whether interventions designed to increase spousal support would decrease hospital readmissions.