Spousal Breadwinning Across 30 Years of Marriage and Husbands' Health: A Gendered Life Course Stress Approach.

OBJECTIVE: Wives increasingly outearn their husbands, and gender relations theory suggests this arrangement may undermine men's well-being. We explore how long-term histories of spousal breadwinning may be associated with older men's self-rated mental and physical health, and risk of nine health diagnoses. METHOD: Using 30 years of couple-level income data from the Health and Retirement Study ( n = 1,095 couples), we use latent class analyses to identify six classes that differ with respect to the timing and level of wife breadwinning. We link these classes to older husbands' later-life health. RESULTS: Classes that transitioned from husband breadwinning to wife breadwinning in early or later adulthood were associated with husbands' poorer overall physical health and risk of cardiometabolic and stress-related diseases. Patterns persist net of sociodemographics, depressive symptoms, health behaviors, and adolescent health. DISCUSSION: Violating cultural expectations, such as the masculinity ideal of male breadwinning, is associated with older men's poorer health.

Beyond sex and gender difference in funding and reporting of health research.

BACKGROUND: Understanding sex and gender in health research can improve the quality of scholarship and enhance health outcomes. Funding agencies and academic journals are two key gatekeepers of knowledge production and dissemination, including whether and how sex/gender is incorporated into health research. Though attention has been paid to key issues and practices in accounting for sex/gender in health funding agencies and academic journals, to date, there has been no systematic analysis documenting whether and how agencies and journals require attention to sex/gender, what conceptual explanations and practical guidance are given for such inclusion, and whether existing practices reflect the reality that sex/gender cannot be separated from other axes of inequality. METHODS: Our research systematically examines official statements about sex/gender inclusion from 45 national-level funding agencies that fund health research across 36 countries (covering the regions of the EU and associated countries, North America, and Australia) and from ten top-ranking general health (the top five in "science" and the top five in "social science") and ten sex- and/or gender-related health journals. We explore the extent to which agencies and journals require inclusion of sex/gender considerations and to what extent existing strategies reflect state of the art understandings of sex/gender, including intersectional perspectives. RESULTS: The research highlights the following: (a) there is no consistency in whether sex/gender are mentioned in funding and publishing guidelines; (b) there is wide variation in how sex/gender are conceptualized and how researchers are asked to address the inclusion/exclusion of sex/gender in research; (c) funding agencies tend to prioritize male/female equality in research teams and funding outcomes over considerations of sex/gender in research content and knowledge production; and (d) with very few exceptions, agency and journal criteria fail to recognize the complexity of sex/gender, including the intersection of sex/gender with other key factors that shape health. CONCLUSIONS: The conceptualization and integration of sex/gender needs to better capture the interacting and complex factors that shape health-an imperative that can be informed by an intersectional approach. This can strengthen current efforts to advance scientific excellence in the production and reporting of research. We provide recommendations and supporting questions to strengthen consideration of sex/gender in policies and practices of health journals and funding agencies.

Getting to the Heart of Masculinity Stressors: Masculinity Threats Induce Pronounced Vagal Withdrawal During a Speaking Task.

BACKGROUND: Previous work has found that traditional masculinity ideals and behaviors play a crucial role in higher rates of morbidity and mortality for men. Some studies also suggest that threatening men's masculinity can be stressful. Over time, this stress can weigh on men's cardiovascular and metabolic systems, which may contribute to men's higher rates of cardiometabolic health issues. PURPOSE: The purpose of this study is to explore how masculinity threats affect men's heart rate and heart rate variability reactivity (i.e., vagal withdrawal) to masculinity feedback on a social speaking task. METHODS: Two hundred and eighty-five undergraduate males were randomly assigned to one of six conditions during a laboratory-based speech task. They received one of two feedback types (masculinity or control) and one of three feedback levels (low, high, or dropping) in order to assess whether masculinity threats influence heart rate reactivity and vagal withdrawal patterns during the speech task. RESULTS: Men who receive low masculinity feedback during the speech task experienced more pronounced vagal withdrawal relative to those who received the control. CONCLUSION: Masculinity threats can induce vagal withdrawal that may accumulate over the life course to contribute to men's relatively worse cardiometabolic health.

Independent review of social and population variation in mental health could improve diagnosis in DSM revisions.

At stake in the May 2013 publication of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), are billions of dollars in insurance payments and government resources, as well as the diagnoses and treatment of millions of patients. We argue that the most recent revision process has missed social determinants of mental health disorders and their diagnosis: environmental factors triggering biological responses that manifest themselves in behavior; differing cultural perceptions about what is normal and what is abnormal behavior; and institutional pressures related to such matters as insurance reimbursements, disability benefits, and pharmaceutical marketing. In addition, the experts charged with revising the DSM lack a systematic way to take population-level variations in diagnoses into account. To address these problems, we propose the creation of an independent research review body that would monitor variations in diagnostic patterns, inform future DSM revisions, identify needed changes in mental health policy and practice, and recommend new avenues of research. Drawing on the best available knowledge, the review body would make possible more precise and equitable psychiatric diagnoses and interventions.

Beyond a catalogue of differences: a theoretical frame and good practice guidelines for researching sex/gender in human health.

Extensive medical, public health, and social science research have focused on cataloguing male-female differences in human health. Unfortunately, much of this research unscientifically and unquestionably attributes these differences to biological causes--as exemplified in the Institute of Medicine's conclusion that "every cell has a sex." In this manuscript we theorize the entanglement of sex and gender in human health research and articulate good practice guidelines for assessing the role of biological processes--along with social and biosocial processes--in the production of non-reproductive health differences between and among men and women. There are two basic tenets underlying this project. The first is that sex itself is not a biological mechanism and the second is that "sex" and "gender" are entangled, and analyses should proceed by assuming that measures of sex are not pristine, but include effects of gender. Building from these tenets--and using cardiovascular disease as a consistent example--we articulate a process that scientists and researchers can use to seriously and systematically assess the role of biology and social environment in the production of health among men and women. We hope that this intervention will be one further step toward understanding the complexity and nuance of health outcomes, and that this increased knowledge can be used to improve human health.

Childhood abuse as a risk factor for sleep problems in adulthood: evidence from a U.S. national study.

BACKGROUND: Accumulating evidence indicates that stress impairs sleep quality. Few studies, however, have examined the extent to which early life stress can jeopardize sleep in adulthood. PURPOSE: Guided by a life course epidemiological perspective on health, this study examined associations between childhood abuse and adult sleep problems. METHODS: We used data from 835 respondents in the National Survey of Midlife Development in the United States (MIDUS). Self-report measures assessed the frequency of physical, emotional, and sexual abuse in childhood, as well as global and component indicators of sleep problems in adulthood. RESULTS: Having experienced all three types of childhood abuse-even infrequently-was associated with global sleep pathology, as well as specific types of sleep problems. Reports of both frequent physical and frequent emotional abuse-even in the absence of sexual abuse-were also associated with poor sleep. CONCLUSIONS: Childhood abuse is a risk factor for individuals' long-term sleep problems.

"Macho men" and preventive health care: implications for older men in different social classes.

The gender paradox in mortality--where men die earlier than women despite having more socioeconomic resources--may be partly explained by men's lower levels of preventive health care. Stereotypical notions of masculinity reduce preventive health care; however, the relationship between masculinity, socioeconomic status (SES), and preventive health care is unknown. Using the Wisconsin Longitudinal Study, the authors conduct a population-based assessment of masculinity beliefs and preventive health care, including whether these relationships vary by SES. The results show that men with strong masculinity beliefs are half as likely as men with more moderate masculinity beliefs to receive preventive care. Furthermore, in contrast to the well-established SES gradient in health, men with strong masculinity beliefs do not benefit from higher education and their probability of obtaining preventive health care decreases as their occupational status, wealth, and/or income increases. Masculinity may be a partial explanation for the paradox of men's lower life expectancy, despite their higher SES.

Does Psychological Well-Being Change with Age?: Longitudinal Tests of Age Variations and Further Exploration of the Multidimensionality of Ryff's Model of Psychological Well-Being.

Using two population-based surveys, we provide the first test of longitudinal age variations in Ryff's scales of psychological well-being (RPWB) across three midlife to later-life transitions. Through these analyses we explore: (a) age variation in RPWB, (b) the structure of RPWB, and (c) the potential for methodologically driven age patterns. In general, RPWB dimensions do not consistently exhibit distinct age profiles; further, longitudinal age variations are exceptionally small, never accounting for more than four percent of the variance. We observe far greater variation within ages or periods than between subscales across age or time - providing strong evidence against substantively different age profiles of RPWB. Moreover, heterogeneity among positively and negatively worded items yield varied age patterns indicating that age variations of RWPB could be driven, at least in part, by methodological artifacts rather than maturation.

Witnessing domestic abuse in childhood as an independent risk factor for depressive symptoms in young adulthood.

OBJECTIVE: This study addresses the relationship between retrospective reports of witnessing domestic abuse in childhood and levels of depressive symptoms in young adulthood. We examine whether the association between having witnessed violence in childhood and depression is independent of having been the direct target of sexual and/or physical abuse, as well as other characteristics and experiences linked with family violence. METHODS: We used two waves of data collected from a sample of 1,175 young adults (ages 20-24) in Miami, Florida. Retrospective self-reports of witnessed abuse and measures of family context and adversities were obtained in 1998-2000. The respondents' level of depressive symptoms was assessed 2 years later in 2000-2002. RESULTS: Multivariate results indicate that frequently having witnessed domestic abuse predicts higher levels of depressive symptoms in young adulthood, independently of other risk factors for depression and family violence. CONCLUSION: Results provide preliminary evidence that frequent exposure to domestic abuse is an independent risk factor for depressive symptoms in young adulthood. PRACTICE IMPLICATIONS: Results support a renewed call for (a) increased attention to depression among children exposed to adults' interpersonal violence, and (b) greater efforts to bridge prevention and intervention efforts regarding domestic violence and child maltreatment.

Gender and health inequities: a comment on the Final Report of the WHO Commission on the Social Determinants of Health.

The Final Report of the World Health Organization (WHO) Commission on the Social Determinants of Health is a substantial and important contribution to understanding the social factors that shape global health inequities. Although gender is highlighted as a key social determinant of health, the report's conceptual approach inappropriately equates gender and health with women's health. This essay discusses the analytic and policy implications of this shortcoming.

Childhood physical abuse and midlife physical health: testing a multi-pathway life course model.

Although prior research has established that childhood abuse adversely affects midlife physical health, it is unclear how abuse continues to harm health decades after the abuse has ended. In this project, I assess four life course pathways (health behaviors, cognition, mental health, and social relation) that plausibly link childhood physical abuse to three midlife physical health outcomes (bronchitis diagnosis, ulcer diagnosis, and general physical health). These three outcomes are etiologically distinct, leading to unique testable hypotheses. Multivariate models controlling for childhood background and early adversity were estimated using data from over 3000 respondents in the Wisconsin Longitudinal Study, USA. The results indicate that midlife social relations and cognition do not function as pathways for any outcome. However, smoking is a crucial pathway connecting childhood abuse with bronchitis; mental health is important for ulcers; and BMI, smoking, and mental health are paramount for general physical health. These findings suggest that abuse survivors' coping mechanisms can lead to an array of midlife health problems. Furthermore, the results validate the use of etiologically distinct outcomes for understanding plausible causal pathways when using cross-sectional data.

Long-term physical and mental health consequences of childhood physical abuse: results from a large population-based sample of men and women.

OBJECTIVE: Child maltreatment has been linked to negative adult health outcomes; however, much past research includes only clinical samples of women, focuses exclusively on sexual abuse and/or fails to control for family background and childhood characteristics, both potential confounders. Further research is needed to obtain accurate, generalizable estimates and to educate clinicians who are generally unaware of the link between childhood abuse and adult health. The purpose of this project is to examine how childhood physical abuse by parents impacts mid-life mental and physical health, and to explore the attenuating effect of family background and childhood adversities. METHODS: We analyzed population-based survey data from over 2,000 middle-aged men and women in the Wisconsin Longitudinal Study using self-reported measures of parental childhood physical abuse, mental health (depression, anxiety, anger), physical health (physical symptoms and medical diagnoses), family background, and childhood adversities. RESULTS: Parental physical abuse was reported by 11.4% of respondents (10.6% of males and 12.1% of females). In multivariate models controlling for age, sex, childhood adversities, and family background, we found that childhood physical abuse predicted a graded increase in depression, anxiety, anger, physical symptoms, and medical diagnoses. Childhood physical abuse also predicted severe ill health and an array of specific medical diagnoses and physical symptoms. Family background and childhood adversities attenuated but did not eliminate the childhood abuse/adult health relationship. CONCLUSIONS: In a population-based cohort of middle-aged men and women, childhood physical abuse predicted worse mental and physical health decades after the abuse. These effects were attenuated, but not eliminated, by age, sex, family background, and childhood adversities.

Writing about risk: use of daily diaries in understanding drug-user risk behaviors.

As part of a larger syringe access and HIV risk study, a subsample of 23 current injection drug users completed daily diaries, highlighting activities related to syringe acquisition, use, and discard. Diaries have been previously utilized in a variety of psychological, public health, and nutrition studies to assess risk as well as correlated behaviors. We piloted the diary methodology in three northeastern U.S. cities (Hartford and New Haven, CT, and Springfield, MA) to learn about correlates of HIV risk. We discovered that the method provided advantages over several other qualitative and ethnographic methods. Results indicate that daily diaries elucidated (1) patterns of injection drug use, (2) sporadic and high-risk events, (3) HIV and hepatitis risk related to the syringe life cycle, and (4) emotional correlates of drug use. Furthermore, we witnessed an unexpected intervention effect that the diary may have in the lives of drug users.

The long-term health outcomes of childhood abuse. An overview and a call to action.

While the association between abuse in childhood and adverse adult health outcomes is well established, this link is infrequently acknowledged in the general medical literature. This paper has 2 purposes: (1) to provide a broad overview of the research on the long-term effects of child abuse on mental and physical health including some of the potential pathways, and (2) to call for collaborative action among clinicians, psychosocial and biomedical researchers, social service agencies, criminal justice systems, insurance companies, and public policy makers to take a comprehensive approach to both preventing and dealing with the sequelae of childhood abuse.

Pharmacy student knowledge, attitudes, and beliefs about selling syringes to injection drug users.

OBJECTIVE: To explore pharmacy school education and pharmacy students' knowledge, attitudes, and beliefs about human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS), drug use, and syringe sales to injection drug users (IDUs). DESIGN: Qualitative study of a convenience sample of pharmacy school students. SETTING: A pharmacy school in the southeastern United States. INTERVENTION: Two focus groups and nine in-depth interviews were conducted about HIV/AIDS education and counseling, syringe sales to possible IDUs, and related pharmacy school education. PARTICIPANTS: 19 Doctor of Pharmacy students, including 88 students in their third professional year and 11 in their fourth professional year. RESULTS: Most participants believed that they would benefit from more class time on HIV/AIDS topics, including AIDS treatment medications and HIV prevention. Most participants believed that the laws and regulations governing syringe sales in their state were vague, leaving syringe sale decisions to pharmacists' discretion. Nine study participants supported selling syringes to possible IDUs, five opposed it, and five were undecided or ambivalent. Classroom education focused on addiction to prescription drugs, with limited attention to illicit drug use. CONCLUSION: Pharmacy students have divided opinions about selling syringes to IDUs. To prepare students for helping their patients with drug-use problems, pharmacy schools should increase training about HIV/AIDS and addiction. Policy makers should consider changing laws and regulations of syringe sales to recognize prevention of blood-borne infections as a legitimate medical purpose for selling syringes to IDUs.