State COVID-19 Policies and Drug Overdose Mortality Among Working-Age Adults in the United States, 2020.

Objectives. To identify relationships between US states' COVID-19 in-person activity limitation and economic support policies and drug overdose deaths among working-age adults in 2020. Methods. We used county-level data on 140 435 drug overdoses among adults aged 25 to 64 years during January 2019 to December 2020 from the National Vital Statistics System and data on states' COVID-19 policies from the Oxford COVID-19 Government Response Tracker to assess US trends in overdose deaths by sex in 3138 counties. Results. Policies limiting in-person activities significantly increased, whereas economic support policies significantly decreased, overdose rates. A 1-unit increase in policies restricting activities predicted a 15% average monthly increase in overdose rates for men (incident rate ratio [IRR] = 1.15; 95% confidence interval [CI] = 1.09, 1.20) and a 14% increase for women (IRR = 1.14; 95% CI = 1.09, 1.20). A 1-unit increase in economic support policies predicted a 3% average monthly decrease for men (IRR = 0.97; 95% CI = 0.95, 1.00) and a 4% decrease for women (IRR = 0.96; 95% CI = 0.93, 0.99). All states' policy combinations are predicted to have increased drug-poisoning mortality. Conclusions. The economic supports that states enacted were insufficient to fully mitigate the adverse relationship between activity limitations and drug overdoses. (Am J Public Health. Published online ahead of print May 2, 2024:e1-e9. https://doi.org/10.2105/AJPH.2024.307621).

Age Differences in Experiences of Pandemic-Related Health and Economic Challenges Among Adults Aged 55 and Older.

BACKGROUND AND OBJECTIVES: The oldest adults faced the highest risk of death and hospitalization from coronavirus disease 2019 (COVID-19), but less is known about whether they also were the most likely to experience pandemic-related economic, healthcare, and mental health challenges. Guided by prior research on vulnerability versus resilience among older adults, the current study investigated age differences in economic hardship, delays in medical care, and mental health outcomes among adults aged 55 and older. RESEARCH DESIGN AND METHODS: Data were from the COVID-19 module and Leave Behind Questionnaire in the 2020 Health and Retirement Study (HRS). We estimated linear probability models to examine differences in experiences of pandemic-related economic and health challenges by age group (55-64, 65-74, 75+) with and without controls for preexisting sociodemographic, social program, health, and economic characteristics from the 2018 HRS. Models accounting for differential mortality also were estimated. RESULTS: Adults aged 65-74 and 75+ experienced fewer economic and mental health challenges and those aged 75+ were less likely to delay medical care than adults aged 55-64. Age gradients were consistent across a broad range of measures and were robust to including controls. For all age groups, economic challenges were less common than delays in medical care or experiences of loneliness, stress, or being emotionally overwhelmed. DISCUSSION AND IMPLICATIONS: Even though the oldest adults were at the greatest risk of death and hospitalization from COVID-19, they experienced fewer secondary pandemic-related challenges. Future research should continue to explore the sources of this resilience for older adults.

The Changing Demography of Late-Life Family Caregiving: A Research Agenda to Understand Future Care Networks for an Aging U.S. Population.

Repeated claims that a dwindling supply of potential caregivers is creating a crisis in care for the U.S. aging population have not been well-grounded in empirical research. Concerns about the supply of family care do not adequately recognize factors that may modify the availability and willingness of family and friends to provide care to older persons in need of assistance or the increasing heterogeneity of the older population. In this paper, we set forth a framework that places family caregiving in the context of older adults' care needs, the alternatives available to them, and the outcomes of that care. We focus on care networks, rather than individuals, and discuss the demographic and social changes that may alter the formation of care networks in the future. Last, we identify research areas to prioritize in order to better support planning efforts to care for the aging U.S. population.

U.S. States' COVID-19 physical distancing policies and working-age adult mental health outcomes.

In the early months of the COVID-19 pandemic, states enacted multiple policies to reduce in-person interactions. Scholars have speculated that these policies may have contributed to adverse mental health outcomes. This study examines potential associations between states' COVID-19 physical distancing policies and working-age (18-64) adults' self-reported mental health. Mental health outcomes (depression, anxiety, worsened mental health, and sought treatment for anxiety or depression) are from the National Wellbeing Survey collected from working-age adults in the United States (U.S.) February 1 to March 18, 2021 (N = 3,804). Data on 12 state policies are from the COVID-19 U.S. State Policy Database. Analyses included logistic regression and Bayesian group index modeling, which identified sets, or "bundles," of policies that were associated with each mental health outcome. Multiple policies (both separately and in bundles) were associated with adverse mental health outcomes, with certain policies (closures and curfews on retail and other businesses) being particularly important. A one-month increase in exposure to respective model-derived physical distancing policy bundles was associated with a 36% increase in the odds of reporting that COVID-19 worsened one's mental health (odds ratio [OR] = 1·36; 95% credible interval [CRI] = 1·01 to 1·80), a 6% increase in the odds of meeting the clinical threshold for anxiety (OR = 1·06; CRI = 0·99 to 1·16), and a 15% increase in the odds of seeking treatment for anxiety or depression (OR = 1·15; CRI = 1·02 to 1·49). To accurately understand the role of states' COVID-19 policies on mental health during the pandemic, researchers must consider how collections of policies might influence outcomes.

Paid care among older adults with long-term care needs declined in the first year of COVID-19 while families stepped in.

Separate strands of research have documented impacts of the COVID-19 pandemic in nursing homes and among paid and family caregivers, yet there is little evidence connecting changes in the residential decisions of older adults with the provision of paid and family care, limiting our ability to identify potential substitutions and gaps in care. Using the 2020 wave of the Health and Retirement Study linked to county-level COVID-19 mortality rates, we found that, among older adults with long-term care needs, higher county-level mortality rates were associated with a decline in nursing home residence and an increase in co-residence with adult children. These changes were coupled with a decline in the likelihood of receiving paid care and in the number of paid caregivers and an increase in the hours of unpaid care received. This analysis documents a reduction in nursing home residence and paid care during the first year of the pandemic and shows that families filled some of the resulting care gaps. Policymaking around long-term care should consider whether declines in the use of paid care are permanent and how they will affect the health of older Americans and their caregivers over the next decade.

Political affiliation and risk taking behaviors among adults with elevated chance of severe complications from COVID-19.

This study determines whether COVID-related risk-taking behavior was different among Republicans, Democrats, and Independents, in adults with elevated chance of severe complications from COVID-19. Using US national survey data collected September 30-October 27, 2020 (N = 6095), behaviors in the prior week examined were: 7 potentially risky activities, mask wearing anywhere, and mask wearing while undertaking each activity. Differences among political affiliations were estimated for adults with 0 and with ≥1 medical risk factors for severe complications, adjusting for sociodemographic factors. Among adults with medical risk factors, the adjusted number of potentially risky activities was higher among Republicans (3.83) but not Independents (3.17) relative to Democrats (2.98). The adjusted percentage of adults with medical risk factors who wore a mask anywhere in the past week was lower for Republicans (87%) and Independents (91%) than for Democrats (97%). While undertaking each specific activity, the adjusted percentage of at-risk adults never wearing a mask was higher for Republicans than Democrats: 24% vs 8% at bar/club; 6% vs 0% at grocery/pharmacy; 63% vs 30% visiting at friend's home; 68% vs 41% hosting visitors; 30% vs 5% at gathering of ≥10 people; 25% vs 11% while within 6 ft of someone they do not live with. Rates of mask wearing among political Independents were between rates among Democrats and Republicans. Efforts to reduce COVID-related risky behavior should recognize that although Republicans take more risks, rates of mask wearing at common activities are low across political affiliations, even for populations vulnerable to severe complications.

Association Between Risk Factors for Complications From COVID-19, Perceived Chances of Infection and Complications, and Protective Behavior in the US.

Importance: It is unknown whether adults who are susceptible to severe complications from COVID-19 recognize their susceptibility and modify behavior to reduce exposure. Objective: To determine whether adults with risk factors for COVID-19 complications perceive an elevated chance of complications and undertake fewer higher infection risk behaviors. Design, Setting, and Participants: This cross-sectional analysis, adjusted for sociodemographic characteristics, included civilian noninstitutionalized US adults of wave 18 of the Understanding America Study collected from November 11 to December 9, 2020. Exposures: US Centers for Disease Control and Prevention-identified medical risk factors for COVID-19 complications and older age. Main Outcomes and Measures: Primary outcomes were perceived percentage chance of infection and hospitalization and death if infected; whether 9 potentially higher infection risk activities were undertaken in the past week and, if so, whether a mask was worn; whether a mask was worn anywhere in the past week; and attitudes toward 12 aspects of mask wearing. Results: In Understanding America Study wave 18 (n = 5910 participants with nonmissing data), the mean age was 48 years, and 52% were women. The response rate was 77%. Adults with 7 of 9 medical risk factors and aged 70 years and older reported a higher perceived chance of complications if infected. Adjusted mean perceived chance of hospitalization if infected ranged from 23.9% (95% CI, 22.2%-25.5%) for those with high blood pressure to 40.4% (95% CI, 34.6%-46.2%) for those with chronic lung disease and was associated with number of medical risk factors: 17.6% (95% CI, 16.4%-18.8%) and 41.8% (95% CI, 38.7%-45.0%) for adults with 0 vs 3 or more medical risk factors, respectively. Fewer potentially higher infection risk activities were undertaken by adults with 3 or more vs 0 risk factors: 2.83 (95% CI, 2.66-2.99) vs 3.12 (95% CI, 3.02-3.22). Wearing a mask sometime last week was nearly universal (90.1%). But during only 1 specific activity (visiting a grocery store or pharmacy) did more than half always wear a mask, and for only 1 activity (visiting a grocery store or pharmacy) was mask wearing more common among adults with 3 or more vs 0 conditions. Conclusions and Relevance: In this cross-sectional survey study, adults with risk factors for COVID-19 complications reported higher perceived susceptibility to complications. During common activities, including visiting with friends, the majority of adults, including the highly susceptible, did not consistently wear masks.

Spatial Distance between Parents and Adult Children in the United States.

OBJECTIVE: This brief report presents contemporary national estimates of the spatial distance between residences of parents and adult children in the United States, including distance to one's nearest parent and/or adult child and whether one lives near all of their parents and adult children. BACKGROUND: The most recent national estimates of parent-child spatial proximity come from data for the early 1990s. Moreover, research has rarely assessed spatial clustering of all parents and adult children. METHOD: Data are from the 2013 Panel Study of Income Dynamics on residential locations of adults 25 and older and each of their parents and adult children. Two measures of spatial proximity were estimated: distance to nearest parent or adult child, and the share of adults who have all parents and/or adult children living nearby. Sociodemographic and geographic differences were examined for both measures. RESULTS: Among adults with at least one living parent or adult child, a significant majority (74.8%) had their nearest parent or adult child within 30 miles, and about one third (35.5%) had all parents and adult children living that close. Spatial proximity differed substantially among sociodemographic groups, with those who were disadvantaged more likely to have their parents or adult children nearby. In most cases, sociodemographic disparities were much higher when spatial proximity was measured by proximity to all parents and all adult children instead of to nearest parent or nearest adult child. CONCLUSION: Disparities in having all parents and/or adult children nearby may be a result of family solidarity and also may affect family solidarity. This report sets the stage for new investigations of the spatial dimension of family cohesion.

Disparities in vulnerability to complications from COVID-19 arising from disparities in preexisting conditions in the United States.

The COVID-19 pandemic has magnified U.S. health disparities. Though disparities in COVID-19 hospitalization by race-ethnicity are large, disparities by income and education have not been studied. Using an index based on preexisting health conditions and age, we estimate disparities in vulnerability to hospitalization from COVID-19 by income, education, and race-ethnicity for U.S. adults. The index uses estimates of health condition and age effects on hospitalization for respiratory distress prior to the pandemic validated on COVID-19 hospitalizations. We find vulnerability arising from preexisting conditions is nearly three times higher for bottom versus top income quartile adults and 60 % higher for those with a high-school degree relative to a college degree. Though non-Hispanic Blacks are more vulnerable than non-Hispanic Whites at comparable ages, among all adults the groups are equally vulnerable because non-Hispanic Blacks are younger. Hispanics are the least vulnerable. Results suggest that income and education disparities in hospitalization are likely large and should be examined directly to further understand the unequal impact of the pandemic.

Disparities in Vulnerability to Severe Complications from COVID-19 in the United States.

This paper provides the first nationally representative estimates of vulnerability to severe complications from COVID-19 overall and across race-ethnicity and socioeconomic status. We use the Panel Study of Income Dynamics (PSID) to examine the prevalence of specific health conditions associated with complications from COVID-19 and to calculate, for each individual, an index of the risk of severe complications from respiratory infections developed by DeCaprio et al. (2020). We show large disparities across race-ethnicity and socioeconomic status in the prevalence of conditions which are associated with the risk of severe complications from COVID-19. Moreover, we show that these disparities emerge early in life, prior to age 65, leading to higher vulnerability to such complications. While vulnerability is highest among older adults regardless of their race-ethnicity or socioeconomic status, our results suggest particular attention should also be given to the risk of adverse outcomes in midlife for non-Hispanic Blacks, adults with a high school degree or less, and low-income Americans.

Relationship between paid leave, financial burden, and patient-reported outcomes among employed patients who have undergone bone marrow transplantation.

PURPOSE: The US does not have universal paid family and medical leave. We examine the direct effects of access to paid leave on patient-reported health, quality of life (QOL), and perceived stress of employed patients who underwent bone marrow transplantation (BMT) to treat advanced blood cancer as well as the indirect effects through reductions in the financial burden (FB) that patients face. METHODS: Our cross-sectional observational study took place at three US transplantation centers in 2014 and 2015. All English-speaking cancer patients 6-month post-BMT were mailed a 43-item survey assessing financial situation, employer benefits, and patient-reported health outcomes. The sample includes the 171 respondents who were employed at the time of BMT. RESULTS: Seemingly unrelated regression analysis confirms that patient access to paid leave was associated with reductions in all three measures of FB, and lower levels of financial hardship were related with improved health, QOL, and perceived stress outcomes. For self-reported health and perceived stress outcomes, all of the effects of patient paid leave operate indirectly through reductions in FB. For QOL outcomes, there is both a direct effect (over 80%) of paid leave and an indirect effect through reduction of FB. CONCLUSION: We found that paid leave affected health outcomes for BMT patients mostly through alleviating FB. These findings suggest universal paid leave policies in the US might alleviate financial hardship and have positive effects on the self-reported QOL of employed patients facing intensive medical treatments.

Stepfamily Structure and Transfers Between Generations in U.S. Families.

Unstable couple relationships and high rates of repartnering have increased the share of U.S. families with stepkin. Yet data on stepfamily structure are from earlier periods, include only coresident stepkin, or cover only older adults. In this study, we use new data on family structure and transfers in the Panel Study of Income Dynamics (PSID) to describe the prevalence and numbers of stepparents and stepchildren for adults of all ages and to characterize the relationship between having stepkin and transfers of time and money between generations, regardless of whether the kin live together. We find that having stepparents and stepchildren is very common among U.S. households, especially younger households. Furthermore, stepkin substantially increase the typical household's family size; stepparents and stepchildren increase a household's number of parents and adult children by nearly 40 % for married/cohabiting couples with living parents and children. However, having stepkin is associated with fewer transfers, particularly time transfers between married women and their stepparents and stepchildren. The increase in the number of family members due to stepkin is insufficient to compensate for the lower likelihood of transfers in stepfamilies. Our findings suggest that recent cohorts with more stepkin may give less time assistance to adult children and receive less time assistance from children in old age than prior generations.

Living Arrangements of Mothers and Their Adult Children Over the Life Course.

Early in the last century, it was commonplace for elderly women to live with their adult children. Over time, the prevalence of this type of living arrangement declined, as incomes increased. In more recent decades, coresidence between adult children and their retirement-age parents has become more common, as children rely on parental support later into adulthood. We use panel data from the Panel Study of Income Dynamics to examine the living arrangements of older mothers and their adult children over the life course. We pay particular attention to the relationship between coresidence and indicators of parental and child needs. Our results suggest that for much of the life course, coresidence serves to benefit primarily the adult children rather than their older mother. We also highlight a little known phenomenon, that of children who never leave the parental home and remain coresident well into their later adult years.

New Estimates of the Sandwich Generation in the 2013 Panel Study of Income Dynamics.

Purpose of the Study: We use the Roster and Transfers Module in the 2013 Panel Study of Income Dynamics to obtain the first estimates of the prevalence of transfers to adult children and parents for United States men and women aged 35-75. Design and Methods: This article extends the current understanding of the sandwich generation by comparing recent transfers of time and money to parents and adult children for men and women and across ages between 35 and 75 years of age. Results: Over 30% of individuals with living parents and adult children provide transfers to two generations. The prevalence of transfers does not differ by age and the differences between men and women are small, though statistically significant. Conditional on providing time transfers, women provide more hours of help than men, particularly to their adult children. The number of hours given to children exceeds the number given to parents. Implications: These findings are the first to show that both men and women are likely to provide transfers to two generations and that transfers to two generations are common across adult ages. Our findings suggest a need to rethink the notion of the sandwich generation, which has focused on women in late middle age, to include men and women across younger and older ages.

Competing Demands from Aging Parents and Adult Children in Two Cohorts of American Women.

In late middle age, individuals may face competing demands on their time and financial resources from elderly parents and young adult children. This study uses the Panel Study of Income Dynamics to examine changes over time in the probability of having children and living parents for women age 45 to 64. We compare two cohorts: those born in the 1920s and 1930s and those born in the 1940s and 1950s. We find that there has been a dramatic increase in the probability of having children and living parents and that this increase has been driven mainly by changes in life expectancy of the parent generation. We further examine transfers of money and co-residence for women in the later cohort. We find that while women may not give to parents and children concurrently, approximately thirty percent of them have provided support to both parents and children at some point in the past.

Intergenerational transfers and rosters of the extended family: a new substudy of the Panel Study of Income Dynamics.

Family members provide support to each other at critical life stages. To better understand the pervasiveness, causes, and consequences of such support, a sub-study of the United States (U.S.) Panel Study of Income Dynamics (PSID) was created. A battery of questions on family relationships and intergenerational transfers was designed, pretested on a U.S. national telephone sample, and then administered in the 2013 wave of the PSID. These new data are available to the public. Given the extensive supporting data available on the respondents and members of their co-resident and non-co-resident family members - many of whom are interviewed themselves - the new sub-study will become a valuable resource to researchers.

The implications of selective attrition for estimates of intergenerational elasticity of family income.

Numerous studies have estimated a high intergenerational correlation in economic status. Such studies do not typically attend to potential biases that may arise due to survey attrition. Using the Panel Study of Income Dynamics - the data source most commonly used in prior studies - we demonstrate that attrition is particularly high for low-income adult children with low-income parents and particularly low for high-income adult children with high-income parents. Because of this pattern of attrition, intergenerational upward mobility has been overstated for low-income families and downward mobility has been understated for high-income families. The bias among low-income families is greater than the bias among high-income families implying that intergenerational elasticity in family income is higher than previous estimates with the Panel Study of Income Dynamics would suggest.

The effect of unemployment on household composition and doubling up.

"Doubling up" (sharing living arrangements) with family and friends is one way in which individuals and families can cope with job loss, but relatively little research has examined the extent to which people use coresidence to weather a spell of unemployment. This project uses data from the Survey of Income and Program Participation (SIPP) to provide evidence on the relationship between household composition and unemployment across working ages, focusing on differences in behavior by educational attainment. Using the SIPP panels, I find that individuals who become unemployed are three times more likely to move in with other people. Moving into shared living arrangements in response to unemployment is not evenly spread across the distribution of educational attainment: it is most prevalent among individuals with less than a high school diploma and those with at least some college.