U.S. Fertility in Life Course Context: A Research Note on Using Census-Held Linked Administrative Records for Geographic and Sociodemographic Subgroup Estimation.

Fertility is a life course process that is strongly shaped by geographic and sociodemographic subgroup contexts. In the United States, scholars face a choice: they can situate fertility in a life course perspective using panel data, which is typically representative only at the national level; or they can attend to subnational contexts using rate schedules, which do not include information on life course statuses. The method and data source we introduce here, Census-Held Linked Administrative Records for Fertility Estimation (CLAR-FE), permits both. It derives fertility histories and rate schedules from U.S. Census Bureau-held data for the nation and by state, racial and ethnic subgroups, and the important life course status of parity. We generate three types of rates for 2000-2020 at the national and state levels by race and ethnicity: age-specific rates and both unconditional and conditional parity- and age-specific rates. Where possible, we compare these rates with those produced by the National Center for Health Statistics. Our new rate schedules illuminate state and racial and ethnic differences in transitions to parenthood, providing evidence of the important subgroup heterogeneity that characterizes the United States. CLAR-FE covers nearly the entire U.S. population and is available to researchers on approved projects through the Census Bureau's Federal Statistical Research Data Centers.

Distinction through distancing: Norm formation and enforcement during the COVID-19 pandemic.

The unequal spread of COVID-19 was accompanied by disparities in adherence to social distancing. Research is needed on social processes that facilitated widespread adherence to distancing, how they connected with existing resource access and belief systems, and how they potentially strengthened intergroup boundaries. We integrated insights from research on social norms and cultural capital to analyze early pandemic (April-August 2020) qualitative interviews with parents and their teenage children in two higher-resource communities in the United States. Our findings uncovered four interrelated processes that facilitated the rapid establishment of norms around distancing, concurrently strengthening group boundaries. Community members: 1) drew on existing cultural capital to smooth the establishment of new social norms, 2) associated social distancing with individual moral worth and community identity, 3) applied double standards that granted certain exceptions to ingroup members to maintain social cohesion, and 4) drew strong distinctions between their own and outsiders' social distancing behaviors and moral worth. Our findings articulate social processes that allowed for rapid cohesion around distancing and show how these mechanisms strengthened existing community social boundaries.

Expanded Contraceptive Access Linked To Increase In College Completion Among Women In Colorado.

Public subsidies for contraception are often justified by assertions regarding their benefits for women's lives, yet there is limited contemporary evidence supporting these assertions. Beginning in 2009 the Colorado Family Planning Initiative abruptly expanded access to the full range of contraceptive methods through Colorado's Title X family planning clinics. Using eleven years of American Community Survey data linked to data from two decennial censuses, we assessed whether exposure to the program led to improvements in college completion among women. Exposure to the Colorado Family Planning Initiative at high school ages was associated with a population-level increase of 1.8-3.5 percentage points in women's on-time bachelor's degree attainment, which represents a 6-12 percent increase in women obtaining their degrees compared with earlier cohorts. Federal and state policies restricting or expanding access to the full range of contraceptive methods can affect women's attainment of higher education in addition to their reproductive health.

Family Socioeconomic Status and Children's Screen Time.

Objective: This mixed-methods study examined whether higher-SES children's digital technology use adhered to contemporaneous pediatric guidelines, how it compared to lower-SES children, and why, as analyses showed, higher-SES children's technology use far exceeded pediatric recommendations. Background: 2013 American Academy of Pediatrics (AAP) guidelines recommended limited "screen time" for children. Higher socioeconomic status (SES) families tend to follow guidelines, but digital technology use-simultaneously a health behavior and a pathway for building human capital-has complex implications. Method: Quantitative analyses provide new nationally representative estimates of the relationship between social class and 9- to 13-year-old children's technology time (including television), device access, and parenting rules (2014 PSID Child Development Supplement, N=427). Qualitative analyses of 77 longitudinal higher-SES parent interviews articulated explanatory processes. Results: Higher-SES children used technology as frequently as others and in excess of recommendations. Their device access, activities, and agency in adhering to rules, however, differed from others. Qualitative analysis uncovered processes that helped explain these findings: parents' ambivalence about technology and perception that expert guidance is absent or unrealistic, and children's exercise of agency to use technology facilitated by "concerted cultivation" parenting styles, led to higher-SES individualistic parenting practices that supported children's increased non-television technology use. Conclusion: Cultures and structures related to children's technology use are in flux, and classed norms and understandings are emerging to construct relevant class-based distinctions around parenting.

Mothers' Sexual Identity and Children's Health.

Sexual minority women face a plethora of structural, socioeconomic, and interpersonal disadvantages and stressors. Research has established negative associations between women's sexual minority identities and both their own health and their infants' birth outcomes. Yet a separate body of scholarship has documented similarities in the development and well-being of children living with same-sex couples relative to those living with similarly situated different-sex couples. This study sought to reconcile these literatures by examining the association between maternal sexual identity and child health at ages 5-18 using a US sample from the full population of children of sexual minority women, including those who identify as mostly heterosexual, bisexual, or lesbian, regardless of partner sex or gender. Analyses using data from the National Longitudinal Study of Adolescent to Adult Health (N=8,978) followed women longitudinally and examined several measures of their children's health, including general health and specific developmental and physical health conditions. Analyses found that children of mostly heterosexual and bisexual women experienced health disadvantages relative to children of heterosexual women, whereas the few children of lesbian women in our sample evidenced a mixture of advantages and disadvantages. These findings underscore that to understand sexual orientation disparities and the intergenerational transmission of health, it is important to incorporate broad measurement of sexual orientation that can capture variation in family forms and in sexual minority identities.

Racial/ethnic and gender differences in smoking in early middle adulthood.

Research has documented important differences in smoking rates across race/ethnicity, gender, and age. Much of the research has either focused on smoking initiation among adolescents or cessation among adults, but little is known about racial/ethnic patterns in intermittent and daily smoking across young and early middle adulthood. We therefore use the life course perspective to identify how racial/ethnic and gender differences in smoking unfold across adulthood. Analyses investigate whether racial/ethnic and gender differences exist in the likelihood of daily smoking in early middle adulthood and whether these disparities persist after the inclusion of adolescent and early midlife sociodemographic characteristics and young adult smoking patterns. Descriptive statistics and multivariate binary logistic regression analyses employ recent data from a nationally representative sample of adults using the National Longitudinal Study of Adolescent to Adult Health (Add Health; N = 8,506). We find evidence that life course patterns of smoking differ across race/ethnicity and gender subgroups. In early middle adulthood (ages 33-44), White women are more likely to smoke daily than Black or Hispanic women. In contrast, there are no significant differences between White and Black men, but White men are more likely to smoke daily than Hispanic men. These racial/ethnic differences are no longer significant for men when previous smoking is controlled, suggesting that early young adult smoking plays an important role in the development of smoking disparities across race/ethnicity. Further, we find that young adult intermittent smoking is associated with daily smoking in early midlife, and this relationship is stronger for Black, compared to White, men and women. Although Black women display lower odds of daily smoking in early midlife compared to White women, they exhibit a higher risk of transitioning from intermittent to daily smoking. These results highlight the importance of considering a greater diversity of life course patterns in smoking across race/ethnicity and gender in future research and policies.

"Dedicated to being healthy": Young adults' deployments of health-focused cultural capital.

Performances of "health" through diet, exercise, and body size are an increasingly important form of cultural capital transmitted to children. Yet less is known about how socioeconomically privileged young people internalize and deploy that capital or how those less privileged manage their relative lack of capital. How does health-focused cultural capital acquired in childhood shape socioeconomic inequalities, health behaviors, and understandings of health in young adulthood? Our analysis of 113 interviews found that health-focused cultural capital acquired in early life reinforced young adults' socioeconomic and health advantages by helping them claim discipline and morality on the basis of their health behaviors and body size. Two key phenomena tended to be present among our many socioeconomically privileged but not our fewer less privileged participants: family socialization into classed diet- and exercise-related health behaviors resulting in a classed appearance of health (despite less-than-ideal behaviors), and cohesive life course narratives linking these behaviors to hard work and moral worth. Less socioeconomically privileged participants' understandings of health and healthy behaviors were different, rarely linking health to worthiness and discipline. To understand the intergenerational transmission of socioeconomic attainment and health in US society, we must consider how behaviors and group-based norms, identities, and understandings of health coalesce in classed health lifestyles that convey cultural capital.

Peer Network Processes in Adolescents' Health Lifestyles.

Combining theories of health lifestyles-interrelated health behaviors arising from group-based identities-with those of network and behavior change, we investigated network characteristics of health lifestyles and the role of influence and selection processes underlying these characteristics. We examined these questions in two high schools using longitudinal, complete friendship network data from the National Longitudinal Study of Adolescent to Adult Health. Latent class analyses characterized each school's predominant health lifestyles using several health behavior domains. School-specific stochastic actor-based models evaluated the bidirectional relationship between friendship networks and health lifestyles. Predominant lifestyles remained stable within schools over time, even as individuals transitioned between lifestyles. Friends displayed greater similarity in health lifestyles than nonfriend dyads. Similarities resulted primarily from teens' selection of friends with similar lifestyles but also from teens influencing their peers' lifestyles. This study demonstrates the salience of health lifestyles for adolescent development and friendship networks.

Developing Health Lifestyle Pathways and Social Inequalities across Early Childhood.

Lifestyles are a long-theorized aspect of social inequalities that root individual behaviors in social group differences. Although the health lifestyle construct is an important advance for understanding social inequalities and health behaviors, research has not theorized or investigated the longitudinal development of health lifestyles from infancy through the transition to school. This study documented children's longitudinal health lifestyle pathways, articulated and tested a theoretical framework of health lifestyle development in early life, and assessed associations with kindergarten cognition, socioemotional behavior, and health. Latent class analyses identified health lifestyle pathways using the US Early Childhood Longitudinal Study - Birth Cohort (ECLS-B; N≈6,550). Children's health lifestyle pathways were complex, combining healthier and unhealthier behaviors and changing with age. Social background prior to birth was associated with health lifestyle pathways, as were parents' resources, health behaviors, and non-health-focused parenting. Developing health lifestyle pathways were related to kindergarten cognition, behavior, and health net of social background and other parent influences. Thus, family context is important for the development of complex health lifestyle pathways across early childhood, which have implications for school preparedness and thus for social inequalities and well-being throughout life. Developing health lifestyles both reflect and reproduce social inequalities across generations.

Contributions and Challenges in Health Lifestyles Research.

The concept of health lifestyles is moving scholarship beyond individual health behaviors to integrated bundles of behaviors undergirded by group-based identities and norms. Health lifestyles research merges structure with agency, individual-level processes with group-level processes, and multifaceted behaviors with norms and identities, shedding light on why health behaviors persist or change and on the reproduction of health disparities and other social inequalities. Recent contributions have applied new methods and life course perspectives, articulating health lifestyles's dynamic relationships to social contexts and demonstrating their implications for health and development. Culturally focused work has shown how health lifestyles function as signals for status and identity and perpetuate inequalities. We synthesize literature to articulate recent advances and challenges and demonstrate how health lifestyles research can strengthen health policies and inform scholarship on inequalities. Future work emphasizing health lifestyles's collective nature and attending to upstream social structures will further elucidate complex social processes.

"Healthier Than Just Healthy": Families Transmitting Health as Cultural Capital.

As the relationship between social class and health strengthens and socioeconomic and health inequalities widen, understanding how parents' socioeconomic advantage translates into health and class advantages in the next generation is increasingly important. Our analyses illustrate how a classed performance of "health" is a fundamental component of transmitting cultural capital in families and communities. Socially advantaged parents' health and class goals for children are often met simultaneously by building children's cultural capital in community-specific ways. This study uses observational, interview, and focus group data from families in two middle-class communities to illustrate how health-focused cultural capital acquisition plays out in everyday life. As parents manage children's lives to ensure future advantages, they often focus on health-related behaviors and performances as symbols of class-based distinction for their children. The synergy between family and community cultural capital is strengthening class and health advantages for some children, even as health-focused cultural capital often has drawbacks for stress and well-being. The intensification of and value placed on "health" in cultural capital may have long-term implications for health, socioeconomic attainment, and inequalities. If health-focused cultural capital continues to become increasingly salient for status attainment, its importance could grow, widening these gaps and reducing intergenerational mobility.

Breastfeeding Initiation and Continuation Among Sexual Minority Women.

OBJECTIVES: Identify disparities in breastfeeding initiation and continuation among sexual minority women (SMW) and determine if known risk factors explain any observed disparities. METHODS: We used data from the 2006 to 2017 National Survey of Family Growth female pregnancy questionnaire. We measured sexual orientation using self-reported sexual identity and histories of same-sex sexual experiences reported by women (heterosexual-WSM [women who only reported sex with men]; heterosexual-WSW [women who reported sex with women]; bisexual, and lesbian. In total, we had 18,696 births that occurred within the last 10 years and used logistic and multinomial regression models to assess sexual orientation disparities in breastfeeding initiation and duration that clustered on women to account for potential multiple births to a woman. RESULTS: Compared to heterosexual-WSM, infants born to lesbian-identified women had decreased odds of ever being breastfed (OR 0.55, 95% CI 0.30, 0.99) and a decreased relative risk of being breastfed more than 6 months (RRR 0.46, 95% CI 0.22, 0.97). Infants of heterosexual-WSW had an increased odds of ever breastfeeding (OR 1.40, 95% CI 1.12, 1.74) and increased relative risk of breastfeeding more than 6 months (RRR 1.32, 95% CI 1.02, 1.69). CONCLUSIONS: Our results show that infants born to lesbian-identified women were less likely to be breastfed than those born to their heterosexual counterparts, even after adjusting for several factors associated with breastfeeding behaviors. We found no differences in breastfeeding between bisexual women and heterosexual-WSM. Understanding and addressing the barriers sexual minority women face for breastfeeding is critical for ensuring maternal and child health equity.

The impact of contraceptive access on high school graduation.

Does access to the full range of contraceptive methods increase young women's educational attainment? Family planning programs are often justified by claims that it does, but contemporary evidence is unexpectedly weak. We use a natural experiment afforded by a 2009 Colorado policy change to assess the impact of expanded access to contraception on women's high school graduation. Linking survey and Census data, we follow a population-representative U.S. sample, including large subsamples of young women living in Colorado in 2010 and in comparison states. Using a difference-in-differences design, we find expansion of access to contraception was associated with a statistically significant 1.66 percentage-point increase in high school graduation. This increase in graduation represents a 14% decrease in the baseline percentage not graduating high school before the policy change. Results are robust to a variety of sensitivity tests. Our findings indicate that improving access to contraception increases young women's human capital formation.

Adolescent Technology, Sleep, and Physical Activity Time in Two US Cohorts.

The advent of internet-enabled mobile digital devices has transformed US adolescent technology use over the last decade, yet little is known about how these changes map onto other health-related behaviors. We provide a national profile of how contemporary technology use fits into adolescents' daily health lifestyles compared to the previous generation, with particular attention to whether and for whom technology use displaces time spent in sleep or physical activity. Time diaries were collected from 11-17 year olds in 2002-03 (N=1,139) and 2014-16 (N=527) through the US Panel Study of Income Dynamics Child Development Supplement. Contemporary adolescents spent 40 minutes more per week in technology-focused activities, but their composition was more varied compared to the earlier cohort. Contemporary technology use was predictive of less time in physical activity, and adolescents engaged in frequent video game play spent less time in physical activity compared to peers with other technology use profiles.

"Everything is Connected": Health Lifestyles and Teenagers' Social Distancing Behaviors in the COVID-19 Pandemic.

Social distancing during the COVID-19 pandemic requires people to engage in new health behaviors that are public, monitored, and often contested. Parents are typically considered responsible for controlling their children's behavior and instilling norms. We investigated how parents and teens managed teenagers' social distancing behaviors. Analyzing 100 longitudinal (2015-2020), dyadic qualitative interviews with teenagers and their parents in 20 families from two middle-class communities in which social distancing was normative, we found that preexisting health lifestyles were used to link social distancing behaviors to specific identities, norms, and understandings of health. The pandemic presented challenges resulting from contradictory threats to health, differing preferences, and conflicting social judgments. Parents responded to challenges by adhering to community norms and enforcing teens' social distancing behaviors. They drew on preexisting, individualized health lifestyles as cultural tools to justify social distancing messages, emphasizing group distinctions, morality, and worth in ways that perpetuated inequalities.

A life course framework for understanding digital technology use in the transition to adulthood.

Rapid increases in young people's time spent using digital technology ("screen time") in the mobile internet era have led to anxiety about long-term effects. This mixed-method US study examines childhood experiences and contextual factors that shape screen time in the transition to adulthood. We recursively analyzed 56 qualitative interviews with young adults in a large metropolitan area in 2016-2018 and prospective longitudinal nationally representative survey data (PSID-CDS-2007 and PSID-TAS-2017) to articulate a conceptual framework of life course influences on young adults' time spent using digital technologies. Inductive qualitative analyses built an initial framework, which was assessed with quantitative data, then further refined with qualitative analyses. Young adults drew on life course perspectives when discussing influences on their current digital technology use. As they suggested, in quantitative analyses more frequent adolescent technology use and greater device access weakly predicted increased technology frequency. Current school enrollment and several current peer factors predicted technology time. Interviewees emphasized the influence of parenting around technology use during adolescence, but parenting did not predict young adult screen time in quantitative analyses. Further qualitative analyses suggested that instead of influencing current technology time, earlier parenting shaped current emotional responses and imagined future technology use. We found young adults' technology use frequency to be informed by earlier experiences but highly malleable. Past technology use and current social contexts matter, but only up to a point. Moving beyond time use to incorporate emotional responses and future plans can better capture how the life course shapes technology use.

A gender framework for understanding health lifestyles.

PURPOSE: A health lifestyles approach holds promise for understanding change in women's and men's health behaviors and reducing gendered health disparities. The emerging theoretical and empirical literature on health lifestyles (individuals' bundled health behaviors that are shaped by group-based identities and norms) helps elucidate complex disparities in health behaviors, but research is needed on how gender shapes the development of health lifestyles. This study proposed and assessed a dynamic multilevel framework for understanding health lifestyles that draws on insights from contemporary gender and life course scholarship. DATA: Using the transition from adolescence into adulthood as an empirical case, we analyzed US data from the National Longitudinal Study of Adolescent to Adult Health (Add Health; N = 6605), which followed adolescents through young adulthood, collecting information on their health behaviors and social contexts. FINDINGS: Latent class analyses showed that health lifestyles differed significantly by gender. Results supported the dynamic multilevel framework, finding more variation in health lifestyle behaviors within genders than between, high levels of change across ages, intersections of gender with age, and socioeconomic status as a structural pathway for gender's influence. CONCLUSION: Taken together, these findings suggest that conceptualizing gender as a dynamic multilevel system intersecting with other social statuses is fruitful for understanding how health lifestyles form and change. These findings can inform more effective policies to change health behaviors.

Sexual Orientation Disparities in Preconception Health.

Objective: In the United States, there have been very few improvements in adverse birth outcomes, such as infant mortality, low birthweight, and preterm birth in recent years. Health promotion before pregnancy (e.g., preconception care) has been increasingly recognized as an important strategy by which to improve these reproductive outcomes. As of yet, no research has examined sexual orientation disparities in preconception health which has important implications for birth outcomes in the United States, since sexual minority women (SMW) are more likely to report stillbirths, low birthweight, and preterm infants than heterosexual women. Methods: This study addresses this gap by utilizing data from the National Longitudinal Study of Adolescent to Adult Health (Add Health) to examine sexual orientation disparities in women's preconception health 1 and 3 years before a live birth (n = 3,133). Results: Our findings suggest that, even after controlling for maternal characteristics, SMW are more likely to report adverse health conditions and behaviors before pregnancy relative to heterosexual women 1 year before the survey, including higher odds of binge drinking, other substance use, having a sexually transmitted infection diagnosis, and depression. Conclusions: Despite new public health policies aimed at improved preconception health, our findings suggest that SMW are even more vulnerable to poor preconception health than their heterosexual counterparts, which has important implications for maternal and child health. This study provides important evidence for the need to invest in the reproductive health of SMW, particularly in the context of pregnancy.

Racial/Ethnic Differences in Unwanted Pregnancy: Moderation by Sexual Orientation.

OBJECTIVE: To explore sexual orientation disparities in unwanted pregnancy by race/ethnicity. BACKGROUND: Previous research has documented that sexual-minority women (SMW) are more likely to report unplanned pregnancy than heterosexual women, and that Black and Latina women are more likely to report unplanned pregnancy than White women. No research has examined how pregnancy intention varies at the intersection of these two identities. METHOD: Data come from the pregnancy roster data in Waves IV and Wave V subsample in the National Longitudinal Study of Adolescent to Adult Health. We used pregnancy as the unit of analysis (n=10,845) and multilevel logistic regression models to account for clustering of pregnancies within women. Per pregnancy, women were asked if they "wanted" to be pregnant at the time of pregnancy. We conducted models stratified by race/ethnicity, as well as models stratified by sexual identity. RESULTS: Among White women, sexual-minority women were more likely to describe their pregnancy as unwanted than were their heterosexual counterparts. Conversely, among Black and Latina women, sexual-minority women were less likely to describe their pregnancy as unwanted than were their heterosexual counterparts. Results stratified by sexual identity underscore these contrasting patterns: Among heterosexual women, White women were less likely to describe their pregnancies as unwanted compared to Black and Latina women; among sexual-minority women, White women were more likely to describe their pregnancy as unwanted than were Black and Latina women. CONCLUSION: Traditional race/ethnicity trends in pregnancy intention (i.e., greater unwanted pregnancy among Black/Latina than White women) are reversed among sexual-minority women.

Sexual Orientation Disparities in Pregnancy and Infant Outcomes.

Objectives Little is known about maternal and infant health among sexual minority women (SMW), despite the large body of research documenting their multiple preconception risk factors. This study used data from the 2006-2015 National Survey of Family Growth (NSFG) to investigate sexual orientation inequities in pregnancy and birth outcomes, including miscarriage, stillbirth, preterm birth, and birth weight. Methods Women reported 19,955 study eligible pregnancies and 15,996 singleton live births. Sexual orientation was measured using self-reported identity and histories of same-sex sexual experiences (heterosexual-WSM [women who only report sex with men]; heterosexual-WSW [women who report sex with women]; bisexual, and lesbian). Logistic regression models were used that adjusted for several maternal characteristics. Results Compared to heterosexual-WSM, heterosexual-WSW (OR 1.25, 95% CI 1.00-1.58) and bisexual and lesbian women (OR 1.77, 95% CI 1.34-2.35) were more likely to report miscarriage, and bisexual and lesbian women were more likely to report a pregnancy ending in stillbirth (OR 2.85, 95% CI 1.40-5.83). Lesbian women were more likely to report low birth weight infants (OR 2.64, 95% CI 1.38-5.07) and bisexual and lesbian women were more likely to report very preterm births (OR 1.84, 95% CI 1.11-3.04) compared to heterosexual-WSM. Conclusions for Practice This study documents significant sexual orientation inequities in pregnancy and birth outcomes. More research is needed to understand the mechanisms that underlie disparate outcomes and to develop interventions to improve sexual minority women's maternal and infant health.