Support for Family Caregivers: Implications of Work Strain and its Intersections with Formal and Informal Help.

OBJECTIVES: This study seeks to assess whether and to what extent caregiver work strain is ameliorated by the presence of additional family caregivers and formal service use. Building on the stress process model and stress-appraisal moderations, we examine how formal and informal support varies in associations with caregiver distress for men and women. METHODS: This study utilizes data provided by the National Study of Caregiving (NSOC), which is linked with care-recipient information from the National Health and Aging Trends Study (NHATS). Using panel methods for the pooled waves, we estimated caregiver outcomes of emotional well-being on the intersection of experiences of work strain and 1) the number of additional caregivers and 2) utilization of six different types of formal support. RESULTS: Additional informal caregivers for each respective care recipient are associated with lower levels of distress, while utilization of formal services (paid help and Medicaid funding) is positively associated with caregiver distress. Informal support can offset the impact of work strain, but interactions are only evident for women caregivers. DISCUSSION: The findings suggest that informal support, exemplified by the number of additional caregivers, corresponds with reduced emotional distress among employed caregivers and can mitigate the negative impacts of work strain. However, positive associations of formal support and male and female caregiver distress suggest that the context of formal services may offer limited or untimely support. This study is expected to broaden our understanding of informal caregiving in later life and provide practical implications on how to sustain informal care.

The impact of local supply of popular contraceptives on women's use of family planning: findings from performance-monitoring-for-action in seven sub-Saharan African countries.

Contraceptive use has substantial implications for women's reproductive health, motivating research on the most effective approaches to minimize inequalities in access. When women prefer to limit or delay fertility but are not using contraception, this potentially reflects demand for contraception that is not being satisfied. Current literature emphasizes a nuanced integration of supply and demand factors to better understand this gap. In this research, we examine the interconnectedness of supply and demand factors both conceptually and methodologically by augmenting existing measures of local supply with a demand-side factor-community-level preferences for contraceptive methods. Using novel data from Performance Monitoring for Action (PMA) in seven sub-Saharan African countries, we test whether the available supply of locally preferred methods at nearby service delivery points (SDP) explains variation in women's uptake of contraception beyond the more typical measure of contraceptive stockouts. Findings from logistic regression analyses (N = 32,282) suggest that demand and supply can be understood as tightly interconnected factors which are directly affected by local social preferences. The odds of women using modern contraception increase significantly when locally preferred methods are available, and this is true even after controlling for the availability of methods in general. The new measure tested in this research centers women and their specific desires in a manner consistent with the promotion of contraceptives as an important human right.

Diversity in Social Communication and Support: Implications for Loneliness Among LGB Adults.

BACKGROUND AND OBJECTIVES: Current research indicates that structural and functional social network attributes influence older adults' well-being. However, these linkages may vary by sexual orientation. This study examines how social communication diversity and support diversity are related to loneliness and differ between lesbian, gay, and bisexual (LGB) and heterosexual adults. RESEARCH DESIGN AND METHODS: Using data from the American Association of Retired Persons Foundation's Loneliness and Social Connection Survey of adults 45+ (N = 3,009), including 10% who identified as LGB, we derive entropy scores, which capture the extent to which network size and quality of relationships are evenly distributed. A series of linear regressions were conducted to examine sexual orientation, social network indicators, and their interactions in predicting loneliness. RESULTS: We found a positive association between social communication diversity and loneliness. This finding was qualified by the interaction with sexual orientation. In addition, we found a negative association between support diversity and loneliness, an effect that was stronger for LGB participants than for heterosexual participants. The effect of support diversity on loneliness was much stronger for LGB adults than heterosexual adults. DISCUSSION AND IMPLICATIONS: While LGB adults tend to score higher on the loneliness scale overall, the findings suggest that communication and support diversity have uniquely different patterns of associations for sexual minority groups. This study highlights the importance of considering multiple dimensions of social networks and has implications for addressing loneliness for heterosexual and LGB adults.

Intergenerational Transmission of Female Genital Cutting: Community and Marriage Dynamics.

OBJECTIVE: This study examined how characteristics of households and communities are linked with the intergenerational transmission of gender inequality and particularly female genital cutting (FGC). BACKGROUND: Human capital perspectives suggest that socioeconomic inequality predicts FGC continuation. This study contributes to discussions of institutional change by examining the association of decisions to forego FGC with household decision-making patterns and community gender norms. METHOD: Multilevel logistic regression was deployed to analyze a pooled sample (N = 12,144) of six Demographic and Health Surveys from Burkina Faso, Egypt, Guinea, Kenya, Mali and Nigeria. A series of models examined how decision-making styles, both at the household and community levels (2,524 DHS cluster aggregations), and community levels of FGC, correspond with the risk of having a daughter cut. RESULTS: Results show that daughters are less likely to be cut when parents make key household decisions jointly. Autonomous decision-making by women at the community level was associated with lower odds of daughters being cut. However, at the community level, the impacts of women's household decision-making were attenuated when FGC was more prevalent. CONCLUSION: The findings suggest that women's decision-making status is an important factor in FGC abandonment although that association is less robust when FGC is highly institutionalized. This study provides new insights into how women, families, and communities can disrupt the intergenerational transmission of behaviors associated with institutionalized gender inequality.

Cooperative Decision-Making and Intimate Partner Violence in Peru.

Using the continuous Demographic and Health Surveys (2005-2012) for Peru, we employ multinomial logistic regression estimates to assess risk for intimate partner violence (IPV). Using empowerment and gender frameworks for IPV, we find that women making more household decisions jointly are less likely to experience physical violence. We also find that education is negatively associated with IPV, unless a woman's attainment exceeds her partner's. Although women earning more than their partners are more likely to experience violence, joint decision-makers have a lower risk of moderate physical violence even when their status exceeds that of a male partner. By adding measures for relationship dynamics, we highlight the ways decision-making within the household contributes to violence risk for women. While deviating from male-breadwinning norms can result in violence, risk factors are conditioned on the nature of cooperation within a partnership. Our findings suggest that shared power within the household reduces IPV risk.

Integrating the Demographic and Health Surveys, IPUMS-I, and TerraPopulus to Explore Mortality and Health Outcomes at the District Level in Ghana, Malawi, and Tanzania.

In this paper, we first show how the Demographic and Health Surveys (DHS) can be integrated with other data sources to expand the types of variables available for analysis of population and health outcomes. Second, we demonstrate one particular example of such integration by modelling the social, physical, and built environment determinants of health outcomes at the district level in Ghana, Malawi, and Tanzania. To do so, we created district-level measures of a number of variables from the DHS, and then merged them with district-level data from the IPUMS, an environmental data set called TerraPopulus, and other sources. We find that it is feasible to combine the DHS with other data sources, and that many health and environment indicators are heterogeneous within countries, justifying further analysis at low levels of geography and suggesting benefits to using such techniques to design fine-grained programmatic interventions.