Part of the gender gap in voting for Democrats arises because a higher proportion of women than men voters are Black.

Women voted for the Democratic candidate more than men did in each US presidential election since 1980. We show that part of the gender gap stems from the fact that a higher proportion of women than men voters are Black, and Black voters overwhelmingly choose Democratic candidates. Past research shows that Black men have especially high rates of death, incarceration, and disenfranchisement due to criminal convictions. These disparities reduce the share of men voters who are Black. We show that the gender difference in racial composition explains 24% of the gender gap in voting Democratic. The gender gap in voting Democratic is especially large among those who are never-married, and, among them, the differing racial composition of men and women voters is more impactful than in the population at large, explaining 43% of the gender gap. We consider an alternative hypothesis that income differences between single men and women explain the gender gap in voting, but our analysis leads us to reject it. Although unmarried women are poorer than unmarried men, and lower-income voters vote slightly more Democratic, the latter difference is too small for income to explain much of the gender gap in voting. In short, the large gender gap among unmarried voters is not a reflection of the lower incomes of women's households but does reflect the fact that women voters are disproportionately Black. We used the General Social Survey as the data source for the analysis, then replicated results with the American National Election Survey data.

Lifetime years married held steady for men with a BA degree since 1960 but dropped to lowest level since 1880 for men without a BA.

Trends in life expectancy and marriage patterns work together to determine expected lifetime years married. In 1880, adult life expectancy was short and marriages were more likely to end by death than divorce. Since then, although there have been substantial life expectancy gains in adulthood, marriage has been increasingly delayed or forgone and cohabitation and divorce are far more prevalent. Whether adults today can expect to spend more or fewer years married than in the past depends on the relative magnitude of changes in mortality and marriage. We estimate trends in men's expected lifetime years married (and in other marital statuses) from 1880 to 2019 and by bachelor's degree (BA) status from 1960 to 2019. Our results show a rise in men's expected lifetime years married between 1880 and the Baby Boom era and a subsequent fall. There are large and growing differences by BA status. Men with a BA have had high and relatively stable expected lifetime years married since 1960. For men without a BA, expected lifetime years married has plummeted to lows not seen among men since 1880. Cohabitation accounts for a substantial fraction, although not all, of these declines. Our results demonstrate how increasing inequality in both life expectancy and marriage patterns combine to amplify educational differences in lifetime experiences of coresidential partnerships.

Separations of romantic relationships are experienced differently by initiators and noninitiators.

Divorces are predominantly initiated by one spouse alone. This might suggest that one spouse typically benefits from divorce (the initiator), while the other is disadvantaged (the noninitiator). At the same time, empirical research on the consequences of divorce commonly focuses on the average effect for both partners. In contrast, I estimate separation trajectories individually for initiators and noninitiators of formerly cohabitating or married couples. The analysis covers a wide range of outcomes and a long period of time surrounding the separation. I employ an event-study design based on individual fixed effects, thereby accounting for time-invariant individual heterogeneity that could be linked to initiator status and the outcomes. The results reveal substantial differences in separation trajectories between initiators and noninitiators. Initiators indeed improve their subjective well-being after a separation and also see gains in other life domains, with the exception of the economic domain. Noninitiators experience significant short-term losses in subjective well-being, from which they recover in the long run. Noninitiators' trajectories in other life domains vary.

A tale of two marital stressors: Comparing proinflammatory responses to partner distress and marital conflict.

Marital quality shares ties to inflammatory conditions like cardiovascular disease and diabetes. For decades, research has focused on marital conflict as a primary mechanism given its potential to trigger inflammatory responses. However, longitudinal evidence suggests that marital conflict declines over time, and little attention has been paid to the inflammatory aftermath of other types of marital exchanges. A spouse's emotional distress is an important but overlooked marital context, as partners are exposed to each other's upsetting emotions throughout adulthood. To directly compare reactivity in proinflammatory gene expression to these two marital stressors and to examine differences by age and marital satisfaction, 203 community adults ages 25-90 (N = 102 couples) provided blood samples and rated their negative mood before and after they 1) watched their partner relive an upsetting personal memory and, in a separate visit 1-2 weeks later, 2) discussed a conflictual topic in their relationship. Controlling for age, sex, race/ethnicity, BMI, alcohol use, smoking, and comorbidities, increases in proinflammatory gene expression were significantly larger after the partner's upsetting disclosure than after marital conflict (B = 0.073, SE = 0.031, p = .018). This pattern paralleled emotional reactivity to the tasks, wherein negative mood rose more in response to the partner's disclosure than to marital conflict (B = 4.305, SE = 1.468, p = .004). In sum, proinflammatory and mood reactivity to spousal distress exceeded reactivity to marital conflict, a well-established marital stressor. Findings reveal spousal distress as a novel mechanism that may link marriage to inflammation-related diseases, and even pose risks for both happy and unhappy couples across adulthood.

HIV status disclosure in the era of treat-all: the complexities of societal expectations and disclosure in marital relationships in Shinyanga, Tanzania.

Robust advancements in clinical treatment of people living with HIV (PLHIV) have resulted in the current "treatment as prevention" strategy: the inability to transmit the virus when it is undetectable. Nevertheless, disclosure within marital relationships remains important to adhere optimally to treatment and further limit transmission in the era of treat-all. Disclosure, however, can have serious social repercussions, particularly for women. This paper examines gendered disclosure decisions and their social consequences in marital relationships in Tanzania. Drawing from a 9-month ethnographic study in Shinyanga Region, we explore how Sukuma societal values shape disclosure decisions. In-depth interviews with 103 PLHIV and 19 FGDs inform our analysis. We found that societal values regarding gender and marriage significantly influence disclosure decisions in marital relationships. The HIV treat-all approach, with its focus on early treatment initiation preserved health and inability to transmit allowed men and women to carefully weigh the costs and benefits of disclosure to their marital aspirations. The benefits of antiretroviral treatment for social relations are often overlooked in medical interventions. We conclude that to reduce difficult disclosure decisions for PLHIV, emphasising community awareness of HIV treatment as prevention to mitigate the negative impacts of disclosure is needed.

Role of Child Marriage and Adolescent Childbearing on Hysterectomy Among Married Women in India: A Cross-Sectional and Time-to-Event Analysis.

OBJECTIVE: Child marriage forces a girl into adult roles before physical and psychological maturity, which can take a toll on women's health over the life course. This article aims to assess whether child marriage and adolescent childbearing are associated with elevated risk of gynaecologic disorders leading to hysterectomy. DESIGN: Cross-sectional and time-to-event analysis. SETTING: India. POPULATION: 528 816 ever-married women, aged 20-49 years. METHODS: Women were grouped in four mutually exclusive categories: (i) married adult-not an adolescent mother (reference category), (ii) married adult-adolescent mother, (iii) married child-not an adolescent mother and (iv) married child-adolescent mother. Multivariable logistic regressions were fitted to assess the odds of hysterectomy for these groups. Nonparametric Kaplan-Meier survivor functions were estimated to evaluate survival rates across the groups. MAIN OUTCOME MEASURES: Whether had a hysterectomy and age when hysterectomy was performed. RESULTS: Compared to women married as adults, not an adolescent mother, women married in childhood and gave birth in adolescence were 1.87 (95% CI: 1.78-1.96) times more likely to have a hysterectomy. The latter group also had the lowest survival probability for hysterectomy at all ages (e.g., 85.80% [95% CI: 85.41-86.18] at age 49 years as compared to 91.65% [95% CI: 91.37-91.89] for the former group). Women married as children but not adolescent mothers and married as an adult but gave birth in adolescence also had higher odds of hysterectomy-1.40 (95% CI: 1.31-1.50) and 1.53 (95% CI: 1.40-1.66) times of that of the reference group, respectively. CONCLUSIONS: Our results, showing a strong relationship between child marriage and hysterectomy, contribute to the literature on later-life health consequences of child marriage.

The impact of HIV/AIDS on marriage in the early years of the epidemic.

The advent of the HIV/AIDS crisis transformed the desirability of committed heterosexual relationships. This paper employs a difference-in-differences approach to investigate the impact of the HIV/AIDS crisis on marriage rates. By using HIV/AIDS death rates as a proxy for HIV incidence, the study exploits county-level variations in HIV/AIDS mortality and finds that counties with higher HIV/AIDS death rates experienced larger gains in marriage rates in the early years of the epidemic. Estimates suggest that the virus increased marriage rates by approximately 0.9% in the early years of the virus (1981-1988).

Who Divorces Whom: Unilateral Divorce Legislation and the Educational Structure of Marriage.

The introduction of unilateral divorce legislation (UDL) starting in the late 1960s led to spikes in U.S. divorce rates. We ask whether making divorce easier affected the educational structure of marriage. Using marriage and divorce certificate data covering 1970-1988, we provide new evidence on the evolution of the educational structure of marriage inflows (newlyweds) and outflows (divorces). Next, we leverage the timing of UDL introduction across states to estimate its effects on both flows. We find that UDL affected the educational structure of divorce but not of new marriages: it made generally unstable hypogamous couples (women married to less educated partners) less likely to divorce and made homogamous couples more stable than hypergamous ones (women married to more educated partners).

Eight Decades of Educational Assortative Mating: A Research Note.

Recent social and economic trends in the United States, including increasing economic inequality, women's growing educational advantage, and the rise of online dating, have ambiguous implications for patterns of educational homogamy. In this research note, we examine changes in educational assortative mating in the United States over the last eight decades (1940 to 2020) using the U.S. decennial censuses and the American Community Survey, extending and expanding earlier work by Schwartz and Mare. We find that the rise in educational homogamy noted by Schwartz and Mare has not continued. Increases in educational homogamy stalled around 1990 and began reversing in the 2000s. We find a growing tendency for marriages to cross educational boundaries, but a college degree remains the strongest dividing line to intermarriage. A key trend explaining this new pattern is women's increasing tendency to marry men with less education than themselves. If not for this trend, homogamy would have continued increasing until the early 2010s. We also show substantial heterogeneity by race, ethnicity, and nativity and among same- versus different-sex couples.

Intergenerational Power Shift and the Rise of Nonarranged Marriages Among Refugees.

The experiences of war and refugee status can alter intrafamily dynamics, with implications for family formation, including marriage. We use the nationally representative Syrian Migrant Sample of the 2018 Turkey Demographic Health Survey (TDHS-S) to conduct a duration analysis of marriage outcomes among Syrian refugees in Turkey, tracking women throughout their residence in prewar Syria (before the conflict began in 2011), postwar Syria (after the conflict began but before arrival in Turkey), and Turkey. We find that early marriage was more prominent among refugees who were unmarried at the time of migration than among those married before migration; the mean marriage age dropped from 19.6 in prewar Syria to 19.1 in postwar Syria and 18.1 in Turkey. Using the TDHS-S and prewar Syrian surveys, we show that this finding aligns with the observed declines in household income and young women's opportunity cost of marriage. Our duration analysis also reveals a notable shift from traditional arranged marriages to more modern marriage forms among refugees in Turkey. An intergenerational power shift might drive the shift toward nonarranged marriages. After arrival in Turkey, wealth and employment of parents decline among refugees. In contrast, Syrian youth in Turkey have higher age-adjusted employment rates than in prewar Syria. Moreover, nonarranged marriages increase more among demographic groups with stronger intergenerational power shifts than among groups with weaker shifts.

Factors Related to the Quality and Stability of Partner Relationships After Stroke: A Systematic Literature Review.

OBJECTIVE: To provide an overview of the current state of knowledge on factors related to relationship quality and relationship stability after stroke. DATA SOURCES: Cumulative Index to Nursing and Allied Health (CINAHL), Embase, MEDLINE, Psychology and Behavioral Sciences Collection, APA PsycINFO, and PubMed were searched on November 15, 2022, for literature on factors associated with (1) relation quality and (2) relation stability after stroke. STUDY SELECTION: English quantitative and qualitative studies investigating factors associated with relation quality and/or stability after stroke were included. Three reviewers independently assessed eligibility. Consensus meetings were held in case of divergent opinions. A total of 44 studies were included. DATA EXTRACTION: Information regarding study objectives and characteristics, participant demographics, independent and dependent variables, and main findings was extracted. Study quality was rated using the Joanna Briggs Institute Checklist for Analytical Cross-Sectional Studies and/or the Critical Appraisal Skills Programme Checklist for Qualitative Research. Both were administered by the lead reviewer and checked by the second reviewer. Identified factors are described and presented according to the domains of the International Classification of Functioning, Disability, and Health model. DATA SYNTHESIS: Thirty-seven factors related to relationship quality after stroke were identified, covering the domains of body functions and structures (eg, cognitive problems), activities (eg, decrease in physical intimacy), participation (eg, being socially active), environment (eg, medication side effects), and personal factors (eg, hypervigilance). Eight factors related to relationship stability were identified, covering the domains of participation (agreement on reciprocal roles) and personal factors (eg, quality of prestroke relation). CONCLUSIONS: Relationship quality and stability after stroke are related to a multitude of factors. Future research should confirm the relevance of factors found in a few studies of suboptimal quality; explore possible associations between relationship stability and factors falling in the domains of body functions and structure, activity, and environmental factors; and explicitly explore potential positive effects of stroke on relationships.

Socio-demographic determinants of intimate partner violence in Angola: a cross-sectional study of nationally representative survey data.

Intimate Partner Violence (IPV) is a global problem of public health importance, which can be found across all social layers and cultural backgrounds worldwide. Angola is still an under-explored country in the context of domestic violence and was therefore chosen as our focus of interest. Our study's goal was to identify the socio-demographic determinants of IPV in Angola. We used nationally representative data from female respondents of the 2015 Angolan Demographic and Health Surveys (DHS). Simple bivariate and multiple logistic regression analyses were used to assess the relationship between the experience of IPV and the women's' individual and contextual characteristics. Out of the 7,699 respondents, 3,070 (41.1%) reported having experienced at least one form of violence by their partners, with physical violence being more prevalent (32.5%) than emotional (27.7%) and sexual violence (7.2%). The partner's use of alcohol, the respondent's tendency to hurt her partner, her having witnessed her father beating her mother and being the first wife showed significantly higher odds of experiencing one or more types of IPV, whereas being older than the partner appears to have protective effects. Our findings reflect the widespread prevalence rates of violence against women in African countries. Future intervention programs should focus on women with risky background characteristics to help decrease domestic abuse in Angola. Our results indicate to focus on young women who have witnessed domestic violence in childhood, those whose partners use alcohol and those who tend to physically hurt their partners themselves. It is also recommended to intensify future research on the effects of co-wives on a relationship since first wives were found to have a higher risk of being physically abused by their partners.

Associations between child marriage and food insecurity in Zimbabwe: a participatory mixed methods study.

BACKGROUND: Child marriage is a global crisis underpinned by gender inequality and discrimination against girls. A small evidence base suggests that food insecurity crises can be both a driver and a consequence of child marriage. However, these linkages are still ambiguous. This paper aims to understand how food insecurity influences child marriage practices in Chiredzi, Zimbabwe. METHODS: Mixed methods, including participant-led storytelling via SenseMaker® and key informant interviews, were employed to examine the relationship between food insecurity and child marriage within a broader context of gender and socio-economic inequality. We explored the extent to which food insecurity elevates adolescent girls' risk of child marriage; and how food insecurity influences child marriage decision-making among caregivers and adolescents. Key patterns that were generated by SenseMaker participants' interpretations of their own stories were visually identified in the meta-data, and then further analyzed. Semi-structured guides were used to facilitate key informant interviews. Interviews were audio-recorded, and transcribed and translated to English, then imported into NVivo for coding and thematic analysis. RESULTS: A total of 1,668 community members participated in SenseMaker data collection, while 22 staff participated in interviews. Overall, we found that food insecurity was a primary concern among community members. Food insecurity was found to be among the contextual factors of deprivation that influenced parents' and adolescent girls' decision making around child marriage. Parents often forced their daughters into marriage to relieve the household economic burden. At the same time, adolescents are initiating their own marriages due to limited alternative survival opportunities and within the restraints imposed by food insecurity, poverty, abuse in the home, and parental migration. COVID-19 and climate hazards exacerbated food insecurity and child marriage, while education may act as a modifier that reduces girls' risk of marriage. CONCLUSIONS: Our exploration of the associations between food insecurity and child marriage suggest that child marriage programming in humanitarian settings should be community-led and gender transformative to address the gender inequality that underpins child marriage and address the needs and priorities of adolescent girls. Further, programming must be responsive to the diverse risks and realities that adolescents face to address the intersecting levels of deprivation and elevate the capacities of adolescent girls, their families, and communities to prevent child marriage in food insecure settings.

Socio-ecological factors of girl child marriage: a meta-synthesis of qualitative research.

BACKGROUND: Child marriage of girls is one example of human rights violations, and is increasingly recognized as a key obstacle to global public health. Given the importance of a comprehensive understanding of the motivations for child marriage, this study aimed to identify socio-ecological factors contributing to gills child marriage. METHODS: A comprehensive search was conducted of all English-language studies measuring causes of child marriage between 2000 and October 2022 in the Web of Science, PubMed, Scopus, PsycInfo, ProQuest, Poplin and Google Scholar databases. Girl child marriage is defined as a marriage under the age of 18. In this study, the CASP evaluation checklist was used to collect data. Two independent reviewers reviewed all articles. RESULTS: A total of 34 eligible qualitative articles were included. The most salient causes of child marriage among girls include low skills and knowledge, internal and external beliefs and motivations, and physical advantages at the individual level. Family characteristics and structure contribute to child marriage at the interpersonal level, while environmental and economic factors play a role at the community level. Social factors and cultural norms, as well as the shortcomings and weaknesses of legislation, are also contributing factors at the society level. CONCLUSION: The results showed that cultural beliefs supporting gender inequality and economic status were the most important causes of child marriage. These results can help policymakers and decision-makers implement strategies to reduce gender inequality to prevent child marriage.

Older men and loneliness: a cross-sectional study of sex differences in the English Longitudinal Study of Ageing.

BACKGROUND: Research into men and masculinities suggests men may be more reluctant than women to state they are lonely, more reliant on partners/spouses and/or alcohol to tackle it, and that this may be a result of poorer social relationships. Ageing is often associated with loneliness, and research has indicated gendered results in older people, but existing evidence lacks generalisability and cultural context. This study tests hypotheses on sex differences in loneliness in older England-based men and women. METHODS: We conducted a cross-sectional study using a sample of 6936 respondents aged 50 + from the English Longitudinal Study of Ageing (wave 8). Multiple imputation with chained equations was conducted to handle missing data. Multivariate regression was used to investigate the impact of sex on a direct question on loneliness whilst controlling for the University of California loneliness (UCLA) scale. Multivariate regression with interaction terms were used to examine sex differences in loneliness and alcohol consumption, partner status, and social relationships. RESULTS: Older men were less likely than older women to state they are lonely even when controlling for UCLA score. Older men showed a greater association between loneliness and alcohol consumption, but only when measuring the number of units consumed in the last week, and not using a less precise measure of the past year. Older men who cohabited with a partner were less lonely than cohabiting older women, whereas previously married but not cohabiting older men were lonelier than their female counterparts. However, never married older men were less lonely than never married older women. Evidence was found to suggests older men's worse friendships mediated this association, but social isolation and number of close relationships did not. Severe isolation predicted greater loneliness in older women, but not older men. CONCLUSIONS: Cultural ideals of masculinity and older men's poorer quality friendships may explain their reluctance to directly state loneliness, greater dependency on partners/spouses, and use of alcohol. Severely isolated older men may under-report loneliness on the UCLA scale as well as a direct question.

Social protection as a strategy for HIV prevention, education promotion and child marriage reduction among adolescents: a cross-sectional population-based study in Lesotho.

BACKGROUND: Lesotho's government has shown consistent efforts to implement social protection programmes. However, while recent evidence established a positive causal relationship between some of these programmes and food security there is little evidence on the extent to which these initiatives are associated with better educational and sexual and reproductive health outcomes among vulnerable adolescents in Lesotho. METHODS AND FINDINGS: The study uses cross-sectional, nationally representative data from the 2018 Lesotho Violence Against Children and Youth Survey. Our research examined the association between social protection receipt and educational and sexual and reproductive health outcomes among adolescents and young people (13-24 years) living in poverty. We employed multivariate logistic regression controlling for age, orphanhood, HIV status and sex. Social protection receipt was defined as household receipt of financial support from a governmental, non-governmental, or community-based program that provides income. Additionally, we fitted a marginal effects model by sex. Among the 3,506 adolescent females and males living in the two lowest poverty quintiles, receipt of social protection was associated with improvements in multiple adolescent outcomes: higher odds of consistent condom use (aOR 1.64, 95% CI 1.17-2.29), educational attainment (aOR 1.79, 95% CI 1.36-2.36), and school enrolment (aOR 2.19, 95% CI 1.44-3.34). Stratified analyses by sex showed that social protection receipt was also associated with reduced likelihood of child marriage among females (aOR 0.59, 95% CI 0.42-0.83) and higher odds of educational attainment and school enrolment among males (aOR 2.53, 95% CI 1.59-4.03 and aOR 3.11, 95% CI 1.56-6.19, respectively). CONCLUSIONS: Our study provides evidence that social protection programs are associated with improved educational, sexual and reproductive health and child marriage prevention outcomes among adolescents living in poverty. Implementing and expanding such social protection initiatives could prove instrumental in improving the well-being of vulnerable adolescents. CONTRIBUTIONS: Social protection programs have been increasing in sub-Saharan African countries, playing a pivotal role in poverty reduction, with Lesotho being no exception. Despite the optimistic outlook brought about by the implementation of the National Social Protection Strategy Lesotho I (2014-19) and II (2021-2031), the impact of these programs on some specific outcomes that concern the lives of the most vulnerable adolescents in Lesotho remains to some extent unexplored. Additionally, Lesotho grapples with high rates of HIV, adolescent pregnancy, child marriage and early school dropout, which can further contribute to poor long-term health and social outcomes among adolescents. In this study, we used data from the 2018 Lesotho Violence Against Children and Youth Survey (VACS) to examine the association between receiving social protection and multiple adolescent outcomes: educational, sexual and reproductive. The findings revealed that social protection programs, particularly the existing government-provided cash transfers, are significantly associated with multiple better outcomes among adolescents living in the poorest households in Lesotho. Such cash transfer schemes in Lesotho are associated with improved sexual and reproductive health outcomes for adolescent females, including reduced child marriage rates, and improved educational outcomes for males. These findings indicate that government-led social protection programmes are positively associated with favourable outcomes that can improve the quality of life for adolescents in resource-limited settings.

Rising nonmarital first childbearing among college-educated women: Evidence from three national studies.

Levels of nonmarital first childbearing are assessed using recent administrations of the National Longitudinal Survey of Youth, 1997 Cohort; the National Longitudinal Study of Adolescent to Adult Health; and the National Survey of Family Growth. Results confirm that the higher a woman's educational attainment, the less likely she is to be unmarried at the time of her first birth. A comparison over time shows increases in nonmarital first childbearing at every educational level, with the largest percentage increase occurring among women with college degrees at the BA or BS level or higher. This article projects that 18 to 27% of college-educated women now in their thirties who have a first birth will be unmarried at the time. In addition, among all women who are unmarried at first birth, women with college degrees are more likely to be married at the time of their second birth, and, in a majority of cases, the other parent of the two children was the same person. A growing proportion of well-educated women, and their partners, may therefore be pursuing a family formation strategy that proceeds directly to a first birth, and then proceeds, at a later point, to marriage, followed by a second birth. Possible reasons for the increase in nonmarital first births among the college-educated include the stagnation of the college wage premium; the rise in student debt; decreasing selectivity; and the growing acceptability of childbearing within cohabiting unions, which have become a common setting for nonmarital childbearing, and among single parents.

How both partners' individual differences, stress, and behavior predict change in relationship satisfaction: Extending the VSA model.

We pooled data from 10 longitudinal studies of 1,104 married couples to test the Vulnerability-Stress-Adaptation (VSA) model of change in relationship satisfaction. Studies contained both spouses' self-reports of neuroticism, attachment anxiety, and attachment avoidance; observational measures of engagement and opposition during problem-solving discussions at baseline; and repeated reports of both spouses' stress and marital satisfaction over several years. Consistent with the VSA model, all three individual and partner qualities predicted changes in marital satisfaction that were mediated by observations of behavior and moderated by both partners' experiences with stress. In contrast to the VSA model, however, rather than accentuating the association between individual differences and behavior, both partners' stress moderated the strength, and even direction, of the association between behavior and changes in marital satisfaction over time. Taken together, these findings indicate that 1) qualities of both couple members shape their behavioral exchanges, 2) these behaviors explain how individuals and their partners' enduring qualities predict relationship satisfaction, and 3) stress experienced by both couple members strongly determines how enduring qualities and behavior predict changes in relationship satisfaction over time. The complex interplay among both partners' enduring qualities, stress, and behavior helps explain why studies may fail to document direct main effects of own and partner enduring qualities and behavior on changes in relationship satisfaction over time.

Development, implementation, and evaluation of the effectiveness of an intervention program to improve the sexual competence of young adult women about to get married: a protocol study.

BACKGROUND: Having competence in initiating sexual interactions is one of the challenges of sexual health in any society. Given that the social, cultural, and religious background of some societies can prevent the acquisition of sexual competence in young women, this study will be done to design, implement, and determine the effectiveness of an intervention program to improve the sexual competence of young women on the eve of marriage. METHODS: The current research is a mixed-method study in a qualitative-quantitative sequence. In the first phase, a qualitative study will be conducted to explore the needs of sexual competence in young adult women about to get married and ways to improve it. Then, after the literature review and combining it with the results of the qualitative study, a draft of the intervention program will be developed. After reviewing the content of the program and validating it in the panel of experts, the final program will be developed. In the second phase, the effect of the program to promote the sexual competence of adult women about to get married will be determined in a quantitative study with a two-group quasi-experimental method. DISCUSSION: Providing a comprehensive and practical intervention program to promote sexual competence based on cultural, social, and religious background can help to improve the quality of sexual interactions of young women about to get married, reduce harm caused by lack of sexual competence, and ensure women's sexual health.

Preparing young people to start safe and satisfactory sexual behaviors and as a result to acquire sexual competence can play an important role in ensuring their sexual health. But in some countries, talking about sexual issues is a cultural and religious taboo. Given that Lack of sexual competence is associated with negative consequences, the present study aims to design, implement, and determine the effectiveness of a program to promote sexual competence in young adult women who are about to get married. In the first phase, to identify the needs of acquiring sexual competence and to explore the strategies for improving sexual competence, a qualitative study will be conducted with a content analysis approach. Individual interviews will be conducted with women aged 18 to 25 about to get married, the teachers of pre-marriage classes, midwives, gynecologists, reproductive health specialists, psychiatrists, and psychologists who work in the field of sexual health. Based on the findings of this phase and after reviewing the literature, an intervention program to improve sexual competence in young adult women will be designed and prepared. After the experts approve the intervention program, in the second phase, a quantitative study will be conducted to determine the effect of the intervention program on improving the sexual competence of young adult women about to get married.

Marital Quality-A Neglected Player in the Prevention of Cardiovascular Diseases: A Systematic Review of Longitudinal Studies.

PURPOSE OF REVIEW: Marital quality (MQ) is a psychosocial factor that has been neglected in cardiovascular prevention guidelines, although its association with cardiovascular diseases has been identified in several studies. Therefore, we aim to investigate how MQ either in positive or negative dimensions affect different cardiovascular risk factors and diseases. RECENT FINDINGS: We systematically searched different databases in September 2023 for longitudinal studies conducted to assess the contribution of MQ to well-established cardiovascular risk factors and diseases. Two independent researchers screened studies and carried out data extraction and quality assessment of included ones. From 12,175 potential studies screened, 40 were included. The presence of significant heterogeneity in methodology, follow-up, and subsequent effect estimates made it unfeasible to do a meta-analysis. Despite the variation, most studies found a significant association of negative MQ measures with physical inactivity (2/2), high levels of smoking (4/5) and alcohol (3/3) use, increased metabolic syndrome risk (3/3), elevated type 2 diabetes mellitus (T2DM) risk and poor T2DM management (3/6), elevated cardiovascular disease risk and progression (9/11), increased body weight and obesity risk (2/3), elevated blood pressure and hypertension risk (7/8). Positive MQ measures were mainly associated with improvement in blood pressure control (2/2), reduced T2DM risk and its good management (1/1), reduced body weight and obesity risk (2/2), and increased survival in cardiovascular diseases (4/4). Based on current evidence, MQ seems to play a crucial role in developing established cardiovascular risk factors and diseases and is worth considering in preventive strategies.