Browsing by Author "Lynch, Scott M"

The life course perspective has long theorized that childhood is a sensitive period for mental, physical, and emotional development, meaning that negative experiences during childhood can have long-lasting impacts on health and wellbeing. Thus, adverse childhood experiences (ACEs), such as parental alcoholism, sexual abuse, and physical neglect, during this sensitive period of the life course may elicit poor mental health both in childhood and as children age into adulthood. Although research on the long term impact of childhood adversity is growing, this research has been somewhat limited in the measurement of childhood adversity, focusing on dichotomous measures (occurred/ did not occur) or the summation of such dichotomous measures. In doing so, this research fails to capture heterogeneity in adversity experience, such as the severity, duration, and context of childhood adversities as well as how specific types of adversities may co-occur, consequently underestimating the impact of negative experiences for those at greatest risk of poor mental health. In this dissertation, I explore how these sources of distinction pattern mental health trajectories, with consequences for mental health disparities across the life course. In broadening the definition of childhood adversity beyond the simple occurrence of negative events, this dissertation provides an analytic blueprint for future research assessing childhood adversity, contributing to stress, life course, and mental health studies. In Chapter 2, I focus on a single adverse experience, parental mental health problems in childhood, to showcase how differences in severity, duration, and context of an adversity correspond to different mental health patterns across adulthood. Using six waves of data from the Panel Study of Income Dynamics (PSID; 2007-2017) and applying growth curve methods I find that more severe and longer exposures to parental mental health problems in childhood correspond to even greater distress in adulthood. The gender of the parent afflicted does not predict differences in adult mental health, but those individuals exposed to both maternal and paternal poor mental health in childhood have the greatest distress in adulthood. Chapters 3 and 4 focus on two other sources of heterogeneity in childhood adversity experience: the number and type of childhood adverse events. These chapters employ latent class analysis (LCA) to capture latent subtypes who are similar in their responses to a set of indicators, essentially estimating adversity classes that capture both the number and type of adversities that co-occur. These classes are then used to predict mental health trajectories across the life course. Before assessing latent classes of childhood adversity, Chapter 3 sets the groundwork for the analytic strategy of predicting outcome trajectories by latent classes. To date, there are several methods for including a distal outcome in latent class models, with no clear analytic strategy for when the outcome of interest is a growth model. Therefore, in Chapter 3, I employ a simulation study assessing the performance of five different methods under 27 different data conditions. Results from this study suggest that a maximum-likelihood (ML) approach best captures the true parameter estimates while maintaining substantive clarity. Chapter 4 uses the identified method in Chapter 3 (ML approach) to assess how latent classes of childhood adversity relate to trajectories of mental health using four waves of data from the National Longitudinal Study of Adolescent to Adult Health (Add Health, Wave I-IV). Findings suggest that in addition to a class represented by low adversity experience, there are two classes with greater experiences of adversity. One adversity class, characterized by household dysfunction, has greater depressive symptoms than the low adversity class in early life, and this gap is maintained into mid-adulthood. The other adversity class, characterized by maltreatment, has both greater depressive symptoms than the low adversity class in early life and becomes increasingly more depressed than this group across the life course. Overall, this dissertation contributes both methodologically and substantively to the study of childhood adversity and life course mental health. Childhood adversity has the ability to shape one’s mental health outcomes for many years after childhood, but this relationship is conditional on the lived experiences of adversity. These findings underscore the importance of severity, duration, context, type, and number of adverse events for patterning which children are at greatest risk for mental health problems in adulthood. Future work should consider these elements in favor over an over-simplified measure that may obscure the life course impact of these negative experiences.

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Discussion

This dissertation explores the interrelated dynamics of economic and political inequality, economic insecurity, and psychological well-being through three connected empirical studies. The first study adjudicates between conflicting findings in the unequal policy responsiveness literature. Many studies of the relative influence of income groups on U.S. policy have focused on issues over which affluent and average Americans disagree. However, scholars have posited different ways of both defining policy disagreement and measuring policy responsiveness. I assess the impact of 22 definitions of policy disagreement and two methods of measuring policy influence—based on win rates and policy change rates—on analyses of unequal responsiveness. The results of this analysis consistently indicate that U.S. policymaking institutions respond to the preferences of the affluent, but not those of average Americans. The second study examines gendered effects of unemployment on the subjective well-being of different-sex U.S. couples using recent data from the Panel Study of Income Dynamics (PSID). I eliminate the confounding influence of time-invariant person-specific characteristics that could impact both unemployment transitions and well-being through fixed effects analysis. While husbands’ unemployment is negatively associated with wives’ well-being, I find no evidence that wives’ unemployment spills over to impact husbands’ cognitive or affective well-being. The final study looks at the relationship between income change and psychological health and investigates possible asymmetry in this relationship. Analyzing data from the PSID with a combination of first-difference estimation and spline regression, I find support for the hypothesis that income losses have a larger impact than income gains on subjective well-being among partnered adults. The relationships between income changes and well-being are insignificant for single adults. Together, these studies offer new insights into the ways economic power and vulnerability shape the subjective and material realities of life for individuals and families in the United States.

In this dissertation, I conduct three studies focusing on differences in social groups and their health outcomes or opinions related to medical practices. In Chapter 1, I outline each study and its findings.

Chapter 2 focuses on the Great Recession in the United States (2007–2009) and how this crisis is associated with health disparities. In this chapter, I use nine waves spanning 16 years (1998-2014) of the RAND version of the Health and Retirement Study (HRS) to examine disparities in cardiovascular disease, stroke, or related death (e.g., circulatory disease) among Americans ages 50 and older to determine whether these health disparities among different educational groups narrowed, widened, or remained constant during and after the Great Recession. In general, findings from discrete-time hazard analyses suggest that the disparities remained relatively constant with some (nonsignificant) evidence of some narrowing between the most educated and least educated groups.

Chapter 3 examines whether there is symmetry in the effects of certain health behaviors—smoking, drinking, weight management—on cardiovascular disease, stroke, or related death between socioeconomic groups. This chapter also uses nine waves (1998–2014) of the RAND HRS. Discrete-time hazard regression analyses indicate that while those with higher socioeconomic status maintain better health outcomes regardless of health behaviors, the effects of health behaviors are not equally distributed. Poor weight management and higher numbers of daily cigarettes are associated with a greater increased risk for those with more education than for those with less. The effects of heavy drinking, however, are less severe for the those with the most education compared to those with the least education.

Chapter 4 studies the role of social change by investigating trends in approval for euthanasia among cohorts in the United States and how those trends are influenced by cohort replacement and religious attitudes. This chapter uses 16 waves of the General Social Survey (1985–2014) and estimates differences in approval ratings between cohorts using logistic regression models. Results show that baby boomers are significantly more likely to approve of euthanasia than either their predecessors or successors, suggesting a cohort effect. Individuals belonging to more conservative religious groups and displaying higher levels of religiosity are less likely to approve. With the meaningful effect of cohorts on approval for euthanasia, findings suggest that as baby boomers age and as the population becomes less religious, approval for euthanasia might increase again.

Examining how structural and cultural factors shape postsecondary educational outcomes is at the heart of sociological research in education. However, although there has been a rich history in exploring these sociological concepts in education, many fundamental questions remain unanswered. Using data from the Education Longitudinal Study of 2002 (ELS), this study extends existing research in the sociology of education by addressing two research questions that relate to how social structure and culture predict youths’ future postsecondary educational outcomes.

Pertaining to structural explanations of educational outcomes, I examine the first research question: do black youth benefit less from increases in their parents’ social class status on their college enrollment and educational attainment. Classic and contemporary studies show greater social class status is associated with higher levels of education for youth. However, racialized processes might constrain the benefits blacks receive from increases in parents’ social class. Therefore, I analyze whether race moderates the relationship between youths’ social class status during high school and two measures of postsecondary educational outcomes: (1) college enrollment two years post-high school and (2) educational attainment eight years post-high school. Results suggest black youth receive lower benefits from social class than whites for both outcomes, and parents’ gender plays a role in the racial differences in the link between social class and both outcomes.

Pertaining to cultural explanations of educational outcomes, I examine the second research question: does within-school variation in school culture during high school predict future college enrollment. Although many studies examine the role school culture—measured as the within-school average in schooling behaviors or beliefs—plays in shaping high school students’ decisions to attend college, few studies investigate how within-school variation in culture predicts college enrollment. Therefore, I analyze whether an association exists between college enrollment two years post-high school and within-school variation in school culture. Results suggest that students in public and private schools are less likely to enroll in college after attending a high school with greater within-school variation in culture. Results from this research question combined with the results of the first research question have implications for the study of structural and cultural factors in education research.

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Conclusion

For decades, life course and stress process scholars have documented that negative, stressful experiences have consequences for health across the life course. However, less attention has been paid to hearing impairment, a highly prevalent functional limitation that has significant implications for the quality of life of older adults. Hearing impairment is common at older ages (reported by 27.3% of those aged 65-74 and 45.1% of those aged 75 and older) and has negative consequences for the quality of life not only of the focal individual but also for those close to them (CDC 2017, Ciorba et al. 2012, Dalton et al. 2003, Wallhagen et al. 2004). The aim of this dissertation is to apply a life course and stress process framework to the experience of hearing impairment via two studies that each use nationally representative, longitudinal data from the Health and Retirement Study (HRS). My findings contribute to our understanding of marriage, family, gender, and health by moving beyond the traditional approach that focuses on individuals with disabilities to explore the impacts of disability on spouses.

In Chapter 2, I build on the stress process framework by conceptualizing hearing impairment as a chronic stressor that impacts mental health and examining the role of social support in this relationship. Using fixed-effects regression models applied to three waves of HRS data (2006, 2010, 2014), I found that worse self-rated hearing is associated with a significant increase in depressive symptoms, and that social support interacted with hearing impairment: low levels of social support were associated with more depressive symptoms but only among people with poor self-rated hearing. Moreover, high levels of social support reduced depressive symptoms for those with poor hearing. These findings suggest that hearing impairment is a chronic stressor in individuals' lives, and that responses to this stressor vary by the availability of social resources.

Chapter 3 examines stress proliferation among married couples. While decades of research show the health benefits of marriage, stress proliferation suggests that chronic stressors such as disability may undermine social relations, thus limiting their role as a coping resource. For this study, I matched couples by household identification number over ten waves of the HRS (1998-2016). Fixed-effects regression models revealed that wives’ hearing impairment is associated with an increase in husbands’ depressive symptoms, but that husbands’ hearing impairment is not associated with wives’ depressive symptoms. This could be because women in heterosexual marriages have traditionally been expected to monitor their husbands’ health, but not vice versa. Since men are less used to serving as caregivers, they may find their wives’ hearing impairment distressing. Also, wives usually find social support outside of the marriage, while husbands traditionally rely on their wives for companionship. This would provide wives, but not husbands, with external resources to cope with their spouses’ hearing impairment. These findings reveal that the stress of hearing impairment does spill over from one spouse to another, depending on gender.

Overall, this dissertation demonstrates that hearing impairment is a chronic stressor that has major implications for individuals’ mental health. Moreover, the mental health consequences of hearing impairment are not only limited to individuals but can also spill over to impact spouses. Further research is needed to extend our understanding of how disability, in general, and hearing impairment, specifically, shapes health across the life course for individuals and those close to them.

In this dissertation, I seek to begin building a new line of health inequality research that parallels the emerging structural racism literature by developing theory and measurement for the new concept of structural sexism and examining its relationship to health. Consistent with contemporary theories of gender as a multilevel social system, I conceptualize and measure structural sexism as systematic gender inequality in power and resources at the macro-level (U.S. state), meso-level (marital dyad), and micro-level (individual). Through a series of quantitative analyses, I examine how various measures of structural sexism affect the health of men, women, and infants in the U.S.

Chapter 2 focuses exclusively on the macro-level and drills down on a single indicator of structural sexism: political gender inequality. Using data compiled from several administrative sources across a twenty-two-year period, I find that women’s political representation in U.S. state legislatures is as strong —or stronger—a predictor of state infant mortality rates than even the state’s poverty level. This relationship holds both between states with varied levels of political gender inequality in a given year, and within the majority of states as women’s representation changes over time. To quantify the population-level costs, I estimate that women’s continued underrepresentation in legislative office was associated with nearly 3,500 excess infant deaths per year in the U.S. compared to what would be expected under conditions of gender parity.

Chapter 3 lays out a more comprehensive, multilevel framework for structural sexism and examines how it shapes the health of women and men at midlife. I measure macro-level structural sexism at the U.S. state-level using indicators of inequality in political, economic, cultural and reproductive domains. Using restricted geo-coded data from the NLSY79, individuals are located within states to capture their exposure to structural sexism. This chapter also incorporates individual- and spousal-level data from the NLSY79 in order to measure exposure to structural sexism at the meso- and micro-levels. Results show that among women exposure to more sexism at the macro- and meso-levels is associated with more chronic conditions, worse self-rated health, and worse physical functioning. Among men, macro-level structural sexism is also associated with worse health. However, at the meso-level greater structural sexism is associated with better health among men. At the micro-level, internalized sexism is not related to health among either women or men. These results highlight the importance of a multilevel approach.

As a whole, this work demonstrates that structural sexism takes a substantial toll on population health in the U.S. The findings also illustrate that effects of structural sexism on health depend both on an individual’s position within the gender system and the level at which sexism exposures are measured. Further research is needed to extend our understanding of how structural sexism shapes health across the life course.

In the United States, geographic and racial-ethnic disparities in adverse birth outcomes have increased over the past decade. High and rising rates of low birth weight, preterm delivery, and infant mortality are concentrated in the South and Midwest and among non-Hispanic Black and other birthing persons of color. These divergent trends are rooted in structural and social systems of inequality, such that cumulative experiences of discrimination and disparate access to resources related to policy contexts and one’s social standing systematically place some birthing persons at greater risk of adverse birth outcomes compared to others. Because these outcomes are associated with both birthing persons’ social positioning and offspring’s later-life socioeconomic status and health, they become mechanisms through which inequality is passed across generations. This dissertation explores the structural and social determinants of intergenerational health inequities by examining how the state policy contexts and discrimination that a mother is exposed to contribute to differences in adverse birth outcomes across US states and two distinct but related status characteristics: race and ethnicity and skin tone. Chapters 2 and 3 use birth cohort-linked birth/infant death restricted-use micro-data from the National Center for Health Statistics. Chapter 2 focuses on a single policy context and evaluates how rates of preterm birth and infant mortality responded to two policies restricting access to reproductive health care in Texas between 2005 and 2017. Using demographic standardization and decomposition techniques, I find that age-education-prenatal care standardized rates of infant mortality increased significantly in the years immediately following restrictions to family planning care (2011), but only for births to non-Hispanic (NH) Black mothers. Standardized preterm birth rates increased slightly and temporarily following 2013 restrictions on abortion providers across all racial-ethnic groups. These salient findings underscore the need to consider the infant health and heterogeneous consequences of rapidly evolving reproductive rights across the US. Chapter 3 takes a multidimensional policy approach to consider, first, how state policies and related characteristics co-occur to form distinct, underlying policy contexts and, second, how those contexts are related to low birth weight and infant mortality. Building on the World Health Organization’s structural determinants of health framework and compiling state-level data from several publicly available sources, results from the latent profile analysis suggest three distinct contexts. Contexts defined by high intervention or high constituent engagement (compared to low intervention) are negatively associated with risks of low birth weight and infant mortality. Overall, the protective effects are most pronounced among births to NH white mothers (compared to NH Black or Hispanic). These findings demonstrate how state policies and characteristics combine to shape health and underscore the importance of considering how racialized experiences may reduce the benefits of certain state contexts among minoritized groups. In Chapter 4, I marry weathering and skin tone stratification frameworks to examine how risks of low birth weight differ across maternal age and skin tone, a marker of cumulative discrimination, among NH Black mothers. Using data from the National Longitudinal Study of Adolescence to Adult Health, I find that, despite similar risks of low birth weight across skin tone at maternal age 16, risks diverge with age such that mothers with the darkest skin tones experience the sharpest increases. These findings underscore the transgenerational consequences of life course exposures to discrimination. Overall, these findings contribute to health equity, maternal and child health, and life course studies by demonstrating how both “protective” and “harmful” policies contribute to racial-ethnic disparities in birth outcomes and by underscoring the importance of considering heterogeneous experiences across the life course and within racial-ethnic groups when addressing birth inequities. Future research should continue to interrogate how the “protective” effects of policies and contexts vary across race and ethnicity to clarify if such policies exacerbate or mitigate inequities, as well as examine how other cumulative and early life course stressors shape birth outcomes.

Low subjective well-being arises from differences between experiences and expectations, often identified through social comparisons. Many studies have investigated how individual exposures to a recessive period associates with contemporaneous changes in subjective well-being, finding inconsistent results. The studies collected here expand prior research by (1) examining contemporaneous associations between subjective well-being and unemployment rates before, during, and after a recession and by (2) investigating whether recessions influence subjective well-being in a more persistent manner through Cohort Socialization. This mechanism predicts first that exposure to recessions in young adulthood changes individual outlooks. Second, it predicts that these differences in outlooks correlate with differences in subjective well-being.

I use the General Social Survey (GSS) repeated cross-sections (1994-2014) and three GSS three-wave panels (2006-2014) to investigate this conceptual model. I analyze these data with various logistic regression models, including hierarchical models for panel data. These studies find a negative association between subjective well-being and contemporaneous unemployment rates across the study period. In addition, these studies find a persistent effect (exceeding five years) of exposure to recessive periods during young adulthood. First, those who experienced a recession in young adulthood have different average levels of subjective well-being from those who did not. Second, exposure to a short recession (near 6 months) in young adulthood (ages 18-22) is associated with higher subjective well-being, while exposure to a long recession (over 16 months) is associated with lower subjective well-being. Third, differences in intergenerational comparative expectations—how people compare their own standard of living to that of their parents and children—is a difference in outlook that partially mediates the observed differences in subjective well-being.