Browsing by Subject "Life course"

Introduction: In the fourth decade of the HIV epidemic, African American women continue to be disproportionately affected by HIV across all age ranges in the U.S. African American women make up only 13% of the female population in the U.S. yet account for 64% of HIV infections among women (Aitcheson et al., 2014). African American women face multiple challenges that intersect to influence how they effectively age into older adulthood and manage their health. Due to the increased challenges experienced by older African American women across the life course, it is imperative to identify factors that may mitigate the challenges of aging with the disease. Scant research exists focusing specifically on older African American women with HIV and thus our understanding of their experiences is still quite limited. Examining the personal strengths and social resources utilized to curb the deleterious effects of aging is necessary to improve health and well-being in this population.

Purpose and Methods: The purpose of this dissertation was to advance our understanding of the experiences of African American women with HIV aging across the life course with particular attention paid to the influence of the role of social relationships on health and well-being. The purpose was achieved through exploring the challenges of aging with HIV as an African American woman and the importance of utilizing the life course perspective (Elder & Giele, 2009) to explore their experiences over time; examining the literature on the relationship between social relationships and health; and presenting two papers from the findings of a qualitative descriptive study conducted with older African American women that explored their experiences over the life course. Eighteen African American women over the age of 50 participated in this qualitative study that utilized in-depth life history interviews and timelines as the primary means of data elicitation. In the first paper, we analyzed the data for experiences with social relationships across the life course. In the second paper, we analyzed trajectories and turning points across the life course.

Results: Findings from the first paper highlight that developing and maintaining relationships over time was influenced by a variety of life course themes at the personal, relational, and structural level presented over three developmental time periods (childhood/adolescence, young/middle adulthood, and older adulthood). Women described tremendous barriers to relationship development and maintenance in both childhood/adolescence and young/middle adulthood including child sexual abuse, crack cocaine addiction, intimate partner violence, and HIV-related stigma. Women also reported having large social networks in younger years but not many important relationships. In contrast, older adulthood was described as a time with more positive social relationships, especially for those who were addicted to crack cocaine in their youth. As women aged, they built supportive networks with people they valued.

Findings from the trajectories and turning points paper show that while trajectories across participants were diverse, they were categorized into three main patterns: anchored; early struggling and upward progression; and continuously struggling. Life experiences were most dissimilar between women who experienced crack cocaine addiction compared to women who never used to drugs. The syndemic impact of substance abuse, violence, and HIV (Singer, 2009) was also important as was the cyclical nature of these co-occurring epidemics over time. Our study provides evidence that a traumatic event in early life may be the first step in the syndemic cycle.

Though families come in all shapes and sizes, many people recognize the birth of their first child as the start of their new family. The transition to parenthood that expectant parents experience has important implications for their future health and the health of their children. This dissertation investigates the experiences of new and expectant parents as they develop their new roles. The findings draw on publicly-available conversations from parenting forums. Investigative phenomenology, descriptive phenomenology, and quantitative analysis are used to explore three research questions: 1) How do people experience perinatal loss? 2) What are parents’ experiences of working with nurses when their infant is in a neonatal critical care unit? 3) What emotions do men experience on their journey to fatherhood? The findings of this dissertation indicate that the transition to parenthood is a time of ambiguity, stress, and potentially, great joy for new parents. During this transition, people take on new identities, perform new roles, experience a broad range of emotions, and develop new relationships. The impacts of this transition are lifelong, so support is vital to promoting the formation of healthy, well-adjusted families. For healthcare providers and researchers, there is a great deal that can be done to help new and expectant parents feel supported and respected. A few of the many potential tools providers and researchers can use include mindfulness, non-judgement, and therapeutic communication.

As an aggregate, American households have shown rising debt levels over the past few decades, yet we do not understand how debt varies within households over time and what factors influence this variation in a meaningful way. To date, household debt appears predominantly as a component of measures of net worth, obscuring heterogeneity in the meaning of debt within a household. Moreover, most studies focusing specifically on indebtedness rely on cross-sectional data. In addition, no cohesive theoretical model exists to account for changing patterns of debt. This dissertation seeks to fill these gaps. Utilizing a variety of methodological approaches and drawing on longitudinal data from the National Longitudinal Survey of Youth 1979, it adds sociological explanation to a social process that has been previously ignored and under-theorized.

First, drawing from literature in economics and sociology, I propose a dynamic, life course model of indebtedness that specifies three mechanisms driving differentiation in household indebtedness: institutional context (period), social heterogeneity, and patterned disadvantage, or structural risk. Second, I use multilevel logistic regressions to explore the association between the hypothesized mechanisms and the likelihood of holding non-collateralized debt. While experiencing negative life course risks increases the likelihood of holding debt, I find that occupying positions of structural disadvantage--being black, being in poverty--decreases the likelihood of holding debt, while having advantages--higher education, being married, holding assets--increases the likelihood of holding debt, pointing to distinct differences in who can access debt to buffer life course shocks and who cannot. Examining the interrelationships between debts and assets further underscores the tenuous economic well-being of the disadvantaged. I find that those most likely to experience negative life events are both less likely to have financial assets with which to buffer these events and more likely to experience constrained access to non-collateralized debt.

Third, I employ multilevel linear regressions to examine the association between the proposed mechanisms and three unique indicators of debt burden. I find that many of the standard coefficients included in models of net worth are not significant predictors of the level of non-collateralized, non-revolving debt, suggesting that we know much more about the correlates of income and wealth than we do household debt. Variation in debt burden may be better understood by heterogeneity in non-economic variables frequently not captured in survey research. To better explore this unobserved heterogeneity, I utilize latent class regression models to estimate the early life course trajectories of debt burden for the NLSY79 cohort. I find four distinct trajectories of indebtedness with varying consequences for later life financial outcomes. Overall, I conclude that household debt is nuanced and contextually contingent. More importantly, debt adds to our understanding of long-term stratification processes when studied as a unique indicator of inequality.

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.

This study examines whether trajectories of multiple social role occupancy, measured by level and dynamics of spouse, parent, and worker roles, are associated with mortality and concurrent trajectories of depressive symptoms and self-rated health. I frame hypotheses with role strain, role enhancement, role context, stress process, and life course theories to examine both within-person changes over age and between-person predictors of health status.

I use data from the Americans' Changing Lives Study, a nationally representative accelerated cohort panel study of U.S. adults interviewed in 1986, 1989, 1994, and 2001/2 with mortality tracking through 2006. I use latent class analysis to estimate disaggregated trajectories of role occupancy, role strain, role satisfaction, depressive symptoms, and self-rated health across the adult life course. I then use multinomial and logistic regression analyses to examine associations between role trajectories and health outcomes.

I find that (1) there is significant heterogeneity in trajectories of role occupancy and characteristics across the adult life course; (2) higher levels of social role occupancy are associated with better depressive symptom and mortality outcomes; (3) lower levels of role strain and higher levels of role satisfaction are associated with better depressive symptom outcomes, and (4); the association between role occupancy and health is robust to the inclusion of role characteristics. Thus, I find support for the role enhancement hypothesis in that higher levels of role occupancy are associated with better health outcomes irrespective of reward and strain associated with those roles.

Older women in the U.S. face greater risks of economic insecurity in comparison with other age groups and with men their own age. Although these risks have been documented in prior research, few studies investigate the life course mechanisms underlying women's retirement insecurity. This dissertation seeks to fill this gap by using a life course perspective and the theory of cumulative disadvantage to examine how women's earlier work and family experiences shape subsequent economic resources in retirement. The three major types of retirement resources in the U.S. - Social Security benefits, occupational pensions, and private retirement wealth - are considered. Analyses use a variety of modeling techniques and panel data from the Health and Retirement Study linked to restricted access Social Security Administration files. In addition, this dissertation specifically investigates retirement insecurity across birth cohorts of older women.

The first substantive chapter examines how Social Security benefit eligibility type is influenced by four major life course predictors: marital continuity, family timing, employment commitment, and cohort change. Social Security benefit type is an important indicator of retirement security for women because, despite nearly universal program coverage, benefit type is associated with differential economic security in retirement for women. Multinomial logit models demonstrate the importance of women's own paid employment histories for later benefit type. Receiving own worker Social Security benefits or being dually eligible for Social Security are more likely outcomes with increased employment experience. The second empirical chapter uses discrete-time even history models to examine the timing of women's access to occupation pension income. The timing of pension income receipt is relevant for women's retirement security because delayed access indicates a missing source of economic resources. Results reveal significant cohort differences in the timing of first pension receipt as well as the important roles of marital continuity and family timing for older women's access to occupational pension income. The final empirical chapter employs age-based growth models to examine differential trajectories of private retirement savings in early retirement (ages 51-65) across U.S. birth cohorts of women. This analysis examines both initial retirement wealth and wealth accumulation over time to understand how life course processes advantage some older women, but contribute to ongoing disadvantage for others as part of this third, major source of retirement security. Results from growth models reveal variation across birth cohorts as well as the negative effects of divorce for initial wealth holdings and growth in retirement wealth. Overall, this dissertation illustrates the importance of women's work and family experiences across the life course for the cumulative disadvantages they face in retirement. Moreover, each type of major retirement resource interacts with different aspects of women's prior work and family roles to produce economic outcomes in retirement.