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Objectives Social participation is known to enhance well-being. Caregiving responsibilities are more intense when caring for an older adult with than without dementia and may affect caregivers’ ability for social participation. We estimate social participation restrictions among caregivers for older persons with versus without dementia, variation within racial/ethnic group, and the mediating effect of care hours. Methods We use the 2017 National Health and Aging Trends Study (NHATS) and National Study of Caregiving (NSOC) to study family caregivers for older adults. We estimate the prevalence of social participation (e.g., visiting family/friends, religious activities, group/club activities, going out) that were important to the caregiver but missed due to caregiving. We use logistic models to test for differences in restrictions by the older adult’s dementia status overall and within race/ethnic group, adjusting for caregiver and care receiver characteristics. Results One-third of family caregivers for older adults with dementia reported restrictions due to caregiving, double the prevalence among caregivers of an older adult without dementia (33.3% vs 16.0%; p < .001). This doubling gap persisted in adjusted models (odds ratio [OR] = 2.4; p < .01) but mainly for White, non-Hispanic caregivers (OR = 3.2; p < .001). Substantially greater caregiving hours for people with versus without dementia was found (104 vs 60 hr per month), which is responsible for about 21% of the total difference in restrictions (p < .05). Discussion More time spent among caregivers of persons with versus without dementia may be an important factor undermining social participation, but hours only partially explain the gap. Future interventions should consider how to facilitate social participation among caregivers.

Objectives Disability in the United States has not improved in recent decades. Comparing temporal trends in disability prevalence across different income groups, both within and between the United States and England, would inform public policy aimed at reducing disparities in disability. Methods Using the Health and Retirement Study and the English Longitudinal Study of Ageing, we estimated annual percent change from 2002 to 2016 in disability among community-dwelling adults (197,021 person-years of observations). Disability was defined based on self-report of limitations with 5 instrumental activities of daily living and 6 activities of daily living. We examined the trends by age and income quintile and adjusted for individual-level sociodemographic status and survey design. Results The adjusted annual percent change (AAPC) in disability prevalence declined significantly in both countries for ages 75 and older during 2002–2016. For ages 55–64 and 65–74, disability prevalence was unchanged in the United States but declined in England. Both countries experienced a widening gap in disability between low- and high-income adults among the younger age groups. For example, for those ages 55–64 in each country, there was no significant improvement in disability for the low-income group but a significant improvement for the high-income group (AAPC = −3.60; 95% confidence interval [CI; −6.57, −0.63] for the United States; AAPC = −6.06; 95% CI [−8.77, −3.35] for England). Discussion Improvements in disability were more widespread in England than in the United States between 2002 and 2016. In both countries, the disparity in disability between low- and high-income adults widened for middle-aged adults. Policies targeted at preventing disability among low-income adults should be a priority in both countries.

Objectives Increased likelihood of having step children among more recent cohorts of older adults, alongside lower levels of assistance from step children, has led to concerns about greater unmet needs for older parents in step families. However, few studies have directly examined family structure and unmet needs. We examined the associations between having step children (vs. only biological children) and receiving care from adult children, and unmet needs for assistance. Methods Using the 2015 National Health and Aging Trends Study, we investigated among older parents with care needs whether levels of care received from adult children and unmet needs differed between those with biological versus step families. We also explored whether a partner or paid care compensated for observed differences. Results Older parents in need of care were more than twice as likely to receive care from their adult children if they had biological instead of step families. Unmet needs among older parents did not differ by family structure, nor did levels of partner or paid care. Discussion Results illustrate that concerns about the implications of the rising prevalence of step families for care parents receive from their children may be warranted. However, there is a lack of evidence of greater unmet need for care for older parents in step families, as risks of unmet needs are high for older parents regardless of family type.

Background: The spatial distance between children and parents substantially influences their lives, yet empirical evidence on life course patterns of child–parent proximity is sparse. Objective: The goal of this study is to identify salient features of child–parent spatial distance across the life course and explain differences by race in these features in the United States. Methods: Using the Panel Study of Income Dynamics, this study examines the spatial distance between residential locations of children and their mothers over 47 years (166,098 person-year observations). Point-in-time, dynamic, and multi-state life table analyses of spatial distance are conducted using location measured at the block level. Differences between Black and White people are assessed, examining various explanatory factors, including life course events. Results: Living very close is common across the life course, with 25% of life-years during ages 18–54 spent within five miles of, but not with, one’s mother. Children who are Black are much more likely than children who are White to live close to their mother if she is alive, but mothers of Black children are much less likely to be alive, especially when children are middle-aged. Observed sociodemographic characteristics of the child and mother account for a substantial share – and in some cases all – of the racial differences. Conclusions: Very close residential proximity to one’s mother beyond coresidence is common across the life course even in the geographically large United States. Racial differences in mortality affect differences between Black and White people in family spatial availability. Contribution: This study provides the first national estimates of intergenerational proximity over the life course in the United States, and hence a basis for further research.

We examine older partnered parents' time spent with adult children in biological and step families, treating time together as an indication of relationship strength. Using a unique national sample of U.S. time diaries from the Panel Study of Income Dynamics, we investigate time with all adult children combined and with each adult child. We find that time together depends on family structure and parent–adult child dyadic relationship type embedded in family structure. In analyses of all adult children combined, an older parent is more likely to spend time with adult children in biological families than in stepfamilies only when there is no shared biological child in the stepfamily. In dyadic analyses, a parent's tie with an adult child who is a biological child of both partners is stronger in stepfamilies than in biological families. Moreover, among stepfamilies, ties are not uniformly stronger with biological children relative to stepchildren; differences emerge only in more complex families when each partner has biological children from previous relationships. Our findings challenge the view that ties with older parents are always weaker with stepchildren in stepfamilies and point to the importance of considering parent–child relationships in the broader family context.

Background: The number of adults living with limitations in daily activities in the United States is large, and projected to increase. Families, which are becoming more complex, are critical to the wellbeing of this population. Objective: We present national estimates of the size and composition of kin networks for adults with activity limitations. Methods: We use the 2013 Panel Study of Income Dynamics to assess kin relationships of adults aged 40 and older with an activity limitation. We assess kin relations up and down one generation and horizontally, including spouses, adult children, parents, siblings, step-kin, parent-in-laws, children-in-law, and sibling-in-laws. We estimate kinship size and differences across race/ethnicity, education, and marital status. We also estimate the number of helpers. Results: Adults with activity limitations have a substantial number of adult kin: 9.1 on average, while only 12% have fewer than four kin. Spouses and adult biological children, the most common caregivers, account for less than one-third of these kin. Kin networks are much larger among those who report their background as Hispanic rather than non-Hispanic white or Black, married rather than unmarried, and less-than-college rather than college-educated. Conclusions: Despite concerns about increasing family complexity, we find that 88% of individuals with a limitation have four or more family members, and as kin size increases the average number of kin helping increases from one to two. Contribution: We provide estimates of kinship size and composition for adults with disabilities, assessing the number of kin, types of kin, and sociodemographic differences.

OBJECTIVE: This brief study examines race/ethnic differences in geographic distance to mothers among adults in the U.S. BACKGROUND: Race/ethnic differences in rates of adult children living with their mothers in the U.S. are well documented but spatial distances beyond shared housing are not. METHOD: Spatial distances between residential locations of adults 25 and older and their biological mothers are estimated using the 2013 Panel Study of Income Dynamics for Hispanics, blacks, and whites. Multinomial logistic regression models and nonlinear decomposition techniques are used to assess the role of demographic factors, socioeconomic status, and health of the child and mother in accounting for race/ethnic differences in adult child—mother proximity. RESULTS: Blacks are more likely than whites to live with their mother and more likely to live within 30 miles but not coresident, whereas whites are more likely to live more than 500 miles away. Geographic proximity to mother is distinct for Hispanics with nearly one-third having their mother outside the U.S. Demographic, socioeconomic, and health factors account for the fact that blacks are about twice as likely as whites to live with their mother but do not fully account for large white—black differences in proximity outside the household. The single most important factor accounting for white—black differences is marital status for coresidence but education for proximity in the U.S. beyond coresidence. CONCLUSION: New national estimates illustrate the complexity of race/ethnic differences in proximity to mothers that are not reflected in studies of coresidence.

The COVID-19 pandemic has magnified U.S. health disparities. Though disparities in COVID-19 hospitalization by race-ethnicity are large, disparities by income and education have not been studied. Using an index based on preexisting health conditions and age, we estimate disparities in vulnerability to hospitalization from COVID-19 by income, education, and race-ethnicity for U.S. adults. The index uses estimates of health condition and age effects on hospitalization for respiratory distress prior to the pandemic validated on COVID-19 hospitalizations. We find vulnerability arising from preexisting conditions is nearly three times higher for bottom versus top income quartile adults and 60 % higher for those with a high-school degree relative to a college degree. Though non-Hispanic Blacks are more vulnerable than non-Hispanic Whites at comparable ages, among all adults the groups are equally vulnerable because non-Hispanic Blacks are younger. Hispanics are the least vulnerable. Results suggest that income and education disparities in hospitalization are likely large and should be examined directly to further understand the unequal impact of the pandemic.

This paper provides the first nationally representative estimates of vulnerability to severe com-plications from COVID-19 overall and across race-ethnicity and socioeconomic status. We use the Panel Study of Income Dynamics (PSID) to examine the prevalence of specific health condi-tions associated with complications from COVID-19 and to calculate, for each individual, an index of the risk of severe complications from respiratory infections developed by DeCaprio et al. (2020). We show large disparities across race-ethnicity and socioeconomic status in the prev-alence of conditions which are associated with the risk of severe complications from COVID-19. Moreover, we show that these disparities emerge early in life, prior to age 65, leading to higher vulnerability to such complications. While vulnerability is highest among older adults regardless of their race-ethnicity or socioeconomic status, our results suggest particular attention should also be given to the risk of adverse outcomes in midlife for non-Hispanic Blacks, adults with a high school degree or less, and low-income Americans.

Adult children are among the most frequent providers for community-dwelling older adults with a disability. This report assesses the extent to which help received from an adult child by older persons with a disability is contingent on the distance between their residences. Using the national Panel Study of Income Dynamics, we selected persons 55 and older with a disability and their adult children (810 older adults; 1,767 dyads of older adult – adult child pairs). The adjusted average hours of help received from an adult child was estimated by the distance between the parent’s and the adult child’s residences using a two-part model with a linear spline of proximity and adjusting for demographic and socioeconomic factors of the parent and child. We found that average weekly hours of help received from an adult child by older adults with a disability declined dramatically as the distance between older adults and their adult children’s residences increased, but only up to 2–5 miles. Adjusted average weekly hours of help received from an adult child were 5.99 (95%CI 3.33, 8.65) if coresident, 3.16 (95%CI 2.04, 4.28) if on the same block, 1.16 (95%CI 0.72, 1.59) if 2–5 miles away, 0.79 (95%CI 0.39, 1.20) if 5–10 miles away, and 0.58 (95%CI 0.25, 0.92) if >100 miles. The amount of help for parents with a disability may require adult children living very near their parents which has important implications for long-term care for the aging population.

Objectives To determine whether the prevalence of cognitive limitation (CL) among Americans ages 55 to 69 years changed between 1998 and 2014, and to assess the trends in socioeconomic disparities in CL among groups defined by race/ethnicity, education, income, and wealth. Method Logistic regression using 1998-2014 data from the biennial Health and Retirement Study, a nationally representative data set. CL is defined as a score of 0-11 on a 27-point cognitive battery of items focused on memory. Socioeconomic status (SES) measures are classified as quartiles. Results In models controlling for age, gender, and previous cognitive testing, we find no significant change over time in the overall prevalence of CL, widening disparities in limitation by income and, in some cases, wealth, and improvements among non-Hispanic whites but not other racial/ethnic groups. Discussion Among people 55-69, rates of CL are many times higher for groups with lower SES than those with higher SES, and recent trends show little indication that the gaps are narrowing.

To receive full Social Security benefits, Americans born after 1937 must claim those benefits at an older age than earlier birth cohorts. Additionally, proposals to improve the fiscal position of Social Security typically include increasing the age at which workers can receive full benefits. Birth cohorts required to work longer are in worse health at ages 49-60, based on multiple measures of morbidity, than cohorts who could retire earlier.

Unstable couple relationships and high rates of repartnering have increased the share of U.S. families with stepkin. Yet data on stepfamily structure are from earlier periods, include only coresident stepkin, or cover only older adults. In this study, we use new data on family structure and transfers in the Panel Study of Income Dynamics (PSID) to describe the prevalence and numbers of stepparents and stepchildren for adults of all ages and to characterize the relationship between having stepkin and transfers of time and money between generations, regardless of whether the kin live together. We find that having stepparents and stepchildren is very common among U.S. households, especially younger households. Furthermore, stepkin substantially increase the typical household’s family size; stepparents and stepchildren increase a household’s number of parents and adult children by nearly 40 % for married/cohabiting couples with living parents and children. However, having stepkin is associated with fewer transfers, particularly time transfers between married women and their stepparents and stepchildren. The increase in the number of family members due to stepkin is insufficient to compensate for the lower likelihood of transfers in stepfamilies. Our findings suggest that recent cohorts with more stepkin may give less time assistance to adult children and receive less time assistance from children in old age than prior generations.

This cross-sectional survey study assesses whether adults with risk factors for COVID-19 complications perceive an elevated chance of complications and undertake fewer higher infection risk behaviors., Key Points Question Do adults with risk factors for COVID-19 complications understand their elevated risk and undertake fewer higher infection risk behaviors? Findings In this survey study of 6084 US adults, those with 7 of 9 medical risk factors for COVID-19 complications reported higher perceived chance of hospitalization or death from COVID-19 if infected compared with those without the factor. While nearly all adults reported recent mask wearing, during several common activities the majority, including susceptible adults, did not consistently wear masks. Meaning Adults with medical risk factors for COVID-19 complications understood their risks were higher, but consistent mask wearing remained low., Importance It is unknown whether adults who are susceptible to severe complications from COVID-19 recognize their susceptibility and modify behavior to reduce exposure. Objective To determine whether adults with risk factors for COVID-19 complications perceive an elevated chance of complications and undertake fewer higher infection risk behaviors. Design, Setting, and Participants This cross-sectional analysis, adjusted for sociodemographic characteristics, included civilian noninstitutionalized US adults of wave 18 of the Understanding America Study collected from November 11 to December 9, 2020. Exposures US Centers for Disease Control and Prevention–identified medical risk factors for COVID-19 complications and older age. Main Outcomes and Measures Primary outcomes were perceived percentage chance of infection and hospitalization and death if infected; whether 9 potentially higher infection risk activities were undertaken in the past week and, if so, whether a mask was worn; whether a mask was worn anywhere in the past week; and attitudes toward 12 aspects of mask wearing. Results In Understanding America Study wave 18 (n = 5910 participants with nonmissing data), the mean age was 48 years, and 52% were women. The response rate was 77%. Adults with 7 of 9 medical risk factors and aged 70 years and older reported a higher perceived chance of complications if infected. Adjusted mean perceived chance of hospitalization if infected ranged from 23.9% (95% CI, 22.2%-25.5%) for those with high blood pressure to 40.4% (95% CI, 34.6%-46.2%) for those with chronic lung disease and was associated with number of medical risk factors: 17.6% (95% CI, 16.4%-18.8%) and 41.8% (95% CI, 38.7%-45.0%) for adults with 0 vs 3 or more medical risk factors, respectively. Fewer potentially higher infection risk activities were undertaken by adults with 3 or more vs 0 risk factors: 2.83 (95% CI, 2.66-2.99) vs 3.12 (95% CI, 3.02-3.22). Wearing a mask sometime last week was nearly universal (90.1%). But during only 1 specific activity (visiting a grocery store or pharmacy) did more than half always wear a mask, and for only 1 activity (visiting a grocery store or pharmacy) was mask wearing more common among adults with 3 or more vs 0 conditions. Conclusions and Relevance In this cross-sectional survey study, adults with risk factors for COVID-19 complications reported higher perceived susceptibility to complications. During common activities, including visiting with friends, the majority of adults, including the highly susceptible, did not consistently wear masks.

Purpose Mental health is critical to young adult health, as the onset of 75% of psychiatric disorders occurs by age 24 and psychiatric disorders early in life predict later behavioral health problems. Wealth may serve as a buffer against economic stressors. Family wealth may be particularly relevant for young adults by providing them with economic resources as they make educational decisions and move towards financial and social independence. Methods We used prospectively collected data from 2060 young adults aged 18–27 in 2005–2011 from the Panel Study of Income Dynamics, a national cohort of US families. We examined associations between nonspecific psychological distress (measured with the K-6 scale) and childhood average household wealth during ages 0–18 years (net worth in 2010 dollars). Results In demographics-adjusted generalized estimating equation models, higher childhood wealth percentile was related to a lower prevalence of serious psychological distress: compared to lowest-quartile wealth, prevalence ratio (PR)=0.52 (0.32–0.85) for 3rd quartile and PR=0.41 (0.24–0.68) for 4th quartile. The associations were attenuated slightly by adjustment for parent education and more so by adjustment for childhood household income percentile. Conclusions Understanding the lifelong processes through which distinct aspects of socioeconomic status affect mental health can help us identify high-risk populations and take steps to minimize future disparities in mental illness., Highlights • Less is known about wealth effects on health compared to other socioeconomic indicators. • Family wealth may help protect young adults’ mental health. • Greater family wealth was associated with better mental health among young adults.

Household wealth and its distribution are topics of broad public debate and increasing scholarly interest. We compare the relative strength of two of the main data sources used in research on the wealth holdings of U.S. households, the Survey of Consumer Finances (SCF) and the Panel Study of Income Dynamics (PSID), by providing a description and explanation of differences in the level and distribution of wealth captured in these two surveys. We identify the factors that account for differences in average net worth but also show that estimates of net worth are similar throughout most of the distribution. Median net worth in the SCF is 6% higher than in the PSID and the largest differences between the two surveys are concentrated in the 1-2 percent wealthiest households, leading to a different view of wealth concentration at the very top but similar results for wealth inequality across most of the distribution.

This study examines whether resources of the extended family influence consumption. Extending prior tests on just food consumption to total consumption, little to no evidence is found in support of the strict definition of altruism among related households. However, resources of the extended family / dynasty do affect one’s own consumption.

Family complexity in the form of step-relationships are increasing across cohorts. Filial obligation, or the social norm that adult children should care for aging parents, are generally weaker in stepfamilies. Further, gender continues to be a main axis of stratification of who provides care within families. Taken together, we test whether biological versus step ties, the gender of the adult child, and the interaction between these two factors are associated with helping aging parents (ages 65 and older) with functional or health limitation based care needs. We use Round 5 (2015) of the National Health and Aging Trends Study. Results illustrate the enduring strength of both biological and gendered ties, with biological daughters being the most likely to help an aging parent, followed by biological sons, step-daughters, and lastly step-sons. This pattern holds even when we control for important characteristics of both the adult child and the care receiver. As families become more complex, these findings could mean that gaps in unmet care needs will emerge, especially for older adults who only have stepchildren.

The paper’s goal is to assess whether and, if so, the extent to which prevalence in disability of adults near retirement ages in the US increased over time compared to their peers in England and examine income group differences in the relative trends. This study uses 2002-2016 Health and Retirement Study (HRS) and English Longitudinal Study of Ageing (ELSA) focusing on adults aged 55-64. Annual percent changes over the period of 2002-2016 for limitations in instrumental activities of daily living (IADL) and activities of daily living (ADL) are estimated for each survey (HRS and ELSA) using multivariable logistic regressions to adjust for individual-level characteristics While disability prevalence of adults ages 55-64 in England improved over the years of 2002-2016 (annual % change= -2.01 for IADL; - 2.53 for ADL), disability prevalence of US adults has not improved and in fact even worsened in terms of IADL (annual % change= +1.35). There are substantial variations in the IADL/ADL trends by income groups. In the US, the adverse trends in disability were more pronounced among the lowest income groups (annual % change in IADL=1.76 for bottom 20% vs. -2.08 for top 20%; annual % change in ADL=1.08 for bottom 20% vs. -2.08 for top 20%). In England, the disability status improved over time for all but the lowest income group. We will examine further to identify specific factors contributing to divergent/convergent trends in disability between the US and England.

The COVID-19 pandemic has magnified U.S. health disparities. Though disparities in COVID-19 hospitalization by race-ethnicity are large, disparities by income and education have not been studied. Using an index based on preexisting health conditions and age, we estimate disparities in vulnerability to hospitalization from COVID-19 by income, education, and race-ethnicity for U.S. adults. The index uses estimates of health condition and age effects on hospitalization for respiratory distress prior to the pandemic validated on COVID-19 hospitalizations. We find vulnerability arising from preexisting conditions is nearly three times higher for bottom versus top income quartile adults and 60 % higher for those with a high-school degree relative to a college degree. Though non-Hispanic Blacks are more vulnerable than non-Hispanic Whites at comparable ages, among all adults the groups are equally vulnerable because non-Hispanic Blacks are younger. Hispanics are the least vulnerable. Results suggest that income and education disparities in hospitalization are likely large and should be examined directly to further understand the unequal impact of the pandemic.

Importance Socioeconomic differences in life expectancy, health, and disability have been found in European countries as well as in the US. Identifying the extent and pattern of health disparities, both within and across the US and England, may be important for informing public health and public policy aimed at reducing these disparities. Objective To compare the health of US adults aged 55 to 64 years with the health of their peers in England across the high and low ranges of income in each country. Design, Setting, and Participants Using data from the Health and Retirement Study (HRS) and the English Longitudinal Study of Ageing (ELSA) for 2008-2016, a pooled cross-sectional analysis of comparably measured health outcomes, with adjustment for demographic characteristics and socioeconomic status, was conducted. The analysis sample included community-dwelling adults aged 55 to 64 years from the HRS and ELSA, resulting in 46 887 person-years of observations. Data analysis was conducted from September 17, 2019, to May 12, 2020. Exposures Residence in the US or England and yearly income. Main Outcomes and Measures Sixteen health outcomes were compared, including 5 self-assessed outcomes, 3 directly measured outcomes, and 8 self-reported physician-diagnosed health conditions. Results This cross-sectional study included 12 879 individuals and 31 928 person-years from HRS (mean [SD] age, 59.2 [2.8] years; 51.9% women) and 5693 individuals and 14 959 person-years from ELSA (mean [SD] age, 59.3 [2.9] years; 51.0% women). After adjusting for individual-level demographic characteristics and socioeconomic status, a substantial health gap between lower-income and higher-income adults was found in both countries, but the health gap between the bottom 20% and the top 20% of the income distribution was significantly greater in the US than England on 13 of 16 measures. The adjusted US-England difference in the prevalence gap between the bottom 20% and the top 20% ranged from 3.6 percentage points (95% CI, 2.0-5.2 percentage points) in stroke to 9.7 percentage points (95% CI, 5.4-13.9 percentage points) for functional limitation. Among individuals in the lowest income group in each country, those in the US group vs the England group had significantly worse outcomes on many health measures (10 of 16 outcomes in the bottom income decile); the significant differences in adjusted prevalence of health problems in the US vs England for the bottom income decile ranged from 7.6% (95% CI, 6.0%-9.3%) vs 3.8% (95% CI, 2.6%-4.9%) for stroke to 75.7% (95% CI, 72.7%-78.8%) vs 59.5% (95% CI, 56.3%-62.7%) for functional limitation. Among individuals in the highest income group, those in the US group vs England group had worse outcomes on fewer health measures (4 of 16 outcomes in the top income decile); the significant differences in adjusted prevalence of health problems in the US vs England for the top income decile ranged from 36.9% (95% CI, 33.4%-40.4%) vs 30.0% (95% CI, 27.2%-32.7%) for hypertension to 35.4% (95% CI, 32.0%-38.7%) vs 22.5% (95% CI, 19.9%-25.1%) for arthritis. Conclusions and Relevance For most health outcomes examined in this cross-sectional study, the health gap between adults with low vs high income appeared to be larger in the US than in England, and the health disadvantages in the US compared with England are apparently more pronounced among individuals with low income. Public policy and public health interventions aimed at improving the health of adults with lower income should be a priority in the US.

Unstable couple relationships and high rates of re-partnering have increased the share of U.S. families with stepkin. Yet data on stepfamily structure are from earlier time periods, include only coresident stepkin, or cover only older adults. This paper uses new data on family structure and transfers in the Panel Study of Income Dynamics (PSID) to describe the prevalence and numbers of stepparents and stepchildren for adults of all ages and to characterize the relationship between having stepkin and transfers of time and money between generations, regardless of whether the kin live together. We find that having stepparents and stepchildren is very common among U.S. households, especially younger households. Furthermore, stepkin substantially increase the typical household’s family size; stepparents and stepchildren increase a household’s number of parents and adult children by nearly 40% for married/cohabiting couples with living parents and children. However, having stepkin is associated with fewer transfers, particularly fewer time transfers between married women and their stepparents and stepchildren. The increase in the number of family members due to stepkin is insufficient to compensate for the lower likelihood of transfers in stepfamilies. Our findings suggest that recent cohorts with more stepkin may give less time assistance to adult children and receive less time assistance from children in old age than prior generations.

Growing evidence suggests that psychological factors, such as conscientiousness and anger, as well as cognitive ability are related to mortality. Less is known about 1) the relative importance of each of these factors in predicting mortality, 2) through what social, economic, and behavioral mechanisms these factors influence mortality, and 3) how these processes unfold over long periods of time in nationally-representative samples. We use 35 years (1972-2007) of data from men (ages 20-40) in the Panel Study of Income Dynamics (PSID), a nationally representative sample in the United States, and discrete time event history analysis (n = 27,373 person-years) to examine the importance of measures of follow-through (a dimension of conscientiousness), anger, and cognitive ability in predicting mortality. We also assess the extent to which income, marriage, and smoking explain the relationship between psychological and cognitive factors with mortality. We find that while follow-through, anger, and cognitive ability are all associated with subsequent mortality when modeled separately, when they are modeled together and baseline demographic characteristics are controlled, only anger remains associated with mortality: being in the top quartile for anger is associated with a 1.57 fold increase in the risk of dying at follow-up compared with those in the bottom quartile. This relationship is robust to the inclusion of income, marriage, and smoking as mediators.

BACKGROUND Cancer presents a substantial hardship for patients and their families in multiple domains beyond health and survival. Relatively little is known about the economic impact of cancer. The authors present estimates of the aggregate effects of a cancer diagnosis on employment and income in a prospective, nationally representative sample of US adults. METHODS The authors used data from the 1990 through 2009 waves of the Panel Study of Income Dynamics, a nationally representative, prospective, population-based observational study with high-quality individual and family-level economic information. Age-adjusted, sex-stratified, individual fixed-effects regression models were used to derive estimates of the impact of cancer on employment, hours worked, individual income, and total family income. RESULTS Significant effects of cancer on all 4 outcomes were observed. The probability of a cancer patient being employed dropped by almost 10 percentage points, and hours worked declined by up to 200 hours in the first year after diagnosis. Annual labor-market earnings dropped almost 40% within 2 years after diagnosis and remained low, whereas total family income declined by 20%, although it recovered within 4 years after the diagnosis. These economic impacts on survivors were driven by effects among men; the effects among women largely were not statistically significant. CONCLUSIONS A cancer diagnosis has substantial effects on the economic well-being of affected adults and their families. With the increasing number of cancer survivors in the US population, there is a growing need for examining the long-term implications for economic well-being and ways to mitigate the economic hardship associated with cancer. Cancer 2015;121:4425–32. © 2015 American Cancer Society.

Recording interviews is a key feature of quality control protocols for most survey organizations. We examine the effects on interview length and data quality of a new protocol adopted by a national panel study. The protocol recorded a randomly chosen one-third of all interviews digitally, although all respondents were asked for permission to record their interview and interviewers were blind as to whether or not interviews were recorded. We find that the recording software slowed the interview slightly. Interviewer knowledge that the interview may be recorded improved data quality, but this knowledge also increased the length of the interview. Interviewers with higher education and performance ratings were less reactive to the new recording protocol. Survey managers may face a trade-off between higher data quality and longer interviews when determining recording protocols.

China has the world's largest oldest-old population, but information on trends in late-life disability is lacking. We use data from the Chinese Longitudinal Healthy Longevity Survey for 1998 to 2008 to determine whether prevalence of limitations with physical functions and daily activities has changed recently among the Chinese population aged 80 to 105 and, if so, to investigate the factors associated with the change. We find that prevalence of need for assistance with activities of daily living and inability to independently conduct instrumental activities of daily living declined substantially. Males did not experience improvement in ability to carry out underlying physical functions over the same period, but females did. Variables associated with trends in one or more of these outcomes were adequacy of medical care as a child, childhood hunger, father's occupation in agriculture, main occupation before age 60 in agriculture, adequacy of current medical care, and body weight.

To assess changes in family residential proximity after a first cardiovascular (CV) event among older adults and to identify families most likely to experience such moves.Using a nationally representative longitudinal study of older adults in the United States, we identified respondents with no prior diagnosis of CV disease (CVD). We examined subsequent development of stroke, heart attack, and/or heart failure among these older adults and examined changes in their residential proximity to their closest child before and after the CV event. We then compared the likelihood of changes in proximity between families with and without CV events. Finally, we determined which types of families are most likely to relocate following a CV event.Having a first CV event increases the 2-year predicted probability of children and adult parents moving in with and closer to each other (relative risk ratio = 1.61 and 1.55, respectively). Families are especially likely to move after a first CV event if the older person experiencing the event is spouseless or has a daughter.CVD is a leading cause of disability, which in turn creates a significant need for personal care among older adults. Assessment of changes in family residential proximity responding to CV events is important to fully understand the consequences of older adults' CV events including the cost of caregiving.

Historically, empirical research on consumption primarily relied on aggregate data, such as the National Income and Product Accounts (NIPA) tables. Beginning in the 1980s, studies of consumption expenditures using household survey data became more common. The majority of this research used the Consumer Expenditure Survey (CE), which for nearly two decades had been essentially the only national survey that provided extensive data on household consumption expenditures. Though rich in detailed expenditure data, the CE has more limited information on income, assets, and other socioeconomic factors. In addition, the CE is a short panel that follows each household for at most four quarters, limiting the extent to which these data can be used to study dynamic behaviors of households. By contrast, the Panel Study of Income Dynamics (PSID) is a longitudinal survey that collects extensive information on socioeconomic characteristics, labor market experiences, income, wealth, health status, and family structure. However, historically only housing and food-related expenditure data were collected in the PSID. In light of the growing interest in household consumption behaviors, the PSID expanded its questions on consumption expenditures significantly in 1999, and even further in 2005. As a result, the PSID now covers essentially all major expenditure categories that are included in the CE. In this article, we describe the features of the PSID survey that make it a unique resource for studying household consumption. We then present statistical results that show that the PSID expenditure data compare favorably to their CE counterparts. We take the CE data as our reference point and a comparison benchmark because despite the fact that it has been demonstrated that estimates of aggregate consumption derived using the CE data fall short of estimates based on the NIPA data, the CE remains the most comprehensive household expenditure survey. Moreover, Bee, Meyer, and Sullivan (2012) documented that most of the major expenditure categories in the CE are fairly consistent with the NIPA estimate.

Academic researchers and policymakers have a long-standing interest in the extent to which economic well-being is transmitted across generations. Most of the research on this issue has focused on the intergenerational correlation in income (see Solon 1999 for a review) and wealth (Charles and Hurst 2003), where as relatively little attention has been paid to the intergenerational correlation in consumption expenditures (Mulligan 1997; Aughinbaugh 2000; and Waldkirch, Ng, and Cox 2004). Yet, consumption is arguably more directly related to consumers’ utility than other indicators of material well-being, and there are reasons to suppose that the intergenerational correlation in consumption may reveal new insights about the extent and explanation for the transmission of material well-being across generations.

To examine the potential role of child and spousal availability in facilitating community-based care for disabled older adults.We used the Health and Retirement Study, a nationally representative longitudinal study of older adults. The analysis sample included older adults who were nondisabled at baseline, but who then developed at least one activity of daily living (ADL) limitation over the subsequent 2-year period (N = 2,094). Using multivariate, multinomial logistic regression, we examined the association of child and spouse availability prior to disablement of the older adults with ADL care receipt status after the onset of disablement, after adjusting for other sociodemographic and clinical characteristics.Lower socioeconomic status (SES) was associated with less availability of a spouse but greater availability of children at baseline. Compared with older adults who had no children nearby (i.e., all children lived further than 30 miles), older adults who had at least one child living with or near them prior to the onset of the ADL limitation were less likely to go to a nursing home (adjusted odds ratio [AOR]: 0.26 for coresident; AOR: 0.44 for 1- 30 miles) and less likely to depend on formal care (AOR: 0.39 for coresident; AOR: 0.51 for 1-30 miles) after the onset of new ADL limitation/s.Understanding SES variations in the informal care resources, and potential role of child geographic availability, may inform the development of cost-effective community-based care programs and policies.

The collapse of the labor, housing, and stock markets beginning in 2007 created unprecedented challenges for American families. This study examines disparities in wealth holdings leading up to the Great Recession and during the first years of the recovery. All socioeconomic groups experienced declines in wealth following the recession, with higher wealth families experiencing larger absolute declines. In percentage terms, however, the declines were greater for less advantaged groups as measured by minority status, education, and prerecession income and wealth, leading to a substantial rise in wealth inequality in just a few years. Despite large changes in wealth, longitudinal analyses demonstrate little change in mobility in the ranking of particular families in the wealth distribution. Between 2007 and 2011, one-fourth of American families lost at least 75 percent of their wealth, and more than half of all families lost at least 25 percent of their wealth. Multivariate longitudinal analyses document that these large relative losses were disproportionally concentrated among lower-income, less educated, and minority households.

Objectives This study examines changes in functional and activity limitations 1998–2012 for individuals 55–69. Methods Logistic models are used to estimate trends in limitations in vision, hearing, physical and cognitive functioning, IADLs, and ADLs. Additional models assess the extent to which trends are associated with and differ by education, smoking, and BMI. Results Changes in prevalence of limitations in vision, hearing, cognitive functioning, and ADLs are not statistically significant. Limitations in physical functioning declined by 0.37% per year. IADL limitations increased by 1.33% per year, but most of the increase occurred between 2008 and 2010/2012, and are associated with economic hardship during the Great Recession. Increases in education are especially beneficially associated with trends in limitations, but reductions in smoking also appear to be advantageous for some outcomes. Increases in BMI are associated with trends in physical functioning, IADL, and ADL limitation. Discussion For Americans 55–69, functional and activity limitations were largely unchanged 1998–2012. Our results suggest that if educational attainment had not increased, most functional and activity limitations potentially could have worsened substantially. Future change in educational attainment is not expected to be so positive. Continued monitoring of trends in activity limitations might well include greater focus on the explanatory roles of environmental factors, including economic circumstances.

It has been well documented that response rates to cross-sectional surveys have declined over the past few decades. It is less clear whether response rates to longitudinal surveys have experienced similar changes over time. This article examines trends in response rates in several major, national longitudinal surveys in the United States and abroad. The authors find that for most of these surveys, the wave-to-wave response rate has not declined. This article also describes the various approaches that these surveys use to minimize attrition.

This article updates trends from five national U.S. surveys to determine whether the prevalence of activity limitations among the older population continued to decline in the first decade of the twenty-first century. Findings across studies suggest that personal care and domestic activity limitations may have continued to decline for those ages 85 and older from 2000 to 2008, but generally were flat since 2000 for those ages 65–84. Modest increases were observed for the 55- to 64-year-old group approaching late life, although prevalence remained low for this age group. Inclusion of the institutional population is important for assessing trends among those ages 85 and older in particular.

Little consensus exists regarding the relationship between socioeconomic status (SES) and substance use. This study examined the associations of three indicators of family SES during childhood--income, wealth, and parental education--with smoking, alcohol use, and marijuana use during young adulthood.Data were obtained from the national Panel Study of Income Dynamics, a survey of U.S. families that incorporates data from parents and their children. In 2005 and 2007, the Panel Study of Income Dynamics was supplemented with two waves of Transition into Adulthood data drawn from a national sample of young adults, 18-23 years old. Data from the young adults (N = 1,203; 66.1% White; 51.5% female) on their current use of alcohol, cigarettes, and marijuana were used as outcome variables in logistic regressions. Socioeconomic background was calculated from parental reports of education, wealth, and income during the respondent's childhood (birth through age 17 years).Smoking in young adulthood was associated with lower childhood family SES, although the association was explained by demographic and social role covariates. Alcohol use and marijuana use in young adulthood were associated with higher childhood family SES, even after controlling for covariates.Findings based on three indicators of family background SES--income, wealth, and parental education--converged in describing unique patterns for smoking and for alcohol and marijuana use among young adults, although functional relationships across SES measures varied. Young adults with the highest family background SES were most prone to alcohol and marijuana use.

The relationship between neighborhoods of residence in young adulthood and health in mid to late life in the United States are examined using the 1968-2005 waves of the Panel Study of Income Dynamics (PSID). The sample consists of persons who were aged 20-30 in 1968 and are followed for a period of 38 years (N=2,730). Four-level hierarchical random effects models of self-assessed general health status as a function of individual, family, and neighborhood factors are estimated. Using the original sampling design of the PSID, we analyze adult health trajectories of married couples and neighbors followed from young adulthood through elderly ages to assess the magnitudes of the possible causal effects of family and neighborhood characteristics in young adulthood on health in mid to late life. Estimates suggest disparities in neighborhood conditions in young adulthood account for one-quarter of the variation in mid-to-late-life health. Living in poor neighborhoods during young adulthood is strongly associated with negative health outcomes in later life. This result is robust even in the presence of a reasonably large amount of potential unobservable individual and family factors that may significantly affect both neighborhood of residence and subsequent health status. Racial differences in health status in mid to late life are also associated with family and neighborhood socioeconomic conditions earlier in life. Three quarters of the black-white gap in health status at ages over 55 can be accounted for by differences in childhood socioeconomic status and neighborhood and family factors in young adulthood.

BackgroundRecently, late-life disability rates have declined in several countries of the Organisation for Economic Co-operation, but no national-level trend analysis for England has been available. The authors provide such analysis, including measures both early and late in the disablement process, and the authors investigate the extent to which temporal trends are associated with population changes in socioeconomic position (SEP).MethodsThe authors fit logistic models of trends in self-reports and nurse measures of 16 health indicators, based on cross-sectional data from those aged 65 years and older from the 1992 to 2007 Health Survey for England.ResultsOverall, prevalence rates of limitations in seeing, hearing and usual activities declined (pConclusionsRecent trends in late-life health and functioning in England have been mixed. A better understanding of which specific activities pose challenges, how the environment in which activities are conducted influences functioning and the causes of relatively worse trends for some SEP groups is needed.

Objectives. We examined the relation between low birth weight and childhood family and neighborhood socioeconomic disadvantage and disease onset in adulthood. Methods. Using US nationally representative longitudinal data, we estimated hazard models of the onset of asthma, hypertension, diabetes, and stroke, heart attack, or heart disease. The sample contained 4387 children who were members of the Panel Study of Income Dynamics in 1968; they were followed up to 2007, when they were aged 39 to 56 years. Our research design included sibling comparisons of disease onset among siblings with different birth weights. Results. The odds ratios of having asthma, hypertension, diabetes, and stroke, heart attack, or heart disease by age 50 years for low–birth weight babies vs others were 1.64 (P < .01), 1.51 (P < .01), 2.09 (P < .01), and 2.16 (P < .01), respectively. Adult disease prevalence differed substantially by childhood socioeconomic status (SES). After accounting for childhood socioeconomic factors, we found a substantial hazard ratio of disease onset associated with low birth weight, which persisted for sibling comparisons. Conclusions. Childhood SES is strongly associated with the onset of chronic disease in adulthood. Low birth weight plays an important role in disease onset; this relation persists after an array of childhood socioeconomic factors is accounted for.

An Incentive Experiment Designed to Increase Response to a Between-Wave Contact Update Mailing in Two Panel Studies

This report describes the method used to estimate the foregone monetary benefits associated with health disparities that were reported in Overcoming Obstacles to Health: Report from the Robert Wood Johnson Foundation to the Commission to Build a Healthier America. We estimate the annual dollar value of the benefits that would accrue to disadvantaged American adults if they experienced the lower mortality rates and better health of more advantaged Americans. The measure of advantaged/disadvantage is based on education, which is strongly related to economic status, closely associated with health and mortality, and has been widely studied. Our estimates suggest a quite large potential benefit of improving the health of disadvantaged Americans: raising the health of all Americans to that of college educated Americans would result in annual gains of just over 1 trillion dollars worth of increased health as of 2006. These estimates are not designed to be a full accounting of the social costs and benefits of particular policies and programs that could reduce health disparities. Rather, they provide a metric for comparing the order of magnitude of health disparities in relation to other social issues vying for attention. Our results suggest large potential aggregate payoffs to identifying cost-effective ways of improving the health of low SES groups. * Authors acknowledge financial support from the Robert Wood Johnson Foundation. Contact information

Background Literature on the socio-economic ‘gradient’ in health often asserts that income is associated with better health not only for the very poor, but also across the entire income distribution. In addition, changes in the shape of the association between incomes during a period of increasing economic inequality have not been previously studied. The goal of the current study was to estimate and compare the shape of the relationship between income and mortality in the USA for the 1970s, the 1980s and the 1990s. Methods Using income and mortality data from the Panel Study of Income Dynamics for respondents aged 35–64 years, we used a Bayesian Cox Model with regression splines to model the risk of mortality over three 10-year follow-up periods. To identify whether income was more strongly associated with mortality at different parts of the income distribution, we treated income as a linear spline with an unknown knot location. Results The shape of the association between income and mortality was quite non-linear, with a much stronger association at lower levels of income. The relationship between income and mortality in the USA was also not invariant across time, with the increased risk of death associated with lower income applying to an increasing proportion of the US population over time (9th percentile of income in 1970–79, 20th percentile in 1980–89 and 32nd percentile in 1990–99). Conclusions Our analyses do not support the claim that income is associated with mortality throughout the income distribution, nor is the association between income and mortality the same across periods. Based on our analyses, a focus on the bottom 30% of the income distribution would seem to return the greatest benefits in reducing socio-economic inequalities in health.

Examination of intergenerational asthma beyond maternal asthma has been limited. The association between childhood asthma and intergenerational asthma status among a national cohort of children was examined. The genealogical sample (2552 children) participating in the Child Development Supplement of the Panel Study of Income Dynamics was studied. Multivariate regression was used to determine intergenerational asthma. Children with a parent with asthma were almost twice as likely (odds ratio [OR] = 1.96) to have asthma compared with those without a parent with asthma. Children with a parent and grandparent with asthma were more than 4 times more likely to have asthma compared with those without a parent and grandparent with asthma (OR = 4.27). Children with a grandparent with asthma were more likely to have asthma (OR = 1.52). A family history of asthma was a significant predictor of physician diagnosed asthma in children regardless of race/ethnicity and socioeconomic status. Findings support the collection of family history, including grandparent asthma status.

The decline in late-life disability prevalence in the United States was one of the most important developments in the well-being of older Americans in the 1980s and 1990s, but there is no guarantee that it will continue into the future. We review the past literature on trends in disability and other health indicators and then estimate the most recent trends in biomarkers and limitations for both the population aged 65 and older and those aged 40 to 64, the future elderly. We then investigate the extent to which trends in education, smoking, and obesity can account for recent trends in limitations and discuss how these three factors might influence future prospects for late-life health. We find that improvements in the health of the older population generally have continued into the first decade of the twenty-first century. The recent increase in the proportion of the younger population needing help with activities of daily living is concerning, as is the doubling of obesity in the last few decades. However, the increase in obesity has recently paused, and favorable trends in education and smoking are encouraging.

This chapter discusses the current evidence base for policies that could address socioeconomic status (SES) health gradientsintheUnitedStates.Thepresentvolumehasdocumentedanenormousamountofresearchonthelinkages betweenSESandhealth,buttherearestillrelativelyfewstudiesthatrigorouslyestablishtheeffectivenessofparticular policies or interventions in reducing those gradients. Given the difficulty in developing randomized evidence for many types of interventions related to social determinants of health, we argue for conducting policy analysis from a Bayesianperspective.ThisBayesianapproachcombinesinformationonbestavailabletheoryandevidenceregarding probable health benefits and costs of an intervention, providing a framework that also incorporates the probable costs of inaction. The second half of the chapter adopts a ladder metaphor to classify policies and interventions that could reduce SES gradients in population health. Using this framework, we consider the evidence base for various types of policies, focusing primarily on the social determinants of health, under the rubric that “all policy is health policy.” We conclude by discussing promising strategies for future strengthening of the evidence base for policy, including the role of health impact assessment.

Keeping track of sample persons between waves of data collection helps minimize attrition in longitudinal studies. All things being equal, the longer the time between data collection waves, the greater the likelihood that sample persons have moved, and the greater the difficulty in locating movers (Couper and Ofstedal 2007; Duncan and Kalton 1987). In 1997, the Panel Study of Income Dynamics (PSID) changed from annual to biennial interviewing. To capture residential changes between waves, PSID began sending families a “contact information update” mailing in the year between data collection waves. Families who update or verify the address and telephone information and return it receive a $10 post-paid check. About half the families responded to this mailing in recent waves. During 2007, families providing this information needed far less tracking or refusal conversion efforts, and half as many contacts to be interviewed, underscoring the cost effectiveness of the mailing. Given these advantages, we designed a study before 2009 production interviewing to improve the response rate of the contact update mailing. Families were randomly assigned to the following conditions: $10 as a pre-versus post-paid incentive, mailing design (traditional versus updated), being sent a study newsletter, and timing and frequency of the mailing (July versus October versus both times). This paper reports on initial findings with regard to response rates to the mailing by these different conditions. Overall, there is no effect of incentive type implying that post-paid incentives are more cost effective. Traditional design performs better than updated design. Families receiving a second mailing have higher response rates than those receiving one mailing. There are some interaction effects with timing-of-mailing, with October-only families having higher response rates when also receiving a prepaid incentive and newsletter. Hypotheses for these findings and next steps for analysis are described.