Family Matters: Research on Family Ties and Health, 2010-2020

Chronic Illness and Disability: A Multisystemic Practice Model

Serious health conditions can severely strain family relationships. This article describes the Family Systems Illness (FSI) model to provide a guiding framework to help individuals, couples, and families navigate the changing landscape in the experience of illness and disability over time. This resilience-oriented practice approach distinguishes three dimensions of the illness experience and trajectory over time: (a) "psychosocial types" of health conditions, based on the pattern of onset, course, outcome, disability, and level of uncertainty; (b) major developmental phases in their evolution over time (initial crisis, chronic, terminal), facilitating longitudinal thinking about chronic conditions as an ongoing process with transitions and changing demands; (c) key family system variables, emphasizing: the interweaving of illness, individual, and family development; multigenerational themes and legacies related to illness and loss that influence coping and adaptation; family health belief systems (e.g., meaning-making, including influences of culture, ethnicity, spirituality, gender, and race), and the goodness of fit in the patient/family/health care provider relationship. The FSI model is intended for a broad spectrum of health conditions in children and adults, diverse health care professional disciplines, and clinical settings. Discussion includes timely, cost-effective applications in different clinical settings, including the use of prevention-oriented family consultations, psychosocial checkups, and brief and intensive interventions.

Intergenerational relationships after parental divorce: variations by levels of family solidarity

This study examines the association between gray parental divorce and family solidarity, defined as the quality and frequency of intergenerational relationships, including contact, emotional closeness, and functional support. The analysis focuses on how the effects of gray divorce vary across families with differing levels of closeness and interaction prior to the divorce, given that families with weaker bonds-such as infrequent contact or less emotional closeness-may face greater challenges in maintaining relationships after divorce compared to those with stronger ties. To test this, I use 13 waves of longitudinal data from pairfam and recentered influence function (RIF) regression that allows to examine how the effects of parental divorce differ across the entire distribution of solidarity, distinguishing between families with weak, moderate, and strong ties. Families with lower solidarity, particularly in terms of contact frequency and emotional closeness, are more likely to experience gray parental divorce. The negative effects of parental divorce on parent-adult child relationships are also more pronounced in these families and among fathers. Conversely, families with moderate or high levels of solidarity are more resilient to the negative impacts of divorce. Accordingly, the gap in intergenerational solidarity widens across families, with low-solidarity families being more likely to experience parental divorce later in life and exhibiting more negative outcomes compared to families with stronger ties. This growing differences across families also highlight the relevancy of targeted policy interventions aimed at supporting families, particularly those with weaker ties, and addressing the unique challenges faced by fathers after divorce.

Family Availability, 'Kinlessness', COVID Stringency, and Loneliness in 26 Countries

Loneliness became an increasing concern during the COVID-19 pandemic, especially as countries enacted "physical distancing" mitigation measures. Under these conditions, older adults with limited family availability (e.g., unpartnered, childless, and "kinless") might have been at higher loneliness risk, or perhaps were more accustomed to less social interaction. Using individual-level data from the Survey of Health, Ageing and Retirement in Europe (SHARE) and country-level data from the Oxford Coronavirus Government Response Tracker (OxCGRT), we analyzed loneliness outcomes for 34,943 older Europeans in 26 countries to examine associations between various types of family availability and loneliness under different COVID-19 stringency conditions. More stringent COVID-19 country contexts and being unpartnered were associated with loneliness, but "kinless" older adults had similar risk of loneliness as unpartnered older adults, underscoring the highly protective role of partnership. We discuss these findings considering the growing global population with limited family ties and make recommendations for future pandemic mitigation efforts.

Does having someone to confide in affect mortality in older adults? a prospective cohort study from 2008 to 2018

OBJECTIVES

Our study investigated the association between confidant networks and mortality among older Chinese adults, focusing on the impact of the absence, types, and size of the networks.

METHODS

A prospective cohort study included 11,930 participants aged over 65 from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) from 2008 to 2018. Cox proportional hazards models were employed for analysis, supplemented by subgroup and interaction analyses.

RESULTS

Participants without confidant networks had higher mortality (HR=1.194, 95% CI 1.097-1.300) after adjusting for confounders. A dose-response relationship was observed between the size of confidant networks and mortality. Notably, having a spouse as a confidant was strongly associated with decreased mortality (HR=0.765, 95% CI 0.677-0.865), whereas having formal helpers as confidants did not significantly affect mortality (HR=0.813, 95% CI 0.636-1.040).

CONCLUSION

Identifying and supporting older adults without confidant networks is crucial for enabling them to benefit from these networks and potentially enhance their longevity.

Mental health of young adults pursuing higher education in Tier-1 cities of India: A cross-sectional study

India, with its vast youth population, grapples with significant mental health issues among young adults in higher education, due to factors such as academic pressure, social isolation, stigma, economic uncertainty, screen time, sedentary lifestyles, and pandemic-related stresses. Though the issue has garnered attention, there's a gap in post-pandemic mental health research for Indian students. This study aims to address this by investigating anxiety, depression, and overall mental well-being among students aged 18-29 in higher educational institutions across eight major Indian cities, categorized by gender, zone, city, and institution type. Using a cross-sectional design and multi-stage sampling, we surveyed 1628 students (47.1 % males, 52.9 % females) using the Mental Health Inventory (MHI-38). Female students reported higher distress levels than males. Students from the Western and Southern zones showed higher positivity and well-being. Kolkata students reported low positivity but superior well-being. Hyderabad students reported low depression levels. Central University students reported more depression, while government arts and science college students reported lower life satisfaction. The majority exhibited moderate to high levels of anxiety (69.9 %), depression (59.9 %), loss of behavioral/emotional control (65.1 %), and distress (70.3 %). These statistics underscore the burden of mental health issues faced by this demographic. Despite the prevalence, a minimal number of young adults accessed mental health services, often due to stigma and cultural biases. This study highlights how the post-pandemic context has exacerbated these barriers, revealing significant mental health issues among participants and underscoring the urgent need for targeted interventions in educational institutions amidst rising suicide rates in this demographic.

Risk and Protective Factors of Conflicts Between Hospitalized Older Adults and Their Family Members: Structural Equation Modeling (SEM)

Family relationships are important for the well-being of older adults, yet these relationships may involve ambivalence and/or conflict, particularly in high-stress scenarios such as hospitalization. This study aimed to identify factors predicting conflict between hospitalized older adults and family members, considering individual, social, and cultural factors. The sample comprised 573 cognitively intact older adults (65+) admitted to internal units in Israeli hospitals. Structural equation modeling (SEM) revealed that emotional support a decrease in conflict (β = -0.105, p = 0.007), while instrumental care (β = 0.146, p = 0.003), number of visitors (β = 0.125, p = 0.011), and the spouse being a primary caregiver (β = 0.159, p < 0.001) was associated with an increase in conflict. On the cultural level, being a Former Soviet Union (FSU) immigrant was a risk factor (β = 0.106, p = 0.016), while being an Israeli Arab had an indirect effect mediated by involvement in instrumental care and larger visitor numbers, which increased the risk for conflict (β = 0.087, p = 0.045). On the individual level, depressive symptoms increased conflict via emotional support (β = 0.01, p = 0.031), and independence in activities of daily living reduced conflict via lower instrumental care (β = -0.002, p = 0.003). These findings highlight the complex interplay of risk and protective factors in predicting conflict and highlight the role of social and cultural factors. Targeted interventions for spouses, caregivers providing instrumental support, and FSU immigrants may help reduce conflict during hospitalization.

A Pilot Trial Evaluating Collaborative Healthcare Encounters With Caregivers: A Checklist-Based Intervention for Primary Care

This pilot trial aimed to evaluate the feasibility, acceptability, and preliminary efficacy of Collaborative Healthcare Encounters with Caregivers (CHEC), a checklist-based intervention designed to enhance caregiver participation in older adults' primary care visits. N = 52 older patient-caregiver dyads were randomized to CHEC (n = 28) or usual care (n = 24). Visits were audio-recorded and analyzed according to a standardized coding procedure. Post-visit questionnaires assessed caregivers' perceptions of the checklist, efficacy in primary care interactions and knowledge of relevant resources. CHEC caregivers perceived the checklist to be useful and easy to complete. Visit duration was comparable in CHEC and usual care visits (M = 31.4 minutes vs. M = 31.8 minutes; p = .55), but CHEC visits allocated a greater proportion of time to discussing caregivers' concerns about the patient (32.9% vs. 18.9%; p = .04). CHEC caregivers reported slightly higher post-visit self-efficacy and significantly greater knowledge of relevant resources. Findings suggest CHEC's potential as a clinically feasible intervention for primary care. Clinical Trials Identifier: NCT04946942.

Dyadic Associations Between Self-Perceptions of Aging and Health Behaviors Among Middle-Aged and Older Couples

BACKGROUND AND OBJECTIVES

Research and theory suggest that older adults' self-perceptions of aging (SPA) are associated with their health behavior engagement. Likewise, romantic partners often play a key role in shaping each other's health behaviors. This study aims to explore the longitudinal dyadic associations between SPA and health behaviors among couples in midlife and older adulthood.

RESEARCH DESIGN AND METHODS

Data were drawn from 3,330 couples ages 50-96 (Mmen = 67.22 [9.43]; Mwomen = 65.42 [8.96]) from the Health and Retirement Study, using pooled samples from 2010/2012 to 2012/2014. We estimated actor-partner interdependence models with moderation to assess whether and to what extent a partner's SPA moderated the links between positive and negative SPA and engagement in preventive and risky health behaviors two years later.

RESULTS

Women's SPA moderated the association between men's SPA and men's risky health behaviors only when women reported extreme levels of negative or positive SPA. In contrast, men's SPA did not moderate the associations between women's SPA and women's health behaviors.

DISCUSSION AND IMPLICATIONS

This study's findings emphasize that links between SPA and health behaviors operate within the broader social environment and in the context of romantic relationships. The results highlight how couples' perceptions of aging relate to their own and their partners' health behaviors. This work contributes to the literature on the gendered and social nature of health behaviors and has implications for designing interventions targeting SPA.

Developing a nationwide registry of UK veterans seeking help from sector charities-a machine learning approach to stratification

The assistance to veterans in the UK is provided by the National Health Service and over 1800 military charities. These charities count services using different definitions and reporting systems, so to date a national registry of service usage does not exist. The aim of the Map Of Need Aggregation ResearCH study is to build a standardized registry of service usage data for the military charity sector. Data are completely anonymized by adopting a Secure Hashing Algorithm. A unique anonymous identifier is generated allowing both privacy protection and avoiding double counts. Data are standardized and linked with an automated process to create an aggregated dataset. The dataset describes the population, using both a priori and machine learning approaches. To date a total of 42 509 veterans with 128 423 needs are included. The mean age was 60.1 years, and 90% were male. 65% were receiving other benefits, 5% were homeless and 1% were in prison. 65% of the needs recorded concerned social wellbeing. 40% of veterans received assistance in at least two different years. The k-means clustering approach returned 4 subgroups of use that were identical to those created using a priori knowledge. The dataset is the most comprehensive source of veteran charity usage data in the UK to date. Service usage is generally homogenous among subgroups, but some differences were highlighted indicating that younger, non-officer veterans may be more at risk of presenting with more complex needs. These first useful insights can help allocate resources to build an effective preventive strategy for more complex cases.

Dyadic Appraisals of Family Decisions and Health Tasks in Midlife-Older Couples

Shared appraisals and collaboration within couples play important roles in optimizing health. Less is known about concordance regarding collaboration, factors associated with concordance, and implications for health. Data from 2,761 couples from the Health and Retirement Study (2014/2016 and 2016/2018 waves) were examined to determine within-couple concordance in completion of two tasks (family decisions and medical forms). The majority of couples were concordant regarding who makes family decisions (69.7%) and who completes medical forms (64.4%); 62% agreed they make family decisions collaboratively versus 25.5% completing medical forms collaboratively. Concordance was significantly associated with greater marital support and longer marital duration. Concordance was not significantly associated with depressive symptoms 2 years later, but the link between concordance in making major family decisions and self-rated health differed by age and gender. Future research at the intersection of concordance and collaboration may shed important light on how older couples navigate tasks and decisions.

Investigation of sexual life and perceived spousal support in female recipients after kidney transplantation

Introduction

End-stage renal failure has negative effects on sexual life, and solid kidney transplantation helps to recovery in sexuality. However, recovery in sexual life progresses slowly, and female recipients may need spousal support during this process. To examine the perceived spousal support and sexual lives of female kidney recipients in the aim of this study.

Methods

The study was conducted as a descriptive and cross-sectional research. 158 female kidney recipients were included in the study. In data collection, Personal Information Form, Spousal Support Scale, and Arizona Sexual Experience Scale were used. The study data were analyzed through descriptive statistics, Mann-Whitney U test, Kruskal-Wallis test, Dunn-Bonferroni post-hoc test, and Spearman correlation analysis.

Results

In this study 47.5 % of the female recipients were within the age range of 28-40 years. 43.7 % had university education and above. 60.1 % had their income equal to their expenses. 38 % of the female kidney recipients suffered from diabetes mellitus and endocrine problems. In this study, sexual dysfunction of female kidney recipients was found to be slightly above average. The spouse support perceived by the female recipients was well above average. As a result of this study was determined that as the economic status of the female recipients improved, perceived spousal support increased (p < 0.05). It was also determined that the female kidney recipients who were 40 years old and above, had poor economic status, used Tacrolimus and Cyclosporine, and had a comorbid chronic disease were under more risk in terms of poor sexual life, and their perceived spousal support was above moderate level.

Conclusion

The sexual life of female kidney recipients is affected by their clinical situation (concomitant diseases, advanced age, medication use). On the other hand, strong spouse support can make significant contributions to improving sexual life. A correlation was found in the study between sexual life and perceived spousal support in the female kidney recipients. The findings of the study point to the importance of spousal support in terms of improving sexual lives in female kidney recipients. Studies should be conducted on these two important concepts in planning care interventions and training programs.

Social Connections, Leukocyte Telomere Length, and All-Cause Mortality in Older Adults From Costa Rica: The Costa Rican Longevity and Healthy Aging Study (CRELES)

OBJECTIVES

To examine the association of social connections with blood leukocyte telomere length (LTL) and all-cause mortality in older Costa Ricans.

METHODS

Utilizing data from the Costa Rican Longevity and Healthy Aging Study (CRELES), a prospective cohort of 2827 individuals aged 60 and above followed since 2004, we constructed a Social Network Index (SNI) based on marital status, household size, interaction with non-cohabitating adult children, and church attendance. We used linear regression to assess SNI's association with baseline LTL (N = 1113), and Cox proportional-hazard models to examine SNI's relationship with all-cause mortality (N = 2735).

RESULTS

Higher SNI levels were associated with longer telomeres and decreased all-cause mortality during follow-up. Being married and regular church attendance were associated with 23% and 24% reductions of the all-cause mortality, respectively.

DISCUSSION

These findings underscore the importance of social engagement in promoting longevity among older Costa Ricans, suggesting broader implications for aging populations globally.

An update of the Couple Adaptation to Traumatic Stress Model: Systematic research synthesis of the association between secondary trauma survivor functioning and couple functioning

Systemic theories addressing posttraumatic stress disorder (PTSD) in couples postulate associations between primary trauma survivor functioning, secondary trauma survivor functioning, and couple functioning. However, there is a lack of examination of the association between secondary trauma survivor functioning and couple functioning, which has clinical implications. Objectives of this study include informing clinicians of the evidence base for these associations and providing a synthesized review of research on PTSD in couples to inform future research. A systematic research synthesis screening 150 articles from three databases resulted in the inclusion of 15 quantitative articles to examine the quality of the available research addressing the association between secondary trauma survivor functioning and couple functioning. Correlation matrices in all studies and other partial evidence supported the current theory positing the relevance of secondary traumatic stress in interpersonal functioning for couples. Discussion includes the need for increased quality and diversity of systemic trauma research and treatment for couples.

All in the family? Understanding differences in the kin-centricity of older US adults' core discussion networks from classic age, period, and cohort table estimates

Panel data have generated several insights about changes in kin relationships, yet few studies examine these shifts across multiple dimensions of time simultaneously. In this paper, we use data from the National Social Life, Health, and Aging Project (N=5,269) in classic lexis tables to examine age, period, and cohort differences in the kin-centricity of older adults' core discussion networks. We estimate population averages in discussion network size, range, kin composition, and kin co-residency across ages and periods. Results indicate that older adults' core discussion networks have become larger, more diverse, and less kin-centric over time. Comparisons of fit statistics across nested models indicate that period and age effects explain most of these changes. Our findings add nuance to concerns about a growing crisis of social isolation, suggesting that declines in core discussion network kin-centricity may be accompanied by the maintenance or addition of more alternative, non-kin close ties in later life.

Unmasking the complexities of healthcare access in low-resource settings: a health systems approach to obstetric and under-5 healthcare in rural settings of Eastern Uganda

BACKGROUND

Access to appropriate obstetric and under-5 healthcare services in low-resource settings is a challenge in countries with high mortality rates. However, the interplay of multiple factors within an ecological system affects the effectiveness of the health system in reaching those in need.

OBJECTIVE

This study examined how multiple factors concurrently affect access to obstetric and child healthcare services in resource-poor settings.

METHODS

The research used social autopsies [in-depth interview] with mothers who experienced newborn death [n = 29], focus group discussions [n = 8] with mothers [n = 32], and fathers [n = 28] of children aged 6-59 months, and the author's field observations in Eastern Uganda's rural settings. The research employed narrative and inductive thematic analysis, guided by concepts of social interactions, behaviour, and health institutional systems drawn from system theory.

RESULTS

The study unmasked multiple concurrent barriers to healthcare access at distinct levels. Within families, the influence of mothers-in-law and gender dynamics constrains women's healthcare-seeking autonomy and agency. At the community level, poor transport system, characterised by long distances and challenging road conditions, consistently impede healthcare access. At the facility level, attitudes, responsiveness, and service delivery of health workers critically affect healthcare access. Negative experiences at health facilities profoundly discourage the community from seeking future health services.

CONCLUSION

The findings emphasise the persistent influence of structural and social factors that, although well documented, are often overlooked and continue to limit women's agency and autonomy in healthcare access. Enhancing universal access to appropriate healthcare services requires comprehensive health systems interventions that concurrently address the healthcare access barriers.

The temporal alignment of mental health consultations across family members: a study of Norwegian adolescents, their parents, and siblings

PURPOSE

Mental health problems among adolescents have become more prevalent in recent years. Parents' and siblings' mental health might be affected by living with a depressed adolescent. This study examines how the mental health of family members develops in the years before and after an adolescent seeks help for depression.

METHODS

Unique Norwegian register data that cover the full population are used to estimate models with individual fixed effects. The development in the probability of mental health consultations for parents and older siblings in families with a second-born adolescent seeking help for depression from a GP for the first time is compared to the respective development in families where the second-born adolescent has not had such health care consultation.

RESULTS

Results indicate that adolescents' depression consultations are associated with a simultaneous increase in mental health consultations in parents and siblings. Mothers and fathers are affected similarly, although the effect seems to be short-lived. Siblings experience a short-term increase in mental health consultations, in addition to a steeper long-term increase across the observation period, compared to peers in families where the second-born adolescent does not seek help for depression. Events that might affect the mental health of multiple family members simultaneously, specifically parental breakup and unemployment, did not explain the observed patterns.

CONCLUSION

Help-seeking for mental health problems is temporally aligned across family members. Intra- and intergenerational spillovers might contribute to this.

Kinlessness at Older Ages: Prevalence and Heterogeneity in 27 Countries

OBJECTIVES

We provide recent and detailed estimates of the prevalence of kinlessness (i.e., people lacking [close] kin) among older individuals in 27 countries. We add to the literature by considering a broad range of kinship ties and examining within-country variabilities by age, sex, education, and rurality of the residential area.

METHODS

Using data from Wave 8 (2019-2020) of the Survey of Health, Ageing, and Retirement in Europe, we estimated the prevalence of kinlessness among individuals aged 65 and over in 26 European countries and Israel. We considered different definitions of kinlessness, from a less restrictive (based on the absence of both a partner and children) to a more restrictive one (absence of partner, children, grandchildren, parents, and siblings).

RESULTS

Kinlessness varied considerably across countries. The percentage of people aged 65 and over who lacked a partner and children ranged between 2% and 3.5% in the Czech Republic, Romania, Israel, and Bulgaria to more than 8% in Switzerland, Spain, Belgium, and Malta. The percentage of older people lacking all close kin considered (partner, children, grandchildren, parents, and siblings) ranged from 0.1% to 4.1%. In addition, there was substantial heterogeneity in kinlessness in some countries by age, sex, and rurality of the residential area, whereas, except for a few cases, we did not find significant differences by education.

DISCUSSION

Understanding the prevalence of kinless older adults is critical for policy-makers and healthcare providers to design appropriate support systems for this potentially vulnerable group of people.

Transactional experiences of discrimination, depressive symptoms, and ethnoracial socialization in Mexican-origin families

Racial-ethnic discrimination is a prevalent stressor for Mexican-origin individuals that potentiates health inequities in depressive symptoms. However, existing research has primarily focused on individual-level associations between discrimination and depressive symptoms, neglecting the interdependent nature within family systems. Little is known about how one family member's discriminatory experiences relate to the depressive symptoms of others. Although ethnoracial socialization may disrupt the link from discrimination to depressive symptoms, how different ethnoracial socialization practices operate and influence parents themselves have not been examined. This study examines the associations among discriminatory experiences, depressive symptoms, and ethnoracial socialization among 604 Mexican-origin adolescents and their parents from low-income families. The findings revealed intraindividual and interindividual discrimination-depressive symptoms associations. Parental ethnoracial socialization's role in the link varied over time, individuals, and practices. Mental health research and services should consider shared and nonshared experiences among family members and adopt personalized approaches to support different family members. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The Impact of Undermining Coparenting on the Mental and Physical Health Outcomes of Black Fathers: The Role of Depression and Restrictive Emotionality

The parenting literature has established the coparenting relationship as central to the parenting behaviors and outcomes of men. The construct of coparenting encompasses supportive efforts among individuals that facilitate the rearing of children and unsupportive actions that can undermine parenting efforts (Merrifield & Gamble, 2013). Few studies have examined undermining coparenting as an experience that shapes Black men's health outcomes. In this study, we apply the social determinants of health framework to examine the impact of Black fathers' perceptions of undermining coparenting on their self-reported ratings of mental and physical health. Using a nationally representative sample of Black men (n = 255), correlational analyses revealed perceptions of undermining coparenting to be a significant predictor of higher levels of anger and poorer perceptions of physical health. These relationships were found to be mediated by depressive symptoms and moderated by restrictive emotionality. It is recommended that the negative impact of undermining coparenting on health be considered as a potential comorbidity contributing to negative health outcomes for Black men. This study adds to the literature on coparenting, Black men's health, and Black fatherhood more generally and urges policymakers and practitioners to consider undermining as an often overlooked, but significant, social determinant of health impacting the well-being of Black men. We also offer recommendations for promoting Black men's health by educating families on the effects of undermining and offering the supports necessary for achieving positive coparenting dynamics.

Age-varying association between discrimination, childhood family support, and substance use disorders among Latin American immigrants in the United States

OBJECTIVES

The cultural stress theory posits that immigrants experience a constellation of cultural stressors such as discrimination that could exacerbate alcohol- and other substance-related problems. Drawing on cultural stress theory, this study investigated the age-varying association between past-year discrimination and substance use disorders (SUDs) among Latin American immigrants aged 18-60 and whether childhood family support moderated the above association.

METHOD

We used data from the National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III) among adults aged 18-60 who identified as a Latin American immigrant (N = 3,049; 48% female).

RESULTS

Time-varying effect models (TVEMs) revealed that experiencing past-year discrimination was associated with greater odds of having a SUD during young and middle adulthood for Latin American immigrants. Furthermore, for immigrants with lower childhood family support, discrimination was associated with SUD risk in young and middle adulthood.

CONCLUSION

The present study documents that past-year discrimination was linked to greater SUD risk during young and middle adulthood. Childhood family support may serve as a protective factor in the association between discrimination and risk for SUD among Latin American immigrants. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Marital Status and Advance Care Planning Among Older Adults: Do Gendered Patterns Vary by Age?

OBJECTIVES

Advance care planning (ACP), which comprises a living will, durable power of attorney for healthcare (DPAHC), and end-of-life discussions, is an inherently relational process. However, it is unclear how marital status affects men's and women's ACP over the life course. Drawing on social control and gender-as-relational frameworks, we examine marital status differences in ACP and how these patterns differ by gender and age.

METHODS

Data are from the 2020 Health and Retirement Study (HRS), a representative sample of U.S. older adults (N = 7,074). We estimate logistic regression models to evaluate whether marital status differences in ACP are moderated by age and gender, and multinomial logistic regressions to examine age and gender differences in DPAHC designations among married parents. Analyses are adjusted for sociodemographic and health covariates.

RESULTS

Multivariable analyses revealed significant moderation effects for discussions only. Among married/cohabiting persons, women are more likely than men to have end-of-life discussions, with gender differences diminishing slightly at oldest ages. Among divorced persons in their 60s and 70s, women are much more likely than men to have had discussions, although this gap converges among the oldest-old. Conversely, young-old widowed men and women are equally likely to have discussions, although women are increasingly likely to do so with advancing age. Men are more likely than women to name their spouse as DPAHC, yet this gap diminishes with age.

DISCUSSION

Healthcare providers can better guide end-of-life consultations if they understand how men's and women's family relationships change with advancing age.

USING MIXED METHODS APPROACHES TO STUDY FAMILIES AND RELATIONSHIPS

Mixed methods research-methodologies that synthesize qualitative and quantitative approaches in the design, collection, analysis, and dissemination of research related to a specific topic or aim-is increasingly common, offering innovative empirical insight into families and relationships. We first elaborate on our definition of mixed methods research, emphasizing that there is significant heterogeneity within mixed methods approaches to studying families and relationships. Second, we discuss benefits of mixed methods projects within family and relationship research, including theory-building and innovation. Third, we provide practical suggestions for designing and implementing a mixed methods project, highlighting useful resources for researchers as they develop research questions, plan designs, collect and analyze data, and disseminate findings. We emphasize the unique opportunities from abductive analytic approaches for mixed methods researchers and point to the need for reflexivity. Fourth, we consider common obstacles associated with disseminating mixed methods research and explain why family researchers need "mixed methods literacy" regardless of their research paradigm. Finally, we identify key areas of future growth for mixed methods researchers. We advocate that understanding mixed methods research has practical benefits, even for researchers not using these approaches. To cohesively build-and critique-our knowledge of families and relationships, family and relationship researchers across paradigms should be familiar with the basic tenets, strengths, and limitations of qualitative, quantitative, and mixed methods research.

Perceptions and Expectations of Patients with Lung Cancer and Melanoma about the Telenursing Approach: A Phenomenological Study

BACKGROUND

Telenursing could improve continuity of care in patients with cancer. This study aims to explore the expectations and perceptions of patients with lung cancer and melanoma toward telenursing.

METHODS

A descriptive qualitative study using a phenomenological approach was conducted on a convenience sampling of twenty patients aged 18 years or over from a Cancer Center. With the consent of patients and the relevant Ethics Committee, in-depth open-ended face-to-face interviews were conducted until data saturation. The phenomenon's essence was achieved through themes emerging from the qualitative data analysis.

RESULTS

Patients' perceptions and expectations were related to areas explored by a general theme on the nurse-patient relationship's importance. Four themes and eleven sub-themes were focused on misconceptions about lack of use, patients' potential and fears, the home as a place of care, and the caring relationship. Fifteen patients perceived the internet as a chaotic "bubble".

CONCLUSIONS

Despite the lack of previous use, patients consider telenursing positively as "a bridge between home and care", especially in the advanced stages of the disease. They highlighted strengths and weaknesses of telenursing, such as having "someone for you", connection, fear of psychological addiction, loss of privacy, and lack of empathy. This study was not registered.

Development and Preliminary Validation of Stigma Measures for Care Partners of Persons Who Are d/Deaf or Hard of Hearing

OBJECTIVES

A great deal of literature documents the significant demands, both physical and psychosocial, that care partners experience when providing care to persons with a range of health conditions. There is, however, far less research available on care partners of adult persons who are d/Deaf or hard of hearing (d/DHH). In response to this gap, the authors developed measures of d/DHH stigma among care partners as part of the work of the Lancet Commission on Hearing Loss' Measures, Models, and Stigma Reduction Subgroup. The measures examined in this article are part of a larger set of parallel measures to enable comparison of stigma measurement across groups.

DESIGN

The present study describes the preliminary validation of five stigma scales specifically tailored for use to assess the prevalence and effect of stigma on the care partners of adult people who are d/DHH in the United States. Care partners in this context are defined broadly and can include spouses, partners, adult children, siblings, and friends of persons who are d/DHH. The scales describe the care partner's own assessment of how the person who is d/DHH experiences and perceives stigma as well as the care partner's own internalized, experienced, and perceived stigma as a result of their association with a person who is d/DHH. This latter set of three scales describes secondary stigma, or the stigma a person experiences related to their association with a member of a stigmatized group. Measures were developed through a process that included a literature review, Delphi groups with people who became d/DHH after they developed spoken language, cognitive interviews, and a pretest. An online, self-administered preliminary validation survey was conducted with 151 care partners.

RESULTS

Results support the internal reliability of each of the five stigma scales (ordinal α's all greater than 0.9) and that each scale is assessing a single factor.

CONCLUSIONS

Additional testing is needed to confirm the validity of these measures. After further validation, they can be used to assess the prevalence and effect of stigma on care partners of persons who are d/DHH and to evaluate the success of interventions developed to address stigma and its effects both on the care partner and the person who is d/DHH and receiving the care.

Opportunities and shortcomings of AI for spatial epidemiology and health disparities research on aging and the life course

Established spatial and life course methods have helped epidemiologists and health and medical geographers study the impact of individual and area-level determinants on health disparities. While these methods are effective, the emergence of Geospatial Artificial Intelligence (GeoAI) offers new opportunities to leverage complex and multi-scalar data in spatial aging and life course research. The objective of this perspective is three-fold: (1) to review established methods in aging, life course, and spatial epidemiology research; (2) to highlight some of the opportunities offered by GeoAI for enhancing research on health disparities across life course and aging research; (3) to discuss the shortcomings of using GeoAI methods in aging and life course studies.

Who's Worried? Memory, Worries About Dementia, and Marital Strain in Midlife Same- and Different-Sex Marriages: A Dyadic Perspective

OBJECTIVES

Prior scholarship has highlighted the importance of marriage for cognition. However, little research has considered how cognition-related concerns may impact marriage. In this study, researchers examine how aging couples view each other's memory and worry about their potential development of dementia in the future. Additionally, researchers investigate whether these cognition-related concerns may strain marriage, and how these dynamics differ for men and women in same- and different-sex marriages.

METHODS

Researchers used 2 waves of dyadic data from the Health and Relationships Project (HARP; 2015-2022), including 594 respondents from 297 same- and different-sex married couples (aged 41-71 at Time 2). Researchers employed the Actor-Partner Interdependence Model (APIM) to explore associations between actor and partner reports of memory and dementia worry with marital strain.

RESULTS

Men and women in same- and different-sex marriages were equally likely to report worries about their own potential development of dementia. However, women reported more concerns about their spouse developing dementia in the future than men did, regardless of whether they were married to a man or a woman. Both partners' reports of memory and dementia worry played a complex role in influencing marital strain, with variations observed across couple types.

DISCUSSION

Concerns about cognitive decline and dementia are common in older populations, and for married couples, spouses have concerns about their own memory as well as that of their partner. Researchers finding identified the significance of concerns about a spouse's memory on marital dynamics among aging couples.

Are social determinants associated with depression among married women of reproductive age? A mixed methods study from urban slums of Islamabad, Pakistan

Depression among married women of reproductive age is on the rise in Pakistan, owing to post-COVID-19 phase, super-inflation, increasing poverty, deteriorating law and order situation and perpetuating the uncertain political situation in the country. This study aimed to investigate the factors associated with depression among married women of reproductive age in Pakistan, using a mixed methods approach. The quantitative phase utilized the Urdu version of the Patient Health Questionnaire-9 (PHQ-9) to assess depression among 340 married women. Twelve women with higher scores on the PHQ-9 were selected for in-depth interviews in the qualitative phase. The quantitative analysis revealed a higher prevalence of depression among women with poor socioeconomic status, lower educational levels, larger family sizes, and recent deaths in the family. In the qualitative phase, the main themes identified were the impact of social conditions, such as societal expectations and gender roles, the influence of medical conditions on mental health, financial difficulties, the stress associated with caring for a larger number of children, and the emotional burden of recent deaths in the family. This study highlights the importance of addressing depression among married women of reproductive age in Pakistan. It is crucial to focus on early diagnosis and prompt treatment to mitigate the adverse effects of depression on the affected individuals and their families. Targeted interventions should consider the social determinants of depression, including improving socioeconomic conditions through safety nets, providing mental health support at the primary health care level, and addressing the specific health issues and needs of women in the reproductive age group. A multi-pronged approach and health system's thinking can reduce the burden of depression among women, ultimately enhancing their overall well-being, productivity and quality of life.

Familial Abuse During Childhood and Later-Life Health: Exploring the Role of Victim-Perpetrator Relationships

OBJECTIVES

Childhood abuse has been extensively studied in relation to later-life health, yet relatively little attention has been given to understanding the nuanced dynamics across victim-perpetrator relationships. This study addresses this gap by identifying typologies of familial perpetrators of childhood abuse in a national sample and examining their associations with various health outcomes, including physical and mental health as well as substance abuse.

METHODS

We used 2 waves of data from the Midlife in the US Study (n = 6,295, mean age = 46.9 at baseline). The analysis was completed in 3 stages. Using Latent Class Analysis (LCA), we identified subpopulations of victims with distinct familial perpetrator histories. With assigned LCA memberships and propensity score weighting, we investigated the extent to which specific victim-perpetrator relationships are associated with health outcomes measured at baseline and a 10-year follow-up adjusting for other early-life risks. We evaluated whether the observed associations differ across the waves.

RESULTS

Parental and sibling abuse commonly co-occur, surpassing the occurrence of single perpetrators. Although minimal health disparities are evident between sibling-only abuse and no/little abuse groups at baseline, parent-only abuse is associated with compromised health outcomes. Severe abuse from both siblings and parents is linked to the most adverse health outcomes. At the follow-up survey, the associations between familiar abuse and health outcomes weakened, particularly for substance abuse.

DISCUSSION

This study, delving into family relationships, family violence, and health disparities, provides new evidence to augment our comprehension of the enduring link between childhood abuse and health within the family context.

Determinants of Health Status and Life Satisfaction among Older South Koreans

South Korea is a rapidly aging society with the lowest fertility rates among the OECD economies. It is projected to become a super-aged society in 2025, with the share of individuals older than 65 reaching twenty percent. These developments make it important to analyze the determinants of health outcomes in older individuals. In this study, we identified the determinants of subjective and objective health outcomes among senior individuals in South Korea. We used self-rated health and life satisfaction scores as the two subjective health status indicators, while the number of chronic diseases was the objective one. We ran Tobit multivariate regressions of all three indicators on a set of factors related to the older citizens' physical, economic, and social characteristics. Active employment status and willingness to work in the future were positively related to self-rated health level but were not statistically related to life satisfaction, while income positively affected both subjective health status indicators. Age did not appear to affect satisfaction with life. Active leisure activities were positively related to both self-rated health and life satisfaction. In contrast, passive leisure, such as watching TV, was negatively related to both health status indicators while being associated with an increased number of chronic diseases. Our findings suggest that older South Koreans view employment primarily as a means of financial support rather than as an opportunity for active social engagement.

Twentieth-Century Change in the Educational Costs of Adolescent Childbearing

Although studies observe heterogeneity in the effects of adolescent childbearing on schooling, little is currently known about when this pattern emerged or how it changed across cohorts of women who lived in distinct periods of US history. This article identifies the potential origins of effect heterogeneity in the educational costs of adolescent childbearing and extends recent advances in causal inference to detect group differences in heterogeneity. The analysis applies this approach to four cohorts of women from the National Longitudinal Surveys (NLS) who entered adolescence before, during, and after expansive economic, demographic, and cultural change in the twentieth century. Results suggest that the educational costs of adolescent childbearing, as well as heterogeneity in those costs, increased for women in the latter half of the twentieth century, especially for millennial women born 1980-84. The authors conclude that midcentury social changes fundamentally altered the educational costs of adolescent childbearing for women.

The relationship between marital status and cognitive impairment in Chinese older adults: the multiple mediating effects of social support and depression

BACKGROUND

Marital status is a potentially essential factor for cognitive impairment. Relevant research examining the potential pathways through which the marital status of spouseless older people is associated with cognitive impairment needs to be more adequate. Therefore, this study aims to investigate the serial mediating effects of various forms of social support and depression between marital status and cognitive impairment in older Chinese people.

METHODS

This study involved a secondary analysis of data from the 2014-2018 wave of the Chinese Longitudinal Healthy Longevity Survey (CLHLS), with a total of 2,647 Chinese older adults and 53.6% being males. Mediation analysis using the SPSS process macro was conducted.

RESULTS

The results indicated that marital status was significantly predictive of cognitive impairment among older people, and those with a spouse exhibited higher cognitive functioning. Informal social support and depression were found to play partial mediating roles in the association between marital status and cognitive impairment. The findings also revealed that marital status was unrelated to formal social support, and no association between formal social support and cognitive impairment was found.

CONCLUSIONS

The study findings highlight the need for social service providers to design programs for promoting connections associated with informal support to reduce their risk of depression and cognitive impairment and for policymakers to develop effective formal social support systems for older people without spouses. This study indicated that older people could regain the benefits of marriage to lower the risk of depression and improve their mental health.

Research Review: Grandparental care and child mental health - a systematic review and meta-analysis

BACKGROUND

The number of children residing in grandfamilies is growing worldwide, leading to more research attention on grandparental care over the past decades. Grandparental care can influence child well-being in various forms and the effects vary across contexts. In this systematic review and meta-analysis, we synthesize the evidence on the relation between grandparental care and children's mental health status.

METHODS

We identified 5,745 records from seven databases, among which 38 articles were included for review. Random effects meta-analyses were used to synthesize evidence from eligible studies. We also examined the variability across study and participant characteristics, including study design, recruitment method, child age, child gender, study region, family type, comparison group, and outcome rater.

RESULTS

The meta-analysis consisted of 344,860 children from the included studies, whose average age was 10.29, and of which 51.39% were female. Compared with their counterparts, children being cared for by their grandparents had worse mental health status, including more internalizing problems (d = -0.20, 95% CI [-0.31, -0.09], p = .001), externalizing problems (d = -0.11, 95% CI [-0.21, -0.01], p = .03), overall mental problems (d = -0.37, 95% CI [-0.70, -0.04], p = .03), and poorer socioemotional well-being (d = -0.26, 95% CI [-0.49, -0.03], p = .03). The effects varied by study design and child gender.

CONCLUSIONS

The findings highlight that grandparental care is negatively associated with child mental health outcomes with trivial-to-small effect sizes. More supportive programs and interventions should be delivered to grandfamilies, especially in disadvantaged communities.

Patterns of Singlehood, Cohabitation, and Marriage in Early Adulthood in Relation to Well-being in Established Adulthood

In a cohort followed from late adolescence until established adulthood, this study examined how singlehood, cohabitation, and marriage are related to well-being at different ages across early adulthood and into established adulthood.Participants (N = 585) from three U.S. sites reported their marital and residential status at ages 18, 23, 28, and 34, when they also reported on physical, psychological, and social indicators of well-being. Findings suggest that being married compared to single earlier in adulthood is related to several indicators of better age 34 well-being. Although single and married participants did not differ on all indicators of well-being, married participants across several ages had less problematic substance use, better health, more economic security, and fewer internalizing and externalizing problems at age 34. Cohabiting participants' well-being was more similar to the well-being of the single than married participants on most indicators (and on all indicators by age 34). Findings did not differ by gender. The findings suggest that despite normative increases in singlehood and cohabitation, the present cohort shows that marriage continued to be associated with well-being at age 34.

The influence of parents' and partner's education on own health behaviours

The link between educational attainment and multiple health behaviours has been explained in various ways. This paper provides new insights into the social patterning in health behaviours by investigating the influence of parents' and partners' educational attainments on a composite indicator that integrates the four commonly studied lifestyle behaviours (smoking, alcohol, physical activity and BMI). Two key outcome indicators of interests were created to reflect both ends of the "healthy - unhealthy spectrum". Data was drawn from The Tromsø Study, conducted in 2015/16 (N = 21,083, aged 40-93 years). We controlled for two indicators of early life human capital and one personality trait variable. Partners' education attainments are relatively more important for avoiding unhealthy behaviour than choosing healthy behaviour; on the contrary, parents' education is more important for healthy behaviour. Heterogeneity by sex and age was also evident. The influences of partner's education on widening the socioeconomic contrasts in health behaviours were much stronger in the younger (40-59 years) age group. In conclusion, our results support the hypothesis that own health behaviour is affected by the educational attainments of our 'nearest and dearest' (i.e. spouse, mother, and father), net of own education. This study facilitates a better understanding of education-health behaviours nexus from a life course perspective and supports the importance of family-based interventions to improve healthy behaviours.

Health Care Utilization and Care-seeking Behavior Among Vulnerabilized Sexual Minority Women: A Social-ecological Approach

Sexual minority women (SMW) experience worse health than their heterosexual counterparts but have largely been omitted from health services research. To address this gap, we conducted 25 semi-structured, in-depth interviews with SMW. Transcripts were analyzed using thematic analysis, and findings were organized using a modified socioecological framework. Key themes at each socioecological level include (1) structural: stigma, sociocultural norms, health infrastructure; (2) organizational: stigma, patient-provider relationship, hours and location, linkage to care and co-location of services; (3) interpersonal: stigma and social support; (4) individual: internalized stigma, self-efficacy, socioeconomic status, health literacy, and intersecting identities. Stigma is the central theme affecting vulnerabilized SMW's experiences accessing care. Anti-stigma initiatives and factors that lead to personal resilience and can mitigate care access barriers were identified at each level. Interventions should focus on building inclusive policies/infrastructure and using SMW's unique social networks to empower and improve care access and health outcomes among vulnerabilized SMW.

Non-standard family histories and wellbeing at older ages

The life course approach emphasizes that health and wellbeing at older ages are influenced by experiences occurred in the previous stages of life. We contribute to the literature by focusing on the role of the non-standardness of family histories and argue that individuals who experienced non-standard trajectories have been exposed to social sanctions throughout their life course with negative long-term consequences on wellbeing. In our study, non-standardness of family histories is the extent an individual's family history differs from those of the others within reference groups, defined combining birth cohort, gender and country of residence. Family histories between age of 15 and 49 are analyzed using Sequence Analysis, thus accounting for events related to fertility and union formation (marriage and cohabitation) and dissolution, and their timing. Dissimilarities between family sequences are measured using optimal matching and are standardized within the reference groups. We use retrospective data from the seventh wave of the Survey of Health Ageing and Retirement in Europe (SHARE) and estimate linear regression models to assess the association between non-standardness of family histories and older people's life satisfaction. Quality of life and depressive symptoms are examined in additional analyses. A negative association is found between non-standardness of family histories and wellbeing, which is stronger for lower educated individuals and in Southern European countries. Results are consistent with the idea that uncommon family behaviors may have a long-term negative effect on wellbeing. Individual resources and a more tolerant societal context can reduce or eliminate the negative consequences of engaging in non-standard family behaviors.

Marital transitions during earlier adulthood and subsequent health and well-being in mid- to late-life among female nurses: An outcome-wide analysis

Comparing outcomes for individuals remaining married to those for single or divorced individuals might overstate the positive effects of the decision to marry, since marriage carries an inherent risk of divorce and its associated negative outcomes. While a growing literature has examined marital transitions, confounding by past marital history remains a concern and only a limited set of outcomes have been examined. To address these issues, this study examined incident first-time marriage and incident divorce/separation in relation to multiple subsequent physical health, health behavior, psychological distress, and psychosocial well-being outcomes in a large sample of female nurses in the U.S.. Data from the Nurses' Health Study II were studied (1993 to 2015/2017 questionnaire wave, Nmarriage analyses = 11,830, Ndivorce/separation analyses = 73,018, interquartile range of baseline age = 35 to 42 years). A set of regression models were used to regress each outcome on marital transition status, adjusting for a wide range of initial health and wellbeing status in addition to other covariates. Bonferroni correction was performed to account for multiple testing. Among the initially never married, those who became married had lower mortality (RR = 0.65, 95%CI = 0.50, 0.84), lower risks of cardiovascular diseases (e.g., RRstroke = 0.64, 95%CI = 0.50, 0.82), greater psychological wellbeing and less psychological distress (e.g., ßdepressive symptoms = -0.10, 95%CI = -0.15, -0.06). Among the initially married, those who became divorced/separated had lower social integration (β = -0.15, 95%CI = -0.19, -0.11), greater psychosocial distress (e.g., RRdepression = 1.23, 95%CI = 1.10, 1.37), and possibly greater risks of mortality, cardiovascular diseases, and smoking. Future research could study similar questions using data from more recent cohorts, examine potential mechanisms and heterogeneity, and also examine alternative social relationship types.

Partnership status and positive DNA methylation age acceleration across the adult lifespan in the UK

Although a significant body of research has shown that married people are healthier and live longer, empirical research on sex differences in the link between marital status and health suggests results are mixed. Moreover, the sex disparities in marital status and health relationships vary across adulthood. The literature on partnership status and measures of ageing is largely focused on older age groups and is limited in its view of early adulthood. Data from waves 2 and 3 (2010-2012) of Understanding Society: UKHLS were used to examine the association of current partnership status with epigenetic age acceleration (AA) assessed with DNA methylation (DNAm) algorithms 'Phenoage' and ' DunedinPACE ' in 3492 participants (aged 16-97). Regression models were estimated separately for men and women, and further stratified by age groups. Divorced/separated and widowed people showed positive age acceleration compared to the married/cohabiting people (reference group). Some sex differences were apparent, especially, among the single and divorced/separated groups. Age differences were also apparent, for example in men, being single was negatively associated with DNAmAA in the youngest group, but positively in the oldest group compared to partnered counterparts. These findings illustrate the importance of partnerships on the ageing process, in particular marital change through divorce and widowhood for positive age acceleration in adults. For single groups, observations were heterogenous by age and sex.

Nurse-led approaches to address social determinants of health and advance health equity: A new framework and its implications

BACKGROUND

The U.S. health care system is burdened by inefficiencies, longstanding health inequities, and unstainable costs. Within the nursing profession and the broader health care sector, there is growing recognition of the need for a paradigm shift that addresses persistent structural problems and advances health equity.

PURPOSE

Despite evidence of the importance of the social determinants of health (SDOH) in shaping inequitable health outcomes, practical tools for applying SDOH theory in the development of effective nurse-led programs to mitigate harmful SDOH remain scarce.

METHODS

We synthesize extant SDOH literature into a heuristic framework for conceptualizing core SDOH mechanisms, constructs, and principles.

FINDINGS

To illustrate how nurse scientists can use the framework to guide the development of programs for SDOH mitigation, we outline a three-step exemplar application to the U.S. Latino HIV epidemic.

DISCUSSION

Our framework can inform a paradigm shift toward nurse-led, multi-level SDOH mitigation across practice, education, and research.

Love and lifestyle: how 'relational healthism' structures couples' talk of engagement with lifestyle advice associated with a new diagnosis of coronary heart disease

OBJECTIVES

Healthy lifestyle change improves outcomes in coronary heart disease (CHD), but is rarely sustained. To better understand barriers to lifestyle change, we examined couples' talk of engaging with lifestyle advice after one partner receives a diagnosis of CHD.

DESIGN

A longitudinal qualitative design, in which a poststructuralist discourse analysis was performed on 35 interviews, conducted with 22 heterosexual British people in a long term relationship. The interviews occurred over three months after one partner was referred to a cardiac rehabilitation programme designed to support lifestyle change.

RESULTS

Couples understood their health as a shared practice underpinned by an ideological framework of healthism, creating a form of 'relational healthism'. Practicing relational healthism was not straightforward because the practices of surveillance, control, and discipline related to healthism often contravened relationship norms of support, acceptance and respect for the other's autonomy. Couples struggled to resolve this tension, dynamically adopting, resisting, and occasionally transforming discourses of health and love in ways that worked for and against engagement in lifestyle change.

CONCLUSION

In foregrounding the discursive and relational contexts of behavioural change engagement, we show the considerable complexity for couples, including costs related to engagement with lifestyle advice.

Effects of clustering and timing of early life stress exposure on mood problems, ADHD symptoms, and problematic drinking

OBJECTIVE

Exposure to early life stress (ELS) may lead to long-term health consequences. The Early Life Stress Questionnaire (ELSQ) is a retrospective measure of multiple ELS and their timing. Latent class analysis (LCA) has not been applied to the ELSQ and questions regarding timing are rarely explored. This study examined the effects of clustering and timing of ELS exposure on internalizing and externalizing symptoms.

METHOD

Data from 1095 participants in the NIAAA Natural History Protocol were analyzed. LCA was conducted on 18 ELS items. Regression and correlational analyses examined associations of latent classes with sociodemographic variables and clinical outcomes.

RESULTS

LCA revealed three classes: Class 1: Minimal ELS (54.2%), Class 2: Moderate ELS (33.2%), and Class 3: Multiple and High ELS (12.6%). Black/African American participants were more likely to be in Class 2, and participants with low household income were more likely to be in Classes 2 and 3. Family history of problematic alcohol use and individual alcohol use disorder diagnosis were linked to Classes with higher ELS exposure. Compared with Class 1, Class 2 reported higher anxiety symptoms, depressive symptoms, ADHD symptoms, and problematic drinking, and Class 3 reported the highest levels across all these outcomes. Regarding timing, earlier exposure to ELS (e.g., sustained family conflict and witnessed domestic violence) was associated with higher psychopathological symptoms.

CONCLUSIONS

The ELSQ can effectively capture clustering and timing of exposure to multiple ELS. Greater and earlier exposure to ELS were positively associated with internalizing and externalizing symptoms, underscoring the need for early and well-timed intervention.

Marital Histories and Associations With Later-Life Dementia and Mild Cognitive Impairment Risk in the HUNT4 70+ Study in Norway

Objectives: Earlier studies suggest that being married in later life protects against dementia, and that being single in old age increases the risk of dementia. In this study, we examine midlife marital status trajectories and their association with dementia and mild cognitive impairment (MCI) at ages 70 plus using a large population based sample from Norway. Methods: Based on a general population sample linked to population registries (N = 8706), we used multinomial logistic regression to examine the associations between six types of marital trajectories (unmarried, continuously divorced, intermittently divorced, widowed, continuously married, intermittently married) between age 44 and 68 years from national registries and a clinical dementia or a MCI diagnosis after age 70. We estimated relative risk ratios (RRR) and used mediation analyses adjusting for education, number of children, smoking, hypertension, obesity, physical inactivity, diabetes, mental distress, and having no close friends in midlife. Inverse probability weighting and multiple imputations were applied. The population attributable fraction was estimated to assess the potential reduction in dementia cases due to marital histories. Results: Overall, 11.6% of the participants were diagnosed with dementia and 35.3% with MCI. Dementia prevalence was lowest among the continuously married (11.2%). Adjusting for confounders, the risk of dementia was higher for the unmarried (RRR = 1.73; 95% CI: 1.24, 2.40), continuously divorced (RRR = 1.66; 95% CI: 1.14, 2.43), and intermittently divorced (RRR = 1.50; 95% CI: 1.09, 2.06) compared to the continuously married. In general, marital trajectory was less associated with MCI than with dementia. In the counterfactual scenario, where all participants had the same risk of receiving a dementia diagnosis as the continuously married group, there would be 6.0% fewer dementia cases. Discussion: Our data confirm that staying married in midlife is associated with a lower risk of dementia and that divorced people account for a substantial share of dementia cases.

Person with Heart Failure and Care Partner Dyads: Current Knowledge, Challenges, and Future Directions: State-of-the-Art Review

Over the past decade, there has been substantial growth in heart failure (HF) research that focuses on persons with HF and their care partners (family members or other close friends that provide unpaid support) as an interdependent team, or care dyad. In this state-of-the-art review, we use a dyadic lens to identify and summarize current research on HF care dyads, from qualitative studies, to nonexperimental quantitative studies, to randomized controlled trials. Although much work has been done, this literature is younger and less well-developed than care dyad literatures from other conditions (eg, cancer, Alzheimer's disease). We discuss the substantial challenges and limitations in this body of work, with an eye toward addressing common issues that impact rigor. We also look toward future directions, and discuss the promise dyadic research holds for improving patient, care partner, and relationship health.

Social Isolation: An Unequally Distributed Health Hazard

Social isolation is a potent predictor of poor health, mortality, and dementia risk. A great deal of research across national contexts provides causal evidence for these linkages and identifies key explanatory mechanisms through which isolation affects health. Research on social isolation recognizes that some people are more likely than others to be isolated, but over the past several decades, researchers have focused primarily on the consequences of isolation for health rather than a systematic assessment of the social conditions that foster isolation over the life course. In this article, we review the available evidence on inequities in social isolation and develop a conceptual framework to guide future research on structural systems that fuel social isolation over the life course. Future work in this area has the potential to identify root causes of inequality in social isolation, as well as targeted policy levers to reduce isolation in vulnerable populations.

Family intimacy and adolescent peer relationships: investigating the mediating role of psychological capital and the moderating role of self-identity

According to existing research, family intimacy affects the formation of peer relationships among adolescents; Parent-child relationships may influence children's relationships with peers, but the mechanism of its influence is still unclear due to the uncertainty of its effect. According to the ecological systems theory, this study examines how family intimacy affects adolescent peer relationships through psychological capital and how self-identity moderates this effect. These hypotheses were tested based on a survey of 414 adolescents, which showed that family intimacy positively affects adolescent peer relationships; The relationship between family intimacy and adolescent peer relationships is mediated by psychological capital; Self-identity positively moderates the direct effects of family intimacy and adolescent peer relationships; Self-identity not only positively moderates the direct effect of psychological capital and adolescent peer relationship, but also positively moderates the indirect effect of family intimacy on adolescent peer relationship through psychological capital. This study provides new perspectives on the relevant mechanism of family intimacy and adolescent peer relationships.

Partnership and Motivations for Starting a Family of One's Own in the Opinions of Students with Disabilities

Creating and maintaining stable, happy intimate relationships is a right every individual has. Previous research has shown that people with disabilities are at risk of building unsatisfactory partner relationships. The aim of the study was to ascertain the beliefs of students with disabilities concerning their motives for starting families and, in regard to potential partners, their tolerance for risky life experiences and the personal qualities accepted. A cross-sectional study was conducted with a sample of 2847 university students in southeastern Poland. It was found that the following motives for entering into a permanent relationship were considered more important by students with disabilities than they were by students without disabilities: enhancement of self-esteem (p = 0.001), high economic potential of a partner (p = 0.007) and a shared system of values and interests (p = 0.036). Love (p = 0.031) and the mental qualities (p = 0.010) of a partner were considered less important by students with disabilities than they were by students without disabilities. Moreover, students with disabilities are far more likely than students without disabilities to accept disability (p < 0.001) in potential partners. They are also significantly more willing to enter into relationships with people who have risky life experiences, even in the form of violence against previous life partners (p < 0.015) and children (p = 0.001), addiction to alcohol (p < 0.001) or drugs (p = 0.01) and the resulting treatment, and those having served time in prison (p = 0.034). Educational and institutional support for students with disabilities should be intensified with regard to partner selection being satisfactory to both partners.

RACIAL DISCRIMINATION AND THE WEATHERING OF NONMARITAL RELATIONSHIPS

Objective

The purpose of this study was to assess the impact of perceived racial discrimination on the satisfaction and dissolution of different-gender, nonmarital relationships among African American young adults.

Background

Racial discrimination has proven detrimental to relationship quality among married couples. Racial disparities in relationship processes begin long before marriages form, however. Racial discrimination may also weather and disrupt nonmarital relationships earlier in the life course.

Method

Survey data from African American young adult couples (N = 407) from the Family and Community Health Study were used to assess the associations between each partner's experience of racial discrimination, relationship satisfaction, and relationship dissolution using structural equation modeling.

Results

Results support a stress spillover perspective in that racial discrimination experienced by both men and women increased the likelihood of relationship dissolution through reduced satisfaction. No support was found for a stress buffering perspective.

Conclusion

Racial discrimination appears to distress and, ultimately, disrupt nonmarital relationships among African American young adult couples.

Implications

Given the role of relationship quality and stability in promoting health and well-being, understanding how discrimination impacts the unfolding of relationships, or linked lives, across the life course is essential to untangling and addressing the "chains of disadvantage" identified by Umberson et al. (2014) as central to racial disparities in health and well-being.

Intergenerational Ties and COVID-19 Contagion: A Study on European Adults Aged 50 Years and Older Using SHARE Data

OBJECTIVES

Intergenerational coresidence and interdependence among family members are salient forms of family support. However, they can also likely increase social and physical contact and thus potential coronavirus disease 2019 (COVID-19) transmission, especially among older adults. This study makes an original contribution to the literature by investigating which individual and household characteristics are associated with the risk of COVID-19 contagion among community-dwelling adults aged 50 years or older living in 27 European countries. We accounted for multiple indicators of intergenerational relationships and conducted a gendered analysis.

METHODS

The data came from the Survey of Health, Ageing and Retirement in Europe (SHARE), including 2 waves of the SHARE Corona Survey. Using linear probability models, the risk of experiencing COVID-19 outcomes was predicted by different family structures and intergenerational relationship indicators.

RESULTS

While intergenerational coresidence was not associated with the risk of COVID-19, a higher frequency of face-to-face contact with adult children was associated with a lower risk of COVID-19 among mothers. This result stresses the importance of social support from adult children during the COVID-19 pandemic. However, we also showed that grandparents who took care of grandchildren were at a higher risk of COVID-19. Additionally, childless individuals had a lower risk of COVID-19 during the second wave of the pandemic.

DISCUSSION

This study highlights the importance of intergenerational relationships in pandemic studies and underscores the need to examine how intergenerational ties might be a source of social support. Implications for policy interventions are discussed in the final section.

COVID-19 precautionary behaviors and vaccine acceptance among older individuals: The role of close kin

The family plays a central role in shaping health behaviors of its members through social control and support mechanisms. We investigate whether and to what extent close kin (i.e., partner and children) matter for older people in taking on precautionary behaviors (e.g., wearing a mask) and vaccination during the COVID-19 pandemic in Europe. Drawing on data from the Survey of Health, Ageing and Retirement in Europe (SHARE), we combine its Corona Surveys (June to September 2020 and June to August 2021) with pre-COVID information (October 2019 to March 2020). We find that having close kin (especially a partner) is associated with a higher probability of both adopting precautionary behaviors and accepting a COVID-19 vaccine. Results are robust to controlling for other potential drivers of precautionary behaviors and vaccine acceptance and to accounting for coresidence with kin. Our findings suggest that policymakers and practitioners may differently address kinless individuals when promoting public policy measures.

Predictors of Feeling of Threat Caused by COVID-19 Pandemic, the Distinctive Effects of Automatic vs. Reflective Emotions

The worldwide pandemic that started in December 2019 was a cause of a great rise in the feeling of threat in society. A feeling of threat and distress can be influenced by the span of emotions experienced by a person, and as it is rather clear, that the situation of pandemic evokes negative emotions, they can range from fear to depression, to even disgust. In this study, we wanted to verify the influence of the negative emotions of automatic origin, related to the well-being and homeostasis of the organism and the negative emotions of reflective origin, which are related to social constructs, on the feeling of threat caused by the pandemic outbreak. We expected automatic emotions to have a greater influence on the feeling of threat. We used an online questionnaire to measure the intensity of negative emotions and the feeling of threat among Polish participants in the time of the early outbreak of the pandemic (March-April 2020). Regression analyses were used to identify the predictors of the feeling of threat. The results show the distinctive effect of automatic and reflective groups of emotions. While automatic emotions always increased the feeling of threat, the reflective emotions suppressed the distress, especially in the group of middle-aged and elderly participants. As reflective emotions are developing in the process of socialization, the observed results could suggest, that young people do not process the situation of the pandemic in reflective categories, which leaves them more worried about the situation. We suggest, that promoting reflective thinking can be helpful in interventions in the cases of anxiety caused by the pandemic, as well as in social communication regarding the topic of the pandemic.