Physical Illness in Gay, Lesbian, and Heterosexual Marriages: Gendered Dyadic Experiences

Minority Stress and Dyadic Stress in Same-Sex Couples: The Role of Dyadic Coping and Relationship Duration

Objectives

We investigated how internalized homonegativity and dyadic stress predicted relationship satisfaction in same-sex romantic relationships and explored the moderating roles of dyadic coping and relationship duration in the aforementioned associations.

Methods

The actor-partner interdependence moderation model (APIMoM) was introduced to deal with mutual influences between both partners in 241 same-sex romantic relationships.

Results

(1) individual internalized homonegativity, dyadic stress, and dyadic coping predict their own relationship satisfaction (i.e., actor effect); (2) individual dyadic stress predicts their partner's relationship satisfaction (i.e., partner effect), but only for those with a shorter relationship duration (i.e., ≤ 36 months); and (3) dyadic coping buffers the effect of individual dyadic stress on their own relationship satisfaction, but only for those in the group with a longer relationship durations (i.e., > 36 months).

Conclusions

These findings highlight the importance of a dyadic approach to further understand the impact of stress on relationship satisfaction. We reflect that interventions on couple-oriented coping could improve relationship well-being and sexual health among same-sex couples.

Doing Genders: Partner's Gender and Labor Market Behavior

Partnered men and women show consistently gendered patterns of labor market behavior. We test whether not only a person's own gender, but also their partner's gender shapes hours worked. We use Dutch administrative population data on almost 5,000 persons who had both male and female partners, whose hours worked we observe monthly over 15 years. We argue that this provides a unique setting to assess the relevance of partner's gender for labor market behavior. Using two-way fixed effects and fixed-effects individual slopes models, we find that both men and women tend to work more hours when partnered with a female partner compared to a male partner. These results align with our hypothesis that a partner's gender influences labor market behavior. For women, we conclude that this finding may be (partly) explained by marital and motherhood status. Additionally, we discovered that women decrease their hours worked to a lesser extent when caring for a child if they have a female partner. Finally, we found that for men, the positive association between own and partner's hours worked is weaker when one has a female partner, indicating a higher degree of specialization within these couples.

"We need a little strength as well": Examining the social context of informal caregivers for Black women with breast cancer

BACKGROUND

Informal caregivers (e.g., partners, other family members, friends) often provide social support to Black women with breast cancer, and caregivers find both benefits and challenges in their caregiving role.

METHODS

In this qualitative study, twenty-four caregivers for Black women with breast cancer participated in focus groups and interviews. Participants responded to a brief close-ended questionnaire as well as semi-structured questions about their experiences as cancer caregivers. Demographic information was collected, and relationship satisfaction was measured by the Relationship Assessment Scale-General scale (RAS-G). Focus groups and interviews were recorded, transcribed verbatim, and coded by two independent coders. Using an iterative, discussion-based process, the study team developed and refined themes.

RESULTS

All caregivers described themselves as Black/African American, and the majority identified as female (79%). The mean RAS-G score was 4.5 (SD = 0.5), indicating high levels of relationship satisfaction. Qualitative themes included using a range of strategies to provide emotional support; shifting between roles; needing time and space; and trying to stay strong. Several female caregivers described how the cumulative experiences of providing care for multiple family members and friends could be draining, as could their own experiences in the patient role.

CONCLUSIONS

These findings show a complex, multilayered social context that affects both the patient-caregiver relationship and the health and wellbeing of caregivers. Clinicians providing treatment and support for Black women with breast cancer should be mindful of how the health context of the family may affect patient and caregiver outcomes.

New Opportunities for Advancing Dyadic Health Science in Gerontology

As dyadic health science enters a golden age, important conceptual, theoretical, and technical challenges remain. This forum review brings together perspectives on the burgeoning dyadic literature from several subdisciplines within aging research. We first define key concepts and terms so that interested researchers can navigate the complex and various ways in which dyadic health research is conducted. We discuss exciting scientific advances and close by identifying crucial challenges and considerations that coincide with important future directions for the field.

How Older White Gay Men and Lesbians Leverage Advantages to Navigate Healthcare

A lifetime of disadvantages shapes how lesbians and gay men navigate healthcare as they age and their fears about end-of-life care. This paper investigates how a localized group of older white, college educated, and economically privileged gay men and lesbians conceptualize their approach to healthcare. Analyzing 23 in-depth interviews with gay men and lesbians over the age of 60 I consider how they utilize their advantages when aging and facing declining health. I pay particular attention to how discriminatory social and legal contexts shaped elders' current situations and ability to be "out" and engage with healthcare professionals. I utilize the theory of cumulative advantages and disadvantages as another way to understand literature on health inequalities and LGBTQ health work, finding that despite systemic inequalities some gay men and lesbian elders use their resources to find gay-friendly primary care physicians, age at home, and build social supports for caregiving as their health declines.

The partner in the plate: the association between changes in partnership status and protein consumption among older people in Europe

Experiencing a change in partnership status at older ages might have detrimental effects on an individual's habits, including eating behaviours. Prior studies presented evidence that widowhood is related to altered diets with a decrease in the amount of protein consumed, which is considered to be an important risk factor of frailty among older people. Using data from Waves 4–8 of the Survey of Health, Ageing and Retirement in Europe (N = 134,313), we investigate the association between stability and changes in partnership status and changes in the frequency of protein consumption at older ages. We also explore the potential moderating role played by changes in economic resources. Having never been married, being divorced and being widowed were significantly associated with a lower frequency of protein consumption among both men and women. The transition to widowhood was significantly associated with a reduction in the frequency of protein consumption, while this same association was not found in the transition to divorce. Subjective evaluation of economic resources did not moderate the relationship between changes in partnership status and frequency of protein consumption. In short, changes in eating behaviours after having experienced the loss of a partner due to widowhood might contribute to accounting for health differentials between those ageing alone and those with a partner.

Marital Stress and Emotion Work in Same-Sex and Different-Sex Marriages: The Moderating Role of Childhood Adversity

Adverse experiences in childhood may set the stage for future response to stress, emotion regulation, and interaction with partners in intimate relationships. Prior research suggests the influence of childhood adversity on stress response is gendered, yet we do not know much about how individuals with a history of significant childhood adversity respond to marital stress outside of a different-sex marriage context. This study examines the moderating role of childhood adversity on the association of daily marital stress with emotion work provision (intentional activities devoted to enhancing others' emotional well-being) and considers whether the association varies for men and women in same- and different-sex marriages. Specifically, I use ten days of dyadic diary data collected from 378 midlife same- and different-sex married couples (n=756 individuals) and conduct multilevel regression models. The results show marital stress is positively associated with emotion work provision, and that the association is stronger for respondents who report more adverse childhood experiences. For respondents with low childhood adversity, the association of marital stress with emotion work is greater for same-sex couples compared to different-sex couples; for those with high childhood adversity, the association is equally strong. Findings from this study suggest that both men and women in same- and different-sex relationships do more emotion work in response to increased daily marital stress. Furthermore, early experiences of adversity are linked to stress responses in adulthood, with differing implications for men and women in different-sex and same-sex unions.

Linked Lives: Does Disability and Marital Quality Influence Risk of Marital Dissolution among Older Couples?

Using fourteen waves of data from the Health and Retirement Study (HRS), a longitudinal panel survey with respondents in the United States, this research explores whether marital quality—as measured by reports of enjoyment of time together—influences risk of divorce or separation when either spouse acquires basic care disability. Discrete-time event history models with multiple competing events were estimated using multinomial logistic regression. Respondents were followed until they experienced the focal event (i.e., divorce or separation) or right-hand censoring (i.e., a competing event or were still married at the end of observation). Disability among wives was predictive of divorce/separation in the main effects model. Low levels of marital quality (i.e., enjoy time together) were associated with marital dissolution. An interaction between marital quality and disability yielded a significant association among couples where at least one spouse acquired basic care disability. For couples who acquired disability, those who reported low enjoyment were more likely to divorce/separate than those with high enjoyment; however, the group with the highest predicted probability were couples with low enjoyment, but no acquired disability.

Equity in the Provision of Diabetes Self-Management Education and Support

Diabetes self-management education and support (DSMES) interventions must be accessible to all people with diabetes. To address equity in the delivery of DSMES, interventions should consider the unique needs of various populations. This article outlines the needs of a wide range of populations, including people with diabetes who are racially or ethnically diverse; have limited English proficiency or literacy; are deaf or hard of hearing; are blind or have low vision; are neurodiverse; live with learning disabilities or intellectual or developmental disabilities; have dementia or cognitive impairment; or are of sexual and/or gender minority. The authors discuss how best to tailor DSMES to meet the needs of these diverse groups.

Missing Pieces: Engaging Sociology of Disability in Medical Sociology

Medical sociologists and sociologists of disability study similar topics but, because of competing or conflicting theoretical paradigms, tend to arrive at different conclusions, engage with different audiences, and pursue different directions for social change. Despite diverging trajectories over the past 20 years, however, there remains clear potential overlap between both subfields in the study of disability and untapped opportunities for cross-fertilization. Our purpose here is to place these literatures in conversation with each other. Toward this end, we identify major themes in the last 20 years of medical sociology scholarship, gaps with regard to disability in those themes, and possibilities (including methodologies) we see at the intersection of medical sociology and the sociology of disability that could address these gaps.

Impairment in Activities of Daily Living and Unmet Need for Care Among Older Adults: A Population-Based Study From Burkina Faso

Objectives

The importance of impairment in performing activities of daily living (ADL) is likely to increase in sub-Saharan Africa because few care options for affected people exist. This study investigated the prevalence of ADL impairment, the extent to which care need was met, and described characteristics of people with ADL impairment and unmet need in Burkina Faso.

Methods

This study used data from the Centre de Recherche en Santé de Nouna Heidelberg Aging Study, a population-based study among 3,026 adults aged older than 40 years conducted in rural Burkina Faso. Information on 6 basic ADL items was sought, with a follow-up question asking whether care need was not met, partially met, or met. Bivariable correlations and multivariable logistic regression were used to determine sociodemographic and health characteristics associated with ADL impairment and unmet need.

Results

ADL impairment of any kind was reported by 1,202 (39.7%) respondents and was associated with older age (adjusted odds ratio: 1.05 [95% CI: 1.04–1.06]), being a woman (1.33 [1.06–1.60]), and reporting depressive symptoms (1.90 [1.65–2.18]). Among those with ADL impairment, 67.8% had at least one unmet need. Severe ADL impairment was found in 202 (6.7%) respondents, who reported a lower prevalence of unmet need (43.1%). Severe ADL impairment was associated with depressive symptoms (2.55 [2.11–3.07]) to a stronger degree than any ADL impairment.

Discussion

Prevalence of ADL impairment and unmet need was high in this setting. Variation in impairment across the population highlighted key groups for future interventions. Unmet need for care was highest in middle-aged adults, indicating a gap in care provision.

Health and Health Care of Sexual and Gender Minorities

Research on the social dimensions of health and health care among sexual and gender minorities (SGMs) has grown rapidly in the last two decades. However, a comprehensive review of the extant interdisciplinary scholarship on SGM health has yet to be written. In response, we offer a synthesis of recent scholarship. We discuss major empirical findings and theoretical implications of health care utilization, barriers to care, health behaviors, and health outcomes, which demonstrate how SGMs continue to experience structural- and interactional-level inequalities across health and medicine. Within this synthesis, we also consider the conceptual and methodological limitations that continue to beleaguer the field and offer suggestions for several promising directions for future research and theory building. SGM health bridges the scholarly interests in social and health sciences and contributes to broader sociological concerns regarding the persistence of sexuality- and gender-based inequalities.

Health Disparities Among Women by Sexual Orientation Identity and Same-Sex or Different-Sex Cohabiting Partnership Status

BACKGROUND

The objective of this study was to compare health outcomes by sexual orientation identity and cohabiting partnership status (defined as whether heterosexual, lesbian, and bisexual women were non-partnered, partnered in a cohabiting same-sex relationship, or partnered in a cohabiting different-sex relationship).

METHODS

We used data on heterosexual (n = 95,289) and sexual minority (n = 2,600) women aged 18 years and older from the 2013-2018 National Health Interview Survey. We estimated adjusted odds ratios (AORs) with 95% confidence intervals (CIs) from multivariable logistic regression models comparing health outcomes by sexual orientation identity and cohabiting partnership status while controlling for sociodemographic characteristics.

RESULTS

Compared with heterosexual women in a different-sex relationship, nonpartnered women generally reported worse health outcomes regardless of sexual orientation. Lesbian women with a same-sex partner were more likely to report poor/fair health (AOR, 1.61; 95% CI, 1.09-2.37), current cigarette smoking (AOR, 1.48; 95% CI, 1.14-1.94), and binge drinking (AOR, 1.63; 95% CI, 1.19-2.23) compared with heterosexual women with a different-sex partner. Bisexual women with a different-sex partner were more likely to report poor/fair health (AOR, 1.91; 95% CI, 1.23-2.97), severe psychological distress (AOR, 2.86; 95% CI, 1.78-4.59), current cigarette smoking (AOR, 1.38; 95% CI, 1.01-1.88), and binge drinking (AOR, 1.66; 95% CI, 1.18-2.32) compared with heterosexual women with a different-sex partner.

CONCLUSION

More research is needed to identify the processes in which heterosexual and sexual minority women partner and cohabitate with members of the same or different sex-and whether or how this influences their health. Meanwhile, health care providers should be mindful that families are diverse, and acknowledging this diversity could be a first step toward achieving health equity for all women regardless of sexual orientation.

Does Sexual Orientation Complicate the Relationship Between Marital Status and Gender With Self-rated Health and Cardiovascular Disease?

A substantial body of work has demonstrated the importance of marital status for health, yet the vast majority of this work has studied heterosexual marriages and relationships. To understand the role of marital status in shaping health among heterosexual, lesbian, gay, and bisexual men and women, we examine data from a probability-based sample of adults living in 40 U.S. states for selected years between 2011-2015. We test two physical health outcomes-poor-to-fair self-rated health and cardiovascular disease-and present predicted probabilities and pairwise comparisons from logistic regression models before and after adjustment for demographic characteristics, socioeconomic status, health behaviors, and depression. Overall, findings reveal some important similarities and differences in the relationships between marital status and health by sexual orientation and gender. First, the health benefits of marriage extend to sexual minority adults, relative to adults who are either formerly or never married. Among heterosexual adults, adjusted models also highlight the healthy status of never-married adults. Second, the health benefits associated with intimate relationships appear less dependent on legal marriage among sexual minorities than among heterosexual adults. Third, we document a persistent health disadvantage for bisexual adults compared with heterosexual adults, particularly among women who are formerly married, indicating some elevated health vulnerability among selected sexual minority women. Fourth, associations between sexual orientation and health are more similar across marital status groups for men than women. Altogether, these findings add much needed nuance to our understanding of the association between marital status and health in an era of increasing diversity in adult relationships.

The Gender-as-Relational Approach for Theorizing About Romantic Relationships of Sexual and Gender Minority Mid- to Later-Life Adults

We deploy the "gender-as-relational" (GAR) approach to enhance the study of the long-term romantic relationships of sexual and gender minority mid- to later-life adults. The GAR approach states that gender within relationships is shaped by three key factors: own gender, partner's gender, and the gendered relational context. This approach highlights that the relationship dynamics of men, women, and gender nonconforming people are highly diverse, reflecting that gender is a social construct formed within interactions and institutions. We explicate how GAR can reorganize the study of sexual and gender diversity in three research areas related to aging and relationships-caregiving, marital health benefits, and intimacy-and discuss theory-driven methods appropriate for a GAR research agenda. A GAR framework reorients research by complicating taken-for-granted assumptions about how gender operates within mid- to later-life romantic relationships and queering understandings of aging and romantic relationships to include experiences outside of heteronormative and cisnormative categories.

"Go See Somebody": How Spouses Promote Mental Health Care

This study considers when, whether, and how spouses encourage professional mental health care by analyzing qualitative data from 90 in-depth interviews with gay, lesbian, and heterosexual spouses. Findings show that a majority of spouses are engaged in promoting each other's mental health care but that the strategies used to promote care vary by gender and the gender composition of the couple. The majority of gay men and lesbian women promote care by framing mental health problems as largely biochemical, fixable only with professional care or medicine, and work to destigmatize this care. Lesbian women uniquely emphasize the influence of a spouse's symptoms on marital quality as a reason to pursue care. Some heterosexual women and men also report seeing their spouse's mental health care as something for them to deal with on their own and thus do not encourage care. This study has important implications for researchers looking to understand why some individuals seek mental health care and others do not and provides policymakers insight into mental health interventions via spouses.

Sexual- and Gender-Minority Families: A 2010 to 2020 Decade in Review

OBJECTIVE

To review research on sexual and gender minority (SGM) families-including lesbian, gay, bisexual, transgender, queer, asexual, and intersex (LGBTQAI+) families- from 2010-2020.

BACKGROUND

Research on the SGM population has increased and diversified in the past decade.

RESULTS

This paper reviews three subareas that make up the majority of research on SGM families today: (1) SGM family of origin relationships, (2) SGM intimate relationships, and (3) SGM-parent families. This review also highlights three main gaps in the existing literature: (1) a focus on same-sex and gay and lesbian families (and to a lesser extent bisexual and transgender families) and a lack of attention to the families of single SGM people as well as intersex, asexual, queer, polyamorous, and other SGM families; (2) an emphasis on white, socioeconomically advantaged SGM people and a failure to account for the significant racial-ethnic and socioeconomic diversity in the SGM population; and (3) a lack of integration of SGM experiences across the life course, from childhood to old age.

CONCLUSION

The next decade should aim to examine the full range of SGM family ties, include more vigorous examinations of race-ethnicity and socioeconomic status, and develop more robust accounts of family across the life course with novel theory and data sources across the methodological spectrum.

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

Family ties have wide-ranging consequences for health, for better and for worse. This decade review uses a life course perspective to frame significant advances in research on the effects of family structure and transitions (e.g., marital status), and family dynamics and quality (e.g., emotional support from family members), on health across the life course. Significant advances include the linking of childhood family experiences to health at older ages, identification of biosocial processes that explain how family ties influence health throughout life, research on social contagion showing how family members influence one another's health, and attention to diversity in family and health dynamics, including gender, sexuality, socioeconomic, and racial diversity. Significant innovations in methods include dyadic and family-level analysis and causal inference strategies. The review concludes by identifying directions for future research on families and health, advocating for a "family biography" framework to guide future research, and calling for more research specifically designed to assess policies that affect families and their health from childhood into later life.

Dyadic quality of life among heterosexual and sexual minority breast cancer survivors and their caregivers

PURPOSE

The number of informal caregivers to cancer survivors is increasing, and limited information is available about caregivers to sexual minority breast cancer survivors. The purpose of this study was to assess dyadic quality of life among sexual minority cancer survivors and their caregivers compared with heterosexual cancer survivors and their caregivers.

METHODS

We recruited 167 survivors of non-metastatic breast cancer of different sexual orientations and their caregivers, who were surveyed via telephone after obtaining consent. We used inverse propensity score weighting to account for differences by sexual orientation in age and length of the survivor-caregiver relationship, and simultaneous equation models consistent with the needs for analyzing dyadic data.

RESULTS

About 6-7 years after diagnosis, survivors and caregivers reported quality of life scores consistent with population norms, and there were no differences by survivors' sexual orientation. With few exceptions, caregivers' and survivors' quality of life influenced one another directly, and these effects were stronger among sexual minority dyads than heterosexual dyads.

CONCLUSIONS

Because of the strength of sexual minority, survivors' and their caregivers' mutual influence on each other's quality of life, interventions, and clinical care for sexual minority breast cancer survivors should consider their caregivers.

Can Spouses Buffer the Impact of Discrimination on Depressive Symptoms? An Examination of Same-sex and Different-sex Marriages

Discrimination due to personal characteristics (e.g., gender, sexuality, appearance) is a common yet stressful experience that is detrimental to mental health. Prior work has not considered how spouses in same- and different-sex marriages help each other cope with discrimination despite the importance of marriage for managing stress and adversity. We analyze survey data collected from both spouses in same-sex and different-sex marriages within the United States (N=836 individuals) to examine whether support from spouses weakens the impact of discrimination on depressive symptoms. Results suggest that discrimination contributes to depressive symptoms, but greater support from spouses buffers the mental health consequences of discrimination. Individuals in same-sex marriages report more spousal support than do individuals in different-sex marriages, even after accounting for experiences of discrimination. Same-sex couples may get needed spousal support, whereas women married to men receive the least spousal support and may be vulnerable to stressors that challenge mental health.

Marriage, Social Control, and Health Behavior: A Dyadic Analysis of Same-sex and Different-sex Couples

Prior research based on studies of heterosexual populations suggests that men's health benefits more from marriage than women's, in part because women do more than men to influence the health habits of their spouse. We extend this work by using dyadic survey data from 838 spouses in 419 gay, lesbian, and heterosexual marriages to consider differences in social control tactics across same-sex and different-sex couples-that is, how spouses monitor and regulate each other's health habits. Results suggest that although gender differences in social control are common, gendered patterns sometimes differ depending on whether one is in a same-sex or different-sex marriage. Results also point to the importance of health habits as strong drivers of relationship dynamics across gay and lesbian as well as heterosexual marriages.

Health and Health Behavior Concordance between Spouses in Same-Sex and Different-Sex Marriages

Research shows that heterosexual spouses are concordant on a variety of health and health behavior outcomes. Yet, little is known about patterns of concordance between spouses in same-sex marriages, or whether concordance patterns differ for spouses in same- and different-sex marriages. Using descriptive techniques, we analyze survey data from both spouses in 121 gay, 168 lesbian, and 122 heterosexual married couples to examine health and health behavior concordance. We find that gay and lesbian couples are more concordant than heterosexual couples on several health and health behavior outcomes. Differences in concordance between gay and lesbian couples are also found. Findings suggest that the pathways through which concordance occurs may differ in important ways for same-sex and different-sex unions.

Social Support and Health-Related Quality of Life Among Gay and Bisexual Men With Prostate Cancer

OBJECTIVES

To describe social support patterns of gay and bisexual men with prostate cancer (GBMPCa) and how social support is associated with prostate cancer outcomes.

SAMPLE & SETTING

A cross-sectional online survey with 186 GBMPCa recruited from a national cancer support group network.

METHODS & VARIABLES

Descriptive statistics of social support and linear regression of social support on general and prostate cancer-specific quality of life (QOL). Social support and health-related QOL were assessed generally and specific to prostate cancer.

RESULTS

Participants primarily relied on partners or husbands, gay and bisexual friends, chosen family, and men from support groups for support. The most common types of support received were informational and emotional social support. Low general social support was significantly associated with worse prostate cancer symptom bother and general mental QOL. Wanting more social support was significantly associated with worse prostate cancer-specific and general QOL.

IMPLICATIONS FOR NURSING

Clinicians should be aware of the different social support networks and needs of GBMPCa and refer them to relevant support groups to improve QOL.

Childhood Adversity, Daily Stress, and Marital Strain in Same-Sex and Different-Sex Marriages

Childhood adversity has enduring consequences for individuals throughout life, including increased reactivity to stress that may contribute to marital strain in adulthood. Past research on gendered experiences of heterosexual spouses raises questions about how the influence of childhood adversity might differ for men and women in same-sex marriages. We analyze dyadic diary data from 756 individuals in 106 male same-sex, 157 female same-sex, and 115 different-sex marriages to consider how childhood adversity moderates the association between daily stress and marital strain. Results suggest that the negative consequences of daily stress for marital strain are amplified by past childhood adversity with variation for men and women in same- and different-sex unions, such that women and those in same-sex marriages may experience some protection from the adverse consequences of childhood adversity.

Planning for Future Care and the End of Life: A Qualitative Analysis of Gay, Lesbian, and Heterosexual Couples

Two key components of end-of-life planning are (1) informal discussions about future care and other end-of-life preferences and (2) formal planning via living wills and other legal documents. We leverage previous work on the institutional aspects of marriage and on sexual-minority discrimination to theorize why and how heterosexual, gay, and lesbian married couples engage in informal and formal end-of-life planning. We analyze qualitative dyadic in-depth interviews with 45 midlife gay, lesbian, and heterosexual married couples ( N = 90 spouses). Findings suggest that same-sex spouses devote considerable attention to informal planning conversations and formal end-of-life plans, while heterosexual spouses report minimal formal or informal planning. The primary reasons same-sex spouses give for making end-of-life preparations are related to the absence of legal protections and concerns about discrimination from families. These findings raise questions about future end-of-life planning for same- and different-sex couples given a rapidly shifting legal and social landscape.

Family Relationships and Well-Being

Family relationships are enduring and consequential for well-being across the life course. We discuss several types of family relationships—marital, intergenerational, and sibling ties—that have an important influence on well-being. We highlight the quality of family relationships as well as diversity of family relationships in explaining their impact on well-being across the adult life course. We discuss directions for future research, such as better understanding the complexities of these relationships with greater attention to diverse family structures, unexpected benefits of relationship strain, and unique intersections of social statuses.

Instrumental- and Emotion-Focused Care Work During Physical Health Events: Comparing Gay, Lesbian, and Heterosexual Marriages

OBJECTIVES

We consider emotion- and instrumental-focused care work and marital stress during significant physical health events in midlife gay, lesbian, and heterosexual marriages.

METHOD

We employ the factorial method, an extension of the actor-partner interdependence model, to analyze survey data from 808 midlife gay, lesbian, and heterosexual spouses in 404 unions.

RESULTS

The amount of emotion- and instrumental-focused care work provided during physical health events, and the associations between care work and marital stress, depends on the gender of the respondent, gender of the spouse, and whether spouses are in a same-sex or different-sex union. For example, in both same- and different-sex marriages, women report providing more emotion-focused care work during their own health event than do men, and respondents report more health-related marital stress when the patient is a woman.

DISCUSSION

Investigating how midlife same-sex and different-sex spouses care for each other during a spouse's health event expands understandings of gendered aging experiences within marriage. Findings can elucidate health policies and clinical strategies that best support the health of men and women in same- and different-sex marriages.