The Role of Work as a Social Determinant of Health in Mother's Own Milk Feeding Decisions for Preterm Infants: A State of the Science Review

In the United States, 10% of infants are born preterm (PT; <37 weeks gestational age) each year and are at higher risk of complications compared to full term infants. The burden of PT birth is borne disproportionately by Black versus non-Black families, with Black mothers significantly more likely to give birth to a PT infant. One proven strategy to improve short- and long-term health outcomes in PT infants is to feed mother's own milk (MOM; breast milk from the mother). However, mothers must make decisions about work and MOM provision following PT birth, and more time spent in paid work may reduce time spent in unpaid activities, including MOM provision. Non-Black PT infants are substantially more likely than Black PT infants to receive MOM during the birth hospitalization, and this disparity is likely to be influenced by the complex decisions mothers of PT infants make about allocating their time between paid and unpaid work. Work is a social determinant of health that provides a source of income and health insurance coverage, and at the same time, has been shown to create disparities through poorer job quality, lower earnings, and more precarious employment in racial and ethnic minority populations. However, little is known about the relationship between work and disparities in MOM provision by mothers of PT infants. This State of the Science review synthesizes the literature on paid and unpaid work and MOM provision, including: (1) the complex decisions that mothers of PT infants make about returning to work, (2) racial and ethnic disparities in paid and unpaid workloads of mothers, and (3) the relationship between components of job quality and duration of MOM provision. Important gaps in the literature and opportunities for future research are summarized, including the generalizability of findings to other countries.

The ten stories: Intergenerational transfer of values

RATIONALE

A troubling phenomenon for caregivers of elderly parents is their tendency to tell the same stories over and over. Repeated storytelling raises concerns about cognitive decline and memory loss and is often considered a disturbing harbinger of the possible onset of dementia.

PURPOSE

This research aims to show that repeatedly told stories are important vehicles for intergenerational transmission of values.

METHODS

Using a narrative inquiry approach, this research involved structured interviews with middle-aged adult children, asking them to tell us the stories they felt they were hearing or had heard repeatedly from their aging parent. Interviews were taped and transcribed, then coded for temporality, purpose and content.

RESULTS

Based on 126 stories told to 13 participants, it can be confirmed that there are approximately ten stories that older parents repeatedly tell to their adult children, mostly about experiences in their teens and twenties. The majority of the stories are told for the purpose of consolidating the elder's identity or sharing wisdom with the adult child. Key themes in the stories include seeking a better life, youthful fun, upholding standards, sticking together and doing what's right. These themes reflect the significant events and prevailing values of the early to mid-twentieth century.

CONCLUSION

This research offers a more constructive way for caregivers to hear the repeated stories told by their aging parents and to offer their loved one the gift of knowing they have been seen and heard.

Will Downward Intergenerational Housing Support Increase Parents' Expectations for Old-Age Care from Adult Children? Evidence from China

Toward a background of young people's decreasing housing affordability and parents' increasing involvement in intergenerational housing support, this study investigates how such support influences parents' expectation of future care from adult children. Using data from the China Health and Retirement Longitudinal Study, we found that, in general, middle-aged/older adults who provided adult children financial housing support were more likely to expect old-age care from them. The help-receiving child was more likely to be an expected caregiver than the other children in multi-children families. Moreover, the reciprocal relationship was most prominent among the 1950s cohort, compared with the pre-1950s and the post-1950s cohorts. Our study broadly contributes to understanding how modernization reshapes intergenerational relationships and family members' expectations of commitments toward each other. It also informs the design of a comprehensive multi-level care system for older adults in China.

Intergenerational transfers and informal care for disabled elderly persons in China: evidence from CHARLS

Aiming at 'ageing healthier and ageing better', a certain amount of high-quality informal care should be available for elderly persons with physical disability as formal care is barely accessible in China. The demographic transition and family structural changes have dramatically weakened traditional norms of filial piety and the structure of intergenerational transfers. This article employed nationwide representative data from the first wave (2011) of Chinese Health and Retirement Longitudinal Study (CHARLS) in order to identify the duration of informal care provision at home for frail elders (1122 in rural areas and 577 in urban areas, total 1699), measured in monthly hours, before estimating the associations between intergenerational transfers and the received time of informal care with Tobit Model analysis. Results showed that financial support from the younger generation was unexpectedly negatively associated with the monthly hours of care, implying a reduction of caring support along with increasing financial transfers towards older parents. The lack of informal care could not be compensated by having more children, co-residing with children, or increasing the parent-to-child/grandchild transfers. Spouses were shown to replace children as the major caregivers. In addition, the community-based long-term care system needs to be promoted to sustain and develop informal care, as the latter will become increasingly important with changing family dynamics. Finally, the received time of informal care, rather than the severity of physical disability measured by difficulty with ADLs or IADLs, was introduced to identify the actual demand for care by elders. The paper argues that it is important to reconceptualise and re-investigate the duration of care provision in the Chinese context in order to develop standards of payment as part of long-term care policies.

Becker and the Demographic Transition

It was a different era when Gary Becker did his groundbreaking work on the economics of fertility, during the years from the late 1950 through the early 1990s. There was great concern then about the “population explosion” due to sustained high fertility in the developing world after mortality declined following World War II. In 1968, Paul Ehrlich published “The Population Bomb” predicting disaster and mass starvation due to rapid population growth: “The battle to feed all of humanity is over. In the 1970s, the world will undergo famines – hundreds of millions of people are going to starve to death. . . .” Robert McNamara, then the President of the World Bank, in 1984 said “Short of thermonuclear war itself, population growth is the gravest issue the world faces over the decades immediately ahead. If we do not act, the problem will be solved by famine, riots, insurrection and war.”

The role of time preferences in the intergenerational transfer of smoking

Evidence suggests that maternal and offspring smoking behaviour is correlated. Little is known about the mechanisms through which this intergenerational transfer occurs. This paper explores the role of time preferences. Although time preference is likely to be heritable and correlated with health investments, its role in the intergenerational transmission of smoking has not been explored previously. This is the first paper to empirically test this. Data (2002, 2003, 2004, 2006 and 2008) from the Household, Income and Labour Dynamics in Australia are used. Estimates by using a pooled probit model show that there is not a direct effect of maternal time preference, measured in terms of financial planning horizon, on the likelihood that their offspring is a smoker. However, there is an indirect effect of maternal time preference. Sons of mothers that are smokers and have a shorter planning horizon are 6% more likely to smoke than if their mother had a longer planning horizon, and daughters of mothers that smoke with a shorter planning horizon are 7% more likely to smoke themselves than if their mother had a longer planning horizon.

A three generation study of the mental health relationships between grandparents, parents and children

BACKGROUND

It is well known that children of parents with mental illness are at greater risk of mental illness themselves. However the patterns of familial mental health problems across multiple generations in families are less clear. This study aimed to examine mental health relationships across three generations of Australian families.

METHODS

Mental health data, along with a range of family demographic information, were collected from over 4600 families in Growing Up in Australia: The Longitudinal Study of Australian Children, a nationally representative cohort study. The social and emotional wellbeing of two cohorts of children aged 4-5 years and 8-9 years was measured using the parent-rated Strengths and Difficulties Questionnaire (SDQ). The mental health of mothers and fathers was measured using the Kessler 6-item K6 scale, and the mental health history of maternal and paternal grandmothers and grandfathers was measured using a dichotomous parent-report item. Multivariate linear regression analyses were used assess the relationships between grandparent and parent mental health and child social and emotional wellbeing at ages 4-5 years and 8-9 years.

RESULTS

Both cohorts of children had greater mental health distress with higher SDQ scores on average if their mother or father had a mental health problem. For children aged 8-9 years, a history of mental health problems in maternal grandmothers and grandfathers was associated with higher SDQ scores in grandchildren, after controlling for maternal and paternal mental health and other family characteristics. For children aged 4-5 years, only a mental health history in paternal grandfathers was associated with higher SDQ scores.

CONCLUSIONS

The mental health histories of both parents and grandparents play an important role in the social and emotional wellbeing of young children.