The Impact of the Family on Health the Decade in Review

Abstract

Inquiry on the family-health nexus cuts across disciplines, focuses on a broad range of issues, and is set confronting a properties marked by increasing diversity of family unit structures and households, aging families, and intensifying concerns about wellness and social inequalities. Over the last decade, a plethora of articles actualization in The Journal of Family and Economic Issues (JFEI) have examined the interplay between family and health. This article attempts to crystallize the primary contributions of this body of work. My discussion is organized around diverse thematic areas that emerged from the review: (a) childbearing, (b) children's health, (c) relationships, (d) caregiving, and (e) the impact of health on household finances. I close past sketching out some useful areas for future research in the next decade.

The interplay between family and health has been of increasing interest to scholars and policymakers over the last decade. Research on the family-health nexus cuts beyond disciplines, focuses on a broad range of issues, and is set against a backdrop marked by increasing diversity of family structures and households, aging families, and intensifying concerns about health and social inequalities. The coronavirus 2019 pandemic (COVID-19) has clarified the importance of understanding family and health linkages. For example, high levels of unemployment associated with the COVID-xix has exerted substantial financial and mental pressures on families, which in turn tin atomic number 82 to health bug or exacerbate existing conditions.

In the final decade, a plethora of manufactures actualization in The Journal of Family unit and Economic Issues (JFEI) take examined topics that broach the family-health nexus. This article attempts to crystallize the chief contributions of this body of work. My give-and-take is organized effectually various thematic areas that emerged from the review: (a) childbearing, (b) children's health, (c) relationships, (d) caregiving, and (e) the touch of health on household finances. While the selected research is not exhaustive of all JFEI publications addressing family-health linkages over the last decade, their inclusion intends to showcase the latitude and telescopic that a range of studies have taken. I close by sketching out some useful areas for hereafter research in the next decade.

Childbearing: Levels, Timing and Policies

A major focus of family-health scholarship in JFEI over the last decade has been childbearing. Shreffler and Johnson's (2013) report implicated women'south career preferences as important for understanding fertility patterns, using two waves of the National Survey of Family and Households (NSFH). The authors showed that the commonly establish negative relationship between women's work hours and fertility becomes nonsignificant once adjustments are made for career and family preferences. Importantly, women with high fertility intentions were plant to accept greater odds of giving nativity, regardless of work hours. Women's work-family preferences should, therefore, the authors argued, receive greater attention in inquiry on childbearing patterns as well equally in pronatalist policy debates.

Childbearing besides depends on a household's socioeconomic circumstance. In this vein, Mansour (2018) provided insights into how economic uncertainty influences the probability of having multiple children relative to one kid. Employing linear and non-linear regression models and using data from the Console Study of Income Dynamics (PSID), the author plant heterogeneous effects of income volatility beyond the income distribution. Measurement of income volatility included indicators of the variance in household earnings beginning from the nativity year of the start kid, as well as an indicator of downwardly volatility, which captured instances when income decreased past more than 5% over the interview period. Importantly, the analysis showed that downward volatility was associated with lower odds of having a second child for mothers in the low and high end of the income distribution. By contrast, negative income changes were associated with higher odds of giving birth to a second child for mothers in the second income quartile. Overall, the experience of negative income changes was found to have greater effects (negative) on total fertility than absolute income volatility, which was not associated with total births.

In addition to assessing how household socioeconomic circumstances matter, the role of public policy in shaping childbearing was a topic of considerable involvement in the JFEI over the terminal decade. Cheng (2011) provided compelling analysis of contraceptive noesis in Taiwan over a period in which various family planning programs were implemented (beginning in 1964). Using cross-sectional, representative data from 1965 to 1985, Cheng plant that mass media campaigns and social networks helped increment contraceptive-related knowledge, which in plough, was associated with lower fertility. These results held using an instrumental variable (IV) approach that adapted for endogeneity in contraceptive knowledge on fertility.

In addition, JFEI inquiry extended understanding of how individuals respond to policies aiming to reduce childbearing costs. In this vein, Barbos and Milovanska-Farrington (2019) assessed the expansion of mandatory maternal paid leave in Switzerland from 8 to 14 weeks using two waves of the European Social Survey from 2004 to 2010. The primary consequence variable examined was a categorical measure of an individual'due south fertility intentions for the three years post-obit the interview ("Definitely not," "Probably not," "Don't know," Definitely yes," and "Probably yep"). The analysis found a pregnant rise in fertility intentions following the expansion, most notably amongst men, individuals anile 31 to 36, and individuals with at least two children.

Ang (2015) studied two pronatalist programs implemented at dissimilar periods in Quebec, Canada: (a) straight cash benefits (baby bonus), and (b) an increment in parental leave payments from 55 to seventy% of prior income (Quebec Parental Insurance program). The results demonstrated that expanded parental leave payments were associated with greater fertility, admitting with some heterogeneity by nativity parity. The cash benefit programme, by dissimilarity, had smaller effects. Interestingly, the author's assessment of the financial implications of both programs found that the parental leave expansion cost substantively less per additional birth than direct cash benefits.

Farther highlighting why public policy matters for childbearing, Abramowitz (2017) examined state-level variation in insurance mandates for assisted reproductive engineering (Art). The author found that state mandates were associated with delayed childbearing and increased probability of first birth after age thirty, but only for college-educated women. Differences in access and knowledge about Fine art and the insurance mandates by educational attainment may explain why college-educated women appeared more responsive to the mandates.

Beauchamp (2016) addressed whether giving birth in states with increasing ballgame costs was associated with a reduction in the likelihood of partnership dissolution. The author also investigated potential spillover effects of giving birth in areas with ascent ballgame costs in terms of sexual behavior and the family contexts in which children live. The study institute lower separation rates and higher cohabitation following a birth amid poor young women living in states with rise abortion costs. No upshot was found on marriage entry. These results held in estimations using miscarriage as a natural experiment, which provided a control group of significant women who faced the same policy milieu, but did non have a child.

Another fix of JFEI studies focused on teen pregnancy. Ruby and Wang (2015) investigated how contextual characteristics at the state level were associated with teen nativity rates from 2001 to 2009. Their work constitute that greater employment among female teenagers and men aged 20–24 was associated with higher teen nascency rates, especially among disadvantaged youth. In another study, Grossbard and Vernon (2017) probed the effects of mutual constabulary marriage (CLM) on teen births, using the Current Population Survey's fertility supplements from 1990 to 2010 and vital statistics data. Comparing earlier-life childbearing in states that eliminated CLM with states that did not, the authors found a small positive effect of CLM elimination on teen births, just just amid teens anile xv–17.

Appearing in JFEI's policy debate department, Block (2014) developed a theoretical discussion that delineated a third position related to abortion. The author first sketched the parameters of the current contend, contrasting pro-life and pro-choice views of the fetus. Confronting this backdrop, the author outlined a tertiary position termed evictionism, which was framed as a unlike way to think near the abortion result that in some ways reflects a compromise between pro-life and pro-choice positions. A central tenant of this position is that women are seen to have the legitimate correct (derived from property rights) to evict the fetus from their bodies at any time during the pregnancy, only they are non legally permitted to kill the fetus. Ane implication, Cake speculated, is that a greater share of fetuses that are evicted during early stages of pregnancy will survive in the future as medical technology improves.

Children'due south Health

Another thematic area of family unit-health scholarship appearing in the JFEI over the last decade considers the sources and consequences of children's wellness. One strand of this work focused on how children's health influences their parents, largely in terms of labor market outcomes. For instance, the effect of having a child with health problems on maternal employment was examined by Zan and Scharff (2018). They plant that having a child with a disability was associated with lower maternal employment, but the effect differed for racial-ethnic subgroups. A particularly strong upshot was found among Hispanic mothers, and Black mothers appeared specially sensitive to time burdens related to children's wellness bug.

Along a like vein, Richard (2016), using two waves of the child evolution supplements (CDS) of the Panel written report of income dynamics (PSID), institute heterogeneous furnishings of having a child with emotional and behavioral problems (EBP) for maternal employment outcomes by family type. Having a child with a mental disorder was constitute to be associated with lower hourly wage rates and annual earnings amongst single mothers, merely it was positively associated with these outcomes among married mothers, although the positive upshot for almanac earnings became insignificant in a Heckman model that controlled for omitted variables related to labor force participation.

Bhatt (2011) looked at how risky health behaviors among adolescents shape intergenerational financial transfers, using information from the first seven waves of National Longitudinal Survey of Youth 1997 (NLSY97). The analysis demonstrated that parents answer to adolescent children'due south excessive drinking by reducing financial transfers to them (i.eastward., pecuniary parental punishment). In some models, the reduction was around 80 to ninety%.

Some other strand of JFEI studies assessed the factors that shape children'south wellness. Given intensified concerns near childhood obesity, Jung and Chang (2016) provide a timely assessment of maternal employment and childhood weight. Adjusting for the selection of mothers into paid work, they plant heterogeneous effects of maternal employment by family structure, income, and kid'due south age. For example, maternal employment was positively associated with child obesity amidst 3rd to 5th graders in two-parent families with incomes below poverty. This could reflect, the authors reasoned, reduced fourth dimension for caregiving (e.g., meal preparation and supervision) at a critical stage of childhood marked past growing independence. Yet, maternal employment was associated with lower childhood obesity among poor female-headed households, reflecting positive links between work hours and resources.

Two of the manufactures reviewed considered how religiosity might influence children's health. Chiswick and Mirtcheva (2013) examined children's concrete and mental health by religious amalgamation and church attendance. Relying mainly on a sample of 2604 children aged 6–xix from the 2002 Child Development Supplement to the Panel Report of Income Dynamics (PSID), the written report institute that religious affiliation and church attendance was associated with improved physical and psychological wellness, especially notable in adolescents' mental health. Results were shown to be robust to adjustments for choice bias into religion using propensity-matching techniques.

Delaney and Winters (2014) probed whether children of the clergy ("preachers' kids") differed in use and intensity of booze, cigarette, marijuana, and other drugs relative to their peers. They found lower use of booze, marijuana, and other drugs among preachers' kids. However, cigarette smoking and intensity of consumption amidst users did non bear witness systematic cross-group differentials. The authors underscore the importance of social relationships and networks for comprehending children's health behaviors.

Gustavsen et al. (2016) besides investigated children's risk behaviors, but focused on the impact of parental relationship dissolution. Examining a sample of adolescents and young adults from Add together Health data, they found parental divorce was associated with greater odds of risky behaviors among adolescents, specially for girls. For instance, children from divorced families had a 10% higher likelihood of binge drinking and alcohol consumption, tobacco use, and marijuana uptake. Difficult drug utilize was not associated with parental divorce, only higher tobacco and marijuana utilise persisted over time.

Hofferth and Pinzon (2011) considered how nonresidential fathers' child support and contact shape children's health post-obit a human relationship dissolution. Using United states data from the Early Childhood Longitudinal Survey (ECLS-One thousand), the authors found that fathers' support payments and contact frequency following relationship dissolution had no effect on children's health. However, poor child wellness was associated with reduced support payments. The authors posited that fathers' fourth dimension and financial investments may depend on child health, suggesting that children with poor health could exist doubly disadvantaged following parental relationship dissolution.

Beyond parental human relationship status mattering for children's wellness, Lim (2019) called attending to the importance of parental employment. Drawing longitudinal data from 1994 to 2008 in the National Longitudinal Survey of Youth and Children and Young Adults 1979, the study identified variation in children's health insurance status past types of maternal employment, including part-time, temporary, contract, and self-employment. The author concluded that children with mothers in nonstandard work were the well-nigh disadvantaged in terms of wellness insurance coverage, particularly amongst single mothers.

Finally, Choi (2011) examined whether parental health influences children's piece of work condition and educational attainment equally they historic period, which in turn shapes their health trajectories. Drawing panel data from the Russia Longitudinal Monitoring Survey (1994–2004), the report estimated the effects of changes in parental self-reported health status on children aged thirteen–29 living with both parents over the 10-year ascertainment period. A significant gender differential was constitute. Health declines amongst fathers was associated with lower educational achievement and labor market place participation among daughters but not sons. Explanations for this blueprint point to the gender gap in caregiving, which leads to a reduction in daughters' (merely not sons') educational investments and labor supply when a parent is ill.

Relationships and Adult Health

The selected JFEI manufactures also demonstrate the importance of social relationships for adult health. Kohn and Averett (2014), using information from xviii years of the British Household Panel Survey, constitute that being in a relationship (matrimony and cohabitation) was protective of health. The written report used a dynamic fixed-effects model with a variety of instruments to suit for potential reverse causality from health status to relationship status. Importantly, their assay showed that marriage and cohabitation had equally beneficial effects for health.

Miller and Pylypchuk (2014) identified preventive care utilization as an important pathway that tin can explicate why marriage improves health. Examining rich data from the Medical Expenditure panel survey (MEPS-HC) and linked National Wellness Interview Survey (NHIS), the authors found that marriage was associated with greater preventive physical and dental examinations relative to those who remained single. For women, marriage also was associated with greater utilization of mammograms and pap smears. A number of spousal characteristics, such as education, income, and risk preferences, were institute to generate heterogeneity in the observed effects.

Recent work by Eshak (2019) highlighted that work-family links likewise can shape health; in particular, that work-family imbalances can impairment mental health. Using a novel cross-exclusive survey administered in Upper Egypt, the author establish that work-to-family unit conflict was associated with greater probability of mental health problems. Family unit-to-work disharmonize also was related to mental health bug but to a lesser caste. Notably, traveling away from abode for piece of work as well as reduced sleep due to family unit responsibilities were among the factors most negatively associated with mental wellness.

JFEI research over the past decade has shown that living arrangements tin shape health via the spillover effects they have. Hither, Robinson (2013) assessed the inside-family effects of wellness and nutrition programs on non-eligible family members, using information from the Usa National Health and Nutrition Examination Survey. The author found positive wellness spillovers of Women'southward, Infants, and Children supplemental (WIC) nutrient program participation across siblings. In detail, non-eligible children in households participating in the WIC program reported better health than comparable children in not-participating households, especially older male children. The author attributed this pattern to the reallocation of financial resource toward older children due to changes in nutrient budgets.

Caregiving: Patterns and Consequences

Caregiving is some other important dimension of the family-health nexus identified in JFEI publications over the last decade. Suh (2016) illustrated the complexity and implications of caregiving measurement, with a focus on "sandwich" care. Using pooled samples from the American Fourth dimension Apply Survey (ATUS), the study distinguished betwixt interactive (e.g., concrete care) and supervisory (east.g., watching children, trips to doctors) forms of care. The author found that the share of individuals aged 25–44 engaged in interactive child and developed intendance on the aforementioned day (sandwich care) was seven.viii% for women and 4.8% for men. However, adopting a broader definition of care, the proportion rose to 77.two% of women and 62.v% of men. The estimated time burden for those engaged in childcare and interactive adult care was 10.nine hateful daily hours for women aged 25–44 and 8.ii for men. The author stressed the demand to develop more comprehensive measures of sandwich care to better understand patterns, consequences, and variation across subgroups.

Shooshtari et al. (2017) provided a timely assessment of the economic and social consequences of caregiving in the Canadian context, using representative data from the 2007 General Social Survey. They found that 42% of Canadian caregivers reported at to the lowest degree one adverse health or social impact, with the most common being a reduction of social and leisure activities. Interestingly, elevated out-of-pocket spending was associated with more than negative consequences of caregiving.

Kusa (2019) looked at caregiving in terms of support for intra-family time transfers. Using representative data (GESIS Panel) in Germany, the author examined variation in the support for the equity principle for budgetary compensation for two types of caregiving: (a) long-term care to elderly parents provided past adult children, and (b) childcare provided by grandparents. The majority (79%) reported back up for monetary compensation for long-term care of elderly parents, while a substantively smaller proportion (38%) reported support for childcare by grandparents. Attitudes varied beyond private characteristics including socioeconomic status, age, and cocky-serving bias measures. Notably, support for budgetary compensation for both caregiving types was highest amongst older respondents.

Impact of Health on Economical Circumstances

A stream of the selected JFEI studies sought to understand the consequences of health for individuals' and households' economic circumstances. Giovanis and Ozdamar (2019) assessed how disability affects the labor supply and wages of Iraqi women. Analyzing data from the Iraqi Household Socio-economic Survey (IHSES (2012–2013), the findings revealed strong negative effects of disability on women's likelihood both to participate in the labor market and their wages if working. The authors emphasized the reduced household bargaining power of disabled women and the need to promote expanded labor market opportunities for them.

Mussida and Sciulli'southward (2019) study addressed how the presence of a disabled person in the household affects the employment of women in cohabiting relationships in three countries (Italy, France, and UK) with unlike cultural and policy milieus. The authors found lower employment rates amid women cohabiting with a disabled person in Italy, a country with more than limited formal caregiving services and a stronger male person breadwinner model. In dissimilarity, the presence of a disabled person was institute to be associated with greater women'south employment in France and the Uk, 2 countries with greater opportunities for part-time piece of work and formal care services.

Other studies remind us of the substantive economic consequences of health. The financial impact of cancer was examined by Svynarenko et al. (2019). Drawing console information from ix biannual waves of the Health and Retirement Report (HRS) spanning 1998 to 2014, a central innovation of the study was to prefer broader measures of economic outcomes that included changes in household liquidity, solvency, and investment ratios. The authors' analysis uncovered of import increases in liquidity and debt-to-assets in the initial phase of cancer care. The costs of cancer intendance and rehabilitation for liquidity and solvency outcomes were more modest among insured survivors, only lasting declines in investment assets to cyberspace worth were observed. This suggested, according to the authors, that cancer survivors may tap into retirement savings to meet the financial needs related to care.

White-Ways and Osmani (2019) focused on cancer survivors' labor marketplace patterns across racial-ethnic groups. Using loftier quality information from the US Medical Expenditure Console Survey (MEPS) over the flow of 2008–2014, the authors found lower probability of employment among Hispanic and Blackness breast cancer survivors relative to Whites. Among those employed, however, Black and Hispanic breast cancer survivors worked more hours. Amid prostate cancer survivors, Blacks had lower employment rates than comparable Whites. The analysis identified racial differences in job characteristics, such as concentration in blueish collar or service occupations, every bit helping to explain the differential outcomes.

In add-on to electric current economic circumstance, health also shapes the need for long-term care insurance (LTC). Barnett and Stum (2012)'due south report sought to improve understanding of the factors that influence admission and coverage to long-term intendance insurance from a couple-level perspective. Conducting a qualitative dyadic analysis of married couples in Minnesota, the study revealed substantive consensus amidst couples in terms of their LTC intentions, but heterogeneity was also found in terms of their decision outcomes, such equally the decision of whether to purchase LTCI, self-insure, or have no action.

Finally, Berger et al. (2016) study of the relationship between household debt and depression (CES-D partial scale) showed that health not just matters for economic outcomes, but economical circumstances also matters for health. Using data from adults ages 21–65 years in ii waves of the National Survey of Families and Households, they found that greater short-term unsecured debt (e.g., consumer debt) was associated with more than depression, while the relationship betwixt longer-term debt and depression was much weaker. According to the authors this may indicate that curt-term unsecured debt may be taken on with less personal choice. The negative associations between unsecured debt and mental health were particularly notable among older individuals and the less educated.

Future Research

Time to come research addressing the interplay between family and health has far-reaching significance, and studies appearing in the JFEI over the last decade accept informed much about these linkages. Despite the progress, significant piece of work remains to be washed.

To begin with, scholarship might benefit from greater focus on the complex and multilevel pathways that link family and health outcomes. Virtually research to date is primarily focused on understanding particular family and health relationships rather than what processes connect them. A claiming is that information oft provide limited data about mechanisms. For example, Jung and Chang (2016) demonstrated significant associations between maternal employment and babyhood weight gain, only data on the potential mechanisms underlying this human relationship are likely not available (due east.g., meal preparation).

Research in the adjacent decade is poised to develop more robust causal evidence about family and wellness linkages. 1 enduring complexity relates to the selection processes that bulldoze both entry and get out into family and wellness statuses. Understanding selection into statuses like marriage and divorce has attracted considerable attending, still existing knowledge is based on patterns observed in older cohorts. Selection processes may be different in younger cohorts. Moreover, option into 2d club marital statuses, like remarriage, or separately, having a child with health problems, are not well studied. One way forwards may be greater utilize of longitudinal or retrospective data that provide information nigh a person's health, family, and economic statuses prior to the contemporaneous relationship of interest. Such data may allow better identification of the sequencing of family unit and health events over the life class. No dubiety, researchers will notice ways to strengthen causal inferences by building on their methodological toolkits.

Another fruitful avenue of futurity investigations entails studying the health implications of the "second demographic transition." The greater complexity and diversity in relationships implicated by the 2d demographic transition means that research may benefit from greater attention to the health consequences of family histories rather than current status (Tamborini et al. 2016). Fewer marital relationships and smaller families as well suggest potentially narrower pools of caregivers. Finally, to the extent that various family unit structures and households become more than normative (e.g., divorce, blended families), reconsideration of a range of family unit-health linkages in more recent cohorts is warranted.

Additionally, in that location is connected demand to account for heterogeneity. The family and health relationships nosotros investigate not simply differ across commonly examined covariates such as gender, educational activity, and income subgroups, just also by the timing of events (eastward.g., early on or late life), duration of statuses (due east.g., length of marriage) and relationship quality, among other aspects.

Novel contributions also tin can be made by devoting greater attention to family unit-health linkages over longer stretches of an individual's life. Although researchers increasingly employ longitudinal data, the follow-upward menses often encompasses only several years. Analysis of long-term longitudinal data or retrospective life histories tin can be revealing and allow for better identification of the sequencing of events (Tamborini et al. 2016).

To be sure, hereafter research also would benefit from assay of the brusk- and long-term impacts of COVID-nineteen. Economical pressures associated with the pandemic, including high levels of unemployment and underemployment, along with social distancing and lockdowns, are probable to alter the timing and incidence of family-related life events including divorce, separation, and union formation. How these life events shape health-related behaviors and long-term health outcomes in the context of the pandemic are besides of interest. COVID-nineteen likewise has important consequences for caregiving. Smaller families have reduced the puddle of informal caregivers for older adults, who are at college take a chance of complications or death from COVID-19, besides as social isolation. The extent to which the agin impacts of COVID-19 for families and health are experienced disproportionately by disadvantaged groups in afflicted countries is a topic of item importance.

Finally, a new generation of research is likely to make utilise of novel sources of information. Innovative data capturing intergenerational ties may allow researchers to cast new lite on family and health processes from one generation to the next. The increasing utilise of administrative data, especially those matched to survey information (Penner and Dodge 2019; Couch et al. 2015), is also promising. Furthermore, emerging methods in text analysis of social media as well every bit new forms of information mining and analytic tools may enhance scholarship on family and health in means not yet anticipated.

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Acknowledgements

All piece of work for this article took place outside of the author'southward official duty hours at the Social Security Administration.

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1. Section of Sociology, The Catholic Academy of America, 103 Aquinas Hall, Washington, DC, 20064, USA

   Christopher R. Tamborini

2. Institute for Policy & Social Enquiry, University of Kansas, Lawrence, USA

   Christopher R. Tamborini

3. Role of Inquiry, Evaluation, and Statistics, U.S. Social Security Administration, Washington, DC, USA

   Christopher R. Tamborini

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This is 1 of several papers published together in Journal of Family and Economic Issues on the "Special Issue on Virtual Decade in Review".

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Tamborini, C.R. Family and Health over the Past Decade: Review of Selected Studies and Areas of Future Inquiry. J Fam Econ Iss 42, 62–69 (2021). https://doi.org/10.1007/s10834-020-09713-9

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• Accepted: 11 September 2020

• Published: 23 October 2020

• Effect Date: July 2021

• DOI : https://doi.org/ten.1007/s10834-020-09713-9

Keywords

• Family
• Health
• Decade in review

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