Journal of Health and Social Behavior

The lack of health insurance is traditionally considered a problem faced by individuals and their families. However, because of the geographically bounded organization and funding of healthcare in the United States, levels of uninsurance in a community may affect everyone living there. Health economists have examined how the effects of uninsurance spillover from the uninsured to the insured, negatively affecting healthcare access and quality for the insured. We extend research on uninsurance into the domain of sociologists by theorizing how uninsurance might exacerbate social inequalities and undermine social cohesion within communities. Using data from the Los Angeles Family and Neighborhood Survey, we show that individuals living in communities with higher levels of uninsurance report lower social cohesion net of other individual and neighborhood factors and discuss implications for implementation of the Affordable Care Act.

A substantial and long-standing body of research supports the widely held conclusion that socioeconomic position (SEP) is a primary determinant of physical health risk. However, supporting evidence derives almost entirely from studies of dominantly white populations, and more recent research suggests that this relationship may vary across race-ethnicity. This article considers the extent to which such evidence applies to African Americans. It does so by examining the within-race relationships between SEP and physical health utilizing alternative research definitions of health and a nearly exhaustive array of measures of SEP. The results offer minimal support for SEP as a fundamental cause of disease among African Americans. They do not challenge the widely held view that health differences are rooted in the fundamental conditions of social context and experience. Rather, they indicate that these conditions tend to be defined more by being black than by being of lower SEP.

Marriage is associated with reductions in both perceived stress and depressive symptoms, two constructs found to be influenced by common genetic effects. A study of sibling twins was used to test whether marriage decreases the proportion of variance in depressive symptoms accounted for by genetic and environmental effects underlying perceived stress. The sample consisted of 1,612 male and female twin pairs from the University of Washington Twin Registry. The stress-buffering role of marriage was tested relative to two unmarried groups: the never married and the divorced. Multivariate twin models showed that marriage reduced genetic effects of perceived stress on depressive symptoms but did not reduce environmental effects. The findings suggest a potential marital trade-off for women: access to a spouse may decrease genetic effects of perceived stress on depressive symptoms, although marital and family demands may increase environmental effects of perceived stress on depressive symptoms.

This population-based study (N = 908,468) examines the effects of spousal loss on being absent from work due to illness or injury (sickness absence) among employed individuals in Norway. Fixed-effects models capturing antecedent and short- and long-term effects of spousal loss over a 15-year period were estimated to explore gender and age differences in the impact of widowhood. The crisis model, the social-role model, and the life course perspective are discussed. Furthermore, the study calls into question whether parenthood explains the gendered age gradient of the widowhood effect. The results show that the theoretical relevance of the crisis and social-role models is best understood in dialogue with a gendered life course approach. The results show that the crisis response is especially high among young widowers, whereas the recovery period is markedly prolonged among young widows. Parenthood at the time of widowhood explains much of the age difference among widowers and widows.

Although the relationship between education and mortality is well documented in the general population, it has not been examined for adults with intellectual disability. Informed by fundamental cause theory, I explore the association between education and mortality in a sample of 4,241 adults with intellectual disability from the 1986–2009 National Health Interview Survey with Linked Mortality Files through 2011. Cox regression models were utilized to analyze the predictive effect of education on mortality risk while taking into account birth cohort differences. Increased education was associated with lower mortality risk for adults with intellectual disability, and this relationship strengthened in later birth cohorts who had greater access to the public education system. Comparison with a sample of 21,205 adults without intellectual disability demonstrates that the association between education and mortality risk was not as robust for adults with intellectual disability and highlights the ongoing socioeconomic challenges faced by this population.

Using five waves of the Taiwanese Longitudinal Study of Aging (1996–2011), we investigate (1) the association between family members’ education and the age trajectories of individuals’ depressive symptoms and (2) gender differences in those relationships. Our examination is guided by several theoretical frameworks, including social capital, social control, age as leveler, and resource substitution. Nested models show that having a more educated father is associated with lower depressive symptoms, but the relationship disappears after controlling for respondent’s education. Including spouse’s education attenuates the coefficient for respondent’s education. A similar pattern appears when children’s education is added to the model. Among all the family members, children’s education has the strongest association with depressive symptoms, with a similar magnitude for both genders, although its strength gradually weakens as respondents age. Our findings suggest the importance of the transfer of resources from children to parents and how it may affect mental health at older ages.

Romantic involvement and mental health are dynamically linked, but this interplay can vary across the life course in ways that speak to the social and psychological underpinnings of healthy development. To explore this variation, this study examined how romantic involvement was associated with trajectories of depressive symptomatology across the transition between adolescence and young adulthood. Growth mixture modeling of data from the National Longitudinal Study of Adolescent to Adult Health identified trajectories of depressive symptomatology as teens grew into their late 20s and early 30s (N = 8,712). Multinomial logistic techniques regressed these trajectories on adolescent and young adult romantic experiences. Adolescent dating was associated with increased depressive symptoms early on, particularly for girls, but this risk faded over time. For both boys and girls, trajectories of decreasing symptoms were associated with young adult unions but also the coupling of adolescent dating with young adult singlehood.

In recent years, quickly discharging patients has become a collective goal at hospitals, as excessive medical workups and extended hospital stays have been associated with unnecessary healthcare spending. Physicians, however, frequently encounter numerous barriers when trying to discharge patients. Presenting ethnographic and interview data collected from September 2010 to September 2013, this paper examines one of the most difficult discharge cases physicians encounter on the internal medicine service at a U.S. teaching hospital: resistant patients—patients and families who refuse to leave the hospital. As physicians try to discharge resistant patients, they are met with conflicting financial and professional incentives. Drawing from the sociological literature on professions, managerialism, and consumerism, I analyze the strategies physicians develop to manage these difficult discharge cases.