Tag Archives: population research

Death of an adult son increases depressive symptoms in mothers, but not fathers (Social Science and Medicine)

Sad mother picture

A study by researchers at Princeton and Georgetown Universities found that Taiwanese mothers – but not fathers – experience depressive symptoms after an adult son’s death, while the death of a daughter had no such effect on either parent.

By B. Rose Huber, Woodrow Wilson School of Public and International Affairs

Mothers – but not fathers – exhibited symptoms of depression and experienced declines in overall health after the death of an adult son, while the death of a daughter had no such effect on either parent, according to one of the first studies to examine the impacts of the death of an adult child on parents aged 65 and older.

In East Asian cultures, an adult son’s role in the family is crucial to the wellbeing and financial stability of his parents, the researchers suggest. Therefore, a traumatic event, like the death of a son, could place quite a strain on elderly parents living in these cultures – particularly women, especially if the deceased son is the eldest or only son.

The researchers, from the Office of Population Research in Princeton University’s Woodrow Wilson School, published their findings in the journal Social Science & Medicine based on data from the Taiwanese Longitudinal Study of Aging, a nationally representative survey designed to assess the health of older people in Taiwan.

“In East Asian cultures like Taiwan, sons hold the primary responsibility for providing financial and instrumental assistance to their elderly parents,” said lead author Chioun Lee, a Princeton postdoctoral research associate. “Older women who have had particularly few educational and occupational opportunities are more likely to rely on their sons for support. Therefore, a traumatic event, like a son’s death, could place quite a strain on a mother’s health.”

Along with study coauthor Noreen Goldman, the Hughes-Rogers Professor of Demography and Public Affairs at WWS, and researchers from Georgetown University, Lee used data collected for the Taiwanese Longitudinal Study of Aging from 1996 to 2007, which included approximately 4,200 participants.

To evaluate parental wellbeing, they used two self-reported measures: one for overall health and another for depressive symptoms. Each respondent’s health was assessed based on the following question: “Regarding your current state of health, do you feel it is excellent, good, average, not so good, or poor?” The items were coded on a one-to-five-point scale with higher scores indicating better health. Past studies have indicated that this measure is a strong predictor of mortality.

Depressive symptoms were measured with an eight-item subset of the Center for Epidemiological Studies Depression Scale, which asks participants to report how often they’ve experienced various situations or feelings in the past week. Possible answers range from “0,” which means rarely or none of the time, to “3,” which is most or all of the time. Higher scores for the eight items indicate more frequent depressive symptoms.

The researchers controlled for parental wellbeing prior to the death of a child and analyzed the data in two stages. First, they tested the extent to which a child’s death affected a parent’s health and then whether that varied by the parent’s sex. Finally, they determined the influence of a deceased child’s sex on parental wellbeing.

They found that women who lost a son scored, on average, 2.4 points higher on levels of depressive symptoms than those who did not lose a child. For men, there were no significant differences. There was no evidence to suggest that either mothers or fathers were significantly affected by depressive symptoms or declines in reports of overall health following the death of a daughter. Lee explains that while finances are a concern, there may be other factors at play.

“I also think that various attributes of deceased children, such as birth order, affective bonds with their parents or cause of death, might influence parental wellbeing,” said Lee, who is a native of Korea and observed son preference and gender inequality throughout her childhood.

According to Goldman, these findings underscore the continued gender inequality in Taiwan.

“Despite large advances in women’s labor market participation and educational attainment in recent years – for example, women in Taiwan are now more likely than men to hold a higher education degree – son preference persists, affecting various aspects of women’s well-being,” Goldman said.

Read the abstract.

Lee, C., et al., Death of a child and parental wellbeing in old age: Evidence from Taiwan, Social Science & Medicine (2013), http://dx.doi.org/10.1016/jsocscimed.2013.08.007

The work was funded by the Demography and Epidemiology Unit of the Division of Behavioral and Social Research at the National Institute on Aging and the Eunice Kennedy Shriver National Institute of Child Health and Human Development.

More or less equal? How men factor into the reproductive equation (Gender & Society)

A new study calls attention to the role of men’s behavior and health in reproductive outcomes, such as fetal health, birth defects and childhood diseases. (Image credit: CDC/Amanda Mills)

A new study calls attention to the role of men’s behavior and health in reproductive outcomes, such as fetal health, birth defects and childhood diseases. (Image credit: CDC/Amanda Mills)

By Bess Connolly Martell, Office of Public Affairs and Communications, Yale University

Researchers know a lot about how women’s bodily health affects their fertility, but less is known about how men’s health affects reproductive outcomes. Yale University researcher Rene Almeling and co-author Miranda Waggoner of Princeton University address this discrepancy in an article published Tuesday, Dec. 3, in the journal Gender & Society.

In the period before conception, family health history and current health behaviors matter for women and men alike, say the researchers, adding that more clinical research needs to be done on how men’s bodily health affects their sperm, and in turn, reproductive health outcomes.

“The lack of attention to men in research on reproduction leaves open many important questions, including how men’s reproductive contributions are understood,” say Almeling, an assistant professor of sociology at Yale, and Waggoner, a postdoctoral researcher in the Office of Population Research in the Woodrow Wilson School of Public and International Affairs at Princeton.

The vast majority of medical and social science research on reproduction focuses on women. It wasn’t until recently that scientists began studying the role that men’s behavior and men’s health play in reproductive outcomes, such as fetal health, birth defects and childhood diseases.

The stereotypical association of women with family and men with work has led to a focus on women’s bodies in reproduction, leaving the question of how men’s health contributes to reproduction unanswered.

“What kinds of advice, if any, do men receive about preparing their bodies for reproduction?” ask the researchers. “Men should be empowered with information about how their age, health history and unhealthy behaviors can affect pregnancy outcomes.”

The sperm bank is one of the few places where men’s reproductive health takes center stage, the researchers note. At sperm banks, men are counseled on healthy eating, avoiding stress and reducing alcohol consumption. Not adhering to this advice can and does lead to lower sperm counts, suggesting that this kind of guidance might be more broadly useful for men trying to conceive children with their partners.

There are also associated policy implications. The Affordable Care Act stipulates that women with private insurance are no longer required to pay for preconception health appointments, but excluding men from such coverage continues to obscure their role in reproduction, say Almeling and Waggoner. “Paying attention to how reproductive equations influence policy can suggest new and different avenues for improving public health,” say the sociologists. They add, “Recent public health initiatives devoted to preconception care offer at least the possibility that men’s reproductive contributions will be considered alongside women’s.”

Read the abstract.

Almeling, Rene and Miranda R. Waggoner. More and Less than Equal: How Men Factor in the Reproductive Equation. Gender & Society December 2013 27: 821-842, first published on April 25, 2013 doi:10.1177/0891243213484510.

Both authors received funding from the National Science Foundation (Almeling grant #0602871 and Waggoner grant #1029087), and Miranda Waggoner also received support from the National Institutes of Health (T32 HD007163).

Small declines in agility, facial features may predict risk of dying (Epidemiology)

Photo source: Shutter Stock

Photo source: Shutter Stock

By B. Rose Huber, Woodrow Wilson School of Public and International Affairs

A new study from Princeton University shows that health assessments made by medically untrained interviewers may predict the mortality of individuals better than those made by physicians or the individuals themselves.

Features like forehead wrinkles and lack of agility may reflect a person’s overall health and risk of dying, according to recent health research. But do physicians consider such details when assessing patients’ overall health and functioning?

In a survey of approximately 1,200 Taiwanese participants, Princeton University researchers found that interviewers — who were not health professionals but were trained to administer the survey — provided health assessments that were related to a survey participant’s risk of dying, in part because they were attuned to facial expressions, responsiveness and overall agility.

The researchers report in the journal Epidemiology that these assessments were even more accurate predictors of dying than assessments made by physicians or even the individuals themselves. The findings show that survey interviewers, who typically spend a fair amount of time observing participants, can glean important information regarding participants’ health through thorough observations.

“Your face and body reveal a lot about your life. We speculate that a lot of information about a person’s health is reflected in their face, movements, speech and functioning, as well as in the information explicitly collected during interviews,” said Noreen Goldman, Hughes-Rogers Professor of Demography and Public Affairs in the Woodrow Wilson School.

Together with lead author of the paper, Princeton Ph.D. candidate Megan Todd, Goldman analyzed data collected by the Social Environment and Biomarkers of Aging Study (SEBAS). This study was designed by Goldman and co-investigator Maxine Weinstein at Georgetown University to evaluate the linkages among the social environment, stress and health. Beginning in 2000, SEBAS conducted extensive home interviews, collected biological specimens and administered medical examinations with middle-aged and older adults in Taiwan. Goldman and Todd used the 2006 wave of this study, which included both interviewer and physician assessments, for their analysis. They also included death registration data through 2011 to ascertain the survival status of those interviewed.

The survey used in the study included detailed questions regarding participants’ health conditions and social environment. Participants’ physical functioning was evaluated through tasks that determined, for example, their walking speed and grip strength. Health assessments were elicited from participants, interviewers and physicians on identical five-point scales by asking “Regarding your/the respondent’s current state of health, do you feel it is excellent (5), good (4), average (3), not so good (2) or poor (1)?”

Participants answered this question near the beginning of the interview, before other health questions were asked. Interviewers assessed the participants’ health at the end of the survey, after administering the questionnaire and evaluating participants’ performance on a set of tasks, such as walking a short distance and getting up and down from a chair. And physicians — who were hired by the study and were not the participants’ primary care physicians — provided their assessments after physical exams and reviews of the participants’ medical histories. (Study investigators did not provide special guidance about how to rate overall health to any group.)

In order to understand the many variables that go into predicting mortality, Goldman and Todd factored into their statistical models such socio-demographic variables as gender, place of residence, education, marital status, and participation in social activities. They also considered chronic conditions, psychological wellbeing (such as depressive symptoms) and physical functioning to account for a fuller picture of health.

“Mortality is easy to measure because we have death records indicating when a person has died,” Goldman said. “Overall health, on the other hand, is very complicated to measure but obviously very important for addressing health policy issues.”

Two unexpected results emerged from Goldman and Todd’s analysis. The first: physicians’ ratings proved to be weak predictors of survival. “The physicians performed a medical exam equivalent to an annual physical exam, plus an abdominal ultrasound; they have specialized knowledge regarding health conditions,” Goldman explained. “Given access to such information, we anticipated stronger, more accurate predictions of death,” she said. “These results call into question previous studies’ assumptions that physicians’ ‘objective health’ ratings are superior to ‘subjective’ ratings provided by the survey participants themselves.”

In a second surprising finding, the team found that interviewers’ ratings were considerably more powerful for predicting mortality than self-ratings. This is likely, Goldman said, because interviewers considered respondents’ movements, appearance and responsiveness in addition to the detailed health information gathered during the interviews. Also, Goldman posits, interviewer ratings are probably less affected by bias than self-reports.

“The ‘self-rated health’ question is religiously used by health researchers and social scientists, and, although it has been shown to predict mortality, it suffers from many biases. People use it because it’s easy and simple,” Goldman continued. “But the problem with self-rated health is that we have no idea what reference group the respondent is using when evaluating his or her own health. Different ethnic and racial groups respond differently as do varying socioeconomic groups. We need other simple ways to rate individual health instead of relying so heavily on self-rated health.”

One way, Goldman suggests, is by including interviewer ratings in surveys along with self-ratings: “This is a straightforward and cost-free addition to a questionnaire that is likely to improve our measurement of health in any population,” Goldman said.

The paper, “Do Interviewer and Physician Health Ratings Predict Mortality? A Comparison with Self-Rated Health,” first appeared online in Epidemology in August 2013. The article also will be featured in the November print edition. The research was conducted with the assistance of colleagues at Princeton’s Office of Population Research, Georgetown University and the Bureau of Health Promotion in the Taiwan Department of Health.

Read the abstract.

Todd MA, Goldman N. Do interviewer and physician health ratings predict mortality?: a comparison with self-rated health. Epidemiology. 2013 Nov;24(6):913-20. doi: 10.1097/EDE.0b013e3182a713a8.

 

Princeton researchers use mobile phones to measure happiness (Demography)

By Tara Thean, Science-Writing Intern, Office of the Dean for Research

World map

Locations of study subjects on world map (Source: Demography)

Researchers at Princeton University are developing ways to use mobile phones to explore how one’s environment influences one’s sense of well-being.

In a study involving volunteers who agreed to provide information about their feelings and locations, the researchers found that cell phones can efficiently capture information that is otherwise difficult to record, given today’s on-the-go lifestyle. This is important, according to the researchers, because feelings recorded “in the moment” are likely to be more accurate than feelings jotted down after the fact.

To conduct the study, the team created an application for the Android operating system that documented each person’s location and periodically sent the question, “How happy are you?”

The investigators invited people to download the app, and over a three-week period, collected information from 270 volunteers in 13 countries who were asked to rate their happiness on a scale of 0 to 5. From the information collected, the researchers created and fine-tuned methods that could lead to a better understanding of how our environments influence emotional well-being. The study was published in the June issue of Demography.

The mobile phone method could help overcome some of the limitations that come with surveys conducted at people’s homes, according to the researchers. Census measurements tie people to specific areas — the census tracts in which they live — that are usually not the only areas that people actually frequent.

“People spend a significant amount of time outside their census tracks,” said John Palmer, a graduate student in the Woodrow Wilson School of Public and International Affairs and the paper’s lead author. “If we want to get more precise findings of contextual measurements we need to use techniques like this.”

Palmer teamed up with Thomas Espenshade, professor of sociology emeritus, and Frederic Bartumeus, a specialist in movement ecology at the Center for Advanced Studies of Blanes in Spain, along with Princeton’s Chang Chung, a statistical programmer and data archivist in the Office of Population Research; Necati Ozgencil, a former Professional Specialist at Princeton; and Kathleen Li, who earned her undergraduate degree in computer science from Princeton in 2010, to design the free, open source application for the Android platform that would record participants’ locations at various intervals based on either GPS satellites or cellular tower signals.

Though many of the volunteers lived in the United States, some were in Australia, Canada, China, France, Germany, Israel, Japan, Norway, South Korea, Spain, Sweden and the United Kingdom.

Palmer noted that the team’s focus at this stage was not on generalizable conclusions about the link between environment and happiness, but rather on learning more about the mobile phone’s capabilities for data collection. “I’d be hesitant to try to extend our substantive findings beyond those people who volunteered.” he said.

However, the team did obtain some preliminary results regarding happiness: for example, male subjects tended to describe themselves as less happy when they were further from their homes, whereas females did not demonstrate a particular trend with regards to emotions and distance.

“One of the limitations of the study is that it is not representative of all people,” Palmer said. Participants had to have smartphones and be Internet users. It is also possible that people who were happy were more likely to respond to the survey. However, Palmer said, the study demonstrates the potential for mobile phone research to reach groups of people that may be less accessible by paper surveys or interviews.

Palmer’s doctoral dissertation will expand on this research, and his adviser Marta Tienda, the Maurice P. During Professor in Demographic Studies, said she was excited to see how it will impact the academic community. “His applied research promises to redefine how social scientists understand intergroup relations on many levels,” she said.

This study involved contributions from the Center for Information Technology Policy at Princeton University, with institutional support from the National Institutes of Health Training Grant T32HD07163 and Infrastructure Grant R24HD047879.

Read the abstract.

Palmer, John R. B., Thomas J. Espenshade, Frederic Bartumeus, Chang Y. Chung, Necati Ercan Ozgencil and Kathleen Li. 2013. New Approaches to Human Mobility: Using Mobile Phones for Demographic Research. Demography 50:1105–1128. DOI 10.1007/s13524-012-0175-z