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The Pro-family Workplace: Social and Economic Policies and Practices and Their Impacts on Child and Family Health

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Abstract

Social and economic policies designed to improve working conditions and employee well-being in adulthood have often resulted in the unintentional improvement of the health of children and their parents. Unfortunately, the USA is behind in implementing such policies and is losing ground in the health of its families compared to most other industrialized countries. We present historical patterns of infant mortality and women’s life expectancy, both indicators of child and family health, over time and across the USA and other industrialized countries. Using a predominantly ecosocial framework, we review the channels or mechanisms that may link social or economic policy to a physiological change in children and/or their close family members. We continue to review a range of family and labor policies and evidence linking specific family and work policies to child and family health outcomes. We argue that, despite challenges, the identification of social and economic policies that impact the work/family interface and promote family health and well-being is critical and that the conditions which improve health for families will likely require modification in the public policy arena.

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... Increased health and wellbeing for families (Berkman & O'Donnell, 2013). ...
... It is known that health disparities begin early in life, and family care policy is an intervention that reduces health and developmental inequalities (Landale, McHale, and Booth, 2013). In most countries, the details of family care policy changed and shifted with political change (Berkman & O'Donnell, 2013). The various stated goals of policy included increasing the health of mother and child, increasing the birth rate, promoting gender equality, maximizing the labor-market by being flexible, reducing emigration, and decreasing child poverty (Brockington, 1996;Chatterji et al., 2013;Davaki, 2010;Galtry & Callister, 2005;Harris, 1919;Nicklett & Perron, 2010;Tanaka, 2005). ...
... The various stated goals of policy included increasing the health of mother and child, increasing the birth rate, promoting gender equality, maximizing the labor-market by being flexible, reducing emigration, and decreasing child poverty (Brockington, 1996;Chatterji et al., 2013;Davaki, 2010;Galtry & Callister, 2005;Harris, 1919;Nicklett & Perron, 2010;Tanaka, 2005). Research has demonstrated that policies that invest in parents have a positive spillover effect that benefits children (Berkman & O'Donnell, 2013). Many argue the long-term cost-effectiveness of investing into mothers and families (Baker & Milligan, 2008;Berkman & O'Donnell, 2013;Folbre, 2001Folbre, , 2006Heckman & Kautz, 2012;Noddings, 2003;Spalter-Roth & Hartmann, 1990). ...
Thesis
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Family care leave policy, including maternity, parental, and childcare leave, has a significant influence on the critical months of a child's life and consequentially an influence on long-term outcomes as well. Guided by research on parent-infant attachment and bonding as well as the theories of Ainsworth (1979, 1991) and Bowlby (1946, 1951) regarding parent and child interaction and long-term wellbeing, this paper examined differences in family care leave policy in relation to self-reported wellbeing indicators of health, income, happiness and life-satisfaction for birth-cohorts in Canada, Switzerland, Germany, Spain, Finland, France, Italy, Norway, Sweden, and the United Kingdom. Independent variables included weeks of maternity leave, parental leave, childcare leave, and paid leave. Control variables included age, education, birth year, survey year, country, and gender. The main goal of this research was to address a gap in family care policy by determining how family care leave policies are correlated with long-term self-reported wellbeing outcomes of health, income, happiness, and life satisfaction for birth cohorts born between 1960–1987 in the selected European countries. The findings illustrate the importance of analyzing family care leave using the detailed variables of the policy, maternity, parental, and childcare leave, separately rather than the combined totals of family care leave. Paid maternity leave as well as paid and unpaid parental leave increased long-term health outcomes. There was a reciprocal positive relationship between health, life satisfaction, and income that created a positive wellbeing spiral. Both unpaid childcare leave and paid parental leave were negatively correlated with income level. Unpaid childcare leave was also negatively correlated with life satisfaction. Unpaid maternity leave and paid childcare leave were not correlated with health, income, happiness, or life satisfaction. As leaders consider changes and modifications to current family care leave policy, it is critical to consider the positive and negative impacts that policies have on long-term wellbeing outcomes. Although these findings are important for leaders and policy makers, it is also paramount that taxpayers, employers, and parents understand the importance of family care leave policy as the earliest intervention and a proactive method of improving the human condition by supporting infants and families.
... Studies investigating the reasons have largely focused on behavioral explanations, such as differential trends in smoking and obesity (e.g., Cutler et al. 2010). However, a complete explanation must incorporate contextual factors that are the social and economic drivers of behaviors, health, and longevity (Berkman and O'Donnell 2013;Montez and Zajacova 2013b;National Research Council 2011). ...
... Moreover, work-family context changed dramatically in post-WWII America. Women's labor force participation rates increased sharply, age at first marriage rose, divorce rates increased, the proportion of nonmarital births rose, and single mother households became more common, while fertility rates changed little (Berkman and O'Donnell 2013;Blau 1998;Cherlin 2010;Raley and Bumpass 2003;Spain and Bianchi 1996;Zeng et al. 2012). In addition, as we describe below, work and family life is strongly patterned by education level and this pattern may have changed in recent decades. ...
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... Professional groups, family researchers, and organizations of parents and other stakeholders can generate the basis for vastly improved federal surveys (Recommendation #2) and investigate what diverse types of families need in terms of resources and capacities to promote the health of their family members. Communicating the strengths and potential of families for promoting health can inform policy makers so that state, local and workplace policies flexibly support different types of families to do what they want to be able to do for the health of their members (27). ...
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Families are vastly overlooked in US initiatives to promote population health and health equity despite being the most proximal context for health across the life course. We urge the public health sector to take the lead in recognizing families as essential for promoting 21st century population health. We highlight ways families influence health by providing context, care, continuity, and connections. The dual private and public aspect of families has contributed to how they have been overlooked in the public health sector. We provide recommendations for better integrating families into population health initiatives through national health goals, research, education, policy, and practice.
... To address these limitations, we built upon existing research that has examined the effects of work and family demands on 'objective' cardiovascular measures (Frankenhaeuser et al., 1989;Orth-Gomer, Lewandrowski, Westman, Wang, & Leineweber, 2005) and offer a longitudinal perspective on the link between WTFC and CVD (Allen & Armstrong, 2006;Landsbergis & Schnall, 2013) in a population that represents the growing service sector (and the growing health care industry, specifically) and the increasingly diverse US workforce. This research focuses on pressures both at work and in the home and draws on job strain theory, specifically the Demand-Control-Support model (Berkman & O'Donnell, 2013;Johnson & Hall, 1988;Karasek et al., 1998). The model considers the combination of job demands and job control believed to produce a sense of strain and incorporates workplace social support hypothesized to combat these strains. ...
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Objective: Work and family stressors may be associated with elevated cardiovascular risk factors. Methods: To assess the effects of work-to-family conflict (WTFC) on biomarkers of cardiometabolic risk, we examined 1524 extended care employees over 18 months and estimated multilevel linear models that accounted for the nested nature of the data. Results: WTFC was positively associated with BMI [β = 0.53, CI = (0.08, 0.98), p = .02 at baseline and β = 0.59, CI = (0.12, 1.04), p = .01 across the 18-month study period] and negatively with HDL cholesterol [β = −0.32, CI = (−0.57, −0.08), p = .01 across the 18-month study period]. The rate of change in BMI from baseline to 18 months increased with higher levels of WTFC as well (β = 0.08, CI = (0.03, 0.15), p = .0007). However, WTFC was not associated with other variables reflecting cardiometabolic risk, such as including blood pressure, cholesterol, glycosylated hemoglobin and cigarette smoking status. Conclusion: Findings suggest that BMI, which is linked to potentially malleable health behaviors, is more closely related to inter-role conflict than biological markers reflecting longer-term physiologic processes. These effects are exacerbated over time and may be particularly detrimental to already overweight and obese individuals.
... We include demand and decision authority in our analyses to make sure we are not conflating work-family strain with straightforward job strain. Furthermore, we have developed a work-family job strain model in which social support may reduce cardiometabolic and other health risks (Berkman & O'Donnell, 2013). Supervisor support related to work-family issues [i.e., FSSB] adds a new dimension to general measures of supervisor support (Frye & Breaugh, 2004;Hammer, Kossek, Bodner, & Crain, 2013;Thomas & Ganster, 1995). ...
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We investigated associations of work-family conflict and work and family conditions with objectively measured cardiometabolic risk and sleep. Multilevel analyses assessed cross-sectional associations between employee and job characteristics and health in analyses of 1,524 employees in 30 extended-care facilities in a single company. We examined work and family conditions in relation to: (a) validated, cardiometabolic risk score based on measured blood pressure, cholesterol, glycosylated hemoglobin, body mass index, and self-reported tobacco consumption and (b) wrist actigraphy-based sleep duration. In fully adjusted multilevel models, work-to-family conflict but not family-to-work conflict was positively associated with cardiometabolic risk. Having a lower level occupation (nursing assistant vs. nurse) was associated with increased cardiometabolic risk, whereas being married and having younger children at home was protective. A significant Age × Work-to-Family Conflict interaction revealed that higher work-to-family conflict was more strongly associated with increased cardiometabolic risk in younger employees. High family-to-work conflict was significantly associated with shorter sleep duration. Working long hours and having children at home were both independently associated with shorter sleep duration. High work-to-family conflict was associated with longer sleep duration. These results indicate that different dimensions of work-family conflict may pose threats to cardiometabolic health and sleep duration for employees. This study contributes to the research on work-family conflict, suggesting that work-to-family and family-to-work conflict are associated with specific health outcomes. Translating theory and findings to preventive interventions entails recognition of the dimensionality of work and family dynamics and the need to target specific work and family conditions. (PsycINFO Database Record (c) 2015 APA, all rights reserved).
... Ghana is presently undergoing rapid social and economic changes, and these can have a profound effect on adolescents, in relation to their health and wellbeing and experience of social support and stressful life events. It is known that social and economic policies have an association with physiological changes in children and/or their close family members (Berkman & O'Donnell, 2013). ...
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... Ghana is presently undergoing rapid social and economic changes, and these can have a profound effect on adolescents, in relation to their health and wellbeing and experience of social support and stressful life events. It is known that social and economic policies have an association with physiological changes in children and/or their close family members (Berkman & O'Donnell, 2013). ...
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There is presently no internationally agreed upon set of indicators for assessing adolescent health and what "health and wellbeing" means to adolescents. The psychosocial context of family, friends, and school plays a crucial role in the construction of health and wellbeing by adolescents. In spite of this, not much is known about the meaning Ghanaian adolescents attach to their health and wellbeing and the role of stress and social support in the construction of this meaning. This study explores how perceived social support and stress influence the construction of the meaning of health and wellbeing to Ghanaian adolescents. Eleven respondents purposively selected from 770 males and females participated in semi-structured interviews, which were transcribed verbatim and analysed with thematic analysis. Findings pointed to the fact that health and wellbeing was largely construed as "ability to perform daily functions," such as ability to take critical decisions and a general sense of vitality and mental strength. These were influenced by perceived social support ("encouragement and advice" and "religiosity or spirituality") and stress ("teasing, strictness, quarrels, and arguments"). These findings suggest that effective communication, mutual respect, and support from significant others, in the midst of stressful life events, contribute substantially to a holistic construction and meaning of health and wellbeing by Ghanaian adolescents.
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Using panel data from the Swedish Labor Force Surveys, this article analyzes the shift from part-time to full-time work among Swedish women in the 1980s This change occurred among all groups of women Two main sources of the shift were found First, since 1983 more women have increased them hours from part time to full time than have reduced them Second, non-employed women have become more inclined to enter full- time rather than part-time work Expanded public childcare facilities are likely to have stimulatcd the rise in hours worked, especially among mothers of young school children The prolonging ot the parental teave period is found to have controbuted slightly to the growth in full-time work. while change, in the age-structure had no impact To account for the shift among all women, I point to the tax reform carried out in 1983 and the subsequent years in combination with a high level of labor demand Marginal tax rates for full-time workers were reduced and those tor part-time workers raised. while average taxes were raised slightlv
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The ability of workers to take time off work when they are ill, and when their children or adult family members are ill, is critical to the health of workers and their families. In this study, we examine labor codes and labor-related legislation for 178 countries available from the International Labor Organization, and 160 individual country reports in Social Security Programs Throughout the World to determine the availability of paid sick leave globally and explore whether there is a correlation with four measures of macro-economic status (unemployment, productivity, GDP, competitiveness). We find that 145 nations from around the globe provide paid sick leave for working adults, 33 for care of children and 16 for care of adult family members' needs, and find no evidence of a negative relationship between paid leave for personal or family health needs and macro-economic status.
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T. Ferrarini, O. Sjöberg. Social policy and health: transition countries in a comparative perspective Int J Soc Welfare 2010: ••: ••–••© 2010 The Author(s), Journal compilation © 2010 Blackwell Publishing Ltd and International Journal of Social Welfare. This article analyses the development and design of unemployment insurance and family policy benefits and their links to health outcomes in Estonia, Poland, the Slovak Republic, Slovenia, the Czech Republic and Hungary from the mid-1990s. Comparing these six transition countries with long-standing welfare democracies reveals important similarities and differences in policy and health. Unemployment benefit schemes resemble corporatist schemes in important respects, however, with lower coverage and average benefits. Subjective wellbeing is also comparatively low among both employed and unemployed in the transition countries. Several transition countries have mixed family policy strategies that simultaneously support dual-earner families and traditional gender roles. One clear exception is Slovenia, which has a highly developed dual-earner support. Family policy generosity is related to lower rates of poverty, infant mortality and child injuries. The article demonstrates the fruitfulness of institutional analyses of the link between social policy and population health in a broader welfare state context.
Article
For the last sixty years, African-Americans have been 75% more likely to die during infancy as whites. From the mid-1960s to the early 1970s, however, this racial gap narrowed substantially. We argue that the elimination of widespread racial segregation in Southern hospitals during this period played a causal role in this improvement. Our analysis indicates that Title VI of the 1964 Civil Rights Act, which mandated desegregation in institutions receiving federal funds, enabled 5,000 to 7,000 additional black infants to survive infancy from 1965-1975 and at least 25,000 infants from 1965-2002. We estimate that by themselves these infant mortality benefits generated a welfare gain of more than $7 billion (2005$) for 1965-1975 and more than $27 billion for 1965-2002. These findings indicate that the benefits of the 1960s Civil Rights legislation extended beyond the labor marker and were substantially larger than recognized previously.
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Ferrarini T, Norström T. Family policy, economic development and infant mortality: a longitudinal comparative analysis Int J Soc Welfare 2010: ••: ••–••© 2010 The Author(s), Journal compilation © 2010 Blackwell Publishing Ltd and International Journal of Social Welfare. In the present study, the impact of family policy legislation and economic development on infant mortality was estimated. Time series analyses indicate that economic growth decreased infant mortality in the earlier part of the 20th century, while the postwar period showed a zero or even a reversed correlation between economic development and child health. The results from fixed effects modelling of data for 18 welfare democracies for the period 1970–2000 are in line with the hypothesis that the more generous the earnings-related parental leave benefits, the lower the infant mortality.
Article
With increased numbers of women employed in their children’s first year of life and with increased attention being paid by parents and policy makers to the importance of early experiences for children, establishing the links that might exist between early maternal employment and child cognitive outcomes is more important than ever. Negative associations between maternal employment during the first year of life and children’s cognitive outcomes at age 3 (and later ages) have been reported using data from the National Longitudinal Survey of Youth–Child Supplement. However, it was not known whether these findings would be replicated in another study, nor whether these results were due to features of child care (e.g., quality, type), home environment (e.g., provision of learning), and/or parenting (e.g., sensitivity). This study explored these issues using data on 900 European American children from the National Institute of Child Health and Human Development Study of Early Child Care, which provides information on child cognitive scores at 15, 24, and 36 months, as well as data about the home environment (as assessed by the Home Observation of the Measurement of the Environment Scale), parental sensitivity, and child–care quality and type over the first 3 years of life. Maternal employment by the ninth month was found to be linked to lower Bracken School Readiness scores at 36 months, with the effects more pronounced when mothers were working 30 hr or more per week and with effects more pronounced for certain subgroups (i.e., children whose mothers were not sensitive, boys, and children with married parents). Although quality of child care, home environment, and maternal sensitivity also mattered, the negative effects of working 30 hr or more per week in the first 9 months were still found, even when controlling for child–care quality, the quality of the home environment, and maternal sensitivity. Implications for policy are also discussed.
Article
Using data for 1960–97 for 22 low fertility countries, we document a dramatic change in the association of fertility levels to women''s levels of labor force participation. Until the 1980s, this association had been strongly negative. However, during the 1980s itbecame positive, and since 1990 strongly positive. We also document an emerging positive association of the country-level total fertility ratio (TFR) and nonmarital ratio (e.g., the proportion of births to unmarried women). We argue that these transformed associations reflect societal level responses that, in some contexts, have eased the incompatibility between mother and worker roles, and loosened the link betweenmarriage and childbearing. These arguments imply that societal responses to mother/worker incompatibility exert substantial influence on fertility levels in low fertility countries.
Article
In 1859 a Hungarian obstetrician named Ignaz Semmelweis, reflecting on his years as resident in the Vienna maternity clinic, wrote a graphic account of his attempt to diagnose and eliminate the then epidemic scourge of childbed fever. The resulting Etiology triggered an immediate and international squall of protest from Semmelweis’s colleagues; today it is recognized as a pioneering classic of medical history. Now, for the first time in many years, Codell Carter makes that classic available to the English-speaking reader in this vivid translation of the 1861 original, augmented by footnotes and an explanatory introduction. For students and scholars of medical history and philosophy, obstetrics and women’s studies, the accessibility of this moving and revolutionary work, important both as an historical document and as a groundbreaking precursor of modern medical theory, is long overdue. Semmelweis’s exposure to the childbed fever was concurrent with his appointment to the Vienna maternity hospital in 1846. Like many similar hospitals and clinics in the major cities of nineteenth-century Europe and America, where death rates from the illness sometimes climbed as high as 40 percent of admitted patients, the Viennese wards were ravaged by the fever. Intensely troubled by the tragic and baffling loss of so many young mothers, Semmelweis sought answers. The Etiology was testimony to his success. Based on overwhelming personal evidence, it constituted a classic description of a disease, its causes, and its prevention. It also allowed a necessary response to the obstetrician’s already vocal, rabid, and perhaps predictable critics. For Semmelweis’s central thesis was a startling one - the fever, he correctly surmised, was caused not by epidemic or endemic influences but by unsterilized and thus often contaminated hands of the attending physicians themselves. Carter’s translation of this radical work, judiciously abridged and extensively footnoted, captures all the drama and impassioned conviction of the original. Complementing this translation is a lucid introduction that places Semmelweis’s Etiology in historical perspective and clarifies its contemporary value. That value, Carter argues, is considerable. Important as a model of clinical analysis and as a chronicle of early nineteenth-century obstetrical practices, the Etiology is also a revolutionary polemic in its innovative doctrine of antisepsis and in its unique etiological explanation of disease. As such its recognition and reclamation allows a crucial understanding, one that clarifies the roots and theory of modern medicine and ultimately redeems and important, resolute, pathfinder.
Article
In the past two decades, many researchers have used the Luxembourg Income Study (LIS) data to analyse women's economic status, or economic gender inequality, across the industrialized countries. Researchers concerned with labour market outcomes have concluded that: (i) women's labour market status lags men's in nearly every LIS country and time period; (ii) motherhood is a consequential factor nearly everywhere; while parenthood typically has little effect (or a positive effect) on men's employment rates and earnings, it weakens women's everywhere; (iii) against this backdrop of commonality, gendered outcomes vary dramatically across countries; and (iv) variation in policies, or policy packages, explains a substantial share of the observed variation in outcomes. Researchers focused on poverty have found that: (i) in several countries, post-tax-and-transfer poverty is more prevalent among women than men, mothers compared with fathers, and female-headed households relative to male-headed households; (ii) solo mothers everywhere face a heightened risk of low income and&sol;or poverty, especially in the English-speaking countries; (iii) across the LIS countries, single elderly women are also at heightened risk, with the USA standing out as an extreme case; and (iv) cross-national variation in tax-and-transfer policies explains a large share of variation in post-tax-and-transfer income.
Article
Employers play a critical role in mothers' success with breastfeeding when these women work full-time. Employers need information on the benefits breastfeeding can provide for working mothers and businesses. This article discusses current legislation and policies supporting mothers' ability to breastfeed in the workplace, the benefits of breastfeeding to the employer, mother, and child, and the need for employers to understand the benefits of breastfeeding. Finally, the role of occupational health nurses in facilitating the success of breastfeeding mothers through the development and implementation of a lactation program is explicated.
Article
Many important social determinants of health are also the focus for social policies. Welfare states contribute to the resources available for their citizens through cash transfer programmes and subsidised services. Although all rich nations have welfare programmes, there are clear cross-national differences with respect to their design and generosity. These differences are evident in national variations in poverty rates, especially among children and elderly people. We investigated to what extent variations in family and pension policies are linked to infant mortality and old-age excess mortality. Infant mortality rates and old-age excess mortality rates were analysed in relation to social policy characteristics and generosity. We did pooled cross-sectional time-series analyses of 18 OECD (Organisation for Economic Co-operation and Development) countries during the period 1970-2000 for family policies and 1950-2000 for pension policies. Increased generosity in family policies that support dual-earner families is linked with lower infant mortality rates, whereas the generosity in family policies that support more traditional families with gainfully employed men and homemaking women is not. An increase by one percentage point in dual-earner support lowers infant mortality by 0.04 deaths per 1000 births. Generosity in basic security type of pensions is linked to lower old-age excess mortality, whereas the generosity of earnings-related income security pensions is not. An increase by one percentage point in basic security pensions is associated with a decrease in the old age excess mortality by 0.02 for men as well as for women. The ways in which social policies are designed, as well as their generosity, are important for health because of the increase in resources that social policies entail. Hence, social policies are of major importance for how we can tackle the social determinants of health.
Article
The present analyses were undertaken to understand the role of workplace characteristics in the breastfeeding practices of working women. The effects of the perception of the availability of employer-sponsored child care, the perception of the availability of a flexible schedule, hours worked at home, and worked a fixed schedule on breastfeeding outcomes were estimated using a sample of 1,506 births from the National Longitudinal Survey of Youth 1979 and the Children of the National Longitudinal Survey of Youth 1979. The availability of employer-sponsored child care increased the likelihood of breastfeeding six months after birth by 47 percent. In addition, working an additional eight hours at home per week, at the mean, increased the probability of breastfeeding initiation by 8 percent and breastfeeding six months after birth by 16.8 percent. Workplace characteristics show promise as an effective way to increase breastfeeding rates among working women.
Article
The low-birth-weight infant remains at much higher risk of mortality than the infant with normal weight at birth. In the neonatal period, when most infant deaths occur, the proportion of low-birth-weight infants, especially those with very low weight, is the major determinant of the magnitude of the mortality rates. Furthermore, differences in low-birth-weight rates account for the higher neonatal mortality rates observed in some groups, particularly those characterized by socioeconomic disadvantages. Much of the recent decline in neonatal mortality can be attributed to increased survival among low-birth-weight infants, apparently as a result of hospital-based services. The application of these services is currently considered cost-effective, although whether this will continue to be true in the future is unclear because of the increased survival of very tiny infants. Although low-birth-weight infants remain at increased risk of both postneonatal mortality and morbidity in infancy and early childhood, the risk is substantially smaller than that of neonatal death. In addition, these adverse later outcomes have not offset the gains achieved in the neonatal period. Nonetheless, the increased survival of high-risk infants raises concern about their future requirements for special medical and educational services and about the stress on their families. Despite increased access to antenatal services, only moderate declines in the proportion of low-birth-weight infants has been observed, and almost no change has occurred in the proportion of those with very low weight at birth. In addition, in many areas of the country the birth-weight-specific neonatal mortality rates are similar for groups at high and low risk of neonatal death. In view of these findings, continuation of the current decline in neonatal mortality and reduction of the mortality differentials between high- and low-risk groups require the identification and more effective implementation of strategies for the prevention of low-weight births.
Article
The perinatal mortality rate in California decreased rapidly in the 1970s; neonatal mortality fell about twice as fast as fetal mortality. Decreases in birth-weight-specific mortality accounted for 81 per cent of the decline in the perinatal rate, with only 19 per cent due to improvements in birth weight. No improvement was observed in the birth-weight distribution for blacks. The decrease in mortality rates was significantly faster for cesarean deliveries than for vaginal births. By 1977, all birth-weight-specific fetal mortality rates for cesarean sections were equal to those for vaginal deliveries or lower. For infants weighing less than 2000 g, perinatal mortality rates were also significantly lower for infants born by cesarean section than for infants delivered vaginally. These results suggest that much of the recent decrease in perinatal mortality rates can be attributed to the advent of neonatal intensive care and the increased rate of cesarean section.
Article
Low birth weight is a major public health problem in the United States, contributing substantially both to infant mortality and to childhood handicap. The principal determinant of low birth weight in the United States is preterm delivery, a phenomenon of largely unknown etiology. Preterm delivery is more common in the United States than in many other industrialized nations, and is the factor most responsible for the relatively high infant mortality rate in the United States. Within the United States, Asian populations experience the lowest preterm delivery rates, while Hispanic and Native American populations experience slightly higher preterm delivery rates than the white population. African Americans, however, have much higher rates of preterm delivery than any of the other major ethnic groups. Poverty is strongly and consistently associated with low birth weight, but the precise social and environmental conditions that produce preterm delivery have not been elucidated. Although it is popular to link illicit drug use to low birth weight, a high low birth weight rate was characteristic of the United States for decades before the cocaine epidemic of the 1980s. Neither the low birth rate nor the preterm delivery rate has improved in the United States in the past quarter century. Most efforts to prevent prematurity or low birth weight, when carefully evaluated, have not proven effective. A major goal of biomedical research ought to be better understanding of the causes of this important public health problem.
Article
'Multiple causation' is the canon of contemporary epidemiology, and its metaphor and model is the 'web of causation.' First articulated in a 1960 U.S. epidemiology textbook, the 'web' remains a widely accepted but poorly elaborated model, reflecting in part the contemporary stress on epidemiologic methods over epidemiologic theories of disease causation. This essay discusses the origins, features, and problems of the 'web,' including its hidden reliance upon the framework of biomedical individualism to guide the choice of factors incorporated in the 'web.' Posing the question of the whereabouts of the putative 'spider,' the author examines several contemporary approaches to epidemiologic theory, including those which stress biological evolution and adaptation and those which emphasize the social production of disease. To better integrate biologic and social understandings of current and changing population patterns of health and disease, the essay proposes an ecosocial framework for developing epidemiologic theory. Features of this alternative approach are discussed, a preliminary image is offered, and debate is encouraged.
Article
Theory suggests that the decision to return to employment after childbirth and the decision to breast-feed may be jointly determined. We estimate models of simultaneous equations for two different aspects of the relationship between maternal employment and breast-feeding using 1993-1994 data from the U.S. Food and Drug Administration's Infant Feeding Practices Study. We first explore the simultaneous duration of breast-feeding and work leave following childbirth. We find that the duration of leave from work significantly affects the duration of breast-feeding, but the effect of breast-feeding on work leave is insignificant. We also estimate models of the daily hours of work and breast-feedings at infant ages 3 months and 6 months postpartum. At both times, the intensity of work effort significantly affects the intensity of breast-feeding, but the reverse is generally not found. Competition clearly exists between work and breast-feeding for many women in our sample.
Article
It is widely recognized that social relationships and affiliation have powerful effects on physical and mental health. When investigators write about the impact of social relationships on health, many terms are used loosely and interchangeably including social networks, social ties and social integration. The aim of this paper is to clarify these terms using a single framework. We discuss: (1) theoretical orientations from diverse disciplines which we believe are fundamental to advancing research in this area; (2) a set of definitions accompanied by major assessment tools; and (3) an overarching model which integrates multilevel phenomena. Theoretical orientations that we draw upon were developed by Durkheim whose work on social integration and suicide are seminal and John Bowlby, a psychiatrist who developed attachment theory in relation to child development and contemporary social network theorists. We present a conceptual model of how social networks impact health. We envision a cascading causal process beginning with the macro-social to psychobiological processes that are dynamically linked together to form the processes by which social integration effects health. We start by embedding social networks in a larger social and cultural context in which upstream forces are seen to condition network structure. Serious consideration of the larger macro-social context in which networks form and are sustained has been lacking in all but a small number of studies and is almost completely absent in studies of social network influences on health. We then move downstream to understand the influences network structure and function have on social and interpersonal behavior. We argue that networks operate at the behavioral level through four primary pathways: (1) provision of social support; (2) social influence; (3) on social engagement and attachment; and (4) access to resources and material goods.
Article
This study investigates whether rights to parental leave improve pediatric health. Aggregate data are used for 16 European countries over the 1969 through 1994 period. More generous paid leave is found to reduce deaths of infants and young children. The magnitudes of the estimated effects are substantial, especially where a causal effect of leave is most plausible. In particular, there is a much stronger negative relationship between leave durations and post-neonatal or child fatalities than for perinatal mortality, neonatal deaths, or low birth weight. The evidence further suggests that parental leave may be a cost-effective method of bettering child health.
Article
The present paper tries to measure the effects of paid maternity-leave on three demographic variables: infant mortality, labor-force participation of women in the prime childbearing ages, and fertility rates. A simultaneous-equations model is constructed, using the individual fixed-effects method and a data set comprising 17 OECD countries and four time periods. The structural estimates provide substantial evidence in support of predictions that lengthening the allowed duration of paid leave reduces infant mortality, while increasing both the labor-force participation of young women and the general fertility rate. However, the reduced-form analysis casts doubt on the long-run fertility effect. Maternal-leave policies in industrial countries are surveyed Section III deals with the data and estimation methods. -from Authors
Article
Breastfed infants in the United States have lower rates of morbidity, especially from infectious disease, but there are few contemporary studies in the developed world of the effect of breastfeeding on postneonatal mortality. We evaluated the effect of breastfeeding on postneonatal mortality in United States using 1988 National Maternal and Infant Health Survey (NMIHS) data. Nationally representative samples of 1204 infants who died between 28 days and 1 year from causes other than congenital anomaly or malignant tumor (cases of postneonatal death) and 7740 children who were still alive at 1 year (controls) were included. We calculated overall and cause-specific odds ratios for ever/never breastfeeding among all children, conducted race and birth weight-specific analyses, and looked for duration-response effects. Overall, children who were ever breastfed had 0.79 (95% confidence interval [CI]: 0.67-0.93) times the risk of never breastfed children for dying in the postneonatal period. Longer breastfeeding was associated with lower risk. Odds ratios by cause of death varied from 0.59 (95% CI: 0.38-0.94) for injuries to 0.84 (95% CI: 0.67-1.05) for sudden infant death syndrome. Breastfeeding is associated with a reduction in risk for postneonatal death. This large data set allowed robust estimates and control of confounding, but the effects of breast milk and breastfeeding cannot be separated completely from other characteristics of the mother and child. Assuming causality, however, promoting breastfeeding has the potential to save or delay approximately 720 postneonatal deaths in the United States each year.
Article
There is convincing evidence that exposures acting across the life course influence adult health outcomes (1–3). Lifecourse epidemiology examines a range of potential processes through which exposures acting at different stages of life can, singly or in combination, influence disease risk (table 1) (4). In the critical period model, an exposure acting at a specific time has long-lasting effects on the structure or function of the body. The fetal origins hypothesis, in its original formulation, took this approach (5). Other examples of processes where outcomes appear to depend upon the time window during which an exposure acts are limb development (in relation to maternal thalidomide use); infection with hepatitis B and risk of adulthood liver cancer (with very early postnatal infection being most implicated); and environmental lead exposure, which results in serious neurodevelopmental deficits only if occurring in infancy and childhood (3). However, the influence of exposures acting during critical periods of susceptibility may be modified by later life exposures. This is the case for the associations of birth weight with coronary heart disease, high blood pressure, and insulin resistance, where associations are stronger (or only evident) among those who become obese during adolescence or adulthood (6–8).
Article
To carry out a preliminary systematic review of literature to address the question - among rich nations (or states within nations) what is the evidence that income inequality and differences in macro-level social policy affect rates of infant mortality and low birthweight (LBW)? A systematic literature review. Medline database (1968-August 2003) was searched for empirical studies of the relationship between macro-level economic and social policies in rich nations and rates of infant mortality (IMR) and LBW. Cross-national comparison of infant mortality and LBW that did not compare the effects of macro-level economic and social policies was excluded from the review as were studies including less developed countries. Keywords representing IMR and LBW were entered into Medline along with exposures related to international comparison and macro-level policy. Abstracts obtained from the initial search were reviewed for relevant studies. Full papers of potentially relevant studies were obtained and reviewed for inclusion. Secondary search of papers cited in included papers was undertaken. For this review, papers were not excluded on the basis of quality although methodological limitations were commented on and taken into account in interpreting the results. Summary statistics were not estimated. Twelve studies, fulfilling the inclusion criteria, were identified. Ten studies examined the association of IMR with income inequality, eight of which reported a statistically significant positive association with higher levels of inequality after adjustment for a range of variables. Six studies reported significant positive associations of IMR with other indicators of less re-distributive social and economic policy. Associations with LBW were reported in four studies; three showed significant positive associations with higher levels of income inequality and one showed no association with low levels of parental leave entitlement. Methodological differences, particularly the wide range of variables used to adjust for confounding, make interpretation of the findings difficult. The results of this review represent a preliminary attempt to summarize the literature linking macro-level economic and social policies in rich nations with IMR and LBW. The findings, taking account of the methodological limitations of the review and of the included studies, suggest a statistically significant association between IMR and higher income inequality and other indicators of less re-distributive social policy. Only three studies examined the association of income inequality with LBW and, although they suggest a significant association, further studies will be needed to confirm this finding.
Article
To review the literature and describe the barriers and facilitators to the continuation of breastfeeding for at least 6 months by working women in the United States. A search of PubMed, CINAHL, Sociological Abstracts, ISI, PsychInfo, and ProQuest. Twenty studies based on the inclusion criteria and published between January 1, 1995, and January 2006. An ecologic framework, which includes the individual (microsystem), social support and relationships (mesosystem), and the workplace environment (exosystem). When working mothers possess certain personal characteristics and develop a strategic plan, breastfeeding is promoted. When social support is available and when support groups are utilized, lactation is also facilitated. Part-time work, lack of long mother-infant separations, supportive work environments and facilities, and child care options facilitate breastfeeding. Health care providers can use the findings of this review to promote breastfeeding among working women by using tactics geared toward the mother, her social network, and the entire community.
Article
A massive literature documents the inverse association between poverty or low socioeconomic status and health, but little is known about the mechanisms underlying this robust relation. We examined longitudinal relations between duration of poverty exposure since birth, cumulative risk exposure, and physiological stress in two hundred seven 13-year-olds. Chronic stress was assessed by basal blood pressure and overnight cortisol levels; stress regulation was assessed by cardiovascular reactivity to a standard acute stressor and recovery after exposure to this stressor. Cumulative risk exposure was measured by multiple physical (e.g., substandard housing) and social (e.g., family turmoil) risk factors. The greater the number of years spent living in poverty, the more elevated was overnight cortisol and the more dysregulated was the cardiovascular response (i.e., muted reactivity). Cardiovascular recovery was not affected by duration of poverty exposure. Unlike the duration of poverty exposure, concurrent poverty (i.e., during adolescence) did not affect these physiological stress outcomes. The effects of childhood poverty on stress dysregulation are largely explained by cumulative risk exposure accompanying childhood poverty.
Article
To update a systematic review on the association between childhood socioeconomic circumstances and cause-specific mortality. Studies published since 2003 include a far greater number of deaths than was previously available justifying an update of the previous systematic review. Individual-level studies examining childhood socioeconomic circumstances and adult overall and cause-specific mortality published between 2003 and April 2007. The new studies confirmed that mortality risk for all causes was higher among those who experienced poorer socioeconomic circumstances during childhood. As already suggested in the original systematic review, not all causes of death were equally related to childhood socioeconomic circumstances. A greater proportion of new studies included women and showed that a similar pattern is valid for both genders. In addition, the new studies show that this association persists among younger birth cohorts, despite temporal general improvements in childhood conditions across successive birth cohorts. The difficulties of establishing a particular life-course model were highlighted.
We find disease incidence and prevalence are both higher among Americans in age groups 55-64 and 70-80 indicating that Americans suffer from higher past cumulative disease risk and experience higher immediate risk of new disease onset compared to the English. In contrast, age specific mortality rates are similar in the two countries with an even higher risk among the English after age 65. Our second aim explains large financial gradients in mortality in the two countries. Among 55-64 year olds, we estimate similar health gradients in income and wealth in both countries, but for 70-80 year old, we find no income gradient in UK. Standard behavioral risk factors (work, marriage, obesity, exercise, and smoking) almost fully explain income gradients among 55-64 years old in both countries and a significant part among Americans 70-80 years old. The most likely explanation of no English income gradient relates to their income benefit system. Below the median, retirement benefits are largely flat and independent of past income and hence past health during the working years. Finally, we report evidence using a long panel of American respondents that their subsequent mortality is not related to large changes in wealth experienced during the prior ten year period.
Article
This paper examines the theoretical propositions and empirical evidence linking policies and fertility. More specifically, the analysis presented in this paper draws attention to the complex mechanisms that theoretically link policies and demographic outcomes: mechanisms that involve imperfect information and decisions that are rationally bound by very specific circumstances. As to the empirical evidence, studies provide mixed conclusions as to the effect of policies on fertility. While a small positive effect of policies on fertility is found in numerous studies, no statistically significant effect is found in others. Moreover, some studies suggest that the effect of policies tends to be on the timing of births rather than on completed fertility. Copyright Springer Science+Business Media B.V. 2007
Article
To understand the relationship between parental leave and child health better, this study examines the aggregate effects of parental leave policies on child health outcomes using data from 18 OECD countries -super-1 from 1969-2000. The focus is investigating the effects of both job-protected paid leave and other leave - including non-job-protected paid leave and unpaid leave - on child health outcomes, more specifically, infant mortality rates, low birth weight and child immunisation coverage. This study explores the effects of other social policies related to families and young children, such as public expenditures on family cash benefits, family allowances, and family services per child, on child health outcomes. Copyright 2005 Royal Economic Society.
Article
This paper uses data from the National Longitudinal Survey of Youth to explore links between mothers' returns to work within 12 weeks of giving birth and health and developmental outcomes for their children. OLS models and propensity score matching methods are utilised to account for selection bias. Considerable associations between early returns to work and children's outcomes are found suggesting causal relationships between early returns to work and reductions in breastfeeding and immunisations, as well as increases in externalising behaviour problems. These results are generally stronger for mothers who return to work full-time within 12 weeks of giving birth. Copyright 2005 Royal Economic Society.